PROVING MEDICAL EXPENSES IN A PERSONAL INJURY CASE

When someone injures you, it can be difficult to recover both physically and financially. For this reason, personal injury victims often ask their lawyers how they can be compensated for their medical expenses after an accident.

On December 30, 2015, Board Certified Trial Lawyer David E. Gordon presented a continuing education course for the Memphis Bar Association. The course – Proving your Client’s Medical Expenses – was an outstanding opportunity for other attorneys from around the state and region to learn real-world strategies from a preeminent leader in personal injury litigation. Proving “damages,” as referred to by many attorneys, can be one of the most challenging aspects of successfully handling a client’s lawsuit.

WHAT ARE DAMAGES?

Damages are the injuries a person has suffered. They can be physical, emotional or financial. The law breaks these down further into categories.

On one hand, you have damages that are “economic.” These damages include financial losses or harms caused by an injury. For example, a person who is severely injured in a car accident may not be able to return to work for months. His lost wages would be considered a form of economic damages. They are financial and must be compensated.

On the other hand, people can also experience less tangible or quantifiable injuries. These are commonly called “non-economic.” In other words, they are not the type of injuries we can calculate numerically. Some examples might include the loss of the ability to play with one’s children and attend school events or post-traumatic stress disorder (PTSD) caused by surviving a life-threatening event.

HOW DO MEDICAL EXPENSES RELATE TO MY CASE?

When you bring a lawsuit for personal injuries, whether due to a car accident or medical malpractice, you are asking someone else to compensate you for the harm they did to you.

Your lawyer first has to prove that you should be compensated. Once your lawyer has done this, the next step is proving how much the defendant should pay.

One important way to do this is to show the medical expenses in a personal injury case. After all, the best way to show the severity of an injury is to establish how much it cost the victim or family to seek treatment.

Therefore, your lawyer should begin requesting medical records and billing statements early in the investigation of your case. This will help build your case and identify what treatment was needed and how much it cost you to recover.

CAN I BE COMPENSATED FOR ALL MY MEDICAL EXPENSES?

In Tennessee, specific rules apply to receiving compensation for medical expenses. Once copies of all related medical bills and expenses are provided, the court “presumes” them to be reasonable. It is then up to the defendant to prove otherwise.

While there is no guarantee that each and every expense will be paid, the presumption is in your favor, under Tennessee Code 24-5-13, if you are able to provide evidence of the expenses.

With that said, you should always expect a defendant to fight against your claim and argue that the bills were either not necessary for treating the injury or unreasonably expensive. At this point, the defendant may hire experts to make such arguments in order to reduce the amount you are compensated.

WHAT IF MY INSURANCE COMPANY PAID THE BILLS ALREADY?

Tennessee has adopted an approach known as the “collateral source rule.” Since health insurance has long been the primary means for paying for medical expenses, many states choose to use this approach.

In short, people pay a monthly premium in exchange for their insurance company agreeing to pay their expenses, if needed. This is a bargained-for arrangement between two private entities – the individual and his or her insurance company.

According to the Restatement (Second) of Torts §920A (1979):
If the plaintiff was himself responsible for the benefit, as by maintaining his own insurance or by making advantageous employment arrangements, the law allows him to keep it for himself. If the benefit was a gift to the plaintiff from a third party or established by law, he should not be deprived of the advantage that it confers.

In short, it would be unjust to fully compensate someone who has no insurance while reducing compensation for the person who has paid for the benefit of insurance. So, an injured plaintiff may recover for medical bills without consideration for whether those expenses were paid by someone else or an insurer.

WHAT IF MY MEDICAL EXPENSES WERE REDUCED DUE TO INSURANCE DISCOUNTS?

This should have no effect on your ability to obtain compensation for medical expenses in Tennessee. Like many states, Tennessee prohibits defendants from using this type of argument to reduce payments to the plaintiff.

If you have paid for insurance, you are entitled to the benefits of that contractual arrangement. The fact that you received helpful discounts due to that arrangement has no impact on how much the defendant should have to pay for its negligence. As such, the total value of medical expenses is included in calculating your economic damages – not the reduced rate or your out-of-pocket costs only.

MORE THAN ONE DEFENDANT CAUSED MY INJURIES. WHO PAYS?

While you may be compensated for the full value of your medical expenses, you may not collect them twice. Tennessee Pattern Jury Instructions T.P.I. 14.01, explain as follows:
You may not duplicate damages for any element by also including that same loss or harm in another element of damage.
So, you can collect only once for your injuries. This is seen in medical malpractice cases where perhaps more than one medical professional contributed to the error. If you are due $1 million for the negligence of several doctors, they each may pay part of the damages or one may pay all. But you cannot get the full amount from each, or duplicate your recovery.

HOW CAN A LAWYER IMPROVE MY MONETARY COMPENSATION?

There are often legal rules that allow you to achieve a goal, such as getting compensated for an injury. However, there are also exceptions to those rules. Insurance companies know every one of them. You may have a perfectly valid claim and all the medical expenses to prove it, but if the defendant can provide experts to disclaim the costs, you could possibly see your recovery dwindle.

If you have been injured in Tennessee, it is in your best interest to contact an attorney immediately. As a Board Certified Tennessee trial lawyer, David Gordon has more than 30 years of experience fighting for clients. Contact us today for a free consultation about your case.