Summary
This source explains the legal risks associated with a treatment gap following a personal injury. Legal experts say that delaying medical care or skipping appointments provides grounds for companies to devalue a claim. The industry assumes that a genuinely injured person will seek immediate and consistent professional help. If a significant amount of time passes between the accident and a doctor’s visit, insurers may argue the injury occurred elsewhere. To protect a case, it is essential to document all medical interactions and avoid long pauses in recovery. Consequently, maintaining a consistent treatment schedule is vital for proving the legitimacy of one’s physical damages.
Frequently Asked Questions (FAQs)
What is a gap in treatment in a personal injury case?
A gap in treatment is a term used by the insurance industry to describe a significant delay between the date of an injury and the first medical visit, or a long interval between subsequent appointments. Insurers often use this concept to challenge the validity or severity of a claim.
How do insurance companies view delays in medical care?
Insurance companies often interpret a delay in seeking care as evidence that the injury was not caused by the accident in question or that the condition is not severe enough to warrant immediate attention. They operate on the principle that a truly injured person would seek medical help as soon as possible.
How long of a delay is considered a treatment gap?
No fixed period constitutes a gap; instead, the determination often depends on the specific severity of the claimed injury. For example, waiting a month to treat a suspected broken bone is viewed much more critically than a shorter delay for a less visible injury.
Why can a gap in treatment lead to a denied claim?
Adjusters may deny a claim because they argue the injury likely occurred in a separate incident or that the individual would have sought immediate hospital care if the injury were genuine. This positioning allows the insurance company to question the causal link between the accident and the injury.
What should I do if I have to miss a medical appointment?
If you must miss a visit, notify your legal team so they can document the specific reasons for the delay and prepare a response for your case. Proactive documentation helps explain the circumstances of the gap and addresses potential concerns from the insurance carrier.
Transcription of the Video
You may have seen my last message to you, where I referenced the treatment gap in your case. The Gap in treatment is one of the three reasons why missing your medical appointments can ruin your case. But what is a gap in treatment? Well, that’s a great question. There is no defined period of time. A gap in treatment is insurance industry lingo; it means there has been a long period between an injury and when you go to the doctor or hospital, or a long delay between one medical visit and the next.
Is it one day, two days, or one month? The answer comes down to the severity of the injury. It is industry-accepted that a person who is severely injured will not delay seeking medical treatment. An effective way I can explain this principle is by giving you an example: if you claim you have a broken foot, it is unlikely you will wait a month to go to the doctor.
Therefore, if you’re trying to receive compensation for a broken foot injury and it takes you a month to go to the doctor from the time of the accident, the insurance company is going to deny that claim for a gap in treatment. Why? Because it is the insurance company’s position that you likely broke your foot somewhere else, not in the accident, you would have gone directly to the hospital or a doctor. The bottom line is this: if you have been injured, do not delay in getting treatment. If something truly arises and you need to skip some time, reach out to our team so that we can document any issues related to the Gap and be prepared to respond in your case.
