After filing a claim for an injury, insurance adjusters will investigate your accident and the injuries sustained to determine a settlement amount.
When determining your “total damages,” adjusters will use a formula looking at the type of medical treatment you receive, and the kind of medical providers from who you receive treatment.
A key component of this equation is called "Medical Specials," which just mean the amount that you have spent on medical bills while having your injuries diagnosed and treated. Medical specials typically make up a significant portion of the financial damages in your claim, including any pain and suffering awarded to your settlement amount.
Nonetheless, not all medical treatment is uniform in the eyes of an insurance company, and some types of treatment will be taken more seriously, and hence rated higher than others when it comes down to a final calculation for damages and pain and suffering.
Learn what medical treatment and health care providers are valued higher when figuring the cost of your injury claim:
How Insurance Adjusters Determine Damages
Both the duration and the nature of the medical treatment can affect how insurance adjusters distinguish medical services, as can the type of medical person or facility providing the service.
Treatment vs. Diagnosis- Before a physician can treat an injury, medical personnel have to diagnose it. Typically, the diagnostic process is relatively quick, and the charge for it amounts to a small part of your medical bills, as compared to the cost of the treatment. They compile all of your medical bills together into one medical specials amount.
Periodically, doctors will put a person through many tests and examinations, merely trying to diagnose what’s wrong, and along the way running up large medical bills. In the case that most of the medical bills are for diagnosis only, and the injury amounts to little treatment, an insurance adjuster may not view the total medical specials as accurately reflecting in the injured person’s pain and suffering. As a result, the adjuster might use a lower multiplier for those medical bills in concluding an appropriate range of damages.
“Who-” Provides Care -The kind of care provider that conducts the treatment for your injuries is another major factor in determining how highly your claim will be valued by insurance adjusters. Mainstream western medicine (physicians, hospitals, and medical clinics) with a firm basis in the scientific method and extensive evidence documenting its effectiveness, tends to be highly favored by insurance companies despite the costs associated with this form of care can, at times, mount to extraordinary heights.
In comparison, treatment offered by physical therapy, chiropractic, acupuncture, herbalists, and other nonmainstream medicine tend to be less well studied and well-documented. Otherwise the evidence concerning the practice is mixed. For some individuals these methods are shown to be very helpful. Unfortunately the insurance company involved in your claim is likely to view them as less “real,” and thus deserving of lower damages multiplier when calculating the value of your case.
One deviation to the rule is physical therapy. Though this kind of treatment often goes hand in hand with the discipline of Western Medicine, insurance companies remain biased to it. This is unlucky for accident injuries because many victims reach their maximum recovery potential when prescribed physical therapy treatment. Insurance adjusters remain unfavorable to physical therapy due to the fact of their skepticism towards the actual length of needed treatment. Insurers assume that the physical therapists will stretch out the patient’s course of therapy for as long as they can get away with to rack up higher bills and make themselves more money.
That’s why if you receive treatment for physical therapy amounting to months of time, and the treatment accounts for the largest part of your medical bills, the insurance adjuster is likely to use a lower multiplier when fitting your medical specials into the damages formula. In contrast, if you only receive a few weeks of treatment prescribed and administered by your doctor’s office, an adjuster may lump it with other medical specials.
Additionally, the value of your claim can drop further depending on where you obtain physical therapy care. For example, if your doctor prescribes physical therapy but you receive the actual treatment outside the physician’s office and control, the insurance adjuster might discount the physical therapy bills. Likewise, if you seek physical therapy independently, without it being prescribed or recommended by your primary physician, and the insurer is likely to discount it even more.
Treatments by all Non-Traditional Methods- Care given by chiropractors, herbalists, acupuncturists, massage therapists, and other non-physician healers, unless presented with a rare blessing of a doctor’s prescription, are given even less weight than physical therapy.
However, this does not exclude the opportunity of being reimbursed for these treatments by the liable person’s insurance company. But it does mean that the insurance adjuster handling your claim will not tally these expenses very highly when deciding how to multiply medical specials within the damages formula.
Length of Treatment 
In similar fashion, the duration of your treatment also factors into the value of your claim. A lengthy recovery period overseen by doctors or involving stretched hospital stays will be seen as clear evidence of a serious injury with a high measure of pain and suffering, and will often be given a higher multiplier.
On the other hand, an extended period of treatment mainly at the hand of physical therapists or alternate medical provider (chiropractor, acupuncturists/acupressurist, massage therapists, herbalists, etc.) will be less credible and a lower multiplier. As stated earlier, insurance companies believe these methods of care give treatment longer than necessary to keep their money rolling in, and this is why they are seen as inadequate means of recovery.
Of course, your principle concern should be to seek the kind of medical care with which you are most comfortable and that you think will help you most. But just know that if you choose services not provided by a physician, an insurance company is likely to compensate you a lower rate.
If you were involved in an accident and suffered injuries, you may be entitled to compensation and have a valid injury claim. Our personal injury attorneys are experienced in negotiating and handling the demands of insurance companies. Adjusters are trained and skilled in manipulating injury victims to accept low settlement offers and will make you believe your best interests are their priority.
Our accident injury lawyers are knowledgeable of the laws about your rights and compensation; we won't let adjusters take advantage of your accident. We can tell you what the maximum value of your case is worth, and help you win a fair settlement.
