Short Answer

In North Carolina, an insurance company often refuses to include certain medical treatment in a car-accident settlement when it believes the treatment was not caused by the crash, was not medically necessary, or was not reasonably connected in time and documentation to the accident. Common reasons include a treatment gap, a note suggesting you reached maximum medical improvement (MMI), or questions about whether a flare-up of a pre-existing condition is truly an accident-related aggravation. The fix is usually better proof—especially clear medical records and a provider opinion tying the treatment to the collision—before you decide whether to file suit.

Understanding the Problem

If you were hurt in North Carolina and the at-fault driver’s insurance company is offering to pay only part of your medical expenses, the key issue is usually whether the insurer accepts that your ongoing treatment is related to the crash—especially when your records show a treatment gap and a provider note about reaching maximum medical improvement.

Apply the Law

North Carolina car-accident cases are typically handled as liability claims: the insurer pays (or settles) only for losses it believes were caused by the wreck and are supported by evidence. For medical treatment, the practical legal focus is on causation (did the crash cause or worsen the condition?) and reasonableness/necessity (was the treatment appropriate for the injury?). Disputes are usually resolved through claim documentation, negotiation, pre-suit mediation in some cases, or a lawsuit in the North Carolina trial courts if the parties cannot agree.

Key Requirements

• Crash-related causation: Your records need to show the treatment is for injuries caused by the collision, including an accident-related aggravation of a pre-existing condition.
• Reasonable and medically necessary care: The insurer may challenge treatment it views as excessive, unrelated, or not supported by objective findings or a clear plan of care.
• Consistent timeline and documentation: Long gaps in treatment can make the insurer argue something else caused the symptoms or that you recovered and later had a new problem.
• Clear provider opinions: Notes about “MMI,” discharge, or “symptoms resolved” can be used to argue later treatment is not accident-related unless the provider explains why care resumed.
• Accurate billing and records: Missing records, incomplete itemized bills, or coding/billing confusion can lead to partial “non-payment” in the settlement evaluation.
• Good-faith claim development: Before suit, parties often exchange additional records (and sometimes narrative reports) to narrow disputes and avoid litigation.

What the Statutes Say

• N.C. Gen. Stat. § 7A-38 (Prelitigation mediation of insurance claims) - Allows certain insurance claims to go to pre-suit mediation and tolls time periods while mediation is pending (and for 30 days after it ends).
• N.C. Gen. Stat. § 44-51 (Disputed medical claims and payment) - Recognizes that disputed medical charges may remain unpaid until the dispute is established and determined by law (often relevant when bills/liens are contested).

Analysis

Apply the Rule to the Facts: Here, the insurer is signaling a causation and documentation dispute: it is willing to value only part of the medical treatment because it points to a treatment gap and a note suggesting MMI. The pre-existing condition flare-up raises a second causation issue—whether the crash worsened the condition versus the condition naturally progressing. The most direct way to address both issues is targeted medical proof (complete records plus a clear provider explanation) that connects the later treatment to the crash and explains why the gap and “MMI” note do not mean you were fully recovered.

Process & Timing

1. Who sends records: The injured person (or their attorney). Where: To the insurance adjuster handling the bodily injury claim in North Carolina. What: Complete treatment records and itemized bills, plus any imaging reports and a short provider narrative letter if the dispute is about causation/MMI. When: As soon as the dispute is identified—before you sign any release or settlement paperwork.
2. Claim review and negotiation: The adjuster typically re-evaluates after receiving the missing records or clarifications. If the insurer still disputes the connection, the next step is often a structured demand package that directly addresses (a) the treatment gap and (b) why MMI did not mean “no future care.” Timeframes vary by carrier and complexity.
3. Escalation if needed: If negotiations stall, you may consider pre-suit mediation in appropriate cases (filed through the Clerk of Superior Court) or filing a lawsuit in the appropriate North Carolina trial court so a judge/jury can decide what treatment was caused by the crash.

Exceptions & Pitfalls

• “Treatment gap” arguments: A gap does not automatically defeat your claim, but it gives the insurer a talking point. If the gap happened because symptoms improved and then returned, or because you could not get an appointment, your records should say that plainly.
• MMI is often misunderstood: Insurers may treat “MMI” like a hard stop. In reality, a person can reach a plateau and still need maintenance care, flare-up care, or additional evaluation if symptoms return—if the provider documents why.
• Pre-existing condition confusion: North Carolina law generally allows recovery for an accident-related aggravation, but you must separate what was already going on from what the crash worsened. The cleanest proof is a provider explanation comparing your baseline before the wreck to your symptoms after.
• Incomplete records: Sending only bills without the supporting notes (or missing key visits) often leads to partial valuation. Make sure the insurer has the full chart, not just a summary.
• Signing a release too early: Once you sign a settlement release, you usually cannot come back for more money if additional treatment turns out to be needed later.
• Medical lien/bill disputes: If there is a dispute about the amount or validity of medical charges, payment issues can complicate settlement until the dispute is resolved.

Conclusion

Insurance companies in North Carolina commonly refuse to pay for some post-crash treatment when they dispute causation or medical necessity—especially with a treatment gap, an MMI note, or a flare-up of a pre-existing condition. To move the claim forward, you generally need complete records and a clear medical explanation tying the disputed treatment to the collision. Next step: send the adjuster the missing records and a provider clarification letter (if needed) before you sign any settlement release.

Talk to a Personal Injury Attorney

If you're dealing with an insurer that is refusing to include some of your medical treatment in a North Carolina car-accident settlement, a personal injury attorney can help you organize the right records, address treatment-gap and MMI arguments, and evaluate whether negotiation, mediation, or a lawsuit makes the most sense. Call CONTACT NUMBER to discuss your options and timelines.

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.