It is not uncommon for a person to experience a violent, traumatic event as a result of another’s negligence and express no complaints of pain. We have all heard people say, “wait a few days and you will feel it.” Many times people will experience pain as a result of such an event immediately. They will be taken to the emergency room by ambulance.
The ER doctor will exam the victim and take x-rays. After the x-rays are completed, the doctor will tell the person there is nothing broken and that he should follow up with his regular doctor if the pain continues. Meanwhile, the ER doc provides his patient with a prescription for powerful pain medication, an anti-inflammatory and a muscle relaxer. The victim fills the prescriptions, takes the medications as directed until they are gone two-three weeks later . . . and his pain returns.
The patient calls his primary doctor to schedule an appointment only to find out the doctor does not treat accident victims. After searching high and low, the injured fellow finds another doctor that accepts his health insurance who will see him in 2 weeks. The new doctor immediately recognizes the poor victim’s symptoms and refers him out for an MRI. 2 weeks later the MRI is completed and the report shows a 5mm bulge of the disc at C5/C6 that effaces the thecal sac. Upon receipt of the report, the doctor immediately refers the patient to an orthopedic surgeon who, after attempting to treat the condition with additional conservative care, recommends surgery.
After the victim’s treatment for his injury is completed, the insurance adjuster handling the injury claim suggests that the surgical condition wasn’t caused by the violent, traumatic incident. If it were the cause, there wouldn’t have been a 5-6 week gap in medical treatment – something else must have been the cause of the condition.
Behr Law Firm is knowledgable and experienced with responding to assertions related to “gaps in treatment.”
Victims of another’s negligence who sustain significant injuries requiring extensive medical treatment are often concerned about paying for their medical care with their own health insurance or with their Medicare/Medicaid benefits.
Because maintaining a course of treatment and being assertive about returning to a productive lifestyle is important for personal injury claimants and because the outcome of the victim’s claims against the responsible party is often uncertain, Behr Law Firm typically recommends that clients’ pay for their medical care with available health insurance coverage as much as possible. Part of the reason for this is that clients have an expectation that their bills will be paid by the responsible party or its liability insurer as they are incurred. That simply does not happen when a person sustains a serious injury that requires extensive medical care and a long period of recovery. As a result, the bills go unpaid and eventually are reported to the appropriate credit bureaus. For many, this is unacceptable and is one of the reasons we typically recommend using available health coverage.
At the same time, we also recognize that clients with health insurance coverage may encounter barriers to receiving the health benefits – sometimes their medical provider will tell them the health insurer will not pay the claim because it is accident related, sometimes the health insurer will verbally tell the client the same thing (though they refuse to put it in writing), and sometimes the deductible associated with the coverage is so high that the client is unable to cover it. In these instances, Behr Law Firm is able to help clients identify other methods of obtaining medical care and paying for same. Give us a call so we can discuss how.