Short Answer

Yes. In North Carolina, you can seek compensation for the aggravation of a pre-existing condition if the crash or incident proximately caused it. You cannot recover for the underlying condition itself—only the added harm. You must prove medical causation and the extent of the aggravation, and you should watch the three-year deadline to file a lawsuit if negotiations stall.

Understanding the Problem

You want to know if, in North Carolina, you can include the worsening of a prior shoulder surgery when negotiating with the insurer on your personal injury claim. The key decision point is: can you claim money for the accident-caused aggravation, and what proof do you need now to support it?

Apply the Law

Under North Carolina law, an at-fault party is responsible for harm they cause, including the aggravation of a pre-existing condition. The law does not allow double recovery for problems that existed beforehand, but it does allow recovery for the additional pain, treatment, and losses that flow from the new trauma. Negotiations usually happen with the liability insurer; if settlement fails, you file a civil lawsuit in the county where the crash occurred or where the defendant lives. The core deadline for most negligence-based injury suits is three years from the date of injury.

Key Requirements

• Negligence and causation: Show the other party’s fault and that the crash proximately caused a measurable worsening of your condition.
• Pre-existing baseline: Establish what your shoulder was like before the accident (symptoms, function, and restrictions) to separate old issues from new harm.
• Medical proof of aggravation: Use treatment records and, when needed, a provider’s opinion to link the new symptoms, imaging, or treatment to the accident.
• Damages: Document the reasonable value of medical care related to the aggravation, lost income, pain and suffering, and necessary out-of-pocket costs (including travel to treatment when reasonably necessary).
• Documentation quality: Keep complete records (prior surgery records, new diagnostics, referrals, therapy notes) to support causation and apportionment.
• Deadline awareness: Track the three-year statute of limitations to preserve your right to sue if negotiations fail.

What the Statutes Say

• North Carolina Gen. Stat. § 1-52 (Limitations of actions) - Most personal injury claims must be filed within three years of the injury.
• North Carolina Gen. Stat. § 8-58.1 (Medical expenses evidence) - Provides a way to prove that medical bills were reasonable and necessary.
• North Carolina Rule of Evidence 414 (Medical expenses paid or payable) - Limits proof of medical charges to amounts actually paid or necessary to satisfy the bills.

Analysis

Apply the Rule to the Facts: You report a prior shoulder surgery and new aggravation after the accident. Your emergency, primary care, orthopedic, neurology, and physical therapy records can establish the baseline and the post-accident worsening. Reasonable travel expenses tied to necessary treatment may be included. The insurer’s low offer and “final” figure are common; your counter should be anchored in clear medical causation and properly documented damages, including only the accident-caused aggravation.

Process & Timing

1. Who files: The injured person (through counsel). Where: First to the liability insurer; if unresolved, file a civil Complaint with the Clerk of Superior Court in the appropriate North Carolina county. What: Settlement demand package (medical records/bills, prior records for baseline, wage proof, mileage log); if suit, file a Complaint and AOC-CV-100 Summons. When: Aim to resolve or file suit within the three-year statute of limitations.
2. Negotiation: Expect back-and-forth offers over a few weeks to a few months as the adjuster reviews records, requests clarifications, or questions causation/apportionment.
3. Resolution: If you settle, you will sign a Release and receive settlement funds after lien/claim resolution. If not, the case proceeds in District or Superior Court (venue depends on the amount claimed).

Exceptions & Pitfalls

• Contributory negligence: If you were even slightly at fault, North Carolina’s contributory negligence rule can bar recovery entirely.
• No double recovery: You can’t recover for the pre-existing condition itself—only the accident-caused aggravation supported by medical evidence.
• Documentation gaps: Long gaps in care, missing prior records, or lack of a clear medical opinion on causation/apportionment weaken the claim.
• Medical bills proof: Under Rule 414, insurers focus on amounts paid or payable—not the full sticker price of bills—so tailor your demand accordingly.
• Liens and subrogation: Health insurance, Medicare, or Medicaid may assert liens; address them before finalizing settlement.
• Release language: Broad releases can waive future claims; confirm the scope aligns with the settlement of the aggravation at issue.

Talk to a Personal Injury Attorney

If you're dealing with an insurance claim involving a worsened pre-existing condition, 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.