Medpay Inquiry from the Other Party’s Insurance
I’m located in Virginia, and the other driver was deemed 100% at fault in my recent car accident. After completing physical therapy, I submitted all necessary documentation to their insurance. However, I was informed today that my claim is still under review due to a so-called “gap in treatment.”
The accident occurred in mid-November, and I attended two orthopedic appointments before starting physical therapy in January. The insurance company is questioning this gap, despite the fact that I attended all scheduled appointments.
What are my options moving forward?
It sounds like you’re dealing with a frustrating situation. Here are a few steps you can take to address the issue with the other party’s insurance regarding the “gap in treatment”:
Gather Documentation: Compile all your medical records, including appointment dates, diagnoses, and treatment plans from both your orthopedic appointments and physical therapy. This documentation can help substantiate your case.
Clarify the Timeline: Create a clear timeline of your treatment. Include the dates of your accident, the orthopedic appointments, and the start of physical therapy. This can help illustrate that your treatment was consistent and necessary.
Contact Your Healthcare Provider: If possible, ask your healthcare provider to provide a statement that explains the necessity of the treatment timeline and why there may have been a delay between appointments. They can also clarify the progression of your injury and treatment plan.
Communicate with the Insurance Adjuster: Reach out to the claims adjuster handling your case and explain your situation. Provide the additional documentation and ask for them to consider it carefully. Maintain a professional demeanor and be persistent.
Request a Review: If the insurance company continues to delay or deny your claim, consider formally requesting a review of your case. Sometimes submitting a written appeal can help escalate the issue.
Consult an Attorney: If you feel overwhelmed or if the insurance company continues to give you trouble, it might be beneficial to consult with a personal injury attorney. They can help advocate on your behalf and ensure that you receive the compensation you deserve.
File a Complaint: If you believe the insurance company is acting in bad faith, you can file a complaint with your state’s insurance commissioner.
Remember to document all your communications with the insurance company, and don’t hesitate to stand up for your rights regarding your medical expenses. Good luck!