How can I recover medical payments from the insurer after my clients’ auto accident settlement?

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How can I recover medical payments from the insurer after my clients’ auto accident settlement? - North Carolina

Short Answer

In North Carolina, you recover medical payments ("Med Pay") by submitting a first-party claim to your client’s own auto insurer with proof that the treatment was reasonable, necessary, and related to the crash. Settlement of the liability or uninsured motorist claim does not eliminate Med Pay benefits because they are contractual. Before disbursing any money to the client, resolve valid medical provider liens and any statutory reimbursement claims (for example, Medicaid, Medicare, or the State Health Plan). Policy notice and proof-of-loss deadlines apply.

Understanding the Problem

You want to know whether, and how, you can still collect Med Pay benefits for your injured clients from their auto insurer after the personal injury claim has already settled. The question matters because Med Pay is a separate first‑party benefit under North Carolina policies, and it can help pay medical bills even when the at‑fault driver is uninsured. Here, the at‑fault driver had no insurance, and both your driver and passenger were treated on the accident date.

Apply the Law

Under North Carolina law, Med Pay is a no‑fault, first‑party auto benefit that reimburses reasonable and necessary accident‑related medical expenses up to the policy limit, subject to policy conditions. Medical providers can assert statutory liens against the client’s personal injury settlement funds, and certain government health plans have statutory reimbursement rights. You submit Med Pay directly to the client’s insurer; no court filing is required. Deadlines are set by the policy (notice and proof‑of‑loss), and lien/reimbursement rules govern how you disburse settlement funds.

Key Requirements

  • Covered treatment: Bills must be reasonable, necessary, and causally related to the crash, within the Med Pay coverage period and limit.
  • Timely notice and proof: Give prompt notice and submit proof of loss per the policy’s Med Pay endorsement.
  • Complete documentation: Provide itemized bills (e.g., UB‑04/HCFA‑1500), medical records showing causation, and assignments/authorizations as needed.
  • Lien/reimbursement coordination: Honor valid medical provider liens from settlement funds and repay statutory payors (e.g., Medicaid, Medicare, State Health Plan) per law.
  • Release/offset checks: Ensure the liability/UM settlement release did not waive Med Pay; confirm any policy offsets or coordination-of-benefits provisions.

What the Statutes Say

Analysis

Apply the Rule to the Facts: Because your clients had same‑day treatment for crash‑related back pain and bruising, those bills typically qualify for Med Pay if within the policy’s time window and limits. The at‑fault driver was uninsured, so your liability claim likely ran through UM; that settlement does not cancel Med Pay. Submit complete billing and records to the clients’ own insurer. From the settlement funds, satisfy valid provider liens and any statutory claims (e.g., Medicaid/Medicare/State Health Plan) before disbursing to the clients.

Process & Timing

  1. Who files: The injured person’s attorney. Where: Directly with the client’s auto insurer’s Med Pay adjuster in North Carolina. What: Representation letter, declarations page and Med Pay endorsement, the insurer’s claim number, adjuster contact, HIPAA/authorizations, and itemized bills/records as proof of loss. When: Immediately after settlement; comply with the policy’s notice and proof‑of‑loss deadlines.
  2. Insurer review: The adjuster confirms coverage/limits and may request additional records. In parallel, collect all lien notices from providers and request final lien amounts from any statutory payors (Medicaid/Medicare/State Health Plan). Response times can vary by carrier and agency.
  3. Payment and disbursement: The insurer issues Med Pay up to limits. Deposit funds in trust, resolve valid provider liens and statutory reimbursement claims from settlement proceeds, and then disburse remaining funds to the clients with a closing statement and lien releases/confirmations.

Exceptions & Pitfalls

  • Release language: Do not agree to a liability/UM release that waives first‑party Med Pay benefits unless that is intended and explained to the client.
  • Statutory payors: Medicaid, Medicare, and the State Health Plan have reimbursement rights that can supersede general lien caps. Get final demands and pay them from settlement funds.
  • Provider liens: Honor timely lien notices under North Carolina law and do not disburse client funds until liens are resolved or compromised in writing.
  • Policy offsets: Some policies coordinate benefits or exclude duplicative payments. Confirm any offsets before advising the client on net recovery.
  • Separate claims: File distinct Med Pay claims for each injured insured (driver and passenger), and verify limits and stacking rules per the policy.

Conclusion

In North Carolina, you can still pursue Med Pay after a personal injury settlement by submitting a first‑party claim with timely notice, proof of loss, and complete medical documentation. Then, pay valid provider liens and any statutory reimbursement claims from settlement funds before disbursing to the client. The next step is to send a representation letter and a complete Med Pay proof‑of‑loss package to the client’s auto insurer per the policy’s deadline.

Talk to a Personal Injury Attorney

If you're dealing with post‑settlement medical payments and lien resolution, our firm has experienced attorneys who can help you understand your options and timelines. Call us today at [919-341-7055].

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.

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