Dealing with the aftermath of a car accident is challenging enough without having to fight with an insurance company that claims your medical treatment is excessive. This situation is unfortunately common in San Antonio and throughout Texas, where insurance companies often employ various tactics to minimize their payouts.

At Ryan Orsatti Law, we understand the frustration and uncertainty this creates for accident victims. This guide explains why insurance companies dispute medical treatments, how Texas law protects you, and what steps you can take to fight back against unreasonable claim denials.

Why Insurance Companies Claim Medical Treatment Is Excessive

Insurance companies operate as businesses with a primary goal of maximizing profits. When they claim your medical treatment is excessive, they’re typically trying to:

1. Reduce their financial liability: Every dollar they don’t pay out increases their profit margins.
2. Force a quick settlement: They hope you’ll accept a lower offer rather than fight a lengthy battle.
3. Create doubt about causation: By suggesting treatments are unnecessary, they imply your injuries weren’t caused by the accident.
4. Exploit medical complexity: They count on most people not having the expertise to challenge their medical assessments.

In San Antonio specifically, we’ve seen insurance adjusters frequently question treatments like:

• Extended physical therapy sessions
• Specialized diagnostic testing
• Pain management procedures
• Surgical interventions
• Mental health counseling for trauma

Texas Law on Reasonable and Necessary Medical Treatment

Texas law provides important protections for accident victims seeking fair compensation for medical expenses. Here’s what you should know:

The Legal Standard for Medical Expenses

In Texas, you’re entitled to recover compensation for medical expenses that are “reasonable and necessary” for treating your injuries. This standard has two components:

1. Reasonable: The charges must be in line with typical costs for similar services in the San Antonio area.
2. Necessary: The treatment must be appropriate and required for your specific injuries.

Proving Medical Necessity in Texas

Under Texas Civil Practice and Remedies Code § 41.0105, recovery of medical expenses is limited to what was actually paid or incurred. However, this doesn’t give insurance companies free rein to deny legitimate treatments.

Texas courts generally respect the medical judgment of treating physicians. The Texas Supreme Court has recognized that doctors, not insurance adjusters, have the expertise to determine appropriate medical care.

Common Tactics Insurance Companies Use in San Antonio

Insurance companies employ several strategies to claim medical treatment is excessive:

1. Independent Medical Examinations (IMEs)

Insurance companies often require you to undergo an examination by their chosen doctor. These “independent” medical examiners frequently minimize injuries or suggest less intensive treatments.

It’s important to understand that these doctors are paid by the insurance company and may have financial incentives to provide opinions favorable to the insurer.

2. Medical Record Reviews

Insurers sometimes have in-house medical professionals review your records without ever examining you. These paper reviews often result in claims that:

• Your treatment exceeded standard guidelines
• Your injuries should have healed faster
• Your symptoms are inconsistent with the accident

3. Computerized Review Programs

Many insurance companies in Texas use software programs that flag treatments exceeding predetermined standards. These automated systems fail to account for individual circumstances and unique medical needs.

4. Pre-existing Condition Arguments

A common tactic is to attribute your symptoms to pre-existing conditions rather than the accident. This allows them to argue that treatments targeted accident-related injuries but were actually addressing chronic issues.

How to Fight Back When Your Treatment Is Called Excessive

When an insurance company challenges your medical treatment in San Antonio, these steps can help protect your right to fair compensation:

1. Follow Your Doctor’s Orders Completely

The most important thing you can do is follow all treatment recommendations and never miss appointments. Gaps in treatment give insurance companies ammunition to claim you weren’t really injured or that treatments weren’t necessary.

2. Maintain Detailed Documentation

Keep thorough records of:

• All medical recommendations and treatments
• How injuries affect your daily life
• Communications with insurance adjusters
• Out-of-pocket expenses
• Work missed due to injuries or treatments

3. Be Careful What You Say to Adjusters

Insurance adjusters are trained to elicit statements that can be used against you. Never admit fault, minimize your injuries, or discuss your treatment without consulting an attorney.

4. Don’t Accept the Initial Settlement Offer

First offers are almost always lower than what your claim is truly worth. Once you accept a settlement, you typically cannot seek additional compensation even if your injuries worsen.

5. Get Expert Medical Testimony

Having your treating physicians provide detailed explanations of why specific treatments were necessary can powerfully counter insurance company claims.

Legal Remedies for Bad Faith Insurance Practices in Texas

When insurance companies unreasonably deny claims or claim medical treatment is excessive, they may be acting in bad faith. Texas law provides several remedies:

Texas Insurance Code Protections

The Texas Insurance Code prohibits unfair settlement practices, including:

• Misrepresenting policy provisions
• Failing to promptly investigate claims
• Refusing to pay claims without reasonable investigation
• Denying claims without explanation

Violations can result in penalties up to three times the amount of actual damages, plus attorney’s fees.

Common Law Bad Faith Claims

Texas also recognizes common law bad faith claims when an insurer breaches its duty of good faith and fair dealing. This applies when an insurer denies or delays payment of a claim without a reasonable basis.

Why Having a San Antonio Personal Injury Attorney Matters

When dealing with insurance companies claiming your medical treatment is excessive, having experienced legal representation can make all the difference:

Leveling the Playing Field

Insurance companies have teams of adjusters, investigators, and attorneys working to minimize payouts. A skilled personal injury attorney provides the legal expertise needed to counter these resources.

Medical Evidence Development

Experienced attorneys work with medical experts to build compelling evidence of treatment necessity. This includes obtaining detailed medical opinions and scientific literature supporting your care plan.

Negotiation Experience

Professional negotiators at insurance companies count on your inexperience. Attorneys who regularly handle personal injury claims understand insurance company tactics and how to effectively counter them.

Litigation Readiness

Sometimes, the only way to receive fair compensation is through litigation. Having an attorney prepared to take your case to court often motivates insurance companies to make better settlement offers.

Specific Challenges in San Antonio Personal Injury Cases

San Antonio presents some unique challenges when fighting insurance companies over medical treatment:

Local Medical Cost Variations

Medical costs in San Antonio can differ significantly from other parts of Texas. Insurance companies sometimes use statewide averages rather than local costs to claim treatments are overpriced.

Regional Treatment Approaches

Medical practices can vary regionally. What’s standard treatment in San Antonio might be less common elsewhere, giving insurance companies an opening to question necessity.

San Antonio Traffic Patterns and Accident Severity

The city’s unique traffic patterns and high-speed roadways like I-10, I-35, and Loop 1604 often result in high-impact collisions. Insurance companies may underestimate how these factors contribute to more severe injuries requiring extensive treatment.

Case Studies: Successful Challenges to “Excessive Treatment” Claims

While respecting client confidentiality, we’ve helped many San Antonio residents overcome insurance company denials:

Case Example 1: A client with soft tissue injuries was denied coverage for physical therapy beyond 12 sessions, despite continuing pain. We secured medical expert testimony explaining why the standard recovery timeline didn’t apply given the client’s specific injury pattern. The insurance company ultimately covered all 30 recommended sessions.

Case Example 2: After a serious collision on I-10, a client required spinal surgery. The insurer claimed the procedure was unrelated to the accident. Through detailed medical evidence and expert testimony, we established clear causation between the accident and the need for surgery, resulting in full coverage of surgical costs.

Preventing Insurance Disputes Before They Happen

Taking these steps immediately after an accident can help prevent later disputes about medical treatment:

1. Seek immediate medical attention even if injuries seem minor
2. Tell medical providers about ALL symptoms, no matter how slight
3. Mention the car accident to every medical provider you see
4. Request detailed treatment notes explaining why specific procedures are necessary
5. Ask your doctor to document causation between the accident and your injuries

When to Contact a San Antonio Personal Injury Attorney

If you’re facing claims that your medical treatment is excessive, contact an experienced San Antonio personal injury attorney immediately. The sooner legal representation begins, the better protected your rights will be.

At Ryan Orsatti Law, we offer free consultations to discuss your situation and explain your options. Our team has extensive experience challenging insurance companies that deny legitimate medical treatments for San Antonio accident victims.

Conclusion

When the other driver’s insurance company claims your San Antonio medical treatment is excessive, they’re hoping you’ll accept less than you deserve. Understanding your rights under Texas law and having skilled legal representation gives you the best chance of receiving fair compensation for all necessary medical care.

Don’t let insurance companies dictate your recovery process. Your health should be determined by medical professionals, not insurance adjusters trying to save their company money.

If you’re facing resistance from an insurance company about your medical treatment after a San Antonio car accident, contact Ryan Orsatti Law today to discuss how we can help protect your right to appropriate medical care and fair compensation.