Can I submit medical bills from my accident to an accidental protection plan?: North Carolina
Can I submit medical bills from my accident to an accidental protection plan? - North Carolina
Short Answer
Yes. In North Carolina, you can submit accident-related medical bills to an accidental protection plan if the plan covers the person and the accident, and you meet its notice and proof-of-loss requirements. For vehicle-based medical payments (MedPay), claims are first-party and typically pay regardless of fault up to the coverage limit. For person-based accident plans, benefits follow the plan’s schedule and rules, and you must provide timely notice and itemized proofs.
Understanding the Problem
You want to know if you can send your accident medical bills to an accidental protection plan in North Carolina so they get paid. You are the injured person (through your attorney), and you need to submit bills for an auto accident. The immediate task is to notify the insurer and submit a claim with supporting documents, but your attorney has not yet received the plan’s coverage packet.
Apply the Law
North Carolina allows first-party claims under both vehicle-based medical payments coverage and person-based accident plans. The core rule is: give prompt notice of claim to the insurer, then submit proper proof of loss (the claim form, itemized bills, and medical records) within the plan’s deadlines. Claims are made directly to the insurer’s claims department, not the court. Individual accident and health policies in North Carolina include standard timelines for notice and proof; group or supplemental plans set timelines in their certificates, which are often similar.
Key Requirements
Covered person and covered accident: The claimant must be an insured under the plan (e.g., named or family member) and the injury must result from a qualifying accident.
Timely notice of claim: Notify the insurer promptly after the accident as the policy requires; individual accident/health policies include a short notice window.
Proof of loss: Provide the insurer’s claim form, itemized bills (not just balance statements), and relevant medical records within the plan’s proof-of-loss deadline.
Coordination of benefits: Plans may coordinate with auto MedPay or health insurance and may require disclosure of other coverages.
Payment handling and liens: Payments may go to you or the provider; providers may assert liens or assignments that affect disbursement.
Appeal or suit if denied: If the insurer denies benefits, follow any internal appeal process and preserve the three-year contract limitation period to sue for benefits.
Apply the Rule to the Facts: Your client likely can submit accident-related medical bills now. First, send prompt written notice and a letter of representation to the insurer and request the full policy/certificate to confirm who is covered under the family plan and which coverages apply (vehicle-based MedPay vs. person-based accident benefits). Next, prepare proof of loss: the insurer’s claim form, HIPAA-compliant authorization, itemized bills, and treatment records. Finally, follow any coordination-of-benefits requirements between the accident plan, auto MedPay, and health insurance.
Process & Timing
Who files: Your attorney. Where: The insurer’s claims department listed on the policy ID card or website. What: Letter of representation; written request for the complete policy/certificate and declarations; insurer’s claim form; HIPAA authorization; itemized bills (CMS-1500/UB-04) and medical records; accident report. When: Give prompt notice; for individual accident/health policies, notice is commonly due within 20 days of the loss and proofs of loss within 90 days of services if reasonably possible (plan terms control).
The insurer opens the claim, may request additional records, and processes payment. For health benefit plans subject to North Carolina’s prompt-pay law, “clean claims” are generally due within 30–45 days (some supplemental/accident-only plans are exempt; check your certificate).
Final step: You receive an Explanation of Benefits and payment (to you or the provider). If denied, follow the plan’s appeal steps and calendar the three-year contract deadline to file suit for benefits if needed.
Exceptions & Pitfalls
Not obtaining the policy/certificate: Always request the full plan to confirm who is covered, deadlines, and exclusions.
Sending statements instead of itemized bills: Insurers typically require itemized billing (codes, dates, charges) and supporting records.
Missing coordination-of-benefits rules: Disclose other coverages (auto MedPay, health insurance) to avoid delays or denials.
Late notice or proof: If you’re late, submit anyway and explain—many policies accept late proofs if not reasonably possible earlier, but don’t rely on discretion.
Release language: Do not sign a liability settlement release that could waive first-party accident benefits.
Payment direction: Clarify whether payment goes to you or the provider and account for any provider liens or assignments.
Conclusion
Yes—you can submit your accident medical bills to an accidental protection plan in North Carolina if the person and the accident are covered and you meet the plan’s notice and proof-of-loss requirements. Give prompt written notice, then send the insurer’s claim form, itemized bills, and records. If it’s an individual accident/health policy, aim to provide notice within about 20 days and proofs within about 90 days. Next step: send the letter of representation and request the full policy/certificate today.
Talk to a Personal Injury Attorney
If you're dealing with accident-related medical bills and uncertain coverage under an accidental protection plan, 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.
