After a jarring car wreck on I-20 or a slip-and-fall in a local business, the path forward for an injured person seems clear: see a doctor, get treatment, and consult an attorney to be made whole. But lurking beyond the initial trauma and legal paperwork is a subtle, yet incredibly destructive, threat to a legitimate personal injury claim: patient non-compliance.
Defined as the failure to follow a prescribed medical treatment plan—whether by missing appointments, not filling prescriptions, or discontinuing physical therapy prematurely—non-compliance is where strong cases go to die. To understand its devastating impact, we look at this single issue from the three perspectives that define the battleground of a personal injury case: the plaintiff’s attorney, the treating physician, and the insurance adjuster.
The Attorney’s Perspective: Building a House on a Crumbling Foundation
For a personal injury attorney, a non-compliant client is a recurring nightmare. My entire job is to prove two things: that the other party’s negligence caused my client’s injury, and that the injury resulted in specific, quantifiable damages. Patient non-compliance systematically destroys both pillars of the case.
The first concept at play is the “duty to mitigate damages.” In simple terms, the law requires an injured person to take reasonable steps to prevent their condition from getting worse. When a client misses physical therapy sessions, they are not mitigating their damages; they are arguably making them worse. This gives the defense a golden opportunity to shift the blame. They will argue that the client’s current pain and suffering isn’t due to the initial accident, but due to their own failure to get better.
Second, it obliterates credibility. Imagine trying to convince a jury that my client suffers from debilitating back pain when the defense attorney can point to a calendar showing they missed half of their chiropractic appointments. The unspoken question hangs in the air: “If you were truly in that much pain, wouldn’t you do everything your doctor told you to do?” It makes the client appear lazy, indifferent, or worse, dishonest.
Finally, it creates what we call “gaps in treatment.” These gaps are poison to a claim. The defense will argue that the gap represents a period where the client was fine, and that some other event (a “superseding cause”) must have happened during that time to cause their current complaints.
When I sit down to negotiate with an adjuster, my leverage comes from the strength of my evidence. A non-compliant client hands all the leverage to the other side. My ability to demand full and fair compensation is crippled, not by the facts of the accident, but by my own client’s actions after the fact.
The Physician’s Perspective: Healing in a Vacuum
From a medical standpoint, a patient’s failure to comply with a treatment plan is profoundly frustrating. My primary objective is the health and recovery of my patient. A treatment plan—whether it involves medication, therapy, or specialist follow-ups—is a carefully constructed roadmap to that recovery. Each step is built upon the last.
When a patient is non-compliant, it directly hinders clinical progress. A muscle won’t strengthen without consistent therapy. An infection won’t clear without a full course of antibiotics. When a patient misses appointments, they not only stall their recovery, they can actively reverse it, leading to chronic conditions that may have been preventable.
This creates a significant documentation and ethical burden. I must meticulously chart every missed appointment and every conversation where I’ve urged the patient to follow the plan. This is not to punish the patient, but to protect myself professionally and to maintain an accurate medical record.
The most difficult position it puts me in is when I am asked for my professional opinion for the legal case. The attorney will ask me to state, to a “reasonable degree of medical certainty,” the cause of the patient’s long-term prognosis. If I believe their poor outcome is directly related to their non-compliance, my medical ethics compel me to say so. I cannot, and will not, lie or speculate to help a legal case.
Ultimately, my goal is to heal. When a patient’s actions prevent that from happening, it’s a frustrating outcome for which I have no cure.
The Insurance Adjuster’s Perspective: A Justifiable Reduction
As an insurance adjuster, my role is to evaluate a claim and determine a fair settlement based on the objective evidence. I have a fiduciary duty to my company to not overpay claims, and patient non-compliance is one of the clearest, most objective pieces of evidence I can find to justify reducing a claim’s value.
When I receive a new claim file, looking for treatment gaps and non-compliance is part of my standard review. It is a massive red flag. It immediately tells me several things:
- The injury may be exaggerated. A person in severe, legitimate pain is typically highly motivated to seek relief. A pattern of missed appointments suggests the pain is not as debilitating as claimed.
- The claimant is not a credible witness. If they don’t take their own health seriously, it’s unlikely a jury will either.
- The causation is now questionable. The claimant has introduced a new variable into their recovery. This gives me a powerful, evidence-based argument that the continued need for treatment is a result of their own inaction, not the insured’s negligence.
In negotiations, non-compliance is my strongest leverage. I will point directly to the medical records and ask the attorney, “How can you demand compensation for permanent impairment when your client refused to even complete their initial course of physical therapy?” It’s not an attack; it’s a logical question based on the facts. It allows me to confidently and justifiably lower my settlement offer, knowing that if the case were to go to trial, a jury would likely have the exact same question.
The Unifying Conclusion
While the attorney, physician, and adjuster all have vastly different roles, they arrive at the same conclusion: patient non-compliance is a case killer. It undermines medical recovery, destroys legal credibility, and provides a legitimate basis for devaluing a claim. For any individual navigating a personal injury case, the lesson is clear: your most important job is to be an active participant in your own recovery. The path to both physical and financial well-being starts and ends with following your doctor’s orders
Matt Rhodes is a former board certified clinician, healthcare administrator and SIU investigator. He is the author of “The Clinician’s Handbook of Personal Injury Practice” and the Founder and CEO of PathLogic.