If you were injured in a car accident in North Carolina, you may be wondering which medical bills can be included in a settlement and which ones you will still have to pay. In many cases, a settlement can include reasonable and necessary medical expenses related to the crash, both past and future, as long as those expenses are clearly documented and tied to your injuries. Coverage limits, medical liens, and reimbursement claims from Medicare, Medicaid, and health insurers can all affect the amount you actually receive.
Lanier Law Group helps crash victims across North Carolina, including Raleigh, Durham, Charlotte, Greensboro, Fayetteville, Wilmington, and surrounding communities, understand how medical expenses, insurance coverage, and liens fit together in a potential settlement.
What Counts as “Medical Expenses” in a North Carolina Car Accident Settlement?
In North Carolina, medical expenses in a car accident claim generally include the reasonable and necessary costs of diagnosing, treating, and rehabilitating injuries caused by the crash. This can cover emergency care, hospital stays, imaging, surgery, follow-up visits, physical or occupational therapy, prescribed medications, durable medical equipment, and mental health treatment when it is related to the collision.
Courts and insurers focus on whether the care is truly connected to the accident and whether the charges are reasonable for the type of service and the local area. The emphasis is often on the amount actually paid or still owed after insurance adjustments, rather than the higher initial “sticker price” that may appear on a first hospital bill.
Examples of medical expenses that may be included:
- Emergency room and hospital car
- Car Imaging tests such as X-rays, CT scans, and MRIs
- Surgery and anesthesia charges
- Follow-up visits with primary care doctors and specialists
- Physical therapy, occupational therapy, and sometimes chiropractic care
- Prescription medications related to crash injuries
- Mental health counseling or therapy for crash-related anxiety, depression, or PTSD
- Durable medical equipment such as braces, slings, boots, crutches, or walkers
These principles apply across North Carolina, whether you were treated after a crash on an interstate near a major city or on a smaller local road. Many people receive care at systems such as UNC Health, Duke, WakeMed, Atrium, Novant, ECU Health, New Hanover Regional, and other North Carolina providers.
What Medical Bills Are Considered Reasonable and Necessary in North Carolina?
To include a medical bill in a settlement, two main questions usually matter:
- Was the treatment reasonably necessary to diagnose or treat injuries from the crash?
- Is the charge reasonable for the type of service and the local market?
Treatment that follows naturally from documented injuries is easier to support. Examples include an emergency room visit immediately after the collision, imaging ordered to check for fractures, follow-up appointments with an orthopedist for a diagnosed injury, or physical therapy to restore strength and range of motion.
Bills may be questioned when:
- Treatment starts long after the crash without a clear explanation
- There are long gaps where care stops and then restarts
- The intensity or duration of treatment does not match the documented injuries
- Records do not clearly connect the complaints to the collision
North Carolina evidence rules and insurer practices often emphasize what was actually paid or remains due for medical services rather than only the original billed amounts. Clear, consistent documentation linking treatment to the crash can make it easier to show that care is reasonable, necessary, and related.
What Documentation Do I Need to Connect Treatment to the Crash?
A strong claim has a paper trail showing how the crash led to your symptoms, diagnoses, and treatment. Helpful documentation includes:
- Emergency room or urgent care records from the date of the crash
- Itemized hospital bills that list services and charges, not just the balance due
- Imaging reports (X-ray, CT, MRI) describing findings related to crash injuries
- Specialist and primary care notes showing diagnoses, treatment plans, and crash history
- Physical and occupational therapy notes and progress reports
- Mental health records if you are receiving counseling or therapy for crash-related issues
- Pharmacy receipts and medication summaries for prescriptions related to your injuries
- Explanation of Benefits (EOBs) from health insurance or MedPay showing what was paid and what remains due
- Written referrals and care plans, such as an emergency referral to orthopedics and then to physical therapy
- Mileage logs or travel records documenting trips to and from appointments
When records present a consistent story about how the collision occurred, what you reported, and how your care progressed over time, it is easier for insurers and, if needed, a jury to connect your treatment and bills to the crash.
Which Past Medical Bills Are Commonly Included?
Most North Carolina settlements include a broad range of past medical bills related to the crash. When treatment meets the reasonable and necessary standard and is backed by documentation, it is often considered in settlement negotiations, subject to coverage limits and lien or reimbursement issues.
Insurers most commonly see:
- EMS and ambulance bills
- Emergency room bills
- Inpatient hospital and ICU charges
- Imaging fees for X-rays, CT scans, and MRIs
- Surgery and anesthesia charges
- Specialist visits, such as orthopedics, neurology, and pain management
- Primary care follow-up visits
- Physical and occupational therapy and sometimes chiropractic care
- Pain management procedures and visits
- Mental health counseling for crash-related issues
- Prescription medication costs
- Durable medical equipment (DME) and home health services
A practical way to organize past medical bills is by type of bill, examples of what it covers, and the proof you should keep:
| Medical Bill Type | Examples | Proof to Save |
| EMS / Ambulance | EMS transport from the scene, first responder care | EMS run sheet, ambulance bill |
| ER Visit | ER triage and evaluation, labs, initial imaging | ER records (triage and provider notes), itemized ER facility and physician bills |
| Inpatient Stay / ICU | Hospital admission, ICU or step-down care, monitoring | Admission and discharge summaries, daily progress notes, itemized hospital bill |
| Imaging | X-rays, CT scans, MRIs | Radiology reports, imaging invoices |
| Surgery / Anesthesia | Operating room fees, surgeon fees, anesthesiologist charges | Operative report, anesthesia record, itemized surgery bills |
| Specialist Visits | Orthopedics, neurology, neurosurgery, PM&R, pain management | Office notes, referral letters, patient statements |
| Primary Care Follow-Up | Primary care visits, ongoing symptom checks, referrals | Visit summaries, billing statements |
| PT / OT / Chiropractic | Physical therapy, occupational therapy, chiropractic adjustments | Treatment plans, progress notes, invoices |
| Pain Management | Injections, nerve blocks, pain-clinic visits | Procedure reports, pain management notes, bills |
| Prescriptions | Pain medication, anti-inflammatories, nerve medications, sleep aids | Pharmacy receipts, medication summaries |
| DME / Home Health | Braces, boots, crutches, walkers, wheelchairs, home nursing | DME invoices, home health visit notes and bills |
| Mental Health | Therapy or counseling for crash-related anxiety, depression, PTSD | Counseling notes, psychologist or therapist bills |
Common issues that can affect how these bills are viewed include:
- Long delays before seeking medical care after the crash
- Large gaps in treatment without a documented reason
- Very extensive physical therapy or chiropractic care that is not well supported by the diagnosis
- Difficulty linking certain complaints to early findings or to how the crash occurred
When there are questions about timing, consistency, or the nature of treatment, insurers may use those questions to argue that some bills should not be included or should carry less weight.
What ER and Hospital Charges Can Be Included After a Crash in Raleigh, Charlotte, or Wilmington?
Reasonable and necessary emergency and hospital charges are often a major part of a settlement when they relate to crash injuries. These charges can include:
- EMS or ambulance transportation from the scene
- ER facility fees and emergency physician charges
- Trauma team or activation fees in serious cases
- Radiology charges for X-rays, CT scans, MRIs, and ultrasounds
- Surgery and anesthesia costs when an operation is performed
- ICU or inpatient room charges
- Specialist consultation fees while you are in the hospital, such as orthopedics, neurosurgery, or cardiology
Hospitals and health systems across North Carolina may issue separate bills for the facility, emergency providers, radiologists, surgeons, and other specialists. Discharge summaries, imaging reports, and physician notes that describe injuries and treatment help show why hospital care was reasonable and necessary.
Examples of ER and hospital charges that may be included:
- EMS and ambulance run and transport bills
- ER facility fee and emergency physician fee
- Radiology and lab charges
- Surgeon and anesthesiologist fees
- ICU or inpatient room charges
- In-hospital specialist consultation fees
Are Prescriptions, Medical Equipment, and Follow-Up Visits Part of a North Carolina Settlement?
Yes. Follow-up visits, prescriptions, and medical equipment are typically included as medical expenses when they are connected to crash-related injuries. This can include amounts paid by insurance and out-of-pocket costs such as co-pays and deductibles.
You should keep documentation for:
- Follow-up appointments with your primary care doctor and any specialists
- Prescriptions filled for crash-related conditions such as pain, muscle spasms, inflammation, nerve-related symptoms, or sleep problems
- Over-the-counter medications recommended by your providers, along with receipts when possible
- Braces, splints, slings, boots, collars, and other orthopedic supports
- Mobility aids such as crutches, canes, walkers, or wheelchairs
- Home health visits for wound care, medication administration, or rehabilitation exercises
Pharmacy receipts, DME invoices, and office visit statements help support these costs. Provider notes that explain why a particular medication or device is needed for your injuries can be helpful if an insurer questions whether an item is related to the crash.
Can Mental Health Treatment Be Included After a North Carolina Car Accident?
Mental health treatment can be part of a settlement when it relates to the trauma of the crash and is supported by documentation. Some people develop anxiety, depression, sleep problems, or PTSD-type symptoms after a serious collision. When a qualified provider connects those symptoms to the accident and provides treatment, those counseling and therapy bills may be considered medical expenses.
This can involve:
- Individual therapy or counseling sessions
- Psychiatry visits for evaluation and medication management
- Trauma-focused care for anxiety, panic attacks, nightmares, or flashbacks related to the crash
Insurers typically look for:
- A documented diagnosis, such as adjustment disorder, PTSD, or major depression
- Treatment notes that show how symptoms relate to the crash and how they are changing over time
- Referrals from primary care providers, emergency physicians, or specialists when appropriate
Mental health treatment provided through large health systems, local counseling centers, or private therapists may all be part of the overall injury picture when properly documented.
Can I Include Mileage, Parking, and Other Travel Costs for Medical Appointments in My North Carolina Settlement?
Travel expenses can be easy to overlook, but they often add up during recovery. Reasonable travel-related costs for necessary medical appointments may be included in a claim when they are carefully tracked and supported by records.
These can include:
- Mileage to and from medical appointments, recorded in a log, calendar, or app
- Parking garage or lot fees at hospitals and clinics
- Highway tolls for trips to out-of-area specialists
- Rideshare or taxi fares when you cannot safely drive yourself
- Public transit passes or fares used to get to treatment
- In rare, serious cases, lodging costs when an overnight stay is medically necessary for out-of-area care
Many people in rural counties must travel into cities such as Raleigh, Durham, Chapel Hill, Charlotte, or Greenville for specialist care. Over time, those costs can become significant. A consistent mileage log and receipts for parking, tolls, and transportation can help support these expenses if they are included in settlement discussions.
Can Future Medical Bills Be Included, and How Are They Proven?
A settlement can also account for future medical care when there is solid evidence that you are likely to need ongoing treatment because of crash injuries. Future care may include:
- A planned surgery or additional procedures
- Extended physical or occupational therapy
- Ongoing pain management visits, injections, or medications
- Continued mental health counseling related to the crash
- Adaptive equipment or home modifications in serious injury cases
Future medical expenses are estimates, not exact numbers. They are usually based on written opinions from treating physicians and, in more serious cases, from specialized experts who evaluate long-term needs.
How Do You Calculate Future Medical Expenses in North Carolina?
Future medical expenses are typically based on a documented care plan. Treating providers may outline:
- The type of ongoing treatment they expect you to need, such as therapy sessions, periodic injections, or a future surgery
- How often you will likely need that care and for how long
- The expected need for follow-up visits, imaging, and laboratory tests
Once a care plan exists, rough cost estimates can be developed using current charge information, billing data, and, when appropriate, expert input. In cases involving long-term disability or catastrophic injuries, a life-care planner may prepare a detailed report projecting the cost of care over many years.
Insurers often challenge future expenses if they appear speculative or if the medical support is vague. Specific provider notes that explain why future treatment is expected, how it relates to the crash, and how long it may be needed can help support a claim for future medical bills.
What Happens if You Settle Before Treatment Is Finished in North Carolina?
Settling before your treatment is finished carries significant risk. Settlement releases in North Carolina car accident cases usually state that you are resolving all claims related to the crash, including future medical bills you may need for those injuries. Once you sign, you generally cannot ask the at-fault insurer for more money if your condition worsens or you end up needing more care than anyone expected.
That is why it is important to talk with your doctors about your long-term prognosis before settling. Ask whether your condition is likely to improve, whether additional procedures or therapy are likely, and what long-term limitations you may face. Discuss those projections with a lawyer so that potential future care can be considered when evaluating any settlement offer.
How Do MedPay, Health Insurance, UM/UIM, and Liability Coverage Affect Medical Bills?
Several forms of coverage may pay or help pay medical bills after a North Carolina car accident:
- The at-fault driver’s liability coverage
- Your MedPay (medical payments) coverage, if you purchased it
- Your health insurance, such as employer plans, ACA marketplace plans, Medicare, or Medicaid
- Your own UM/UIM coverage if the at-fault driver is uninsured or underinsured
In many cases, MedPay and health insurance pay bills while treatment is ongoing. Liability and UM/UIM coverage most often pay later through a lump-sum settlement or judgment, which can then be used to address remaining balances and reimbursement obligations.
Here is a simplified overview:
| Coverage Type | Who Pays | When It Applies |
| Liability | At-fault driver’s auto insurer | Pays at settlement or judgment for medical expenses and other damages, up to liability limits |
| MedPay | Your auto insurer | Pays reasonable medical and funeral expenses for you and certain occupants, regardless of fault, up to the MedPay limit |
| Health Insurance | Your health plan (employer plan, ACA marketplace, Medicare, Medicaid, and others) | Pays covered treatment as it occurs; may have a right to reimbursement from a settlement |
| UM / UIM | Your auto insurer | Applies if the at-fault driver has no insurance (UM) or not enough to cover your losses (UIM); can pay medical expenses and other damages up to your UM / UIM limits |
The order in which bills are processed and which coverage pays first can depend on policy language and coordination-of-benefits rules. When several forms of coverage are in play, careful tracking of who paid what and when can help avoid surprise reimbursement claims at the end of the case.
What Is MedPay in North Carolina and What Does It Cover?
MedPay, or medical payments coverage, is optional coverage that can be added to a North Carolina auto policy. It pays reasonable and necessary medical and funeral expenses for covered persons up to the MedPay limit, regardless of who was at fault in the crash. It usually applies to the named insured, certain family members, and passengers listed in the policy terms.
MedPay can be especially useful for early out-of-pocket expenses such as emergency room copays, deductibles, and initial bills, while the liability or UM/UIM claim is still under investigation. MedPay does not replace a claim against the at-fault driver’s liability coverage or your own UM/UIM coverage. Instead, it works alongside those claims and may later be part of reimbursement and lien discussions.
Who Pays Medical Bills While the Claim Is Pending in North Carolina?
While your claim is pending, providers usually bill health insurance and, if available, MedPay. If you do not have health insurance or MedPay, you may pay directly, work out payment plans, or in some situations sign a letter of protection in which a provider agrees to wait for payment from a future settlement.
The at-fault driver’s liability insurer usually does not pay bills as they arrive. Instead, that insurer evaluates liability and damages and may offer a single lump-sum settlement later. When a settlement is reached, those funds are often used to:
- Reimburse health insurers, MedPay carriers, or government programs that paid medical bills
- Pay any outstanding balances to medical providers
- Compensate you for other damages such as lost wages and pain and suffering
How Did North Carolina’s July 1, 2025 Auto Insurance Changes Affect Coverage Minimums?
For policies issued or renewed on or after July 1, 2025, North Carolina increased its minimum auto liability coverage requirements. The bodily injury and property damage minimums rose from 30 / 60 / 25 to 50 / 100 / 50. In practical terms, this means:
- At least $50,000 of bodily injury liability coverage per person
- At least $100,000 of bodily injury liability coverage per accident for all injured persons combined
- At least $50,000 of property damage liability coverage per accident
Higher minimums can increase the amount of liability coverage available in many collisions, which may help cover medical bills and other losses. Serious injuries can still exceed these limits, so underinsured motorist coverage, MedPay, and other layers may remain important parts of an overall protection plan.
How Do Medical Liens and Reimbursement Claims Affect Your Settlement?
Even when coverage is available, medical liens and reimbursement claims can significantly change the amount you receive from a settlement. Several different entities may have a right to be paid out of your settlement proceeds. These can include:
- Hospitals and certain other providers that assert statutory liens
- Medicare
- North Carolina Medicaid
- Private health insurers with subrogation or reimbursement rights
These claims usually must be addressed, and at least partially satisfied, before net settlement funds are distributed to you. Understanding who must be paid, how much is claimed, and whether there is room for negotiation is crucial when evaluating any settlement offer.
Can a Hospital Put a Lien on My Settlement in North Carolina?
Yes. Under North Carolina law, hospitals and certain other providers may assert statutory liens on personal injury settlements for reasonable charges for care they provided. These liens can arise from statutes such as N.C. Gen. Stat. §§ 44-49 and 44-50 and give providers a legal claim against a portion of the settlement proceeds.
Hospitals and health systems such as UNC Health, Duke, WakeMed, Atrium, Novant, New Hanover Regional, Cape Fear Valley, and others may assert liens when bills remain unpaid. A lien does not usually allow a provider to take an entire settlement. Statutory limits and practical considerations often restrict how much of the settlement can go to liens, and experienced lawyers may be able to negotiate lien amounts in light of available coverage and the overall settlement figure.
Do I Have to Pay Back Medicare or Medicaid After a North Carolina Settlement?
If Medicare or North Carolina Medicaid paid for treatment related to your car accident, both programs generally have rights to be reimbursed from your settlement. Medicare treats many such payments as conditional under the Medicare Secondary Payer rules, and Medicaid has subrogation rights under state law.
In most cases, you or your lawyer will need to:
- Notify Medicare or North Carolina Medicaid about the claim
- Request a statement of the amounts paid for crash-related care
- Resolve those claims as part of the settlement process
Ignoring Medicare or Medicaid reimbursement can lead to penalties and future coverage complications. Many law firms communicate directly with Medicare and with the North Carolina Department of Health and Human Services to make sure these obligations are handled correctly before funds are distributed.
Do I Have to Reimburse My Health Insurance Company After a North Carolina Car Accident?
Many private health insurance plans, particularly employer-sponsored ERISA plans, include subrogation or reimbursement provisions. Whether you must reimburse your health insurer from a settlement depends on several factors:
- The wording of the plan documents
- Whether the plan is self-funded or fully insured
- How federal and state law applies to your specific plan
Some plans assert a clear right to reimbursement, while others may not. It is important to review your health plan or summary plan description and any subrogation notices you receive. Because these issues can be complex, many people ask a lawyer to review plan language and negotiate with the insurer so that reimbursement is addressed fairly and in accordance with applicable law.
How Do Medical Liens and Reimbursement Claims Change My Net Settlement Amount in North Carolina?
Your gross settlement is the total amount agreed to with the insurer. Your net settlement is what you actually receive after all required payments are made. After a gross settlement is reached, funds are typically used in this general order:
- Attorney fees, according to your fee agreement
- Case costs, such as expert fees, records fees, and court costs
- Payment of medical liens and reimbursement claims, including hospitals, Medicare, Medicaid, and health insurance
- Payment of any remaining provider balances
Whatever remains after these payments is your net settlement. Even though a settlement figure may include your medical expenses, the entities that paid or are owed money for your care often must be paid from those proceeds.
Questions to consider before signing a release include:
- Have my doctors provided a clear sense of future medical needs, so I am not settling too early?
- Have all hospital, Medicare, Medicaid, and health insurance liens and reimbursement claims been identified?
- What amounts are those lienholders claiming, and is there any room for negotiation?
- What provider balances remain outstanding and will need to be paid?
- After fees, costs, and all liens are handled, what will my estimated net settlement be?
- Should I ask a lawyer to help verify and negotiate these numbers before I sign?
Get Help Navigating Medical Bills After a North Carolina Car Accident
If you are overwhelmed by medical bills after a North Carolina car accident, you do not have to untangle them on your own. Sorting out which charges can be included in a settlement, what is considered reasonable and necessary, how MedPay and health insurance fit in, and which hospitals or insurers have lien or reimbursement rights is complicated even in straightforward cases. Early legal advice can help you connect treatment to the crash, organize records from providers across systems, understand how coverage limits and the July 1, 2025 minimum-limit changes affect your claim, and avoid signing a release that leaves you responsible for more medical debt than you expected.
If you have questions about which bills should be part of your claim, who must be repaid from your settlement, or what your net recovery might look like after liens and reimbursements, you do not have to make those decisions alone. Call Lanier Law Group at 919-342-1368 or contact us online for a free consultation. Our team is ready to review your medical expenses, explain your options under North Carolina law, and fight like heavyweights to protect your right to pursue a settlement that accounts for both your care and your bottom line.