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Patient noncompliance as a defense to a large insurance claim

On Behalf of | Mar 9, 2021 | Insurance Law |

Pushing back against large insurance claims can be a difficult and even a risky thing to do. Unsuccessful insurance defense might result in allegations of bad faith insurance practices, which can cost even more than an approved claim.

Whether your company has a massive workers’ compensation claim to handle or a premises liability claim because someone slipped and fell while visiting, medical costs can be a big part of the expenses sought by the claimant. If you can show medical noncompliance on their part, that can be a cornerstone of your defense strategy.

What is medical noncompliance?

When someone suffers an injury because of an incident at work, a car crash or a slip-and-fall accident, they should go to a doctor for diagnosis and treatment. The physician will recommend a specific course of care. The patient has an obligation to follow through with that treatment.

When they don’t, they may not get better. In fact, their symptoms might get worse. Someone who does not take responsibility for their own health might actively harm their own recovery. By refusing surgery, not taking medication or quitting physical therapy, a patient might make their condition worse than it would be if they followed all medical recommendations.

Medical noncompliance might put the responsibility on the patient

When someone files a large insurance claim, they ask for coverage based on fault and liability. When that person does not follow through with medical care, they have some personal fault for their failure to recover. You may be able to limit what your company pays for medical care and lost wages if you can show that the person filing the claim did not follow through with medical recommendations. Your attorney can provide valuable guidance.


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