After sustaining injuries in a car accident or any other tortious accident caused by another party’s recklessness, negligence, or intentional action, it’s advisable to seek medical care before filing a personal injury claim. You’ve already suffered other financial losses (such as lost income and repairs of property damages), and the only question you have in mind is: how does medical treatment affect your personal injury settlement or award?
Being an accident victim is devastating, and you can feel helpless. A personal injury lawyer can help you get through your medical concerns. They can gather the related documentation and accurately calculate your medical damages.
So, how do your medical expenses affect your personal injury recovery amount? This article provides the answer and the nitty-gritty about your settlement concerns as far as medical costs are concerned.
How Does Medical Treatment Affect Your Personal Injury Settlement or Award?
Personal injury claimants are entitled to recover damages that include past and future medical costs.
Let’s consider this example: Suppose you’re involved in a car crash and suffer back, neck, and limb injuries due to the negligence of another vehicle’s driver. You now have to undergo diagnostic tests, surgery, and rehabilitative care for a year to regain your strength. Besides other losses (such as lost income, emotional distress, pain and suffering, etc.), you can also recover your medical costs and the related long-term expenses.
Medical expenses are a critical component of the economic damages included in personal injury settlements. That makes medical costs a subject of criticism in the litigation context. Depending on the type of medical care you receive, the defendant may argue that the healthcare you received is not reasonably necessary.
Past Medical Expenses
Past medical expenses refer to the costs of care services you receive after the accident and before filing your claim. Examples include the costs associated with diagnostics, treatment, rehabilitative care, etc. It’s crucial to carefully store your medical records (inpatient reports and medical bills) to have reliable evidence when claiming medical damages.
Future Medical Expenses
Determining future medical costs is not as straightforward as past medical expenses since there are no tangible records to equate their costs. You may have to involve a qualified medical professional to testify that future treatments are necessary and the estimated expenses are reasonable.
Establishing that any future treatment is reasonably necessary depends on the circumstances. If a professional medical doctor hasn’t recommended a future medical procedure, you may not be able to claim damages for that medical expense.
Reasonable Charges
In some cases, especially if you’ve undergone medical treatment that the defendant considers “excessive,” “non-traditional,” or “risky,” the at-fault party may deny liability for the costs you incurred for the medical care they deem reasonably unnecessary.
For example, if you suffer a leg injury and decide to go for an experimental, costly, and risky surgery (yet you could’ve undergone traditional, cheaper surgery to achieve the same health outcome), the at-fault party may argue that the costs were unreasonable.
Seeking the “Right” Medical Care Increases Your Personal Injury Settlement
Your post-injury treatments affect how your insurance adjuster values your settlement. They’ll usually factor in your medical expense when calculating your compensatory amount. The formula used depends on several factors, including:
- The type of medical care you receive
- The medical providers who provide the care
Types of Medical Treatments
To the defendant’s insurer, not all medical services are created and offered equally, and that has a significant impact when valuing your injury compensation. Here are the variables they consider:
Diagnostics and treatments
Before receiving treatment for any injury, a medical professional will have to diagnose it. Usually, diagnoses are quick and account for a smaller portion of the medical bills compared to the treatment. In some cases, insurance adjusters don’t calculate the two separately. Instead, they bundle up the medical bills into a single medical cost.
However, some doctors perform several unnecessary tests without really diagnosing the injury. That results in huge medical bills. If the diagnoses account for a large part of those bills, and you receive little treatment for a lower cost, an insurance company considers the medical expenses inaccurate. Thus, the adjuster will use a lower multiplier when calculating the personal injury settlement, arriving at the appropriate and lower range of damages.
Physicians versus Non-Physicians
Insurance companies usually favor treatments by certified medical doctors in recognized hospitals and clinics over therapies provided by physical therapy, acupuncture, or other forms of alternative medicine. Therefore, any medical bills from a qualified physician or medical facility, however outrageous, are considered legitimate and warrant a higher multiplier in the settlement calculation formula.
While treatments offered by non-medical doctors may be equally effective, they are usually less costly. Even so, the insurance adjuster will apply a lower multiplier, hence a lower settlement.
Physical therapy
Insurers don’t consider physical therapy a major type of treatment, especially if you underwent it for a few weeks. In such a case, the adjuster lumps it as part of the overall medical expenses. If your therapist administers rehabilitative care for months, and it accounts for the largest part of your medical bills, the adjuster will likely apply a lower multiplier when calculating your medical costs into the damages formula.
Where you receive physical therapy also affects your settlement. If you receive therapy outside your doctor’s office without their supervision, the insurance adjuster will discount the therapy bills, as physical therapists tend to treat injuries endlessly. They might reduce the bill even further if you decide to go for the therapy independently without a prescription from your doctor.
Treatments by chiropractors, acupunctures, acupressurists, and other non-physician healers
Without a doctor’s prescription, treatments provided by other non-traditional healthcare providers fall lowest in the pecking order than physical therapy. That doesn’t mean the at-fault party’s insurer won’t reimburse you for the medical expenses, but they’ll not hold the costs in high regard when plugging in your economic damages in the settlement formula.
Why Should You Partner with a Personal Injury Lawyer?
Dealing with a severe injury is devastating without considering the nuances of personal injury law. Medical expenses usually form the bulk of your damages award in a lawsuit. Partnering with a professional personal injury attorney helps in many aspects of the claims process.
A lawyer can handle your case, and determine the value of your medical expenses, as well as other financial losses you’ve suffered. By gathering the necessary medical bills and partnering with your doctor(s), a personal injury lawyer can calculate those expenses and negotiate with an insurance adjuster to ensure you recover your economic damages.
Frequently Asked Questions (FAQs)
Who pays for my medical expenses after suffering a personal injury?
If you suffer an injury in a car accident because of another person’s negligence, their insurer is responsible for compensating you for the medical damages. However, the insurance company will only compensate you once the case is settled. Therefore, you’ll incur the initial treatment costs for your injuries. You can pay for the expenses through your health insurance, medical payment coverage, public health plans (such as Medicaid or Medicare), or a lien agreement with your healthcare provider.
How much does a personal injury lawyer charge?
Most PI lawyers charge a contingency fee. That means you pay for your attorney fees after receiving your settlement. In such an agreement, the lawyer takes a percentage of the net recovery, usually 25%-35%.
