Short Answer
Yes. A pedestrian injured by a driver may pursue the driver’s liability insurance while also seeking benefits under the pedestrian’s own auto policy, depending on the policy and circumstances. Potential first-party coverage may include medical payments coverage and, if the driver has no insurance or inadequate insurance, uninsured or underinsured motorist coverage. Opening multiple claims does not guarantee payment, and coordination or reimbursement issues may affect the amounts ultimately retained.
Which Insurance Coverages May Apply to an Injured Pedestrian?
Being on foot does not automatically prevent an injured person from using an auto policy. In a North Carolina pedestrian accident, several types of coverage may need to be investigated separately.
The Driver’s Liability Insurance
A bodily injury liability claim seeks compensation from the insurance covering the driver or vehicle that caused the collision. This is a fault-based claim. The injured pedestrian generally must show that the driver failed to use reasonable care and that this conduct caused the injuries and losses.
Depending on the evidence, recoverable losses may include medical expenses, lost income, pain and suffering, reduced earning ability if supported, and reasonable out-of-pocket expenses. Coverage limits, disputed fault, and the available documentation can affect the claim.
Medical Payments Coverage Under the Pedestrian’s Policy
Medical payments coverage, often called MedPay, is first-party coverage that may pay qualifying accident-related medical expenses up to the applicable policy limit. It generally operates without requiring the insured to prove that the other driver was at fault, but the policy must actually include the coverage and the person seeking benefits must qualify as an insured.
Relevant expenses may include ambulance, emergency, hospital, diagnostic, and follow-up bills, subject to the policy’s language and requirements. The insurer will commonly request itemized bills, medical records, proof that the expenses relate to the collision, and completed claim forms.
A MedPay claim is separate from the liability claim against the driver. Payment under one coverage does not necessarily resolve the other claim. Coordination issues, reimbursement rights, health-plan requirements, and the wording of any release should be reviewed before the claims are concluded.
Uninsured and Underinsured Motorist Coverage
The pedestrian’s auto policy may also matter if the driver is uninsured, has disputed coverage, or lacks enough insurance for the documented losses. Under N.C. Gen. Stat. § 20-279.21, uninsured and underinsured motorist coverage protects qualifying insured people who are legally entitled to recover for injuries caused by certain uninsured or underinsured drivers.
The statute’s definition of an insured includes the named policyholder and, while residing in the same household, the named insured’s spouse and qualifying relatives, whether they are in a vehicle or otherwise. That language can allow coverage to follow a qualifying person who was walking when struck.
Uninsured motorist and underinsured motorist claims remain tied to legal responsibility. The pedestrian ordinarily must establish the other driver’s liability and the accident-related damages. Notice requirements also matter. An insurer should be informed promptly when UM or UIM coverage might apply, even if the driver’s liability claim is still being investigated.
Why Fault Still Matters in a North Carolina Pedestrian Claim
MedPay may not depend on who caused the collision, but the liability, uninsured motorist, and underinsured motorist claims generally do. Evidence may need to show where the pedestrians were walking, whether they were in a crosswalk, the traffic signal status, lighting and visibility, the driver’s speed and attention, and what each person did immediately before impact.
North Carolina permits contributory negligence as a defense. If the defense proves that an injured pedestrian’s own negligence helped cause the collision, that can create serious problems for the fault-based claim. The party raising this defense generally carries the burden under N.C. Gen. Stat. § 1-139.
For that reason, the evidence should address both the driver’s conduct and why the pedestrian acted reasonably. A police report is useful, but photographs, video, witness information, signal sequencing, and the pedestrians’ own recollections may provide important context that does not appear in the report.
What to Gather for Both Insurance Claims
Each injured person should maintain a separate, organized set of records. Helpful materials include:
- The police report and any report supplement.
- Photographs or video of the scene, crosswalk, traffic controls, lighting, and visible injuries.
- Names and contact information for witnesses.
- The driver’s insurance information and all liability adjuster communications.
- The pedestrian’s auto policy, declarations page, endorsements, and insurance cards.
- Claim numbers and adjuster contact information for every opened claim.
- Ambulance, hospital, medical, pharmacy, and other accident-related bills.
- Medical records and visit summaries connecting the care to the collision.
- Work records supporting missed time or reduced income.
- Copies of denial letters, coverage letters, releases, and settlement documents.
Do not assume that opening a MedPay claim automatically opens a UM or UIM claim. Ask the insurer to identify the claim type, assigned adjuster, claim number, requested forms, available coverage, and any notice or proof requirements. Coverage ultimately depends on the policy, the people insured under it, and the facts of the collision.
Be Careful Before Resolving the Driver’s Claim
A release signed for the driver may affect other potential claims. North Carolina’s underinsured motorist statute includes procedures for notifying the UIM insurer before settling with the driver, which can protect the insurer’s rights against the responsible party. A proposed liability settlement should therefore be evaluated for possible UIM implications before a release is signed or money is accepted.
Deadlines also continue while insurance discussions are underway. N.C. Gen. Stat. § 1-52 provides a three-year period for many North Carolina personal injury actions, although the correct deadline depends on the claim and facts. Negotiating with an adjuster or waiting for MedPay documents does not automatically extend the time to file a lawsuit.
How This Applies to the Policyholder and Spouse
Where a policyholder and spouse were struck while walking and both required ambulance transportation, opening a medical payments claim is a reasonable step if their policy includes that coverage. Using the police report can help the carrier identify the collision, but the insurer will likely need separate medical documentation and expense records for each spouse.
The assigned adjuster’s name, direct contact information, claim number, applicable forms, and confirmation of the coverage being investigated should be obtained in writing. It is also important to determine whether a bodily injury claim has been opened with the driver’s insurer and whether UM or UIM notice should be given under the couple’s own policy. Opening the MedPay claim alone is not a coverage decision or a settlement of the broader injury claims.
When Wallace Pierce Law May Be Able to Help
Wallace Pierce Law may be able to review the driver’s liability claim and the pedestrians’ own auto policy to identify possible MedPay, uninsured motorist, or underinsured motorist coverage. The firm can also help organize separate medical records and bills for each injured person, communicate with adjusters, track claim requirements, and review proposed releases for possible effects on other coverage.
When fault is disputed, an attorney can evaluate the police report and other available evidence for issues involving crosswalk use, traffic signals, visibility, and contributory negligence. Any assessment depends on the policy language, available evidence, medical documentation, and applicable deadlines.
Talk to a Personal Injury Attorney in Durham
If your question involves injuries, insurance, fault, medical documentation, settlement paperwork, or a possible deadline, speaking with a licensed North Carolina attorney can help clarify your options. Call (919) 313-2737 to discuss what happened and what steps may make sense next.
Disclaimer: This article provides general information about North Carolina personal injury law based on the single question stated above. It is not legal advice and does not create an attorney-client relationship. It is not medical advice, tax advice, or insurance policy interpretation. Laws, procedures, and local practice can change and may vary by county. If there may be a deadline, act promptly and speak with a licensed North Carolina attorney.
