Short Answer

Yes. In North Carolina, medical payments ("Med Pay") coverage is a first-party benefit under your own auto policy and can be paid regardless of any ongoing subrogation negotiations by a health plan or others. You still must meet your policy’s requirements (covered accident, reasonable and necessary medical expenses, and proof of loss). Coordination matters: reimbursement or lien issues may affect later settlement distribution, but they do not block Med Pay processing now.

Understanding the Problem

You want to know if you can use your North Carolina Med Pay benefits now even though a benefits administrator is pursuing subrogation related to your crash. The core question is: can you collect first-party Med Pay while another entity seeks repayment from any future settlement?

Apply the Law

Under North Carolina law, Med Pay is optional first-party auto insurance that reimburses reasonable and necessary medical expenses from an auto crash, regardless of fault. It is separate from the at-fault driver’s liability insurance and from any health plan recovery. The claim is handled by your own insurer, not the court. Policy conditions control timing and proof requirements, and insurers must handle claims promptly and fairly under state insurance standards. Provider liens can attach to third-party settlements, and UM/UIM coverage is governed by statute and policy language.

Key Requirements

• Covered loss: The medical expense must arise from the auto accident and fall within Med Pay’s scope.
• Reasonable and necessary expenses: Bills must be medically necessary and reasonable in amount.
• Proof of loss: You must submit itemized bills/records and any required forms or authorizations to your insurer.
• Policy timing: Policies often require prompt notice and limit coverage to expenses incurred within a specified period; suit deadlines also may apply.
• Coordination: Health-plan subrogation and medical-provider liens affect settlement distribution later but do not prevent Med Pay processing.

What the Statutes Say

• N.C. Gen. Stat. § 58-63-15 (Unfair claims settlement practices) - requires insurers to adopt reasonable standards and handle claims promptly and fairly.
• N.C. Gen. Stat. § 20-279.21 (Required auto coverages; UM/UIM) - sets rules for liability and UM/UIM; Med Pay is contractual and coordinated with these coverages.
• N.C. Gen. Stat. § 44-49 (Medical provider liens) - gives providers a lien on personal injury recoveries.
• N.C. Gen. Stat. § 44-50 (Lien distribution) - limits and prioritizes payment of provider liens from settlements.

Analysis

Apply the Rule to the Facts: Because you have Med Pay coverage, you can submit your accident-related medical bills to your own insurer now. If your treatment is complete and the bills are reasonable and necessary, your insurer can process payment upon receiving proof of loss. The health plan’s subrogation file targets any future third-party settlement, not your Med Pay claim. Coordination will matter at settlement to address any reimbursement or lien rights.

Process & Timing

1. Who files: You (the insured). Where: Your auto insurer’s claims department in North Carolina (online portal, app, or by mail). What: Proof of loss form (insurer-provided), itemized medical bills/records, crash report if available, and a medical authorization. When: Submit promptly; follow your policy’s notice and proof-of-loss requirements.
2. Your insurer reviews and may request clarifications or records. Many Med Pay claims are decided within a few weeks after complete documentation, but timelines vary by insurer.
3. Approved payments are issued to you or directly to providers, depending on your policy and any assignments. Keep copies for later coordination with liability or UM/UIM claims.

Exceptions & Pitfalls

• Policy exclusions or limits (per-person Med Pay limits, time windows for incurred expenses) can cap or bar payment.
• Failing to provide itemized bills, CPT/diagnosis codes, or medical authorizations can delay payment.
• Provider liens attach to third-party settlements; plan subrogation (especially self-funded ERISA plans) can affect how settlement funds are distributed later.
• Some policies contain non-duplication or credit provisions that can affect UM/UIM payouts; review your policy language before settling.

Talk to a Personal Injury Attorney

If you're dealing with Med Pay, subrogation, and potential UM/UIM issues from a North Carolina crash, 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.