Short Answer

To get medical payments (MedPay) benefits in North Carolina, give the insurer proof that you have MedPay on the policy and that your medical expenses are reasonable, necessary, and related to the crash. Send your claim/policy number, an itemized bill and treatment records for each provider, proof you paid out-of-pocket amounts, a narrowly tailored medical authorization if needed, and lien information. Ask the adjuster to confirm any proof-of-loss form and the deadline to submit bills.

Understanding the Problem

You want to know what to give the insurer so it will pay MedPay under your North Carolina auto policy. The key decision is: what documents and details must you provide so the adjuster can verify coverage and pay eligible bills. Here, a claim number exists, but the insurer has not confirmed whether MedPay applies.

Apply the Law

Under North Carolina law, MedPay is a contractual benefit in an auto policy. It typically pays reasonable and necessary medical expenses caused by a covered motor vehicle accident, up to your MedPay limit, without regard to fault. The main forum is the insurer’s claims department. Your policy sets the proof-of-loss requirements and deadlines, which often include prompt notice and submitting itemized bills and records within a set time window.

Key Requirements

• Confirm coverage and limits: Show your policy/claim number and ask the adjuster to confirm MedPay is on the policy and the dollar limit.
• Accident-related, necessary treatment: Provide facts tying your treatment to the crash and bills that reflect reasonable, necessary services.
• Proof of loss: Submit itemized bills (with CPT/diagnosis codes), corresponding medical records, and receipts for co-pays, prescriptions, or devices.
• Timely submission: Meet the policy’s notice and bill-submission deadlines; ask the insurer to confirm them in writing.
• Authorizations and liens: If requested, give a narrowly tailored medical authorization for crash-related records and identify any provider, hospital, Medicare/Medicaid, or health plan liens.

What the Statutes Say

• North Carolina Gen. Stat. § 58-63-15 (Unfair claim settlement practices) - Insurers must adopt reasonable claim standards and handle claims promptly and fairly.
• North Carolina Gen. Stat. § 44-49 (Medical providers’ lien) - Providers get a lien for accident-related services and must provide itemized records at reasonable cost.
• North Carolina Gen. Stat. § 44-50 (Distribution and lien limits) - Sets limits and priorities for paying medical liens from recoveries.

Analysis

Apply the Rule to the Facts: You have a claim number but unclear coverage. First, request the declarations page and written confirmation of MedPay and its limit. Then submit itemized bills and corresponding records showing crash-related treatment, plus receipts for co-pays. Provide a narrowly tailored authorization limited to crash-related providers if the adjuster needs to verify records. Identify any known liens so the insurer can address them in payment.

Process & Timing

1. Who files: The injured insured or their attorney. Where: The insurer’s claims department in North Carolina (use the adjuster’s email/portal). What: Written MedPay request referencing the policy/claim number, request for written confirmation of MedPay and limits, and the insurer’s proof-of-loss form (if any), plus itemized bills, records, and receipts. When: As soon as possible; confirm your policy’s submission deadline in writing.
2. After submission, the insurer typically acknowledges and may request clarifications or additional records. Ask for all requests in writing and respond promptly to avoid delays.
3. Once verified, the insurer issues payment up to the MedPay limit, often directly to you or the provider, taking into account any valid liens. Keep copies of the payment and closing letter.

Exceptions & Pitfalls

• Coverage not on the policy: If MedPay is not listed on your declarations page, it may not apply.
• Overbroad authorizations: Limit any medical release to crash-related providers and dates.
• Incomplete proof: Bills without itemization or missing records can delay or reduce payment.
• Liens and subrogation: Hospital, Medicare/Medicaid, or health plan liens can affect who gets paid; disclose them early.
• Work-related crashes: Workers’ compensation may be primary; the auto policy may offset or exclude certain payments.
• Missed deadlines: Late proof-of-loss or bill submissions can jeopardize benefits; get the deadline in writing.

Talk to a Personal Injury Attorney

If you’re trying to get MedPay to cover your crash-related medical bills, our firm has experienced attorneys who can help you understand your options and timelines. 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.