After an accident, getting medical care may not always be simple. You may miss an appointment because of work, transportation problems, financial concerns, or because you temporarily feel better. Unfortunately, an insurance company may use a gap in treatment to challenge or reduce your personal injury claim.
A treatment gap injury claim is not necessarily invalid. However, gaps in your medical records can create questions about the severity of your injuries and whether your ongoing symptoms are connected to the accident.
Why Do Insurance Companies Focus on Gaps in Treatment?
Medical records are often an important part of a personal injury claim. They can document your injuries, symptoms, treatment, and recovery over time.
When there is a significant break in treatment, an insurance adjuster may argue that:
- Your injuries were not as serious as you claim.
- You recovered and were later injured again.
- Your ongoing symptoms are caused by something other than the accident.
- You failed to follow your doctor’s treatment recommendations.
- You did not take reasonable steps to recover from your injuries.
These arguments may lead to an insurance denial or a lower-than-expected offer.
However, a gap in treatment does not automatically mean your claim should be denied. The reason for the gap and the other evidence available can matter.
Common Reasons for Gaps in Medical Care
There are many legitimate reasons why an injured person may have difficulty continuing treatment. For example, you may be unable to get time off work, lack reliable transportation, have trouble scheduling an appointment, or be concerned about mounting medical bills.
In other cases, a doctor may tell you to wait and see whether your symptoms improve before returning. You may also experience a period of improvement followed by a return or worsening of pain.
If there is a reasonable explanation for the gap, documenting it may help provide important context. Keep records of canceled appointments, scheduling difficulties, referrals, insurance problems, and other circumstances that affected your ability to receive care.
What About Delaying Treatment After a Florida Car Accident?
A gap in ongoing treatment is different from waiting too long to seek initial medical care. For accidents subject to Florida’s Personal Injury Protection (PIP) requirements, Florida law generally requires an injured person to receive qualifying initial medical services and care within 14 days of a motor vehicle accident to obtain PIP medical benefits.
Even when that specific rule does not apply, waiting to seek care can make it more difficult to establish a clear connection between an accident and an injury. Some injuries may not produce immediate or severe symptoms, but prompt medical evaluation can create documentation of when symptoms began and how they developed.
How Can You Protect Your Injury Claim?
If you are receiving treatment after an accident, follow your medical provider’s recommendations as closely as reasonably possible. Attend scheduled appointments and communicate with your provider if you need to cancel or cannot continue a particular course of treatment.
You should also be honest about your symptoms. Do not exaggerate your pain, but do not minimize it either. Tell your medical provider if symptoms improve, worsen, or change.
If you have already experienced a gap in care, do not assume that your case is over. Resume appropriate medical care if you still have symptoms and explain the reason for the interruption to your provider and attorney.
Speak With a Florida Accident Lawyer About a Treatment Gap
Insurance companies may scrutinize medical records for reasons to dispute an injury claim. A Florida accident lawyer can review your treatment history, identify potential issues, and help present evidence explaining why a gap occurred.
If an insurer has questioned your medical treatment or issued an insurance denial, you may still have legal options. An attorney can evaluate the circumstances of your accident, your medical records, and the insurer’s stated reasons for challenging the claim.
A gap in medical treatment can complicate a personal injury case, but it does not automatically eliminate your right to pursue compensation. If you were injured because of someone else’s negligence, consider speaking with a Florida personal injury attorney about your case and the steps you can take to protect your claim.
If you have been involved in a personal injury incident, seeking legal advice is essential to protect your rights. Our legal team has more than 40 years of experience seeking justice for accident victims. Our attorneys have sought and won millions of dollars for our injured clients.
Call 850-601-1111 to schedule a complimentary consultation with no obligations. This consultation will help you explore your legal options. Let us help you fight for fair compensation.
Mark continued his studies at Florida State University College of Law, graduating cum laude in 2008. While in law school, Mark was a member of the Journal of Land Use & Environmental Law and the Journal of Transnational Law & Policy, as well as a certified legal intern with the FSU Public Interest Law Center, where he assisted low-income clients with a wide range of family law issues. He also served as a law clerk intern to The Honorable L. Clayton Roberts of Florida’s First District Court of Appeal.