Why Is Making Sure There Are No Gaps In Your Treatment Important For Your Case In North Carolina?
Key Highlights:
- According to insurance adjusters, gaps in medical treatment North Carolina for your injury are the most-used basis for reducing or denying your injury claim.
- Insurance adjusters can use the contributory negligence rule to argue that missing treatment made your condition worse and effectively block your recovery.
- It is possible to be compensated for your injury from the delayed medical treatment injury claim, but you must provide evidence relating to why the treatment was delayed.
- Consistent medical treatment after accident creates the necessary paper trail to link your injury and accident, which helps establish your case before a jury or adjuster; the solution, however, requires an honest, timely, and documented care provider along with an attorney who is familiar with how to protect your case timeline.
In North Carolina, if you are injured in an accident, there is a gap between the treatment you receive and when you resume treatment that can be used against you from an insurance company’s perspective.
A treatment gap can take many forms. You may have failed to seek or obtain care because of cost, lack of means of transportation, waiting for an appointment with a specialist, feeling your pain would go away, or not appreciating that missing appointments would affect your medical records personal injury lawsuit. Without an explanation for a treatment gap, insurance companies will create their “story” of how you healed, did not suffer serious injuries, or how something other than your accident caused your ongoing pain. This “story” may cost you everything because in North Carolina, if you hold 1% of the fault for an accident, you cannot recover damages of any kind.
I am Robert Tatum, an attorney at the Tatum & Atkinson Law Firm. Since 2005, my partner and I, both of whom are veterans, have utilized our 65-plus years of combined legal expertise to assist injury victims throughout North Carolina in protecting their claims against insurance companies by successfully overcoming one of the most often made and substantial defenses by insurance companies, the treatment gap defense.
What Exactly Is A Treatment Gap, And Why Do Insurers Target It?
In addition to being a treatment gap, which can involve going months without treatment, a treatment gap could mean that a patient has waited two weeks since their accident to see their doctor, failed to make appointments for physical therapy for two consecutive weeks, stopped seeing their physician before when their physician recommends, or failed to attend a follow-up appointment for six weeks or longer without documentation.
Insurers view these treatment gaps as opportunities to discount or deny claims. Their primary argument is this:
“If you were actually injured, you would be seeking treatment.”
It makes sense on the surface. The reality of business is indeed very aggressive. Patients will stop seeking treatment because they have too many bills or are threatened with the loss of their jobs.
Because they cannot find childcare and are unable to care for their child or they have been referred to someone (physician/specialist/etc.) with long wait-time periods (some as long as 6 weeks to get into a physician’s office), or the pain from the original accident may have gone away while they were in physical therapy and they were under the “false impression” that they were no longer injured.
None of these reasons is a valid excuse, but if you do not have documentation for your reason(s), an insurance adjuster may not give you the benefit of the doubt when they determine how much they will pay you for your damages.
The insurance company treatment gap defense is based entirely on the “lack of evidence” (what your records do not say). Therefore, part of your responsibility and that of your attorney will be to make sure the documentation is sufficient and clearly supports your claims.
How North Carolina’s Contributory Negligence Rule Makes Treatment Gaps Especially Dangerous
Comparative negligence is found in nearly every state, meaning that if you were found to be 20% at fault for your injury, your recovery will be reduced by 20%. North Carolina takes a different approach; they utilize the contributory negligence doctrine.
N.C. Gen. Stat. § 1-13 actually relates to the burden of proof for contributory negligence.
The party that is claiming that you contributed to your injury will have to prove that you did so (evidence of your contribution is required). This is an important distinction between the two systems because it allows the insurance companies in North Carolina to get very aggressive in asserting that their insureds contributed to their own injuries.
Insurers not only utilize gaps in medical treatment North Carolina to try to minimize the claim amount from the injury itself. They will also use the gaps as evidence that you caused or aggravated the injury, since you failed to follow medical advice or other treatment guidelines. This presents a huge risk to your case in the event that the argument gains traction.
The insurers in a state that follows the contributory negligence doctrine could use the claim that you did not follow medical advice to assert that you contributed to the ongoing treatment compliance accident case claim by failing to follow that medical advice. If they can gain traction with that argument in your case, they may be able to eliminate your settlement rather than simply reducing it.
For a case in North Carolina involving a treatment compliance accident, it takes more than good medical records; you need to have a well-documented, continuous, easily explained history of care so there is no way the argument can be used against you.
Why A Delayed Medical Treatment Injury Claim Is Hard But Not Hopeless
A delayed medical treatment injury claim begins in a disadvantageous position.
If your first medical record is dated three weeks after your accident, the insurance company is going to ask,
- What happened in those three weeks?
- Did you get injured somewhere else?
- Were you really experiencing pain?
- Why did you wait?
The defense can use the gaps in your treatment or delay in obtaining treatment to assert that you were not as severely injured as you claim or that your injuries are from another cause. That does not mean your claim will be denied, but it does mean you may need to provide additional evidence to close the gap.
The strongest claims with late starts have 3 things in common:
A documented reason for the delay
Financial hardship, transportation restrictions, backlog of specialists, or initial signs that seemed mild but got worse. Make sure to inform your treating physician and ask that they document it in your record.
A consistent history of symptoms
Family members, coworkers, and your personal journal document your ongoing pain from the day of your accident until the day of your first medical appointment.
A connection of the medical records between providers
These providers have reviewed your history and documented the cause of your injuries from your accident and have accounted for your late start in treatment in their documentation.
You will not be disqualified just because you had a late start to your treatment, but you will be disqualified if you cannot explain what happened to cause your treatment start date to be delayed.
How Missed Appointments Damage A North Carolina Personal Injury Case
The type of argument made by an insurer concerning a missed doctor appointments injury claim is about the requirement of mitigation of damages. The law in North Carolina requires that any injured party must take reasonable steps to reduce their losses. The insurance company will use your failure to attend a doctor’s appointment without a reason to show that you did not comply with your obligation to mitigate your losses.
Some of the worst gaps in the record are not always the longest. For instance,
- if you miss several physical therapy appointments in a row,
- It can be seen as a series of missed appointments that show a practice of not following your doctor’s orders.
- If you change doctors without records explaining why or when you decided to stop seeing someone, it is seen as a contradiction to your claim.
- When you stop treatment before your doctor has indicated that you can return to work, it implies you’ve already recovered.
Regardless of whether or not any of these things are actually true, if records do not provide different evidence, then the insurer creates the story.
What to do if you miss an appointment?
- Contact the provider the very day of the appointment, and reschedule it
- Document the reason in a text, email, or diary note
- Instruct your provider to document any scheduled barriers, financial hardships, or delays in referrals in your electronic medical record chart.
- And save any record of reschedule confirmations.
One no-show with documentation and a follow-up usually does not hurt a claim, but a pattern of missed visits with no documentation may be more damaging.
What Medical Records Build The Strongest Injury Settlement Documentation
Injury settlement medical documentation serves as the foundation for your claims valuation. Insurers have a much more difficult time trying to dispute any part of your injury if your medical paper trail is both clear and complete.
Below, we have compiled a list of your most important records to support a personal injury claim in North Carolina:
Injury settlement medical documentation
Records from these visits date and document the inception of your injury.
Primary care and specialist visit notes
These may include the notes from your doctor’s appointment where you are shown to have developed symptoms, received a diagnosis, and were provided with a treatment plan.
Physical therapy and rehabilitation records
These will document both your functional limitations and how you progressed during physical therapy or rehabilitation.
Imaging tests
These may include X-rays, MRIs, CT scans, and other related tests, even if the results are ‘normal’ (the term ‘normal’ does NOT preclude the existence of an injury).
Prescription medication records
These prescription medication records will tie in with your pain management.
Work restrictions
Work restriction letters will connect your ability to work to your income loss as a result of the injury.
Discharge instructions
Discharge instructions will document what you were advised to do and confirm that you complied with the discharge instructions.
Patient Portal Records
According to MedlinePlus, a patient portal is a secure way for patients to communicate with their healthcare providers, to keep a record of their visits, to view test results, to maintain billing statements, to obtain prescription information, and to send messages. All of this becomes critical evidence in support of your claim.
Keep copies of everything related to your treatment:
- appointment summaries,
- referral slips,
- billing statements from the provider,
- messages from the provider,
- letters from the insurance company,
- mileage to all of the appointments, etc.
You cannot rely on someone else to keep track of the complete picture of your recovery.
How Treatment Gaps Affect Compensation: The Full Picture
When the question comes, “How treatment gaps affect compensation?”
It is just one of three factors affecting how much compensation you will receive. The size of the gap and reason for the gap, as well as whether or not there is proof of the gap, will all affect how your case is presented to the parties who are responsible for compensating you for your injuries.
Treatment Issue |
How Insurers Use It |
| Waiting weeks before seeing a doctor | “The accident did not cause the injury.” |
| Missing physical therapy sessions | “The person did not follow treatment.” |
| Stopping care before being cleared | “The injury must have resolved.” |
| Switching providers without explanation | “Treatment was inconsistent and unreliable.” |
| Symptoms returning months later | “Something else caused the current pain.” |
| No documentation of gap reasons | “There is no explanation — we fill in ours.” |
A treatment gap does not necessarily mean that you cannot collect compensation for a North Carolina personal injury case. Documenting your medical care consistently and receiving medical attention promptly will provide you with immediate evidence of the injuries you have sustained and the relation of the injuries to the cause of action. The value of your settlement diminishes when evidence has gaps.
In serious cases with large treatment gaps, when the settlement value would have otherwise been well into the six figures, your settlement value may decrease dramatically before you ever speak with an attorney.
How To Protect Your Claim: A Practical Documentation Checklist
You do not have to have a complete set of medical records to pursue your case; however, you must have consistent, complete, honest, and timely medical records with a documented reason for every gap in treatment.
Follow this checklist from the day of your accident
- See a doctor the day of your accident or the next day, regardless of how minor your injury appears; the reason being when you are hurt, your body produces adrenaline, which prevents you from feeling pain. As such, a doctor’s visit on the same day has the most weight when starting to build your medical records.
- Follow your doctor’s instructions regarding treatment; this includes attending all appointments, following through with any therapies recommended, obtaining all prescriptions, and following the discharge instructions given.
- Immediately reschedule any appointment that you missed; if possible, reschedule on the same day, and retain proof of your rescheduling.
- Document in writing any barriers you encounter in obtaining treatment; barriers may be due to money, transportation, work scheduling, or scheduling to see your physician.
- Write a diary of your symptoms every day; for example, keep track of the date, your pain level, and the things you were unable to do; writing a short daily note about discomfort levels or how little you were able to sleep will help support your claims for non-economic damages in your suit.
- Retain copies of any documentation related to your claim, for example: billing statements, receipts, appointment cards, referral slips, doctor-to-doctor communications, communications from your insurance company, etc.
- Do not post information about your injury on any social media site; there are claims adjusters from insurance companies that search social media for information that contradicts your medical record.
- Before you make a recorded statement regarding what you were told during treatment, contact an attorney; your statements regarding your compliance with treatment are often used in North Carolina as evidence to show contributory negligence.
When Should You Talk To A Lawyer About Treatment Gaps?
There are some reasons.…
- If you’ve missed out on receiving treatment,
- Delayed starting care, stopped counseling early,
- Switched providers,
- Or received a low offer on your case because of your medical history
Talk to a lawyer immediately…
- If the insurer is contacting you,
- If the other party is disputing fault,
- If your injuries are related to conditions that change with time (e.g., traumatic brain injury, spinal cord injuries, etc.).
Talk to a lawyer sooner rather than later because insurers tend to take advantage of lag periods where evidence may be compromised by waiting too long to receive treatment.
Time is dependent on a personal injury claim in North Carolina, and therefore, evidence must be collected in a timely manner in order to preserve evidence such as video footage, witness statements, and records before they are compromised.
If there are any gaps in treatment, an attorney will be able to review your history of treatment.
- Provide you with an explanation for the gaps and provide you with any support documentation (such as medical bills)
- Help organize the necessary proof to substantiate your Personal injury claim evidence NC, and to negotiate vigorously on your behalf against the insurance company when they attempt to use your real-world issues as a reason to deny your claim.
Talk To Tatum & Atkinson Law Firm About Your North Carolina Injury Case
If you’re wondering why is making sure there are no gaps in your treatment is important for your case in North Carolina, here’s your answer: Your medical records are your claim. Each visit to the doctor, symptom recorded, and how you cope with an accident can be used to demonstrate that your accident caused you an injury and has changed your life.
Insurance companies will use gaps in your treatment as an opportunity to write their own version of the story; a local attorney ensures they use yours.
The initial consultation is free, and you will not pay any attorney fees unless we recover money on your behalf. Please call (800) 529-0804 today!
FAQs: Why Is Making Sure There Are No Gaps In Your Treatment Important For Your Case In North Carolina?
Can switching doctors create the appearance of a treatment gap?
Yes, insurers may argue that there is a discrepancy based on your record if there is no documentation to support the reason for switching either the provider or the referral or the provider has retired or moved out of the area. Maintain records of all documentation that supports your change from one provider to another.
What if I missed appointments because I could not afford treatment?
Inform your physician and have the financial barrier documented in your medical chart. Financial hardship is a valid and explainable reason for a gap in treatment and, when properly documented, may enhance the credibility of your claim.
Can telehealth appointments count as ongoing treatment?
Yes, if the history from the telemedicine visit linked the consequences of your injury to the accident-related symptoms, the telehealth visits count as documented care. This is particularly true in instances where it would have been difficult to obtain in-person visits, such as when there were restrictions based on mobility, transportation, scheduling, etc.
What if my symptoms improved and then returned months later?
Obtain treatment immediately and document your return to treatment in as much detail as possible. A patient’s return or worsening of their symptoms will impact the patient’s treatment needs as well as the value of future damages and the value of settlement; however, evidence of these conditions must be entered into the medical records before the insurer questions the continuity of your treatment.
Can a treatment gap affect claims for future medical expenses?
Insurers could use any gaps in care as an excuse to say future treatment isn’t needed or is unrelated to the accident. Documenting an ongoing need for treatment, plus the reason for the gap, through strong physician opinions will be an effective way to refute this argument.
