Q-5: Is There a "Gap" in Medical Treatment?

In an ideal world, a personal injury victim would be able to show a clear connection between the accident and the injuries sustained.  In legal jargon, this is known as “causation” – meaning that the Plaintiff can show that the accident was, in fact, the cause of the injuries being claimed.  This is important because insurance companies are always trying to argue that while you may be injured, the accident was not the cause of the injuries.  They like to claim that you must have been hurt before the accident and are trying to get money for an injury that you already had.  Or they try to argue that you hurt yourself after the accident and are trying to link injuries that were not caused by the accident.  

The truth is, many people do have a medical history before their accident, but they were able to manage just fine until they were hit in a car wreck.  In these cases, a previous episode, complaint of temporary soreness or a visit to the chiropractor for help with regular aches and pains may present a molehill that the insurance company will try to turn into a mountain. 

What is a "Gap" in Treatment?

How do you combat these false claims? Begin to seek and receive treatment for injuries immediately after an accident and continue to receive treatment on a consistent basis thereafter. This is a crucial step in proving your injuries are directly related to the accident. If the injured person goes to the emergency room directly from the accident site and then follows-up with a private physician a few days later, it is obvious that the plaintiff was going to the doctor for injuries caused by the accident.  However, sometimes, injured victims have what insurance companies call a “gap in treatment” – meaning that there is a gap between the day the person was injured and the day they finally went to the doctor.  The longer the gap, the more it hurts the case. 

There are several reasons a person who is legitimately injured might delay treatment.  Sometimes, they do not immediately realize that they are seriously injured.  At the accident scene, the adrenalin coursing through their body sometimes blocks pain and the victim doesn’t realize that they have been injured for a few days.  Other times, people realize that they are in pain shortly after the accident, but they hope that it is just a sprain that will mend without treatment.  Still, others want to go to a doctor, but they don’t have insurance or, if they do, they can’t afford the co-pays.  So they go without treatment even though they know they need it.  Regardless of the reason, a gap in treatment – particularly a long gap in treatment – can reduce the value of a case.

Visit Your Doctor Regularly Following Your Accident

In addition to the “gap” between the car accident and the initial visit to the doctor, there sometimes is a gap between doctor visits.  This can also hurt your case.  Say, for example, that a person is hit in a car wreck, goes to the emergency room, has therapy for two weeks, but then has to go back to work and does not return to the doctor for an additional three months.  At that point, the pain becomes so bad that he goes back to the doctor and gets an MRI, which shows damage to the disc in the spine.  In such a case, the three-month gap will give the insurance company an argument that if the accident were really the cause of the injury, you would not have waited three months to go back to the doctor. 

This is not to say that a gap in treatment will kill your case, but it doesn’t help.  Thus, if you are injured in an accident, it is best to go to the hospital or doctor as soon as you realize that you are injured.  Moreover, you need to go to the doctor/physical therapist/chiropractor consistently and keep all your appointments.  If you have a conflict that requires you to miss an appointment, call the doctor’s office ahead of time and reschedule so the office notes will reflect that you weren’t simply ignoring the appointment. 

Don't Delay Treatment For Any Reason! 

If you do have a gap in treatment, make sure that you explain to the doctor why you didn’t go earlier so the doctor may put that in the notes explaining your circumstances.  You also may want to keep a journal explaining your daily pain and the activities of daily living that you are not able to do because of the accident.  It is important to note, avoiding going to the doctor because you do not have insurance or can’t pay the co-pays is only going to hurt you more in the long run. Get the treatment you need and take care of your injuries. In the end, it will help you and your case! 

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