Montana Claims Dispute & Statutory Guide
Montana operates an At-Fault automobile insurance framework under Title 33 and Title 61 of the Montana Code Annotated (MCA). Motor vehicle liability is governed by modified comparative fault with a 51% bar under MCA § 27-1-702. Montana enforces an absolute Made-Whole rule barring MedPay subrogation until the insured is 100% compensated, and providers enforce statutory medical liens under MCA § 71-3-1111.
Statutory Framework & Jurisdiction
At-Fault / Traditional Tort (Absolute Made-Whole Doctrine & Montana Medical Lien Act)
Montana is an at-fault tort liability state without mandatory Personal Injury Protection (PIP) insurance. Medical expenses resulting from motor vehicle collisions are covered through optional first-party Medical Payments (MedPay) coverage, private health insurance, or third-party automobile liability insurance. Under longstanding Montana Supreme Court precedent (Swanson v. Hartford Ins. Co.; Conway v. Benefis Health System), an auto insurer has no right of subrogation or reimbursement for MedPay benefits until the injured insured has been completely made whole for all economic and non-economic damages, including attorney fees. Healthcare practitioners and hospitals secure balances using statutory medical liens under MCA § 71-3-1111.
PIP / MedPay Coverage & Medical Fee Rules
optional Med Pay Coverage
MedPay is optional in Montana (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 accident
absolute Made Whole Rule
Under Montana public policy and common law (Swanson v. Hartford), an automobile insurer cannot subrogate or seek reimbursement from an insured's third-party recovery until the insured is made 100% whole, taking into account all losses and legal expenses
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
Montana 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 medical 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 motor vehicle collision.
Administrative Appeals & Dispute Mechanism
prompt Payment Statute
Under MCA § 33-18-232, insurers must pay clean claims within 30 calendar days of receipt. Claims not paid within 30 days accrue statutory interest from the date the claim became overdue.
medical Lien Act
Under MCA § 71-3-1111 et seq., physicians, nurses, physical therapists, dentists, and hospitals have a statutory lien upon personal injury tort claims, settlements, and judgments for reasonable medical charges. To perfect the lien, the provider must file a notice of lien with the county clerk and recorder within 30 days after services are rendered, and serve written notice on the patient and liability insurer.
dispute Forum
Montana District Court (county district 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 | 30 calendar days from receipt of clean claim (MCA § 33-18-232) |
| County Recorder Lien Filing | Must be filed with county clerk and recorder within 30 days of service (MCA § 71-3-1114) |
| Statute of Limitations | 3 years from accident date for personal injury tort claims (MCA § 27-2-204); 8 years for written contracts |
Required Evidentiary Filing Checklist
- ✓Montana 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
- ✓Recorded Notice of Medical Lien with county clerk recording stamp (MCA § 71-3-1114)
- ✓Insurer Explanation of Benefits (EOB) or written explanation of claim determination
Official Primary Sources & Legislative Authorities
Governing Regulatory Authorities
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