How the "Right" Medical Treatment Can Increase an Injury Settlement

A key component of most personal injury claims is the total amount of medical bills related to diagnosis and treatment of the claimant's accident-related injuries. But it's not just the dollar amount of the medical treatment that's considered when valuing a personal injury settlement. The type of medical treatment behind those bills is also a big factor.

What Are "Medical Special Damages"?

"Damages" is just another word for an injured person's accident-related losses. "Medical special damages" (or "medical specials") are part of the personal injury compensation formula that many insurance companies use to figure out a claimant's total losses.

The formula depends on a number of key factors, including:

• the total amount of your accident-related medical bills
• the type of medical treatment you receive, and
• the kind of medical providers from whom you receive that treatment.

Insurance adjusters will tell you that not all medical services are created equal when it comes to figuring out the value of a personal injury claim. Let's take a closer look at some of the variables.

Injury Treatment Versus Injury 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 don't 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's 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 use a lower multiplier for those medical bills in arriving at the appropriate range of damages.

Learn more about medical bills and your personal injury claim.

M.D.'s and Hospitals Versus Non-M.D.'s

Right or wrong, one of the insurance industry's prejudices is in favor of mainstream treatment by physicians, hospitals, and medical clinics—and against physical therapy, chiropractic, acupuncture, and so-called "alternative" medicine.

Any medical bill that comes from 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 non-physician medical providers are often equally effective and much less costly, but insurance adjusters tend to apply lower multipliers. (Learn more about how an insurance adjuster determines a personal injury settlement offer.)

Does Physical Therapy Increase Settlement Value?

In accident-related injury claims, physical therapy is a common treatment, but it's generally considered to be lower in the pecking order than other kinds of medical care. That's not to suggest that physical therapy is seen as less legitimate; it's just that compared with diagnosis and treatment from an M.D. or a specialist, physical therapy carries less weight in the eyes of claims adjusters.

If you receive a few weeks of physical therapy prescribed by your doctor's office, an insurance adjuster may lump it in with other medical specials, especially if your medical records show that physical therapy was recommended—and your progress was monitored—by your doctor.

But if you decide on your own to see a physical therapist 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 plugging your medical specials into the damages formula.

Chiropractors, Acupuncturists, and Other Non-Physicians

Unless bestowed with the rare blessing of a doctor's prescription, other nontraditional treatments are given less weight than physical therapy. This doesn't 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 obtaining the kind of medical care you're most comfortable with, and that you think will help you most. Just 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 and Injury Settlement Value

Logic says that if an injury receives a long period of medical treatment, it's followed by a long period of healing, 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 timeline was evidence of the seriousness of the injury.

What's Next?

Understanding how your medical treatment affects the value of your settlement is just one piece of the puzzle when it comes to your personal injury claim. To learn more about a closely-related issue, check out how the nature and extent of your injuries affects injury case value.

And if you're concerned that your treatment records might not paint a complete picture of your personal injury damages, it might make sense to see if an attorney might be able to best frame your accident-related medical care for a fair settlement. Learn more about hiring and working with a personal injury lawyer.

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