Personal Injury
If you were hurt in an accident, suffered a herniated disc, and chose physical therapy or chiropractic care instead of spinal surgery, there is a good chance the insurance company is already building a case to lowball your claim. I see it constantly in my personal injury practice. The adjuster's logic is simple and cynical: "If your injury were really that serious, you would have had the surgery."
That argument might sound persuasive on the surface, but it ignores medical reality, patient autonomy, and the well-documented risks of spinal surgery. I'm Joshua C. Sussex, a personal injury attorney at SG Legal Group in Towson, Maryland, and I want to explain what's really going on when insurance companies attack your decision to pursue conservative treatment — and exactly how we fight back.
A herniated disc occurs when the soft, gel-like center of a spinal disc pushes through a tear in its tough outer wall. Doctors sometimes compare it to a jelly doughnut being squeezed until the filling leaks out. When that displaced material presses against nearby spinal nerves, the result can be excruciating. Symptoms range from sharp, shooting pain down the legs (sciatica) or arms, to numbness, tingling, and muscle weakness that makes everyday tasks — picking up your child, sitting through a workday, sleeping through the night — unbearable.
More than three million Americans are diagnosed with a herniated disc each year. The condition most commonly strikes people between ages 30 and 50, and it is one of the most frequent injuries I see in car accident cases, truck accidents, and motorcycle crashes. The force of a rear-end collision or a T-bone impact is more than enough to herniate a disc, even in someone with no prior back problems.
Here's the part the insurance companies don't want you to know: the overwhelming medical consensus is that conservative, non-surgical treatment is the correct first-line approach for the vast majority of herniated disc patients. The World Federation of Neurosurgical Societies stated in its 2024 consensus paper that conservative treatment should be the first line of care for disc herniation patients who do not have severe neurological deficits. The American Association of Neurological Surgeons agrees. Fewer than 10% of herniated disc patients are even candidates for surgery. Choosing conservative treatment isn't a sign your injury is minor. It's what the medical community recommends.
When I sit down with a client who has a herniated disc and ask about their treatment plan, many tell me their doctor advised against surgery. Others tell me they researched the risks and made a personal decision to avoid it. Both of those reasons are medically and legally valid, and I want to explain why.
Spinal surgery carries real, well-documented risks that justify a patient's reluctance. Failed back surgery syndrome — persistent or worsening pain after surgery — affects a significant percentage of spinal surgery patients, depending on the procedure. That means a substantial number of patients who undergo a microdiscectomy still have significant problems afterward, and the numbers get worse for spinal fusions. Surgical site infection rates can be meaningful, with deep infections after instrumented fusions costing upward of $100,000 in additional medical expenses. And if the first surgery doesn't work, the odds drop steeply with each subsequent revision.
Recovery is another major factor. A microdiscectomy typically requires 12 weeks before the patient can return to work, and physically demanding jobs take longer. Spinal fusion recovery can stretch well beyond a year. For someone who is the primary breadwinner in their family, taking months off work to undergo a procedure with a meaningful failure rate is not a casual decision. It can be financially devastating.
The medical evidence also supports the idea that conservative treatment delivers comparable long-term results. The landmark SPORT trial — the largest study ever conducted comparing surgical and non-surgical outcomes for lumbar disc herniation, involving 1,244 patients across 13 spine clinics — found that while surgery provided faster initial pain relief, both treatment groups improved significantly and long-term outcomes at four to eight years showed comparable results. A well-known 2007 randomized controlled trial found that outcomes between early surgery and prolonged conservative treatment were statistically similar at one year, and a five-year follow-up confirmed no significant differences. Conservative treatment works. The science is settled on that point.
Despite all of that medical evidence, insurance adjusters and defense attorneys have developed a well-worn playbook for attacking herniated disc claims where the patient chose physical therapy, chiropractic care, or epidural injections over surgery. I've seen these tactics hundreds of times, and they fall into a few predictable categories.
The "Treatment Food Chain" Argument
The defense constructs a hierarchy — physical therapy at the bottom, steroid injections in the middle, surgery at the top — and argues that where you fall on that ladder reflects the severity of your injury. If you never "escalated" to surgery, your injury must not have been that serious. This is a distortion. Treatment decisions are based on individual medical circumstances, patient risk factors, and physician recommendations — not a one-size-fits-all escalation ladder.
The "If It Was Really That Bad" Attack
This is the most common tactic I encounter. The adjuster or defense lawyer will argue that a reasonable person in genuine, severe pain would have pursued the most aggressive treatment available. The implication is that your pain must be exaggerated because you didn't go under the knife. This argument ignores the well-established right to refuse medical treatment and it ignores the mountain of evidence showing that spinal surgery is a high-risk procedure that many competent physicians advise against.
The "Excessive Treatment" Label
If you've been in physical therapy or chiropractic care for a year or more, the defense will label your treatment "maintenance care" rather than curative care and argue it was not medically necessary. They'll claim that if conservative treatment hadn't resolved your symptoms within a few months, you should have either gotten surgery or accepted that you were better. This completely disregards medical guidelines showing that conservative treatment timelines vary widely and that gradual improvement over months or even years is well within the norm.
The Defense Medical Examination
Insurance companies will frequently request a so-called "Independent Medical Examination," though there is nothing independent about it. These IME doctors are selected and paid by the insurance company, and many of them derive a substantial portion of their income from conducting these exams. They commonly conclude that the herniation is age-related degeneration rather than trauma from the accident, that the patient has reached "maximum medical improvement" and needs no further treatment, or that the condition was never severe enough to justify the treatment received. I always advise my clients to bring an observer to these examinations and to document everything that occurs during the visit.
Countering these defense tactics requires a strategic, evidence-based approach — and it starts well before any settlement negotiation or trial. Here's what I focus on when representing clients with herniated disc injuries and conservative treatment in Maryland personal injury cases.
Building a Bulletproof Treatment Record
Documentation is everything in a conservative treatment case. I work closely with my clients and their treating physicians to ensure that medical records clearly state the causal connection between the accident and the herniated disc, the medical reasoning behind choosing conservative care over surgery, the patient's ongoing symptoms and functional limitations at each visit, and the prognosis for future treatment needs.
When a treating physician can testify that they specifically recommended against surgery due to the risks, and that the conservative care plan was medically appropriate for this patient's condition, that testimony is extraordinarily powerful. The treating doctor who has seen you dozens of times over months carries far more credibility than an IME physician who spent 15 minutes with you once.
Leveraging the Medical Literature
I cite the SPORT trial, peer-reviewed randomized controlled trials, NASS guidelines, and the WFNS consensus directly in demand letters and at trial. When the defense argues that failing to get surgery means the injury isn't serious, I show them that every major medical authority recommends conservative treatment first and that long-term outcomes are comparable to surgery. That reframes the narrative from "this patient refused necessary treatment" to "this patient followed the medically recommended course of care."
Projecting Future Costs With a Life Care Plan
Even without surgery, a herniated disc patient may need ongoing physical therapy, periodic epidural steroid injections, pain medication, and future diagnostic imaging for years or even a lifetime. A life care plan prepared by a qualified expert projects those future costs and dramatically increases the economic value of the claim. This is critical because without surgery, the total past medical bills may be modest, and a life care plan fills that gap.
Addressing the Surgery Question Proactively
I never let the defense be the first to raise the question of why my client didn't have surgery. We address it head-on, early, and through medical testimony. If the treating physician believes surgery may become necessary in the future, that "delayed surgery" testimony can transform the value of the case. Strong medical evidence supporting the conservative treatment approach — combined with compelling plaintiff testimony about daily pain and limitations — is what moves the needle in these cases.
Filing a herniated disc claim in Maryland involves navigating some of the most defendant-friendly personal injury laws in the country. Maryland is one of only four states that still follows the pure contributory negligence doctrine, which means that if the defense can show you were even 1% at fault for the accident, you are completely barred from recovering any compensation. This makes it critical to establish that you bore absolutely zero fault, and it's one of the main reasons insurance companies in Maryland fight so aggressively on every claim — the risk of a total bar at trial depresses settlement values.
Maryland also caps noneconomic damages — your compensation for pain, suffering, and diminished quality of life. For injuries occurring between October 1, 2024, and September 30, 2025, the cap is $950,000. For injuries from October 1, 2025, through September 30, 2026, it rises to $965,000. While most herniated disc cases settle well below these figures, the cap matters in severe cases involving permanent disability. There is no cap on economic damages like medical bills and lost wages, which is another reason documenting every dollar of treatment — past and future — is so important.
The statute of limitations for personal injury cases in Maryland is three years from the date of the accident. That might sound like plenty of time, but when you're focused on recovering through conservative treatment, three years can pass faster than you expect. I've had clients come to me at the two-and-a-half-year mark who still hadn't spoken with an attorney. Don't let that happen to you.
One piece of Maryland law that works in your favor is the eggshell plaintiff doctrine. If you had pre-existing degenerative disc disease — which many adults over 30 do — and the accident aggravated that condition, the defendant is responsible for the full extent of your injury. Maryland's pattern jury instructions make clear that a defendant takes the plaintiff as they find them, and that a person with a pre-existing condition is entitled to full damages for the aggravation of that condition. This directly counters the defense tactic of blaming your herniated disc on aging or degeneration rather than the accident.
If you have a herniated disc from an accident and you are pursuing conservative treatment, there are concrete steps you should take to protect the value of your case. These are the same things I tell every client at our initial consultation.
Never skip or delay treatment appointments. Gaps in your treatment record are the single easiest weapon the insurance company has against you. Every missed appointment gets flagged as evidence that your pain isn't as bad as you claim. Stay consistent with your physical therapy, chiropractic visits, and follow-up appointments, even when life gets in the way.
Keep a daily pain journal. Record your pain levels, what activities you couldn't do that day, how the injury affected your sleep, your mood, and your ability to work or care for your family. This documentation provides the day-to-day evidence of suffering that medical records alone cannot capture, and it is invaluable at mediation or trial.
Ask your doctor to document why conservative treatment is appropriate for you. Your treating physician's notes should explicitly address why surgery was not recommended, why the conservative care plan is medically reasonable, and how your symptoms connect to the accident. If your doctor's notes simply say "continue PT" at each visit without context, the defense will argue the treatment was rote and unnecessary.
Do not give a recorded statement to the insurance company without speaking with an attorney first. Adjusters are trained to ask leading questions designed to elicit admissions — like "so you decided not to have surgery?" — that they will later use to minimize your claim.
Consult with a personal injury attorney early, even if you are not ready to file a lawsuit. An experienced attorney can guide your treatment documentation strategy from the start, not just pick up the pieces later. The earlier I get involved in a case, the stronger the record we build.
The insurance company wants you to believe that choosing conservative treatment for your herniated disc was a mistake — or at least a sign that your injury isn't worth much. That is a calculated strategy, not a reflection of reality. The medical evidence overwhelmingly supports conservative treatment as the appropriate first-line approach for herniated discs, and the long-term outcomes are comparable to surgery for most patients. You should not have to undergo a risky surgical procedure just to prove to an insurance adjuster that you are in pain.
What you do need is proper documentation, a treating physician who will support the medical reasonableness of your care, and an attorney who understands how to dismantle the defense playbook. Every day in my practice, I work with herniated disc clients who chose the conservative path and were told their case was worth next to nothing. Those clients often have strong cases — they just need someone who knows how to present them.
If you were injured in a car accident, truck accident, motorcycle crash, or workplace incident and you're treating a herniated disc without surgery, I want to hear from you. Call SG Legal Group at (410) 618-1277 or contact us online to schedule a free consultation. We'll review your treatment records, evaluate the strength of your claim, and build a strategy that reflects the true impact this injury has had on your life — surgery or not.
Disclaimer: The information provided in this article is for general informational purposes only and does not constitute legal advice. Laws and regulations are subject to change, and individual circumstances vary. For advice specific to your situation, please consult with a qualified attorney.
Joshua C. Sussex, Esq.
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