Date*** ***[your claims
adjuster] RE: Claim # *** ***[your name] Dear ***[claims adjuster], I am the physician who referred *** [your name]to ***[name of physical therapy or other doctor office].. ***[your name] came to me on ***[date] suffering from continuing pain in ***[your injury] due to a fractured third metacarpal he sustained in an automobile accident on ***[date]. I referred ***[you] to ***Physical Therapy. I have a close relationship with the staff there and support their diagnosis and their evaluations. ***[you] recently came to me for help interpreting the 9/27/04 “ortho clinic notes” initialed by ***[doctor name] from the *** Medical Center. Dr. *** has left on a five-year leave of absence to open an orthopedic clinic in the Dominican Republic. Since he cannot be reached and I was ***[your name] other treating physician I want to clarify your understanding of Dr. ***’s notes. The statement “disabled x 2 weeks” is a common practice. It is routinely written in the files of patients who have their casts removed. It means the patient is not fit to return to work and should return to a physician in two weeks after having his cast removed for a re-evaluation of his injury. In a case like ***[your name]’s when the injury was a fractured third metacarpal it in no way means ***[you] would return to 100% of his pre-accident strengths and abilities two weeks after his cast was removed. ***[you] is a plumber and works with both his left and his right hand. It wouldn’t be unreasonable to say that it would take a minimum of four to six weeks of physical therapy to enable ***[you] to regain the use and strength in his left hand in order for him to be able to perform his duties at work. However, when an insurance company who is responsible for a patient’s medical bills, as you are, doesn’t pay those bills then a patient is unable to receive reasonable medical care. I was told ***[you]’s mother had to cash in her life insurance policy to provide ***[you] with the finances that would enable him to finish his medical treatment. As a doctor who relies on insurance companies to pay for patient care I am appalled at your insensitivity to your obligation to pay for injuries caused by your insured who rear-ended ***[you]. I am of the opinion that an insurance company who purposely withholds medical treatment from a patient is responsible for all expenses and loss of wages incurred by that patient for the duration of the period the insurance company withholds treatment. ***[you]’s left hand was in pain when he came to me on ***[date]. It is my opinion that he could not have performed his job as a plumber in the condition he was in on that day and I firmly believe that he would absolutely not have been able to return to work two weeks after his cast was removed. ***[you] was released to go back to work on ***[date] by ***[therapist's name] at *** Physical Therapy and I will stand behind his professional evaluation of ***[your name]’s condition and agree that ***[you] was not released to return to work until February 28th. Please contact me if you have any questions. Sincerely,.
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