A fender bender can turn your life upside down. Suddenly, you’re dealing with car repairs, potential injuries, and the often-confusing world of insurance claims. Many assume that insurance companies cover all medical care after an accident. Unfortunately, that’s not always the case.
This post explains how too many treatments after an accident or treatments deemed unnecessary can seriously jeopardize your claim in California. Insurance adjusters scrutinize medical records, and excessive or inappropriate treatment can lead to claim denial or devaluation.
Our goal is to help you understand what constitutes reasonable and necessary medical care so you can protect your right to compensation. So, how do you ensure your treatments after an accident don’t raise red flags with insurance companies? Keep reading to find out.
The Insurance Company’s Perspective
Insurance companies are businesses, and their primary goal is to minimize payouts. This means adjusters are trained to carefully review all medical bills related to motor vehicle accidents, looking for anything that seems excessive or unnecessary. They want to ensure that all medical treatments are “reasonable and necessary” – a key concept in insurance claims.
Insurers typically define this as a treatment generally accepted within the medical community for the specific accident injuries sustained and designed to improve the patient’s condition. Anything beyond that can raise red flags.
Here are some common red flags that might make an insurance adjuster question your treatments after an accident:
- Overlapping treatments from multiple providers for the same issue: Seeing several specialists for the same problem simultaneously, without clear coordination, can appear redundant and costly. Insurance companies may view this as an attempt to inflate medical expenses.
- Prolonged treatment beyond what is considered typical for similar injuries: While some injuries require extensive care, treatment that stretches on for months without demonstrable progress can be suspect. Insurers often have guidelines on typical recovery times.
- Unconventional or experimental treatments without clear medical justification: While alternative therapies can be helpful for some, insurers generally prefer established, evidence-based medical care. Experimental treatments without strong supporting research may be denied.
- Treatments that don’t align with the documented injuries from the accident: The treatment plan should directly relate to the documented accident injuries. Extensive treatment for major injuries would seem inconsistent if you only reported minor injuries.
What Constitutes “Too Much” Treatment?
There’s no magic number of medical treatments after an accident that automatically triggers a claim denial. What matters most is the nature and justification of your medical care.
Insurance companies focus on whether the treatment aligns with your specific injuries and contributes to your recovery process. The key is that the treatment must be reasonable and necessary for your injuries.
Let’s look at some examples:
Acceptable
Ongoing physical therapy for a documented whiplash injury. Physical therapy is a common and accepted treatment for whiplash, and consistent attendance at follow-up appointments demonstrates a commitment to recovery.
Questionable
Chiropractic adjustments multiple times a week for months without demonstrable improvement. While chiropractic care can be beneficial, frequent, long-term treatments without showing positive results may be viewed skeptically. Insurance adjusters may question the necessity of continued treatments if there is no improvement in the injured body.
Unacceptable
Seeking medical treatment unrelated to the accident, such as seeing a dermatologist for a pre-existing skin condition, can be viewed as an attempt to exploit the claim. Treatments after the accident must directly relate to injuries sustained. If medical history shows prior similar treatment, clearly demonstrate how the accident worsened the pre-existing issue.
Essential Steps to Protect Your Claim
- Seek treatment after a car accident from qualified and reputable healthcare professionals. This ensures you receive appropriate care for your injuries, whether they are physical or emotional. Don’t delay seeking treatment, even if you initially feel okay, as some injuries may not be immediately apparent.
- Ensure all treatments are thoroughly documented, including diagnoses, treatment plans, and progress notes. Detailed medical records are crucial for supporting your claim. This documentation serves as evidence of your injuries and the necessity of your treatment.
- Discuss treatment plans with your doctor and understand the expected duration and necessity of each procedure. Open communication with your healthcare providers is essential. Understanding your treatment plan helps you make informed decisions about your care and ensures it aligns with your recovery goals.
- Be wary of providers who seem to prioritize billing over patient care. Some providers may recommend excessive or unnecessary treatments, which can raise red flags with insurance companies and ultimately hurt your claim. Focus on finding healthcare professionals who prioritize your well-being.
- Seek an accident attorney in Crenshaw to help navigate your insurance policy and the claims process if your accident was in Crenshaw. Before extensive treatment, especially for severe injuries impacting your quality of life, consult our experienced personal injury attorney. They can advise you on protecting your rights and securing fair compensation.
Get the Help You Need
Excessive or unnecessary treatment after a car accident can negatively impact your claim. Focus on reasonable and necessary care, meticulously documenting everything. Consulting an experienced personal injury attorney is crucial, especially if you’re dealing with emotional trauma or hidden injuries affecting your quality of life.
Insurance claims adjusters scrutinize treatment records, so a personalized treatment plan developed with your doctor is essential. If you’ve been injured in or around Crenshaw, our accident attorney in Crenshaw can help. Contact us today for a free consultation.
