Can the Insurance Company Control My Medical Treatment?

The single most important thing that you can do after an injury is to promptly get the medical treatment that is necessary to help you recover. Contrary to what some insurance adjusters may tell you, they have no right control what treatment you get. Sometimes they try and make you think they do by saying things like:

• “I cannot pay for any treatment after the emergency room” or
• “An MRI isn’t necessary, and we cannot cover it.”

Thankfully, insurance adjusters don’t decide what medical treatment you get or expenses you recover.  The law does.  In Georgia, the law is you are entitled to recover the reasonable value of all necessary expenses resulting from your injury.

What medical treatment is necessary after my injury?

You need to approach your medical treatment just like you would if there was not another person at fault. You know how you feel. If you believe you need to see a doctor, do it. If your doctor orders tests or other treatment, get it. The only insurance company you need to worry about having the o.k. from concerning your treatment is your health insurance, if you have it.

Why do insurance companies try to control my medical treatment?

Adjusters would love to keep you from getting medical treatment, because that reduces the value of your claim. Trying to convince you they, not you, control your medical treatment, is one way they can do that.

Sometimes insurance companies do not prevent you from getting medical treatment, but they delay the treatment.  Unfortunately, insurance companies also win if they only delay your treatment. Then, they argue you had “a gap in treatment”.  They argue that the “gap in treatment” is proof that your injuries resolved and any ongoing medical problems are not their responsibility.

Telling you that they can’t pay for anything after the emergency room may get you to delay your treatment by weeks or months. I’ve had adjusters argue that just a two week delay between emergency room treatment and the first doctor’s visit proved my client wasn’t hurt badly. If you want to read more about how insurers use delay tactics to reduce the value of claims, check out Professor Jay M. Feinman’s book.

Shouldn’t I trust what the adjuster tells me?

No matter how nice or helpful an adjuster seems, remember that their job is to pay you as little as possible.  After all, insurance companies are in business to make money.  They have a host of tactics they use to minimize the amount they pay you.  But, their most effective tactic is influencing your medical treatment decisions.

Don’t ever take an adjuster’s word for what you may or may not do or what you are or are not entitled to recover. Find out what the law actually says. I’m happy to tell you what that is in a free consultation about your personal injury case.  To set up a free consultation, simply call the phone number or complete the “Need Help” form on this page.