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deny your claim devalue your claim Providence Accident Claim: Gaps in Treatment Devalue Your Claim landry 8

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If you are injured in an accident you will probably be making a few visits to your doctor. There will be tests as well as follow up visits to keep track of your injuries and the progress you are making as you heal. It is extremely important that you keep up with these appointments, because consistency of care is going to benefit you greatly. Secondary to that, if you decide to file a personal injury claim, a gap in treatment could lessen your compensation greatly.

What’s a Gap?

There are two types of gaps in treatment; one is the gap between when you got in the accident and when you first start treating injuries from that accident. For example you were in a car accident, but you did not seek medical help until six months later. The other type of gap is when you did see a doctor for your injuries and then let several months go by before you see him or her again.

In a personal injury case, the insurance adjuster will be looking for ways to devalue your claim. If they see that there is a gap in your medical treatment they will try to use this as evidence that your injuries are not as severe as you are claiming. That is why it is important not only to meet with your doctor regularly, but you should also keep a journal of your visits, pain, and symptoms new or existing.

Legitimate Reasons You May Have a Gap

A gap in treatment does not mean you are not injured. Chances are that if you have a gap in treatment it was not because you weren’t experiencing pain and problems. Sometimes a gap simply cannot be avoided. You may experience a sickness or illness that prevents you from making your appointments. For example, maybe you had an unrelated surgery that required extended healing time, that would be an acceptable explanation for the gap. Perhaps you went out of town on vacation or to visit a sick relative. This is perfectly acceptable and of course your personal injury claim does not mean that you must stop living your life. By communicating anything that could cause a gap in treatment with your attorney, they will be able to document the reasoning behind the hiatus so that it cannot be used against you by the insurance company.

Follow Your Doctors Orders

Put simply, your health and well-being are the most important reason behind avoiding gaps in treatment. When you have injuries from an accident you may be living with them for the rest of your life. The severity may lessen with treatment, but chances are the residual effects will continue to affect you. It is in your best interest to take care of your health and stick with the treatment your doctor suggests, and if you do decide to file a claim it will really help your case.

A key component of most injury cases is “medical special damages,” which just means the amount you have spent on medical bills while having your injuries diagnosed and treated. Medical specials are part of the injury damages formula that adjusters use to figure out your total damages. The formula depends on a number of key factors, including the type of medical treatment you receive, and the kind of medical providers from whom you receive that treatment.

Types of Medical Treatment

According to insurance adjusters, not all medical services are created equal. Both the nature and the duration of a medical service can affect how insurance companies perceive it, as can the type of medical person or facility providing the service.

Let’s take a closer look at some of the variables.

Treatment versus diagnosis. Before you can be treated for an injury, medical personnel have to diagnose it. In many cases, the diagnostic process is relatively quick, and the charge for it amounts to a small part of your medical bills, as compared with the cost of treatment. In such cases, insurance companies do not usually bother to make any distinction between diagnosis and treatment. They lump all your medical bills together into one medical specials amount.

Sometimes, though, doctors will put a person through many tests and examinations, simply trying to diagnose what is wrong, and running up large medical bills in the process. If most of the medical bills are for diagnosis only, and the injury winds up requiring little treatment, an insurance adjuster might not view the total medical specials as accurately reflecting the injured person’s pain and suffering. Consequently, the adjuster might use a lower multiplier for those medical bills in arriving at the appropriate range of damages.

M.D.s and hospitals versus non-M.D.s. One of the insurance industry’s strong prejudices is in favor of mainstream Western treatment by physicians, hospitals, and medical clinics — and against physical therapy, chiropractic, acupuncture, and other nonmainstream medicine. Any medical bill you have incurred at the hands or machines of a medical doctor, hospital, or medical clinic, no matter how outrageously expensive, will be considered legitimate by almost any insurance adjuster and will usually be given a high multiplier in the damages formula. Treatments by non­physician medical providers are often equally effective and much less costly, but insurance adjusters tend to apply lower multipliers.

Physical therapy. For example, in accidental injury claims, physical therapy is a common treatment, yet it is generally considered to be lower in the pecking order than other kinds of medical treatment. If you receive a few weeks of physical therapy prescribed and administered by your doctor’s office, an insurance adjuster may lump it in with other medical specials. But if you have physical therapy for months and the therapy accounts for the largest part of your medical bills by far, the insurance adjuster is likely to use a lower multiplier when fitting your medical specials into the damages formula.

Also, where you receive physical therapy may affect how the insurance company views it. If your doctor prescribes physical therapy but you receive the actual treatment outside the doctor’s office and beyond the doctor’s control, the insurance adjuster might discount the physical therapy bills. That’s because insurance companies believe that when left to their own devices, physical therapists tend to treat patients endlessly. And if you seek physical therapy independently, without it having been recommended or prescribed by your physician, an insurance adjuster is likely to discount it even more.

Treatments by chiropractors, acupuncturists, acupressurists, herbalists, massage therapists, and other non-physician healers. Unless bestowed with the rare blessing of a doctor’s prescription, other nontraditional treatments are given even less weight than physical therapy. This does not mean that you cannot be reimbursed at all for these treatments by the liable person’s insurance company. But it does mean that the insurance adjuster handling your claim will not count these expenses very highly when deciding how to multiply medical specials within the damages formula. Of course, your primary concern should be to obtain the kind of medical care with which you are most comfortable and that you think will help you most. But you should be aware that if you choose services not provided by a physician, an insurance company is likely to compensate you at a lower rate.

Duration of Treatment

Logic says that if an injury receives a long period of medical treatment, the injury requires a long period to heal, and that translates to a high degree of pain and suffering. So, if you undergo a long period of treatment, you can argue to an insurance adjuster that the long treatment was evidence of the seriousness of the injury.

However, insurance adjusters are suspicious of physical therapists and chiropractors, believing that they often give treatment longer than necessary to keep their money rolling in. So, if you have had a long period of physical therapy or chiropractic treatments, an insurance adjuster is less likely to consider that as good evidence of the seriousness of your injury than if you had received a long period of treatment from a physician or medical clinic.