No Medical Treatment for 5 Months, Now Insurance Won't Cover It....

by Vilma
(Portland, Oregon)

I had an accident in January 2011. It wasn't severe, but as a result I now have pain in my back. I stopped seeing the Chiropractor because I didn't like the way he was treating my back problems. I stopped and didn't see any other chiropractor for 5 months.

Now that I want to see an Acupuncturist, not a Chiropractor, the adjuster said it's a long time without medical attention, and they won't cover it. What are my rights in this case?

Disclaimer: Information provided in your response is not formal legal advice, it is generic legal information and is based on the very limited information given in your question. You should always get a formal case evaluation from a licensed attorney.

ANSWER for "No Medical Treatment for 5 Months, Now Insurance Won't Cover It....":

Vilma:

From the facts you present it isn’t clear what precipitated the injury. In the facts you present you mention an “adjuster”. We will presume you were the victim, possibly in an automobile collision and had been dealing with an insurance Claims Adjuster.

If your Claims Adjuster refuses to pay for your acupuncturist treatment we are afraid your options may limited. There are three factors which will be problematic...

The first is the length of time you didn’t seek treatment. They will presume if you were not seeking treatment for your injury during the 5 month period your symptoms may have ceased.

The second is during the interim 5 month period you may have suffered another unrelated injury, or have engaged in some activity which may have exacerbated your existing injury.

The third is the lack of substantial medical opinion supporting the efficacy of acupuncture for the treatment of injuries.

We might suggest you independently put together as much medical and other related information which supports the use of acupuncture; especially for the treatment of your specific injury. Present the information to the Claims Adjuster and hope it will be persuasive enough for her to change her mind.

Since laws change frequently and across jurisdictions you should get a personalized case evaluation from an attorney licensed in your state (if you haven't already). Find an experienced local attorney to give you a FREE personalized case review here.

Best of luck,

Law Guy

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