An adjuster will review the extent of your injuries by viewing your medical records. If there are any gaps in your treatment, the value of your claim might significantly drop.
Following an accident, whether you are injured or not, you should visit your doctor for a medical checkup. If you were injured, your doctor will conduct a few tests and depending on the extent of your injuries, you might need to make a follow up visit in order for the doctor to track your injuries and the progress you are making as you heal.
If you regularly miss your appointments, there will be gaps in your treatment and your healing time might be longer than necessary. In the event you file a personal injury claim, the adjuster might use the gaps in your treatment to reduce the value of your claim.
Additionally, the details of your post medical treatment will affect how the adjuster values your claim. The amount you spent while getting your injuries diagnosed and treated will play a key role in your claim. Adjusters use what’s known as “medical specials”, which is basically how much you spent in medical treatment, the kind of medical treatment you received and the kind of medical providers who gave you the treatment.
How Gaps in Medical Treatment Can Affect Your Personal Injury Claim
There are two types of gaps:
- The first gap is the time between when you got into an accident and your first visit to the doctor to get your injuries treated
- The second gap is whereby you had started the treatment process but skipped several months before visiting your doctor.
Once an adjuster sees that there is a gap in your claim, they will use it as evidence that your injuries weren’t as severe as you claimed they were. This is why we emphasize that you should always keep your appointments and keep a personal journal that details your recovery process including all old and new symptoms, pain and hospital visits.
With that being said, sometimes a gap can be due to legitimate reasons. For instance, you may have suffered from an illness that prevented you from going to the hospital for your regular appointments. Whatever your reasons may be for the gap in your medical treatment, ensure that you communicate them to your personal injury attorney.
Ensure that you also follow your doctor’s orders to avoid gaps in your medical treatment. Depending on the severity of your injuries, you may be left with residual effects which might affect you for the rest of your life. You therefore need to take care of yourself and adhere to your doctor’s instructions.
The Right Medical Treatment Will Increase the Value of Your Claim
Adjusters look at the below variables when calculating the value of your claim:
The Kind of Medical Treatment You Received
Treatment vs Diagnosis
Typically, a medical professional would need to diagnose you before giving you any kind of treatment. The diagnostic process is usually fast and does not cost as much as the treatment. Insurance companies do not separate diagnosis from the treatment and will lump the cost for both of these processes together.
In some instances, however, a medical professional might put you through so many tests during the diagnostic process such that a huge part of the bill is the diagnosis while the treatment needed doesn’t cost as much.
An adjuster in such a case might lower the value of your claim because the medical specials do not accurately reflect your pain and suffering.
Non M.D.s vs M.D.s and Hospitals
Insurance adjusters consider mainstream treatment from medical clinics, doctors and physicians as legitimate. It’s not uncommon for insurance adjusters to give a high multiplier in the damages formula for a ridiculously high medical bill from a medical doctor as opposed to one from a chiropractor or a clinic that practices alternative medicine. They do not consider treatment by non M.D.s to be legitimate despite the fact that they are less costly and equally effective. They will still apply a low multiplier.
Physical Therapy
If you were in a car accident or any other kind of accident, physical therapy is usually part of the treatment plan. However, adjusters will still use a low multiplier when calculating your damages especially if you have been going for physical therapy for several months. This is not always the case, however, if you receive a few weeks of therapy prescribed by your doctor. Adjusters usually just lump together the physical therapy with other medical specials.
Adjusters also consider other factors when it comes to physical therapy. For instance, if your doctor prescribes physical therapy but you decide to receive it outside the hospital or doctor’s office the insurance company might discount the physical therapy bill. This is because adjusters believe physical therapists tend to treat patients endlessly. It gets even more complicated if you seek physical therapy without a doctor’s recommendation.
Treatment by Massage Therapists, Herbalists, Chiropractors and Others
Unless a doctor recommends treatment by non-physical healers, an insurance adjuster will compensate you at a much lower rate. At the end of the day it’s up to you to choose a form of treatment that you are most comfortable with. But keep in mind that if you decide to choose medical services not offered in a hospital an insurance adjuster will not count your medical expenses highly.
How Long Your Treatment Lasted
The severity of your injuries will determine the duration of your injuries. A longer period of treatment indicates a long period of healing. You can argue with your adjuster that since you underwent a long period of treatment, you endured a lot of pain and suffering during the process. Of course, the value of your pain and suffering claim boils down to the type of medical treatment you were receiving. As mentioned earlier, adjusters tend to apply a lower multiplier for physical therapy bills because they believe physical therapists extend treatment in order to rake in more money.
Do You Need to Hire a Personal Injury Lawyer?
You might be able to handle a simple claim on your own but if you have a serious case, you might benefit from the experience and expertise of a personal injury lawyer. If you live in Providence, RI, you can get in touch with us via 401-751-0101 for a free initial consultation.
