Can I resume medical care after a gap in treatment and still seek compensation for my injuries?: North Carolina Personal Injury
Can I Resume Medical Care After a Gap in Treatment and Still Seek Compensation for My Injuries? (North Carolina)
Short answer: Yes. A gap in treatment does not automatically bar your personal injury claim in North Carolina. However, insurers will scrutinize the gap and may argue your later care was unrelated or unnecessary. You can still recover if your medical records and provider explain why the gap happened and how your current treatment ties back to the crash or incident.
Detailed Answer
Why a Treatment Gap Matters
Insurers and defense attorneys look for breaks in care to challenge two key points:
Causation: They may claim your current symptoms stem from something other than the accident.
Damages and mitigation: They may argue you waited too long, which worsened your condition, so they should not pay for later treatment.
These are arguments—not automatic disqualifiers. Clear, consistent medical documentation can overcome them.
What North Carolina Law Says
Statute of limitations: Most personal injury claims must be filed within three years of the injury under N.C. Gen. Stat. § 1-52. Some latent injury claims use a discovery rule in subsection (16). Wrongful death claims have a two-year limit under N.C. Gen. Stat. § 1-53. A treatment gap does not change these deadlines—do not miss them.
Medical bills as evidence: In North Carolina, properly presented medical bills are prima facie evidence that the charges were reasonable and the treatment was necessary (N.C. Gen. Stat. § 8-58.1). The defense can still challenge necessity—especially if there’s a long treatment gap—so provider notes connecting the care back to the accident are valuable.
Medical liens: Many North Carolina providers assert statutory liens on injury settlements under N.C. Gen. Stat. § 44-49 and § 44-50. A later return to treatment can still be lienable if it is related and necessary.
North Carolina also follows contributory negligence. While a gap is not “negligence,” the insurer may argue you failed to reasonably care for yourself (mitigation). You can counter that with a documented, sensible reason for the gap and a doctor’s opinion tying your resumed care to the original injury.
How to Resume Care the Right Way
Restart treatment promptly. Schedule with your primary care doctor, urgent care, or the specialist recommended after the accident. The sooner you restart, the easier it is to connect your care to the incident.
Tell your provider the full story. Explain the accident, your initial symptoms, what treatment you had, why you paused (cost, scheduling, transportation, family obligations, temporary improvement, etc.), and how symptoms persisted or returned. Ask the provider to note this in your record.
Be consistent in your history. Use the same timeline when speaking to every provider and the insurance company. Inconsistencies fuel denials.
Get a medical opinion on causation. Ask your provider to state, in their medical judgment, that your current condition and treatment are related to the incident. This helps counter “gap” arguments.
Follow the treatment plan. Attend appointments, take prescribed medications, and do home exercises. Good compliance strengthens your claim.
Collect records. Keep copies of prior and current records and bills. These will support necessity and reasonableness under § 8-58.1.
Common, Legitimate Reasons for a Gap
Cost or lack of insurance. Document attempts to find affordable care, pending Medicaid/Marketplace applications, or charity care inquiries.
Work and family conflicts. Keep notes (or employer documentation) showing schedule limitations or caregiving duties.
Temporary improvement. Many injuries wax and wane. If symptoms returned or worsened, tell your provider when and how.
Transportation issues. Note if your vehicle was totaled or you lacked reliable transportation.
Example
Suppose you were rear-ended and treated for two weeks, then paused for six weeks because you lost childcare. Your neck pain flared, and you resumed care. Your doctor records that the pause was due to childcare issues, your symptoms never fully resolved, and your current treatment plan relates to the crash. Even with the gap, your claim remains viable because your records explain the gap and link treatment to the accident.
Insurance Tips
Expect skepticism. Adjusters often downplay claims with gaps. Strong medical notes and consistent histories help.
Consider MedPay. Many North Carolina auto policies include optional Medical Payments coverage. It can help pay bills early, which may prevent gaps caused by cost.
Mind the deadlines. The three-year personal injury filing window (§ 1-52) still applies even if you paused treatment.
Helpful Hints
Write a brief symptom timeline to share with each provider.
Ask your doctor to note in your chart why you paused treatment and why care now is still accident-related.
Keep appointment cards, therapy logs, and home-exercise checklists.
Save bills and EOBs; they help prove reasonableness and necessity under § 8-58.1.
Do not exaggerate or minimize symptoms; accuracy builds credibility.
Consult an attorney early to avoid missing the statute of limitations and to manage liens under § 44-49 and § 44-50.
If you paused treatment, you are not out of options. The key is smart documentation and timely action. Our North Carolina personal injury team has the experience to protect your rights, coordinate your medical records, address liens, and present a persuasive claim. For a consultation, call us at 919-313-2737.
