What dispute deadlines should providers track in Louisiana?

Accident Notice: Notice to insurer as soon as reasonably practicable; MedPay Claim Submission: Submission within policy billing windows (typically 1 to 3 years); Insurer 30-Day Pay Window: 30 calendar days from receipt of satisfactory proof of loss (La. R.S. 22:1892). Verify the trigger date, current agency notices, and any extension before acting.

Which agencies administer these rules in Louisiana?

The guide identifies Louisiana Department of Insurance (LDI). The correct agency depends on the plan and claim jurisdiction.

Auto Accident, PIP & Medical Billing State Guides

Louisiana Auto Accident, PIP & Medical Billing Laws

Louisiana operates an At-Fault automobile insurance framework under Title 22 of the Louisiana Revised Statutes. The state features a Direct Action Statute (La. R.S. 22:1269) permitting direct lawsuits against liability insurers, strict 30-day prompt-pay penalty provisions under La. R.S. 22:1892, and statutory healthcare provider privileges on tort recoveries under La. R.S. 9:4751.

Accountability & Review

Reviewed by Millennova Legal Operational Integrity Team, Senior Audit and Arbitration Analysts

Last Reviewed

2026-03-01

Plain-language overview

At-Fault / Traditional Tort (Direct Action Statute & Healthcare Provider Privilege)

Louisiana follows a pure comparative fault system (La. Civ. Code art. 2323). Mandatory automobile liability insurance is enforced, while first-party Medical Payments (MedPay) coverage is optional. Uniquely under Louisiana's Direct Action Statute (La. R.S. 22:1269), an injured person or their provider holding an assignment can bring a direct civil lawsuit against the at-fault motorist's liability insurer. Healthcare providers secure treatment balances by asserting statutory privileges (liens) on settlement proceeds under La. R.S. 9:4751.

PIP and MedPay coverage

Optional Med Pay Coverage

MedPay is optional in Louisiana (typically $1,000 to $10,000+ per person), providing no-fault reimbursement for reasonable and necessary medical and funeral expenses resulting from a motor vehicle crash

Direct Action Statute

Under La. R.S. 22:1269, injured claimants and healthcare providers have a direct right of action against the at-fault driver's automobile liability insurer within the terms and limits of the policy

Assignment Of Benefits

Healthcare providers routinely accept patient assignments of benefits to pursue direct claims against both first-party MedPay and third-party liability insurers

Medical fee schedule and reimbursement rules

Name

Reasonable and Customary Fee Standard

Rules

Louisiana does not enforce a statutory fee schedule table for motor vehicle accident medical bills outside of workers' compensation. Healthcare providers bill standard reasonable and customary fees prevailing in the local medical community.

Cpt Basis

CPT/HCPCS itemized coding on standard CMS-1500 or UB-04 billing claims

Preauthorization and utilization review

Requirement

Preauthorization is not required by statute for emergency trauma care or initial acute hospitalization. Elective surgeries, advanced imaging, and long-term therapy are evaluated under insurer medical necessity guidelines.

Independent Medical Examinations

Under standard insurance contract terms and Louisiana Code of Civil Procedure art. 1464, insurers may request independent physician examinations when the extent of injury is disputed.

Appeals and dispute resolution

Thirty Day Bad Faith Statute

Under La. R.S. 22:1892, an insurer must pay the amount of any claim due any insured or third party within 30 days after receipt of satisfactory proof of loss. Failure to pay within 30 days, when arbitrary, capricious, or without probable cause, subjects the insurer to a 50% penalty on the amount due plus reasonable attorney fees.

Insurer Good Faith Duty

Under La. R.S. 22:1973, an insurer owes a duty of good faith and fair dealing; knowing failure to pay claims within 60 days of satisfactory proof subjects the insurer to penalties up to twice the damages sustained or $5,000.

Healthcare Provider Privilege

Under La. R.S. 9:4751 - 9:4755, hospitals, physicians, chiropractors, physical therapists, and ambulance providers have a statutory privilege (lien) on third-party settlements and judgments for the reasonable value of services. Written notice must be served via certified mail on the injured party and liability insurer prior to payment of proceeds.

Dispute Forum

Louisiana Judicial District Court or City Court for civil recovery actions.

Claim and dispute deadlines

Deadlines can depend on the trigger event and may be affected by agency relief notices. Confirm the live rule before filing.

Event	Timeframe
Accident Notice	Notice to insurer as soon as reasonably practicable
MedPay Claim Submission	Submission within policy billing windows (typically 1 to 3 years)
Insurer 30-Day Pay Window	30 calendar days from receipt of satisfactory proof of loss (La. R.S. 22:1892)
Healthcare Privilege Notice	Written notice served via certified mail prior to settlement payment (La. R.S. 9:4753)
Prescriptive Period (Statute of Limitations)	2 years from accident date for delictual (personal injury) actions occurring on or after July 1, 2024 (La. Civ. Code art. 3492 / 3493.10); 1 year for accidents prior; 10 years for contracts

Documentation checklist

Louisiana 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 department documentation, operative reports, and imaging findings
Written Notice of Medical Privilege served via certified mail with postal return receipts (La. R.S. 9:4753)
Insurer Explanation of Benefits (EOB) or written explanation of claim determination

Responsible agencies

Louisiana Department of Insurance (LDI)Statewide Regulation of Auto Insurers, Rate Filings & Consumer Protection

Primary legal and regulatory sources

Louisiana Revised Statutes Title 22, Section 1892 (Payment of Claims, Policies Other Than Life and Health; Penalties)Louisiana State Legislature · 2024
Louisiana Revised Statutes Title 9, Section 4751 (Privileges of Providers of Medical Services)Louisiana State Legislature · 2024
Louisiana Revised Statutes Title 22, Section 1269 (Direct Action Against Insurer)Louisiana State Legislature · 2024

This operational reference is educational, is not legal advice, and does not create an attorney-client relationship.

Common questions

What rules govern auto accident, pip & medical billing state guides in Louisiana?: Louisiana operates an At-Fault automobile insurance framework under Title 22 of the Louisiana Revised Statutes. The state features a Direct Action Statute (La. R.S. 22:1269) permitting direct lawsuits against liability insurers, strict 30-day prompt-pay penalty provisions under La. R.S. 22:1892, and statutory healthcare provider privileges on tort recoveries under La. R.S. 9:4751.
What dispute deadlines should providers track in Louisiana?: Accident Notice: Notice to insurer as soon as reasonably practicable; MedPay Claim Submission: Submission within policy billing windows (typically 1 to 3 years); Insurer 30-Day Pay Window: 30 calendar days from receipt of satisfactory proof of loss (La. R.S. 22:1892). Verify the trigger date, current agency notices, and any extension before acting.
Which agencies administer these rules in Louisiana?: The guide identifies Louisiana Department of Insurance (LDI). The correct agency depends on the plan and claim jurisdiction.