What happens after an insurance company receives a letter of representation for an injury claim?

What the Insurance Company Usually Does First

A letter of representation tells the insurance carrier that an attorney represents the injured person for a particular claim. Once the carrier receives and processes the letter, it will commonly update its claim file with the attorney’s contact information.

The carrier may send an acknowledgment to the attorney and identify the adjuster, claim number, and documents needed to continue the review. If the letter does not clearly identify the accident, insured person, date of loss, and scope of representation, the carrier may ask for clarification.

The scope is especially important when the attorney represents the person only for bodily injury. A clear letter can state that the lawyer is handling the injury and medical payments issues while the individual continues to communicate directly with the carrier about vehicle repairs, a total-loss decision, rental transportation, or other property damage matters.

Injury Communications Are Generally Routed Through Counsel

After the representation is recorded, communications about the injury claim should generally go through the attorney. This may include requests for medical records, bills, photographs, wage-loss documents, recorded statements, or information about prior injuries.

That does not necessarily mean every communication with the insurance company must stop. When representation is limited to the injury claim, the person may still speak with the property damage adjuster. To avoid confusion, communications should identify whether they concern bodily injury, medical payments coverage, or property damage.

The Carrier May Open or Separate Multiple Claim Files

An auto accident can involve several parts of an insurance claim. Even when one insurance company handles all of them, different adjusters or claim numbers may be used for:

• The bodily injury liability claim against the allegedly responsible driver.
• Medical payments coverage under an applicable auto policy.
• Damage to the vehicle and other personal property.
• Uninsured or underinsured motorist coverage, if it later becomes relevant.

These claim components do not always move together. A property damage issue may be resolved while the injury claim remains under investigation. Medical payments benefits may also be reviewed separately from the question of which driver caused the collision.

What Happens With Medical Payments Coverage?

Medical payments coverage, often called MedPay, generally pays eligible accident-related medical expenses without deciding who caused the crash. Whether benefits are available, which people qualify, what expenses are covered, and what conditions apply depend on the policy language and the facts.

After receiving the representation letter, the carrier may ask counsel for a medical payments claim form, itemized bills, visit summaries, proof that the claimant was an eligible occupant or insured person, and information connecting the expenses to the accident. Counsel may also ask the carrier to confirm the applicable coverage, claim number, submission procedure, and remaining benefits.

Submitting a representation letter by itself is not the same as submitting proof of a medical expense. Bills and supporting documentation usually must still be provided. Payment may be issued to a medical provider, the insured person, or another proper recipient depending on the policy, prior payments, assignments, and applicable reimbursement obligations.

If Medicare, Medicaid, health insurance, or another benefit program paid accident-related expenses, coordination and reimbursement issues may also need review. Those issues should be addressed before injury settlement funds are distributed.

The Injury Investigation Continues

A letter of representation does not establish fault or prove damages. The liability adjuster may continue reviewing the crash report, witness accounts, photographs, vehicle damage, available video, medical documentation, and statements from the drivers.

North Carolina permits contributory negligence to be raised as a defense. If the carrier contends that the injured person’s own negligence helped cause the collision, that position can create a serious obstacle to the liability claim. Evidence should therefore address both the other driver’s conduct and why the injured person acted reasonably. Medical payments coverage is commonly reviewed without regard to fault, although the policy terms still control.

North Carolina’s insurance statutes identify certain unfair claim practices when committed or performed with enough frequency to indicate a general business practice, including failing to conduct a reasonable investigation or failing to provide a reasonable explanation for a denial or compromise position. N.C. Gen. Stat. § 58-63-15 describes those standards in more detail. If the carrier denies first-party medical payments coverage, counsel may ask for the policy-based and factual reasons in writing.

What the Letter Does Not Accomplish

A representation letter is an important administrative step, but it does not:

• Force the carrier to accept liability.
• Prove that medical treatment resulted from the accident.
• Guarantee that medical payments coverage applies.
• Require an immediate bodily injury settlement.
• Authorize settlement without the client’s approval.
• Automatically preserve photographs, electronic data, or other evidence held by third parties.
• Pause or extend a lawsuit deadline.

For many North Carolina personal injury actions, N.C. Gen. Stat. § 1-52 provides a three-year filing period. Different facts or claim types can produce different deadlines. Negotiations, document exchanges, and ongoing discussions with an adjuster do not automatically extend the time to file a lawsuit.

Documents to Preserve While the Claim Is Being Reviewed

The injured person and counsel should keep an organized record of materials related to each part of the claim, including:

• The letter of representation and proof that the carrier received it.
• Claim numbers and contact information for each adjuster.
• The insurance policy or declarations page, if available.
• Medical bills, records, visit summaries, and payment statements.
• Letters or forms concerning medical payments coverage.
• The crash report, photographs, video, and witness information.
• Property damage estimates, repair records, and rental documents.
• Emails, letters, denial notices, and settlement communications.
• A list of accident-related expenses and missed work, if relevant.

Evidence that may disappear—such as vehicle data, surveillance footage, or damaged components—may require a separate preservation request. A basic representation letter does not always give enough detail to preserve every relevant item.

How This Applies to an Injury-Only Representation

In the situation described, counsel represents the individual for the auto-related injury claim and is seeking information about medical payments coverage. The carrier may communicate with counsel about injuries, treatment documentation, MedPay forms, and bodily injury evaluation while continuing to work directly with the individual on property damage.

The representation letter should clearly describe that division. If the carrier sends injury questions to the individual or sends property damage documents to injury counsel, a written clarification can help keep the two tracks separate. The individual should also avoid signing a release labeled as a full or general release without confirming whether it affects bodily injury claims as well as property damage.