What Happens if I’m Hurt But Stop Treating Without a Reasonable Explanation?

In New York, if someone stops treating an injury sustained in a motor vehicle accident without a reasonable explanation, an insurance company may try to question the seriousness of the injury. While stopping treatment may, in some cases, raise doubts concerning the severity of an injury, someone who stopped treating can still seek a recovery for pain and suffering, especially where the injury reached maximum medical improvement or additional treatment would serve no medical purpose.  

What Constitutes a “Gap” in Treatment?

A “gap” in treatment broadly describes the duration of time that a person has not received medical treatment for their injury. It may refer to the amount of time that elapsed between the occurrence of a motor vehicle accident and when the injured person first sought medical treatment. A gap in treatment can also indicate the amount of time that occurred between medical treatments. Oftentimes, the at-fault motorist’s auto insurance company will consider an injured motorist’s gap in treatment as an indication that the injury is not that serious.  The amount of time that constitutes a gap in treatment can vary depending on the situation.  

What Might Qualify as a “Reasonable Explanation” for Discontinuing Treatment?

One situation that may provide a reasonable explanation for a gap in treatment is where no-fault insurance no longer covers the medical treatment. This can occur when a person’s no-fault benefits have been discontinued while they were pursuing regular medical treatment.  

Another reasonable explanation may occur where an injured person’s doctor determines that they have reached maximum medical improvement. Generally, this happens when a person has exhausted all medical treatment options such that recovery or further improvement of the injury is not possible even with additional treatment. When someone has reached this state, any additional treatment may provide only temporary relief, but will not fix the cause of pain or the injury itself. In cases of maximum medical improvement, New York courts tend not to expect injured people to continue medical treatment. As observed by New York’s highest court: “the law surely does not require a record of needless treatment.” 

Similarly, another reasonable explanation for gaps in treatment may include cases where a person’s doctor recommends that they continue therapeutic exercises on their own outside of the medical facility. Depending on the surrounding circumstances, engaging in prescribed at-home exercises may provide a reasonable explanation.   

Courts can also take into account other factors, include pregnancy, childrearing, or other situations involving a person’s home and family life.  

Hurt in a Car? Call William Mattar.

It is important to remember that the factors that may support a reasonable explanation are only examples. Here at William Mattar, P.C. our experienced car accident attorneys can review the circumstances surrounding your “gap” in treatment and help determine your legal options moving forward.