Understanding the Problem

If you were hurt in a North Carolina motor vehicle crash and you stop treating for a period of time, can the insurer treat that gap as a reason to refuse paying for later medical bills even though you later return to care for the same body part?

Apply the Law

In a North Carolina injury claim, the key issue is usually causation: whether the crash caused the condition that led to the later treatment. A treatment gap is not a legal “bar” by itself. Instead, it is a fact the insurer uses to argue that your later treatment was not caused by the collision (or that your condition would have happened anyway because of a pre-existing problem). The more time that passes without documented complaints or care, the more the insurer will push for a “break in the chain” between the crash and the later bills.

North Carolina also draws an important line between (1) whether medical services were reasonably necessary and (2) whether those services were necessary because of injuries caused by the crash. Even if the treatment itself was reasonable, you still must connect it to the wreck to recover it as damages.

Key Requirements

• Crash-related causation: You must be able to show the later treatment was for injuries caused (or made worse) by the collision, not a separate event or natural progression.
• Documented symptom history: Medical records should show when symptoms started, whether they improved, and why they returned after the gap.
• Clear explanation for the gap: A non-medical reason (cost, scheduling, caregiving, work demands) or a medical reason (trial of home exercise, symptoms temporarily improved) can matter because it explains why records go quiet.
• Provider support (especially for flare-ups): When there is a pre-existing condition, it helps if a treating provider explains whether the crash aggravated it and why the later flare-up still ties back to the collision.
• Handling “maximum medical improvement” (MMI) notes: An MMI note can be used to argue you were “done” treating; later care often needs a clear medical explanation for why treatment resumed.
• Reasonable medical charges: You must be able to prove the amounts paid (or required to be paid) and that the charges are reasonable under the rules that apply in North Carolina civil cases.

What the Statutes Say

• N.C. Gen. Stat. § 8-58.1 (Medical charges evidence) - Allows an injured person to testify about medical charges with supporting records; creates presumptions about reasonableness/necessity of services, but does not presume the treatment was caused by the crash.
• N.C. Gen. Stat. § 8-44.1 (Hospital medical records) - Helps with admitting hospital medical records into evidence if otherwise admissible, which can matter when proving the timeline of symptoms and treatment.

Analysis

Apply the Rule to the Facts: Here, the carrier is pointing to a treatment gap and a note suggesting you reached maximum medical improvement, and it is offering a settlement that includes only part of the medical expenses. That is a common causation argument: the insurer claims the later physical therapy/specialist care (and any flare-up of a pre-existing condition) is not tied to the crash. The way to push back is to use records to show a consistent injury story (even if symptoms waxed and waned), explain the gap, and obtain a clear medical link between the collision and the later treatment.

Process & Timing

1. Who sends records: The injured person (or their attorney). Where: To the insurance adjuster handling the bodily injury claim in North Carolina. What: Updated medical records and itemized bills, plus a short written timeline explaining the gap and why treatment resumed. When: Before you accept any settlement or sign a release.
2. Address the “gap” directly: Ask the treating provider (or a later provider) to document, in the chart or a narrative, why the later care relates back to the crash and whether the crash aggravated a pre-existing condition.
3. Re-evaluate settlement posture: If the carrier still denies the later bills, you decide whether to negotiate further, use pre-suit dispute resolution if available, or file a lawsuit so you can use formal discovery (records subpoenas, depositions) to prove causation.

Exceptions & Pitfalls

• “Something else happened” argument: The insurer may claim a new incident (a fall, a work activity, a new workout) caused the later symptoms. If that happened, you need careful medical documentation separating what is crash-related from what is not.
• MMI is not always “no future care”: MMI often means you plateaued at that time, not that you can never need treatment again. But if the record reads like you were fully resolved, later treatment needs a clear explanation.
• Pre-existing condition confusion: If your records do not clearly distinguish baseline symptoms from post-crash changes, the carrier may label later care as “degenerative” or “unrelated.” A provider’s clear comparison (before vs. after) helps.
• Gaps created by missing documentation: Sometimes the “gap” is really missing records (urgent care notes, PT discharge summary, follow-up instructions). Incomplete records can make a continuous course of care look broken.
• Settling too early: If you settle while treatment is still changing, you may end up personally responsible for later bills that you could have supported with better documentation.

If you want more background on common reasons carriers dispute treatment, you may find this helpful: Why is the insurance company refusing to pay for some of my medical treatment after a car accident?. If the dispute centers on an MMI note, see: Can the insurance company rely on a doctor’s note about maximum medical improvement to cut off coverage for later treatment?.

Conclusion

In North Carolina, an insurer can use a gap in treatment to argue your later medical bills are not crash-related, especially when the records include an MMI note and later care restarts after a break. A gap does not automatically defeat your claim, but it raises a causation issue you must address with clear medical records and a coherent timeline. Next step: gather updated records and a provider explanation tying the later treatment to the collision before you sign any settlement release.

Talk to a Personal Injury Attorney

If you’re dealing with a treatment gap dispute and the insurer is refusing to include later medical bills in a North Carolina car accident claim, our firm has experienced attorneys who can help you understand your options and timelines. Reach out today. Call (800) 555-1234.

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.