Gaps in Treatment Can Affect Your Spinal Cord Injury Claim. Know What to Watch For.

If your spinal cord injury care slowed down after a crash, you may worry that an insurer will use the pause against you. A gap in treatment is one of the first things adjusters look at. A gap is measured against the treatment plan your doctor set, and the reason for it matters as much as the dates.

This page explains what a gap is, why staying on your medical plan comes first, and how your records can explain a pause in care. It also covers the New Mexico rules that shape a spinal cord injury claim.

What a Gap in Treatment Means After a Spinal Cord Injury

A gap in treatment is a period when care your doctor recommended stops or is delayed. Common examples include missed appointments, skipped therapy, and a long stretch with no provider visits.

The key question is what the treatment plan called for. A gap is measured against the plan your doctor set, not against a fixed number of days. If your plan calls for therapy twice a week, a stop in those sessions is a gap.

Many people assume a set number of days turns a break into a gap. In practice, the plan and the reason for each break matter more than the calendar.

A planned pause is different. If a physician tells you to hold a treatment for a set period, that pause follows the medical plan. It is not a lapse in care. Ask your providers to write any pause or change into your chart, with the date.

Why Following Medical Advice Comes First

Following your medical advice comes first, because your health depends on it. Your doctor’s plan is the main guide for your recovery. A claim should never shape that plan.

Follow-up visits let your doctors check for changes, adjust medication, and fit equipment and therapy. Rehabilitation, medication changes, and equipment fittings all depend on regular visits with your providers.

If something changes between visits, tell your provider right away. Do not wait for the next scheduled appointment. Report new numbness, weakness, pain, or any change in how you feel on the day you notice it.

No legal concern should lead you to skip or delay care. A claim and your treatment can move forward together, but your health comes first.

How Insurers Use Treatment Gaps to Dispute a Claim

Insurance adjusters often read medical records for timing. They look closely at the space between visits. A gap can become the basis for an argument in three common ways.

First, that the injury was not as serious as claimed. Second, that the condition came from something other than the accident. Third, that the injured person did not follow medical advice.

A gap can shape how an adjuster values a claim, even when the gap had a good reason. That is why the records need to show what happened and why. A clear note explaining a pause can answer the question before it grows.

Common Reasons Care Pauses and How to Document Them

Care often pauses for practical reasons, and each reason should be written down. Cost concerns, transportation problems, work schedules, and caregiving duties are common. So is a physician’s instruction to pause a treatment.

Write the reason in your medical chart at the time it happens. Ask the provider to note the date and the reason. A note made close to the date is easier to explain later than a memory from months afterward.

Keep a personal symptom and appointment log. Record pain, changes in mobility, and any missed visit with its reason next to it. Keep it simple, with one line per appointment or per day. Note whether a ride fell through, work kept you away, or cost was a barrier.

When you return to care, document that too. Tell the provider which symptoms you have now and what changed since your last visit. Ask that the visit note reflect those symptoms.

Records That Connect Your Care to the Accident

The records that matter most tie your injury to the crash and show each step of your care. These include emergency and hospital records, imaging, surgical notes, therapy logs, prescriptions, and bills.

A treating doctor’s written link between the accident and the injury helps a claim. New Mexico courts ask whether an act was a cause of the injury. A cause contributes to bringing about the injury, and the injury would not have occurred without it, and it must be reasonably connected as a significant link to the injury, as UJI 13-305 explains.

It need not be the only cause.

Accident reports matter too. A driver in a crash that causes bodily injury or death, or total property damage to an apparent extent of five hundred dollars ($500) or more, must send a written report to the Department of Transportation within five days, under NMSA 1978, § 66-7-207. New Mexico also limits how accident reports can be used as trial evidence, under § 66-7-213.

Evidence can disappear over time. New Mexico recognizes claims for intentional spoliation of evidence, which is destroying evidence on purpose. Keeping your own copies early is the simplest step.

How Treatment Gaps Can Affect a Spinal Cord Injury Claim

A gap can lead an insurer to question future care. It can also raise doubt about whether the injury is tied to the accident. Claims for a spinal cord injury often include past and future medical costs.

Future costs are often laid out in a life care plan prepared with medical input. You can read more in our life care plan in a New Mexico lawsuit guide.

The effect of any gap depends on the medical records, the reasons documented, and the treating providers’ opinions. No outcome can be predicted from a gap alone.

New Mexico uses comparative negligence, which means shared fault. Under New Mexico law, your own fault reduces your damages. Under New Mexico law, your percentage of fault is subtracted from your total damages.

Steps to Take If You Have Had a Gap in Care

Return to your treating doctor promptly and report every symptom. Include new or worsening problems, even if they seem minor. Say what changed since your last visit.

Ask providers to note the reason for any past gap, plus any restrictions or instructions, in the chart. If you can’t recall a date, say so and ask the provider to check the record.

Keep copies of records, bills, and your symptom log. Talk with an insurance adjuster carefully. Stick to facts, and review your situation before you give a recorded statement.

Some timing rules also apply. Under NMSA 1978, § 41-1-1, a person whose interest is adverse to an injured patient who is under a provider’s care or confined to a hospital or sanitarium as a patient may not, within fifteen days from the date of the occurrence causing the injury, negotiate or attempt to negotiate a settlement, seek a general release, or obtain a statement from the injured patient for use in negotiating a settlement or obtaining a release. A settlement agreement, release of liability, or written statement is void unless the injured party acknowledges it before a notary public who has no interest adverse to the injured person.

New Mexico’s general deadline for an injury-to-person lawsuit is three years, under NMSA 1978, § 37-1-8. The firm represents personal injury clients in New Mexico, and people injured in Santa Fe, Rio Rancho, or Las Cruces are welcome to contact it. Early guidance can help you understand how your records will be read.

Talk With El Gringo Law About Your Gap in Care

If your spinal cord injury care paused and an insurer is asking about the timing, you do not have to sort that out alone. Describe the accident, the injury, and the care you have received so far through the El Gringo Law contact form. The initial consultation is free, confidential, and carries no obligation to continue.

Josh Wood, a lawyer licensed in New Mexico and Arizona, is responsible for this page’s content. You can reach El Gringo Law at elgringolaw.com.

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