Short Answer

Your insurer typically needs your ER records and an itemized ER bill, plus proof of what was actually paid. In North Carolina, adjusters also look for documents that show the treatment was caused by the incident and that any medical liens will be resolved. Send a HIPAA-compliant authorization so the adjuster can verify records, and include the claim number and policy information to avoid delays.

Understanding the Problem

You want to know what your North Carolina insurer needs to fairly evaluate your emergency room expenses in a personal injury claim. The key player is your insurer’s claims department, which must review medical proof tied to the incident. You (or your attorney) must submit the right documents promptly so the adjuster can confirm what treatment you received and what amounts are owed or already paid. Here, you already filed a claim and your attorney is following up with the adjuster.

Apply the Law

Under North Carolina law, insurers must investigate and evaluate claims based on adequate proof. For ER charges, that proof includes medical records that show diagnosis and causation, itemized billing that shows each charge, and documentation of the amounts paid or written off. Adjusters may also require permission to verify records directly with providers and information needed to address any medical provider liens before payment. The main “forum” is your insurer’s claims unit; disputes can be raised with the North Carolina Department of Insurance. Policy “proof of loss” provisions and claim handling rules can impose timing requirements, so act promptly.

Key Requirements

• Proof of treatment and diagnosis: ER records, including triage notes, provider notes, test results, imaging reports, and discharge instructions.
• Itemized medical charges: An itemized hospital bill (often a UB-04) and related professional bills (often CMS-1500/HCFA) showing CPT/HCPCS codes and charges.
• Amounts paid vs. billed: Explanation of Benefits (if health insurance was used) or provider statements reflecting adjustments and actual amounts paid.
• Causation link: Accident report (if available), brief incident description, and any EMS records to connect the ER visit to the injury.
• Authorization to verify: A HIPAA-compliant medical authorization limited to relevant providers, dates, and body parts.
• Lien and reimbursement info: Identification of medical provider liens and notice that liens will be satisfied from claim proceeds.

What the Statutes Say

• North Carolina Gen. Stat. § 58-63-15(11) (Unfair claim settlement practices) - requires fair, prompt investigation and evaluation of claims.
• North Carolina Gen. Stat. § 44-49 (Medical provider liens) - gives providers a lien on personal injury recoveries for reasonable charges.
• North Carolina Gen. Stat. § 44-50 (Distribution of recovery with liens) - limits how much of the recovery can be used to pay medical liens.
• North Carolina Rule of Evidence 414 (Amounts paid for medical expenses) - at trial, medical expense evidence is limited to amounts paid, not the full billed charges.

Analysis

Apply the Rule to the Facts: Because you already filed a claim, send the ER record set (including imaging reports) and the itemized ER bill so the adjuster can verify what was done and why. Include the EOB if health insurance paid any part of the bill, so the insurer can see the amounts paid versus written off. Provide a narrow medical authorization to let the adjuster confirm records and address any provider liens before payment.

Process & Timing

1. Who files: You or your attorney. Where: Your insurer’s claims department in North Carolina (use your claim portal or the adjuster’s secure email/address). What: Cover letter with claim number, ER records, itemized ER bill (UB-04), related professional bills (CMS-1500), EOBs, EMS run sheet if any, accident report if available, and a HIPAA authorization. When: Submit promptly and within any “proof of loss” deadline stated in your policy.
2. The adjuster verifies treatment, matches codes to charges, confirms paid amounts, and checks for medical liens. Expect follow-up requests if anything is missing or if prior records are needed to address pre-existing conditions.
3. Once verified, the insurer issues a coverage letter and, as applicable, pays covered medical benefits directly to you or the provider, or includes the medical amounts in its settlement evaluation for a liability claim.

Exceptions & Pitfalls

• Submitting a balance statement instead of an itemized bill slows review; send the UB-04 and any CMS-1500 forms.
• Overbroad medical authorizations invite unnecessary delays; tailor the release to relevant providers and dates.
• Gaps in care or inconsistent histories raise causation questions; include EMS notes and discharge instructions to connect the ER visit to the incident.
• Ignoring provider liens can hold up payment; identify and plan to satisfy liens under North Carolina’s lien rules.
• If health insurance paid the ER charges, the insurer will focus on amounts paid rather than full billed charges, consistent with how North Carolina treats medical expenses at trial.

Talk to a Personal Injury Attorney

If you're dealing with an ER bill review in a North Carolina injury claim and want to make sure your documentation is complete, 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.