Short Answer

In North Carolina, you typically open a health plan subrogation or reimbursement claim by sending the plan’s recovery unit a written notice with key claim details: who was injured, when and how the crash happened, the at-fault driver’s information, the police report number, all medical providers and dates of service, and your client’s plan and policy identifiers. Include settlement status and the liability insurer’s contact so the plan can verify payments and assert any lien before funds are disbursed.

Understanding the Problem

In North Carolina personal injury cases, the question is: what do I, as the client’s attorney, need to send the health insurer to open or update a subrogation claim so we can address any lien before disbursing settlement funds? Here, the personal injury case has settled after a broadside collision, and the health plan paid multiple medical providers. You need to notify the plan and supply enough information for it to identify paid claims, confirm plan rights, and coordinate repayment.

Apply the Law

North Carolina law recognizes different types of reimbursement rights in injury settlements. Medical providers can assert statutory liens that affect distribution of settlement funds. Certain payors, like the State Health Plan and Medicaid, have specific statutory recovery rights. Private health plan rights depend on the plan type and terms; self-funded ERISA plans may enforce contract reimbursement despite state limits. The Clerk of Superior Court does not manage these negotiations; communications go to the plan’s subrogation/recovery unit. Addressing valid liens and payor recoveries typically occurs before disbursing settlement funds.

Key Requirements

• Accident and liability details: Date, location, crash description, at-fault driver, and police report number so the plan can open a third-party liability file.
• Plan identification: Member name, date of birth, plan ID/group number, and administrator/vendor handling subrogation.
• Medical billing scope: Provider list, dates of service, and diagnosis codes if available; request an itemized paid-claims ledger for injury-related charges.
• Settlement information: Gross settlement amount, attorney’s fees/costs, and liability/UIM carrier contacts to coordinate repayment and release.
• Legal contacts and documentation: Letter of representation, HIPAA authorization if requested, and any court orders or allocation terms relevant to medical payments.

What the Statutes Say

• North Carolina Gen. Stat. § 44-49 (Medical provider liens) – Allows providers to assert liens on recovery for injury-related services.
• North Carolina Gen. Stat. § 44-50 (Settlement distribution cap) – Limits the portion of settlement available to medical liens to protect the injured party and fees.
• North Carolina Gen. Stat. § 135-48.37 (State Health Plan recovery) – Authorizes recovery from third-party liability for medical payments made by the State Health Plan.
• North Carolina Gen. Stat. § 108A-57 (Medicaid lien) – Grants the state a lien on recoveries for Medicaid-paid medical care.

Analysis

Apply the Rule to the Facts: Because the case is settled and the health plan paid multiple providers, you’ll need to give the plan accident details and the police report number so it can verify third-party liability. Provide the member’s plan ID and a provider list to help the plan generate a paid-claims ledger. Share settlement and liability insurer information so the plan can calculate any reimbursement and issue a lien satisfaction or release before you disburse funds.

Process & Timing

1. Who files: Injured party’s attorney. Where: The health plan’s subrogation/recovery unit or its outside vendor (North Carolina, by mail, secure portal, or email per plan instructions). What: Notice letter of representation; accident details; police report number; plan ID and group; provider list and dates; request for paid-claims ledger and plan terms; settlement and liability/UIM insurer contacts; HIPAA authorization if required. When: As soon as liability is apparent and before disbursing settlement funds.
2. Plan review and ledger: The plan verifies eligibility and issues an itemized ledger of injury-related payments and a preliminary lien amount; timeframes vary by administrator.
3. Resolution: Negotiate reductions if applicable, confirm the final amount due, obtain a written satisfaction/release, and include the plan on the settlement disbursement check if required by the plan.

Exceptions & Pitfalls

• Plan type matters: State Health Plan and Medicaid have statutory recovery rights; Medicare has federal recovery. Self-funded ERISA plans may enforce contract terms despite state limits; fully insured private plans may be more constrained by state law.
• Missed documentation: Failing to include the police report number, complete provider list, or settlement details delays the lien calculation and release.
• Distribution errors: Statutory medical provider liens and certain payor recoveries must be honored before disbursement; North Carolina law caps portions payable to medical liens relative to fees and the client’s share.
• Scope disputes: Confirm which charges are injury-related; ask for an itemized ledger and challenge unrelated or duplicate entries.
• Notice gaps: If Medicaid or the State Health Plan paid, notify the correct state unit early; procedures and forms can change by agency.

Talk to a Personal Injury Attorney

If you’re resolving a North Carolina personal injury settlement and need to open or negotiate a health plan subrogation claim, our firm has experienced attorneys who can help you understand your options and timelines. Call us today at [919-341-7055].

Disclaimer: This article provides general information about North Carolina law based on the single question stated above. It is not legal advice for your specific situation and does not create an attorney-client relationship. Laws, procedures, and local practice can change and may vary by county. If you have a deadline, act promptly and speak with a licensed North Carolina attorney.