Short Answer

In North Carolina, you can challenge an insurer’s “not reasonable or necessary” claim by strengthening your medical proof, negotiating with targeted evidence, and, if needed, filing a lawsuit. You prove that the crash caused your injuries, that your chiropractic and hospital care was appropriate, and the amounts claimed are the amounts paid or still owed. Medical affidavits and North Carolina’s evidence rules help you meet these requirements, and medical liens can be negotiated and capped by statute.

Understanding the Problem

In North Carolina, can you push back when the at‑fault driver’s insurer says your soft‑tissue treatment was not reasonable or necessary? You, the injured person, want payment for chiropractic and hospital bills after a crash, and the insurer has lowballed your claim.

Apply the Law

Under North Carolina law, an injured person must prove the crash caused the injury, the treatment was reasonably necessary, and the amounts claimed reflect what was paid or is still owed. Courts accept itemized medical bills and records to show reasonableness and necessity when the statute’s notice steps are followed, and the evidence rules limit medical expense proof to amounts actually paid or to be paid. If a settlement is reached, medical providers may assert liens, but state law caps and prioritizes how much must be repaid from your recovery.

Key Requirements

• Causation: Connect your symptoms and treatment to the crash through medical records and provider opinions.
• Reasonableness & necessity: Show that the type, duration, and cost of care (including chiropractic) were appropriate for your injuries.
• Amounts recoverable: Prove the dollar figure using the amounts paid or still owed for care, consistent with evidence rules.
• Admissible proof: Use medical bills/records and statutory affidavits to create prima facie evidence if litigation becomes necessary.
• Liens & paybacks: Identify, verify, and negotiate medical provider liens; apply statutory caps and priority rules to protect your net.
• Forum & deadline: File suit in the proper North Carolina court if negotiations fail; most injury claims must be filed within three years of the crash.

What the Statutes Say

• N.C. Gen. Stat. § 8-58.1 (Medical bills and records) - Allows medical bills/records to serve as prima facie evidence of reasonableness/necessity when statutory steps are met.
• N.C. Gen. Stat. § 8C‑1, Rule 414 (Medical expenses; paid vs. owed) - Limits evidence of medical charges to amounts actually paid or still owed.
• N.C. Gen. Stat. § 44‑49 (Medical provider lien) - Grants providers a lien on personal injury recoveries for reasonable charges.
• N.C. Gen. Stat. § 44‑50 (Lien payment and caps) - Caps the portion of your recovery payable to medical provider liens and requires pro‑rata sharing within the cap.

Analysis

Apply the Rule to the Facts: You report soft‑tissue injuries with chiropractic and hospital care. Your medical records and a concise provider statement can link the crash to your symptoms (causation) and explain why your course of care was reasonable and necessary. We would present bills limited to amounts paid or still owed to satisfy the evidence rules, then address any provider liens using statutory caps and pro‑rata methods to protect your net recovery.

Process & Timing

1. Who files: You (through your attorney). Where: Civil action filed with the Clerk of Superior Court in the North Carolina county where the crash occurred or where the defendant lives. What: Pre‑suit demand with medical records/bills; if suit is needed, file a Complaint and an AOC‑CV‑100 Civil Summons. When: Aim to resolve pre‑suit in 30–90 days after a complete demand; if not, file suit before the statute of limitations expires (often three years from the crash).
2. Build proof: Obtain treating provider narratives or affidavits, organize bills to show amounts paid/owed, and correct any gaps in treatment documentation. Expect insurer review and, once in court, mediation is commonly required on a set timetable.
3. Resolve liens & finalize: After settlement or judgment, negotiate and pay valid liens within statutory caps, then disburse funds and close the claim.

Exceptions & Pitfalls

• Large gaps in care or missed appointments can undermine “necessity”; document reasons (work, childcare, access) and resume care as advised.
• Preexisting conditions are not disqualifying, but you must separate prior symptoms from new or aggravated injuries.
• Submitting sticker‑price bills without clarifying paid/owed amounts invites Rule 414 pushback; present the correct figures.
• Medicare, Medicaid, ERISA, and State Health Plan recovery rights can override or differ from provider lien caps; address them early to avoid delays.
• Signing broad medical authorizations or giving recorded statements can harm your claim; tailor disclosures to what is relevant.

Talk to a Personal Injury Attorney

If you're dealing with an insurer disputing the reasonableness or necessity of your treatment, our firm has experienced attorneys who can help you understand your options and timelines. Call us 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.