What a gap in treatment costs a case.

What the defense actually does with a gap

It is not subtle, and it does not need to be. The sequence runs roughly the same way every time:

• Establish the date of the accident and the date treatment stopped.
• Establish the length of the break, in weeks, out loud.
• Ask whether anything prevented the plaintiff from seeking care during that period.
• Invite the inference: a person in the pain being described would have kept treating.

The argument does not have to be true to be effective. It only has to be available. And an adjuster evaluating a file pre-suit applies the same discount without anyone having to say it aloud — a treatment record with a hole in it is simply worth less.

What actually causes most gaps

Rarely recovery. In practice the common causes are money, transport, work and language: a copay the client cannot clear, a clinic they cannot reach, shifts they cannot miss, or instructions they did not fully understand.

The medication gap is the most common and the least visible of these, because it does not produce a missed appointment anybody notices. Between 22% and 28% of written prescriptions are never taken to a pharmacy at all, and of those that are, a few percent are never collected. Nobody calls the law firm to report it. It surfaces months later, in a records review, as a prescription with no corresponding fill.

Why the medication gap is the one worth fixing first

Three reasons, in order of how much they matter.

It is the cheapest to close. A course of generic analgesics, a muscle relaxant and an antiemetic is a small number. Closing an equivalent gap in physical therapy or imaging costs an order of magnitude more.

It cascades. A patient in uncontrolled pain stops going to physical therapy, and the physical therapy gap is the one the defense actually points at. Fixing the prescription frequently prevents the larger gap that follows it.

It is documented either way. A dispensing record is dated, itemized and tied to a prescriber. Whether it exists or does not exist, somebody will eventually read it.

How to close it without creating a different problem

Three things, and the order matters.

• Run the coverage first. If the client has health insurance they can use, or med-pay on the auto policy, that is the better route. Telling a client to bypass usable coverage is bad for the client and creates a failure-to-mitigate argument aimed at your own case.
• Ask about cost at intake, not at the demand. Clients do not volunteer that they cannot afford a prescription. By the time a records review surfaces it, the gap already exists and cannot be closed retroactively.
• Where there is no coverage, use a provider whose billing survives scrutiny. A lien pharmacy that charges usual and customary cash prices closes the gap without opening a new argument. One that charges a lien-specific markup, or bills for compounded topical creams, trades a treatment-gap problem for a reasonable-value problem — and the second one is worse.

What this is not

Closing a treatment gap is not the same as building damages, and the distinction matters. The goal is that a person who was prescribed something actually takes it. A provider that markets itself to plaintiff firms on the basis of increasing settlements is writing the defense's cross-examination for them, and the case is worse off for it.

Related

• What a pharmacy lien is — the mechanism, in plain terms
• For personal injury attorneys — what the firm gets, and what it has to sign
• Ten questions to ask a lien pharmacy before you refer anybody
• Gap in treatment in the glossary

General information, not legal advice. We are pharmacists; no attorney has reviewed this page.