Short Answer

Yes. In North Carolina, you can use your health insurance for necessary treatment while your workers’ compensation claim is pending. If the claim is later accepted, the workers’ comp carrier should pay the covered medical bills and typically reimburses what your health plan paid; your reasonable out-of-pocket costs (like copays) can usually be repaid. Some health plans exclude work injuries or require a denial letter first, so expect paperwork and keep all receipts and Explanation of Benefits (EOBs).

Understanding the Problem

You’re asking whether, under North Carolina personal injury and workers’ compensation law, you can use your own health insurance now and still be made whole later if your claim is approved. You work for an employer, a shelving unit struck you, you received stitches at urgent care, and you have a follow-up scheduled. You want to know if using your health insurance affects your right to have workers’ comp ultimately cover those medical bills.

Apply the Law

North Carolina’s Workers’ Compensation Act requires employers to provide and pay for “medical compensation” for a compensable work injury. The North Carolina Industrial Commission oversees these claims. Employers/insurers control non-emergency medical care, but you may get emergency treatment without advance approval. Insurers must promptly accept, deny, or pay without prejudice while they investigate. Timely notice to your employer and filing your claim with the Industrial Commission protect your right to have workers’ comp pay the medical bills, including amounts your health plan may have advanced.

Key Requirements

• Work injury by accident: The injury must arise out of and in the course of employment and be caused by an accident (a departure from your usual routine).
• Notice to employer: Tell your employer about the injury as soon as possible, preferably in writing, and within 30 days.
• File with the Commission: File a Form 18 claim with the North Carolina Industrial Commission within two years of the accident.
• Emergency care is allowed: You may seek emergency/urgent treatment right away; ongoing care is typically directed by the employer/insurer.
• Carrier decision window: The insurer must quickly admit, deny, or pay without prejudice during a limited investigation period; if accepted, they pay providers directly under the fee schedule.

What the Statutes Say

• North Carolina Gen. Stat. § 97-25 (Medical compensation) - Employer must provide necessary medical care; emergency treatment is permitted; Commission can oversee provider selection.
• North Carolina Gen. Stat. § 97-18 (Acceptance/denial/payments) - Insurer must promptly accept, deny, or pay without prejudice while investigating.
• North Carolina Gen. Stat. § 97-22 (Notice to employer) - Employee should give written notice to the employer within 30 days, with limited excuses for delay.
• North Carolina Gen. Stat. § 97-24 (Time to file claim) - File the claim with the Industrial Commission within two years of the accident.

Analysis

Apply the Rule to the Facts: A shelving unit striking you and causing a laceration can qualify as an “injury by accident” at work. You obtained stitches at urgent care, which fits the emergency/urgent care exception, so you did the right thing by getting treated right away. Using your health insurance now is fine; if the insurer later accepts the claim, it should pay the covered medical bills and reimburse amounts advanced by your health plan, including your reasonable out-of-pocket costs. File your Form 18 promptly to protect these rights.

Process & Timing

1. Who files: You (the employee). Where: North Carolina Industrial Commission (NCIC). What: File Form 18 (Notice of Accident to Employer and Claim of Employee). When: Give employer notice within 30 days and file Form 18 within two years of the accident.
2. The insurer will contact you, investigate, and either accept (Form 60), deny (Form 61), or pay without prejudice (Form 63) typically within a short window after notice. If accepted or paid without prejudice, the carrier should authorize a provider for follow-up care and pay providers directly.
3. If accepted: The carrier pays under the fee schedule; your health plan is usually reimbursed, and you can submit receipts for copays/deductibles. If denied: You may request a hearing by filing Form 33 with the NCIC.

Exceptions & Pitfalls

• Health plan exclusions: Many health policies exclude work injuries or require a workers’ comp denial letter; ask your plan what it needs and keep all EOBs.
• Unauthorized care: Non-emergency treatment with a provider not authorized by the carrier can delay payment; request authorization or a change of physician through the Commission if needed.
• Investigation period: A Form 63 means the insurer is paying while investigating; it can still deny later—keep appointments and provide requested information.
• Receipts matter: Save bills, EOBs, and proof of any copays/deductibles so you can seek reimbursement if the claim is accepted.
• Notice and filing: Late employer notice or failing to file Form 18 on time can jeopardize coverage; act promptly even if your employer filed its own report.

Talk to a Personal Injury Attorney

If you’re dealing with a work injury and medical bills while your claim is pending, 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.