• I want to consult about a traffic accident in Yaizu/Makinohara
• The insurance company told me they would cut off my medical expenses, but I still want to continue treatment
• I want to negotiate with the insurance company to continue treatment as long as possible

Are you troubled by something like this in Yaizu, Makinohara, Omaezaki, Fujieda, Shimada, Yoshida Town, or surrounding areas?
We receive a great number of consultations such as "I was told my treatment would be cut off even though I am still in pain" and "The insurance company will not listen even though treatment is necessary." In most cases, the termination of medical expenses is driven by the insurance company's desire to reduce the amount it pays—a decision based on the company's own convenience—and is rarely supported by medical evidence.
Yaizu General Law Office offers a free initial legal consultation for traffic accident matters. You are under no obligation to retain us after consulting. We are available on weekday evenings and Saturdays. Please feel free to contact us by phone or email.

Notice of Termination of Medical Expenses by the Insurance Company

Naturally, even if you are injured in a traffic accident, the insurance company will not pay your medical expenses indefinitely.

However, there are cases where the insurance company notifies you that it will terminate your medical expenses while you are still undergoing treatment for your injuries.

Whiplash (cervical sprain), lumbar sprain, and shoulder pain, among other conditions, take a long time to improve. In many cases, the insurance company unilaterally decides that you should already be healed and cuts off payment, even though continued treatment is medically necessary.

In most cases, the insurance company's notice of termination lacks medical justification. If you simply comply, not only will you be unable to receive necessary treatment, but it will also be disadvantageous for your residual disability certification.

Below, we explain how to respond when an insurance company notifies you that it will terminate your medical expenses.

Steps to Take When the Insurance Company Says It Will Cut Off Your Medical Expenses

Even if the insurance company tells you it will terminate your medical expenses, you do not need to stop treatment immediately. First, confirm with your attending physician whether continued treatment is necessary, and then proceed accordingly.

In summary, the process is as follows:

Response Stage	What to Confirm/Do
Receive notice of termination from the insurance company	Confirm the scheduled termination date and the reason for the termination decision.
② Consult your attending physician	Confirm your current symptoms, the need for continued treatment, and the expected timing of symptom stabilization.
③ Obtain a diagnosis that continued treatment is necessary	If necessary, have a medical certificate prepared stating the need for continued treatment and the expected duration of treatment.
④ Negotiate with the insurance company to continue treatment	Convey the physician's diagnosis and request that the insurance company continue its lump-sum payment arrangement for medical expenses.
⑤ Continue treatment even if expenses are cut off	Switch to health insurance and continue necessary treatment. Keep all receipts and medical statements.
⑥ Settle accounts after full recovery or symptom stabilization	Consider claiming self-paid medical expenses incurred after termination and applying for residual disability certification.

Whether to Terminate Medical Expenses Should Be Based on the Physician's Diagnosis, Not the Insurance Company's Decision

This is particularly common with whiplash (cervical sprain). About four to six months after treatment begins, you may receive a notice from the at-fault party's insurance company stating that it will terminate your medical expenses.

Specifically, regardless of your treatment status or current symptoms, the insurance company may say something like: "Several months have passed since treatment began, so your symptoms are now stabilized. We will send you the forms, so please have your attending physician complete a residual disability diagnosis." They unilaterally demand the end of treatment. This is because insurance companies want to keep the compensation paid to the victim as low as possible.

Symptom stabilization means that further treatment is unlikely to produce recovery. Once symptom stabilization is reached, the victim must bear subsequent medical expenses. However, determining symptom stabilization is the role of the treating physician, not the insurance company.

Therefore, even if the insurance company notifies you of the termination of medical expenses, if the physician diagnoses that continued treatment is necessary (i.e., symptoms have not stabilized), it is possible to continue treatment and have the insurance company pay for it.

In other words, only a physician can determine "whether treatment is medically necessary," and the insurance company cannot unilaterally declare "symptom stabilization."

As long as your attending physician determines that continued treatment is necessary, you can claim medical expenses from the insurance company. No matter what the insurance company says, your attending physician's diagnosis takes priority.

Responding to a Notice of Termination of Medical Expenses

① First, confirm with your attending physician whether continued treatment is necessary

If the physician has not diagnosed symptom stabilization, you are not required to comply with the insurance company's notice of termination of medical expenses.

If several months have passed since the accident and you still have lingering symptoms and wish to continue treatment, but the insurance company is hinting at termination, confirm with your physician the expected duration of treatment until symptom stabilization and convey this to the insurance company.

When consulting your attending physician, it is important not to simply say "I am still in pain," but to specifically explain your remaining symptoms, the impact on your work and daily life, and whether your symptoms have been improving with treatment.

② Have a medical certificate prepared if necessary

In some cases, having the physician prepare a medical certificate stating the expected remaining treatment period and submitting it to the insurance company can facilitate negotiations.

The medical certificate should include your current symptoms, the necessity of continued treatment, and the expected future treatment period.

That said, physicians do not always prepare medical certificates with insurance company negotiations in mind. Therefore, it is advisable to explain during your visit that the insurance company has notified you of the termination of medical expenses.

③ Negotiate with the insurance company based on the physician's diagnosis

If your attending physician has determined that continued treatment is necessary, convey the diagnosis to the insurance company and request that they continue the lump-sum payment arrangement.

Rather than simply saying "I am still in pain and want to continue treatment," it is important to present specific information such as your attending physician's opinion, your visit history, and the progress of your symptoms.

Also, if the insurance company has notified you of the termination of medical expenses, make sure to confirm the scheduled termination date and the reason for the decision.

④ Continue necessary treatment even if expenses are cut off

If the insurance company still refuses and terminates medical expenses, switch to health insurance and continue treatment. It is possible to use health insurance even for traffic accident cases.

The end of the insurance company's lump-sum payment arrangement and the end of the medical need for treatment are not the same thing.

If your attending physician has determined that continued treatment is necessary, it is important not to stop visiting the hospital simply because the insurance company has stopped paying. Discontinuing treatment may not only affect your recovery but may also lead to disputes about the causal relationship between the accident and your symptoms later on.

⑤ Keep receipts for self-paid medical expenses

After full recovery or symptom stabilization, it is possible to claim from the insurance company the medical expenses you bore after the termination. Even if the insurance company forcibly terminates payment, it is important not to give up.

If you continued treatment using health insurance or at your own expense after the termination, be sure to keep records such as medical expense receipts, medical statements, pharmacy receipts, and transportation expense records.

However, not all self-paid medical expenses will necessarily be recognized; the necessity and reasonableness of the treatment are typically disputed.

In our firm's experience, insurance companies almost never voluntarily pay for medical expenses incurred after termination, even when claimed.

For this reason, we recommend consulting an attorney as soon as you are notified of the termination.

If the Physician Determines Symptom Stabilization, Consider Applying for Residual Disability Grade Certification

When the insurance company notifies you of the termination of medical expenses and your physician also determines that symptom stabilization has been reached, it is unfortunately difficult to claim further medical expenses (you may, of course, continue treatment at your own expense, but it will be treated as unrelated to the traffic accident). In such a case, it is better to shift your focus to having your physician prepare a residual disability diagnosis and pursuing residual disability grade certification.

After symptom stabilization, it is extremely important to proceed with residual disability grade certification rather than continuing to seek medical expenses. Whether appropriate documentation and examinations are conducted at this stage significantly affects the outcome of disability certification and the amount of compensation.

Negotiations with the Insurance Company Should Be Handled by an Attorney

For most people, a traffic accident is a first-time experience, and they are unfamiliar with the process. As a result, when the at-fault party's insurance company notifies them of the termination of medical expenses, they tend to simply comply. However, the at-fault party's insurance company is by no means your ally. The insurance company notifies you of the termination for its own convenience (to keep compensation costs low). Victims need to understand this reality.

Negotiating the continuation of treatment with an insurance company that has handled thousands or tens of thousands of traffic accident cases is an arduous task. Studying the process from scratch and confronting the insurance company on your own takes considerable time and effort. Many insurance companies change their attitude once an attorney becomes involved, and there are numerous cases where the termination has been reversed and treatment has been allowed to continue. We encourage you to consider retaining an attorney to handle the negotiations so that you can focus on your treatment.

Frequently Asked Questions

The Initial Legal Consultation for Traffic Accidents at Yaizu Sogo Law Office Is Free of Charge

Yaizu Sogo Law Office provides a free initial legal consultation regarding traffic accidents.

We handle all traffic accident-related legal matters, regardless of severity or whether they involve property damage or personal injury. If you are feeling stressed by dealings with insurance companies, or if you want to know whether the amount offered by your insurance company is fair, please do not hesitate to consult with us.

Yaizu Sogo Law Office is available not only during regular weekday hours but also on weekday evenings and Saturdays. Please contact us by phone or email to schedule a legal consultation.

Are You Troubled by a Traffic Accident?

• Settlement Offers from Insurance Companies Are Almost Always Low
• The Insurance Company Said They Would Cut Off My Medical Expenses
• Dissatisfied with the Fault Ratio
• When and How to Consult a Lawyer About a Traffic Accident
• What Claims Can Be Made in a Personal Injury Accident?
• What Claims Can Be Made in a Property Damage Accident?
• What You Need to Know About Whiplash
• Traffic Accidents and Health Insurance
• Procedures and Steps to Follow After a Traffic Accident
• Fault Proportions Between a Through-Going Vehicle and a Right-Turning Vehicle at an Intersection
• Diminished Value (Loss of Market Value)
• Amount Claimable from the Other Party When Personal Injury Protection Insurance Was Used Prior to the Claim for Damages Against the Other Party
• Free legal consultation is available for traffic accidents
• Filing a Victim's Claim with Compulsory Automobile Liability Insurance (CALI)
• Lost Wages for Salaried Employees (Wage Earners) in Traffic Accidents
• Understanding a Company's Losses When Employees Are Killed or Injured in a Traffic Accident
• Finding the Court with Jurisdiction over Traffic Accident Lawsuits
• Want to Know Whether You Can Offset the Other Party's Damages Against Your Own in the Same Traffic Accident
• The at-fault party refuses to use their voluntary automobile insurance. What should I do?
• I was seriously injured in a traffic accident in June 2017, before the enforcement of the amended Civil Code (April 1, 2020). Three years have passed (but less than five years) since I completed my treatment. Is the statute of limitations still valid?
• How to Identify a Hit-and-Run Driver from a Vehicle License Plate Number
• Methods of Dispute Resolution in Traffic Accidents
• What You Need to Know About Medical Commuting Transportation Expenses
• How to Find the Insurance Company of the At-Fault Driver in a Traffic Accident
• Understanding Workers' Compensation Insurance in Traffic Accidents (Leave Compensation)
• How Much Is the Standard Compensation for a Traffic Accident?
• What Is Residual Disability Grade Certification in Traffic Accidents?
• How Much Compensation Can You Get for Whiplash from a Traffic Accident?
• Benefits of Hiring a Lawyer for Traffic Accidents
• Key Points When Dealing with Insurance Companies After a Traffic Accident
• How to Calculate Lost Income from a Traffic Accident
• The Relationship Between Number of Hospital Visits and Compensation for Pain and Suffering in Traffic Accidents (Key Considerations When Visit Frequency Is Low)
• What Is Maximum Medical Improvement (MMI) After a Traffic Accident?
• How to Use Lawyer Fee Special Coverage for Traffic Accidents?
• How to Handle a Traffic Accident When the At-Fault Driver Has No Insurance
• Damages in Bicycle Accidents
• Claiming Compensation When a Passenger Is Injured in a Traffic Accident
• Do You Have to Pay a Traffic Fine for a Burned-Out Brake Light?
• "I Said I Would Pay the Full Repair Cost" in a Bicycle Accident
• If Repair Costs Exceed Your Car's Market Value After a Traffic Accident, Can You Still Recover the Full Amount?
• Can a Car Proceed if a Pedestrian Yields at a Crosswalk?
• What Are "Replacement Incidental Costs" When a Vehicle Is Totaled in a Traffic Accident?
• What Damages Can Be Claimed When a Family Member Dies in a Traffic Accident?

See all articles on traffic accidents