Insurance claim & medical report

Denno666

Hi,

My partner was in a car accident and he's supposed to be getting physio for his injuries via a company that his insurance put him through to.

The medical report said his expected prognosis/recovery period was 12 months. The company are now saying the reason for his treatment being delayed (about 2 years now) was because admin delays meant they didn't get the medical report and refer it to the medical agency until 9 months after it had been written. They have said that this meant they were outside of the expected prognosis period which expired in June 2016 (6 months on from the medical report being completed) and so the medical agency couldn't arrange the treatment.

We're a bit confused and was wondering if anybody can tell us why are there 2 different prognosis periods? Are they two separate things (i.e. the first is medical and the second is a limit that the medical agency have), or are they just trying to fob us off?

Hopefully that makes sense, any help would be very much appreciated!

FutureGirl

The 'prognosis period' is the length of time the medical expert thinks you will experience the pain / injury, starting from the accident date. So if the accident was, for example, June 1st 2015, they are deemed recovered from their injuries June 1st 2016.

If you are now 2 years after the accident, your partner will not need physiotherapy as they have recovered from the injuries.

lisyloo

If he needed treatment then why didn't he go NHS or why wasn't this followed up sooner?


My understanding is that they are saying he would be well after 12 months, so he doesn't need treatment now.


I can't see 2 prognosis periods, but if he needed treatment why wasn't something done to get it?

Denno666

Sorry for not being clearer, I meant to put he has just finished the physio sessions which started this April and his accident claim started back in March 2015.

The prognosis period given in the medical report was on condition of him having the physio/chiropractor sessions, so he'd be expected to recover after 12 months if he'd had the physio.

He has complained about the delay and they are saying (for some reason) that the prognosis period expired after 6 months (in June 2016) so they were unable to arrange treatment. He even received a letter at the start of 2017 saying they would be arranging the treatment for him, it was only after this he was told that the prognosis period had apparently expired.

He had to go back to their consultant at the end of 2017 for them to do another medical report before he was able to start his treatment.