The "Right" Medical Treatment Increases the Settlement Value of an Injury Claim

Both the nature and duration of the medical treatment you receive will play a large role in how the insurance company values your claim.

A key component of most injury cases is "medical special damages," which just means the amount you have spent on medical bills while having your injuries diagnosed and treated. Medical specials are part of the injury damages formula that adjusters use to figure out your total damages. The formula depends on a number of key factors, including the type of medical treatment you receive, and the kind of medical providers from whom you receive that treatment.

Types of Medical Treatment

According to insurance adjusters, not all medical services are created equal. Both the nature and the duration of a medical service can affect how insurance companies perceive it, as can the type of medical person or facility providing the service.

Let's take a closer look at some of the variables.

Treatment versus diagnosis. Before you can be treated for an injury, medical personnel have to diagnose it. In many cases, the diagnostic process is relatively quick, and the charge for it amounts to a small part of your medical bills, as compared with the cost of treatment. In such cases, insurance companies do not usually bother to make any distinction between diagnosis and treatment. They lump all your medical bills together into one medical specials amount.

Sometimes, though, doctors will put a person through many tests and examinations, simply trying to diagnose what is wrong, and running up large medical bills in the process. If most of the medical bills are for diagnosis only, and the injury winds up requiring little treatment, an insurance adjuster might not view the total medical specials as accurately reflecting the injured person’s pain and suffering. Consequently, the adjuster might use a lower multiplier (see The Multiplier For Injury Claim Valuation) for those medical bills in arriving at the appropriate range of damages.

M.D.s and hospitals versus non-M.D.s. One of the insurance industry’s strong prejudices is in favor of mainstream Western treatment by physicians, hospitals, and medical clinics -- and against physical therapy, chiropractic, acupuncture, and other nonmainstream medicine. Any medical bill you have incurred at the hands or machines of a medical doctor, hospital, or medical clinic, no matter how outrageously expensive, will be considered legitimate by almost any insurance adjuster and will usually be given a high multiplier in the damages formula. Treatments by non­physician medical providers are often equally effective and much less costly, but insurance adjusters tend to apply lower multipliers.

Physical therapy. For example, in accidental injury claims, physical therapy is a common treatment, yet it is generally considered to be lower in the pecking order than other kinds of medical treatment. If you receive a few weeks of physical therapy prescribed and administered by your doctor’s office, an insurance adjuster may lump it in with other medical specials. But if you have physical therapy for months and the therapy accounts for the largest part of your medical bills by far, the insurance adjuster is likely to use a lower multiplier when fitting your medical specials into the damages formula.

Also, where you receive physical therapy may affect how the insurance company views it. If your doctor prescribes physical therapy but you receive the actual treatment outside the doctor’s office and beyond the doctor’s control, the insurance adjuster might discount the physical therapy bills. That’s because insurance companies believe that when left to their own devices, physical therapists tend to treat patients endlessly. And if you seek physical therapy independently, without it having been recommended or prescribed by your physician, an insurance adjuster is likely to discount it even more. 

Treatments by chiropractors, acupuncturists, acupressurists, herbalists, massage therapists, and other non-physician healers. Unless bestowed with the rare blessing of a doctor’s prescription, other nontraditional treatments are given even less weight than physical therapy. This does not mean that you cannot be reimbursed at all for these treatments by the liable person’s insurance company. But it does mean that the insurance adjuster handling your claim will not count these expenses very highly when deciding how to multiply medical specials within the damages formula. Of course, your primary concern should be to obtain the kind of medical care with which you are most comfortable and that you think will help you most. But you should be aware that if you choose services not provided by a physician, an insurance company is likely to compensate you at a lower rate.

Duration of Treatment

Logic says that if an injury receives a long period of medical treatment, the injury requires a long period to heal, and that translates to a high degree of pain and suffering. So, if you undergo a long period of treatment, you can argue to an insurance adjuster that the long treatment was evidence of the seriousness of the injury.

However, insurance adjusters are suspicious of physical therapists and chiropractors, believing that they often give treatment longer than necessary to keep their money rolling in. So, if you have had a long period of physical therapy or chiropractic treatments, an insurance adjuster is less likely to consider that as good evidence of the seriousness of your injury than if you had received a long period of treatment from a physician or medical clinic.

This article is excerpted from How to Win Your Personal Injury Claim by Attorney Joseph Matthews (Nolo).

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