What Usually Must Happen Before Payment
- Settlement terms confirmed: The parties agree on the settlement amount and the basic terms, including that the claim will be resolved in exchange for payment.
- Documents signed: The injured person typically signs a release (and sometimes other settlement paperwork). Once signed, the insurer processes payment under its internal procedures.
- Liens/reimbursements addressed: Before money is distributed to the client, the attorney’s office usually checks for reimbursement claims tied to accident-related medical care (for example, health insurance payments, Medicaid, or other payers). This step helps avoid a later demand for repayment after the funds are gone.
- Disbursement: After the settlement funds arrive, the office prepares a disbursement that accounts for case costs (if any), any valid reimbursement claims that must be paid, and the client’s net proceeds.
What Can Cause Delays
- No file opened yet: If the recovery vendor has no reference number on record, a new file may need to be opened before they will research payments and issue a demand.
- Time to identify accident-related charges: The plan/vendor often has to pull claims data and decide which charges they say are related to the wreck.
- Back-and-forth on the amount: Disputes can come up over dates of service, unrelated treatment, duplicate charges, or whether the plan already got repaid elsewhere.
- Multiple payers: If more than one entity paid medical bills, sorting out who claims what can take additional time.
- Processing time after agreement: Even after the numbers are agreed, it can take time for the plan/vendor to issue a final letter showing the payoff amount and confirming satisfaction.
Liens and Reimbursement Claims (Plain English)
A “health insurance reimbursement” claim usually means the health plan says: “We paid medical bills caused by someone else’s negligence, so if you recover money from that person’s insurance, we want to be paid back from that recovery.” This is often called subrogation or reimbursement.
Two practical points matter in real life:
- It can affect timing: Many law offices will not finalize the client’s payout until they know whether a reimbursement claim exists and, if it does, the amount needed to resolve it. That helps prevent the client from being chased later for repayment.
- It can affect the “take-home” amount: If the reimbursement claim is valid and must be paid, it comes out of the settlement funds, which can reduce the net amount the client receives.
In North Carolina, some reimbursement rights are created by statute for certain programs. For example, Medicaid has statutory subrogation rights and specific rules about how its claim is calculated and challenged. See N.C. Gen. Stat. § 108A-57. Certain state-administered plans can also have statutory subrogation rights. See, for example, N.C. Gen. Stat. § 135-48.37.
For many private health plans, the key details come from the plan documents and federal rules that may apply to employer-sponsored plans. That is one reason the office may need time to confirm what kind of plan it is and what reimbursement rights it can enforce.
How This Applies
Apply to the facts: Because treatment has ended and the claim is already settled, the remaining “wrap-up” work often includes confirming whether the health plan (through its recovery vendor) paid any accident-related bills and, if so, what amount it claims must be reimbursed. If the vendor had no reference number and a new file had to be opened, that can add time because the vendor typically needs to locate the claims, link them to the accident, and issue a demand or a confirmation that nothing is owed. Until that step is complete, the final disbursement may be held to avoid an unexpected repayment demand later.
Conclusion
Health insurance reimbursement claims are a common reason a settled North Carolina injury case can take longer to fully pay out, and they can reduce the net amount you receive if repayment is required. The practical goal is to confirm whether a claim exists, verify that only accident-related charges are included, and resolve the final payoff before disbursing funds. One next step: ask your attorney’s office what type of health plan is involved and whether they are waiting on a “final demand” or a “no-claim” letter from the recovery vendor.
