Gaps in Treatment

Gaps in Treatment

How gaps in treatment destroy your health and your case

The most common mistake people make during their personal injury case is allowing gaps in their medical treatment. A gap in treatment is a period of time where a patient misses treatment with one of their health care providers. For example, missing your physical therapy session or failing to go back to your doctor for follow-ups. Sometimes there are good explanations for gaps in treatment, like a death in the family, an unexpected emergency, or a pre-planned family vacation. Those type of events will not hurt your case. If you had a situation like any of those, make sure you tell your doctor why you missed the medical appointment. That way your doctor can write the reason for your gap in treatment in your medical records.

What Being Finalized Means

Serious gaps in treatment in many situations can kill your case. You can lose thousands of dollars off your settlement from unexplainable gaps in medical treatment. Doctors who don’t know how to manage your care as it relates to your case cause gaps in treatment. The biggest mistake I see is doctors telling patients they have been “finalized” or have reached “maximum medical improvement.” After hearing that, patients think they’re done with treatment and don’t need follow-ups anymore. This is an expensive misunderstanding for your settlement, and more importantly, your health.

The Two Types of Medical Care

There are two types of medical care: rehabilitative care and palliative care. Rehabilitative care is when the doctors are trying to stabilize your injuries to keep you from getting worse. Once stable, doctors try to heal your injuries. For example, a broken leg may require surgery and then a cast to maintain alignment while the fracture heals. After the cast removal, doctors prescribe physical therapy to improve your strength, flexibility, and muscle function. In other types of injuries without a broken bone, the treatment is designed to reduce the pain and inflammation. Reducing pain and inflammation helps your muscles return to normal. This takes pressure off nerves and breaks the pain cycle. Once the healing process begins, the doctors will change your treatment plan. This helps the body strengthen and increases flexibility.

The American Medical Association says rehabilitative care, in most cases, should take about six months. After six months of rehabilitative care, you should reach a medical plateau. In other words, you reach “maximum medical improvement,” or MMI. Unfortunately, many doctors and patients think this is the end of the treatment, which is completely wrong. After MMI, the next phase of treatment is called palliative or maintenance care.

Palliative Care

Palliative care specializes in focusing on pain relief from permanent symptoms and pain caused by injuries. The goal of palliative care is to improve the quality of life for the patient, to prevent and slow down the effects of degeneration such as arthritis, to keep your function and mobility as high as possible and to prevent set-backs. A team of doctors, nurses, and other specialists provide palliative care and work together to provide an extra layer of health. This type of care is designed to maximize bodily function, reduce flare-ups, and promote the highest level of health possible. Examples of palliative care include stretching, massage, chiropractic adjustments, physical therapy, medication, and occasional re-evaluations by specialists like orthopedic surgeons, neurologists, and psychiatrists.

Everyone understands the rehabilitative treatment phase. If you don’t get treatment for injuries right away they get worse, not better; hurt people seek treatment. When the first phase of treatment is over, many people stop because they don’t know or understand the value of palliative or maintenance care. Once healed, people think they can stop treating. This is a big mistake because continued treatment will keep you feeling good longer. If you don’t maintain your health, it will start to gradually decline. Sure, no one likes going to the doctor, but consider this: if you continue maintenance care, you will feel better, have more energy, and function at a higher level. It will extend your good health and slow down the long term effects of arthritis.

The Importance of Maintenance

If you don’t do the maintenance and palliative care, your body will experience the effects of arthritis sooner. You may also experience degeneration of the joints, ligaments, and tendons. As a result, you will experience a rapid decline in your health. This may require more serious treatment such as pain management or surgery. From a purely logical standpoint, it is extremely important to maintain your health at the highest level possible. Think about this: star athletes who are in great health and injury-free, take advantage of palliative health care to maintain high-quality health and maximum bodily function.

At the end of the rehabilitative care phase after an accident, your doctor will write down your future medical needs in your records. The doctor may be specific and tell you to get monthly massages, stretch daily, undergo six weeks of aggressive palliative care once per year, meet with a neurologist twice per year, and get an MRI every two years. Usually these recommendations are for the rest of your life. Lawyers use these recommendations to explain to an insurance adjuster or jury how expensive your future palliative medical care will be as a result of the accident.

Why Gaps in Treatment Kill Your Case

When a doctor writes maintenance instructions for you in your medical records and you do not follow them and have big gaps in treatment, it is difficult to communicate the full extent of your injuries to an audience. It causes jurors or the insurance company to think, “Hmmm, if I’m hurt, I would seek treatment and keep maintaining my health. So the client must not hurt that badly since they stopped treating and aren’t listening to their doctors.” This leads to clients receiving no compensation for their future medical care caused by an accident. Remember, someone else’s negligence caused your injuries. If you don’t keep treating, why would anyone pay you for your future medical care? If you don’t follow your doctor’s’ orders and actively maintain your health, you hurt your health and your case.

Ask your doctors, “What can we do to help maintain the level of health that I have today? What can we do to prevent the degenerative process from taking over? What can we do to delay  arthritis and degeneration?” If your doctor says there’s nothing you can do, look for another doctor. Find a doctor that is thinking about the long term effects your injury will have on your life. When a doctor finalizes you or you are at MMI, it means the rehabilitative phase is complete and you are ready for the second phase of your treatment. I hope understanding why maintenance care is so important will help you live a longer, healthier, and higher-quality life.

0 thoughts on “Gaps in Treatment”

  1. Matt,
    I watched your video on Systems for Maximizing Your personal Injury Practice that I ordered from Trial Guides. Just wanted to say thank you and that I found the video informative and helpful. About a 1/4 of my caseload is personal injury and even though I’ve been practicing for 31 years, I am always looking forward to improve my practice for my clients. Thank you again.


    • Hi Steve,
      Thank you for watching the video about how to maximize the efficiency of your cases. I appreciate your feedback. It has taken me many years to figure out a good system to process cases much more efficiently. The client’s are happier when they get their case settled for full and fair value quicker. Thanks again, Matt


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