Connecticut Claims Dispute & Statutory Guide
Connecticut operates an At-Fault automobile insurance framework under Title 38a and Title 52 of the Connecticut General Statutes (C.G.S.). Motor vehicle liability is governed by modified comparative negligence with a 51% bar under C.G.S. § 52-572h. Medical providers bill optional first-party Medical Payments (MedPay) and enforce statutory hospital liens on third-party settlements under C.G.S. § 49-73.
Statutory Framework & Jurisdiction
At-Fault / Traditional Tort (Modified Comparative Fault & Connecticut Hospital Lien Act)
Connecticut repealed its former no-fault system in 1993, establishing a pure at-fault tort liability structure. Motor vehicle collision medical expenses are billed to optional first-party Medical Payments (MedPay) coverage, private health insurance, or third-party automobile liability insurance. Under C.G.S. § 52-572h, an injured claimant may recover damages if their negligence was not greater than the combined negligence of the defendants. Non-profit and state-aided hospitals secure treatment receivables against third-party liability proceeds through statutory liens under C.G.S. § 49-73.
PIP / MedPay Coverage & Medical Fee Rules
optional Med Pay Coverage
MedPay is optional in Connecticut (commonly written in limits of $1,000 to $10,000+ per person), providing no-fault reimbursement for reasonable medical, surgical, dental, hospital, and ambulance expenses resulting from an automobile collision
collateral Source Rule
Under C.G.S. § 52-225a, collateral source reductions are made post-verdict by the court, except where a right of subrogation exists; under § 52-225c, insurers cannot bring direct actions for collateral source reimbursement unless authorized by contract
assignment Of Benefits
Healthcare providers routinely obtain patient assignments of MedPay benefits for direct claims submission to automobile insurers
Official Medical Fee Schedule & Reimbursement Standards
name
Reasonable and Customary Fee Standard
rules
Connecticut does not enforce a statutory fee schedule table for motor vehicle accident medical bills outside of workers' compensation. Providers bill standard reasonable and customary charges prevailing in the local medical community for comparable care.
cpt Basis
CPT/HCPCS itemized coding on standard CMS-1500 or UB-04 billing claims
Preauthorization & Decision Point Review
requirement
Preauthorization is not required by statute for emergency trauma stabilization or initial acute management. Elective surgical interventions and prolonged physical therapy regimens are evaluated under insurer medical necessity guidelines.
carrier Examinations
Under standard auto policy terms, insurers may request medical records or independent physician reviews to evaluate causal relationship to the collision.
Administrative Appeals & Dispute Mechanism
prompt Payment Statute
Under C.G.S. § 38a-816(15), insurers must pay clean claims within 20 calendar days for electronic claims (60 calendar days for paper claims). Claims not paid within these timeframes accrue statutory interest at the rate of 15% per year.
hospital Lien Statute
Under C.G.S. § 49-73, any hospital receiving state aid or non-profit hospital has a statutory lien upon proceeds of any accident or liability policy or tort settlement for the reasonable value of hospital services. To perfect the lien, the hospital must file notice with the town clerk of the town where the hospital is located and serve the insurance company before payment.
dispute Forum
Connecticut Superior Court (county superior court) for civil recovery actions.
Critical Statutory & Dispute Deadlines
| Dispute Phase / Trigger Event | Statutory Timeline / Deadline |
|---|---|
| Accident Notice | Notice to insurer as soon as reasonably practicable |
| MedPay Claim Submission | Submission within standard policy billing deadlines (typically 1 to 3 years) |
| Clean Claim Payment Window | 20 calendar days for electronic claims; 60 days for paper claims (C.G.S. § 38a-816(15)) |
| Town Clerk Lien Filing | Must be filed with town clerk and served on insurer prior to settlement distribution (C.G.S. § 49-73) |
| Statute of Limitations | 2 years from accident date for personal injury tort claims (C.G.S. § 52-584); 6 years for written contracts |
Required Evidentiary Filing Checklist
- ✓Connecticut MedPay Claim Application Form
- ✓Executed Assignment of Benefits (AOB) and medical records authorization
- ✓Itemized CMS-1500 or UB-04 billing form with CPT/HCPCS codes and ICD-10 diagnostic coding
- ✓Contemporaneous medical records, emergency intake documentation, operative reports, and imaging findings
- ✓Filed Notice of Hospital Lien with town clerk recording stamp (C.G.S. § 49-73)
- ✓Insurer Explanation of Benefits (EOB) or written explanation of claim determination
Official Primary Sources & Legislative Authorities
Governing Regulatory Authorities
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