How Gaps in Treatment Affect Injury Claims

One of the frustrations many people experience when trying to settle their personal injury claim with an insurance adjuster is trying to figure out what a “gap in treatment” is, and why the at-fault driver’s insurance refuses to pay for some medical treatment. If you were hurt by someone else, and you have medical bills that are the result of treatment you received following the injury, how is it possible that those bills will be your personal financial responsibility, when the reason you have them in the first place is because someone else was negligent? This article will help people who have been injured in a car crash understand what the insurance companies look for.

 Treatments to the back, neck, and spine, such as chiropractic and physical therapy care, can sometimes last several months after a car crash.

Treatments to the back, neck, and spine, such as chiropractic and physical therapy care, can sometimes last several months after a car crash.

Chronology of Medical Treatment

Immediately following your injury, which for the sake of using an easy to follow example, we’ll say was the result of a car crash. The law in California is that the person who hurt you must make you “whole” again, or put you in as close to the same condition you were in before the car crash. This means physically, emotionally, financially, and sometimes even socially. So if you were hurt, and you seek medical treatment, it follows that the person who hurt you should pay for your medical bills, right? Yes, and no. The at-fault driver is responsible for reasonable and medically-necessary treatment. So the insurance company can deny payment for medical treatment you receive that they say is not the result of your injury, in this example a car crash.

The most common way an insurance adjuster will deny payment on medical bills is by saying there was an unreasonable gap in treatment. If you wait too long to receive treatment, they will argue that you weren’t really hurt, and that treatment you receive after a gap is not really their insured’s responsibility. So what should you do to make sure the insurance adjuster doesn’t refuse to pay your medical bills by saying you waited too long to treat your injury?

 Proper diagnostic studies, such as an MRI, can help avoid gaps in treatment. If you know the severity of the injury, you're better equipped to treat it properly.

Proper diagnostic studies, such as an MRI, can help avoid gaps in treatment. If you know the severity of the injury, you're better equipped to treat it properly.

The first thing any injury lawyer will advise their attorney to do is get a medical checkup as soon as possible. If you’re hurt, go to a doctor. Go to an urgent care, or an emergency room, if necessary, but if you were injured, you need to have a medical professional document the nature of your injury. From there, you should follow the advice you are given. For example, if you go to your primary care physician and he or she tells you that you require an x-ray, or an MRI, then it is your responsibility to follow up and get the care they tell you is needed. If you don’t do what your doctor says, the insurance companies will say you were non-compliant with recommended treatment. This hurts your claim, and as it relates to the outcome of your case, it is more likely you will receive less compensation during the settlement phase of your injury case.

What is a gap in treatment?

Our office has seen insurance adjusters claim that delays in seeking the advice of a doctor for as little as three days after a car accident is unreasonable. More common, any delays of more than five days after a crash will certainly be disputed, and the longer you go in between treatment, the worse it will be for your case. This can be difficult for single parents and anyone who works, as taking off work, or scheduling a babysitter to make it possible for you to visit a doctor and receive the treatment you need is sometimes a difficult obstacle. A good injury attorney will be able to successfully argue that any gaps were not only reasonable, but that you did everything you could to follow up on medical treatment. After all, the injury was not your fault in the first place, so you should not have to turn your life upside down to go to the doctor.

What is a proper treatment sequence?

If your primary care physician says you need chiropractic care, or physical therapy, generally the minimum number of appointments you should plan on attending is one per week; gaps of more than one week can hurt your claim. Of course, life happens and it can be hard to stay consistent with treatment. The medical benefits of going to a chiropractor or physical therapist are greater if you go more frequently; a good chiropractor or physical therapy office will be able to work around your scheduling conflicts, and give you therapy you can do at home to help alleviate your pain. Most personal injury law firms in California are aware of the good chiropractors and physical therapy offices that help people recover from car accidents, as well as those who perhaps have a reputation of not helping their patients reach a full recovery.

what if I need to return to treatment after a gap?

Unfortunately, many people have no choice but to return to treatment, such as a chiropractor or physical therapist, not because their schedule was crazy or they were being lazy, but because their symptoms/injuries returned. That is, after a sequence of treatment at a chiropractor or physical therapist, the doctor says let's see how it goes, and after a few weeks, you realize you are still suffering from pain from the car crash. Most doctors put in their notes that this may happen. This is often referred to as a flair up. Insurance companies do whatever they can to deny paying for these kinds of treatment. In many cases, the only way you'll successfully get them paid for is by hiring an attorney. In fact, this is a common reason people seek advice from an injury lawyer - they have a need to continue medical treatment for their injury, but the at-fault driver's insurance is saying they won't cover the bills.

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Can an Injury Attorney Help?

It is hard to imagine a circumstance where contacting an injury attorney after a car crash would be a bad idea. If nothing else, you'll be able to ask the questions you're wondering about, and get the advice from someone who works on this type of legal case every day. Gaps in treatment can hurt your claim, but not all "gaps" that insurance adjusters deny are fairly denied. Keep in mind that the best attorney to answer your question may not be in town. This is normal, and most injury firms that practice exclusively injury law in California represent clients throughout the state. If you live in a rural area or small town, chances are the best injury lawyer to consult with is not close by. However, many law firms in areas of California with greater populations, such as Orange County and Los Angeles County, are able to fully service clients that live within the state of California, with ease using technology.