What Coverage Questions Usually Mean
This question usually comes up when the claim is being handled as “medical bills only” (MedPay), but you are actually pursuing a negligence-based injury claim (liability bodily injury). The difference matters because liability bodily injury claims typically involve a fault investigation, injury documentation, and a different negotiation track than MedPay benefits.
Common Potential Sources of Payment (High-Level)
- At-fault party liability coverage (if applicable): This is the bodily injury claim against the person or entity that caused the crash (for example, a driver or a bus operator/owner), based on negligence.
- Medical payments coverage (MedPay): This is commonly treated as no-fault medical expense coverage. It may pay certain medical bills up to the MedPay limit, regardless of who caused the crash.
- Health insurance as an immediate payer: Health insurance often pays treatment bills while the liability claim is being investigated (coordination and reimbursement issues can arise later).
Information to Gather
- Proof of representation: A short letter from your attorney stating they represent you for injuries from the bus crash and where claim communications should be sent.
- Claim identifiers: Any claim number(s), the current adjuster’s contact info, and any letters/emails showing the claim is coded as MedPay.
- Crash basics: Date, city/county, and the vehicles involved (keep it general; no identifying details).
- Injury/treatment timeline (high-level): When symptoms started, general types of care received, and whether treatment is ongoing (no medical advice needed).
Common Coverage Disputes and Practical Next Steps
- Make a clear written “re-code/open BI liability” request: Ask the insurer/claims administrator to (1) open a liability bodily injury claim (or re-code the existing file), (2) assign it to a bodily injury adjuster, and (3) confirm in writing the correct claim number and adjuster contact.
- Separate the two tracks: It is common for MedPay to remain a separate benefits file even while a liability bodily injury claim is opened. The key is making sure the liability claim exists and is being investigated as a fault-based injury claim.
- Be careful about recorded statements and broad authorizations: If the insurer asks for a recorded statement or a very broad medical authorization, it is reasonable to ask what it is for and to have your attorney handle it so the record stays consistent.
- Confirm how bills are being paid right now: If MedPay is paying bills, that can affect later reimbursement issues with other payers. In many cases, the goal is to avoid confusion about what payments were “no-fault benefits” versus what is part of a liability settlement.
- If the bus is tied to a government entity, the process may differ: Some bus-related claims can involve special procedures and forums. For example, certain school bus-related negligence claims can fall under a tort-claims process handled through the North Carolina Industrial Commission rather than a standard liability insurer claim.
How This Applies
Apply to the facts: Here, you were a passenger on a bus and your attorney believes the file was opened under MedPay when it should be handled as a liability bodily injury claim. The practical next step is for your attorney to send a short written request with proof of representation asking the claims administrator to open (or re-code) a liability bodily injury claim and reassign it to the correct adjuster, then confirm the new claim number and point of contact in writing.
What the Statutes Say (Optional)
- N.C. Gen. Stat. § 1-52 – Provides a three-year limitations period that commonly applies to personal injury negligence claims.
- N.C. Gen. Stat. § 143-300.1 – Addresses certain school bus-related tort claims and procedures through the Industrial Commission.
Conclusion
If your bus-accident injury claim is stuck in “MedPay,” it may not be getting handled as a fault-based bodily injury claim. In many cases, the fix is administrative: a written request (usually from your attorney) to open or re-code a liability bodily injury claim, assign the right adjuster, and confirm the correct claim number in writing. One next step: ask for written confirmation that a liability bodily injury claim has been opened and who the assigned adjuster is.
