Significance of Post-Accident Medical Treatment

The formula used by insurance companies, when calculating the value of a submitted claim, relies on the insertion of certain sums of money. Those represent the total cash that the claimant has spent on medical bills.

Insurance companies are interested in the cost of any treatment, not the cost of any diagnostic procedures.

Still, if the claimant had undergone standard x-ray procedures, prior to treatment, the insurance adjuster would probably lump the cost of such x-rays with the treatment. On the other hand, if someone were to be the subject of multiple diagnostic tests, and then that same person received a minor treatment, the adjuster would have reason to withhold reimbursement of the diagnostic procedures.

Factors that affect an insurer’s assessment of the value obtained by the adjuster, when using the standard formula:

Insurers check to see who provided the treatment that was part of the claimant’s recovery program.

—Had the treatment been prescribed and administered by a medical doctor?
—Had the healer been a non-physician? That would be someone that was able to administer an alternative type of treatment, such as:

A physical therapist, especially one that worked with the patient outside of the doctor’s office, or outside of a rehabilitation facility.

• A chiropractor
• An acupuncturist
• An administrator of acupressure procedures
• An herbalist
• A message therapist
• A practitioner of biofeedback
• A practitioner of homeopathy
• A practitioner of naturopathy
• An administrator of procedures that relied on creative visualization

Situations in which the diagnostic results ought to be questioned

That could be the case if an employee with a pre-existing condition were to report an unhealthy or alarming reaction to the movements required, while carrying out an assigned task. The same employee might be examined by a physician at a clinic, or in the emergency room at a local hospital.

The examining doctor’s unfamiliarity with the patient’s condition could account for delivery of an incorrect or incomplete diagnosis. At that point a Personal Injury Lawyer in Brantford or paralegal should contact the ER physician and explain the situation. Then the patient could be referred to a proper specialist.

A different situation could result from a miscommunication in the offices of the doctor that was supposed to offer the diagnosis. That could cause the insurance company to receive an incorrect diagnosis.

Here again, a lawyer or paralegal should intervene. He or she should explain the situation to the insurance company. Then the physician performing the diagnostic procedures should release the correct results, along with an explanation for the previous mix-up.

A lawyer’s intervention would keep the insurance company from questioning the veracity of any claims. If it suspected fraud on the part of the claimant, it could call for performance of a private investigation.