How Avoid Loss in Accident Injury Claim Value Due to Treatment Gaps

If you are treating for an injury from an accident and miss a week or two of treatments you will have a gap in treatment which is also called a treatment gap.  Treatment gaps sometimes happen when, in the middle of your treatment, you miss a week or two of treatment due to a family emergency or vacation.  In California if your medical records show such a treatment gap the insurance company computer software named Colossus may decrease the value of your claim. This problem is easily prevented in California if you simply tell your doctor or therapist that you are going to have a treatment gap before you go and ask them to record the good reason or even to just record the reason when you return.

Reasons for gaps in treatment

There are many reasons for treatment gaps. You may be very busy with your family, work or other things.  You may be a good patient and try to make all of your appointments but life just keeps getting in the way. You may have gaps in treatment due to some of the following reasons:

  1. You go on vacation.
  2. You have a family emergency such as with an aged parent
  3. A loved one passes away.

If one of these thing s happens you may just forget to tell your doctor or therapist that you are going to be missing treatments.  Then, when you return you realize that you have created this huge gap in treatment and wonder if it will hurt your case.

Colossus software reduces case value if gaps in treatment found

In California, when the insurance adjuster of the person who caused the accident receives your medical records and bills the adjuster starts feeding the information into a computer software program called Colossus.  The adjuster enters your date of injury and each date you received treatment into the software, The job of the software is to compute a financial value of your claim. If the computer software spots a treatment gap it automatically offers less money on your claim. The reason for this is that the insurance adjuster can now say “You could not have been injured too badly because you took a week or two off treatment.”

Fix the problem by asking your doctor to record the reason on your records

The Colossus software program in California only deducts for gaps in treatment for which no reasonable excuse is stated by the doctor in the medical records. If you know you are going to go on vacation just tell your doctor and ask the doctor to write in the records something like “Patient had a pre-planned vacation and advised would be out of treatment for two weeks.” Colossus is programmed in California and to accept a vacation as a reasonable excuse for a gap in treatment with no deduction in case value. If you have a family emergency and don’t have time to tell the doctor then when you return you should ask the doctor to record something like “Patient had a family emergency and had to be out of treatment for two weeks.”

Then, when your records and bills are submitted to the insurance company a cover letter should just point out the doctor’s note and, if there was a reasonable excuse for the treatment gap, there should be no deduction in California by Colossus or the adjuster.


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