Short Answer
After you report a claim in North Carolina, the insurer assigns an adjuster, investigates fault and damages, and then decides whether to pay, negotiate, or deny. Insurers must handle claims fairly and promptly under North Carolina law. If settlement stalls or the offer is unfair, you can pursue negotiation, mediation, or file a lawsuit before the deadline. Third-party insurers (the at-fault driver’s company) owe duties primarily to their own insured, not to you.
How North Carolina Law Applies
Once a claim is opened, the adjuster gathers facts: accident reports, photos, witness statements, medical records, bills, and proof of lost wages. The company will review liability (who was at fault) and damages (injuries, medical costs, lost income, and pain and suffering). For third-party claims, you are not required to give a recorded statement or sign broad medical authorizations; for first-party claims (your own policy), cooperation is usually required by the policy.
North Carolina law requires insurance companies to act in good faith and avoid unfair claim practices. Practically, that means timely communication, reasonable investigations, and fair settlement efforts when liability is clear. If a fair settlement is not reached, you can negotiate further, consider mediation, or file suit. Most personal injury claims have a three-year deadline to sue, so track your time.
Example: After a rear-end crash, you submit a claim to the at-fault driver’s insurer. An adjuster calls, collects the police report, and inspects your vehicle. You finish medical treatment, then send a demand package with records, bills, lost wage proof, and photos. The insurer evaluates liability (clear in a rear-end) and your damages, then negotiates settlement. If the offer is too low, you can continue negotiations or file a lawsuit before the deadline.
Key Requirements
- Provide accurate contact info and claim details (date, location, parties, policy numbers).
- Share documentation: police report, photos, witness info, repair estimates, medical records/bills, and wage loss proof.
- For first-party claims, follow your policy’s cooperation duties (timely notice; reasonable information).
- Protect health-care provider liens and reimbursements (e.g., hospital, Medicare/Medicaid, health insurance).
- Track the statute of limitations; many injury claims must be filed within three years in North Carolina.
- For UM/UIM claims, give your own insurer timely notice and follow consent-to-settle requirements.
Process & Timing
- Claim setup: The insurer assigns a claim number and adjuster and requests basic information. Expect an initial contact within days.
- Investigation: The adjuster reviews the police report, interviews drivers and witnesses, inspects vehicles or the scene, and may request medical records. You can decline a recorded statement to the other driver’s insurer.
- Coverage review: The insurer may send a reservation-of-rights letter while it investigates policy coverage and liability.
- Treatment and documentation: You complete medical care. Keep all bills, records, and out-of-pocket receipts. Avoid settling injury claims before you know your diagnosis and future needs.
- Demand package: You (or your attorney) send a demand with a summary of liability, injuries, medical expenses, lost income, and supporting documents.
- Negotiation: The adjuster evaluates and makes an offer. Counteroffers may follow. Property damage often resolves faster; injury claims take longer, especially if treatment is ongoing.
- Liens and subrogation: Before disbursement, resolve medical provider liens and health-plan reimbursements to avoid future repayment demands.
- Settlement and release: If you agree on an amount, you sign a release. Read it carefully; most releases end all claims from the incident.
- If no settlement: Consider mediation or file a lawsuit. Do not miss the statute of limitations or UM/UIM consent requirements.
What the Statutes Say
Exceptions & Pitfalls
- Recorded statements: You generally do not have to give one to the at-fault party’s insurer and it can be used against you. Your own policy may require cooperation.
- Overbroad medical authorizations: Limit authorizations to relevant records and dates to protect your privacy.
- Social media: Posts, photos, and comments can hurt your claim. Assume the insurer will see them.
- Gaps in care: Delays or missed appointments can undermine causation and damages.
- Releases: A signed release usually ends all claims related to the event. Read carefully before signing.
- UM/UIM traps: Settling with the liability insurer without your UIM carrier’s consent can jeopardize UIM benefits. Follow G.S. 20-279.21 procedures.
- Deadlines: Do not let the statute of limitations expire while negotiating. File suit on time if needed.
- Liens: Ignoring provider, Medicare/Medicaid, or health-plan reimbursement claims can lead to later collection.
