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The “Reasonableness” of Your Medical Expenses: A Brief Overview

If you or anyone you know has been injured due to someone else’s negligence, you know that no amount of money can completely make up for the trauma and injuries you have sustained. However, a personal injury suit may be the only recovery available.

Personal injury suits provide plaintiffs who have been injured the opportunity to recover damages and help pay for expenses that were incurred as a result of their injuries, such as those for medical services. However, medical billing is not as straightforward as charging a patient for services rendered. Combine this with the presence of different health care systems and insurance companies, and it makes for a complex billing process and an even more complex recovery process.

In order to recover for past medical expenses, the injured party must present evidence to prove that the medical expenses incurred were both “reasonable” and “necessary.” Although it seems simple enough, compensation for medical services has actually become a major issue of contention in personal injury cases over the years; defining “reasonableness” and determining the “reasonableness” of medical services and expenses incurred can be controversial and confusing.

Under the Florida collateral source rule, evidence that the injured party has received compensation for medical expenses from a source other than the defendant or tortfeasor, is prohibited. In a lawsuit where a plaintiff may recover more than their actual loss or the defendant may pay less than the damage they inflicted, the law would rather side with the plaintiff and allow them to recover more than their loss. In order to recover for past medical expenses and enter medical bills into evidence plaintiffs needed to prove three elements: (1) the plaintiff has paid or become liable to pay the medical bills; (2) the plaintiff necessarily incurred the medical expenses because of the injuring resulting from the defendant’s negligence; and (3) the charges were reasonable for services of that nature. However, issues arose when defendants began contesting medical bills for not being “reasonable” or “incurred” if they were being paid by collateral sources. Collateral sources include Medicaid, Medicare, private health insurance, workers compensation and governmental assistance programs. The defendants’ argument is that “reasonable” expenses should only include the amount the plaintiff actually paid, and exclude any charges that were paid or written off by collateral sources. This controversy has led to each state adopting its own way of calculating the “reasonableness” of medical services.

States generally follow three basic approaches—amount paid, amount billed, and reasonable value. Florida follows the actual amount paid approach, limiting a plaintiff’s recovery to the amount of medical charges paid, regardless of whether that amount is paid by an insurance company, out-of-pocket, or by another entity. The major downside to this approach is that an injured party without insurance may not recover the same amount as an injured party with insurance. Opponents to this approach also argue that it goes against the original purpose of the collateral source rule to prevent the tortfeasor from benefiting from any compensation by collateral sources. As previously mentioned, most other states take different approaches.

In sum, the process of determining past medical expenses for the purposes of evaluating damages in a personal injury suit can be complex and confusing. This article is merely a brief overview of the legal process. We understand that recovering from the injuries you may have sustained in an accident or fall is difficult as it is, without adding the stress of recovering for your past medical expenses.

If you or a loved one are involved in a pedestrian or vehicle accident, it is important to contact an experienced personal injury attorney as soon as possible.  Your attorney can help you find and evaluate any liabilities and help you recover any available remedies.

While we hope you and your family never run into this unfortunate event, should it ever occur, contact the experienced personal injury lawyers at the Friedland | Carmona as immediately as possible. The South Florida personal injury attorneys at the Friedland | Carmona handle all types of bicycle accident, negligence, product liability, personal injury, negligent security, slip/trip and fall, and car accident cases throughout the state of Florida, including Boca Raton, Homestead, North Miami, South Miami, Miami Beach, Coral Gables, Pembroke Pines, Hialeah, Kendall, Aventura, Fort Lauderdale, and Palm Beach. The Friedland | Carmona handles all types of personal injury cases. Call the Miami personal injury attorneys today and let our family take care of your family.

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