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How Do Delays and Gaps In Medical Treatment Affect a Car Accident Claim?
Medical treatment is the single most important factor that insurance companies consider when paying out car accident claims. Insurance companies consider both the amount of the treatment as well as the nature of the treatment. Medical treatment provides the insurance company with measurables that they know how to evaluate.
This includes whether the type of treatment was reasonable and necessary. This also includes whether the charges for the treatment were customary. Finally, an insurance company may consider the course of the treatment as well as the providers who rendered it.
What Medical Treatment Does the Insurance Company Expect to See for a Soft Tissue Injury?
What treatment the insurance company expects to see for an injury differs depending on the injury. Obviously, the treatment for a broken leg is much different than the treatment for a soft tissue injury. Soft tissue injuries are strains and sprains. They include whiplash injuries and lumbar strains which occur frequently in a car accident.
A soft tissue injury typically has the following course of treatment. A person seeks out treatment at the emergency room, urgent care or with a primary care doctor within the first five days following a car accident. At the initial evaluation, the provider may order x-rays and prescribe muscle relaxers or other pain medication.
Typically, the patient is told to go home and rest and use pain medication as needed. The patient is also told to return for a follow up appointment if his or her condition does not improve over the next 2-5 days. If the patient does not improve, he or she then follows up for another appointment and further evaluation.
During the return appointment, the provider will evaluate the patient again. If warranted, the provider may order additional treatment. Often times this includes physical therapy or other rehabilitative treatment such as chiropractic care. The length and amount of the rehabilitative care may differ. However, typically, it is 2-3 times per week for the course of between 6-12 weeks.
What Additional Treatment May Be Required If I Suffered a Disc Injury in a Car Accident?
When the client’s car accident injury results in a disc injury, the treatment required can be much more extensive than what is described above. “Disc injuries” is a broad term for any spinal injury involving the discs. The discs are jelly like structures that separate the vertebrae bones which make up the spinal column. These discs provide the spine with cushioning to absorb impacts and also allows the spine to bend and twist.
When these discs are compromised, the symptoms can be painful and debilitating. Often times, they cause nerve pain. Some typical disc injuries include:
- Herniated discs
- Disc bulges
- Ruptured discs
- Disc fissures
When someone has a disc injury that impinges on the spinal cord, there can be several symptoms. These symptoms include:
- Shooting sensations through limbs
- Radiculopathy or pins and needles in the limbs
- Numbness in the limbs
- Radiating pain
When someone has a disc injury, a diagnostic test is performed to confirm it. Most often an MRI of the spine is performed to determine if it is a disc injury and to what extent. Once the disc injury is confirmed, the provider may choose to treat it conservatively or with more invasive procedures. Typically, an appointment with an orthopedic surgeon is indicated and scheduled. The decision on how to treat the injury is made after that consultation.
Treating a disc injury conservatively includes additional physical therapy. If the physical therapy does not alleviate the problems, then a patient may be referred to a pain management doctor. A pain management doctor may then decide if spinal injections should be tried to help with the condition.
Often times, a pain management doctor will administer a steroid injection. Sometimes, the steroid injection will fix the problem. Other times, it will not and may need to be repeated. If the client or patient exhausts pain management options, the next step is a follow-up appointment with the orthopedic surgeon.
The orthopedic surgeon and patient can then discuss what options the patient has. This can include living with the pain and managing it or scheduling a surgical procedure to try to correct the condition.
Will Gaps In Treatment Affect My Injury Claim?
Insurance companies do not like seeing gaps in medical treatment. When there are significant gaps in medical treatment, the insurance company can then argue that something else caused the injury. In other words, an intervening event or trauma caused the injury, not the car accident. Gaps in treatment do not necessarily mean that someone cannot recover for their car accident claim. However, this should be navigated carefully with a skilled personal injury attorney.
Will Delays In Treatment Affect My Injury Claim?
Insurance companies do not like to see delays in treatment either. Substantial delays in treatment give the insurance company wiggle room to argue that something else is responsible for the injury. Of course, not everyone can arrange for the exact treatment the insurance company likes and is accustomed to seeing. If you have significant delays in treatment, you should consult with an experienced car accident attorney to determine the best way to handle this issue.
If I Get No Medical Treatment Will It Affect My Car Accident Claim?
No treatment will absolutely affect your car accident claim and may make it that you receive little or nothing for your injuries. Simply put, insurance companies equate medical treatment with injury. Without it, the insurance company has no measurable benchmark to assess your car accident claim. Worse yet, the insurance company may believe you were not injured at all.
Two people could have identical injuries from the same car accident. One person could receive medical treatment while the other person declined and decided to self-treat at home. Both people could have identical pain and suffering. However, in the eyes of the insurance company, the person who treated will be the only one that was injured and the only one who is deserving of compensation for that injury.
The Medical Treatment Must Be Reasonable
The medical treatment a person receives as the result of a car accident must be reasonable for an insurance company to recognize and pay for it. Just because a person has a lot of treatment, does not mean that the insurance company will pay for it or recognize that it was needed. For example, if a person suffers a whiplash injury and treats every day with a chiropractor for a year straight, that is not reasonable.
Not only is such treatment not reasonable in the length of time, it is also not reasonable in the consecutive days it was provided. Typically, a person must wait a few days between treatments for he or she to receive the benefits of the treatment. An insurance company confronted with this set of circumstances would not believe the treatment was reasonable or necessary.
The insurance company would take the position that the individual overtreated. The insurance company would likely only consider 2-4 appointments a week for 4-6 months as reasonable. This would likely be the outer bounds of what they would consider and the most they would pay for and relate to the injury.
The medical treatment a person receives as the result of a car accident must be reasonable for an insurance company to recognize and pay for it.
Likewise, if someone waited for six months following a car accident to begin treating for a lumbar strain or whiplash injury, the insurance company would not find that reasonable. Most soft tissue injuries heal within the first 4-6 months with or without treatment. As a result, if someone waited until the customary symptom period was over and then began treating, the treatment would be discredited by the insurance company. The insurance company would conclude that the treatment was not reasonable or related to any injury caused by the car accident.
Of course, all the above are subject to exceptions. Each case is different and fact specific. If you have an experienced attorney, he will give you the best chance of a recovery if these issues exist.
Our attorneys have dealt with both delays and gaps in treatment and have helped clients recover in the past. Sometimes, there are explanations and reasons as to why these gaps and delays exist. It is the attorney’s job to explain to the insurance company why they exist and obtain a recovery if possible.
The Charges for the Medical Treatment Must Be Customary
An insurance company will only pay for the customary charges of the medical treatment received. The insurance companies have extensive databases listing what charges are reasonable and customary for services clients received. These databases are adjusted to the exact geographic areas where the treatment was rendered. In sum, the insurance company knows what providers typically charge in the area where the services are performed and will pay no more than that amount.
An insurance company will only pay for the customary charges of the medical treatment received.
For example, assume a client treats with a physical therapist and is charged $250 for massage therapy and therapeutic exercises. However, the insurance company, by analyzing its database, determines that the customary amount of those services is $100. The insurance company will only pay the $100 it believes is reasonable.
Contact a Skilled Personal Injury Attorney to Handle Your Car Accident Claim
If you or a loved one was involved in a car accident or suffered other serious personal injuries, contact our law firm today. Nothing is more important than experience when handling a car accident or serious injury claim. Our personal injury attorneys have extensive experience obtaining top results and high dollar settlements in serious injury claims. We know what the insurance companies think and do and can use that to your advantage so you receive as much money as possible for your injury case. Contact us today for a free consultation. We only charge a fee if we recover for you.
About the author: The content on this page was provided by Scottsdale personal injury attorney and civil rights lawyer Tony Piccuta. Piccuta graduated with honors from Indiana University-Maurer School of Law in Bloomington, Indiana (Previously Ranked Top 35 US News & World Report). Piccuta took and passed the State bars of Arizona, California, Illinois and Nevada (all on the first try). He actively practices throughout Arizona and California. He is a trial attorney that regularly handles serious personal injury cases and civil rights lawsuits. He has obtained six and seven figure verdicts in both state and federal court. He has been recognized by Super Lawyers for six years straight. He is a member of the Arizona Association of Justice, Maricopa County Bar Association, Scottsdale Bar Association, American Association for Justice, National Police Accountability Project and Consumer Attorneys of California, among other organizations.
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