Gaps in Treatment: The Quiet Way PI Cases Get Killed

You missed three weeks of PT because you couldn’t find childcare. Your adjuster just called it proof you were never really hurt.

That’s not a misunderstanding. That’s the playbook.

Treatment gaps are the single quietest way a personal injury case loses value — and most people don’t find out until the offer comes in 60% lower than it should be. No one calls you to warn you. The adjuster just writes it in their notes and waits.

Let’s talk about what’s actually happening, why it happens to good people with real injuries, and what you can still do about it.

Why Adjusters Weaponize Missed Appointments

Insurance adjusters are trained to look for one thing in your medical records: discontinuity. Not pain. Not diagnosis. Not MRI findings. Gaps.

Here’s the logic they run, and they run it every single time:

• If you were really hurt, you would have kept going to the doctor.
• You stopped going to the doctor for three weeks.
• Therefore, you weren’t really hurt — or you healed and then re-injured yourself doing something else.

That argument is nonsense on its face. Anyone who has ever had a job, a kid, or a deductible knows why people stop going to PT. But it works, because the adjuster isn’t trying to convince you. They’re trying to build a file that lets their supervisor approve a low offer.

A clean gap in your treatment records gives them that file. Your pain doesn’t show up on paper. The empty calendar does.

The 30-Day Rule of Thumb

There’s no statute about this. No Michigan law says “thou shalt not miss more than 30 days of PT.” But among defense attorneys and claims adjusters, the informal threshold is real:

Any gap longer than about 30 days gets flagged and questioned.

Shorter gaps (a week here, two weeks there) usually slide. A full month or more becomes a talking point in negotiations, mediation, and — if the case goes that far — trial. The defense will literally put your attendance record on a screen in front of a jury and ask the doctor, “Is this what compliance with a treatment plan looks like?”

Two gaps of three weeks each, spaced apart, can be worse than one gap of 45 days. It looks like a pattern.

The fix isn’t to never have a gap. The fix is to make sure every gap has a paper trail explaining it.

Legitimate Reasons — And How to Document Them

Real reasons people stop treating, all of which we see every week:

• Childcare fell through
• Couldn’t afford the copay or the gas to get there
• Work wouldn’t give you the time off
• You felt better for a while
• The clinic was 40 minutes away and you didn’t have a car
• A family member got sick and you were caregiving
• The PT wasn’t helping and you were waiting on a referral to someone else
• You got COVID, the flu, or something else knocked you down
• Depression and pain fatigue — you just couldn’t do one more appointment

Every single one of these is legitimate. None of them mean you weren’t hurt. But unless they’re in writing somewhere, the adjuster gets to pretend they don’t exist.

How to create the paper trail

You don’t need a lawyer to do any of this. Start today:

1. Call your provider when you cancel. Don’t just no-show. Say the reason out loud — “I can’t afford the copay this week,” “my daughter is home sick” — and ask them to note it in the chart.
2. Text your doctor’s office through the portal. MyChart, Athena, whatever they use. Written messages end up in your records.
3. Keep your own log. A note on your phone with date + reason is better than nothing. It won’t be evidence by itself, but it helps you testify accurately later.
4. When you go back, tell them you were still in pain the whole time. That single sentence — documented in the next visit note — closes the gap narratively. “Patient reports symptoms continued throughout absence from care” is a powerful line.

How Michigan’s Fee Schedule Creates Gaps

This part is specific to Michigan, and it’s worth understanding because it’s probably not your fault.

Since the 2019 auto no-fault reform took effect in July 2020, Michigan has a fee schedule that caps what auto insurers pay medical providers for crash-related care. For services Medicare covers, the cap is tied to a percentage of the Medicare rate. For services Medicare doesn’t cover, there’s a separate cap tied to what the provider charged in early 2019.

Translation: a lot of PT clinics, pain management practices, and specialists lost a significant chunk of revenue on auto cases overnight. Some stopped taking auto no-fault patients entirely. Others limited how many visits they’d approve.

If you’ve been bounced between providers, told “we’re not taking new PIP patients,” or had your PT cut off after a certain number of visits — that’s the fee schedule, not you being difficult. And it shows up in your records as a gap, even though the gap was created by the system.

A good lawyer knows how to reframe a fee-schedule gap as exactly what it is: an access-to-care problem, not a credibility problem.

What a Good Lawyer Does With an Existing Gap

If you already have a gap in your treatment, don’t panic and don’t lie about it. Lawyers and doctors who know what they’re doing can work with almost any honest timeline. What they can’t work with is a client who pretends the gap isn’t there.

Here’s what a competent PI attorney actually does:

• Gets a narrative report from your treating doctor that explains, in medical language, why your symptoms persisted during the gap and why the gap doesn’t undermine the diagnosis.
• Pulls pharmacy records showing you were still filling pain medication, muscle relaxers, or anti-inflammatories during the gap.
• Subpoenas your employer for attendance records, light-duty notes, or any documentation of you struggling at work during that time.
• Gets a sworn statement from you explaining the reason for the gap — childcare, cost, transportation — before the defense gets to ask the question cold at deposition.
• Orders an IME or a second opinion if the gap is long enough that they need a fresh exam to anchor current symptoms.

The goal isn’t to hide the gap. The goal is to tell the story around it, on paper, before the adjuster gets to write their own version.

If your current lawyer hasn’t asked you a single question about why you stopped treating — or worse, told you “don’t worry about it” — that’s a warning sign. The defense is going to worry about it. A lot.

The Bottom Line

A gap in treatment doesn’t kill your case. A gap in treatment that nobody explained kills your case.

If you stopped PT because your life got hard, you’re not a bad plaintiff. You’re a normal human being. The question is whether your file reflects that — or whether it reflects an empty calendar the adjuster gets to interpret however they want.

Go back to treating if you can. Document the reason for the gap. And if your lawyer has been quiet about it, that silence is its own red flag.

If you’re not sure your current attorney is building the record your case needs, Fire My Lawyer offers a free, no-pressure second opinion. We’ll look at where your case is, flag what’s missing, and tell you straight whether you need to make a change — or whether you’re already in good hands. Call 1-855-FML-2DAY (1-855-365-2329) or request a review at FireMyLawyer.com.