The Cost of Non-Adherence: ER Visits and Hospitalizations in PI Cases

Amar Lunagaria — Co-Founder & Chief Pharmacist, LienScripts | March 4, 2026 | 8 min read

When personal injury plaintiffs cannot afford or access their prescribed medications, the resulting non-adherence frequently leads to emergency room visits and hospitalizations that dramatically increase case costs, extend treatment timelines, and create documentation challenges attorneys must understand.

The Cost of Non-Adherence: ER Visits and Hospitalizations in PI Cases

Medication non-adherence in personal injury cases does not simply mean a plaintiff skipped a few pills. It means uncontrolled pain escalating to emergency department visits, untreated muscle spasms causing secondary falls, unmanaged post-surgical inflammation leading to complications, and preventable hospitalizations that multiply the total cost of care while simultaneously giving the defense ammunition to argue the plaintiff failed to mitigate damages.

• Non-adherence to prescribed medications is a leading cause of preventable ER visits and hospitalizations among PI plaintiffs
• The average cost of a single ER visit for uncontrolled pain exceeds the cost of months of properly managed outpatient prescriptions
• Defense attorneys exploit non-adherence as evidence of failure to mitigate, malingering, or exaggeration
• LienScripts' pharmacy lien model eliminates the primary financial barrier to medication adherence during litigation
• As Amar Lunagaria, PharmD, LienScripts' Chief Pharmacist explains, every ER visit attributable to medication non-adherence is a preventable event that weakens the case

The Clinical Cascade of Non-Adherence

When a plaintiff with post-traumatic cervical radiculopathy stops taking gabapentin because the out-of-pocket cost is unaffordable, the neuropathic pain does not simply persist at a manageable level. It escalates. Within days, the patient may experience breakthrough pain episodes that drive them to the emergency department. The ER physician prescribes a short course of opioids and muscle relaxants — medications that would not have been necessary if the maintenance regimen had continued uninterrupted.

This pattern repeats across injury types:

Musculoskeletal injuries: Discontinuing muscle relaxants and anti-inflammatories leads to increased spasm, reduced mobility, and pain crises that result in ER visits and sometimes readmission for pain management.

Post-surgical cases: Failing to maintain post-operative medications — including antibiotics, anti-inflammatories, and nerve pain agents — increases the risk of surgical complications, wound infections, and rehospitalization.

Traumatic brain injury: Interrupting anti-seizure prophylaxis, mood stabilizers, or cognitive medications creates acute decompensation events that frequently require emergency intervention.

Chronic pain management: Abruptly discontinuing opioids (rather than a medically supervised taper) can cause withdrawal symptoms severe enough to require emergency care, while simultaneously disrupting pain management protocols.

The Financial Mathematics

The economics are straightforward. A month of properly managed outpatient prescriptions through a pharmacy lien represents a fraction of the cost of a single emergency department visit, which typically involves imaging, lab work, IV medications, physician evaluation, and often an observation period. When non-adherence leads to hospitalization, the cost differential becomes even more extreme.

For the personal injury case specifically, these preventable ER visits and hospitalizations create several problems:

Inflated medical specials. The total medical costs increase, but the additional costs were preventable and attributable to a gap in medication access rather than the injury itself. This gives the defense a basis to argue that some medical costs should be excluded from damages.

Treatment timeline extension. Each ER visit or hospitalization interrupts the treatment plan, delays recovery, and extends the overall case timeline. What might have been a twelve-month treatment course becomes an eighteen-month course with multiple acute episodes.

Credibility challenges. A plaintiff who presents with multiple ER visits for pain crises may face defense arguments that the visits reflect drug-seeking behavior rather than genuine medical need — an argument that is entirely preventable when the underlying medication regimen is maintained.

The Defense Argument: Failure to Mitigate

The most damaging consequence of non-adherence is the defense's failure-to-mitigate argument. If a plaintiff was prescribed medications to manage their injury and chose not to take them, the defense argues that any resulting complications, ER visits, or extended treatment are the plaintiff's fault, not the defendant's.

This argument has clinical support when non-adherence is truly voluntary. But in personal injury cases, non-adherence is overwhelmingly driven by financial barriers. The plaintiff cannot afford the medications because they are out of work, their insurance denied coverage for accident-related prescriptions, or the out-of-pocket costs exceed their financial capacity during litigation.

The pharmacy lien model directly addresses this. By providing medications at zero upfront cost during the case, LienScripts eliminates the financial barrier that causes non-adherence. For more on how pharmacy liens remove access barriers, see Lien Pharmacy Bypasses Insurance Barriers in PI Cases.

Documenting the Adherence Record

LienScripts generates a MERIT (Medication Evaluation & Rationale for Injury Treatment) report for every case, providing pharmacist-signed documentation for demand packages. This documentation includes a complete dispensing timeline showing consistent medication access throughout the case — evidence that directly rebuts any failure-to-mitigate argument.

The adherence record also supports the credibility of the plaintiff's pain complaints. Consistent, timely medication refills demonstrate that the plaintiff is following medical advice and actively managing their condition. For a deeper discussion of how adherence strengthens credibility, see Medication Adherence as Credibility Evidence.

Preventing the Problem

The most effective strategy is prevention. Enrolling a client in a pharmacy lien program at the outset of the case — before the first prescription goes unfilled — eliminates the financial barrier that triggers the non-adherence cascade. Every ER visit prevented is a defense argument eliminated, a treatment timeline preserved, and a case narrative strengthened.

Contact LienScripts to discuss how pharmacy lien services prevent medication non-adherence and the costly complications that follow.