I have a surgery recommendation. Why hasn’t my case settled for the policy limits?
I am often asked why insurance companies do not just pay out the policy limits when an individual has a recommendation for an expensive surgery. This usually comes up when there are $100,000-$250,000 policy limits on the line and the insurance company does not want to immediately surrender the whole policy. It can be, but typically is not, an issue on smaller policy limit cases.
Pragmatically, if an individual has a recommendation for surgery, but does not actually get the surgery, they may have a harder time getting the higher settlement value.
The reason is that insurance companies do not want to pay for the cost of future medical treatment that is not certain. You may have seen some of my earlier blogs that explain how the cost of medical treatment is highly negotiable. If the cost of operation is in itself uncertain, why would the insurance company pay a certain cost for something that is not certain to happen?
The best thing for an individual’s personal injury case after getting a surgery recommendation is to actually get the surgery done. This turns a debatable future medical treatment into something fixed and tangible. While the cost can still be debated, it provides more evidence for your claim by adding another link to the damages chain. Personal injury victims only get one bite at the apple. If they settle their case, they cannot later go back and ask the insurance company for more money. Actually getting the surgery done shows the insurance company that the injury was severe and bothered them enough that the plaintiff undertook the risk of surgery to correct the problem.
While getting surgery may be best for your personal injury claim, it may not be best for you. I do not recommend everyone get surgery nor do I suggest that anyone get surgery solely for the benefit of their personal injury claim.
If a surgery is recommended, the decision to go through with it is one that should not be taken lightly. I advise my clients to take their future health in consideration along with the risks involved with getting the surgery. There is typically a chance, however small, that the type of surgery recommended does not fix the problem and makes it worse. Even if that chance is small, it does not mean that it will not happen to you. The surgery also could carry risks that far outweigh the benefits. I make sure that my clients make the decision to get surgery on their own, not based solely on what may make their case value higher.