What do I do if the insurance adjuster does not believe my medical treatment is related to my car accident?
Detailed Answer
Why Adjusters Question Medical Treatment
Insurance companies look for any reason to reduce or deny a bodily-injury claim. The most common objections are:
Gap in treatment. If you waited days or weeks to see a doctor, the adjuster may argue something else caused the pain.
Pre-existing condition. Prior injuries or degenerative findings on imaging give the insurer ammunition to blame your symptoms on age or prior trauma.
Subjective complaints. Soft-tissue injuries do not show up on X-rays. Adjusters often label these as “non-objective” and minimize their value.
Overlapping events. A second incident (even a minor one) can break the causal chain unless you document why the first crash remains the primary cause.
North Carolina Law on Causation
To win a negligence claim, you must prove the collision proximately caused your injury. North Carolina recognizes medical testimony as the best proof of causation. If litigation becomes necessary, testimony must satisfy Rule of Evidence 702 (qualified opinion based on reliable principles). The statute of limitations for personal-injury lawsuits is three years from the date of the crash under N.C. Gen. Stat. § 1-52(16).
Step-by-Step Plan When the Adjuster Disputes Causation
See the right provider quickly. Prompt treatment creates a clear timeline and minimizes speculation.
Request a narrative report. Ask your treating physician for a short letter stating, “To a reasonable degree of medical certainty, the injuries were caused by the motor-vehicle collision on [date].” The phrase tracks North Carolina evidentiary language.
Gather complete records and bills. Under N.C. Gen. Stat. § 90-411, providers must furnish copies for a reasonable, set fee. Be sure to include diagnostic imaging, progress notes, and discharge summaries.
Document prior health history. If you had similar conditions before the wreck, order those records as well. Show the difference in pain levels or functional ability before and after the crash.
Maintain a pain journal. Daily notes on pain, medication, and activity limits reinforce the timeline and severity.
Consider an independent medical exam (IME). A well-credentialed physician who reviews all records can provide an unbiased opinion linking treatment to the collision.
Keep health insurance involved. Pay your bills through your own coverage when possible. North Carolina s collateral-source rule prevents the at-fault driver from benefiting from your private insurance payments.
Let an attorney handle communications. Statements you make can be misconstrued. An attorney presents medical evidence in the format insurers respect and, if needed, files a lawsuit before the three-year deadline.
What If Settlement Talks Stall?
When the insurer continues to deny causation, filing suit in the county where the crash occurred often changes the conversation. Discovery lets you:
Depose the adjuster on why the claim was denied.
Subpoena the insurer s medical review notes.
Introduce treating-doctor testimony that satisfies Rule 702.
Many carriers reassess their position once faced with trial costs and potential verdict exposure.
Helpful Hints
Always list every complaint at the emergency room intake — absent notes hurt credibility.
Follow through on referrals to specialists or physical therapy; missed appointments suggest the injury is minor.
Save receipts for prescriptions, braces, and mileage to and from appointments.
Avoid social-media posts showing strenuous activity; adjusters monitor public profiles.
Talk to an attorney early. Preserving evidence and framing medical issues correctly is easier at the start than months later.
Ready to strengthen your claim? Insurance companies do not get the final word on your health. Our firm has experienced North Carolina attorneys who fight disputed causation arguments every day. Call us now at 919-313-2737 for a free, no-obligation consultation.
