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Title: Insurer won't pay for my physiotherapy

Date: 03 August 2015

Question

I had an accident which was not my fault about 4 months ago and the other driver’s insurer has admitted liability. They instructed a rehabilitation company to get me back to normal. However the insurance company are refusing to pay for my physiotherapy to help my back and neck pain because they say they dispute “causation”. However they are happily paying for my CBT for my anxiety due to the accident. I don’t understand. What is going on?

Stephen Brookes, by email

In a claim for personal injuries you must prove that the accident caused the injuries for which you are claiming compensation. This is evidenced by obtaining independent expert medical evidence in the form of a medical report. Things that can be relevant are any pre-existing conditions that may have existed, for example previous back or neck ache, either constitutional or as a result of a previous accident.

It is important that your medical expert has access to all of your medical records so he can deal with this issue and the report should deal with any relevant history and the causation of your injuries, in other words were they more likely than not caused by the mechanism of the accident. Assuming you have supportive medical evidence then there is no reason why the defendant should not pay for your physiotherapy costs. The defendant may wish to obtain its own medical evidence if they believe there was a pre-existing condition at the time of the accident that is to blame for ongoing symptoms.

If for example, you had fallen off a ladder a few weeks before the bike accident and you had the pains prior to the bike accident then your opponent’s insurance company does not have to compensate you as the injury pre-dated the accident. However, accidents can exacerbate pre-existing symptoms and it is therefore very important that the medical experts deals with this where applicable, apportioning injury between the ongoing symptoms pre-dating the accident and the bike accident itself.

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