Short Answer

In North Carolina, you find out what your accidental protection plan covers by getting the complete policy and benefit summaries from the insurer, then comparing those terms to your accident and medical bills. Give written notice of the claim promptly, request the full policy, and submit proof of loss (itemized bills and records) within the time limits the policy and state law set. If coverage is split between vehicle-based and person-based benefits, evaluate each bucket for payment.

Understanding the Problem

You want to know whether an insurer’s accidental protection plan will pay specific auto‑crash medical bills. In North Carolina, the insured (or the insured’s attorney) can ask the insurer to disclose the policy, riders, and benefit summaries so you can match the plan’s terms to the accident. Here, the plan has both vehicle‑based and person‑based coverages and is a family plan, and you have not received the introductory packet.

Apply the Law

Under North Carolina law, accident and health‑type policies generally require prompt notice of claim, a timely proof of loss with itemized bills, and compliance with policy terms such as exclusions, coordination of benefits, and internal appeal steps. The insurer’s claims department is the main forum. State statutes set baseline timelines for notice and proof of loss, and unfair‑claims rules require insurers to handle claims promptly and fairly.

Key Requirements

• Give timely notice of claim: Notify the insurer soon after the crash using the claim number or policy info.
• Get the complete contract: Request the declarations page, full policy, riders/endorsements, schedule of benefits, and any family‑plan certificates.
• Identify all coverage buckets: Check both vehicle‑based (e.g., accident/medical tied to vehicle use) and person‑based (e.g., accident, hospital, AD&D) benefits for eligibility.
• Submit proof of loss: Send itemized medical bills, records, accident details, and required forms within policy and statutory timeframes.
• Watch exclusions and coordination: Look for other‑insurance clauses, occupational or use exclusions, and how the plan coordinates with auto MedPay, UM/UIM, or health insurance.
• Use internal review if denied: Follow the plan’s appeal steps and keep written deadlines on your calendar.

What the Statutes Say

• North Carolina Gen. Stat. § 58-51-15 (Accident and health policy provisions) - Sets standard notice of claim and proof‑of‑loss timing and other required policy provisions.
• North Carolina Gen. Stat. § 58-63-15 (Unfair claim settlement practices) - Prohibits insurers from failing to promptly acknowledge, investigate, and pay claims when liability is reasonably clear.
• North Carolina Gen. Stat. § 20-279.21 (Motor vehicle liability policy) - Describes required auto liability and UM/UIM coverages; helps distinguish these from optional accident/medical benefits.

Analysis

Apply the Rule to the Facts: Because you have a family accidental protection plan with both vehicle‑based and person‑based coverages and no introductory packet, first give written notice of claim and request the complete policy and benefit schedules. Next, match each outstanding medical bill to the eligibility terms for both buckets (for example, whether the injury arose from vehicle use versus any covered accident). Then submit a timely proof of loss with itemized bills and required forms. If the insurer denies or only partially pays, use the plan’s internal appeal process before considering escalation.

Process & Timing

1. Who files: Your attorney. Where: The insurer’s claims department (North Carolina claim). What: Letter of representation and a written request for the declarations page, full policy, riders/endorsements, schedule of benefits, family‑plan certificate, claim forms, and any coordination‑of‑benefits rules. When: Send notice of claim as soon as possible, ideally within 20 days of the crash if the plan follows standard accident/health timelines.
2. Gather and submit proof: Provide the insurer’s forms, accident details, and itemized medical bills/records as your proof of loss, typically within 90 days of services unless the policy allows more time or you show it was not reasonably possible.
3. Review and decision: The insurer reviews coverage and issues an explanation of benefits (approval/denial). If denied or underpaid, file an internal appeal by the policy’s deadline; consider a complaint to the North Carolina Department of Insurance if claim handling appears unfair.

Exceptions & Pitfalls

• Other‑insurance and coordination clauses can reduce or bar payment if another policy pays first; read both the accident plan and any auto MedPay/health coverage.
• Common exclusions include non‑covered activities (for example, commercial use, racing) or non‑accidental injuries; confirm definitions like “accident,” “covered person,” and “family member.”
• Missed deadlines for notice, proof of loss, or internal appeals can forfeit benefits; calendar every date in writing.
• Incomplete proofs (missing itemized bills, ICD/CPT codes, or provider details) delay payment; send complete, legible copies and keep receipts.
• If the insurer is unresponsive, document all communications and consider contacting the North Carolina Department of Insurance about claim‑handling concerns.

Talk to a Personal Injury Attorney

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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.