Short Answer

In North Carolina, you can recover the reasonable cost of necessary therapy from the at-fault party as part of your injury claim, and their insurer typically pays by settlement or judgment. You rarely sue the insurer directly; you pursue the at-fault person. Unpaid therapy balances can be included if they are related, reasonable, and documented. Medical providers may have liens that must be paid from any recovery, subject to statutory limits.

Understanding the Problem

North Carolina personal injury question: can you get an insurer to cover a remaining therapy balance when one therapy date shows only a partial payment but other dates were reimbursed? You want to know if, and how, you can include that outstanding charge in the personal injury recovery and get it paid at settlement or judgment.

Apply the Law

Under North Carolina law, you recover medical expenses (including therapy) as damages from the at-fault party if the treatment was reasonable, necessary, and caused by the incident. You usually resolve payment through the liability insurer by settlement, not by a direct lawsuit against the insurer. If you have Med Pay on your auto policy, you may also claim directly under that coverage. Health care providers can assert statutory liens against your recovery, and your attorney must address those liens at disbursement within statutory limits and priorities.

Key Requirements

• Liability and causation: Show the at-fault party caused the injury and that therapy was for that injury.
• Reasonable and necessary charges: Prove the therapy and the amounts were reasonable and medically necessary.
• Outstanding balance proof: Document the unpaid date(s) of service, payments received, adjustments, and current balance.
• Proper payor path: Present the claim to the at-fault party’s insurer (or your Med Pay, if available) rather than suing the insurer directly.
• Lien compliance: Resolve any provider liens from settlement funds, observing statutory caps and attorney-fee priority.

What the Statutes Say

• North Carolina Gen. Stat. § 44-49 (Health care provider lien) - Providers may assert a lien on injury recoveries for reasonable charges.
• North Carolina Gen. Stat. § 44-50 (Lien limits and priorities) - Caps the total provider liens and prioritizes attorney’s fees.
• North Carolina Gen. Stat. § 1-52 (Three-year limit for personal injury) - Most injury claims must be filed within three years of the injury.
• North Carolina Gen. Stat. § 58-63-15(11) (Unfair claims settlement practices) - Lists prohibited insurer conduct; not a direct action rule but informs claim handling.

Analysis

Apply the Rule to the Facts: If the therapy was for the crash injury, you can include the unpaid date of service in the damages claim. Because other dates were reimbursed, gather the ledger showing the partial payment and the exact remaining balance to prove reasonableness and necessity. Present the full therapy charges to the at-fault carrier (and Med Pay if available). At settlement, your attorney should resolve any valid provider lien on that therapy balance within the statutory lien cap.

Process & Timing

1. Who files: Injured person (through counsel). Where: First, present a claim to the at-fault insurer (and your Med Pay carrier, if applicable). If suit is needed, file a civil complaint in the Clerk of Superior Court in the North Carolina county where the defendant resides or where the crash occurred—District Court for claims up to $25,000; Superior Court if over $25,000. What: Civil complaint (no statewide AOC complaint form). Serve per Rule 4. When: File within three years of the injury.
2. Negotiate with the insurer using provider bills, EOBs, and a current statement from the billing service showing the unpaid therapy charge; allow several weeks for records review and evaluation (time varies by insurer and county).
3. On settlement or judgment, the attorney disburses funds, honors valid provider liens, and obtains payoff confirmations/releases for the therapy account.

Exceptions & Pitfalls

• No direct action: You usually cannot sue the at-fault party’s insurer directly—pursue the at-fault person; the insurer pays by settlement or judgment.
• Evidence limit: Courts focus on amounts paid or necessary to satisfy bills; get current balances and adjustments in writing from the provider/billing service.
• Lien limits: Provider liens are capped by statute and must be shared pro rata; attorney’s fees are prioritized. Neglecting lien caps or notice can delay disbursement.
• Coverage path: If Med Pay exists, submit the unpaid therapy bill promptly to your own auto insurer; policy notice requirements apply.
• Venue/jurisdiction: File in the correct civil division; the Clerk’s Office does not adjudicate tort claims.

Talk to a Personal Injury Attorney

If you're dealing with an outstanding therapy balance after a North Carolina accident, our firm can help you understand coverage options, lien limits, and deadlines. Call us today.

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.