Can my insurance adjuster cancel my Physical Therapy treatments?

I was in a car accident in November 2012. I have already received about 10 weeks of physical therapy. Upon returning to my doctor for an examination, she determined that I was at about 80% range of motion, and wrote me a prescription for more physical therapy, to return me to 100%. My insurance adjuster called my Physical Therapy office and told them she wasn't going to pay for the second round of treatment, and now the office won't even let me make an appointment. The longer I go without Physical Therapy, the more the pain slowly starts returning. Is this legal? Don't they have to pay for all of my treatments that are prescribed by a doctor?

Long Beach, CA -

Attorney Answers (6)

Asmik Jasmine Gevorkyan

Asmik Jasmine Gevorkyan

Personal Injury Lawyer - Sherman Oaks, CA
Answered

You should contact a personal injury attorney asap. Your attorney will find a doctor who would be willing to continue your treatment on a lien basis. If you have injuries and pain you should receive proper medical attention. You may contact us for a free consultation. We don't charge a fee unless And until there is recovery.

Jasmine Gevorkyan
818-497-8565 direct

The response given is not intended to create, nor does it create an ongoing duty to respond to questions. The... more
Christian K. Lassen II

Christian K. Lassen II

Car / Auto Accident Lawyer - Philadelphia, PA
Answered

Unfortunately, most insurance companies only cover so many pt visits per year. For example, blue cross only covers about 20 visits for my injured clients per year. Have your lawyer send the pt place a letter of protection.

Paul J Molinaro

Paul J Molinaro

Car / Auto Accident Lawyer - Corona, CA
Answered

In general (there are exceptions but these are quite technical and uncommon) Insurance companies do not direct medical care but instead decide which services they will pay for... that means they deny payment not deny care. This is an issue with liability insurers as well as health insurers... and one that has caused a battle for decades now. Fortunately, the patient being denied coverage should be able to easily find a local lawyer who can look for available sources of coverage and use the laws to obtain what his or her client is entitled to receive.

Fortunately, most of us personal injury types offer free consultations and take such cases on contingency, so there is nothing to fear in calling us.

- Paul

Paul J. Molinaro, M.D., J.D.
Attorney at Law, Physician, Broker
Fransen & Molinaro, LLP
980 Montecito Drive, Suite 206
Corona, CA 92879
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David Brian Snyder

David Brian Snyder

Car / Auto Accident Lawyer - Syracuse, NY
Answered

I agree with my colleagues. You should be consulting with a personal injury attorney in your area as soon as you can. There are limitations specific to your state as to the number of physical therapy visits you would be entitled to. If there is a potential lawsuit monetary award expected, your providers may agree to treatment with the expectation that there will be a lien against any award. You will need to be careful because anything that you receive will be reduced by all of the liens that you have including your healthcare (Medicaid/Medicare/insurance/Workers' Compensation). The end result could mean that you do not have any sizable amount of money moving to you at the conclusion of your case. Your attorney should be able to give you a good faith estimate as to the value of your case.

The valuation of a case is not an easy thing for any attorney, and is not an exact science. While the attorney cannot give you any guarantees as to the outcome of the case, if you win the case, there would be an expected value range. At the low end of this range is exceeded by the expected liens, your potential compensation could be nil.

Richard Andrew Harting

Richard Andrew Harting

Car / Auto Accident Lawyer - Long Beach, CA
Answered

You need to hire an attorney. Auto insurance claims are handled on a reimbursement basis. With the help of an attorney you can get your necessary medical treatment. Our office in Long Beach is available for a free in person consultation. 562-981-1010

Christopher Steven Hoffmann

Christopher Steven Hoffmann

Car / Auto Accident Lawyer - Saint Louis, MO
Answered

If you are in a car accident and the insurance company is paying for treatment directly, the insurance company can only address the issue of coverage. The adjuster is not licensed to practice medicine and cannot cancel physician order and interfer with treatment. Report the adjuster to the Department of Insurance as this is an improper claims practice.

24 Hour Attorney Call Center (314) 361-4242 or visit us on the Web at http://www.hoffmannpersonalinjury.com.

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