What This Question Is Really Asking
Most people ask this because the offer feels “upside down”—the carrier’s number is lower than the medical bills they’ve seen. In reality, insurers often evaluate claims based on more than the face value of bills, including what amounts were actually paid (or are still owed), whether the treatment clearly relates to the incident, and whether there is proof of lost income or other damages. Negotiation is usually about filling those gaps with clear, organized proof.
A Practical Step-by-Step Path
- Confirm what the “medical bills” number really is: In NC, the amount that matters is often the amount actually paid to satisfy bills that have been paid, plus the amount actually necessary to satisfy bills that are still owed. That can be different from the original “sticker price” on a provider’s statement.
- Make sure the carrier has the right medical documentation: Bills alone usually do not explain why treatment was needed. A clean set of records (visit notes, diagnoses, imaging reports if any, discharge instructions, therapy notes) helps connect the care to the incident.
- Address causation and gaps head-on: If there was delayed treatment, a prior similar condition, or a long gap in care, expect the adjuster to argue the bills are not fully related. A timeline (incident date → first symptoms → first visit → follow-ups) can help.
- Document wage loss (if claimed): If the carrier says there is “no wage-loss documentation,” that usually means they will not pay for it yet. Common proof includes pay stubs, a letter verifying missed time, and any written work restrictions (without oversharing medical details).
- Put your counteroffer in writing with a simple explanation: A short demand-style letter often works better than back-and-forth calls. It should summarize liability, injuries, treatment, the paid/owed medical totals, time missed from work (if any), and how the injury affected daily life.
- Be careful about quick settlement paperwork: If you settle, you will likely be asked to sign a release. Once you sign, you typically cannot come back later for more if symptoms worsen or new bills arrive.
Timing: What Can Speed Things Up or Slow Things Down
- Records and billing delays: Providers and billing vendors can take time to produce complete records and itemized statements.
- “Paid vs. billed” confusion: Health insurance adjustments can change the medical-expense figure the carrier is willing to recognize, especially if they are focused on what was actually paid or required to be paid.
- Unclear liability: If the carrier disputes fault, they may discount the offer heavily. In North Carolina, contributory negligence can be a major issue because even small fault arguments can become settlement leverage.
- Missing wage documentation: Without it, the carrier may treat wage loss as unproven and value the claim lower.
- Multiple payers or potential liens: Health insurers and medical providers may have reimbursement rights or liens that must be addressed as part of settlement planning.
How This Applies
Apply to these facts: Here, the carrier says the offer is based on submitted medical bills, health-insurance-related reductions/payments, and no wage-loss documentation. A practical next move is to (1) verify the paid/owed totals (not just the original charges), (2) send the supporting records that tie treatment to the incident, and (3) provide wage proof if any time was missed or work duties changed. If the documentation is stronger than what the carrier relied on, that can support a higher counteroffer.
What the Statutes Say (Optional)
- N.C. Gen. Stat. § 8-58.1 (medical charges evidence) – Allows an injured person to testify about amounts paid (or required to be paid) for medical charges and creates rebuttable presumptions about reasonableness in certain situations.
- N.C. Gen. Stat. § 44-49 (medical provider liens) – Creates a lien right in favor of certain providers for treatment-related charges, with specific notice and itemization requirements.
Conclusion
You can negotiate a higher settlement offer in Durham even if the insurer’s number is currently below the medical bills. The most effective approach is to tighten the proof: confirm the paid/owed medical totals, provide records that connect the treatment to the incident, and add wage-loss documentation if it exists. If the carrier is discounting the claim based on liability arguments or documentation gaps, a licensed North Carolina personal injury attorney can help you frame a clear counteroffer and protect deadlines.
