Medical Bills: What Will a Court Consider To Be Reasonable?

Medical Bills What Will a Court Consider To Be Reasonable

Getting into a car accident is a surefire way to put a damper on your day. If it was a relatively minor accident, it ruins your mood and adds many items to your already packed to-do list — exchanging information with the other driver, filing a police report, and contacting your insurance company. If it was a more serious accident — or if the minor accident resulted in long-term injuries — you deal with the worry and anxiety that comes from needing to seek medical care and all associated costs. What you never expect is to end up in lengthy litigation about whether your medical costs are reasonable. You need the treatment. So why is the other party’s insurance company playing hardball when it comes to paying them?

Why would medical bills be an issue after a car accident?

Let’s start with the basics. Every car insurance policy in Florida is required to provide personal injury protection (PIP). This feature covers 80% of medical expenses and 60% of lost wages — up to $10,000 — regardless of who was at fault for the accident. While it’s a good thing to have, it still leaves you with 20% of your medical bills if your injuries were relatively minor. And, if they were more than 10K, then you want whoever caused the accident to be liable for it.

However, it’s no secret that the United States is a litigious society. Every day, people file lawsuits. Many are warranted and serve the purpose of seeking justice. Others could be seen as opportunistic and a way to provide a gratuitous windfall. It is because of the latter that the former can sometimes face an uphill battle when proving the reasonableness of their medical bills in a car accident lawsuit. The burden is on the Plaintiff (the injured party) to prove that the requested coverage is reasonable and necessary — and it takes more evidence than providing the bills.

Generally, for a serious injury, a Plaintiff could expect to incur costs due to the following:

  • Initial medical appointment
  • Imaging services, blood testing, urine samples, etc…
  • Treatment
  • Medications
  • Follow-up visits
  • Visiting another physician for a second opinion if surgery was recommended
  • Additional testing
  • Surgery (if necessary)
  • Physical and/or occupational therapy (if necessary)
  • Future treatment (if necessary)
  • Future surgeries (if necessary)

What would a court consider to be reasonable medical bills?

When determining the reasonableness of medical bills, a court will look at the totality of circumstances. This includes the bills, physician’s and Plaintiff’s testimonies, medical records, the extent of disability (if any), permanency of injuries, possibly a medical expert’s testimony, and evidence that the necessity of treatment was caused by the car accident.

Prior to going to court, parties to the lawsuit go through a process called discovery. During this time, the Defendant’s insurance company can request documents as well as depose individuals with firsthand knowledge of the medical treatment. For example, requesting to see your medical bills. If they have any doubts as to their reasonableness, they may request to schedule a deposition (sworn testimony) of you, your doctor, and/or the doctor’s billing specialist, and request to see the doctor’s qualifications.

In addition, the attorney for the Defendant’s insurance company could request a compulsory medical examination (CME), where the defense hires a doctor to examine you. The type of doctor depends on the case and the types of injuries. If the CME physician agrees with your doctor’s assessment of your injuries — as well as permanency and future treatment —  the case will likely settle. If the medical providers don’t agree, the case will proceed to trial.

If You Were Hurt in an Accident, Let Us Help You

This entire process can be drawn-out and complicated, and anything you say could later be used against you to diminish the Defense’s liability. This is why it’s crucial to speak with an experienced attorney as soon as possible after the accident.

At Carey, Leisure & Neal, we have more than three decades of experience successfully representing clients involved in car accidents. All of our attorneys are accessible and Board Certified in civil trial law.

Contact us online or call us at 727-799-3900 to schedule a free consultation.

Disclaimer: This blog is for informational purposes only and does not create an attorney/client relationship.

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