Medical Expenses for Personal Injury Claims
Did you suffer an unexpected injury in an accident that wasn’t your fault? If so, the last thing you should have to worry about is covering your medical expenses. But if you’re like many injury victims, worrying about healthcare costs might be a reality.
While you’re still getting the care you need and waiting on a settlement for your personal injury claim, healthcare providers often waste no time sending you pile after pile of medical bills.
It seems like the at-fault party should be the one who must deal with all of this. But until you settle your injury claim, ignoring these bills will affect your credit score, not theirs. And if you have future medical expenses due to your current injuries, your financial concerns might not end there.
So, what can you do in the meantime? An important first step is to understand who is responsible for your medical expenses after an accident injured you so you can identify all potential sources of coverage. You’ll also need to understand which types of medical expenses are eligible for compensation, so you know exactly how much your injury claim is worth.
Finally, you’ll need to know which types of evidence you can use as proof of your medical expenses so you can maximize the value of your claim settlement. Read on to learn more about each aspect of getting coverage for your personal injury claim with a personal injury lawyer.
Who Can You Hold Responsible for Your Medical Bills After an Unexpected Injury?
When you get hurt because of another party’s bad behavior, the law says that the party is financially responsible for your resulting medical expenses. After all, you wouldn’t have those expenses in the first place if not for the other party’s wrongdoing. However, you should understand two things about the at-fault party’s duty to cover your medical expenses after a preventable accident:
First, the at-fault party is not responsible for paying your medical bills as you receive them. Your medical bills are in your name, which means you are solely responsible for them until you resolve any underlying insurance claims or legal disputes. Before you prove the other party’s fault to the insurance company or a court of law, the assumption is that your medical bills are yours to pay.
Second, the law does not require the at-fault party to cover your medical expenses on an ongoing basis. If and when you succeed in proving the other party is to blame for your injuries, the at-fault party must pay for the losses you have claimed up to that point.
You will not receive compensation for any medical expenses you fail to include in your claim, and you cannot go back and ask for more money after a settlement. So, if you will likely need additional medical care for your injuries in the future, you will need to demand money for those projected expenses now or risk paying out-of-pocket later.
Since you are entirely responsible for your medical bills before you prove the other party’s liability, you might turn to your own insurance providers for coverage in the meantime. If you have more than one applicable insurance policy, you should know that certain types of insurance will only kick in once you use up other sources of coverage.
For instance, if you have medical payments (MedPay) coverage through your auto insurance provider, that’s a type of primary coverage for any injuries you sustain in a crash. If you got hurt in a car accident, you would need to exhaust the limits of your primary (MedPay) insurance coverage before you could get compensation from any secondary sources of coverage, like a health insurance policy.
What Types of Medical Expenses Can I Recover With an Injury Claim?
Medical expenses often add up quickly after an unexpected injury and make up most of the value in a personal injury case, especially if you have severe injuries requiring long-term care. When you are building your claim, it’s essential to account for all the financial implications of your injuries, including early expenses like ambulance bills and projected expenses you might incur in the future.
Let’s explore some common types of medical expenses that injured people include in their insurance claims and personal injury lawsuits:
- Hospital bills. Hospitals might bill patients for outpatient doctor visits, emergency triage and treatment, room and board for inpatient stays, medical supplies and services, and anesthesia services, among other expenses. Many hospital bills for unexpected injuries are astronomical.
- Ambulance expenses. Research suggests roughly 10 percent of insured Americans get to ERs by ambulance, and 51 percent of those who use ambulance services receive surprise bills after the fact. Nationwide, the median out-of-pocket cost of a ground ambulance ride is $450.
- Surgical expenses. Depending on the circumstances, you might need emergency surgery immediately after a life-threatening injury, or your doctor might recommend surgery after a course of less successful alternatives. Surgical procedures are costly, often tens of thousands of dollars, due to the number of medical professionals and the amount of specialized equipment involved.
- Diagnostic expenses. Your doctor might order diagnostic tests, like blood work, CT scans, X-rays, or MRI scans, to determine the extent of your injuries and the types of treatment you need. Both invasive and non-invasive diagnostic tests require specialized skills and tools and are, therefore, quite expensive.
- Doctor’s office bills. If you go to a primary care physician after an injury, they might charge you for the basic costs of your visit, plus the costs of things like blood work, electrocardiograms (ECGs), and vaccinations. And if you visit a specialist, the associated costs will likely be higher.
- Therapist bills. If you need physical therapy or rehabilitation services after your injury, you can expect to pay tens or hundreds of dollars per session. Multiply that by one or two sessions per week for multiple weeks or months, plus the costs of any equipment you need. If you need help recovering enough to return to work after an injury, you might also need help from an occupational therapist.
- Medication expenses. If you need prescription medications or over-the-counter drugs to recover from your injuries, you should be eligible for reimbursement for those costs, so be sure to include them in your claim.
- Medical equipment costs. For some injuries, you might need durable medical equipment, like wheelchairs, walkers, canes, or shower chairs. If you have long-term or permanent impairments because of your injuries, you might also need technological aids or accessibility modifications to help you at home.
- Travel expenses. Finally, you can seek compensation for travel expenses you incur due to your medical needs. For instance, if you must travel by air or cross long distances to get the treatment you need, you could recover related costs.
How Do I Prove My Medical Expenses for an Injury Claim?
Including a list of medical expenses in an injury claim is not enough to obtain the money you deserve as reimbursement.
You must provide evidence to back up your claim, and there are many ways to develop that evidence, including:
- Seeking prompt medical care for your injuries. One of the most important ways you can support your injury claim is by visiting a hospital, urgent care clinic, or doctor’s office as soon as possible after an unexpected injury. A healthcare professional can evaluate, diagnose, and treat your condition as necessary, then record everything in your official medical records. If you don’t have this formal medical documentation showing that you took immediate steps to protect your health after an injury, the insurance company could argue that it shouldn’t have to pay since your injuries don’t seem too severe.
- Following the care plan, your doctor prescribes. After you receive the initial treatment for your injuries, another important step is to follow your doctor’s care plan as closely as possible. Depending on the circumstances, this might include resting as much as you need to, taking prescription medications faithfully, doing at-home physical therapy exercises, and attending follow-up appointments. Do not give the insurance company any opportunity to imply that you are not taking your health seriously.
- Gather evidence of the causes of your injuries. Once you lay the groundwork for your claim by taking care of your health, your next step will be gathering evidence of how your injuries occurred and who was at fault. Take photos or video footage of the site where your injuries occurred, whether it’s a car accident scene or a wet floor where you slipped and fell. If a liable party is present, get their contact details and insurance information. And if any witnesses saw the incident occur, politely ask them for statements and their contact details. Report the incident as necessary to the local authorities, the property owner, and any other party that can and should produce a formal report of the incident. Finally, write down everything you can recall about the accident in detail as soon as possible afterward while the details are still fresh in your memory.
- Retaining documentation related to your injuries. There will likely be plenty of paperwork associated with your injury case, and you should retain everything in a safe location for your records. The documents you should keep include copies of hospital bills, doctor’s office invoices, prescription copay receipts, and proof of any other medical expenses you incur as a result of your injuries.
If the insurance adjuster is not satisfied with the evidence you present with your claim, they might ask you to sit for an independent medical exam (IME). As its name suggests, an IME is a medical evaluation by an independent healthcare professional. Insurance companies sometimes order IMEs to answer questions or resolve disputes in injury claims. If the insurance company requires you to have an IME, they are usually responsible for choosing and paying the provider.
What if My Doctor Says I Will Need Additional Care in the Future?
You will usually need to wait until you reach maximum medical improvement (MMI) to receive money for your injury claim. Reaching MMI means you have recovered as much as possible from your injuries, and your doctor does not expect additional treatment to improve your condition. However, at this stage in your recovery, you and your doctor might agree that you are still likely to need additional care in the future.
Many injury victims need ongoing treatment for pain management and secondary conditions that arise long after they reach MMI. For this reason, as an injury victim, you can demand money for projected future medical expenses when you file your claim. But proving that you are eligible for this type of compensation is often challenging.
Claiming compensation for past and current medical expenses is usually as simple as providing clear documentation of those expenses. But if you seek compensation for expenses that haven’t happened yet, you will need reasonable proof showing that you are more likely than not to need these future medical treatments.
You can demonstrate your future medical needs by presenting testimony from your treating physician describing the prognosis for your condition. An attorney can also help you locate independent medical experts who can provide unbiased testimony about the probable future consequences of your injuries.
Can I Still File an Injury Claim if Health Insurance Paid My Bills?
Robert W. Boatman, Personal Injury Attorney
Yes, you can still get money from a third-party insurance claim or personal injury lawsuit against the at-fault party if your health insurance covers some or all of your medical expenses. However, you should know that your health insurance company, other insurance providers, and healthcare providers could be eligible for reimbursement if they pay for your medical care and you eventually receive compensation for your injuries.
Many insurance companies and healthcare providers have the right to subrogation, meaning they can seek repayment from a personal injury settlement or trial award if they spent money on your treatment. Federal providers like Medicare and Medicaid also have a right of subrogation. Any of these providers could place a medical lien against your personal injury claim. That means they would be able to require you to pay back medical expenses they’ve paid if and when you receive compensation for your claim.
If any provider demands reimbursement for a medical lien, it’s important to determine which provisions in your insurance policy or state law give them the right to do so. Liens are a complex legal practice area, and a good attorney could find ways to help you reduce or eliminate your obligation to pay the lien.