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Avoid Red Flags with Insurance Companies: Treatment Gaps

Mary Erney December 14, 2017

You were just involved in an automobile accident. You are dealing with the adrenaline of the accident and trying to figure out exactly what just happened. Once the dust settles, your next steps may be critical as it relates to your potential claim against the at-fault driver, his/her insurance company, and possibly your own insurance company.

 

Once the police arrive, they will first determine if anybody is injured and requires an ambulance. Depending on the extent of your injuries, it may be the case that you require immediate medical attention and the ambulance will take you swiftly to the hospital. However, often times I speak with clients who tell me that they were in a state of shock and weren’t able to fully grasp the extent of their injuries at the time. They knew they were hurt, but did not want to be taken to the hospital by ambulance.

 

If you refuse to be taken to the hospital by squad, and you feel that you may be injured, it is critical that you seek treatment either that day or the following day.

 

Insurance companies are looking for every possible red flag to devalue your case and pay you less money than you may be entitled to, such as:

 

Gaps in treatment

 

            A) Waiting too long following the accident

 

A gap in treatment may come in two forms. First, you could wait too long following your accident to see a doctor. As mentioned above, it is best to first seek treatment either that day or the following day. For example, a significant gap may be waiting for one month following the accident, whereas an insignificant gap may be waiting three to five days following the accident.

 

So why does this matter?

 

Insurance companies are looking for every possible way to pay you less money. If you have a significant gap in treatment, they will likely argue that you were either a) not really hurt or b) your injury is not related to the automobile accident but rather, happened sometime after the accident but before you first sought treatment.

 

This now lowers the value of the case, and may possibly result in the insurance company denying your claim altogether.

 

            B) Treating, then waiting too long to follow-up

 

The second gap in treatment is when you treat immediately following the accident, but then do not follow-up with your physician’s treatment plan. For example, your physician may recommend that you have surgery or physical therapy. Something comes up in your life or your job, and you wait one or two months before following up with your physician’s recommendations.

 

So why does this matter?

 

Insurance companies may look at this and again question whether a) your injuries were that serious and/or b) whether your injuries were worsened by something else that happened in that timeframe.

 

In sum, to avoid giving insurance companies a reason to devalue your claim, stick with your doctor’s orders and see your treatment through until you are completely healed, and your doctor agrees.

 

If you have a valid reason for a gap in treatment, such as a family emergency or some other sort of emergency, be sure to document the reason for your gap in treatment with your physician and keep your lawyer updated so we can properly explain your situation to the insurance company.    

 

Finally, if you have any questions or need help with presenting your claim with the at-fault insurance company, call us at 614-258-6100. That is what we do.

 

 

Mary E. Erney, Esq.

Robert D. Erney, Esq.