If you’re reading this, you’re wondering about whether your health plan has a right to get paid back from your potential injury claim settlement. Perhaps I’ve told you to look into this or maybe you’ve just arrived at this concern on your own. Either way, a phone call needs to be made. But what needs to be asked?

When you call your health plan, tell them you live in North Carolina and were involved in an accident that someone else might be responsible for. The health plan is paying for your treatment, but you want to know whether or not the health plan has what they might call a right of subrogation, or perhaps a right of reimbursement against third party proceeds. Ask them who you would need to talk to to get that question answered.

If you’re lucky, they’ll send you to the right place immediately. Normally someone will take your information and then they’ll have a third party company (often The Rawlings, sometimes Conduent, or perhaps another organization) reach out to you. When they do, you should put them in touch with your attorney, which is hopefully me. If you’re not represented, good freaking luck. Do they have a valid right of reimbursement? How would you know? What does your Summary Plan Description say? Do they file a Form 5500? This stuff is wacky, so you might want some help.

If you’re unlucky, the person with whom you’re speaking won’t have a clue as to how to help. In my experience that just means you call back later and hope to get a different person. Sometimes you can cut to the chase and learn from your Summary Plan Description (SPD) if this is something you even need to be worried about. That’s also where an attorney can probably help you. Those things are written in ancient legaleze.

For more information on this issue, check out this post.

Back in the olden days it was customary to meet with your attorney prior to beginning the attorney/client relationship. Those were special days, but times have changed a lot and, at the risk of being too blunt, meetings are just a waste of time these days and really, really not necessary.

I know, I know. The past is really hard to let go of. I still love my 90s music. I like having a hard drive I can put my hands on as opposed to working “from the cloud.” I write checks! In some ways, old ways are good and still relevant. But I’m here to tell you: There is almost never a really compelling reason for us to meet in order for me to handle your auto accident injury claim.

I’ve heard all of the reasons for insisting on a meeting. Please allow me to briefly refute them below:

• I’m a real person. You don’t need to touch me for me to prove that to you. Contact the NC State Bar and ask if I’m current with my Bar dues. Ain’t no fake attorney paying Bar dues. I’m real.
• It’s just unreasonable to believe you’re going to trust me more after touching me. In fact, it’s a little creepy. If you don’t believe me when I tell you you can trust me, once again, check with the NC State Bar and see how many complaints there are about me. Also, check out my Google Reviews. I don’t know how to fake those, so to the extent you can trust anything on the internet, you can trust my Google Reviews.
• There’s a saying in the corporate world that, “That meeting could have been a phone call and that phone call could have been an email.” Exactly. Email is the BEST! If you have a question, email me. I can explain complex legal topics FAR better in writing, at my own leisure, in a way that can be easily digested, than in any other way available. Even better, it stays there FOREVER! You can go back and read it anytime you need to! And I can point back to it if you ask the same question again! I can do the same on the phone if you absolutely need to hear it (some people are auditory learners, so I get that) and ask immediate follow up questions. That’s fine. I’m happy to talk on the phone, too.
• Allow me to share a startling statistic with you: Nearly 30% of people who set up in-person meetings with me fail to show up. That may not seem like a big deal, but it is a HUGE waste of time for me. For the person requesting the meeting that fails to show, it’s nothing. They’re doing whatever it is that’s more important to them anyway. For me, it’s a great big time suck. I have to dress for a meeting (a GREAT inconvenience these days, let me tell you). Moreover, I have to set aside that time JUST for that person. I have to be at the office instead of working more conveniently from home. This guarantees about 30 minutes of wasted time on my part, and sometimes more depending on how long I wait. For a personal injury attorney that works on contingency fee, my time is difficult to value, but the latest estimate is that my work time is worth about $500/hour. So if you look at half of that, for EVERY no call/no show I lose about $250. Would you like to sign up to lose $250 three times out of every ten times that someone asks for a meeting? I bet you wouldn’t.
• Nowadays, if you REALLY want to see me, we can Zoom or whatever the nearest equivalent is. Meetings. But that’s just a phone call with extra complications, so just call me, please.

Look, I probably want to represent you or we wouldn’t have gotten this far in a conversation. But I’m telling you, we REALLY don’t need to meet in person. I can do everything I need to do for you remotely and I’ll probably do it faster and better if you leave me time to do it instead of insisting on a 19th Century way to do business. Let’s get to work, shall we?

Here’s how it’s suppose to work in North Carolina: You get in an accident, you go to the hospital, your health insurance is billed and they pay accordingly. But it doesn’t always happen that way.

Sometimes, hospitals will “forget” to bill your health insurance. I use the ” ” because I think that this is done in an effort to increase the hospital’s recovery. They think that they can/should get money from your auto accident settlement, and while that’s not totally wrong, here’s the problem: When they accept health insurance, they agree to take a discount, so they lose some of what they claim their services are worth for the certainty of getting paid. But if they get money from an auto accident claim, they’re not bound by their agreement with your health insurance, so they hope to recover the full amount they billed. In other words, they want to rob you of the discount that you pay for by buying health insurance. Not cool.

If you’re in an automobile accident in North Carolina and end up in the hospital, watch your bill and make sure that your health insurance is being billed. This stuff gets complicated, so call an expert. Call me at 919-929-2992.

Sometimes I frustrate clients when I don’t tell them what to do. I get it. They call me wanting me to fix their problem. Heck, I want to fix it for them! But here’s the deal: I can’t make decisions for my clients.

You’ve probably heard the term “attorney and counselor at law.” That says it all. I “counsel.” My job is to give advice. It’s to tell you what your options are and what those options look like in terms of cost/benefit. With that information, what I hope is that I give you the chance to make the best decision for you under your particular circumstances. I’m not you and I can’t tell you what’s best. I can only give you as much information as I can get to put you in the best position possible to make the decision most likely to help you in your particular situation.

I can help, but I can’t and won’t dictate. That’s not me or my job.

If you have an injury claim, let me counsel you. 919-929-2992.

My personal injury clients are sometimes asked by their healthcare providers to ask me to send them what they call a “letter of protection.” In short, I can’t. But let’s talk about why.

The “letter of protection” that these providers want is a promise from me that I’ll pay their bill from the settlement. This is problematic on several levels, but let’s focus on the big one. For an attorney to promise to hold someone else’s interests over the interests of their clients is a conflict of interest, and if you have watched television in the past two decades, you know that that is a bad thing. Obviously, I cannot create such a conflict by promising a party that I’ll protect them over my client.

The good news is that these letters of protection are totally unimportant in the collections process. If the health care provider wants to treat the patient/client on a lien basis and get paid from the settlement, all they have to do is read the NC lien statute and perfect their lien! And trust me, that’s a very low bar and is very easy to accomplish. A perfected lien creates a legal obligation for me to address that bill in disbursement, and that a law is better than any letter I can write.

It is worth noting that sometimes these requests belie a somewhat nefarious end. I’ll be the first to say that health insurance sucks. But that’s the system we have and so we’re stuck with it. Of course when you use health insurance, that results in an “adjustment,” which is really just a fancy word for discount. This means that when you use health insurance the health care provider gets paid less than they would if you just paid them cash (or if they got paid from a settlement). Sometimes, though not always, a health care provider will advise a patient/client in a personal injury setting to NOT use their health insurance in an effort to make the health care provider’s bill payment higher. To that end they request the aforementioned letter of protection which in their minds solidifies their ability to get paid at the end of an injury claim. This is not often in the interests of the patient/client, as they could use their health insurance, get that discount, and not be burdened with the hassle of balances later. Of course, I’m not saying every provider who asks for such a letter is out to improve their billing, and maybe the motivation is benevolent in some instances. But sometimes it ain’t.

This, like lots of topics surrounding personal injury claims in NC, can be complicated. If you have a personal injury claim, call me at 919-929-2992.

This should probably go without saying, but if you’re going to hire an attorney, DO NOT agree to settle your claim with the insurance company beforehand.

Seriously, people do that.

I get it, sort of. You’re talking to the adjuster, they’re being really nice and persuasive, and they get you to say “yes” to a settlement offer. Sadly, that’s binding (most of the time) in NC. That means your case is settled. And while you might be able to find an attorney willing to fight it, best case scenario you’ve created a monster cluster$#@# that didn’t need to be there ON TOP OF the underlying problem of your injury claim, and worst case scenario you go through a lot of hassle, expense, and heartache and lose.

Don’t create problems for yourself. You already have enough. Don’t agree to settle your damn claim. Please.

Health insurance is supposed to be there to cover you when you need it. And, for the most part, it kind of is. But should they have the right to get paid back from your injury claim proceeds? According to some plans, they should.

North Carolina generally doesn’t allow this right of reimbursement to third party claims on the part of health plans. Sometimes this is referred to as “subrogation” but that may not be precisely the right word depending on plan language. As you can imagine, there are exceptions to every rule. One of those exceptions is if you have an employer-sponsored ERISA health plan. Those plans are set up under a Federal law that supersedes State law and allows health plans to get back what they paid out when/if an insured gets paid from a “third party” (like in an auto accident) for the incurred medical expenses.

We can talk about why these plans were designed with this right, but that’s for another post. For now, the issue is whether or not YOU have one of those plans and if you do, are we going to have to pay them back from your settlement.

IF your plan has this right you don’t want to ignore this potential right because they can take away benefits and/or might pursue you in court for the payback, so don’t play around. As such, we need to do some digging.

So what should you do now?

Call your health plan with your insurance card in hand and ask them if your particular plan has a “right of reimbursement for third party claims” or “subrogation in third party claims.” If they claim to have such a right, have them get you to the right people to set that claim up and give that information to your attorney. That should get us to the right folks so we can then discuss with them the source of their perceived right and the amount of payment, if any, to which they may be entitled.

This stuff can get complicated and it’s important to make sure you’re on the right track. Talk to someone who knows what’s up. Talk to me. 919-929-2992.

There is a really simple answer to this which no one is going to like, but I’m going to explain it after I give it and it should, hopefully, make you feel better.

Who is paying for your healthcare after an accident? You are.

Eek. That’s a hard pill to swallow, I know. You weren’t at fault, you didn’t cause the accident, you didn’t ask to get hurt, so why should you pay for it? It’s a systemic issue that does have a remedy. If it helps, you can think that you’re temporarily renting the bills until you get someone else to buy them. What the hell does that mean? Let me explain…

The best way to begin this analysis is to look at it is that nothing is certain until it’s certain. If you have a need for healthcare, it’s just that: A need for healthcare like any other, so you have to pay for it. If there is a liability claim against the person who caused the need for the care, then there might be a way to get reimbursed for it. But the take-home message is this: In North Carolina, there is no system set up to protect you from paying for your own health care needs following an accident that was caused by someone else. Your bills are yours until and unless you (or your attorney) can make someone else take responsibility for them.

The good news is that there IS a system for RECOVERING your losses, including medical expenses, from an accident that was someone else’s fault. But the hard bit to swallow is that you have to incur those losses first in order to recover for them. That means, for the most part, that you’re responsible for paying your bills until and unless we can make someone else responsible. But it’s a two-step process.

This can be frustrating. It can also be a difficult system to navigate. This is why there are personal injury attorneys like me. Call me at 919-929-2992.

In Durham and Chapel Hill, there are a LOT of people walking about. With two giant universities and vibrant downtown areas, pedestrians are everywhere. As a result, there are a lot of accidents involving pedestrians. Why is this? Well, let’s talk about a few issues associated with pedestrian v. automobile accidents.

DRIVERS AND PEDESTRIANS

Part of the problem is these accidents don’t happen in a vacuum. It’s not always just this one car struck this one pedestrian. Often times, a pedestrian has begun walking in a crosswalk and one car stops for them, but a car in the other lane doesn’t see them or understand why the car has stopped and BOOM, there’s trouble. If you’re operating a vehicle in a multi-lane road and a car in the lane next to you stops for a pedestrian, YOU MUST STOP TOO! This can be frustrating for drivers because it takes the decision out of their hands, but this rule is right. Once someone has stopped for a pedestrian, it’s best to just let them get across safely and not have to play real life version of the video game Frogger.

RIGHT OF WAY…WHO HAS IT?

Traffic lights give us a good idea as to who has the right of way, but NC law can be a bit squishy on this. Once a pedestrian is in the roadway and/or crosswalk, that creates a duty on the part of the driver to yield to the pedestrian, even if the pedestrian shouldn’t have been there because of what the light is doing. This seems somewhat unfair, but think of it this way: We can’t just run over people simply because they’ve made a bad decision. Of course, that doesn’t mean it’s ALWAYS the driver’s fault…

CONTRIBUTORY NEGLIGENCE

I’ve written and talked about this issue ad nauseum…check out this vid for a more detailed description, but the short version of Contributory Negligence is if a victim is even 1% at fault, they are statutorily prevented from being awarded ANYTHING from the person who is 99% at fault. North Carolina is one of only 4 states who still have this fossil of English Common Law on the books, sadly. It can be a very difficult barrier for many pedestrian claims in that it’s fairly easy to make an argument that even if the pedestrian had the right of way, the pedestrian had the duty to exercise reasonable care, too, and maybe they didn’t and that’s at least PART of the reason why they were hit. The take-home message here is that Contributory Negligence can really be a killer for pedestrian cases, so you should call an attorney if you have one.

Call me for help with any injury claim. 919-929-2992.

Most of what I do is personal injury claims arising from auto accidents. So normally, I’m on the other side of this so I don’t really actively seek out this kind of work. Having said that, I like to give out useful info, so if you caused an accident in Orange County, North Carolina and got a ticket for it, here’s how I would handle it:

First, make sure your auto insurance company is aware of the accident. Once a claim is set up, they’ll determine if they’re going to pay damages to the other side. If they are accepting liability, that will make things easier for you vis-a-vis the ticket.

Second, once they’ve resolved the property damage claim of the other party, get a letter from your insurance company stating the following info:

• they insured you at the time of the accident
• they HAVE PAID (past tense) the property damage of the other party(ies)
• and have them spell out the amount paid

Normally, though not always, that is enough to get your ticket dismissed in Orange County, NC. Just take that letter with you to your court date and knock on wood that will work. If the accident was more serious and/or if you have more serious charges, then it might not be as simple as that.

You will likely be concerned that your rates are going to go up now. They are.

Hopefully you don’t need me for this kind of thing, but if you want to hire me to deliver that letter instead of doing it on your own, I’m happy to talk to you (as long as I don’t represent the injured party already).

Call me at 919-929-299.