Why Do Insurance Companies Treat Soft Tissue Injuries Different?
What Are Soft Tissue Injuries?
Soft tissue injuries refer to damage to the muscles, ligaments, and tendons – the connective tissues in the body that are not bones.
These types of injuries often occur due to trauma from common causes like car accidents, falls, sports incidents, and other accidents.
Injuries to the soft tissues can take many forms, including:
Sprains: Sprains cause pain, swelling, and instability in the affected joint, making repetitive motions challenging.
Strains: When a muscle or tendon is overexerted or pulled, resulting in a strain or pull.
Bruises: The result of blunt force impact, causing bleeding and inflammation in the soft tissues under the skin. Severe bruises can affect deeper muscles.
Whiplash: A common cause of neck strain or sprain from the sudden back-and-forth jerking motion of the head, often suffered in a car accident.
While these sprains, strains, and other injuries may not involve an open wound on the body, torn cartilage, or broken bones, they can still cause serious pain.
Unlike obvious traumatic injuries, common injuries from tissue damage are not always apparent from the outside and you may need to prove your case.
Listening to your body, following your doctor’s medical recommendations, and diligently tracking your pain and recovery are crucial to prove your injury.
How Are Soft Tissue Injuries Defined?
Soft tissue injuries are categorized as those affecting muscles, tendons, and ligaments in the body without involving fractures or other visible damage. Common soft tissue injuries include whiplash injury after an accident, torn cartilage, and severe soft tissue injuries like ligament tears.
Insurance companies require extensive documentation, including medical records and imaging scans, to validate these injuries.
Why Soft Tissue Injuries Are Handled Differently
Subjectivity and Diagnosis Challenges
Injuries to the soft tissues are often subjective and challenging to diagnose accurately. Symptoms like pain, swelling, and reduced mobility can be difficult to measure objectively.
Historical Fraud Concerns
Historically, soft tissue injury cases have been prone to fraud, with some individuals exaggerating their symptoms to recover compensation.
To combat this, insurance companies have developed stringent processes to scrutinize soft tissue injury cases closely, often requiring substantial proof before approving a claim.
Cost Containment Strategies
Financially, most soft tissue injuries can be costly due to the potential for chronic pain and long-term treatment like physical therapy.
To manage these costs, the insurance company may employ tactics to minimize payouts for your personal injury, including offering lower settlements and questioning the necessity of certain treatments.
The Claims Process for Soft Tissue Injuries
If you’ve suffered a soft tissue injury in an accident, seek treatment immediately. Document every aspect of your injury, pain, and care, including medical bills, notes from your doctor, and any prescribed physical therapy. Early and continuous documentation strengthens your case and counters any arguments from the insurance company about the validity of your injury.
When filing a soft tissue injury claim, ensure you follow the correct procedures and submit all required documentation.
Detailed and accurate submissions are crucial to a successful accident claim.
Dealing with Insurance Adjusters
Insurance adjusters play a significant role in the process. They assess the injury and determine the settlement amount. To ensure you receive fair compensation, communicate effectively with adjusters, providing clear, consistent information about your injury and treatment.
Common Challenges in Soft Tissue Injury Claims
Proof of Injury
One of the biggest challenges in a soft tissue injury claim is proving the injury’s existence and severity. Medical evidence, professional assessments, and continuous medical records are essential.
Delayed symptoms can complicate claims, so timely documentation is critical.
Lowball Settlement Offers
Lower settlements are often offered for injuries to the soft tissues, betting that claimants will accept less to avoid prolonged negotiations. Understanding your injury’s worth and being prepared to negotiate or seek legal assistance can help secure a fair settlement.
Denial of Claims
The insurance company may deny soft tissue injury claims, citing reasons like lack of evidence or discrepancies in your story.
If your claim is denied, it’s essential to understand the reasons and take appropriate steps, such as providing additional documentation or seeking legal advice.
When to Consider Legal Assistance
If you face difficulties with your soft tissue injury claim, consider hiring an experienced attorney. Signs you might need legal help include denied claims, inadequate settlement offers, or complex medical evidence requirements. An attorney can navigate these challenges effectively.
An attorney can significantly strengthen your claim by gathering comprehensive evidence, negotiating with the insurance company, and representing you in court if necessary.
With professional support, you can focus on recovery while your attorney handles the legal complexities of what may be an uphill battle.
Tips for Maximizing Your Soft Tissue Injury Claim
Comprehensive Medical Documentation
Thorough medical documentation is vital. Keep detailed records of all treatment options, symptoms, and medical advice. This documentation can provide indisputable evidence of your injury’s severity and necessary treatments.
Consistent and continuous support not only aids your recovery but also strengthens your claim. Follow your doctor’s advice and attend all recommended treatments and follow-up appointments to demonstrate your commitment to recovery.
Legal and Professional Support
Utilizing medical experts and legal professionals can bolster your personal injury claim. Expert testimonies and legal guidance ensure that your case is presented effectively, increasing the likelihood of a fair settlement.
Contact Poynter & Bucheri Law Firm
At Poynter and Bucheri Law Firm, we understand that navigating the legal system can be overwhelming. Our compassionate, experienced attorneys are here to guide you every step of the way. If you’ve been injured in an accident, understanding why insurance companies treat soft tissue injuries differently is crucial for receiving fair compensation.
Contact Poynter & Bucheri Law Firm today by calling 1-800-265-9881 for your free case review.