Short Answer

In North Carolina, the at-fault party is responsible for injuries caused by the crash, including any worsening (aggravation) of a preexisting condition. Insurers compare your pre-accident baseline to your post-accident symptoms and treatment and look for medical opinions tying the change to the crash. They will try to pay only for the portion linked to the wreck. If you cannot agree, a court decides using medical records and testimony.

Understanding the Problem

In North Carolina personal injury claims, you want to know whether the insurer can separate what the crash caused from what you already had. The adjuster’s role is to evaluate accident-related harm and any aggravation of an older condition. Here, the insurer is questioning how much of your current concussion symptoms were made worse by the collision while you were already in treatment, and it is asking for prior records before making an offer.

Apply the Law

North Carolina allows recovery for new injuries and for the aggravation of preexisting conditions that the crash proximately caused. Insurers assess “relatedness” (is this from the wreck or something else?) and “necessity” (was the treatment reasonably needed for the accident effects?). The practical forum starts with an insurance claim; if unresolved, suit is filed in North Carolina District or Superior Court, and the general deadline to file most personal injury lawsuits is three years from the injury.

Key Requirements

• Causation: You must show it is more likely than not the crash caused new symptoms or made your prior condition worse.
• Baseline proof: Pre-accident records help establish how you were doing before, so the change after the wreck can be measured.
• Apportionment: Payment is limited to the portion reasonably attributable to the crash; the insurer will separate preexisting symptoms from post-accident worsening when possible.
• Reasonable and necessary treatment: Bills and records should show the care was appropriate for crash-related injury or aggravation.
• Consistency and timing: Close-in-time complaints, imaging, and provider notes that document a change after the wreck strengthen the link to the accident.
• Deadline awareness: If settlement does not resolve the dispute, you must file suit within the applicable statute of limitations to preserve the claim.

What the Statutes Say

• North Carolina Gen. Stat. § 8-58.1 (Medical bills as evidence) - Itemized medical bills are prima facie evidence of the reasonableness of charges and necessity of treatment, subject to rebuttal.
• North Carolina Rule of Evidence 803(6) (Business records) - Medical records can be admitted as business records when foundational requirements are met.
• North Carolina Gen. Stat. § 1-52 (Three-year limitation) - Most negligence claims must be filed within three years from the date of injury.

Analysis

Apply the Rule to the Facts: The insurer’s request for prior records is aimed at proving your pre-accident baseline and apportioning only the crash-related aggravation of your concussion. To meet causation and apportionment, obtain clear treating-provider notes that your symptoms materially changed after the wreck and that the crash more likely than not worsened your condition. Use itemized bills and records to show the post-accident care was reasonable and tied to that worsening. If your provider cannot separate old from new precisely, ask for a simple explanation of the functional changes and why the crash is the likely cause.

Process & Timing

1. Who files: The injured person (or attorney). Where: With the at-fault driver’s liability insurer; if needed, file a lawsuit in the Clerk of Superior Court for the county where the crash occurred or where the defendant resides (District or Superior Court based on amount). What: Submit a demand package with pre- and post-accident medical records, itemized bills, and a concise provider letter addressing aggravation; if suing, file a Complaint and Civil Summons (AOC-CV-100). When: Aim to send the demand after your condition stabilizes; file any lawsuit within three years of the accident.
2. Insurer review: Adjusters typically take several weeks to evaluate records, compare baseline to post-crash findings, and may ask for targeted additional records or clarifications from your provider.
3. Resolution or suit: If you reach agreement, you sign a release and the insurer issues payment. If not, proceed with litigation and use discovery and medical testimony to prove aggravation and related damages.

Exceptions & Pitfalls

• Gaps or inconsistent reports: Long gaps in care or changing symptom descriptions weaken causation and aggravation arguments.
• Overbroad record authorizations: Limit authorizations to relevant timeframes and body systems; broad releases can invite unrelated denials.
• No provider opinion: Adjusters discount claims without a clear treating-provider statement linking the worsening to the crash.
• Only subjective complaints: When possible, include objective findings (e.g., testing, neurologic exams) to support the change after the wreck.
• Missing the deadline: Waiting too long to file suit can forfeit the claim even if liability is clear.

Talk to a Personal Injury Attorney

If you’re dealing with an insurer disputing what the crash caused versus what was preexisting, our firm has experienced attorneys who can help you understand your options and timelines. Reach out today at (919) 341-7055.

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.