Short Answer

In North Carolina, the hospital and doctors will usually bill you first if you do not have health insurance, even if someone else caused the crash. You may later be able to get those medical expenses reimbursed through the at-fault driver’s liability insurance and/or applicable auto coverages (like uninsured/underinsured motorist coverage) depending on fault and available insurance. If you recover money for your injury claim, medical providers may have a lien against that recovery for treatment related to the crash.

Understanding the Problem

If you were hurt in a North Carolina car wreck and went to the ER the same day, can you make the other driver (or an insurance company) pay your medical bills even though you do not have health insurance?

Apply the Law

North Carolina is an “at-fault” state for car crashes. That means the person who caused the collision is generally responsible for the harm they caused, including reasonable medical expenses. But “responsible” in the legal sense is different from “who gets the bill in the mail.” Providers typically bill the patient first, and payment often gets sorted out later through insurance claims, settlements, or (if needed) a lawsuit.

Because you were a passenger in a rideshare vehicle, there may be multiple insurance layers to check: the at-fault driver’s liability policy, the rideshare driver’s coverage, and transportation network company (rideshare) coverage that applies when the driver is logged in or actively transporting a passenger. North Carolina law also requires uninsured motorist (UM) coverage and underinsured motorist (UIM) coverage in most auto policies, which can matter if the at-fault driver has no insurance or not enough insurance.

Key Requirements

• Fault (who caused the crash): You generally need proof that another driver’s negligence caused the collision before their liability insurance pays injury-related medical bills.
• Coverage identification: You must identify which policies apply (at-fault driver liability, rideshare-related coverage, and any UM/UIM coverage available to you as an “insured”).
• Medical causation: The bills must be for treatment that relates to injuries from the crash (not an unrelated condition).
• Reasonable and necessary charges: Medical expenses must be reasonable in amount and tied to necessary care; disputes can arise about what amount is “reasonable” if a provider would accept less than the sticker price.
• Lien risk on any recovery: If you recover money for your injury claim, certain medical providers can assert a lien against that recovery for crash-related treatment.
• Rideshare status matters: Whether the rideshare driver was logged into the app and/or actively transporting a passenger can change which policy is primary and what limits apply.

What the Statutes Say

• N.C. Gen. Stat. § 20-279.21 (Motor vehicle liability policy; UM/UIM requirements) - Sets key requirements for auto liability policies and requires uninsured and underinsured motorist coverage in most policies.
• N.C. Gen. Stat. § 20-280.4 (Transportation network company insurance) - Requires primary liability coverage and UM/UIM coverage for rideshare activity and explains when rideshare coverage must apply.
• N.C. Gen. Stat. § 44-49 (Medical provider liens) - Creates a lien in favor of medical providers on sums recovered as damages for personal injury, subject to statutory requirements.
• N.C. Gen. Stat. § 8-58.1 (Evidence of medical charges) - Addresses proof of medical charges and presumptions about reasonableness in civil cases.

Analysis

Apply the Rule to the Facts: Because you were a passenger and went to the ER the same day for a reported head injury, the ER and follow-up providers will usually bill you directly if you do not have health insurance. If the rear-end crash was caused by another driver, that driver’s liability insurance is typically the first place to seek reimbursement for your injury-related medical expenses. If the at-fault driver has no insurance or not enough insurance, UM/UIM coverage (including coverage connected to the rideshare trip) may be a key backup source.

Process & Timing

1. Who files: You (or your attorney) opens injury claims with the relevant auto insurers. Where: With the insurance carriers (not the court at first). What: Claim notice, the crash report number, medical records/bills, and proof of lost time from work if claimed. When: As soon as practical, especially if you may need UM/UIM coverage or rideshare coverage decisions.
2. Medical billing while the claim is pending: Providers may send bills and collection notices to you. You can ask for itemized bills and keep all records organized so the claim can be documented and negotiated.
3. Resolution: If the claim settles, medical bills are typically addressed out of the settlement funds, including any valid medical provider liens. If the claim does not settle, a lawsuit may be needed to prove fault and damages and to trigger certain insurance obligations.

Exceptions & Pitfalls

• “You get billed first” is normal: Even when another driver is clearly at fault, providers often do not wait for an insurance settlement and will pursue the patient for payment.
• Insurance limits can cap what is available: Liability and UM/UIM coverage have limits. If bills and other damages exceed available coverage, you may still face balances unless another source applies.
• Medical liens can reduce what you take home: Under North Carolina law, providers can have a lien on injury recoveries for crash-related treatment, which can affect how settlement funds get distributed.
• Rideshare coverage depends on status: Whether the driver was logged into the app and whether a passenger trip was in progress can change which policy is primary and what limits apply under North Carolina’s rideshare insurance statute.
• Gaps in documentation: Missing records (EMS report, ER discharge papers, follow-up notes) can make it harder to connect the bills to the crash and to negotiate payment.
• Recorded statements and early settlement pressure: Insurers may ask for statements quickly; inaccurate details about symptoms or timing can be used to dispute causation or the need for treatment.

Conclusion

In North Carolina, if you do not have health insurance after a car accident, medical providers will usually bill you first, but the at-fault driver’s liability insurance (and, if needed, UM/UIM coverage, including rideshare-related coverage) may reimburse those medical expenses once fault and damages are established. Because medical providers may assert a lien on any injury recovery, a smart next step is to promptly open the appropriate insurance claims and start gathering itemized bills and records while treatment is ongoing.

Talk to a Personal Injury Attorney

If you're dealing with medical bills after a North Carolina car accident and you do not have health insurance, an attorney can help you identify all available insurance coverages, document your medical expenses, and understand how liens and settlement payments typically get handled. Call 704-343-2399 today.

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.