Gaps in Treatment: How They Hurt Your Michigan Injury Case

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.

Gaps in treatment are the single quietest way a Michigan personal injury case loses value — and most people don’t find out until the offer comes in far lower than they expected. 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 do adjusters care so much about missed appointments?

Because a gap lets them argue you weren’t really hurt, and that argument lowers offers. 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.

How long of a gap is too long?

There’s no legal limit, but gaps longer than about 30 days tend to get flagged. 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.

What are legitimate reasons for a gap, and how do you document them?

Almost any real-life reason is legitimate if it’s written down somewhere. 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 or 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.

Can Michigan’s no-fault fee schedule cause a treatment gap?

Yes. Some providers stopped taking auto patients after the fee schedule took effect, which leaves patients scrambling. This part is specific to Michigan, and it’s worth understanding because it’s probably not your fault.

Since July 2, 2021, the 2019 no-fault reform’s fee schedule has capped what auto insurers pay medical providers for crash-related care (MCL 500.3157). For treatment Medicare pays for, the cap is a percentage of the Medicare rate. For treatment Medicare doesn’t pay for, the cap is a percentage of what the provider charged as of January 1, 2019. (Our post on why your doctor dropped you after a car accident has the details.)

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. If your PIP coverage has run out entirely, see who pays your medical bills when Michigan PIP runs out.

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 can a good lawyer do about a gap you already have?

Explain it on paper, with medical, pharmacy and personal evidence, before the defense tells its own version. 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.
• Arranges an evaluation with a treating specialist if the gap is long enough that your current symptoms need a fresh exam to anchor them.

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. And if you’ve lost confidence in your lawyer, it’s usually not too late to switch.

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. You can get a free second opinion on your file at any point.

For what a well-documented treatment day looks like in practice, read physical therapy at 9, adjuster at 11. If a gap is already showing up in a low offer, see what to do when the adjuster’s offer is an insult and what your Michigan auto accident case may be worth.

This article is general information about Michigan law, not legal advice for your situation.