For no-fault automobile accident benefits, there is a limit of $3,500 for medical and rehabilitative treatment if you have what is considered a minor injury. It is assumed that the treatment expenses for minor injuries should not exceed $3,500.
The problem is that insurance companies frequently take the position that someone has a minor injury, when he or she does not. Broadly speaking, minor injuries include things like sprains, strains, bruises, abrasions and any “clinically associated sequelae” of these injuries. However, just because you have a sprain or other minor injury, doesn’t mean you don’t also have other serious conditions that cannot be treated for under $3,500. Examples could include chronic pain, a brain injury or severe depression.
This issue was recently addressed in the case Arruda v. Western Assurance Company (FSCO A13-003926). The insurance company took the position that Ms. Arruda was limited to the $3,500 minor injury cap because she had soft tissues injuries and “minor psychological difficulties.” Ms. Arruda argued that she was not healed and 20 months after the car accident was diagnosed as suffering from a chronic pain syndrome.
The arbitrator agreed that Ms. Arruda suffered from chronic pain and more importantly, that chronic pain falls outside of the minor injury guideline. In this case, the insurance company was ordered to pay for reasonable and necessary medical and rehabilitation expenses beyond $3,500, after the onset of chronic pain.
This case demonstrates that just because you are initially diagnosed with an injury that is minor, you may also develop injuries and symptoms that are not minor. When this happens the insurance company has to pay more than $3,500 for treatment.
The difference between the $3,500 minor injury cap and the non-catastrophic cap of $50,000 can make the world of difference to your recovery. Your insurance company may say you only have a minor injury when you still need more treatment. Contact us for a free consultation to discuss your rights.