A car crash leaves you hurting, confused, and facing medical charges you never expected. If you are wondering, “Who is going to cover my hospital bill? The at-fault driver’s liability insurance? My health insurance? The medpay of my own car insurance?” Many people assume the other driver’s liability insurance will immediately handle everything after a collision, only to find out the process works very differently. Understanding what happened helps you protect your rights and plan your next steps before the situation becomes even more urgent.
Understanding Car Accident Insurance Claims
Navigating the aftermath of a car accident can be overwhelming, especially when it comes to dealing with medical bills and the various insurance companies. The process of handling a personal injury claim involves several steps, starting with determining who was at fault and what damages were sustained. Typically, the at-fault driver’s insurance company is responsible for paying your medical expenses, property damage, and other losses. However, liability insurance companies rarely pay the victim’s medical bills immediately as they come in. Instead, they will usually insist on paying you for the medical bills only after you sign a full release, thereby absolving them from any further responsibility. Of course, you will not want to release the liability insurance until you have finished the healing process and know what medical bills, lost income, and pain and suffering you will have.
Understanding the insurance claims process is essential to protect your rights and maximize your recovery. Filing a personal injury claim allows you to seek compensation for your medical bills, lost wages, and other expenses related to the accident. This process can be complex, involving detailed documentation, negotiations with potentially multiple insurance companies, and, in some cases, legal action. An experienced personal injury lawyer can guide you through each step, ensuring your claim is properly presented and that you pursue fair compensation for your injuries and other losses. In North Carolina, working with a knowledgeable injury lawyer can make a significant difference in the outcome of your personal injury claim, helping you seek the medical expenses and other damages you are entitled to after a car crash.
Your Health Insurance
Since 2011 North Carolina law has assumed that anyone who has health insurance will first use that health insurance to pay medical bills caused by someone else’s negligence, such as a car accident. (Rule of Evidence 414) All health insurance companies have negotiated rates much, much lower than the hospitals and doctors put on the retail bill that is the first bill you usually see. The liability insurance for the other driver then has to pay you only what your health insurance actually paid for the bill plus whatever you had to pay out of pocket to satisfy the bill.
For example, if you incur a $10,000 hospital bill, your health insurance may pay as little as $2,000 to satisfy that bill. Let’s further assume that you have a $500 deductible that you owe the hospital also. The other driver’s liability insurance only has to reimburse you for $2,500, not $10,000. As you can see, the North Carolina Legislature gave the car insurance industry a huge gift in 2011. What happens in this example if you don’t file the hospital bill with your health insurance? The liability insurance still only has to compensate you for the $2,500 you would have owed the hospital if you had filed the health insurance, leaving you still owing the hospital $10,000. You will then have lost $7,500 when your injuries were the fault of someone else. This is why it is absolutely essential to call an experienced, knowledgeable personal injury attorney at Younce, Vtipil, Baznik & Banks in Raleigh.
It is critical to file your medical bills on your health insurance immediately because some plans will not cover bills submitted after a certain period of time.
It is also important to understand that some health insurance coverages can seek reimbursement of the money they paid for your accident-related bills from the liability insurance, and others cannot. That is a complicated topic that will have to be covered in another article. Suffice it to say that you will need an experienced, knowledgeable attorney from Younce, Vtipil, Baznik & Banks to navigate that mine field.
Determining Liability in a Car Accident
Establishing who is responsible for a car accident is a critical step in determining who pays for your medical bills and other damages. Under North Carolina law, the principle of contributory negligence applies, meaning that if you are found even partially at fault for the accident, you may be barred from receiving compensation from the other driver’s liability insurance. However, you will still be able to file your medical bills on your own car insurance’s medpay and your own health insurance (if you have it). This makes it especially important to have an experienced personal injury lawyer on your side to investigate the accident, gather evidence, and build a strong case that clearly shows the other driver’s fault.
The at-fault driver’s insurance company will assign an insurance adjuster to review the claim, assess the evidence, and determine their policyholder’s liability. The insurance adjuster’s responsibility to the shareholders of their employer is to minimize the amount they have to pay, which is why having a skilled injury lawyer negotiate on your behalf is crucial to achieving a fair settlement. If the at-fault driver has enough insurance coverage, their policy should pay for your medical expenses and other losses. However, if the other driver is uninsured or does not have enough insurance to cover your damages, you may need to turn to your own uninsured or underinsured car insurance or explore other sources of compensation.
What Is Med-Pay?
Some drivers carry Medical Payments Coverage. This optional coverage provides quick help for medical bills after a car accident, regardless of who caused the collision. Med-pay is not required coverage in North Carolina, so you need to look on your car insurance declarations page to see if you have it and how much of it you have. Usually people buy med-pay in much smaller amounts than their liability or uninsured/underinsured coverages. Nevertheless, it usually is paid relatively fast so it can cover deductibles or copays. Insist that your car insurance company send the med-pay check directly to you, not your medical providers, so you can use it in the manner that helps you most.
What Are Some of the Reasons Insurance Companies Deny or Cut Reimbursement for Medical Bills?
Not Medically Necessary
Insurance companies review every charge to decide whether the treatment was “medically necessary.” If the adjuster decides that you did not need a specific test, image, or treatment, they can reject the bill. This gives insurers significant power. Hospitals act fast after a crash, which means they sometimes order tests out of caution. That caution protects you, but your insurance may try to avoid paying for it.
Not Considered a Covered Member Under the Policy
If your name is not on the health insurance policy, or if coverage lapsed before the crash, the insurer will not pay anything. Sometimes the fine print creates confusion about who counts as a covered member. A small detail, such as a missed premium or incorrect information, can cause the company to deny the entire claim.
Out-of-Network Provider
An out-of-network hospital can cost significantly more than an in-network one. Even during an emergency, your health insurance can deny or limit payment if a healthcare provider outside their network treats you. You may also see the insurer cover only a portion, leaving you with a large balance. Many people discover this issue for the first time when the bill arrives.
Out-of-Pocket Costs
Most insurance plans require deductibles, copays, and coinsurance. If you have not met your deductible or if your policy includes high out-of-pocket responsibilities, you may owe more than expected. Even when the treatment is covered, these built-in costs still land on you. The good news is that, even in high deductible policies, the health insurance company often has negotiated huge discounts off of the retail medical bill you would otherwise be dealing with.
What to Do If Your Medical Bills Exceed Liability Policy Limits
A lawyer can step in here to examine the facts, review your policies, and look for additional coverage options. Sometimes North Carolina law may allow you to access the liability policies of family members of the at-fault driver. You may have access to Medical Payments Coverage (Med-Pay), uninsured or underinsured coverage from your car insurance, health insurance, or other resources. Medical liens can be placed on settlements to ensure that medical providers are paid for services rendered to the injured party. Medical liens often play a significant role in dealing with medical bills not paid by health insurance or med-pay, as they encourage healthcare providers to delay sending your medical bills to a bill collector or reporting the overdue bills to the credit bureau. Many people never realize how many layers of coverage exist until an attorney connects the dots for them.
What if There’s Just Not Enough Insurance Money to Pay All Medical Bills?
Hospitals often negotiate balances when a crash leaves the patient responsible for a significant amount of the balance even after all available insurance. Remember, medical providers, especially hospitals, inflate their bills tremendously, so they can negotiate substantial discounts and still turn a tidy profit. A lawyer can handle those conversations for you, gather itemized statements, and correct billing errors. This helps lower your financial stress while your claim moves forward.
Personal injury lawyers can negotiate with insurance companies so your medical treatment expenses are covered. They often work on a contingency fee basis, meaning you do not pay upfront costs and only pay if you win your case. Contact us today for a free consultation to discuss your personal injury case and your options for recovery.
Call Our Compassionate Car Accident Attorneys Today
Recovering from an injury should not leave you stressed about medical bills. When insurance complications arise, Younce, Vtipil, Baznik & Banks draws on over 100 years of combined experience to support you. If you have been injured in an auto accident, our firm can help review your auto insurance policies to ensure you have the right coverage and guide you through the process of securing compensation.
We recently helped a client denied benefits after an on-the-job auto collision, securing his medical coverage and ongoing wage benefits despite the insurance company’s refusal. As one client wrote:
“I recommend the office of Younce, Vtipil, Baznik & Banks, P.A.! They handled my case very efficiently and professionally with a good outcome.” – Mark
We use a state-of-the-art case-tracking system to give you timely updates and personal attention. Our English- and Spanish-speaking staff offer clear communication and hands-on support. If you are worried about hospital bills after a car accident, call 919-661-9000 today for a free case evaluation. We are here to support you. Contact us now for immediate assistance with your car accident or personal injury case.
About the Author
Joseph R. Baznik
Joseph Baznik is an attorney at Younce, Vtipil, Baznik & Banks P.A. who specializes in workers' compensation and personal injury. Joseph speaks both English and Spanish fluently. He is licensed to practice law in the State of North Carolina and the U.S. District Court for the Western District of North Carolina.
