Medical payments coverage (often called “MedPay”) is optional, no-fault coverage in North Carolina that reimburses reasonable and necessary medical expenses from a car crash up to your policy limit, regardless of who caused the wreck. To claim it, open a MedPay claim with your own auto insurer and submit your accident-related medical bills and supporting records. Deadlines and documentation requirements come from your policy language, so read it carefully. In many cases you may access MedPay from more than one applicable policy, but the rules depend on the policy terms.
North Carolina does not require MedPay, but most insurers offer it as an add-on. Because it is first-party, no-fault coverage, you do not have to prove the other driver was at fault to get paid—only that your medical charges were reasonable, necessary, and caused by the crash. Your policy sets the limit (commonly $1,000 to $10,000 or more) and the steps to claim. You can usually use MedPay to cover co-pays, deductibles, ambulance bills, ER visits, follow-up care, and similar expenses that stem from the accident.
Example: You were a passenger in a friend’s car and went to the ER and follow-up physical therapy. You may be able to claim MedPay under the car you were riding in and, depending on your own policy and household status, under your personal auto policy as well. Whether multiple policies apply and whether you can “stack” limits depends on each policy’s definitions and anti-stacking language.
Covered Person + Covered Accident: You must be an insured under the policy definition (often the named insured, a household member, or an occupant of the insured vehicle) and the injury must arise from the use of a motor vehicle as described in the policy.
Reasonable and Necessary Expenses: MedPay typically covers reasonable charges for medically necessary treatment caused by the crash. Insurers often request itemized bills (UB-04/CMS-1500) and related records to evaluate necessity and causation.
Policy Limits and Deductibles: MedPay pays up to the purchased limit; there is usually no deductible. Once the limit is exhausted, the coverage stops.
No-Fault Benefit: Fault does not matter for MedPay eligibility. Separately, your bodily injury claim against the at-fault driver is not reduced because you used MedPay (that’s the collateral source rule).
Deadlines Come From Your Policy: Policies require prompt notice, timely proof of loss, and cooperation. Suit deadlines for contract claims can be short and may differ from general injury deadlines.
Find your MedPay coverage and limits: Check your Declarations Page for “Medical Payments” and the limit per person.
Open a MedPay claim with your insurer: Call the number on your insurance card and specify you want to open a MedPay claim. Ask for the claim number and where to send bills and records.
Gather documents: Provide the police report (if available), a brief accident description, and itemized medical bills and related records. If your provider will bill the insurer directly, you may need to sign an assignment of benefits.
Submit proof of loss: Send itemized statements showing dates of service, provider names, CPT codes if available, and balances due. Keep copies. Ask your adjuster to confirm what else they need (for example, wage verification if your policy includes limited funeral or similar benefits).
Confirm payment method: Insurers may reimburse you or pay providers directly. If you paid out of pocket, submit receipts so you can be repaid.
Track the limit: Request a running tally so you know how much MedPay remains. If multiple policies may apply (e.g., the car you occupied and your own household policy), ask about making claims under each, subject to policy terms.
If delayed or denied: Ask for the specific policy provision relied on, and a written explanation. You can escalate to a supervisor and, if needed, seek legal help. Contract claim deadlines can apply if you need to challenge a denial.
North Carolina General Statutes § 20-279.21: Describes mandatory auto liability and uninsured/underinsured coverage. MedPay is optional and contractual; this statute helps you understand what coverage is required versus optional.
North Carolina General Statutes § 58-63-15 (Unfair Claim Settlement Practices): Lists unfair claims practices by insurers, such as failing to adopt reasonable standards for prompt investigations or not attempting in good faith to effectuate prompt, fair settlements when liability is clear. If your MedPay claim is unreasonably delayed or handled improperly, these standards may be relevant.
North Carolina General Statutes § 44-49 and § 44-50: Create healthcare provider liens on personal injury recoveries from the party at fault and limit how much of those recoveries can be claimed for medical bills. These liens typically apply to tort recoveries, not to first-party MedPay benefits, though providers may seek direct payment via assignment of benefits.
North Carolina General Statutes § 1-52: Establishes a three-year limitations period for most contract actions. Your policy may also include shorter internal deadlines for notice and proof of loss, so check the language carefully.
Policy definitions control eligibility: Whether you qualify as an insured (named insured, resident relative, or occupant) and whether multiple policies can be used depends on each policy’s wording and any anti-stacking clauses.
Provider liens vs. MedPay: Provider liens attach to tort recoveries, not usually to MedPay. But if you sign an assignment of benefits, your insurer may pay the provider directly from your MedPay benefits.
Reimbursement/subrogation: In North Carolina, MedPay is typically not reimbursed from your bodily injury settlement. Confirm current law and your policy because reimbursement language and legal exceptions can be nuanced.
Deadlines and cooperation: Missing policy deadlines for notice or proof of loss, or refusing reasonable cooperation (e.g., providing needed records), can delay or jeopardize payment.
Accident use exclusions: Policies may exclude certain uses (e.g., using the vehicle as a ride-for-hire, certain off-road use) or certain vehicles. Read exclusions before assuming coverage.
Don’t let liability adjusters offset MedPay: The at-fault driver’s insurer generally cannot reduce your injury claim because you received MedPay (collateral source rule).
If you’re dealing with medical bills after a crash and want to use MedPay effectively—or you’re facing delays or denials—our firm has experienced attorneys who can help you understand your options and timelines. Call us today at 919-313-2737.
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.
