A key component of most personal injury claims is the injured person's "medical special damages," which just means the amount the claimant spent on medical bills while having their injuries diagnosed and treated. 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 type of medical treatment you receive, and the kind of medical providers from whom you receive that treatment. (On a related note, learn how the nature and extent of your injuries affects the value of your personal injury case.)
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 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. One of the insurance industry’s strong 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 you have incurred at the hands 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. (Learn more about how an insurance adjuster determines a personal injury settlement offer.)
Physical therapy. For example, in accident-related 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 plugging 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 those bills 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.
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 timeline was evidence of the seriousness of the injury. (Learn more about "pain and suffering" in a personal injury case.) But again, insurance adjusters are suspicious of physical therapists and chiropractors, believing they treatment longer than necessary to keep their money rolling in.
This article is excerpted from How to Win Your Personal Injury Claim by Attorney Joseph Matthews (Nolo).