Closing the Gap in Personal Injury Claims: A Case for Incentivizing Treatment Adherence

The Dual Imperative: Navigating Recovery and Litigation

In the complex aftermath of a personal injury, claimants face a dual challenge: pursuing physical recovery while simultaneously navigating the intricate demands of a legal claim. The success of both endeavors is deeply intertwined and hinges on a factor that is often underestimated and poorly managed: consistent adherence to prescribed treatment regimens. For injuries requiring rehabilitative care, such as physical therapy or chiropractic sessions, patient dropout and missed appointments are not minor administrative issues; they represent a critical failure point that can jeopardize a patient’s long-term health and severely undermine the financial value of their legal claim.¹˒²

While attorneys and medical providers focus on establishing liability and providing care, the patient’s day-to-day behavior—specifically, their commitment to attending therapy—becomes a cornerstone of the entire personal injury case. Non-compliance is a pervasive problem, with studies showing physical therapy attendance rates as low as 73% and self-discharge rates as high as 55% for patients in chronic pain, a common outcome of personal injuries.³ This gap between prescribed care and actual patient behavior creates significant vulnerabilities, which are often exploited during settlement negotiations.¹

The High Cost of Non-Compliance: Compromising Health and Devaluing Claims

When a personal injury claimant fails to adhere to a prescribed course of physical or chiropractic therapy, the consequences are twofold, creating a cascade of negative outcomes that affect both their physical well-being and their financial settlement.

The Physical Cost: Delayed Recovery and Worsened Outcomes

From a clinical perspective, consistent attendance at therapy sessions is fundamental to recovery. Physical therapy and chiropractic care are designed to restore function, reduce pain, and prevent long-term complications like muscle imbalances and joint stiffness.⁴˒⁵ When appointments are missed, the therapeutic momentum is lost, potentially prolonging recovery time, decreasing the chances of a full recovery, and in some cases, leading to the need for more invasive and costly treatments down the line.⁶˒⁴ Patients who drop out of therapy prematurely often experience greater physical pain, more significant functional limitation, and a decreased quality of life compared to those who complete their prescribed course of care.⁵

The Financial Cost: Undermining the Personal Injury Claim

In the context of a personal injury lawsuit, non-compliance has devastating financial repercussions. Insurance companies and defense attorneys scrutinize medical records for any sign of weakness in a claim, and a pattern of missed appointments is one of the most damaging pieces of evidence.¹⁻⁶

Here’s how non-adherence devalues a claim:

• Questioning the Severity of Injury: The primary argument leveraged by insurers is that if the claimant were truly in as much pain as they allege, they would not miss their appointments.¹˒²˒⁷˒⁶ If you don’t go to physical therapy, the insurance company might argue that your injuries aren’t that serious.⁸ Missed sessions are framed as evidence that the injury is less severe than claimed, thereby justifying a lower settlement offer.¹
• Failure to Mitigate Damages: The law requires that an injured party take reasonable steps to minimize their losses—a concept known as “mitigating damages”.⁹ By skipping therapy, a claimant can be accused of failing to do so. The defense can argue that the patient’s own non-compliance, rather than the initial incident, is responsible for their prolonged pain or incomplete recovery, thus reducing the defendant’s liability.⁹˒¹⁰ In states with comparative negligence laws, a patient’s compensation can be formally reduced by their percentage of fault, and missing appointments can be used to assign fault to the patient.¹¹
• Weakening Evidentiary Support: Consistent therapy creates a detailed, contemporaneous record of the patient’s pain levels, functional limitations, and recovery trajectory.⁷˒⁸˒¹² This documentation is crucial evidence for substantiating both economic damages (the cost of care) and non-economic damages (pain and suffering).⁷˒¹² Gaps in the treatment record create ambiguity and make it harder for the claimant’s attorney to prove the full extent of the injury.¹

The financial impact is significant. One study in Florida found that 60% of malpractice cases involving missed appointments resulted in reduced settlements, with an average reduction of 25%.¹¹

The Psychology of Dropout: Why Personal Injury Patients Stop Treatment

Understanding why claimants discontinue care is essential to developing effective solutions. The decision is rarely a simple one and is often driven by a complex interplay of practical, financial, and psychological factors unique to the personal injury context.

Common Barriers to Adherence:

• Cost and Financial Strain: Even with insurance or a pending settlement, out-of-pocket costs, co-pays, and deductibles can be prohibitive.⁵˒¹³˒¹⁴ One in four Americans forgoes healthcare due to cost, and this pressure is acute for someone who may also be out of work due to their injury.⁵ Approximately 35% of patients report that financial concerns influence their decision to discontinue physical therapy.¹⁵
• Lack of Perceived Progress: Recovery from musculoskeletal injuries is often slow and non-linear. Patients may become discouraged when they don’t see immediate results, leading them to believe the therapy is ineffective.⁵˒¹⁶˒¹⁷
• Pain and Fear of Re-injury: Physical therapy can be uncomfortable or painful. This, combined with a fear of making the injury worse, can lead to avoidance of prescribed exercises and appointments.¹³˒¹⁶˒¹⁷
• Logistical Hurdles: Simple life circumstances, such as scheduling conflicts with work, lack of transportation, or childcare needs, are significant barriers to consistent attendance.¹¹˒¹⁷
• Psychological Factors: Personal injury claimants often experience a unique psychological burden. They may be dealing with denial about the severity of their condition, a lack of trust in medical providers, or feelings of anger and victimization that reduce their motivation to engage in their own recovery.¹³˒¹⁸˒¹⁹

These factors create a perfect storm where the immediate, tangible costs and hassles of attending therapy loom much larger than the distant, abstract benefits of recovery and a potential legal settlement.

A Behavioral Economics Solution: Using Incentives to Bridge the Intention-Action Gap

The consistent failure of patients to follow through on necessary treatment, despite understanding its importance, is a classic behavioral problem. Behavioral economics offers a powerful framework for understanding and solving this issue by acknowledging that human decisions are not always rational. A key concept is present bias, the tendency to overvalue immediate rewards and costs while undervaluing those in the future.²⁰

For a personal injury claimant, the costs of therapy—time, travel, discomfort, and out-of-pocket expenses—are immediate and certain. The benefits—a gradual recovery and a potential settlement—are delayed, uncertain, and abstract. Due to present bias, the immediate costs feel more significant, leading to a series of “rational” short-term decisions to skip appointments, even when it undermines the patient’s long-term goals.

Financial incentives are a tool designed specifically to counteract present bias. By providing a small, immediate, and certain reward for attending a therapy session, an incentive program fundamentally alters the decision-making calculus at the moment of choice. It introduces a tangible “win” into the present, helping to offset the immediate costs and making the long-term healthy choice also the most attractive short-term one. This approach is grounded in reinforcement theory, which posits that behaviors followed by a desirable consequence are more likely to be repeated.²¹ The incentive acts as a direct positive reinforcer for the act of attendance.

Designing Effective and Ethical Incentive Programs in a Litigated Setting

While the theory is sound, the effectiveness of an incentive program hinges on its design and its ability to navigate the unique legal and ethical landscape of personal injury claims.

Key Design Features for Success

Research into health incentives provides clear guidance on how to structure programs for maximum impact:

• Form of Incentive: Patients overwhelmingly prefer direct financial rewards like cash, gift cards, or vouchers over other forms of recognition.²² In a chiropractic setting, incentives can also take the form of discounts on future services or prepaid package deals that lock in patient commitment.²³˒²⁴
• Certainty and Schedule: Guaranteed, or “fixed,” payments for each attended session are generally more effective than lotteries.²⁵ A constant, predictable reward for each visit appears to be superior for reinforcing a regular habit like attending therapy.²⁶
• Determining the Incentive Amount: There is no universal magic number, but studies show that even modest incentives can be effective. For appointment attendance, payments in the range of $10 per visit have been shown to work.²⁷ In a physical activity context, incentives of around $1 per day were sufficient to generate significant improvements.²⁶ The key is that the reward must be salient enough to be motivating. Programs can also be structured as loyalty systems, where patients earn a discount or a complimentary service after a certain number of completed sessions.²³˒²⁴

Navigating Legal and Ethical Considerations

Introducing direct financial incentives into a litigated claim requires careful consideration to avoid potential pitfalls.

• Strengthening, Not Tainting, Evidence: A primary concern is that an opposing counsel could argue that the patient only attended therapy to receive the incentive, not because they were genuinely injured. However, this argument can be countered. The incentive is not a payment for the injury itself, but a tool to overcome known behavioral barriers to completing a treatment plan prescribed by a medical professional. The detailed medical records generated from consistent therapy provide objective evidence of the injury’s extent and the patient’s response to treatment, which is far more powerful than the incentive itself.²⁸˒²⁹˒³⁰ The program should be framed as a support mechanism to help the patient comply with their doctor’s orders.
• The Role of the Attorney: Personal injury attorneys are uniquely positioned to facilitate such programs. By providing the incentive, they are not just encouraging attendance but are actively helping their client build a stronger case and mitigate the damages that could be used against them.⁷˒³¹ This aligns with their duty to secure the best possible outcome for their client. The process must be transparent, with clear communication between the attorney, the client, and the provider.³⁰
• Avoiding Coercion and Exploitation: Ethical objections often center on whether incentives are coercive, particularly for financially vulnerable individuals.³²˒³³ However, an incentive is a voluntary offer that adds a desirable option to the patient’s choice set; it does not remove an option or punish them for non-compliance. The patient remains free to refuse the offer and the treatment. The purpose is to help the patient achieve their own stated goals—recovery and fair compensation—by overcoming the intention-action gap.³⁴

Conclusion: A Strategic Investment in Patient and Case Health

Treatment non-compliance is a critical and costly vulnerability in personal injury litigation. It harms patients by impeding their physical recovery and harms their legal case by providing defense attorneys and insurance companies with powerful ammunition to devalue the claim. The reasons for patient dropout are complex but are rooted in predictable patterns of human behavior, particularly the tendency to prioritize immediate costs over future benefits.

A well-designed financial incentive program, offered as a tool to support adherence to prescribed physical and chiropractic therapy, is a strategically sound and ethically justifiable solution. By providing a small, immediate reward for attendance, these programs directly counteract the behavioral biases that lead to non-compliance. This is not about “paying a patient to be injured”; it is about making a modest investment to ensure the patient completes the necessary care that will lead to a better health outcome and a more accurate, and therefore fairer, valuation of their legal claim. For personal injury attorneys, healthcare providers, and even insurers, viewing adherence as a solvable behavioral challenge—and using proven tools to solve it—is a crucial step toward closing the gap between a patient’s injury and their ultimate recovery, both physical and financial.

Works Cited

1. Isaacs & Isaacs Personal Injury Lawyers. The Value of My Case if I Don’t Go to Physical Therapy. We Win. Accessed July 24, 2025.
2. Daniel P. How Physical Therapy Impacts a Personal Injury Settlement. Patrick Daniel Law. Accessed July 24, 2025.
3. Balinski M, Blanchard L, Mendoza R, et al. Factors Associated With Physical Therapy Attendance Rate and Self-Discharge in People With Chronic Pain. JOSPT Open. 2024.
4. One Accord Physical Therapy. How Soon Do I Need Physical Therapy After My Car Accident? Published 2024.
5. Thigpen M. Expectation vs. Reality: Why Patients Really Drop Out of Therapy. WebPT. Published 2024.
6. GMFM Law. Why You Shouldn’t Miss Medical Appointments for Injury Claims. Published 2024.
7. Abeyta Nelson Injury Law. How Physical Therapy Impacts a Personal Injury Settlement. Published 2024.
8. Gould Cooksey Fennell. Does Physical Therapy Increase Your Settlement? Published 2024.
9. Wex Definitions Team. Mitigation of Damages. Legal Information Institute, Cornell Law School. Published June 2020. Accessed July 24, 2025.
10. Shaked Law Personal Injury Lawyers. How to Mitigate Damages in a Personal Injury Case. Published 2024.
11. Paul & Perkins, P.A. Missed Appointments, Lost Compensation: Navigating Comparative Negligence. Published 2024.
12. Harrell & Paulson, LLP. How Do Insurance Companies Calculate Pain and Suffering? Published March 3, 2025.
13. Jack K, McLean SM, Moffett JK, Gardiner E. Barriers to treatment adherence in physiotherapy outpatient clinics: a systematic review. Man Ther. 2010;15(3):220-228.
14. Gilman & Bedigian. How Patient Non-Compliance Contributes to Potential Cases of Medical Malpractice. Published 2024.
15. Sprypt. 6 Critical Warning Signs of Physical Therapy Patient Dropout. Published 2024.
16. Beltran L. Why Patients Stop Going to Physical Therapy. Luna. Published September 27, 2018.
17. Tandem Strength & Balance. The Case of Patients Quitting Physical Therapy: Lack of Challenge and Therapist Responsibility. Published 2024.
18. Christmas Injury Lawyers. Non-Compliance Is A Valid Medical Malpractice Defense. Published 2024.
19. Lybbert T. Personal Injury: What PTs Should Know About This Unsung Market. WebPT. Published 2024.
20. Number Analytics. Present Bias in Health Economics: A Comprehensive Guide. Published 2024.
21. The Decision Lab. Reinforcement Theory. Published 2024.
22. Patel MS, Asch DA, Rosin R, et al. Patient preferences for financial incentives for medication adherence. J Gen Intern Med. 2021;27(6):772-783.
23. Noterro. Chiropractic Loyalty Program Ideas to Retain Clients. Published 2024.
24. MyChiroPractice. 3 Chiropractic Campaigns to Expand Your Patient Reach. Published 2024.
25. Campos-Mercade P, Meier AN, Schneider FH, Meier S, Pope D, Wengström E. Incentives to Vaccinate. Becker Friedman Institute for Economics at UChicago; 2024.
26. Patel MS, Asch DA, Rosin R, et al. A randomized, controlled trial of behavioral economic incentive design to improve physical activity. Ann Intern Med. 2019;171(4):233-240.
27. DeFulio A, Silverman K. The use of incentives to reinforce attendance at therapy sessions for depression: a preliminary study. Psychiatr Serv. 2006;57(3):414-416.
28. Dallas Accident & Injury Rehab. Chiropractic Records as Legal Evidence. Published 2024.
29. AlignMed. The Importance Of Chiropractic Records In Personal Injury Claims – How Chiropractors Support Personal Injury Cases. Published 2024.
30. zHealth. What Chiropractors Need to Know Before Choosing Personal Injury Software. Published 2024.
31. Kucher Law Group. Does Physical Therapy Increase Settlement? Published 2024.
32. Pugh J. Financial Incentives, Coercion and Psychosis. Practical Ethics, University of Oxford. Published November 2013.
33. Priebe S, Burton A, Ashby D, et al. Money for medication: financial incentives to improve medication adherence in assertive outreach. Psychiatr Bull. 2005;29(6):212-215.
34. Ghose T, Bloome J, Clanon K, et al. Are financial incentives an appropriate means for encouraging medication adherence among people living with HIV? AMA J Ethics. 2021;23(5):E410-418.