Gaps in Treatment during COVID-19


June 9, 2020

When evaluating a personal injury claim, insurance adjusters routinely look at your medical records. One of the first things they look for are “gaps in treatment.” In the insurance industry, a “gap in treatment” is a term that means that your medical records show a gap or break in seeking medical attention for injuries that were caused by an accident or incident. A gap in treatment can mean you did not seek medical attention immediately after the accident. It could also mean that you did seek medical attention immediately after the collision, but at some point after you began your medical treatment, there was a significant period of time wherein you did not seek/receive medical treatment.

The insurance industry uses “gaps in treatment” to discount your medical treatment. To an insurance adjuster, a gap in treatment means you did not need medical care or that you weren’t in pain. In the real world, though, we all know that there are many different reasons why someone would not seek immediate medical attention or allow a significant amount of time to pass between doctor visits. Some people don’t have the medical insurance or money to pay for treatment. Others may not be able to take off of work for doctor visits or may have recently relocated to a new city where they have more limited treatment options.

A gap in medical treatment has never been a valid reason to discount someone’s medical treatment, but the events of the past three months have further discredited that point of view. The COVID-19 pandemic began shutting down a multitude of business worldwide in early March, including many healthcare facilities. As of the date of this article, many healthcare facilities continue to be either closed or operating at a reduced capacity. Sadly, some have been shut down altogether.

As a result, if you needed medical treatment in the past three months, it is highly probable that your medical provider was not able to see you for treatment for a period of time. In fact, given the priority that was given to COVID-19 patients and the burden that those patients placed on many facilities across the world, even those who were in need of emergency medical care were at times not able to receive treatment in some areas. Furthermore, some people undoubtedly decided that even though they were in pain and had access to a healthcare provider, seeking treatment was not a good idea because of the increased risk of exposing themselves to COVID-19, and certainly no one would fault them for that decision.

So, in light of the recent dynamics of COVID-19, how can the insurance industry continue to use “gaps in treatment” as a basis for discounting, and in some cases, denying claims? The prudent insurance carriers will not continue to do so, because they realize that the world has changed, including how people are forced to deal with their injuries and receive treatment. The imprudent insurance carriers, though, will continue to robotically chant “gaps in treatment” in evaluating their claims, but when those claims become lawsuits, they will soon find a jury made up of six or twelve human beings who have all been through the events of COVD-19 and who will judge those insurance companies harshly for continuing to make the same old “gaps in treatment” argument.

Are you having issues with contacting a medical provider or seeking treatment following a motor vehicle crash? Give our office a call today and make a free appointment to speak with one of our Car Crash Specialist.

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