Short Answer

In North Carolina, insurers pay injury claims based on medical care that is reasonable, necessary, and caused by the accident. If the adjuster cut off payment at “MMI” or after a treatment gap, you can push for a higher offer by getting a clear medical opinion tying your resumed chiropractic care to the accident, organizing concise records and bills showing actual paid amounts, addressing any treatment gaps, and resolving medical liens. If talks stall, filing suit before the deadline preserves your leverage.

Understanding the Problem

In North Carolina, can you negotiate a higher bodily injury settlement for chiropractic care when the insurer says treatment after “maximum medical improvement” will not be covered? Here, the adjuster made an initial offer and refused to cover care beyond the MMI cutoff after you took a break and then resumed treatment.

Apply the Law

Under North Carolina law, an injured person may recover the cost of medical care that is reasonable, necessary, and proximately caused by the at‑fault party. Insurers often dispute chiropractic care that continues after MMI or after a gap, arguing it is maintenance rather than active treatment. Settlement talks usually happen with the liability insurer; if negotiations fail, you may file a lawsuit in the appropriate trial court. A key deadline is the statute of limitations for personal injury, which is generally three years from the injury date.

Key Requirements

• Causation: A treating provider links your resumed chiropractic care to the original injury (or a flare‑up) from the accident.
• Reasonableness and necessity: Records show why the care was needed (symptoms, exam findings, and a treatment plan) rather than routine maintenance.
• Amount of medical charges: Settlement valuation focuses on amounts paid or owed, not just amounts originally billed.
• Documentation: A concise demand with provider narratives, billing summaries, and proof of payments supports each charge.
• Liens and subrogation: Identify and resolve medical liens or reimbursement claims so more of any settlement flows to you.

What the Statutes Say

• North Carolina Gen. Stat. § 1-52 (Personal injury limitations period) - Most personal injury claims must be filed within three years.
• North Carolina Rule of Evidence 414 (Medical expenses) - Allows evidence of amounts actually paid or necessary to satisfy medical bills.
• North Carolina Gen. Stat. § 44-49 (Medical-provider liens) - Providers may assert liens on personal injury recoveries.
• North Carolina Gen. Stat. § 44-50 (Enforcement and limits of medical liens) - Governs payment priority and caps for medical liens from settlements.

Analysis

Apply the Rule to the Facts: Because you resumed chiropractic care after being released at MMI, the insurer questions causation and necessity. Ask your treating provider for a narrative that explains why the later care addressed ongoing injury symptoms (not maintenance), references exam findings, and connects the flare‑up to the accident. Submit updated records and a billing summary showing amounts paid or owed. Address the treatment gap with a brief explanation (for example, temporary improvement or access issues) and include any referrals to corroborate medical judgment.

Process & Timing

1. Who files: You or your attorney. Where: Liability insurer’s claims department for the at‑fault party. What: A demand package with a cover letter, medical narrative(s), treatment records, billing ledger showing paid/owed amounts, and lien information. When: After you have the provider’s opinion tying resumed care to the accident and before the three-year statute of limitations.
2. Negotiate: The adjuster reviews and may request clarification. Provide focused updates (e.g., a short addendum from the chiropractor or a referral note). Many carriers respond within a few weeks, but timing varies by insurer and county practice.
3. If talks stall: File a lawsuit in the appropriate North Carolina trial court to preserve your claim and apply formal rules of evidence and discovery. Continue negotiating while the case is pending.

Exceptions & Pitfalls

• Pre‑existing conditions or prior similar injuries increase the need for a clear medical explanation tying current care to the accident.
• Unexplained treatment gaps undermine necessity; address the gap and show objective findings when care resumed.
• Submitting only full, undiscounted charges without proof of amounts paid can depress offers; include paid/owed figures.
• Ignoring provider or insurer lien rights can delay settlement distribution; identify, negotiate, and document lien resolutions.
• Recorded statements or broad medical authorizations can be used against you; limit disclosures to relevant time periods and conditions.
• Waiting too long can risk the statute of limitations; calendar the deadline and file suit if needed.

Talk to a Personal Injury Attorney

If you’re dealing with an insurer cutting off chiropractic care after MMI, our firm can help you evaluate medical proof, address liens, and time your next steps. Reach out today to discuss your options. Call (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.