Can the Insurance Company Stop Funding my Treatment?

Have you been injured in a car crash, workplace accident, criminal assault or public liability incident recently? If so, you may be undertaking medical treatment to help you get back on your feet. If your medical treatment is funded by an insurance company, it’s common to have concerns about the extent of your treatment funding and how long your cover will last. So, can your insurance company stop paying for your treatment?

Generally speaking, an insurance company will fund all reasonable medical treatment costs, however they may send you for independent examinations from time to time. This assessment is reviewed by an independent medical specialist, and if he or she decides you do not require any further treatment, or your current treatment is no longer relevant to your condition, they could put a stop on funding your treatment.

You may have some other concerns and questions surrounding your treatment and your rights in relation to the insurance companies, which we have covered below.

CAN THE INSURANCE COMPANY DICTATE WHAT TREATMENT I GET?

No! The insurance company may only decide what they will fund and they have no say on the type of treatment. It is important to always discuss what treatment you require with your treating medical practitioner.

Should the funding from your insurance company cease, but your treating medical practitioner advises you still require further treatment, it is time for you to knuckle down and do whatever it takes to ensure you get the treatment you need, so you can continue on the road to recovery. This may mean dipping into savings or borrowing from family or friends. You will need to go through Medicare or your private health fund, and if you are unable to pay your medical bills fully or in part, see if you can come to an arrangement with the treatment provider. They may be able to carry the cost of your treatment until your claim is settled. We will then make sure we contact all your treatment providers, Medicare and your private health fund to determine any outstanding amounts owed so we can include them in the settlement.

On a positive note, occasionally insurers may initially deny treatment on a claim, but then resolve the claim or include some kind of contribution at settlement.

DO I HAVE TO ATTEND THE MEDICAL ASSESSMENT?

Yes! You are required by law to attend this appointment, and if you do not, the insurer or your employer may apply for your funding or weekly compensation payments to be stopped.

DO I HAVE TO UNDERGO THE RECOMMENDED TREATMENT?

No, you are not legally required to undergo the recommended treatment. However, we will provide your GP and other treating practitioners with a copy of your medical report, which we suggest you discuss with your doctors.

Should you have any further questions or would like to book an initial obligation-free consultation with Peninsula Personal Injury Lawyers, please contact us on 08 9581 4339 (Mandurah office) or 08 9443 5312 (North Perth office).