What is a treatment gap?

An interval between documented medical encounters long enough that a carrier may argue the claimant had recovered or that later treatment is unrelated to the incident.

How long an interval counts as a gap?

There is no fixed rule. Intervals beyond roughly 30 days commonly attract attention, and intervals beyond 60 days are usually addressed explicitly in the narrative.

Medical chronology & records

Treatment gaps in personal injury files

Treatment gaps

Direct answer

A treatment gap is an interval between documented medical encounters long enough that a carrier may argue the claimant recovered or that later care is unrelated. Gaps are facts rather than defects: many have documented explanations such as authorization delays, referral waits or work constraints, and the difference in evaluation comes from whether the demand addresses them.

NORBU Demand Editorial · Last reviewed 2026-08-31

Treatment gap Causation Medical chronology

How gaps are detected

Detection requires the full merged timeline across providers, not a single provider's chart. A patient may appear to have stopped therapy while actually being seen by an orthopedist during the same interval.

Merge all providers into one chronological sequence
Measure intervals between consecutive encounters
Check billing for dates of service missing from the records
Check referrals for the delay between order and appointment

Documented explanations

Insurance authorization or approval delay noted in the referral
Provider scheduling wait recorded at intake
Work, travel or caregiving constraints noted in the chart
Interim treatment with a different provider that was not initially collected

Presenting a gap in the demand

State the interval, state the documented reason, cite the page. An interval that is acknowledged and explained is far less useful to a carrier than one the reviewer discovers on their own.

Relevant capability

Before You Send™ →

See how this works inside the platform.

FAQ

Common questions

What is a treatment gap?: An interval between documented medical encounters long enough that a carrier may argue the claimant had recovered or that later treatment is unrelated to the incident.
How long an interval counts as a gap?: There is no fixed rule. Intervals beyond roughly 30 days commonly attract attention, and intervals beyond 60 days are usually addressed explicitly in the narrative.

Run this against a real file.

Upload a case and review readiness before anything leaves the firm.

Start free See a sample HIPAA Compliant · SOC 2 Type II