How can I prove that a flare-up of a pre-existing condition was caused or worsened by a car accident?
How can I prove that a flare-up of a pre-existing condition was caused or worsened by a car accident? - North Carolina
Short Answer
In North Carolina, you can recover for a pre-existing condition that a car wreck made worse, but you must prove the crash was a proximate cause of the flare-up and that the treatment you’re claiming was reasonably connected to that crash-related worsening. The most persuasive proof usually comes from consistent medical documentation, a clear timeline (before vs. after the wreck), and a treating provider’s opinion tying the flare-up and the need for treatment to the collision. Treatment gaps and “maximum medical improvement” notes don’t automatically defeat a claim, but they often give insurers a reason to dispute causation unless you address them with records and explanations.
Understanding the Problem
If you had a condition before the crash and your symptoms flared afterward, can you show—under North Carolina personal injury rules—that the wreck caused or worsened that flare-up so the at-fault driver’s insurer should pay for the related treatment, especially when there was a gap in care and the insurer is pointing to a note about reaching maximum medical improvement?
Apply the Law
North Carolina car-accident injury claims are built around causation and damages. Even if you had a medical issue before the wreck, you may still recover damages for the additional harm the collision caused—often described as an “aggravation” or “flare-up” of a pre-existing condition. Practically, that means you must connect (1) the crash, (2) the change in your symptoms or function, and (3) the medical care you received, so the insurer (or a jury) can see why the collision is a proximate cause of the worsening and why the disputed treatment fits the crash-related course of care.
Key Requirements
Baseline vs. change: You need a clear “before the wreck” baseline (how you were functioning and what symptoms you had) and a clear “after the wreck” change (new symptoms, increased pain, reduced function, new restrictions, or a return of symptoms that had been controlled).
Consistent medical documentation: Your records should repeatedly reflect the same story: the crash happened, symptoms changed afterward, and the provider is treating those crash-related complaints.
Medical causation support: A treating provider’s narrative (often in chart notes or a letter) that the collision caused a flare-up or materially worsened the condition is usually the strongest way to address an insurer’s “unrelated” argument.
Reasonable treatment connection: The disputed care should match the injury pattern and timeline (for example, therapy aimed at restoring function after the wreck, follow-up imaging or referrals prompted by persistent post-crash symptoms, or medication changes due to the flare-up).
Address treatment gaps: If there was a gap, you should be able to explain it with records (for example, scheduling delays, insurance/authorization issues, symptom fluctuation, work constraints, or being told to try home exercises first).
MMI is not the same as “not caused”: A “maximum medical improvement” note can mean you plateaued, not that you were never injured or that later care is automatically unrelated. You still need documentation explaining why any later flare or renewed treatment is connected to the crash-related aggravation.
What the Statutes Say
N.C. Gen. Stat. § 1-52 (Civil actions; three years) - In many car-accident injury cases, the lawsuit filing deadline is generally three years, so causation disputes often need to be resolved (or suit filed) before that clock runs out.
Apply the Rule to the Facts: Here, there is ongoing treatment (therapy and specialist care), but the insurer is disputing whether part of that care—including a flare-up of a pre-existing condition—was proximately caused by the wreck. The insurer is also pointing to a treatment gap and a provider note about maximum medical improvement to argue the later treatment is not reasonably connected to the crash. To strengthen causation, you would want the medical records to clearly show your pre-crash baseline, the post-crash change, and a provider’s explanation that the collision worsened the condition and that the disputed treatment was aimed at treating that crash-related worsening.
Process & Timing
Who sends the proof: The injured person (or their attorney). Where: To the at-fault driver’s insurance adjuster (and, if applicable, your own insurer for medical payments or uninsured/underinsured coverage). What: A focused records package plus a short cover letter that explains the timeline and flags the key pages (initial complaints, objective findings, therapy progress notes, specialist impressions, and any causation language). When: As soon as the insurer disputes causation, and well before any settlement deadline or the lawsuit filing deadline.
Fill the “gap” with documentation: Provide appointment logs, referral orders, therapy discharge notes, and any messages showing why there was a break (and what symptoms were doing during that time). Ask the provider to clarify in the chart if the gap was due to scheduling, authorization, or a trial of conservative care.
Request a causation clarification: If the insurer is relying on an MMI note, ask the treating provider (or the specialist managing the pre-existing condition) for a concise clarification: what improved, what remained, whether the crash aggravated the condition, and whether the disputed treatment was reasonable for the crash-related flare-up.
Exceptions & Pitfalls
“Same symptoms as before” problem: If records read like you had the same complaints at the same level before and after, insurers argue the wreck changed nothing. Make sure providers document what is different now (frequency, intensity, limitations, new radiation/numbness, reduced range of motion, new work restrictions, etc.).
Gaps without explanation: A gap can look like you got better or that something else caused the flare. If there was a gap, document why and show what symptoms did during that period.
MMI misunderstood: Insurers may treat MMI as “case closed.” If symptoms later flare and treatment resumes, you need a medical explanation tying the renewed care to the crash-related aggravation rather than a separate event.
Incomplete records package: Sending only bills often backfires. The insurer usually needs the narrative records (history, exam findings, assessment/plan, therapy notes) to evaluate whether treatment relates to the crash.
Inconsistent history: If early records don’t mention the crash, or later records describe a different cause, the insurer will use that inconsistency to deny the flare-up connection. Correct errors promptly through the provider’s normal amendment process.
Conclusion
To prove a crash-related flare-up of a pre-existing condition in North Carolina, you must show the wreck was a proximate cause of the worsening and that the disputed treatment reasonably fits that crash-related aggravation. The best proof is a clean before-and-after timeline, consistent medical notes, and a treating provider’s clarification that the collision worsened the condition despite any treatment gap or MMI language. Next step: gather the full narrative records and send a focused causation packet to the adjuster well before the three-year filing deadline.
Talk to a Personal Injury Attorney
If you’re dealing with an insurance dispute over whether a pre-existing condition flare-up is related to a car accident, our firm has experienced attorneys who can help you organize the right records, address treatment-gap arguments, and understand your options and timelines. 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.
