Causation and necessary medical treatment describe a concept that can catch many people engaged in personal injury lawsuits by surprise if they have never prepared for the possibility.
As the usual progression goes, someone is injured in a traffic accident, it has been determined that another person is at fault and as a result, it is reasonable to expect that any and all medical care or treatment necessary for injuries resulting from that accident will be covered by the at-fault person’s insurance. This is a very wrong assumption to make, and has presented more than one client a nasty surprise.
In Washington State, and indeed in most courtrooms across the nation, once it has been conclusively proven that the accident was someone else’s fault, it must then be conclusively proven that it was the accident in question that caused the injury AND that the care that someone receives for that injury was both reasonable and necessary.
On the surface it seems sensible but because these two areas of dispute must be individually proven, it means the insurance company will always dispute causation.
By disputing causation, they are basically saying that if the claimant had a previous injury to the same area, or even if there is a subsequent injury that occurs after the accident, because while the claimant may say the injury was caused by the accident, the insurance company will claim any damages are a result of this more recent injury.
Reasonableness and necessity of medical care means they can hire a doctor to say they don’t believe this or that care was necessary or reasonable. While this runs contrary to the Hippocratic Oath, it would appear that there are plenty of doctors who are willing to make these types of statements.
What these statements do is imply that while the accident was the defendant’s fault as proven in a court of law, that doctor will cast doubt on the claim of injuries. They will argue that the injured party was in fact, not hurt at all by the actions of the defendant, and that if injury did occur, it wasn’t as a result of the accident. Rather, it was the age of the claimant or their occupation or anything other than this accident.
Further, they will attest that if medical care was delivered, it wasn’t needed and doctors should never have put in for this test, or that treatment.
Under the color of law, it is legal for insurance companies to argue these tests and treatments and their appropriateness as it relates to the claimant. It can be time and work-intensive, and even then, very difficult to dispute some of these very subjective medical standards under the law.
With all the differing opinions it can be hard to connect all the dots and get clients the recovery and compensation they need and deserve.
Visit Wiener and Lambka to discuss your claim and to determine if hiring an attorney for your personal injury case is a prudent course of action.