Ohio Claims Dispute & Statutory Guide
Ohio operates an At-Fault automobile insurance framework under Title 39 and Title 45 of the Ohio Revised Code (R.C.). The state enforces modified comparative negligence with a 51% bar. Medical providers bill first-party Medical Payments (MedPay) coverage where available, subject to Ohio's Made-Whole doctrine, and protect third-party balances through contractual assignments and Letters of Protection (LOP).
Statutory Framework & Jurisdiction
At-Fault / Traditional Tort (Modified Comparative Fault & MedPay Made-Whole Rules)
Ohio does not mandate Personal Injury Protection (PIP) insurance. Motor vehicle accident medical care is funded through optional first-party Medical Payments (MedPay) coverage, private health insurance, or third-party automobile liability insurance. Under Ohio Revised Code § 2315.33, an injured claimant may recover damages if their fault is not greater than 50%. Because Ohio lacks a general statewide private hospital lien statute, healthcare providers rely on patient assignments of MedPay and formal Letters of Protection (LOP) from claimant attorneys to secure balances pending liability resolution.
PIP / MedPay Coverage & Medical Fee Rules
optional Med Pay Coverage
MedPay is optional in Ohio (typically written in limits of $1,000 to $10,000+ per person), providing no-fault reimbursement for reasonable and necessary medical, surgical, and funeral expenses arising from a crash
made Whole Doctrine
Under Ohio common law (Northern Buckeye Education Council v. Lawson), an insurer's contractual right of subrogation for MedPay benefits cannot be exercised until the injured insured has been made completely whole for all damages, unless unambiguous policy language specifically states otherwise
assignment Of Benefits
Healthcare providers routinely accept 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
Ohio does not establish a statutory fee schedule table for motor vehicle accident medical bills. Providers bill based on reasonable and customary charges prevailing in the local medical community for comparable treatments.
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 acute emergency services or diagnostic imaging. Insurers evaluate extended physical therapy, chiropractic treatments, and elective surgical procedures under standard medical necessity criteria.
carrier Examinations
Auto liability and MedPay insurers may request medical records or independent physician reviews to evaluate causal relationship to the collision.
Administrative Appeals & Dispute Mechanism
prompt Payment Statute
Under R.C. 3901.381, insurers must pay clean medical claims within 30 calendar days of receipt. Claims not paid or denied within 30 days accrue statutory interest at the rate of 18% per year under R.C. 3901.389.
contractual Assignments And L O Ps
Because Ohio does not provide a general statutory lien for private hospitals or physicians, providers secure receivables against third-party liability settlements using formal written contractual assignments of proceeds and attorney Letters of Protection (LOP). An attorney who distributes settlement proceeds with notice of a valid assignment may be held directly liable to the provider.
dispute Forum
Ohio Court of Common Pleas (or Municipal Court for claims within jurisdictional limits) for civil contract 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 complete proof of claim (R.C. 3901.381) |
| Assignment Notice | Notice of assignment and LOP served on claimant's attorney and liability carrier prior to settlement |
| Statute of Limitations | 2 years from accident date for personal injury tort claims (R.C. 2305.10); 6 years for contract claims |
Required Evidentiary Filing Checklist
- ✓Ohio 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 notes, operative reports, and imaging findings
- ✓Executed Letter of Protection (LOP) or contractual Assignment of Settlement Proceeds signed by patient and legal counsel
- ✓Insurer Explanation of Benefits (EOB) or written explanation of claim determination
Official Primary Sources & Legislative Authorities
Governing Regulatory Authorities
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