One of the most common surprises for people pursuing a personal injury claim is learning they may have to reimburse their health insurance provider from their settlement. Understandably, this can feel frustrating and confusing, especially when you're dealing with injuries, missed work, and mounting stress.
At Shankle Law Firm, we help clients navigate this process with clarity, care, and legal expertise, so you're not caught off guard by unexpected bills.
Who Pays Your Medical Bills After an Accident?
After a car accident or other injury caused by someone else’s negligence, many assume the at-fault driver’s insurance (also known as the liability carrier) will pay for medical bills as they happen.
Unfortunately, that’s not how the system works in North Carolina.
Here’s what actually happens:
- You are responsible for your own medical treatment while your personal injury claim is pending.
- If you have health insurance, you should use it, it typically reduces what you’ll owe.
- Once your case is resolved, part of your settlement may be used to repay your health insurance or other parties that helped cover your care. It will depend on the type of plan you have in place, which is a complicated question to navigate.
This process is often triggered by what’s called a medical lien or subrogation claim.
What Is a Medical Lien or Subrogation Interest?
A medical lien or subrogation interest is the legal right of a third party, like your health insurance provider, Medicare or Medicaid, to be repaid from your settlement if they paid for treatment related to your injury.
Whether that applies depends on what kind of plan you have. Common situations include:
- ERISA plans (self-funded employer health plans)
- Medicare or Medicare Advantage
- Medicaid
- State-funded assistance programs
These programs often have strict rights to reimbursement, and failure to handle these correctly can result in financial or legal consequences.
Should I Use My Health Insurance at All?
Yes, in most cases, using your health insurance is the smartest choice. Here's why:
- It reduces your out-of-pocket expenses while your case is pending.
- You avoid full “cash” billing rates that some providers may charge if you’re uninsured.
- Even if reimbursement is required, it’s often less than what you would have paid directly.
However, some providers may try to discourage you from using insurance, hoping to recover more by billing you directly or placing a lien on your settlement. You have the right to request that providers bill your insurer, and it's often the smarter move financially.
Why This Affects Your Final Settlement
The total amount you’re awarded in a personal injury case is not always what you take home. Once your case resolves, your net settlement is calculated after deducting:
- Attorney fees
- Case expenses
- Any medical liens or reimbursement obligations
If liens aren’t handled properly, you could end up paying more than necessary, or even facing collection notices after your case closes.
Why Legal Help Matters
Medical liens and subrogation rights can significantly affect your net settlement, the amount you actually take home after your case is resolved.
At Shankle Law Firm, we:
- Review all potential medical liens or insurance repayment issues
- Work to minimize what you may owe through negotiation
- Help you make informed decisions about your treatment and claim
- Ensure your rights are protected every step of the way
Get the Answers You Deserve
If you’ve been injured in an accident and are unsure who gets paid, and when, we’re here to help.
Contact Shankle Law Firm today for a free consultation with Attorney/Owner Maggie Shankle, a seasoned personal injury lawyer who can walk you through your options and protect your financial future.
*Please Note - The content on this website is for informational purposes only and does not constitute legal advice. Viewing this site, using information from it, or communicating with Shankle Law Firm, PA through this site does not create an attorney-client relationship. For legal advice tailored to your situation, please contact us directly at (704) 370-1212.