Allowing Gaps in Your Medical Treatment

Don’t delay getting medical care, following your doctor’s advice, and following up as prescribed. Failure to do so will become “evidence” that your injuries weren’t that serious.

So many people have gone to the ER right after a wreck but didn’t see their doctors for several weeks after that. A huge mistake. What if when you went to the ER right after the wreck with complaints of knee pain? Those pains could have been masking neck pains that you noticed only later. Such neck pains could get worse and could be signs of a pinched nerve or a herniated disc. You end up later going in for that neck pain, but it’s weeks after the accident. Guess what spin an insurance adjuster will put on that? If an injury shows up in your medical records weeks after an accident, here’s what they’ll be thinking:

  1. Wow! Three weeks later and just now following up? They must have seen some TV lawyer commercials and think they’re going to get rich!
  1. Really? Three weeks with no pain and all of a sudden he goes to the doctor? And he wants to blame it on the wreck? What caused his neck to hurt? It’s probably an old injury he wants us to pay for. Or maybe he did this working around his home. Not on my watch, mister!

The adjuster’s Rule #1 is that if it’s not in a medical record or doctor’s note, it never happened!

I’m not making this up. Adjusters are trained to be cynical, so it’s not all their fault; it’s the culture in which they operate. I see it every day in my practice. I once had an insurance defense lawyer tell me, “I know plaintiffs are lying only when I see their lips moving.” For Heaven’s sake, do not help them out by delaying your treatment.

Make sure you tell your doctor every injury you sustained in your wreck; don’t assume your doctor can figure it out or can guess at it. If your accident made prior injuries worse, tell your doctor that.

I don’t make up these rules; the insurance companies do. We just have to beat them at their own game.

Takeaway: If you’re hurt in a car wreck, go to the doctor immediately and document each pain. Make sure to relate it to the wreck if that’s the truth.

Do Not tell your doctor EVERYTHING

When you go to a doctor for the first visit after your wreck, more likely than not, you’ll be asked to fill out a new patient questionnaire. This document will be highly scrutinized later by the insurance adjuster and defense lawyer. Anything in your handwriting will be closely reviewed; they will try to use anything to defeat your claim.

On that form, there will be basic information about when your pain started. The forms will usually ask you something like, “How long have you had this pain?” If your pain began when the wreck occurred, make sure to note that.

But watch out—if you had pain in that area before the wreck, especially if you were actively being treated for it, make sure to list that prior pain or injury on the doctor’s intake questionnaire. Many people fall into the trap of thinking, “Well, I haven’t been treated for this for weeks or months before this wreck, and I felt better anyway, so I won’t list that.” Wrong thinking! You just severely damaged your case.

What if your knee injury five years ago hasn’t been hurting you, but now you have knee pain due to the wreck? If the form doesn’t ask you about prior injuries, you might end up not telling your doctor about it. “Well, since they didn’t ask, and it’s an old injury that’s better now, it isn’t important, so I won’t list or mention it.” Wrong thinking! You just severely damaged your case.

When I was a claims adjuster in the early 90s, we’d get a claimant’s Social Security number right off the bat so we could put it into the Index System, a joint effort of insurance companies to share claims information about you and your past. I’ve been out of claims since 1997, a time when my cell phone had a cord connected to my car. Can you imagine how much more sophisticated they are now in tracking information about you? The point is that they already know all about your prior claims once you make a claim for injuries. The truth will always come out.

Tell your medical professionals about previous injuries even if they don’t ask, and list them on any medical forms even if there’s no request for them on the forms. This might sound like overkill, but your failure to disclose prior injuries will be used against you later.

Every week, I depose doctors to help prove my clients’ cases and prior (old) injuries are regularly a favorite topic of insurance defense lawyers. Once I finish with my questions to the treating doctor, it’s the defense lawyer’s turn. Let’s take a case with a prior neck injury for example. The insurance defense lawyer’s cross-examination goes something like this.

Q: Doctor, when you first saw Ms. Jones, did you take a history from her?

A: Yes sir, I did.

Q: And is it important to take a history from your patient?

A: Of course.

Q: And when you take that history from the patient, do you expect your patient to be honest with you?

A: Absolutely.

Q: That’s because you base your opinions on what your patient tells you.

A: Yes.

Q: If your patient were to have told you something that was not true or incorrect, your opinions regarding what caused her pain may not be accurate; isn’t that true?

A: Yes.

Q: In Ms. Jones’s case, she told you that her neck pain began on September 13, 2014, the night of this wreck, true?

A: Yes sir, that is what she said.

Q: And that is what she put on the intake form, true?

A: Yes sir.

Q: As a matter of fact, here is a copy of her intake form, and it appears to be in her handwriting, true?

A: Yes, it does appear so.

Q: And on that intake form, you also expect her to tell you the truth and be honest with you, true?

A: Absolutely.

Q: So, when she gave you this history, did she tell you that back in 2009 she was involved in another wreck in which she hurt her neck?

A: (Doctor gets concerned look) Uhhh … no, she never told me that.

Q: Did she tell you she went to a chiropractor for five months for approximately forty visits in 2009?

A: No.

Q: Isn’t that something you would have liked to have known before relating all her pain to this wreck?

A: Yes sir, that would have been nice to have known.

You see what happened here? The truth is, an old neck or knee injury may have completely healed and not bothered you for five years, but by not having mentioned it to your doctor, the defense lawyer has just made you look like a liar. Of course, I will always do my best to explain it away, and how it is not relevant, but … the damage is done.

Insurance defense lawyers love this type of trickery. They know if they can confuse a jury, the jury will not give a plaintiff a fair verdict, and they exploit this. Insurance defense attorneys’ jobs are easy—all they have to do is question everything while proving nothing. All they have to say is “Prove it”; it is your and your attorney’s job to do so.

Don’t help defense attorneys out by opening the door wide enough for them to get their foot into it and claim you’re dishonest. This is exactly how they do it, and I share it with you because I don’t want you to get suckered by them.

I call all my clients at least monthly to find out how they’re doing. If they respond they are great, we work on getting the case settled. But if they’re still hurting, I ask, “When was the last time you told your doctor about that?” If they say it has been a couple of months, I remind them of the insurance company’s rule that if it’s not in a doctor’s note, it didn’t happen. Get back to your doctor and document your injury now!

Takeaway: Always make sure to share all your old, preexisting injuries with your doctor even if you don’t think they relate to your current injuries. Personal injuries are serious and while you may not think your injuries are severe, many injuries such as TBI (Traumatic Brain Injury), do not show up for weeks, months or even years. If you were given an annuity or structured settlement for your injuries, be wary of which company you choose if you want to sell your structured settlement payments.