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Can my insurance adjuster cancel my Physical Therapy?

Long Beach, CA |

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?

I'm sorry, apparently my question wasn't very clear. I was in a car accident. The guy that hit me was 100% at fault. Now his car insurance company is refusing to pay for the rest of my Physical Therapy. Can they do that?

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Attorney answers 8

Posted

You should consult with a personal injury attorney ASAP. If your former doctor is hesitant to continue with your treatment your lawyer will find a doctor who would be willing to c

The response given is not intended to create, nor does it create an ongoing duty to respond to questions. The response does not form an attorney-client relationship, nor is it intended to be anything other than the educated opinion of the author. It should not be relied upon as legal advice. The response given is based upon the limited facts provided by the person asking the question. To the extent additional or different facts exist, the response might possibly change. Attorney is licensed to practice law only in the State of California. Responses are based solely on California law unless stated otherwise.

Asmik Jasmine Gevorkyan

Asmik Jasmine Gevorkyan

Posted

Continue your treatment on lien basis. 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

Asker

Posted

Thank you, but my doctor's great. It's the insurance adjuster that is refusing to pay for my second round of physical therapy. Even though I got a second prescription from my doctor.

Asmik Jasmine Gevorkyan

Asmik Jasmine Gevorkyan

Posted

The insurance adjuster's job is to pay as little as possible for your claim. They may refuse to pay. But if you have an attorney the attorney will make sure that you receive proper compensation for your injuries, out of pocket costs, pain and suffering, loss of wages if any and much more. If the other party is at fault And it looks like the adjuster is already trying to avoid proper compensation for your damages, I wouldn't recommend you to handle the claim by yourself. Your recovery may be maximized by assistance of an attorney. I hope this is helpful.

Posted

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.

Asker

Posted

I'm sorry, apparently my question wasn't very clear. I was in a car accident. The guy that hit me was 100% at fault. Now his car insurance company is refusing to pay for the rest of my Physical Therapy. Can they do that?

Posted

You need to talk with an attorney.

Posted

That is infuriating to hear. An adjuster is interfering with your medical care in a third party case. Which insurance company is that? There is something seriously wrong with an adjuster calling your PT facility and limiting your treatment. That sounds like a violation of HIPPA, interference with contract, interference with prospective economic advantage, and inconsistent with insurance code 790.03. Call a lawyer!

Marc Lazarus
www.russellandlazarus.com

Asker

Posted

Thank you so much!

Posted

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
(951)520-9684
www.fransenandmolinaro.com / www.888MDJDLAW.com

"When you need a lawyer, call the Doctor... Call Paul J. Molinaro, M.D., J.D... Call (888)MDJDLAW."

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** Fransen & Molinaro, LLP practices in the areas of personal injury, medical malpractice, and real estate law.

Paul J. Molinaro, M.D., J.D. ... Attorney at Law, Physician, Broker... Fransen & Molinaro, LLP... 980 Montecito Drive, Suite 206... Corona, CA 92879... (951)520-9684... www.fransenandmolinaro.com / www.888MDJDLAW.com... "When you need a lawyer, call the Doctor... Call Paul J. Molinaro, M.D., J.D... Call (888)MDJDLAW." ... * This post and all others I make on Internet are for informational purposes only. None of the information or materials I post are legal advice. Nothing I post as comments, answers, or other communications should be taken as legal advice for any individual case or situation. This information is not intended to create, and receipt or viewing of this information does not constitute, an attorney-client relationship. While I try to be accurate, I do not guarantee accuracy... ** Fransen & Molinaro, LLP practices in the areas of personal injury, medical malpractice, and real estate law.

Posted

With a case like yours it seems like you have some good facts in order to get a high settlement. The most important thing when building your case are: liability (were you at fault); how bad are your injuries to your body and your property; and of course how high is the at fault person's policy. A lot of these things sound like they are not complete yet in your case so its something that is worth hiring an attorney for in order to get a sense of whether you have a case and what the strategy would be for you to build a strong case!

I've handled many of these cases and wouldn't mind speaking to you.

View my website & call for a FREE consultation if you are a California resident 877-427-2752 or you can email me at Michael@Kingofpersonalinjurylaw.com www.KingofPi.com I am licensed in California only and my answers on Avvo assume California law. Answers provided by me are for general information only. They are not legal advice. Answers must not be relied upon. Legal advice must be based on the interplay between specific exact facts and the law. This forum does not allow for the discussion of that interplay. My answer to any specific question would likely be different if that interplay were explored during an attorney-client relationship. I provide legal advice during the course of an attorney-client relationship only. The exchange of information through this forum does not establish such a relationship. That relationship is established only by personal and direct consultation with me followed by the execution of a written attorney-client agreement signed by each of us. The communications on this website are not privileged or confidential and I assume no duty to anyone by my participation on Avvo or because I have answered or commented on a question. All legal proceedings involve deadlines and time limiting statutes. So that legal rights are not lost for failure to timely take appropriate action and because I do not provide legal advice in answer to any question, if you are an interested party you should promptly and personally consult with an attorney for legal advice. Also, see Avvo's terms and conditions of use, specifically item 9, incorporated by this reference

Posted

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

Posted

An adjuster canceling a physician order for physical therapy needs to be reported to the department of insurance. This behavior cannot be tolerated in a car accident claim. If you were represented by counsel, I do not think this would happen.

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

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