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Hergott: Defend your legal claim

Beg, borrow or steal—a quick Internet search comes up with definitions of this expression such as: “to do whatever is necessary to get something” and “obtain by any possible means.”

That expression comes up often when I am advising my clients how important it is to find a way to pay for recommended medical treatment. When I say “recommended,” I mean medically recommended by your treatment team.

I don’t mean recommended or “authorized” by whatever insurance company is defending your claim.

As obvious as that distinction might seem, it is not so obvious when the insurance company is holding the purse strings to the money you need to afford medical care.

Most of us carry on through life with monthly spending that seems to magically equal, if not slightly exceed, our monthly earnings.

Yes, our parents taught us to sock a bit of money away for unforeseen expenses but that’s one of several life lessons that can seem impossible to follow. When injury strikes and that disaster relief fund doesn’t exist, we turn to the insurance company to help us afford the medical care to treat our injuries.

A circular dance ensues. The insurance company won’t pay for any rehabilitation care that they don’t “authorize.”

Initially, all they require for their “authorization” is a referral note from your doctor.

After a few weeks the “authorization” expires and you have to jump through the hoop of getting an updated referral note in the hopes that the insurance company will extend their authorization.

At some point the further referral note isn’t good enough and funding for the medically recommended care is cut off.

It is at this point when the insurance company representative often steps in to play doctor, saying: “I won’t pay for this care anymore, but I would pay for this other type of care.” Injured victims who rely on insurance company funding regularly stop therapies when funding for them is cut off.

Desperate to get better, they follow through with whatever therapy the insurance company decides to pay for. When funding is cut off completely, the rehabilitation stops completely.

Instead of your rehabilitation being directed by the medical doctor and others on your treatment team, your care is directed according to the whims of an insurance company representative who is unlikely to have any medical training whatsoever.

Not only is there a lack of medical expertise, but the insurance representative is in a direct conflict of interest. What better way to defend your claim than to prematurely end medical care, making it appear that you must have recovered from your injuries? Why else would you stop attending for recommended physiotherapy, massage therapy or chiropractic care?

I have no medical training either, but Dr. Paul’s medical advice is to follow the medical recommendations of your treatment team without any regard for what the defending insurance company might “authorize.”

How do you pay for care that the insurance company doesn’t “authorize?” That’s when “beg, borrow or steal” comes in.

Your first resort is to the cheap line of credit financing you can hopefully get from your bank.

If your injuries disabled you from continuing with work and interrupted your income flow, though, good luck with that.

Next resort is offering a fair interest rate to family members who might want to earn more than the two per cent interest they are likely earning on their savings.

If that avenue isn’t open to you, swallow your pride and approach friends who might be willing to make some money off of you.

Loans from friends and family can be secured by way of an irrevocable assignment of the small portion of your claim that will be needed to pay them back.

However reluctant the insurance company might be to authorize  and pay for medical care up front, they will always have to reimburse you for reasonably incurred medical expenses when your claim finally is resolved.

If those options are exhausted, you turn to a private lender if you can find one, though you can count on paying high (15 per cent) interest plus processing fees.

A last resort is commercial lenders who seem to prey on vulnerable victims by charging much more exorbitant interest rates.  However exorbitant, though, it is worth it to get the medical care you need to achieve as full and speedy a recovery as is possible.

Any interest you incur can be added to your claim. If the beg (to the insurance company) and borrow options fail and you find yourself looking at the “steal” word at the end of the expression, contact me and I’ll try to help you find funding for the care you need.

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