What Usually Must Happen Before Payment
- Settlement terms confirmed: The parties confirm the settlement amount and what claims are being resolved (usually injury claims; property damage is often handled separately).
- Documents signed: The injured person typically signs settlement paperwork (often including a release). The insurer then processes payment.
- Liens/reimbursements addressed: Before funds are distributed, the attorney’s office usually checks for medical liens and reimbursement claims (including health insurance payments related to the crash) and works to confirm what is actually owed.
- Disbursement: Once the office has enough information to do a proper settlement breakdown, funds are distributed according to the settlement statement and any valid lien/reimbursement obligations.
What Can Cause Delays
- No file opened yet (or no reference number): Recovery vendors sometimes cannot locate a file without specific identifiers, so a new file may need to be opened.
- Ledger delays: Even when a file exists, it can take time to receive an itemized list of payments the plan claims are related to the accident.
- Plan type questions: Employer-provided plans can have different reimbursement rules than fully insured plans, and confirming the plan’s status may require plan documents.
- Mismatch issues: Payments may be coded to the wrong date of injury, mixed with unrelated care, or missing provider bills—each issue can require back-and-forth to correct.
Liens and Reimbursement Claims (Plain English)
When your health insurance pays medical bills after a crash, it may claim a right to be paid back from your settlement—often called a reimbursement or subrogation claim. In practice, many plans use a separate recovery vendor to identify accident-related charges and send letters requesting repayment.
Two practical points matter in North Carolina:
- Get the plan documents, not just a demand letter. For many employer plans, the exact reimbursement rights depend on the written plan terms. Whether the plan is self-funded can change how state insurance rules apply.
- Confirm the amount with an itemized ledger. A proper ledger helps verify that the plan is only seeking repayment for accident-related payments and helps spot unrelated charges.
How This Applies
Apply to the facts: Here, treatment has ended and the injury claim has settled, but there was no existing reference number when the attorney’s office contacted the health-plan recovery vendor. Opening a new file was a reasonable step to create a trackable case number. The next practical step is to request (in writing) the opened file/reference number and an itemized payment ledger tied to the date of loss, then review it for accident-related charges before any final disbursement decisions are made.
Conclusion
To find out whether your health insurance opened a reimbursement claim, ask the plan or its recovery vendor for the file/reference number, the date the file was opened, and a current itemized payment ledger tied to the accident. If the plan is through an employer, also request the plan’s reimbursement language so you can confirm what rights the plan is actually asserting. One next step: have your attorney’s office send a written request for the ledger and plan terms and calendar follow-ups until you receive them.
