Short Answer

In North Carolina, an insurance company can use a doctor’s “maximum medical improvement” (MMI) note as part of its argument that later treatment is not related to the crash or is not reasonable or necessary. But an MMI note does not automatically “cut off” your right to claim payment for later treatment if that later care is still caused by the wreck. The real issue is medical causation and proof, not the label “MMI.”

Understanding the Problem

If you were hurt in a North Carolina car crash and your insurer (or the other driver’s insurer) points to a provider note saying you reached maximum medical improvement, can the insurer refuse to pay for later physical therapy or specialist care even though you are still treating?

Apply the Law

In a North Carolina personal injury claim, an insurer generally pays (or offers to pay in settlement) only for damages that are legally tied to the crash. That usually means you must be able to show the later treatment is still connected to the collision and is medically reasonable in light of your symptoms and diagnosis. A note saying “MMI” often means the provider believes you have recovered as much as you are likely to recover with the current course of care, or that your condition has stabilized. It is not a court order, and it is not a legal cutoff date by itself.

When an insurer disputes later bills, it commonly argues (1) the treatment is for something else (including a pre-existing condition), (2) a gap in treatment suggests the crash was not the cause of the later flare-up, or (3) the later care is not medically necessary. In North Carolina, those disputes are ultimately decided by evidence—especially medical records and medical opinions—if the case goes to court.

Key Requirements

• Crash-related causation: You must be able to connect the later treatment to injuries caused or aggravated by the collision, not just to pain that happens to appear later.
• Reasonable and necessary care: The later treatment should make medical sense for the condition being treated (for example, documented symptoms, exam findings, and a treatment plan).
• Clear medical documentation: Records should explain why treatment continued (or restarted after a gap) and what changed clinically.
• Handling pre-existing conditions: If the crash aggravated a prior condition, the records should explain the difference between baseline symptoms before the wreck and the post-crash change.
• Consistency over time: Gaps in treatment, missed follow-ups, or inconsistent complaints can make it easier for an insurer to argue the later care is unrelated.
• Settlement terms matter: If you sign a full and final release, you typically cannot come back later for additional payments for later treatment related to the same crash.

What the Statutes Say

• N.C. Gen. Stat. § 75-1.1 (Unfair or deceptive acts or practices) - Sets the general rule that unfair or deceptive acts in commerce are unlawful; sometimes raised in insurance-claim conduct disputes depending on the facts.
• N.C. Gen. Stat. § 8-44.1 (Hospital medical records) - Addresses how hospital medical records may be received into evidence if otherwise admissible, which can matter when proving what treatment was for and when it occurred.
• N.C. Gen. Stat. § 1-540.2 (Motor vehicle property damage settlement not an admission; effect of settlement terms) - Explains that settling one part of a motor-vehicle claim does not automatically settle other parts unless the written settlement says so, highlighting why release language matters.

Analysis

Apply the Rule to the Facts: Here, the insurer is using a treatment gap and an MMI note to justify paying only part of the claimed medical expenses. Under North Carolina practice, that is a causation and documentation dispute: the insurer is essentially saying the later physical therapy/specialist care (including the flare-up of a pre-existing condition) is not tied to the crash or is not medically necessary after the MMI point. If your later records clearly explain why treatment resumed and how the crash caused or worsened the condition, the MMI note becomes less persuasive as a “cutoff.”

Process & Timing

1. Who sends information: The injured person (or their attorney). Where: To the insurance adjuster handling the bodily injury claim. What: Updated medical records, itemized billing, and—when helpful—a short provider narrative clarifying causation, the reason for any treatment gap, and why later care is still related. When: As soon as the insurer raises the MMI/gap issue, and before signing any release.
2. Insurer review: The insurer may re-evaluate, request additional documentation, or obtain its own medical review. Timeframes vary, and delays are common when records are incomplete or causation is disputed.
3. If no agreement: A lawsuit can be filed in the North Carolina trial courts (typically District Court or Superior Court depending on the case), and the dispute becomes evidence-driven through the litigation process.

Exceptions & Pitfalls

• MMI is not the same as “no future care”: Many people reach a plateau and still need intermittent treatment later (for example, a flare-up). The key is whether the later care is still crash-related and documented.
• Gaps in treatment need an explanation: If there was a break in care, records should explain why (symptoms improved, insurance/transportation issues, scheduling delays, etc.) and what changed when symptoms returned.
• Pre-existing condition arguments: Insurers often argue the later treatment is “just the old condition.” Clear notes comparing pre-crash baseline to post-crash symptoms can help address this.
• Beware of signing a broad release: If you settle and sign a full release, you usually cannot seek additional payment later, even if you need more treatment.
• Incomplete records: Sending only a single “MMI note” without the surrounding treatment notes can backfire. Context matters (what the provider meant, what restrictions remained, and what follow-up was recommended).

Conclusion

An insurer in North Carolina can point to an MMI note as a reason to dispute later medical bills, but it is not an automatic legal cutoff for crash-related treatment. The deciding issue is whether the later care is still reasonably connected to the collision and supported by medical documentation, especially when there is a treatment gap or a pre-existing condition flare-up. Next step: gather updated records and a clarifying provider statement and send them to the adjuster before you sign any release.

Talk to a Personal Injury Attorney

If you’re dealing with an insurer disputing later treatment based on an MMI note or a gap in care, our firm has experienced attorneys who can help you understand what documentation matters, how causation is proven, and what timelines you need to protect. Reach out today. Call [CONTACT NUMBER].

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.