Were you in a car wreck or trucking accident and trying to figure out why your medical bills are piling up and not getting paid? After all, you were not at fault in this accident! Personal Injury claims in North Carolina can leave you feeling like you got the short end of the stick at times, and unfortunately, that feeling could extend to the settlement of your claim as well based on some applicable NC laws. Consulting an attorney who handles these cases routinely is the best way to maximize your recovery.
The “billed vs. paid” laws in NC limit what evidence can be offered for you to obtain recovery in settlement or to a jury if your case does not settle. So how does it all work? Unfortunately, there is no straightforward answer, and the applicable law is confusing. However, we will go over some laws you should be aware of in NC.
Prior to 2011 in NC, accident victims were allowed to present damages as to the total amount billed by a healthcare provider to obtain recovery in a settlement. However, as of October 1, 2011, North Carolina changed the applicable laws and amended Rule 414 (also known as the “Billed vs Paid Rule”). Here is the amended and applicable rule for your review:
Rule 414 states:
Evidence of medical expenses. Evidence offered to prove past medical expenses shall be limited to evidence of the amounts actually paid to satisfy the bills that have been satisfied, regardless of the source of payment, and evidence of the amounts actually necessary to satisfy the bills that have been incurred but not yet satisfied. This rule does not impose upon any party an affirmative duty to seek a reduction in billed charges to which the party is not contractually entitled. (2011-283, s. 1.1; 2011-317, s. 1.1.)
So, what does this mean for a personal injury case? The quick answer is that your health insurance company rarely pays full price for medical bills and typically has pre-negotiated a lower rate for the service provided. The result is that you are limited to assert evidence that shows what has actually been paid for your bills and this significantly decreases your ability to recover damages for medical expenses and pain and suffering in NC. Here is one example of how this law applies:
Hypothetical Sally was injured in a car wreck and was taken by ambulance to the Emergency Room. She received multiple CT scans, xrays, and medication for her pain while in the ER. Her ambulance and ER bill was $60,000 in total charges. Sally provided her health insurance card to the ER for her charges. Her health insurance paid her bills which cost them $25,000 total since they have a lower negotiated rate with the medical provider. The rest of the $60,000 will was adjusted and the balance remaining is now $0. However, Sally is only allowed to present $25,000 in medical damages that were paid to satisfy her bills rather than the full $60,000. Sally was billed $60,000, but insurance paid $25,000, which explained the “billed v. paid” law. Now Sally recovers based on $25,000 in medical damages, not $60,000.
Knowing the value of our claim and navigating the process of a Personal Injury claim can be very stressful. If you’ve been involved in a car accident, you want an experienced Attorney to navigate this process for you! Contact us immediately at Shankle Law Firm to schedule a free consultation with Attorney/Owner, Maggie Shankle.