If another's negligence has injured you, it should be simple to recover all the costs of your medical treatment, lost wages, and pain & suffering.
Unfortunately, that is rarely how North Carolina personal injury claims work. This post discusses what to do if the insurance company offers less than the cost of your medical bills and expenses.
The Bishop Law Firm represents personal injury victims in North Carolina. We do not get paid unless we win your case. Call us today for a free case review or start online now.
What can I do if the adjuster is offering less than the cost of my medical bills?
- The first step is to find out the exact amount of your accident-related medical bills. Emergency room visits can generate several different bills (EMS, ER physicians, hospital charges, radiology charges, etc). A victim needs to be aware of all bill totals.
- The second step is to ensure that the adjuster has all of your medical bills, medical records, proof of lost wages, evidence regarding pain and suffering, etc.
- If the insurance adjuster's offer is less than the total of your bills, ask the adjuster what they are excluding and why.
- You can attempt to negotiate with the adjuster, but demanding more money without the possibility of litigation hanging over the adjuster's head doesn't always work.
- If the adjuster will not move higher, you have two options:
- Accept the offer and negotiate bills and liens with medical providers or insurance later (see below).
- Pursue litigation. If you have not settled your claim, hire a North Carolina Personal Injury Attorney to help you. Personal Injury Lawyers only get paid if you win, and their fee is based directly on how much you recover, so they are interested in attaining the best recovery possible for you.
Why would an insurance adjuster offer less than my medical bill expenses?
Insurance adjusters generally seek to resolve claims at the lowest possible amount and can pay only up to their insured's policy limits.
A low settlement offer does not necessarily reflect the true value of your case.
Insurance companies often begin negotiations with settlement offers that are much lower than what they may ultimately be willing to pay.
Why Do Insurance Adjusters Make Low Settlement Offers?
Many adjusters believe they are not legally required to pay all of your accident-related expenses, and will try to settle your claim for less than it is worth.
An insurance adjuster will tell you that medical treatment is not related to your accident when it clearly is.
Read our post about North Carolina Pre-Existing Conditions
We frequently have adjusters who object to medical treatment even though our client reported the symptom in their first medical treatment post-accident.
Adjusters will also say treatment is not related when there is a gap in treatment (even a week!), when it is well known that getting the appointment can take substantial time.
Policy Limits Matter
In addition to low offers from adjusters, policy limits can reduce the amount of money a victim can receive.
In North Carolina, the minimum auto liability limits are $50,000 per person, $100,000 per accident, and $50,000 for property damage.
If someone with a minimum-limits policy causes a serious accident, the amount available to compensate an injured victim is limited by those policy limits.
Read about North Carolina Policy Limits
If you settle with the insurance for less than the cost of your expenses, you have effectively had to pay for someone else's negligence twice.
At my firm, we never recommend settling for less than the cost of our client's accident-related medical treatment if possible, nor do we recommend accepting the insurance companies' first offer.
Please remember that if you accept the money from the insurance company (no matter how unfair), your case is done, and no further money can be obtained.
North Carolina Personal Injury Law
In North Carolina, an injured victim can recover the cost of their accident-related medical expenses, lost wages, and pain and suffering.
Most insurance adjusters do not want to pay for pain & suffering and are reluctant to give money for lost income without comprehensive documentation.
Do not rely on an insurance adjuster to determine a fair settlement amount for serious injuries or to tell you what you are legally entitled to recover. This will not happen.
If the insurance adjuster offers you less than the cost of your medical bills, you are not alone. If the at-fault party's insurance company "thinks" that you have received too much medical treatment or if the medical bills are "too expensive", they will try to pay you less than the value of the medical bills.
Read North Carolina Personal Injury Lawyer.
How Do I Calculate My Total Medical Bills?
The first step for an injured person or their personal injury lawyer in obtaining a fair personal injury settlement is determining the total amount of medical bills and liens due in the case. Consider the following:
- Don't settle your case until you receive all necessary medical care or until you know the value of future medical costs.
- Once you have finished treatment, ask your medical providers for your medical records and any outstanding medical bills.
- Certain facilities (i.e., emergency room visits) bill separately for physicians and diagnostic testing (e.g., X-rays, MRIs), so you may have more than one bill for a single visit.
- Don't forget to get the bill for the ambulance ride!
- Ask your health insurer whether they will file a medical lien on your personal injury settlement if you used your health insurance to pay for your accident-related medical expenses. Whether your health insurance company can assert a lien depends on the type of insurance company it is. North Carolina is an anti-subrogation state, but there are several exceptions:
- Medicare, Medicaid, and ERISA Plans, to name a few
- In North Carolina, you can be compensated for the amount your health insurance paid on your behalf, the amount you paid out of pocket, and the cost of the future medical treatment needed (future need will need to be documented by a physician) (See Rule 414).
- For the insurance adjuster to make a fair settlement offer, all expenses must be included in a demand letter with supporting documentation.
- Knowing how much your medical bills actually are can give you a line in the sand when dealing with the insurance adjuster.
Do I have to pay medical bills out of my settlement?
Yes, you need to pay your medical bills out of your settlement to avoid problems later. However, an experienced personal injury attorney can help identify unrelated medical bills from healthcare providers and ensure your settlement proceeds can pay all your medical bills.
Under North Carolina Law, the settlement funds are subject to liens from medical providers and certain health insurance providers (such as Medicare, Medicaid, and ERISA).
If you do not pay these liens, they can become judgments against you. Unpaid medical bills will result in calls from debt collectors and can affect your credit.
However, that does not mean you should accept and pay the bills at face value. Don't be afraid to negotiate! Negotiating medical bills can result in significant savings for accident victims.
Even a failed negotiation to reduce bills is better than no negotiation. In other words, you have nothing to lose by asking the medical provider to negotiate on their bills.
In addition, in North Carolina, pro rata distribution can be used to negotiate medical bills and liens.
Is filing a court case the only way to get more money for my NC Personal Injury Claim?
It depends. For the adjuster to make you a decent offer, they must have all your medical records, medical bills, lien information, lost-wage information, photographs, doctors' work notes, and other supporting documentation for the settlement amount you are asking for.
Read why medical evidence is important in North Carolina injury claims.
Adjusters who lack all necessary documentation are reluctant to increase the value of their offer.
Sometimes, even with clear and complete evidence, the adjuster may not offer you a fair amount.
However, some adjusters will increase their offer when presented with all the evidence.
After providing the adjuster with all the evidence and making a demand, some adjusters still will not offer enough money to cover your accident-related expenses.
In these cases, you can settle with the adjuster and then contact your medical providers to attempt to reduce your medical bills due to the amount of your settlement.
Do I need an NC Personal Injury Attorney to file litigation?
Usually, the better option when a settlement offer is insufficient to cover your accident-related bills is to file a personal injury lawsuit in the county court where the accident occurred.
Filing a lawsuit forces the insurance company to include the potential cost of litigation in your claim, which can increase the claim's value.
While you can file a case independently, you must keep track of deadlines and provide the requested information to the court and opposing counsel, or your case could be dismissed.
To start your personal injury litigation case, you must file a complaint, civil summons, and discovery with the District or Superior Civil Court in the county where the accident occurred before the NC Statute of Limitations runs out.
If you hire an NC Personal Injury Lawyer, they can help you with both litigation and pre-litigation matters. As mentioned above, some adjusters will offer more money if faced with more evidence during settlement negotiations.
A personal injury attorney can help you gather this evidence and present it to the adjuster.
If the adjuster refuses to offer more money for settlement, an attorney can discuss whether filing a lawsuit is the best option for recovery in your case.
If you find yourself in a situation where your NC Personal Injury Medical Bills are More Than the Settlement, just know that The Bishop Law Firm represents injured clients in North Carolina.
We do not get paid unless you win, and we offer free case reviews. Call us today at (919) 615-3095 or start your free online case review now!
