A plaintiff's post-incident course of treatment can significantly impact the settlement value of a personal injury case.
There’s often a flurry of medical activity immediately following an incident. During this time, any prolonged gaps in treatment can undermine a case's credibility and reduce its value.
When determining the value of a personal injury case, attorneys and support staff must understand how treatment gaps impact case value and settlement negotiations as well as how to effectively address them.
This article explores why treatment gaps are detrimental, highlights five ways consistent treatment timelines can boost settlement potential, and shows how EvenUp helps attorneys identify and mitigate the impact of these gaps.
A treatment gap is a period of 30 or more days between medical visits. While there may be valid reasons for these gaps—such as scheduling conflicts, lack of transportation, or the conclusion of prescribed treatments—insurance adjusters and opposing counsel often view them as red flags. These gaps can lead to:
EvenUp’s 2025 Breaking the Benchmarks report, which examines law firm revenue and cash flow benchmarks, shows that 17% of personal injury cases include a detrimental treatment gap of 30+ days. Identifying these gaps is critical for understanding case valuations and managing negotiations with adjusters.
Our benchmarks report shows that maintaining consistent treatment and avoiding gaps can increase settlement value by 20% per case. Additionally, a thorough treatment history strengthens negotiation leverage by eliminating opportunities for adjusters to devalue the claim based on gaps in care.
While EvenUp’s tools are invaluable for identifying existing treatment gaps, preventing them in the first place is always the ideal scenario. Here are some practical steps case managers can take to set expectations with clients from case intake and the onset of treatment to maintain consistent timelines:
Clients may not realize that inconsistent treatment can significantly weaken their case. From the start, case managers should explain how regular medical visits contribute to their physical recovery and reinforce the legitimacy of their claims. Emphasizing that adjusters scrutinize gaps in care can help clients understand why sticking to a treatment plan is essential. Reference EvenUp’s benchmarks of how gaps in treatment can reduce settlement value by up to 20% to highlight the importance of consistent treatment.
Regular communication is key to preventing treatment gaps. Case managers can establish a routine for checking in with clients through scheduled phone calls, text messages, or emails. These touchpoints allow case managers to remind clients of upcoming appointments, address concerns, and ensure they stay engaged in their treatment plans.
Many treatment gaps arise due to logistical challenges such as transportation issues, financial constraints, or scheduling conflicts. Case managers can help mitigate these obstacles by proactively identifying potential roadblocks and connecting clients with solutions. This may include arranging medical transport services, helping clients find providers with flexible hours, or guiding them to financial assistance programs for treatment-related costs.
Despite best efforts, treatment gaps sometimes happen due to valid reasons like illness, provider availability, or personal emergencies. When gaps are unavoidable, it is crucial to ensure they are well-documented in medical records. Case managers can work with healthcare providers to include detailed notes explaining any missed appointments and the steps taken to resume treatment. This documentation helps attorneys counter adjusters’ attempts to devalue claims based on perceived inconsistencies in care.
A structured plan can help clients adhere to their medical care. Case managers can provide a semi-weekly treatment checklist outlining the next 10 business days. The checklist can help staff verify past appointments, track upcoming ones, and input details into the case management system to remind clients of their next visits. Encouraging clients to check off completed treatments can help them stay engaged and accountable. A well-maintained checklist also serves as a quick reference tool, ensuring no key treatments are overlooked and reinforcing the importance of adherence to their care plan.
EvenUp’s Claims Intelligence Platform™ empowers personal injury attorneys to spot treatment gaps—even after they’ve occurred—and factor them into case valuation and negotiation strategies. Treatment Timelines automatically identify gaps in treatment and provide a clear, chronological view of a plaintiff's medical care.
Key capabilities within treatment timelines include:
EvenUp’s Treatment Timelines provide attorneys with critical insights to strengthen their case strategies. Beyond identifying treatment gaps, EvenUp’s time-saving capabilities indirectly help support staff manage their plaintiffs’ treatment timelines.
By visually highlighting gaps in care, the timeline allows attorneys to address these issues proactively when preparing demand packages. It also enables them to integrate these gaps into case valuation, assess their impact on settlement value, and adjust their approach accordingly. Additionally, with detailed insights, attorneys can enhance negotiations with adjusters by directly addressing concerns and advocating more effectively for their clients.
This operational efficiency helps case managers better manage cases and ensures that plaintiffs’ medical care is documented to maximize settlement potential.
Treatment gaps can significantly reduce case value, but they don’t have to derail its potential.
Case managers can strengthen case strategies and negotiate more effectively by leveraging EvenUp’s Claims Intelligence Platform™, complete with the Treatment Timelines feature. Combined with proactive measures to support clients’ treatment timelines, personal injury firms can achieve a $10,000* increase in settlement value per case and deliver better client outcomes.
Ensure every case reaches its full potential by mitigating treatment gaps. With EvenUp’s Treatment Timelines, you can keep client care consistent, build stronger demands, and confidently drive better settlement results.
*$10K benefit per case from avoiding treatment gaps is calculated based on (1) 20% estimated lift in settlement value when avoiding treatment gaps multiplied by (2) the national average estimated settlement amount of $50K (from $100K avg policy limit).
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