In the aftermath of a car crash, slip-and-fall, or workplace accident, your focus is divided. You’re trying to manage your pain, deal with the trauma of the accident, and tend to life’s normal responsibilities. If it seems like all your time is taken up with doctor’s visits and physical therapy, it’s easy to see why you might need a break. You wonder, does one missed appointment really matter?
The answer is yes, it does matter, especially if you’re involved in litigation over your injury. Insurance companies closely monitor the medical treatment timeline of personal injury claims. When they find that you skipped physical therapy or failed to follow up on specialist referrals, they see evidence that your claim isn’t that serious.
If you live in the Sunshine State, experienced attorneys will tell you that any treatment gap in a Florida injury claim can create severe credibility issues. Here’s a look at why that’s the case, and what you can do to protect your Florida injury claim.
Why Insurers Focus on Treatment Gaps
To understand why insurers care so much about gaps in care, you have to put yourself in the mind of an insurance adjuster. Their primary goal is to minimize the amount of money their company has to pay out. They meticulously scrutinize your medical treatment records, looking for inconsistencies, delays, or gaps.
The adjuster is planning to dismantle your case by questioning the three main elements of any personal injury claim: documentation, causation, and credibility. Here’s why each of these components is important to your case:
Documentation
Your medical records are the primary evidence of the severity of your injuries, the pain you’re experiencing, and the cost of your recovery. When you stop going to the doctor, the documentation stops.
To an insurer, if there are no medical records for a specific length of time, you were not in pain or struggling during that period.
Causation
In any personal injury case, you must prove causation. This legal concept links the specific accident in question to your injuries. If you wait two months to see a doctor, or if you get treatment for a week and then vanish for three months before returning to a clinic, the insurance company will argue that something else caused your pain during that gap.
For example, the insurance company might suggest that you tweaked your back at the gym, and that’s the cause of your current pain. In court, this could break the chain of causation between the policyholder’s negligence and your injury.
Credibility
Insurance adjusters operate on a simple, often unfair assumption: “If you were truly as injured as you claim, you would be doing everything in your power to get medical help.”
When you miss appointments or delay care, they use this to attack your credibility. They will argue that your injuries must have resolved, or worse, that you are exaggerating your pain for a financial settlement. Ultimately, missed appointments hurt injury claims because they give the defense ammunition to label you an unreliable claimant.
Common Reasons Gaps Happen (and How to Document Them)
At Long & Jean, P.A., we know you aren’t skipping doctor’s appointments because you don’t need treatment. We understand that life in the real world is complicated. There are several legitimate reasons that gaps in your healthcare might happen, including:
- The high cost of healthcare: If you don’t have adequate health insurance (or any coverage at all), you might be unable to afford the out-of-pocket costs or high deductibles required to continue seeing a doctor.
- Lack of access to specialists: It can take weeks or even months to get an appointment with an orthopedic surgeon or a neurologist, or to get an MRI. These gaps in healthcare are not your fault, but they can still help insurance companies question your case.
- Inflexible work schedules: Taking time off work for physical therapy three times a week is impossible for many hourly workers or single parents. Fearing job loss or missing out on essential wages is a powerful deterrent to seeking care.
- Family obligations: When you’re a caregiver for young children or elderly parents, finding the time and coverage to sit in a doctor’s waiting room can be a logistical nightmare.
For these and other reasons, some gaps in medical treatment are unavoidable. The best way to ensure they aren’t used against you is to document them. For example, if you can’t afford care, keep your bank statements, denial letters from health insurance carriers, or emails with your doctor’s billing department.
If your specialist appointment is still a ways out, save all communications that document the gap between referral and your appointment date. If work or childcare obligations are the issue, save copies of your timecards and all communications with your HR department regarding your inability to take time off.
Steps to Protect Your Claim if You Missed Care
If you already have some gaps in medical treatment, don’t panic. Get back on track as soon as you can to help mitigate any damage to your claim. Here’s what to do:
- Schedule a follow-up immediately: Pick up the phone and schedule an appointment with your doctor, physical therapist, or other professional, as soon as you can.
- Explain your absence: When you resume treatment, be honest about why it happened. Ask the doctor to include these reasons in their notes, as this puts your justification on the official record.
- Request alternatives: If you can’t afford the treatment plan recommended by your doctor, ask about exercises you can do at home in place of physical therapy. Also, inquire about telehealth appointments that might better fit your schedule.
If you do have to pause or stop care, make sure your doctor’s notes explain why. And even if you know you can’t afford additional care, don’t ignore the doctor’s instructions. If they tell you to follow up with an orthopedist within three days, contact them and explain your situation.
Not following medical advice is known in court as a “failure to mitigate damages,” which is something you don’t want on your record.
Evidence That Helps Explain Gaps in Care
Doctors’ records are excellent evidence in a personal injury case. But if you must have gaps in your medical treatment, you can still provide evidence of your condition. Here are a few things you can control that serve as proof you were still suffering from the accident:
- Symptom logs: Keep a journal of your daily pain levels (on a scale of 1-10). Also, document any physical limitations you experience throughout the day. Make a list of any at-home remedies you use to help alleviate the pain (e.g., ice packs, heating pads).
- Pharmacy receipts: Collect receipts for OTC pain relievers, braces, or other items you purchased at the pharmacy during treatment gaps. These records prove you were actively trying to manage your pain between doctor’s visits.
- Work records: Emails to your boss or HR department mentioning your ongoing pain or requesting time off are strong evidence of your ongoing suffering.
- Witness statements: Friends, family members, and co-workers can share written testimony about the changes they observed in your physical abilities during the gap period.
When Legal Help Makes Sense
Maintaining a perfect timeline of personal injury care is tricky. Insurance adjusters are professionals who look for a single lapse in your records that can help them win the case. Even if you’re doing everything right, it’s best to have an experienced legal professional at your side, working to get you the best outcome.
That’s why the best time to seek legal help is immediately after your accident, before any gaps have the chance to form. An experienced attorney can often help you find doctors who will treat you on a Letter of Protection (LOP), meaning you don’t have to pay out-of-pocket until your case settles, effectively eliminating cost-related treatment gaps.
If you already have some gaps in care, it’s even more imperative that you seek legal counsel right away. Bring all the documentation you can — medical records, email communications with doctors or your work — and explain why you missed your appointment. A lawyer experienced in Florida personal injury cases, like the team at Long & Jean, P.A., will know how to frame this evidence to protect your rights.
Protecting Your Florida Injury Claim
Gaps in medical care can jeopardize your personal injury claim in any state, but it’s particularly damaging in Florida.
Because the Florida state legislature passed strict Personal Injury Protection (PIP) laws, insurance companies can capitalize on undocumented gaps in care. PIP dictates that you must seek initial treatment within 14 days of an auto accident to access your benefits. This makes it even more critical to seek medical and legal help as soon as possible.
The team at Long & Jean, P.A. knows how insurance adjusters can exploit a treatment gap in a Florida injury claim. Get the legal assistance you need before the record works against you, and contact us today.
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