What happens if the other driver’s insurance offers their policy limits but my injuries still aren’t fully covered?

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What happens if the other driver’s insurance offers their policy limits but my injuries still aren’t fully covered? - North Carolina

Short Answer

In North Carolina, a “policy limits” offer usually means the at-fault driver’s liability insurer is offering the most it will pay under that policy—so the claim against that policy is effectively capped. If your damages are higher, the next common step is to look for other available coverage, especially underinsured motorist (UIM) coverage on your own auto policy (or a household policy). Before you sign a full release or finalize a limits settlement, you must protect any UIM rights by giving proper notice and following the UIM procedure, including a key 30-day window for the UIM carrier to respond.

Understanding the Problem

If you were hurt in a North Carolina car crash and the other driver’s insurer offers the full policy limits, can you still pursue more compensation when your injuries are more serious than that insurance will cover—especially when you had emergency treatment and you have Medicare?

Apply the Law

In a North Carolina injury claim, the at-fault driver’s liability insurance has a maximum payout (the “policy limits”). When that insurer tenders (offers) the limits, it is signaling it will not pay more under that policy. That does not automatically mean your case is “worth only the limits”—it means that particular policy is exhausted.

If your injuries and losses exceed the liability limits, North Carolina law often shifts the focus to other sources of recovery. The most common is underinsured motorist (UIM) coverage, which is coverage on your own auto policy (and sometimes additional policies you qualify under) that can apply when the at-fault driver’s available liability coverage is too low. North Carolina’s UIM rules are largely set out in the Motor Vehicle Safety and Financial Responsibility Act, including how UIM applies after a liability limits settlement and the notice/advance-payment process that protects the UIM carrier’s subrogation rights.

Separately, because you have Medicare, you also need to plan for Medicare’s reimbursement rights for accident-related medical payments. That issue does not change whether UIM exists, but it can affect how a limits settlement is structured and the timing of final disbursement.

Key Requirements

  • Policy limits really are the ceiling for that policy: Once the at-fault driver’s insurer offers the full limits, you generally cannot get more from that insurer under that policy, even if your damages are higher.
  • Check for UIM coverage: UIM may apply if the at-fault driver is “underinsured” compared to the UIM limits available to you. UIM can come from your own policy and, in some situations, other policies you qualify under.
  • Exhaustion/tender triggers UIM: North Carolina treats liability coverage as “exhausted” for UIM purposes when the limits are paid or tendered on the claim (including when multiple claims use up the per-accident limit).
  • Do not sign away UIM rights by mistake: A broad release or settlement paperwork can accidentally cut off UIM claims if it is handled incorrectly.
  • Give the UIM carrier written notice before settling: Before you finalize a settlement with the at-fault driver, you must give your UIM insurer written notice of the tentative settlement so it has a chance to protect its rights.
  • Watch the 30-day advance-payment window: After receiving proper notice of a tentative settlement, the UIM insurer has a statutory 30-day period to advance the settlement amount (in effect, stepping into the at-fault driver’s shoes) to preserve subrogation rights.
  • Account for Medicare reimbursement: If Medicare paid for crash-related care, you typically need to identify and resolve Medicare’s repayment claim before finalizing what you take home from a settlement.

What the Statutes Say

Analysis

Apply the Rule to the Facts: Here, you reported neck and shoulder pain, headaches, and concussion-like symptoms and you were transported by ambulance to the ER with imaging, followed by additional care. If the at-fault driver’s insurer is offering its policy limits, that offer may be the most money available from that liability policy, even if your medical care and other losses are higher. The next step is usually to evaluate whether you have UIM coverage that can apply once the liability limits are paid or tendered, and to handle the settlement in a way that does not accidentally waive UIM rights or create Medicare repayment problems.

Process & Timing

  1. Who files: The injured person (or their attorney) makes the claim. Where: First with the insurance companies (liability carrier and any UIM carrier); if suit is needed, in the appropriate North Carolina trial court (typically Superior Court) in the proper county. What: A written demand/claim package and, for UIM protection, written notice of the tentative liability settlement to the UIM carrier. When: Send UIM notice before you finalize the liability settlement paperwork.
  2. UIM carrier decision window: After the UIM carrier receives proper written notice of the tentative settlement, it has 30 days to advance a payment equal to the tentative settlement amount if it wants to preserve subrogation rights.
  3. Finalize settlement and pursue remaining coverage: Depending on what the UIM carrier does, you may (a) complete the limits settlement and pursue UIM benefits for the remaining uncompensated damages, or (b) accept the UIM advance and continue the claim with the UIM carrier involved. In parallel, you should identify and address Medicare’s repayment claim so the settlement can be distributed correctly.

Exceptions & Pitfalls

  • Signing the wrong release: If you sign a full release too early (or with the wrong language), you can unintentionally harm a UIM claim. Limits settlements often need careful wording and sequencing.
  • Not giving proper UIM notice: If you settle without giving the UIM carrier the notice required by statute, you may create avoidable coverage fights.
  • Assuming “policy limits” equals “fair value”: A limits offer can reflect limited insurance, not the true value of the injury claim.
  • Overlooking other applicable policies: In some situations, more than one UIM policy may apply, but the rules about combining coverages are technical and fact-specific.
  • Medicare repayment issues: If Medicare paid for accident-related treatment, failing to identify and resolve Medicare’s repayment claim can delay settlement distribution and create compliance problems.
  • Deadline pressure: Even when insurers are negotiating, you still must protect any lawsuit filing deadlines that may apply to preserve the underlying injury claim.

Conclusion

In North Carolina, if the at-fault driver’s insurer offers its policy limits, that usually means you cannot collect more from that liability policy—even if your injuries cost more. The next step is to look for other available coverage, especially underinsured motorist (UIM) coverage, which can apply once the liability limits are paid or tendered. To protect UIM rights, give your UIM carrier written notice of the tentative limits settlement and allow the required 30-day response window before finalizing the settlement.

Talk to a Personal Injury Attorney

If you’re dealing with a policy-limits offer but your medical care and symptoms are ongoing, a North Carolina personal injury attorney can help you identify possible underinsured motorist coverage, follow the required notice steps, and coordinate lien and Medicare repayment issues so you understand your options and timelines. Call 704-343-3400 to discuss next steps.

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.

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