Medical Bills

Medical Bills (Proving):

Personal injury law in Texas allows a person who has been injured due to another's negligence to recover their medical bills, both past and future that the negligence caused. If you have had an auto injury accident in Dallas, Texas or the surrounding area, you will likely run into the following excuses by insurance adjusters regarding why they don't want to pay your full medical bills that were caused by the auto accident.

Texas Law:

Past Medical Expenses: In court, in order to recover for past medical expenses, a person must prove the amount of the expense, that the treatment was necessary, and that the expense was reasonable. This can be proven by introducing the actual bill, having the plaintiff testify to the amount, and by having a person from the medical facility testify that this was their charge and its reasonableness. In some cases the medical facility must also produce a doctor to testify that the treatment was necessary for the injury. Blankenship v Mirick, 984 S.W.2d 771 (Tex.App.--Waco 1999, pet. denied).

Future Medical Expenses: Texas uses a "reasonable medical probability" rule for future medical expenses. This is a matter for a jury to decide. No "precise" evidence is required, but courts prefer the evidence of future medical expenses to be shown by "medical testimony". Whole Foods Mkt. Southwest, L.P. v. Tijerina, 979 S.W.2d 768 (Tex.App.--Houston [14th Dist.] 1998, pet. denied).

Courts and juries may award future medical expenses based on the nature of the injuries, the medical care rendered before the trial, and the condition of the injured person at the time of trial.

If there is any probative evidence for future medical expenses, and a jury awards money for that amount, then the jury verdict must be upheld. Beverly Entm't of Tex. v. Leath, 829 S.W.2d 382 (Tex.App--Waco 1992, no writ). This means that you don't have any "magic words" that you must give to the court to prove your future medical expenses. As long as the evidence points to the fact that there will (or probably will) be future medical expenses, the courts will infer the "reasonable medical probability" language into the evidence if the jury awards money for this element of damage.

Minors: Parents are responsible (liable) for their minor child's medical expenses, so the parent is the person who does the collecting for their minor child's medical expenses.

When a minor reaches 18 years of age, a they become an adult and may recover for medical expenses. Molina v. Moore, 33 S.W.3d 323 (Tex.App.--Amarillo 2000, no pet. h.).

The recovery may need to be in multiple parts, as the parents may need to recover for the medical bills incurred when the minor was under 18 years of age, and then the minor (who has become an adult) may need to recover for his medical bills after he has has turned 18. If a parent is negligent, or partially negligent (contributory or comparative negligence), it only affects the parent's part of recovery (not the minor's). Roth v Law, 579 S.W.2d 949 (Tex.Civ.App.--Corpus Christi 1979, writ ref'd n.r.e.).

If on the other hand the minor is contributory or comparatively negligent, this will affect the minor and the parent's recovery. Dartex v. Gadbois, 541 S.W.2d 502, 509 (Tex.Civ.App.--Houston [1st Dist.] 1976, no writ).

Transportation Expenses: If you incur transportation expenses in obtaining medical treatment, Texas law allows you to recover for those expenses. Coca-Cola Bottling Co. of Plainview v White, 545 S.W.2d 279 (Tex.Civ.App.--Waco 1977, no writ).

Nursing Services When Caring for Catastrophic Injury: Often, when a person has suffered a catastrophic injury, they are released from the hospital and a family member must spend countless hours caring for and tending to the needs of that injured person. The family member is not officially a "nurse", but the at-fault party still may owe for the "reasonable value" of the nursing services given. Even if the services are gratuitous (no bill generated), a recovery may be given. The services given must be different than those normally given by the spouse or family member (in other words, cooking and cleaning in the house that you normally did anyway is not recoverable). You must show the "reasonable value" of the nursing service by obtaining the testimony of a qualified nurse or nursing home administrator. Transp. Ins. Co. v. Polk, 400 S.W.2d 881 (Tex. 1966).

Future medical care by family members of catastrophically injured people has been upheld in Texas courts. In Baptist Mem'l Hosp. Sys. v. Smith, 822 S.W.2d 67 (Tex.App.--San Antonio 1991, writ denied), the court upheld an award of $1.3 million for future medical expenses based on around the clock care provided by family members.

Pitfalls in Claims for Medical Expenses:

There are a few pitfalls that you need to be aware of though. Common areas that insurance companies try to avoid payment in an auto injury accident in Dallas or the DFW area, when it comes to medical bills are - 1) bills too high, 2) treated too often, 3) didn't follow doctor's orders, 4) prior similar injury, 5) subsequent injury, 6) faking it, 7) bills paid, written off or adjusted.

This is why you most often will need to hire a Dallas auto injury accident lawyer if you have been injured in or around the Dallas, Texas area.

  1. Bills Too High: Medical bills are high. Insurance companies know this. Often, they will claim that the bills are much higher than reasonable. Rarely do they back this up with anything that you can use though - they just "claim" it. When they claim this, be sure to ask them if they can please send their documentation that shows the medical bills were too high. Let the adjuster know that you would really appreciate the help, because you can use their documentation showing that the doctors bills were too high when you call your doctors to try and negotiate the bills to a reasonable rate. Unfortunately, the liability insurance company usually will not do this. They typically are just making up numbers, and rarely do they ever give you anything that you can show your doctor or hospital to show that the bills are actually too high.

  2. Treated Too Often: Your insurance adjuster will often claim that your doctor "over treated" you. They will claim that the "standards" indicate that you should not have had the MRI, or that you should have only gone for treatment 3 times rather than 15 times. Again, ask the insurance adjuster for documentation, so you can use that documentation to show your medical facility when you are attempting to get them to reduce their bill. The adjuster will typically refuse to send you anything. Again, usually they are making up numbers when they tell you this. If they do send you something, be sure to send it to your doctor and ask if they will put something in writing backing up their treatment - so you can get the insurance company to pay the bill.

  3. Didn't Follow Doctor's Orders: Often, in our busy schedules, we miss doctors appointments, and try to make them up later. The insurance adjuster will use this against you if your injury is one that lingers. They will claim that if you had just followed your doctor's orders, you would have recovered fully. But because you chose to disregard your doctor, you caused yourself to be harmed, and that this is not their fault.

  4. Prior Similar Injury: If your neck was injured in an auto accident, then the insurance adjuster will look into your medical history, and claims history, and look for similar injuries. If you had any other neck or shoulder injury in the past, (regardless of whether you recovered, or how long ago it was), they will try to claim that you already had this injury, and that you are just trying to claim an old injury on this accident.

  5. Subsequent Injury: For example: If you are injured in an auto accident on January 1, and have been seeing a doctor for your injury while you are recovering, and then on January 30 you are injured again in another accident of some sort, the insurance adjuster for BOTH incidents will use this against you. The adjuster from the January 1 incident will cut off any medical bills he will pay for at January 30 (the time of the 2nd incident), and the adjuster for the January 30 incident will claim that you were already hurt, and will try to avoid paying ANY medical bills at all.

  6. Faking It: Often, insurance adjusters will treat a person who was injured as though they are “faking it” and refuse to pay your medical bills. This happens most often in the following situations:

    1. Damage to vehicle Looks Minor: If the damage to your vehicle does not look bad, the adjuster will use this against you, and try to avoid paying your medical bills.

    2. Multiple Prior Claims: If you have had the misfortune of being the victim of several bad drivers in the past few years, and have been hurt in those collisions, the adjuster will try to label you as a “career claimant”, and act as though you are trying to make a career out of being hurt. They will use this try and refuse to pay your medical bills.

    3. Inconsistency in Medical Records: If your hospital’s medical records indicate you were suffering one type of pain, and then when you go to your treating physician for follow-ups you complain of different problems that have popped up, they will try to claim you are making up symptoms, and will try to avoid paying your medical bills.

  7. Bills Paid: If your medical bills were paid, written off, or adjusted, your insurance adjuster will act as though those bills are not owed, and will try to avoid paying your medical bills.

    1. Paid: If your medical bills were paid by a health insurance type plan – such as your health insurer, Medicaid, Medicare, Workers Comp, or other health source – you likely are legally or contractually obligated to pay back the health insurance-type plan out of any money you receive from the liability insurance adjuster. The adjuster will not tell you this, and will act as though this was “free money” and they don’t need to pay it back. This can get you into legal trouble with your health insurance-type plan. You MUST recover enough money to pay them back, and actually pay them back – or negotiate something with them.

    2. Written Off: If your bills were written off to charity, or written off as a bad debt, you must still recover the money for those written off bills. Charity - If the hospital or doctor finds out that you settled for money with an automobile insurance company, they will revoke their charitable write-off and demand that you pay them out of your settlement proceeds. Bad Debt – If your medical facility has written off your bills as a bad debt, that often means they have turned this in on your credit, or even worse, have turned it over to bill collectors – meaning that the only way to repair your credit or get those bill collectors off your back, is to get the bad debt taken care of.

These are just a few examples of reasons auto insurance adjusters will deny your medical bills in a clear liability claim. You need to have a Dallas auto injury accident lawyer if you have had a personal injury claim in the Dallas, Texas area. Contact the Law Office of Doug Goyen at (972) 599 4100 to discuss your claim.

Personal Injury Areas We Help With Are:

Auto Accident and Injury Cases, Personal Injury Cases, 18 Wheeler & Commercial Vehicle Injury Accident Cases, Motorcycle Accident and Injury Cases, Wrongful Death Cases, Pedestrian Injured by Automobile Cases, Slip and Fall & Premises Cases, Workplace & Constructions Injury Cases, Dog Bite Injury Cases, Bicyclers Hit by Automobile Cases .

Types of Coverage in Automobile Injury Cases:

Automobile Liability Insurance, Uninsured Motorist Insurance, Personal Injury Protection (PIP), Medpay Insurance, Property Damage & Collision Coverages for Your Auto

Damages Often Recoverable in Personal Injury Cases Include the Following:

Past and future medical bills, past and future lost earning capacity, past and future lost income, past and future physical impairment, past and future disfigurement, past and future mental anguish, past and future pain and suffering, property damage, loss of use of your property - such as rental car bills, storage, total loss of property, diminished value of property, loss of body member (arm, leg, . . .), loss of body capacity (hearing, eyesight, . . . ), loss of consortium (spouse, parental, child/filial), loss of services, emotional/mental trauma (bystander injury), prenatal injury, exemplary damages, prejudgment interest, attorney's fees, and court costs.

By Doug Goyen,