Gaps in medical treatment and how it affects your personal injury claim

Here at Willis, Willis & Rizzi we often find ourselves speaking to our clients about what insurance companies like to call “gaps in treatment” and how that is beginning to play a role in their personal injury case.

We can classify injuries into two categories: objective injuries and soft tissue injuries.

With objective injuries such as broken bones or injuries to internal organs the treatment is almost automatic. Oftentimes you are being rushed to a hospital, life flighted, you’re being admitted, and having surgery. Your life has been disrupted to the point where you can’t even entertain working and you are not going to get better unless you have the surgery as well as the follow-up treatment. It’s not common to see gaps in medical treatment in these types of cases.

What is far more common is when we have injuries that are not objective such as strains or sprains in the neck and back, or aggravation of a prior injury to those areas such as a previous surgery that has now been disrupted. Or we may have someone who has never had a serious injury but has a sprain that won’t go away in their knee or back.

In these cases what we find is that people are going to do as little medical treatment as possible. They don’t want their lives disrupted any further than what the accident has already disrupted. They have a family, they have a job, and responsibilities so they are going to do as little medical treatment as they can humanly get away with, and we don’t blame them!

However, the insurance companies are going to use this to say the injuries must not be that severe if you’re not seeking medical treatment. So, we need to look at your life circumstances. Are you retired? Do you have job responsibilities? Is your family grown, or do you have little ones at home? What are the circumstances that are competing for your time against this medical treatment?

We have clients who have so many responsibilities they are going to put this treatment last and it’s understandable, it’s almost impossible to get that treatment. We also have clients that don’t have a lot going on, they are retired and otherwise healthy and they can get to these treatments. The insurance companies are going to look at that too – do you have a reason you are not getting to these medical treatments, is it a valid reason? Or is there nothing else going on in your life in which case, you must not be hurting too badly because you have nothing else stopping you from getting to the medical treatments.

Another factor to consider in these types of situations is other health issues. Are you fighting some other disease or injury that has nothing to do with this case, but is demanding a lot of your time for treatment? In those cases, we are almost looking at two files for one person. We may be looking at a person who is going through cancer treatment which has nothing to do with their injury case, except that it does because it is hampering their recovery of the injury case.

The final factor we look at regarding gaps in medical treatment is, is this gap being driven by doctors, or is the gap being driven by you? Sometimes treatments providers will instruct you to take a break after completing a course of therapy to see how you feel. That is technically a gap, but there is documentation that the doctors have instructed you not to treat to see how your body responds.

The main concern is when the doctors are telling you that you should seek a course of treatment and you are not doing that. Insurance companies call this “non-compliant” and they will use this to paint a picture of a person who is claiming they are hurt, but they must not be.

At Willis, Willis & Rizzi we understand that real life is messier and, in our experience, it is usually a function relative to there is only so much time in a person’s life. But it is a factor you need to be aware of in your case. You’re going to hear us say in every case, if you can and your doctor is telling you to go get that treatment, trust your doctor and go get that treatment if at all humanly possible.

The biggest issue here is, how does this claim ultimately resolve. We talk a lot about peace of mind with our clients. And that peace of mind applies to your medical treatment – did you receive the treatment you needed to recover but also how the legal process resolves with your attorney and the insurance company. If you have gaps in medical treatment that not only will disrupt your peace of mind with your medical recovery, but also how your case concludes.

In the most simple terms, a gap in medical treatment is going to lower the value of the case if the insurance company can find a way to make it stick. Gaps in treatment are one of the most common tools that insurance companies use to reduce the value of your personal injury claim.

Contact Willis, Willis & Rizzi today at 330-535-2000 or fill out the form on this page, if you need help with your personal injury claim.