What can I do if an insurer's settlement evaluation does not include all of my physical therapy visits?

First, Confirm What the Insurer Actually Reviewed

A settlement evaluation may omit physical therapy for several reasons. The insurer may not have received every record, a billing statement may cover only part of the treatment period, or the adjuster may have received a bill without the corresponding treatment notes. In other cases, the records were received but the insurer questioned whether certain visits were related to the accident.

Start by comparing the insurer's evaluation with the claimant's complete treatment history. A useful review should answer:

• What physical therapy dates appear in the provider's records?
• Which dates appear on the itemized bill or account ledger?
• What records and bills were previously sent to the insurer?
• Which visits appear to be missing from the insurer's summary?
• Did the insurer exclude the visits, or did it simply use a different total?

Requesting the insurer's medical expense summary, if one is available, can make this comparison easier. Keep copies of the request and the insurer's response.

Submit a Focused Request for Reevaluation

A request for reevaluation should do more than state that treatment was overlooked. It should show exactly what is missing and provide the documents needed to review it.

The supplemental submission may include:

• A list of the omitted dates of service.
• Physical therapy evaluation notes, daily treatment notes, progress notes, and discharge records, if applicable.
• An itemized bill or ledger matching charges to treatment dates.
• Any existing referral, treatment order, or medical record connecting the therapy to the injuries at issue.
• Health insurance explanations of benefits when they help reconcile billed, adjusted, and paid amounts.
• A copy of the earlier demand or counteroffer and proof of what was previously submitted.

It is often helpful to mark the relevant pages or organize the documents by date. The cover letter can identify the earlier total, the omitted visits, and the corrected treatment record without requiring the adjuster to reconstruct the history from a large file.

Updated evidence should generally be sent promptly. An insurer cannot meaningfully consider records or charges it has not received. If the submission includes new information, the letter should clearly ask the adjuster to confirm receipt and issue an updated evaluation.

Why Complete Records Matter

Physical therapy bills show charges, but treatment notes provide important context. They may document the reason for each visit, the symptoms reported, the services provided, attendance, progress, and the treatment period. That information can help address whether the visits are connected to the accident rather than a separate condition.

An insurer may still raise questions about causation, gaps in care, prior symptoms, repeated services, or whether all charges are supported by the records. When that happens, an existing report from a treating provider may help clarify the medical history or the relationship between the treatment and the injury. Obtaining or interpreting medical opinions should be handled carefully and without asking a provider to change an accurate record.

The number of visits or the total charges does not control the settlement evaluation by itself. A North Carolina personal injury claim may also involve the nature of the injury, how it affected the claimant, lost income if supported, out-of-pocket expenses, available insurance, disputed fault, and other case-specific evidence. The insurer may reconsider the claim without increasing its offer or without accepting every charge.

Do Not Overlook Billing and Reimbursement Issues

The provider's ledger should be reviewed for duplicate entries, incorrect accident dates, unrelated treatment, adjustments, insurance payments, and outstanding balances. A clean reconciliation reduces confusion about what was charged and what remains owed.

Medical provider claims, health-plan reimbursement rights, or other liens may also affect how settlement proceeds can be distributed. These issues are separate from whether the insurer included every visit in its evaluation, but they should usually be reviewed before settlement paperwork is completed. Do not assume that an amount listed as billed is the same as the amount that must ultimately be paid from a recovery.

Be Careful Before Signing a Release

If the claim has not settled, the claimant or attorney can continue discussing the omitted treatment with the insurer. A signed settlement release, however, will usually resolve the covered injury claim and prevent a later request for additional compensation. Review the treatment totals and settlement paperwork before signing.

Also keep the lawsuit deadline in view while the insurer reevaluates the claim. N.C. Gen. Stat. § 1-52 provides a three-year period for many North Carolina actions involving injury to a person, although the correct deadline depends on the claim. Settlement negotiations, a pending counteroffer, and a request for reevaluation do not automatically extend the time to file a lawsuit.

How This Applies to the Submitted Counteroffer

Here, an attorney previously sent a settlement counteroffer and believes that part of the claimant's physical therapy was not considered. Requesting reevaluation is a reasonable claim-handling step, but the request should identify the exact missing visits rather than relying on a general statement that records were overlooked.

The attorney can compare the treatment timeline, provider ledger, and documents previously sent to the insurer. Any missing records and bills can then be supplied with a short explanation of the corrected totals and a request for written confirmation that the complete therapy course was reviewed. The attorney should also preserve the prior correspondence, submission confirmation, and the insurer's revised response.

Practical Steps While Waiting for a Response

1. Obtain the complete physical therapy record and itemized account ledger.
2. Match each charge to a date of service and treatment note.
3. Identify precisely what was missing from the prior evaluation.
4. Send the omitted material in an organized supplemental package.
5. Ask the insurer to confirm receipt and provide an updated written position.
6. Track any lawsuit deadline separately from settlement discussions.
7. Do not sign a release until the treatment history and settlement terms have been reviewed.