Is Your Patient Paying For Injury Rehab Out of Pocket?

December 27th, 2020
Sheena Sodhi
LLB, Lawyer

If you’re injured, the last thing you want to worry about is how you’re going to cover treatment expenses. 

Unfortunately, this is the reality many patients face every day. Unaware of their available options, many are forced to pay out of pocket after exhausting their Extended Health Insurance, burning through their savings in order to get the injury rehabilitation they need. Or, rather than focusing their energy towards healing, patients instead compromise the process of their recovery due to a lack of funds.

These are actions taken with the false resignation that there is no other way. However, if a patient sustains a serious injury, there are many instances where they could have access to financial assistance to help cover their medical expenses. 

When a Patient Should Seek Legal Advice

It can often be difficult to determine when a patient should look towards seeking legal advice. As the first point of interaction for a patient, doctors, and other medical professionals need to recognize the different situations that could qualify for a viable personal injury claim.  

The first thing you need to evaluate is what kind of accident your patient was involved in. If they were involved in a motor vehicle accident – as a driver, passenger, or pedestrian – accident benefits are the answer. If they were involved in a slip and fall at a public establishment or suffered an injury due to a faulty product, this points towards a negligence case, which means that your patient may want to pursue damages. Damages cover income loss, pain and suffering, as well as loss of competitive advantage – which is applicable when an injury impacts your ability to advance in your career. 

You then need to determine whether or not your patient was at fault for the accident. For example, an at-fault driver will have access to accident benefits should they sustain injuries, but wouldn’t have access to a tort claim to seek damages. In contrast, a patient – who is not at fault – has the ability to sue for a tort claim or an accident benefits claim, depending on the nature of the incident. 

The best time to approach the topic of finances with your patient is the first visit. After all, funds directly influence the type of treatment plan you devise for your patient moving forward. A patient may feel hesitant to complete an extensive, long-term treatment plan if they don’t have the means to do so financially. Therefore, educating your patients at intake is the best way to present them with their options and help them seek legal consultation if necessary. 

Filing a Personal Injury Claim

The claims process can be intimidating; depending on a patient’s situation, the process can extend over a long period of time. This is precisely why it pays to seek the assistance of a legal professional. Lawyers exist to alleviate these pain points and help patients attain assistance they may otherwise not have access to when handling a claim on their own. 

Deeper issues can arise when a patient simply chooses to not pursue a claim at all. Many believe that if they report an injury, their insurance premiums will skyrocket. This isn’t always the case; if you’re involved in an accident through no fault of your own, there’s no reason for an Insurer to bump your premiums. This is important to note, as this assumption often proves to be a major deterrent when it comes to filing a claim. 

As such, some patients may believe that paying out of pocket is the cheapest option for managing their treatments. While this could be true initially, future issues could arise down the line. Undermining an injury is common practice, and can be a very damaging mindset. Injuries are not always straightforward – what appears manageable one day may give rise to serious conditions and corresponding symptoms down the road. Needless to say, a treatment plan for a minor injury compared to that of a serious injury will differ greatly. 

As such, it’s important that a patient consults with a lawyer immediately after sustaining an injury. Getting an injury on file with a medical professional is crucial to prove that the incident is directly responsible for their injuries, and can make all the difference when trying to attain financial assistance down the road if a condition or injury worsens. Point blank, paying out of pocket is often not enough to support the treatment costs of a major injury. The unfortunate reality is that many small injuries can give way to larger, harder-to-deal-with issues in the future, and starting a claim from the very beginning is the best safety net for this very common situation. 

Accident Benefits Breakdown

Accident Benefits are available to those who have suffered injuries in motor vehicle accidents. There are three tiers of medical and rehabilitation benefit coverage available:

Minor injuries are typically soft tissue injuries – they aren’t lasting and won’t negatively impact an individual’s life too severely. Major injuries are more serious and lasting, and therefore require more financial assistance to facilitate a full recovery. If a patient sustains an injury that can be classified as “catastrophic” (loss of a limb, spinal cord injuries, paraplegia), they are qualified for an increase in benefits. 

Every claim is automatically deemed minor. It’s up to a lawyer to speak to medical professionals, learn about their injuries and related past history, and connect the dots to up their benefits. 

Repercussions of Waiting

If a patient isn’t actively taking the necessary steps to obtain financial assistance early on, it could invite recurring consequences in the future. 

The minute an individual walks away from an injury-causing incident, the clock starts ticking. Time constraints make it difficult to pursue a claim if too much time has passed since the incident. Causation is one of the key factors a lawyer must prove, and without immediately reporting an injury, causation could become murky if too much time has passed. Who’s to say an injury was caused by one particular incident if so much has happened since then? 

Furthermore, starting a claim later down the road usually results in a lack of medical evidence – to take on a file, a lawyer must prove that their client’s injuries are serious, which they’re only able to do if there is compelling medical evidence to support the client’’s claim. 

Underestimating an injury, and opting to pay out of pocket not only exhausts a patient’s hard-earned funds, but it could also potentially debilitate their ability to receive financial assistance in the future. 

What To Do Next?

If you have a patient whom you suspect is paying for injury rehab out of pocket, point them towards seeking legal advice. We’re here to get your patients the financial assistance they need. 

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