What Are the Steps of the Insurance Claim Process, Including Negotiating Liens and Settlement?

Woman looking tired next to bills

Detailed Answer

Below is a practical, step-by-step roadmap of a typical North Carolina personal-injury insurance claim, from the first phone call to the final settlement check. The process applies to motor-vehicle collisions, slip-and-falls, and most negligence cases handled outside of court.

1. Open the Claim Immediately

Notify every relevant insurer in writing—the at-fault driver’s liability carrier, your own MedPay or Uninsured/Underinsured Motorist carrier, and any health insurer. Give only basic facts (date, time, parties). Do not give a recorded statement until you understand your rights; North Carolina’s strict three-year statute of limitations keeps you from rushing.

2. Investigate and Preserve Evidence

  • Photograph the scene, vehicles, and injuries.
  • Order the police crash report (Form DMV-349).
  • Identify witnesses and obtain their written statements.
  • Secure black-box or surveillance footage before it is overwritten.

North Carolina follows pure contributory negligence; if you are even 1 % at fault you could lose your claim. Solid evidence helps defeat the insurer’s blame-shifting tactics.

3. Document Medical Treatment and Other Losses

Tell every provider each injury stems from the incident so medical records reflect causation. Keep:

  • Itemized medical bills (UB-04 or CMS-1500 forms)
  • Out-of-pocket receipts (medications, braces, mileage)
  • Wage-loss proof (employer letter, tax returns)
  • Pain journal entries showing daily limitations

4. Identify and Protect Liens & Subrogation Rights

Under N.C.G.S. § 44-49 and § 44-50, medical providers automatically obtain a lien on settlement proceeds if they furnish records and bills. Statutory caps ordinarily limit total medical liens to 50 % of net settlement after attorney fees, but federal liens (Medicare, Medicaid) and ERISA health plans have separate rules. List every potential lienholder early so nothing surprises you during disbursement.

5. Reach Maximum Medical Improvement (MMI)

Settle only after doctors declare you at MMI or provide a permanent impairment rating. Accepting money too soon leaves you responsible for later medical costs.

6. Prepare a Comprehensive Demand Package

Send a persuasive, indexed packet to the adjuster that includes:

  • Liability analysis (accident law, traffic citations, witness statements)
  • Medical chronology and bills summary
  • Lost-wage calculation
  • Photographs and videos
  • A demand figure with an adequate negotiation margin

7. Negotiate Methodically

The adjuster will respond with “valuation software” numbers. Expect several rounds of counteroffers. Emphasize:

  • Strong liability evidence (to overcome contributory negligence)
  • Consistent treatment timeline
  • Comparable jury verdicts in your county
  • Future medical needs justified by physician opinions

If talks stall, consider mediation or filing suit to restart leverage.

8. Review the Release Carefully

Insurers will not issue funds until you sign a full and final release. Confirm it covers only the intended party and does not waive UM/UIM rights or property damage claims unless you intend to. A minor’s claim requires court approval.

9. Negotiate and Pay Liens

After agreeing to a gross settlement, you—or your lawyer—must reduce liens:

  • Use the 50 % cap of §§ 44-49/50 to lower provider liens.
  • Request Medicare Final Demand or Medicaid Reduction.
  • Challenge ERISA plan language unless it is truly self-funded.
  • Seek hardship reductions if net proceeds dip below equitable thresholds.

Obtain written satisfaction letters from each creditor before releasing funds.

10. Disburse Funds and Close the File

Prepare a settlement sheet showing:

  • Gross settlement amount
  • Attorney fee (usually 33⅓ % in NC unless previously agreed otherwise)
  • Case expenses
  • Itemized lien payments
  • Client net recovery

Finally, store records for at least three years in case tax, lien, or insurance questions arise.

Helpful Hints

  • Photocopy every check and lien release before mailing.
  • Never post case details on social media—insurers monitor them.
  • Respond to adjuster requests within 48 hours to keep momentum.
  • Ask providers to code bills correctly; coding errors complicate lien reductions.
  • Track mileage to medical visits—reimbursable at the IRS rate.

Still Unsure? The insurance claim process is technical, and missed steps can slash your recovery. Our North Carolina personal-injury team handles claims, negotiations, and lien reductions every day. Call us now at 919-313-2737 for a free consultation and let us protect your rights while you focus on healing.

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