"Not medically necessary" usually means one thing: the insurance company doesn't want to pay for care that got expensive.

That letter is not a neutral medical opinion. It's a cost-control move.

If you were hit by a truck in a Manchester construction zone with cones everywhere, old striping still showing, and lanes shifting by the day, the insurer already knows this claim can get ugly. A crash near I-293, Granite Street, South Willow, or one of those downtown work zones where arrows and temporary paint don't match the pavement can turn into a blame fight fast. So the next move is often to attack the treatment.

That matters even more if you're 72 and living on Social Security, a pension, or whatever fixed monthly amount is keeping the lights on. The insurer knows a denial letter lands differently when one MRI bill or round of physical therapy could wreck your month.

Why they say your care "wasn't necessary"

Here's the game.

First, they act like the crash wasn't that serious. Maybe low speed. Maybe "confusing traffic pattern." Maybe "preexisting degeneration," because once you're over 70, they love that word. Then they say the ER visit was fine, but the follow-up treatment was excessive. Too many PT sessions. Imaging too late. Specialist referral unsupported. Injections not related.

It's not because they suddenly became careful stewards of medicine.

It's because if they cut off treatment, they cut off the size of the claim.

And if you start skipping care because the bills scare you, they'll use that too. They'll say you must not have been badly hurt after all.

The "friendly" call is part of the same playbook

You may get an adjuster who sounds helpful. Soft voice. "Just trying to understand your condition." "Just want to clear this up." "Tell me how you're feeling today."

That is not small talk.

If you say, "I'm doing better," they may write down that you recovered quickly. If you say, "I drove to Market Basket," they may decide you can't be that limited. If you mention an old back ache from shoveling after a nor'easter, suddenly your current pain is "not from the crash."

Manchester claims adjusters and defense firms do this every day. They know older residents often try to sound polite and not complain. That politeness gets weaponized.

Don't be shocked if someone starts watching

This is where it gets ugly.

On a serious truck case, especially one with ongoing treatment, private investigators are absolutely on the menu. So is social media surveillance. Photos, public Facebook posts, comments from family, church event pictures, grandkid birthday videos. Anything that can be clipped out of context.

A 20-second video of you carrying a bag into your house does not show what happened after, or how much pain hit that night. But the insurer will still wave it around like it proves something.

Same with a car ride to Derry, a stop in Bedford, or standing outside for ten minutes while road crews tear up another lane. They're not documenting your life fairly. They're collecting scraps.

Why the quick money offer shows up early

Because they want you to settle before the full picture is in.

A truck-zone crash with bad lane markings can cause neck, back, shoulder, or hip injuries that don't declare themselves cleanly in the first week. Older adults often get hit harder by what looks like a moderate collision. Recovery can be slower. Balance gets affected. Sleep gets wrecked. A seemingly "routine" round of therapy can turn out to be the beginning, not the end.

That early offer is aimed right at fixed-income panic.

And New Hampshire's no sales tax, no state income tax setup doesn't magically make recovery cheap. Prescriptions, gas to appointments, home help, parking, medical equipment, all of it still adds up. Fast.

What actually helps after that denial

• Keep every denial letter, bill, explanation of benefits, and appointment note in one folder.
• Ask each provider for chart notes that explain why the treatment was ordered and what problems it addressed.
• Stop chatting casually with the adjuster about symptoms, daily activities, or whether you're "better."
• Set every social account to private and assume nothing online is private anyway.
• Don't let a fast settlement happen while testing, therapy, or specialist follow-up is still unfolding.

The biggest point is simple: "not medically necessary" is often just insurer code for "too expensive for our liking."

And in a Manchester construction-zone truck crash, where the lane markings were a mess to begin with, cutting your treatment down on paper is one of the easiest ways for them to shrink what they owe.