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How To Calculate Medical Bills in a Texas Car Accident Case

The biggest factor in deciding how much a Fort Worth car accident case is worth is the amount of the injured person’s medical bills. However, this is a convoluted subject that usually requires the knowledge that a skilled personal injury lawyer brings.

Insurance companies are amazingly profitable. They take in a shocking $___ more than they pay out in claims each year. The difference is profit. So they fight injured victims on every medical bill submitted to hold down the size of their settlement offers and jury verdicts. The last thing they want to happen is for the injured person(s) to hire good car wreck attorneys who can take their cases to trial if necessary to obtain a much larger amount than what was offered without a lawyer being involved.

You are allowed to recover the amount of your reasonably priced medical bills that were necessitated by the crash. But deciding those two restrictions can be tricky.

In a typical case, the victim may be rushed by ambulance to an emergency room where he or she is often tested with expensive diagnostic tools like CT scans which are read by specialists called radiologists. Depending on the hospital and companies involved, these bills from the first day can easily be billed at a total of $10,000.00. Then, depending on their injuries, that person usually seeks further medical treatment and may require more sophisticated tests like MRIs, pain management, injections, and surgeries which can cost another $10,000.00 and more. Is the defendant driver’s liability company automatically required to pay these amounts?

Texas courts and the state legislature have imposed restrictions where health insurance companies, Medicare, Medicaid, workers compensation, or other entities pay all or some of the medical bills. After the Texas Supreme Court’s decision in 2011, lawmakers enacted Article 41.0105 of the Civil Practices & Remedies Code commonly referred to as the “paid vs. incurred statute.” What this means is that the defendant’s carrier is only required to pay the amount of medical bills that were actually paid by health insurance, the victim, or are still outstanding. Consider this example:

$20,000.00 – total bills incurred

Less  $8,000.00 – total paid by CIGNA

Less  $10,000.00 – contractual write-off

Less    $1,000.00 copays and deductible paid by victim

$1,000.00 remains outstanding

The total “paid” amount is now only $8,000.00 + $1,000.00 + $1,000.00 = $10,000.00, not $20,000.00. And there are a number of ways the above numbers can change.

However, if the injured party does not have health insurance and is not eligible for payment by another entity, this statute does not apply unless the personal injury lawyer reduces outstanding balances. Our office works diligently to make medical providers cut their often inflated medical bills and the amount we save our clients often exceeds the amount of the fees charged – another reason to hire an experienced injury lawyer.

Even if there is health insurance, often the carrier will refuse to pay medical bills, claiming they are secondary to the primary auto liability company, which is not true. Or they will delay the process for months, pay only a few of the bills, and then demand reimbursement under complicated subrogation (reimbursement) policies that may or may not be in effect or can be challenged.

This paid vs. incurred statute unfairly punishes those who have jobs and pay premiums for their health insurance benefits, another example of the unfairness of the civil justice system.

It also punishes someone who is whisked away to a hospital or specialist who is, unknown to them, out-of-network with their health insurance plan so those bills are denied.

If the insurance adjuster is allowed to cut down the amount of medical bills, other damages which flow from that calculation are then reduced as well. This is a reason not to allow the company to arbitrarily use its own internal formulas to dictate how much money they consider to be reasonable or necessary.

Someone is allowed to recoup future medical bills but once again, the way the laws and court cases are drafted, this can be another difficult project. The reports and testimony of a medical professional are essential. And again, the cost of future surgery or treatment are highly scrutinized and discounted, if given the chance.

Please contact Berenson Injury Law to further explore how we can help you recover all of the damages you have incurred after a crash involving a car, truck, commercial truck like an 18-wheeler, or motorcycle -the only cases that we handle. The first consultation to analyze your case is free.

For other articles on this topic:

Proof of medical bills will be more difficult


Paid Vs. Incurred Medical Bills – New Cases

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