Visitor Question

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

Submitted 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: Our response is not formal legal advice and does not create an attorney-client relationship. It is generic legal information based on the very limited information provided. Do not rely upon the information in our response, or anywhere else on this site, when deciding the proper course of a legal matter. Always get a personalized case review from a local attorney.

Answer

Dear Vilma,

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.

The above is general information. Laws change frequently, and across jurisdictions. You should get a personalized case evaluation from a licensed attorney. Find a local attorney to give you a free case review here , or call (888) 647-2490.

Best of luck,

Published: June 22, 2011

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