This page provides information about reimbursement of medically necessary expenses under automobile insurance policies.
The following links provide access to applicable statutes, regulations, and administrative rules in states where automobile insurance reimbursement is governed in whole or in part by a state-mandated fee schedule. In instances where the fee schedules are not publicly available online, the associated ordering information is listed.
Florida – Florida now reimburses, for the most part, using a percentage of Medicare Part A and Medicare Part B. The statute that sets forth the applicable percentage for the applicable service is found in Fla. Stat. Ann. 627.736(5)(a)(2).
Hawaii – Hawaii uses the Workers' Compensation Supplemental Medical Fee Schedule, which is available for download here.
New Jersey – The New Jersey Fee Schedule is listed on the New Jersey Department of Banking and Insurance website. The schedules for the State of New Jersey are provided in seven exhibits:
New York – Learn more about the New York State Insurance Department and its Regulation 83.
Oregon – Oregon reimburses according to workers' compensation using specific rules.
Pennsylvania – Pennsylvania reimburses at a percentage of Medicare, as detailed in 31 Pa. Code Chapter 69.
Utah – The fee schedule in Utah is not a statute or a regulation and is not available online. A copy of the fee schedule can be purchased for $15.00 from:
Jilene Whitby, Information Specialist
Utah Insurance Department
801-538-3803
jwhitby@utah.gov
FAIR Health – As part of its bill review program, one option that Auto Injury Solutions offers is the use of benchmarketing data from FAIR Health, an independent, not-for-profit organization that licenses a number of benchmarking database products. Auto Injury Solutions licenses the following FAIR Health products:
Auto Injury Solutions uses data from these products, sometimes known as usual and customary data, at the percentile levels chosen by clients who choose to use this service. Learn more about FAIR Health and the products Auto Injury Solutions licenses.
Other Companies – Auto Injury Solutions also licenses several other applications from health care data companies:
| Vendor | Product(s) | Description |
| 3M | Core grouping software, Medicare pricer table, New York pricer table | Data are used to properly group, edit, and reimburse inpatient / outpatient claims for FL, HI, NY and PA |
| Thomson MicroMedex | Red book pharmacy | Used to apply average wholesale price (AWP) calculation on pharmacy NDC codes |
| GreatData | Zip code updating | Used to update zip codes |
Other Data Sources – Auto Injury Solutions' clients may use their own data and/or methodologies to determine reimbursement for medically necessary services under automobile insurance policies; in such instances Auto Injury Solutions' role is to apply this data and/or methodologies as requested.
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