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Proving Medical Expenses

Proving Medical Expenses

Like lost earnings, many personal injury victims have medical bills that are necessary for treatment of their injuries. While the law clearly allows injury victims to be reimbursed for their medical bills, the law is murky on how medical bills are calculated for purposes of a personal injury claim. Commonly referred to by lawyers and insurance companies as the “paid versus incurred” rule, an injury victim can recover the sum total of:

  1. The amount the injury victim has actually paid for “reasonable and necessary” medical care up to the time of settlement or trial;
  2. The amount that has been paid on behalf of the injury victim for “reasonable and necessary” medical care (i.e. from the victim’s health insurance company) up to the time of settlement or trial; and
  3. The amount the injury victim still owes for “reasonable and necessary” medical care up to the time of settlement or trial.

For injury victims who choose to use their health insurance to pay for medical treatment following an injury (which is a choice they do not necessarily have to make), it is important to account for the money the injury victim’s health insurance company has spent on their medical care before settling their claim with the liability insurance companies (i.e. an at-fault driver’s insurance). Because most health insurance companies have the right to get paid back from any money the victim collects from the liability insurance company (through a process called subrogation), failing to account for that money when resolving a case can have very negative consequences for the injury victim, including cancellation of their health insurance.

A personal injury victim can also seek compensation for medical bills the victim will likely pay or incur in the future. Proving future medical costs can be extremely challenging, and failure to do so properly can cost the injury victim a substantial amount of money. It is not sufficient for a personal injury victim to simply voice concerns about their future medical needs. Instead, the law demands the victim prove the future costs through competent evidence. Generally, this requires an expert in the relevant field of medicine show what medical care will likely result because of the injury, as well as the likely cost of the future care. In addition, in cases involving serious injury (such as brain injuries, spine injuries, or catastrophic injuries), the injury victim can benefit from a life care plan, which consists of a thorough analysis by a certified life care planner of all aspects of the victim’s likely future medical needs. Speaking with an attorney about your future medical concerns can help make sure you do not get taken advantage of by an insurance company, and can help ensure you can afford to pay for your future medical care. This is true even for injuries the victim might consider minor; it is better to be safe than sorry.