Legal Question in Personal Injury in North Carolina

Re: when coverage does not cover medical bills

Under the circumstances you describe, the ONLY available insurance is the $50,000 liability limits of the party at fault. Whether your group health plan is entitled to be repaid for amounts it paid to cover medical expenses is sometimes not clear. There are some situations in which a group health plan is covered by federal, not state, law and in those situations the health plan has a right of reimbursement. That right does not, however, create a lien in favor of the health care plan. Sometimes, in cases where manifest injustice might otherwise result, the health benefit plan can be convinced to waive, or at least substantially reduce, its claim. This is general information only and is not intended to represent a legal opinion on the facts of your case. Such an opinion can be rendered only after an examination of pertinent documents, including the explanation of benefits from the heatlh care plan. I hope this answers your questions.

Re: when coverage does not cover medical bills

The other answer is fairly thorough and accurate. You may need an attorney to look into the subrogation/lien issue. The insurance company with whom your are negotiating will also probably want to resolve this issue. As for avenues of recovery, some things to consider are: (1) whether there might be any additional Underinsured Motorist Coverage available (e.g. if you had a separate insurance policy), (2) whether the other driver might have any additional insurance (e.g if he was driving a car owned by another person, or if the person could have had some umbrella policy), (3) if there is another person potentially liable (e.g. if he was working for an employer at the time), (4) personal assets of the other driver. These are all factors which should make you consider hiring an attorney.