As someone injured in an accident, you want to make sure you recover all eligible damages to which you are entitled. Medical expenses are a significant component of personal injury claims, but there is often confusion around incurred vs paid medical costs. Understanding the difference is critical to maximizing your settlement or award.
Incurred medical expenses refer to the total cost of medical care you have received and will receive in the future due to your injuries. Paid medical expenses are the portion of incurred costs that have actually been paid out-of-pocket by you or your health insurance company at the time of settlement. The total incurred costs are used to determine the full value of your medical expenses claim, while the paid costs are reimbursed. The difference between incurred and paid is often substantial, so you need to keep records of all medical bills, expenses, and insurance payments to claim the maximum entitled to you under the law.
While the legal and insurance aspects of personal injury claims can be complex, educating yourself on key concepts like incurred vs paid medical costs will help you navigate the process and achieve the best possible outcome. With the right legal representation, you have the opportunity to recover incurred expenses, even those not yet paid, so you can move on financially and physically from your accident. Talk with a Texas personal injury lawyer today.
Understanding Incurred vs Paid Medical Expenses in Texas
As a personal injury plaintiff in Texas, it is important to understand the difference between incurred and paid medical expenses. Incurred medical expenses refer to the total amount billed for medical treatment, while paid medical expenses refer to the total amount actually paid out of pocket by the plaintiff or their health insurance.
In Texas, plaintiffs are entitled to recover incurred medical expenses in personal injury cases, not just paid medical expenses. This means plaintiffs can seek compensation for the full amount billed for medical treatment, even if their health insurance paid for some or all of the expenses. Defendants are responsible for paying the full cost of treatment required due to their negligence.
However, plaintiffs must be able to prove through evidence like medical bills, records and testimony the amount incurred for medical treatment. Defendants are within their rights to challenge incurred medical expenses they believe are unreasonable or unrelated to the injury. It is best for plaintiffs to keep meticulous records of all medical treatment received, including physician notes, to support the amount being claimed.
The distinction between incurred and paid medical expenses is an important one in Texas personal injury law. Plaintiffs should understand they are entitled to claim total incurred expenses, not just out-of-pocket costs, while also being prepared to provide proper documentation to support the full amount. Keeping good records and evidence of medical treatment will help strengthen a personal injury claim. Understanding incurred vs paid medical expenses in Texas can make a significant difference in the total compensation received.
How Medical Expenses Impact Damages in Personal Injury Cases
How Medical Expenses Impact Damages in Personal Injury Cases
In personal injury litigation, damages refer to the amount of compensation a plaintiff can recover. Medical expenses make up a significant portion of damages. As the plaintiff, you are entitled to recover amounts for medical care you have already received as well as future medical expenses you will likely incur due to injuries from the accident.
Medical bills you have paid out-of-pocket for treatment of your injuries are considered "incurred" medical expenses. The defendant is typically liable for reimbursing you for these incurred costs. Medical care you have not yet received but will need in the future as a result of your injuries are "future" medical expenses. An estimation of these future costs will also make up part of your damage claim.
To recover incurred medical expenses, you will need to provide records of medical bills, receipts, statements and other evidence showing the amounts you have paid for medical care relating to the accident injuries. For future medical expenses, doctors will need to determine a treatment plan and estimate associated costs. Life care planners or vocational experts are often used to evaluate future medical costs, especially for catastrophic injuries.
The liable defendant is obligated to compensate you for all reasonable and necessary medical expenses resulting from their negligence. However, they are not required to pay for unrelated medical costs or overly aggressive treatment plans. Only medically necessary care and standard treatment options are typically recoverable. Expenses must also be fair and reasonable for the types of injuries sustained.
By providing detailed evidence of medical expenses, both incurred and anticipated, you have the best chance of recovering the maximum damages possible in a personal injury lawsuit. Compensation for medical bills helps ensure you can afford the care you need to recover from your injuries.
Proving and Documenting Incurred Medical Expenses
To recover incurred medical expenses in a personal injury claim, you must be able to prove and document all medical bills related to the accident.
Treatment Records
Obtain complete records of any treatment received for injuries sustained in the accident, including:
- Emergency room visits and hospital stays
- Doctor appointments
- Physical therapy sessions
- Prescriptions and medical devices
These records should include dates of service, diagnosis codes, and itemized charges. Provide copies of all bills, invoices and insurance explanations of benefits (EOBs) to substantiate the total amount incurred for medical care.
Out-of-Pocket Expenses
In addition to large medical bills, keep records of any out-of-pocket costs like:
- Co-pays for doctor visits and prescriptions
- Over-the-counter medication purchased to treat injuries
- Medical supplies such as bandages, ointments or braces
- Transportation for medical appointments
While seemingly small amounts, these expenses can add up significantly over the course of treatment and recovery. Keep receipts or a written log detailing each cost, the date incurred and its purpose.
Lost Wages
If injuries from the accident caused you to miss work, obtain records from your employer verifying:
- Dates of work missed due to medical appointments or while incapacitated
- Rate of pay, number of hours typically worked
- Value of any sick/paid time off used
Lost income, both current and future, can often be recovered in a personal injury claim when properly documented. Keep copies of pay stubs, timesheets, doctor's notes and other records confirming your lost wages.
Carefully documenting all incurred medical expenses and other related costs is crucial to recovering fair compensation for your personal injury claim. Maintaining thorough records and providing concrete proof of the amounts you are owed will strengthen your case and increase the likelihood of a satisfactory settlement.
What if You Can't Afford Treatment for Your Injuries?
If you have been injured in an accident but cannot afford medical treatment, you still have options to recover compensation for your incurred medical expenses.
Medical Lien
Some doctors and healthcare providers will treat patients on a “medical lien” basis. This means the provider will defer payment for treatment until your personal injury claim settles. The provider takes a lien on the proceeds of your settlement to secure payment. This allows you to get necessary treatment even if you lack health insurance or cannot pay out-of-pocket costs.
Contingency Fee Personal Injury Lawyer
Hiring a contingency fee personal injury lawyer is another way to obtain medical care when finances are limited. The lawyer will advance the costs of your medical treatment and then deduct those costs from your settlement or judgment. The lawyer only gets paid if your case is successful. This ensures you have access to doctors and treatment, without owing money upfront.
Payment Plan
Some physicians and physical therapists will work with personal injury victims by offering an installment payment plan. You can make modest payments over time after treatment has concluded and your case settles. Be upfront with providers about your situation, and inquire if they offer payment plans for patients in need.
Apply for Assistance
There are also charitable organizations that may be able to help fund medical care for those unable to pay due to a catastrophic injury. Groups like the American Red Cross, Salvation Army and local charities or places of worship may be able to offer some financial assistance for treatment, medications and other injury-related costs. You can also check if you qualify for Medicaid or Social Security Disability.
While the costs of medical care and treatment should not be an obstacle to recovery, for some accident victims it is a grim reality. However, by exploring options like liens, payment plans, charity care and legal assistance, you can get the medical attention you need after an injury. Focus on following the recommended course of treatment from doctors so you have the best chance of maximum medical improvement.
Working With a Texas Personal Injury Lawyer on Medical Expenses
When pursuing a personal injury claim, medical expenses will typically be a key component of damages. As the plaintiff, you will need to provide evidence of expenses incurred for diagnosis and treatment. Your Texas personal injury attorney can help determine which medical costs are relevant to your case.
Medical bills, receipts, statements, and expense reports should be collected and organized. Your lawyer will review these records to identify charges directly resulting from injury due to the defendant’s negligence. Unrelated medical care will not be considered applicable. Keep in mind that the total amount billed by providers may differ from the actual amount paid after insurance adjustments. Your attorney will pursue recovery of the full cost of care necessitated by your injuries.
Liability for medical expenses depends on proximate cause. If shown that the defendant’s actions or inactions directly led to your harm and need for treatment, they can be held accountable for resulting costs. Future medical expenses, as well as past bills, may be considered. Your lawyer can work with doctors to determine an estimation of costs for ongoing care, physical therapy, medications, or other needs.
Some expenses may be disputed by insurance companies or defendants. Your attorney has experience negotiating with adjusters and can advocate to recover the maximum amount you are owed under the law. They understand strategies commonly used to reduce claim value and will build a strong case with supportive evidence to counter unreasonable challenges.
With the assistance of a skilled personal injury lawyer, you have the best chance of recovering incurred medical expenses. They can handle communications with insurance companies and defendants, so you can focus on healing. Their knowledge and experience with Texas law ensures you receive fair compensation for bills, both paid and outstanding. Let a reputable attorney help ease the financial burden of your injury.
Fletcher Law Texas Injury Lawyers Have Experience To Help
When pursuing compensation for medical expenses in a personal injury case, it is important to understand the difference between incurred and paid expenses. Medical expenses that were incurred refer to the total cost of medical treatment, while paid expenses refer to the amount actually paid out of pocket by the plaintiff or their health insurance provider.
In Texas, the liable party is typically responsible for reimbursing the incurred medical expenses, not just the paid amounts. This means that even if health insurance covered most of the costs, the defendant may still owe the total incurred amount. Our firm has years of experience successfully pursuing compensation for clients’ full incurred medical expenses.
To calculate incurred medical expenses, we gather detailed records from hospitals, emergency medical services, physicians, physical therapists, and any other healthcare providers involved in the plaintiff’s treatment. We meticulously document all charges to determine the total cost of care. Defendants and insurance companies will often try to dispute incurred expenses or claim certain treatments were unnecessary. Our attorneys are well versed in evaluating medical records and advocating for the inclusion of all reasonable and necessary care.
While health insurance subrogation claims can complicate matters, we work diligently to ensure that any settlement or judgment fully compensates the plaintiff for their injuries and losses. Our goal is to make the plaintiff whole again while also protecting their legal rights regarding health insurance reimbursements. With our experience and expertise, Fletcher Law has successfully recovered millions of dollars in incurred medical expenses for personal injury victims across Texas.
If you have suffered injuries in an accident due to another party’s negligence, do not hesitate to contact us to discuss pursuing compensation for your incurred medical expenses. Our consultations are free, and we do not collect fees unless we win your case.
Conclusion
As a plaintiff in a personal injury case, you need to understand the difference between incurred and paid medical expenses to ensure you receive fair compensation. While incurred expenses refer to the total amount billed by healthcare providers for services rendered due to an accident, paid expenses are the actual out-of-pocket costs you have paid to date. Be prepared to provide records and evidence for both incurred and paid expenses.
Paid medical bills are not the only losses that should be considered in a settlement or verdict. Your attorney can help determine the total value of your claim by including incurred costs and other damages. Don't settle for less than you deserve - make sure your settlement or award covers all incurred medical expenses so you can move on from this difficult experience without undue financial hardship. The injury lawyers at Fletcher Law are here to help.