Why Follow Suggested Medical Plans?
If the person does not follow the recommendations of the doctor and the case goes to trial, the defense would bring up, in front of the jury, the fact that the person went to the doctor but did not do what he/she recommended and they would argue why they should pay the person for any potential future medical care if they were not going to do it anyway.
I do not tell people to go have injections or go have surgery, but if it is recommended and they do not feel they are in enough pain to warrant having that done, then they really should not have it done.
If they are in enough pain that they needed that relief and they are willing to undergo injections or surgery, then doing it during the case would be the best time to do it. They might as well get it done now if they were going to try to wait it out and then ultimately get treatment 2 or 3 years later.
Do Preexisting Issues Count Toward The Current Case For Damages?
Yes, it would definitely factor in. Insurance companies always look at pre-existing conditions to see if they can say everything was already there before the accident occurred. When we make our demands to the insurance company, we try to get all of the records from the pre-existing condition whether it was from an accident or just something that happened to the person. We provide those records to the insurance company to let them know we were not hiding anything, and we explain how the person’s condition had changed as a result of the injury.
An example would be someone who may have had a lower back surgery 10 years ago, and had not received treatment for 8 years until this accident happened. During that time they were working full time, they were leading a normal life and then this accident happened which caused them to be in pain again. The pre-existing condition definitely plays a role in the way the case is evaluated by the insurance company. We can present this to the jury showing through logical reasoning how their current condition was different from prior to the accident.
We have all lived lives and things have happened to all of us, but that does not mean that just because someone had a back injury 10 years ago, the person who caused the accident yesterday should not be held responsible for the pain they caused today.
How Can A Gap In Care Affect Someone’s Case?
It can be overcome, but it can be very problematic. If the person had an accident and treated for their injuries consistently for a few months but then all of a sudden did not treat for 6 months to a year, it would be understood they did not need the treatment or else they would have sought it out and received it.
If they did not need the treatment during that time, the jury would consider whether something else could have happened during that time period, regardless of whether or not there was any evidence of it. The jury would have this question in the back of their mind when they consider why the person decided to get treatment a year later, or it might even be the mere fact that the person was getting ready to go to court which was why they went back for treatment. This is why it is so important to have consistency of care.
Can You Help Clients Negotiate Medical Bills?
Yes, this is a service we provide. Things can become very difficult, which is why we try to find out at the very beginning what the insurance amount is and if the client has health insurance, so we can let the client know they need to be careful because there is only a certain amount of insurance.
It does become very complicated, and I have had cases where the person knew there was hundreds of thousands of dollars in medical bills because of a very serious crash, but there was only $10,000 in the policy or $50,000 or maybe even $100,000 which would obviously not be able to cover the medical bills.
If the client had health insurance, we will make sure all the providers are aware of that health insurance from the very beginning. There is a certain time period during which the health care providers would have to file with the insurance company, because if they do not do that then the health insurance would not have to pay it either. We try to get the bills paid as we go along and we try not to have them outstanding any more than we have to, although it may still end up that the medical bills are more than the actual settlement.
I recently had a case where this happened. We called the individual providers and tried to negotiate with them and explain to them that there were very low limits and there was only a certain amount available there. We try to get everybody compensated for the services they provided, and for the most part the providers are very receptive to that. They understand that it is what it is and they can continue to bill but they would not be able to get any money from it, which is why they often try to negotiate with us. The last resort would be to do a motion for equitable distribution.
If you get to the point where the medical provider is not willing to negotiate with the person before going to the motion hearing, then they will probably not be willing to negotiate at the motion hearing either. The judge would then make the determination of how that settlement would be dispersed. The judge will often say that if it is a $100,000 settlement, then they would take the attorney fees and costs off of there and then 50% of that would go to the providers split pro-rata, depending on what their medical bills were, and 50% of that would go to the client.
This would not release the client from owing those medical bills, which is actually a popular misconception. Even if the judge allowed us to disperse the funds, meaning the hospital bill was for $100,000 but the funds would only cover $20,000 of that $100,000 hospital bill, the hospital would still have the right to pursue their patient for the remaining balance. This is something we are generally successful in doing, but there would be no way to give someone a 100% guarantee that would happen.
For more information on Medical Care In Personal Injury Case, a free initial consultation is your next best step.