Personal Injury Gap

Gaps in Treatment in Florida Personal Injury Case

Being involved in an accident can have a serious effect on a person’s life. One second you are living you life perfectly fine, the next you may be dealing with serious injuries that may hinder your ability to perform the everyday responsibilities of your life. 

Luckily for you, in the U.S. you are able to pursue compensation for your injuries and losses sustained as a result of an accident caused by the negligence of another. As part of the process of receiving compensation for you injuries and losses, you will likely need to receive medical treatment to get better and to increase the value of your claim.

However, there are ways that an insurance company can devalue your case. 

One of those methods is by claiming that there are significant gaps in your treatment. In other words, the insurance company will argue by saying, essentially, “how hurt can he/she be?” if there are significant delays between your treatments. They will see this as a major red flag. 

During the evaluation of a personal injury claim, the insurance carrier will look for two types of gaps in treatment:

  • Was there a gap between the date of the accident and first seeking medical care?
  • Was there a significant gap between initially seeking medical attention and seeing the appropriate doctor for a follow-up visit?

On a practical level, some gaps in treatment have a perfectly reasonable explanation. You may have gotten sick with COVID and was unable to attend your therapy sessions. You may be caring for a loved one. Your work hours may not allow you to regularly attend therapy (bills have to be paid after all). Make sure you tell your doctor why you missed a medical appointment so they may include it in their medical records.

The insurance companies, however, see this as very black and white. They don’t care to hear personal reasons why there were gaps in your treatment. They will still use any gaps against you to minimize your injuries. 

With that being said, this article will provide some background information on gaps in treatment and how they can affect your Florida personal injury case. 

How gaps in treatment hurt your case

Medical care should begin within 14 days following the accident. Seeking treatment immediately after an accident helps to clearly show the connection between injuries you’re dealing with and the incident noted in your injury claim. Some people choose not to seek medical treatment, because certain car accident injuries aren’t visible or noticeable immediately. Insurance carriers may claim that the injuries were pre-existing and not caused by the accident if a person didn’t go see a doctor within this time frame.

Doctors who don’t know how to manage your care as it relates to your personal injury case can cause gaps in treatment, which can kill your case and cause you to lose thousands of dollars off your settlement. The biggest mistake I see is doctors telling patients they have been “finalized” or have reached “maximum medical improvement.” In a normal accident case, you will be prescribed and complete a treatment plan which may include a certain number of therapy sessions depending on your injuries. You will be doing these therapy sessions 2-3 a week or however often you can. At the end of this treatment plan, a doctor will “finalize” you and say that you have reached the maximum medical improvement that you can. After hearing that, however, patients think they’re done with treatment and don’t need follow-ups anymore. There is still other methods of treatments that you will likely have to do in order to maximize the value of your case, such as palliative maintenance care, visiting an orthopedic specialist, doing MRI’s, etc. Failing to seek continued treatment after being “finalized” can be an expensive mistake.

The Two Types of Medical Care

In a typical accident case, there are two types of medical care: rehabilitative care and palliative care. Rehabilitative care is when the doctors are trying to stabilize your injuries to keep you from getting worse. Once stable, doctors try to heal your injuries. For example, a broken leg may require surgery and then a cast to maintain alignment while the fracture heals. After the cast removal, doctors prescribe physical therapy to improve your strength, flexibility, and muscle function. In other types of injuries without a broken bone, the treatment is designed to reduce the pain and inflammation. Reducing pain and inflammation helps your muscles return to normal. This takes pressure off nerves and breaks the pain cycle. Once the healing process begins, the doctors will change your treatment plan. This helps the body strengthen and increases flexibility.

Rehabilitative care, in most cases, should take about six months. After six months of rehabilitative care, you should reach “maximum medical improvement,” or MMI. Unfortunately, many doctors and patients think this is the end of the treatment, which is completely wrong. After MMI, the next phase of treatment is called palliative or maintenance care. 

Palliative care specializes in focusing on pain relief from permanent symptoms and pain caused by injuries. The goal of palliative care is to improve the quality of life for the patient, to prevent and slow down the effects of degeneration such as arthritis, to keep your function and mobility as high as possible and to prevent set-backs.

Everyone understands the rehabilitative care portion. You’re in an accident, you’re hurt, you get treatment and you get better. They think they’re done. But you need to get palliative maintenance as well as part of your treatment plan. 

If you have been injured in a car accident, then it is really in your best interest to follow your doctor’s treatment plan. When people don’t, that’s a significant red flag for insurance carriers when reviewing personal injury claims. People who are seriously injured are expected to seek the appropriate medical treatment and adhere to the prescribed treatment plan. When someone doesn’t show up for follow-up appointments or doesn’t seek the prescribed treatments, the insurance company will assume that the injuries must not be that serious.

This is one of the most common causes of undervalued or denied personal injury claims. If you don’t follow your doctor’s treatment plan, there isn’t much your attorney will be able to do to recover the compensation you may need.

If you are involve in an accident, call Jaime ”Mr. 786 Abogado” Suarez today to Get You Paid!


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