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What Does My Health Insurance Have To Do With My Injury Claim?

If you have recently been in a car accident, or another type of accident in North Carolina, the odds are good that you have been asked questions by either your lawyer or the insurance company regarding whether you have health insurance. Many accident victims are confused or concerned about this, because they feel that their health insurance should not have to pay for something caused by another person who acted negligently. Health insurance is increasingly becoming an issue in personal injury cases, however. 

In 2011, the North Carolina General Assembly passed a tort reform package that included a change to the rule of evidence concerning medical bills. Previously, a car accident victim could claim the entire amount charged by the provider. However, the rule of evidence has been changed to where the automobile accident victim can now only claim those amounts which have been paid, regardless of the source, and those amounts that remain to be paid. As a result, insurance carriers and their attorneys are interested in knowing whether the plaintiff has health insurance to determine the amount that can be claimed in the lawsuit as health insurance plans allow for contractual adjustments and write-offs on the bills. 

For example, suppose you have been in a car wreck and went to the emergency room and incurred a $7,000.00 bill. The hospital filed the bill with your health insurance carrier, and that carrier paid $4,000.00 of the bill. The remaining $2,500.00 is written off as a contractual adjustment and $500.00 is the balance on the account. Previously, you would be able to claim the entire $7,000.00 bill. However, now you are allowed to claim only the $4,000.00 actually paid, and the $500.00 remaining to be paid, for a total of $4,500.00. 

Should you tell the medical provider to not file your health insurance to maximize your claim recovery? No. Many personal injury attorneys do not recommend this approach for a variety of reasons. One concern is that it may give rise to a failure to mitigate defense, as the plaintiff in a personal injury case is under a duty to try to minimize their damages if possible. Another concern is that many medical providers do not hold collection attempts pending the outcome of a legal case, so failing to file the bills on health insurance could potentially result in adverse effects on the injury victim’s credit.

Issues surrounding health insurance can quickly complicate an injury claim. In addition to the issues discussed above, there can be issues surrounding liens and the requirement that portions of the injury settlement be paid back to the health insurance carrier. If you have been injured in a collision or suffered another type of accident, you should consult with and consider retaining an experienced personal injury attorney regarding these issues and to help maximize your recovery. You can contact us directly by clicking here.

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