Short Answer

In North Carolina, payment of auto medical benefits (often called MedPay, and sometimes labeled PIP) is governed by your insurance policy. If the insurer denies some bills, you can challenge the decision by demanding a written explanation tied to the policy, curing documentation gaps, using the carrier’s appeal process, filing a complaint with the N.C. Department of Insurance, and, if needed, suing for breach of contract within the applicable deadlines.

Understanding the Problem

In North Carolina, can you require your auto insurer to pay accident-related medical bills under your MedPay/PIP benefits when it denied some charges, even though your policy limit is not exhausted? You are the insured seeking payment; the action is to contest a partial denial of coverage; the trigger is the insurer’s denial after you received payment for one emergency bill.

Apply the Law

Under North Carolina law, MedPay/PIP benefits are contractual. The policy typically promises to pay reasonable and necessary medical expenses caused by the auto accident up to the limit, regardless of fault, if you meet policy conditions (timely notice, proof of loss, authorizations, and cooperation). Disputes usually turn on whether the treatment is accident-related, reasonable and necessary, adequately documented, within limits, and compliant with the policy’s procedures. Your main forums are: (1) the insurer’s internal review/appeal, (2) the N.C. Department of Insurance complaint process, and (3) District or Superior Court (or Small Claims Court, if the disputed amount is $10,000 or less). Contractual and statutory deadlines can apply.

Key Requirements

• Covered treatment and causation: The medical care must arise from the crash and fall within the policy’s covered expenses.
• Reasonable and necessary charges: Amounts must be medically necessary and reasonably priced under the policy’s standards.
• Complete, proper documentation: Submit itemized bills and records (dates of service, CPT/diagnosis codes if available) and proof of payment if you seek reimbursement.
• Compliance with policy conditions: Give timely notice, provide requested authorizations, and submit any required proof-of-loss forms within the policy’s timelines.
• Within policy limits and no exclusions: Remaining benefits must be available and no exclusion or coordination clause may bar payment.

What the Statutes Say

• North Carolina Gen. Stat. § 58-63-15 (Unfair claim settlement practices) - Bars certain unfair claims handling practices by insurers.
• North Carolina Gen. Stat. § 75-1.1 (Unfair and deceptive trade practices) - Prohibits unfair or deceptive acts in commerce; sometimes used in insurance disputes based on claims handling conduct.
• North Carolina Gen. Stat. § 1-52 (Three-year limitations period for many contract claims) - Sets a general three-year deadline to sue on contracts; your policy may have shorter suit limitations.

Analysis

Apply the Rule to the Facts: You have remaining benefits and one ER bill was paid, which supports that coverage exists. The insurer can deny later bills if it believes they are not accident-related, not medically necessary, not properly documented, or barred by a policy condition. To overcome this, submit itemized invoices and records for each date of service, tie the treatment to the crash, and confirm you met notice and proof-of-loss timelines. Ask for a written denial quoting the policy section relied on and use the carrier’s appeal process.

Process & Timing

1. Who files: You (the insured). Where: Start with your insurer’s claims/appeals department; you may also file a complaint with the North Carolina Department of Insurance. Court filings go to the appropriate Division of the General Court of Justice in your county (Small Claims, District, or Superior Court). What: Submit itemized bills and medical records with your claim number; request a written explanation citing the policy. If suing, file a civil complaint for breach of contract (and, if warranted, related statutory claims). When: Follow any policy deadlines for proof of loss or appeals; contract suits generally must be filed within three years unless your policy shortens that period.
2. Appeals/review: After you fax the bills, confirm receipt and ask for a written coverage decision. If denied, send a concise appeal with the missing documentation within the timeframe in your denial letter (often 30–60 days, but check your policy). You can simultaneously or subsequently submit a complaint to the N.C. Department of Insurance for help facilitating a review.
3. Court: If the insurer maintains the denial, consider filing suit. Use Small Claims Court if the disputed amount is $10,000 or less for a faster, simpler process; larger disputes go to District or Superior Court. Expected outcomes include a settlement or a court judgment on coverage.

Exceptions & Pitfalls

• Untimely notice or proof-of-loss: Late or incomplete submissions may justify denial even when treatment is covered.
• Insufficient documentation: Balance statements are not enough; send itemized bills and records linking treatment to the crash.
• Causation disputes: If the insurer questions whether treatment is accident-related, ask your provider for a brief statement tying the care to the collision.
• IME or authorization issues: Refusing a reasonable medical authorization or examination required by the policy can suspend benefits.
• Venue/amount missteps: Filing in the wrong court level or county can delay your claim; choose Small Claims only if the disputed amount does not exceed $10,000.
• Policy suit limitations: Some policies shorten the time to sue; do not assume the general statute applies if your contract sets an earlier deadline.

Talk to a Personal Injury Attorney

If you’re facing a partial denial of accident-related medical bills under your auto policy, our firm can help you assess coverage, gather proof, and navigate appeals and deadlines. Call us today.

Disclaimer: This article provides general information about North Carolina law based on the single question stated above. It is not legal advice for your specific situation and does not create an attorney-client relationship. Laws, procedures, and local practice can change and may vary by county. If you have a deadline, act promptly and speak with a licensed North Carolina attorney.