Filing Medical Bills: In NC a Necessary Step Following a Personal Injury Accident

Personal injury lawyers are often asked by clients if they need to file medical bills with an insurance company. These procedure questions can be a result of an automobile wreck on other accident. In particular, a person who goes to a doctor or chiropractor after a wreck may want to know if he Medical Billsshould file medical bills with a health insurance company. The answer to that question is the health insurance should be filed.

Personal injury clients are often confused after a car wreck or other accident as to why it is to their advantage to file with the insurance company. The injured person may wonder why they should file the medical bills with their health insurance when another party, namely the other driver and their automobile insurance company, is at fault for the wreck. The reason to file with health insurance is that North Carolina personal injury law imposes a duty for the injured party to do so.

Personal injury law medical bills and duty to mitigate

When a person is injured, they have a duty to reduce their damages, if they can do so with a reasonable effort. This duty, called a duty to mitigate, requires, for example, a landlord to re-rent rental property when a tenant moves out rather than let it sit vacant and sue the tenant for the entire amount of rent left on the lease. This same duty to mitigate applies to persons injured in a car wreck. If the person can reduce his damages, he has a duty to do so.

In October, 2011, the NC Rules of Evidence were amended to change the amount of damages an injured person can introduce to the amount that it took to satisfy the medical bills. For example, imagine a person is injured in a wreck and goes to a doctor. If the person is insured with Blue Cross, and Blue Cross pays $50 for a bill, and the person co-pays $5, the amount that is admissible at trial would be $55 for that bill. It may be that the bill was originally $100, but if this amount was reduced to $55 in insurance and co-payments, then the amount admissible at trial is only $55.

Therefore, since an injured person in a car wreck can reduce, or mitigate, their medical bills by using their health insurance, they have a duty to do so. If a person fails to file their health insurance, then the amount of damages that can be introduced can be reduced by the judge to the amount that health insurance would have paid. This situation could put the injured person in a difficult financial situation, since he may be liable to the medical provider for the full amount, even though he would not be able to recover these full amounts from the defendant and/ or his insurance company.

NC Court System Involved In Personal Injury Outcome

A second, but equally important reason to file health insurance is that recovery of medical expenses in a personal injury or automobile wreck case is not absolutely certain. Insurance companies evaluating a personal injury claim and/ or juries deciding a personal injury claim in court might decide that some, or even all, of the incurred medical costs are not accident related. This scenario is especially common when a person aggravates a body part that was previously injured. Also, there are various defenses which might apply to a case which would reduce or eliminate liability for the defendant and therefore result in no recovery for the injured person. Therefore, if health insurance was not filed, and the injured person did not recover medical bills from the case, the injured person could owe thousands of dollars in medical bills that would have been satisfied by health insurance.

Even if a case does not go to trial, automobile and other insurance companies evaluating personal injury claims often refuse to consider an injured person's medical bills until the insurance company has proof of what, if any, health insurance has been applied to the bills. The accident insurance company will often want to review EOB (explanation of benefits) statements to discover the amount paid by health insurance. If health insurance was not filed, many auto and other liability companies do not consider the medical bills.

Client and Medical Provider Interests May Not Be the Same

Sometimes, the medical providers advise the injured person not file with his health insurance company. These doctors and hospitals sometimes counsel their injured patients not to file their health insurance and, instead, attempt to bill the accident/ auto liability company directly. The injured patient needs to recognize the motivation of the medical provider in encouraging such an action which is greed. The medical provider usually has a contract with the patient's health insurance to accept a reduced rate. If the medical provider does not file the health insurance, they can hope to collect the full medical bills cost from either the injured patient or the automobile insurance company. In most situations, the medical provider is breaching its contract with the patient's health insurance when they refuse to accept and file the health insurance. Additionally, by providing this advice, the medical provider is likely engaging in the unauthorized practice of law, and could be subject to civil and criminal penalties, NC Bar Unauthorized Practice of Law. Finally, the medical provider is violating its own ethical duties by putting its profits before its patients' interests.

For some types of health insurance, namely Medicare and Medicaid, the medical provider has the option of not filing the health insurance. In the event that the injured patient is insured through one or both of these types of health insurance, the patient should still ask the medical provider, in writing, to file their health insurance in order to attempt to mitigate their damages.

Medical provider refuses to file medical bills: what should you do?

If a medical provider refuses to file medical bills with the insurance company, the injured person should seek a more ethical medical provider for his or her care. If that is not feasible, then the injured person should ask the medical provider, in writing, to file the medical bills with the insurance company, and keep a copy for themselves. If that approach is not successful, the injured party should file a complaint with the health insurance company, as well as with the ethics division of the medical board overseeing the medical provider's practice. The injured patient should also take steps to file the medical bills themselves through their health insurance. If the medical provider advised the injured patient not to use their health insurance, the injured patient may also file a complaint with the N.C. State Bar against the medical provider for engaging in the unauthorized practice of law.

Certainly, issues regarding health insurance for injured persons following a car wreck or other accident can be complicated. However, one general rule applies in all cases: if health insurance exists, it should be filed for every visit and for every procedure.

If you have an injury from a car wreck or accident and have questions about filing medical bills with your health insurance, the Ruth Smith Law Firm is here to help you.

Each case is different. Many factors such as the severity of injuries, ability to prove liability, amount of liability insurance coverage, jurisdiction, medical expenses, and many other factors can determine the outcome of a particular case. You should not use these examples as a representation of what recovery you will obtain in your particular case, as every case is unique. Ruth Smith does not guarantee that the outcome of your case will be similar to the results listed above.