Why Gaps in Treatment Hurt an Injury Claim
The argument every adjuster reaches for
When an adjuster reviews an injury claim, one of the first things they look at is the timeline of your medical care. They are looking for gaps: days between the crash and your first visit, or weeks between one appointment and the next.
A gap lets them tell a simple story. If you were really hurt, you would have gone to the doctor. If you stopped going, you must have healed. And if you came back later, something else must have happened in between.
That story is often wrong. People miss appointments for all kinds of reasons that have nothing to do with how they feel. But it is an easy story for an insurer to tell, and a hard one for an injured person to answer after the fact.
The two gaps that matter most
The first gap: between the crash and your first visit. Adrenaline hides pain, and plenty of people feel shaken but fine at the scene, then wake up two days later unable to turn their head. That is normal. But the longer you wait, the more room the insurer has to argue the injury came from somewhere else. Get examined as soon as you can, even if you think you are fine.
The second gap: in the middle of treatment. You start physical therapy, go for three weeks, then stop for a month because of work. When you go back, the insurer will argue the first injury had resolved and the new complaints are unrelated.
Real reasons people miss care
Most gaps have an explanation:
- You could not get time off work, or you were afraid to ask for it
- You had no one to watch your children
- You had no health insurance, or could not afford the copays
- The next available appointment was weeks away
- You were waiting on a referral or an insurance approval
- You felt a little better and tried to push through
Every one of these is understandable. The problem is that the explanation usually exists only in your head. If it is not written down anywhere, the insurer is free to invent its own.
How to protect yourself
- Tell your doctor every symptom, at every visit. If your back still hurts but you only mention your neck, your records will say your back got better.
- Follow the treatment plan. If you cannot, tell your doctor why, so it goes in the chart.
- Keep a short record. A few lines a week about how you feel, what you could not do, and any appointment you had to miss and why.
- Do not quit because you feel a little better. Ask your doctor whether you are done. If you are, that is fine, and the record will show it.
- Tell your lawyer when cost is the problem. There are often ways to keep treatment going: your own medical payments coverage, your health insurance, or providers who will treat you and wait to be paid from the settlement under a medical lien.
If there is already a gap
A gap does not end a claim. It just has to be explained, with records and with the reason. Tell your lawyer about it early, honestly, and with as much detail as you can remember. It is far easier to deal with a gap you know about than one the insurer finds first.
Talk to Boyd
If you have been hurt and are not sure how to keep your care going, call before the gap grows. The consultation is free, and Boyd takes the call himself: (714) 656-2400.