You missed three physical therapy appointments this month. Work got busy. Bills piled up. The sessions cost $150 each and insurance only covers half. You’re feeling a bit better anyway, so you figure you’ll resume next month.
Meanwhile, the at-fault driver’s insurer just received your medical records. They see a four-week gap between appointments. Their settlement offer drops from $85,000 to $50,000. Their reasoning: “If plaintiff was truly injured, he wouldn’t have missed a month of treatment. Gap indicates injury resolved. Subsequent treatment is for unrelated issues.”
Treatment gaps – defined as 14 or more days between medical visits without documented medical reason – give insurers the ammunition they need to argue your injuries weren’t serious, already healed, or were caused by something other than the crash.
This guide shows you the quantified settlement impact of gaps, how to document legitimate reasons insurers will ignore anyway, and what to do if you’re currently in a gap or have already created one.
What Treatment Gaps Are (And Why Even Legitimate Ones Hurt)
Definition:
14+ consecutive days between treatment visits for the same injury without a medically documented reason for the delay.
Legitimate reasons that still create gaps:
Financial barriers: You can’t afford co-pays, deductibles, or out-of-pocket costs. Legitimate. Understandable. Insurers don’t care. They argue that if you were truly in pain, you’d find a way to pay.
Insurance authorization delays: Your insurer requires pre-authorization for physical therapy. The approval process takes three weeks. You can’t start treatment until approved. Legitimate. Documented. Insurers still argue the gap shows injury wasn’t urgent.
Provider availability: Your physical therapist is booked solid for two weeks. You can’t get an appointment sooner. Legitimate. Provable through scheduling records. Insurers argue you should have found a different provider.
Feeling better, then worsening: Pain fluctuates. You have a good week and skip therapy thinking you’re healed. Pain returns worse than before. Medically normal for soft tissue injuries. Insurers argue injury resolved and you re-injured yourself doing something else.
Work schedule: You work shift hours, travel for work, or can’t take time off without risking your job. Legitimate. Insurers argue injury can’t be serious if you prioritize work over treatment.
The pattern: insurers acknowledge these reasons exist but refuse to accept them as excuses. Their position is simple: truly injured people prioritize treatment over everything else. Gaps prove you weren’t truly injured.
The Settlement Math: How Much Each Week Costs
Practitioner experience and industry data suggest treatment gaps reduce settlement value approximately 5-10% per gap week for moderate injuries. This compounds. A four-week gap can reduce a $100,000 claim to $60,000-$70,000.
Example calculation – moderate injury:
Economic damages:
- Medical bills: $30,000
- Wage loss: $10,000
- Property damage: $5,000
- Total economic: $45,000
Non-economic damages (pain and suffering):
- Multiplier for moderate injuries: 2-4x economic damages
- With clean treatment history: $45,000 × 3 = $135,000 total claim value
With a four-week treatment gap:
Insurer argument: “Medical records show patient improved significantly by week 2 (last documented visit before gap). Gap from week 2 to week 6 indicates resolution. Treatment resumed week 6 is for new injury or pre-existing condition worsening, not crash-related injury. We compensate weeks 1-2 only.”
Revised calculation:
- Week 1-2 medical bills: $8,000
- Multiplier reduced to 1.5x (gap undermines severity claim): $8,000 × 1.5 = $12,000
- Plus property damage (undisputed): $5,000
- Insurer offer: $17,000
You’ve lost $118,000 because of a four-week gap – even though your injuries are real, continuous, and crash-caused.
Example calculation – severe injury:
Economic damages:
- Medical bills: $150,000 (surgery, hospitalization, extensive PT)
- Wage loss: $40,000
- Property damage: $8,000
- Total economic: $198,000
Non-economic damages:
- Multiplier for severe injuries: 3-5x economic damages
- Clean treatment: $198,000 × 4 = $792,000 total
With a six-week gap post-surgery (missed PT sessions):
Insurer argument: “Surgery successful. Patient made excellent recovery. Six-week gap indicates full recovery achieved. Subsequent PT is maintenance, not necessary treatment. We compensate through discharge from surgery plus two weeks post-op. Gap proves injury resolved.”
Revised calculation:
- Treatment through two weeks post-surgery: $85,000
- Multiplier reduced: $85,000 × 2 = $170,000
- Plus property: $8,000
- Insurer offer: $178,000
You’ve lost over $600,000. The gap gave them an argument that you can’t definitively rebut without expensive expert testimony.
These numbers aren’t hypothetical. Practitioners report settlement differentials in this range routinely when gaps appear in treatment records.
Documenting Gap Reasons Insurers Ignore
Documentation doesn’t eliminate the gap’s impact, but it limits the damage. Without documentation, insurers claim you have no explanation. With documentation, they acknowledge the explanation but argue it’s insufficient. The latter is marginally better.
Financial barriers:
What to save:
- Insurance explanation of benefits (EOB) showing high co-pays or denied coverage
- Denial letters for pre-authorization
- Collection agency notices for unpaid medical bills
- Bank statements showing insufficient funds to pay for treatment
- Correspondence with provider about payment plans that fell through
What to document in medical records:
When you return to treatment, tell the provider: “I had to stop treatment for [X] weeks because I couldn’t afford the co-pays. I’ve now secured [medical payments coverage from my insurer / payment plan with your office / financial assistance], so I’m resuming.”
Request the provider document this in their notes: “Patient experienced [X]-week treatment gap due to financial hardship. Unable to afford co-pays during gap period. Now resuming treatment with payment arrangement in place.”
This creates a contemporaneous medical record explaining the gap.
Insurance authorization delays:
What to save:
- Pre-authorization request submission date
- Approval date (showing weeks-long delay)
- Correspondence with insurance company about authorization status
- Provider’s notes documenting they couldn’t proceed without authorization
What to document:
“I couldn’t start PT for three weeks while waiting for insurance approval. Authorization came through [date], and I’m starting today.”
Provider documents: “Patient referred for PT [date]. Insurance authorization delayed until [later date]. Patient beginning therapy now that coverage approved. Gap attributable to payor administrative process, not patient non-compliance.”
Provider availability:
What to save:
- Scheduling records showing you requested earlier appointment but none available
- Waitlist confirmation if provider placed you on one
- Documentation that you attempted to find alternative providers in-network
What to document:
“Dr. X referred me to PT on [date]. I called to schedule but earliest available appointment was three weeks out. I’m starting now.”
Provider documents: “Patient attempted to schedule immediately following referral. Practice capacity limited availability to [later date]. Gap reflects scheduling constraints, not lack of medical necessity.”
Worsening after improvement:
What to save:
- Pain journals showing good days followed by bad days
- Text messages to family/friends during “good” period mentioning you still have pain, just less severe
- Work attendance records showing you continued having limitations even during gap
- Activity logs showing what you could/couldn’t do during gap
What to document:
“I felt better for about 10 days and thought I was healing, so I didn’t schedule PT. Pain came back worse, so I’m here now. This is the same shoulder pain from the crash, not new.”
Provider documents: “Patient reports temporary improvement in symptoms leading to self-directed pause in therapy. Symptoms subsequently worsened. This fluctuation pattern consistent with soft tissue injury recovery. Resuming treatment for ongoing crash-related injury.”
The key phrase: “Consistent with crash-related injury.” This ties current treatment to the original crash despite the gap.
Returning to Treatment: What to Say
You’re returning after a gap. The provider asks why you stopped coming.
Don’t say:
- “I felt fine” → Documents resolution
- “I forgot” → Documents non-compliance, undermines injury severity
- “I didn’t think it was helping” → Documents treatment ineffective, insurer will argue further treatment unnecessary
- “I was busy” → Documents injury not limiting, contradicts disability claims
Do say:
“I had a gap in treatment due to [specific documented reason]. During that time, my [injury] symptoms [remained the same / worsened / fluctuated]. I’m resuming treatment because the pain/limitation hasn’t resolved.”
Best version:
“I had to stop PT for three weeks because I couldn’t afford the co-pays [or: insurance authorization took three weeks / or: you didn’t have an opening for two weeks]. During that gap, I [tried home exercises but they weren’t sufficient / or: pain remained constant / or: had some better days but then worsened]. I’m back because I still need treatment for my crash injuries.”
Request the provider document:
- Why the gap occurred (specific barrier)
- What your symptoms were during the gap (didn’t resolve)
- That current treatment is for the same crash-related injury (continuity)
Get it in writing:
If your provider is willing, ask for a brief narrative letter:
To Whom It May Concern:
[Patient name] was under my care for injuries sustained in a motor vehicle crash on [date]. Treatment was initiated [date] and continued through [date]. Patient experienced a [duration] gap in treatment from [date] to [date] due to [documented reason].
Despite this gap, the patient’s injuries remain consistent with the original crash mechanism. [Specific injury] has not fully resolved and continues to require therapeutic intervention. The gap in treatment does not indicate resolution of injury but rather reflects [barrier to access].
I am resuming treatment for the same crash-related injuries.
[Provider signature, credentials, date]
This letter costs you $100-200 typically (providers charge for non-treatment documentation). It’s worth every dollar. Your attorney will use it to counter insurer gap arguments.
When Gaps Kill Claims Completely
Not all gaps are recoverable. Some destroy claims entirely.
Claim-killing gaps:
Severe injury + multi-week gap + no documented symptoms during gap:
Example: You claim permanent disability from back injury. Medical records show intense treatment for four weeks post-crash, then an eight-week gap with zero medical contact, then treatment resumes.
Insurer argues: If you were disabled, you’d have sought treatment during the gap. Eight weeks of no medical contact proves injury resolved. Subsequent treatment is for new injury.
Your attorney needs expensive expert testimony to overcome this. Treating physician may not be enough – you may need independent medical examination from a specialist opining that the injury remained continuous despite lack of treatment.
Gap longer than active treatment period:
Example: You treated for six weeks post-crash, stopped for three months, resumed treatment.
Insurer argues: You treated for six weeks and stopped because you healed. Three months is far too long for “delayed authorization” or “financial hardship.” You clearly recovered, then re-injured yourself.
This is difficult to overcome even with perfect documentation.
Multiple gaps:
Example: You treated for two weeks, gap for three weeks, treated for one week, gap for four weeks, treated for two weeks.
Insurer argues: Pattern of non-compliance indicates injury isn’t serious. Truly injured patients maintain consistent treatment.
Multiple gaps compound. Each gap is harder to explain than the last.
Gap immediately after major treatment milestone:
Example: You have surgery, attend two post-op appointments, then disappear for six weeks.
Insurer argues: Surgery resolved issue. Post-op recovery went well (evidenced by only two follow-ups needed). Six-week gap proves resolution. Subsequent treatment is unrelated.
Surgeons typically schedule specific post-op timelines. Missing those appointments without documented reason is devastating.
During the Gap vs. Post-Gap Mitigation
If you’re currently in a gap, you can still limit damage. If the gap already happened, your options are more limited.
Currently in gap – resume immediately:
Day 1 (today): Call your provider. Schedule appointment. Mention “continuing treatment from motorcycle crash on [date].” Request earliest available slot.
Don’t wait until next week. Don’t wait until you get paid. Don’t wait until it feels more convenient. Every day the gap extends is another 0.7% off your settlement (roughly – 5% per week / 7 days).
At resumed appointment:
Explain gap reason to provider. Request documentation in notes. If financial, explain how you’re now able to pay. If authorization, show approval documentation. If scheduling, reference your earlier attempts to book sooner.
Gap already happened – damage control:
You can’t erase the gap, but you can mitigate it:
Step 1 – Resume treatment: Even if gap is weeks or months old, resume now. Every additional day without treatment makes it worse.
Step 2 – Document gap reason: Gather everything that explains why gap occurred (financial records, authorization correspondence, scheduling records).
Step 3 – Get provider narrative: Request written statement from provider explaining that injuries remain consistent with crash despite gap. This costs money but is essential.
Step 4 – Gather corroborating evidence: Prove you were still suffering during gap even though you weren’t in treatment:
- Pain journals (if you kept them – retroactive journals are worthless)
- Text messages/emails mentioning pain (“Can’t sleep, back is killing me” sent during gap)
- Witness statements (family members who saw you in pain, struggling with daily activities)
- Work records (called in sick, requested light duty, noted inability to perform usual tasks)
- Activity limitations (proof you couldn’t do things: canceled gym membership, stopped recreational activities, avoided social events)
Step 5 – Attorney handles expert testimony: If gap is severe, your attorney may need to hire a medical expert who reviews records and opines that injury remained continuous despite gap. This is expensive ($3,000-5,000 for independent medical exam and report) but may be necessary to salvage the claim.
Virtual Telemedicine as Gap Prevention
Telemedicine visits during gaps can preserve treatment continuity even when in-person visits are impossible.
How it works:
You can’t afford in-person PT ($150/session). But you can afford a 15-minute telemedicine check-in with your treating physician ($50-75/session).
Schedule virtual visit every 10-14 days. During visit:
- Report current symptoms (pain level, functional limitations)
- Discuss what home exercises you’re doing
- Get provider’s assessment that injury persists
- Request provider document visit notes: “Telemedicine follow-up for ongoing crash-related injuries. Patient reports persistent [symptoms]. Recommends continuation of home exercise program with plan to resume formal PT when financially feasible.”
This creates medical documentation during what would otherwise be a gap. Insurers can’t argue “no treatment = resolution” when medical records show regular provider contact.
Cost-benefit:
$75 virtual visit every two weeks = $150/month. One four-week gap can cost $30,000-50,000 in settlement value. The telemedicine visits are a rounding error compared to gap impact.
Not all injuries require this. Minor injuries healing normally don’t need gap-prevention telemedicine. But moderate to severe injuries with financial/scheduling barriers to in-person treatment? Virtual visits can preserve claim value.
Treatment Gap Framework
Legitimate reason doesn’t matter to insurers – only documentation matters.
Gap happening now: Resume treatment today. Not tomorrow. Not next week. Today.
Gap already happened: Document reason, resume treatment, get provider narrative linking current treatment to original crash injury despite gap, gather corroborating evidence of continuous suffering.
Future gaps unavoidable: Virtual telemedicine check-ins preserve continuity when in-person treatment is impossible. $75 every two weeks prevents $30k+ settlement loss.
Every gap week costs 5-10% of settlement value: In a $100,000 moderate injury case, one gap week = $5,000-10,000. Four-week gap = $20,000-40,000. This isn’t theory. This is practitioner-reported settlement negotiation reality.
Treat medical appointments like court dates – you wouldn’t skip a hearing because you’re busy at work. Your medical treatment continuity is just as critical to your case outcome. Insurers are tracking every gap. Make sure you are too.
Disclaimer: This article provides general information about Georgia motorcycle accident law and is not legal advice. Every case is different. Consult a qualified Georgia motorcycle accident attorney to discuss your specific situation. Nothing in this article creates an attorney-client relationship.