Mind The Gap

A few years ago, I had a client who fell down some steps at his apartment complex and injured his back. The cleaning company had just mopped the floor, but had not gotten around to putting up the wet floor signs yet. He began treating for his back, but then found himself in jail. The client received medical care for his back while in jail, and was released after approximately 2 months. I don’t do criminal work, and I don’t recall the details of his incarceration, except that it was for something minor. The client completed his care after his release and I was posed with a difficult question. When sending my demand to the cleaning company’s insurance company, should I submit the medical records from the jail, or should I allow them to believe there was a gap in treatment?

Insurance adjustors aren’t original, we know what defenses they will raise and what they are going to say. If you’re injured in a car accident, the insurance adjustor will tell you that you treated too long, that your medical bills are too high, that the injuries you did not have 5 minutes before your car crash are somehow not related to the crash, and if there is a gap in treatment, you clearly were 100% better. In the world of insurance adjusting, there is nothing worse for a plaintiff than a gap in treatment.

So the question is, what constitutes a gap? Generally, it is span of time during active physical therapy or chiropractic care, where you miss appointments or don’t seek treatment. It doesn’t matter to the insurance company if you had to go out of town for work, if you had a death in the family, if there was snow, or if the provider was booked. If you miss appointments, they will tell you that the only possible conclusion is that you didn’t need any more care, and that you are all better. Some benevolent adjustors will consider the circumstances of a gap if it is documented in the medical records, but they are few and far between.

For my client that fell down the wet stairs, it was better that the adjustor heard that my client was in jail than for her to think there was a gap. I was able to negotiate a fair settlement for the client.