North Dakota Claims Dispute & Statutory Guide
North Dakota operates a mandatory No-Fault automobile insurance framework under North Dakota Century Code Chapter 26.1-41. Every motor vehicle policy must provide basic no-fault benefits of at least $30,000 per person for medical, rehabilitation, and disability losses. Unpaid benefits are subject to an 18% annual interest penalty under N.D.C.C. § 26.1-41-09.
Statutory Framework & Jurisdiction
No-Fault (Mandatory Basic No-Fault Benefits under N.D.C.C. § 26.1-41-06)
Under North Dakota law, occupants of an insured motor vehicle and injured pedestrians recover basic no-fault benefits from the automobile insurer regardless of fault. To maintain a tort claim for non-economic damages (pain and suffering) against an at-fault motorist, the injured person must meet the statutory tort threshold under N.D.C.C. § 26.1-41-08 by incurring more than $2,500 in medical expenses or sustaining 60 days of disability or permanent injury.
PIP / MedPay Coverage & Medical Fee Rules
basic No Fault Limit
$30,000 maximum aggregate benefit per person for medical, surgical, hospital, and rehabilitation expenses, plus work loss and replacement services (N.D.C.C. § 26.1-41-01(2))
optional Excess Coverage
Insurers must offer optional excess no-fault benefits increasing aggregate coverage up to at least $80,000 per person (N.D.C.C. § 26.1-41-04)
assignment Of Benefits
Medical providers may obtain direct payment authorization through standard written assignment agreements
Official Medical Fee Schedule & Reimbursement Standards
name
Reasonable Medical Charges Standard (N.D.C.C. § 26.1-41-01(9))
rules
North Dakota does not maintain a statutory auto medical fee schedule. Charges for medical, surgical, and diagnostic services must be reasonable and customary for comparable treatment in the relevant geographic community.
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. Advanced diagnostic imaging, elective procedures, or extended chiropractic/physical therapy care may be subject to insurer medical management review.
independent Medical Examination
Under N.D.C.C. § 26.1-41-11, an insurer may require an injured person to submit to physical examination by an independent physician when the physical condition is material to a claim.
Administrative Appeals & Dispute Mechanism
thirty Day Prompt Payment
Under N.D.C.C. § 26.1-41-09(2), benefits become overdue if not paid within 30 days after the insurer receives reasonable proof of the fact and amount of loss. Overdue benefits bear interest at the rate of 18% per year.
attorney Fee Awards
Pursuant to N.D.C.C. § 26.1-41-09(3), courts award reasonable attorney fees to a claimant or provider if the insurer rejected a claim without reasonable foundation.
dispute Forum
North Dakota District Court. Actions to recover overdue no-fault benefits are filed in county district courts.
Critical Statutory & Dispute Deadlines
| Dispute Phase / Trigger Event | Statutory Timeline / Deadline |
|---|---|
| Notice of Accident / Injury | Notice to insurer as soon as reasonably practicable |
| Medical Bill Submission | Submission with itemized proof of loss and treatment records |
| Carrier 30-Day Pay Window | 30 calendar days from receipt of proof of loss (N.D.C.C. § 26.1-41-09) |
| Medical Tort Threshold | $2,500 in medical expenses to maintain non-economic tort action (N.D.C.C. § 26.1-41-08) |
| Statute of Limitations | 4 years from accident date or 2 years from last no-fault payment (N.D.C.C. § 26.1-41-19) |
Required Evidentiary Filing Checklist
- ✓North Dakota Basic No-Fault Application for Benefits
- ✓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, and objective diagnostic reports
- ✓Insurer Explanation of Benefits (EOB) or written notice of denial
Official Primary Sources & Legislative Authorities
Governing Regulatory Authorities
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