What can I do if insurance will not pay my medical bills because fault is disputed? — Durham, NC

Woman looking tired next to bills

What can I do if insurance will not pay my medical bills because fault is disputed? — Durham, NC

Short Answer

You can challenge the fault decision with additional evidence and ask the insurer to explain its position in writing, but the other driver’s liability insurer may continue withholding payment while fault remains disputed. In North Carolina, contributory negligence can create serious problems if the insurer claims that your conduct helped cause the crash. Meanwhile, you can explore available health insurance, medical payments coverage, and collision coverage without giving up your injury claim. Preserve the evidence and watch the filing deadline while the dispute is pending.

Why Disputed Fault Can Delay Payment

The other driver’s liability insurer generally investigates whether its insured caused the accident before agreeing to pay bodily injury or property damage claims. It may review driver statements, vehicle damage, photographs, witness accounts, traffic laws, and the police report. When those materials do not clearly establish responsibility, the insurer may deny the claim or delay payment while requesting more information.

A police report stating that fault could not be determined does not necessarily settle the issue. Under N.C. Gen. Stat. § 20-166.1, law enforcement investigates reportable crashes and prepares a written report containing crash information. The report can be important, but an insurer may conduct its own investigation, and responsibility ultimately depends on the complete evidence rather than one box or conclusion on the report.

It is also important to separate two issues:

  • Medical bills: The other driver’s liability carrier may not pay bills as they arrive, particularly before accepting responsibility. An injury claim often considers medical expenses as part of an eventual resolution rather than as a bill-by-bill payment system.
  • Vehicle repairs: The liability carrier may refuse to repair the vehicle until it accepts fault. If you have collision coverage, your own carrier may provide another route, subject to the policy terms and any deductible.

Steps You Can Take to Challenge the Fault Decision

Ask for the insurer’s position in writing

Request a written explanation identifying why fault is disputed and what information the adjuster relied on. Ask whether the investigation is still open and whether the insurer needs particular documents. Keep copies of letters, emails, claim numbers, and notes showing the date and substance of each conversation.

Submit evidence that tells the complete story

Photographs from the police report may help, but they should be considered with other evidence. Useful items may include:

  • The complete crash report, including diagrams and supplemental pages.
  • Original photographs and videos showing vehicle positions, impact areas, skid marks, debris, traffic controls, and road conditions.
  • Dash-camera or nearby surveillance footage.
  • Names and current contact information for witnesses.
  • Repair estimates and photographs documenting each vehicle’s damage pattern.
  • Messages or statements from the other driver concerning how the crash occurred.
  • A written timeline prepared while your memory is fresh.

Do not alter original photographs or discard damaged property before it has been documented. Video can be overwritten quickly, so requests to businesses or property owners may need to be made promptly.

Address allegations about your conduct

North Carolina allows contributory negligence as a defense. If the defense proves that the injured person was negligent and that this conduct helped cause the injury, it can seriously affect the claim. The party raising the defense generally carries the burden of proving it under N.C. Gen. Stat. § 1-139.

For that reason, evidence should show both what the other driver did wrong and why you acted reasonably. Relevant details may include speed, lane position, signals, visibility, right of way, distractions, evasive action, and what each driver could see before impact. Be accurate and avoid guessing when discussing these points with an adjuster.

Ways to Address Medical Bills While Liability Is Unresolved

You remain responsible for managing medical accounts even while an insurance investigation is pending. Consider the following practical options without assuming that any particular coverage applies:

  1. Submit bills to available health insurance. Give providers your current insurance information and ask whether all claims were submitted on time. Keep bills, claim forms, explanations of benefits, denial notices, and proof of payment. A health plan may have reimbursement rights if money is later recovered, so retain all plan correspondence.
  2. Check for medical payments coverage. Medical payments coverage under an auto policy may cover qualifying accident-related medical expenses without requiring a decision about who caused the crash. Availability, limits, deadlines, and required documentation depend on the actual policy. Send relevant bills and medical records promptly if you open a claim.
  3. Ask providers about account handling. Contact each billing office, explain that an accident claim is pending, and request an itemized statement. You may ask about payment arrangements or whether the account can be held from collection, although a provider is not necessarily required to agree.
  4. Keep medical documentation organized. Save visit summaries, bills, receipts, mileage records, and records of missed work. Follow your medical providers’ instructions and document symptoms accurately. Delays or unexplained gaps in care may later lead the insurer to question whether the treatment was connected to the crash.

For more detail about possible first-party coverage, review whether you can use your own auto insurance while the liability dispute continues. You can also learn about handling medical bills while a car accident claim is pending.

Options for the Damaged Vehicle

If the other carrier will not authorize repairs, review your own declarations page and policy documents for collision coverage, rental coverage, and applicable deductibles. Using your own coverage does not necessarily decide who was legally at fault, although your carrier may later seek repayment from the responsible party or insurer.

Before repairs begin, preserve photographs, estimates, towing invoices, storage notices, rental records, and communications about whether the vehicle is repairable. Storage charges can grow quickly, so ask the repair facility or tow yard for written information about daily fees and vehicle-release requirements.

How This Applies When the Report Is Inconclusive

Here, the report photographs may support the individual’s account even though the report says fault could not be determined. The practical task is to identify what the photographs actually establish—such as impact location, lane position, vehicle direction, or debris—and connect those details to witness statements, traffic controls, and the vehicle damage. Simply telling the insurer that the photographs prove fault may be less useful than presenting an organized explanation supported by the original images and other records.

The medical-bill and repair issues should be handled on parallel tracks. Evidence can be submitted to challenge the liability decision while available first-party medical or collision coverage is investigated. Any use of personal coverage depends on the applicable policy and does not guarantee payment.

Do Not Let the Insurance Dispute Consume the Filing Deadline

N.C. Gen. Stat. § 1-52 provides a three-year period for many North Carolina claims involving personal injury or physical property damage, although the correct deadline depends on the claim and facts. Negotiations, requests for more records, or an ongoing insurance investigation do not automatically extend the time to file a lawsuit. An attorney should review the date promptly if there is any uncertainty.

When Wallace Pierce Law May Be Able to Help

Wallace Pierce Law may be able to review the crash report, photographs, vehicle damage, witness information, and insurance correspondence to evaluate why fault remains disputed. The firm can also help organize medical records and bills, communicate with insurers, identify potentially available sources of coverage, and track deadlines.

An attorney’s review does not guarantee that an insurer will change its decision. It can, however, help identify missing evidence, unclear statements, contributory-negligence concerns, and practical steps for presenting the Durham car accident claim in an organized way.

Talk to a Personal Injury Attorney in Durham

If your question involves injuries, insurance, fault, medical documentation, settlement paperwork, or a possible deadline, speaking with a licensed North Carolina attorney can help clarify your options. Call 919-313-2737 to discuss what happened and what steps may make sense next.

Disclaimer: This article provides general information about North Carolina personal injury law based on the single question stated above. It is not legal advice and does not create an attorney-client relationship. It is not medical advice, tax advice, or insurance policy interpretation. Laws, procedures, and local practice can change and may vary by county. If there may be a deadline, act promptly and speak with a licensed North Carolina attorney.

Categories: 
close-link