Protecting the Injured From Insurance Companies Who Limit Medical Treatment

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by | May 10, 2023 | Personal Injury

At Horn Law, we have dedicated our law practice to protecting the injured. A big part of our work is making sure our injured clients are afforded the best possible medical treatment and rehabilitation.

After suffering a head, neck, back, shoulder or other traumatic injury, there is nothing more important to an injured person than the medical recovery and being able to return to a normal life.

For an injured person, a successful medical recovery starts with proper medical evaluations followed by appropriate medical treatments and rehabilitation. In this regard, it is important that our clients are being treated by rehabilitation-orientated doctors, such as a chiropractic physician or other specialists who make sure the rehabilitation stays on track and the patient is improving.

Unfortunately for many motor vehicle accident victims, health insurance companies are now actively working to limit the amount of medical care and rehabilitation treatment they will cover. What follows is a discussion as to how our legal representation can play an important role in helping the injured person obtain prescribed treatment that will provide the best opportunity for a full medical recovery.

Insurance Companies That Will Not Authorize MRIs and Other Diagnostic Tests

If you are injured playing college or professional football, you are most likely going to get an MRI or other diagnostic test within a very short period of time after the onset of the injury. The reason for this is obvious. Treating doctors want to know the nature and extent of the injury so they can make the medical recommendations that lead to the fastest and best recovery.

However, it doesn’t quite work that way if you are injured in a motor vehicle accident. In many situations, health insurance companies are reluctant to authorize diagnostic tests ordered by the treating doctors. Sometimes it can take weeks (even months) until the diagnostic testing is authorized and administered. For the doctors and patient, this presents a huge obstacle in providing the best medical care.

As an injury lawyer, I can do something about this. When an insurance company tells my clients they will not authorize a diagnostic test recommended by the doctor, we step in and make sure our client receives the testing, including MRIs and other diagnostic tests.

I know that the quicker the doctor can make an assessment of the injury, the sooner the appropriate rehabilitation can take place. I don’t want my client to be compromised in their medical recovery. While injury lawyers are prohibited from paying for the testing or treatment, I often facilitate a medical lien arrangement whereby the medical bills for diagnostic testing are covered under the injury claim settlement.

Insurance Companies That Limit Rehabilitation Treatment

This is becoming more common. Insurance companies save a lot of money on claims by limiting the number of rehabilitation treatments that they will pay for. For example, an insurance company might allow 40 visits to a physical therapist to rehabilitate a shoulder injury. After the patient has had 40 sessions of physical therapy, the patient is told that, in order to continue rehabilitation, they will have to pay for the additional rehabilitation out of their own pocket.

This comes up more and more frequently as insurance companies continue to clamp down on claims. Because we always want our clients to have the full scope of rehabilitation recommended by the doctor, we strive to resolve this situation in a similar way as we do with unauthorized diagnostic testing. With our client’s authorization, we facilitate an arrangement by which the rehabilitation provider agrees to file a lien against the injury settlement to cover the extra rehabilitation expense.

Again, the first priority is to make sure our client is afforded the treatment necessary to fully rehabilitate the injury. Ultimately, the objective of the medical care is to progress the medical recovery until the injured person reaches maximum medical improvement.

Recovering for the Longer-Range Consequences of the Injury

As an injury lawyer, my over-riding responsibility is to obtain a fair, full, and maximum settlement or award for my injured client. Because an injured person is usually entitled to only one settlement or award, it is crucial that the compensation to my client account for every way the injury has impacted my client’s life, including the continuing effects of the injury.

As most rehabilitation doctors, chiropractic physicians, and physical therapists will agree, most injuries trigger an assortment of physical consequences. This is especially true with injuries to the head, neck, back, shoulder, and extremities.

A traumatic injury frequently results in a loss in range of motion and freedom of movement. Often times, injured persons do not have the same physical capacity as they did prior to the accident. Even a slight physical impairment can make it more difficult to engage in extended physical activities, obtain restful sleep, and perform at your pre-accident level. If this is part of the medical evidence, it needs to be accounted for within the settlement.

A traumatic injury also makes a person more vulnerable to on-going aggravation, pain, and discomfort. An injured person is going to have to make a concerted effort to manage the injury. This may mean more reliance on medication or avoiding physical activities. All of this results in a loss in quality of life and is another factor that must be accounted for in the settlement or award.

No matter what the nature and extent of the injury, expert medical opinions are invaluable in identifying the issues an injured person may face as they age. Securing this important evidence from medical experts is another function of the legal representation.

About Doug Horn

Since 1990, Attorney Doug Horn has focused his law practice on representing injured persons in Missouri, Kansas, and across the Midwest. His areas of concentration include cases involving head, neck, back, and other serious injury requiring extended medical care and rehabilitation. In addition to his law practice, Horn frequently presents to national attorney audiences in the area of personal injury law and litigation.