Defendants Might Challenge Your Medical Bills and Expenses in Court

It should go without saying, and is almost common sense, that in an accident, you should be compensated and can be compensated the reasonable value of your medical bills and expenses.

Many people interpret that to mean you automatically get 100% of your outstanding medical bills after an accident. But that would be forgetting an important word: “reasonable.”

What is Reasonable?

The law doesn’t say you get all outstanding medical expenses or bills, it says you get your “reasonable” bills and expenses.

Which means that in some cases, the Defendant has a right to fight the amount of your medical bills and expenses, if there are grounds to say that they are unreasonable, inflated, or not within the normal standard charged for the medical services provided to you.

As you can imagine, the cost of medical care in the country has grown–it is extraordinarily expensive to get medical care. But by the same token, that’s not your fault, as an accident victim–you just go to the doctor and you’re charged whatever you’re charged.

Even though that may be the case, you or your injury attorney still must be prepared to defend your medical expenses against attacks by the Defendant that those expenses should be “cut down,” or reduced, because they are unreasonable.

Showing Reasonableness

How does a Defendant show that your medical bills are reasonable or unreasonable?

It doesn’t have to do with what your doctor was actually paid–everybody knows that many health insurers or government medical programs like Medicare or Medicaid, pay doctors below the value of services. And to make up for that monetary loss, many doctors bill uninsured patients more than the value of the services.

To challenge your medical bills as being “unreasonable,” the Defendant must show that what you were charged is outside the normal range that the doctor charges for that particular medical service, and to some extent, the Defendant may also use what other medical providers charge for whatever procedure you had.

Expert witnesses can also be called to testify as to standard or traditional billing practices, and what the standard charges are for given procedures in your community.

Doctors do have a lot of leeway to charge what they want, and with the soaring cost of medical expenses, in most cases, your doctors’ bills will be considered reasonable. But in larger cases, where there are hundreds of thousands of dollars being billed, to save money the Defendant will try to challenge the reasonableness of these charges.

What the Doctors Were Paid

The Defendant cannot present as evidence, the amount your doctor was actually paid–again, this is because everybody knows that what was actually paid by insurers or other sources, is not determinative of the value of the medical services rendered. Evidence of actual payments made, can be used to consider the range of payments doctors get for given services.

What About Necessary?

Reasonable is one thing, but necessary treatment is another. Defendants can also say that treatment, procedures, or other therapies were just not necessary to treat you–that you were overtreated.

There are doctors that do, admittedly, overtreat patients. But by and large, they do not, and especially in larger, more catastrophic treatments, Defendants will have a hard time second guessing doctors, and trying to convince a jury that a doctor did something that was truly medically unnecessary.

Don’t let insurance companies try to reduce your compensation. Let us help you get what you deserve for your injuries. Call our Boston personal injury lawyers at The Law Office of Joseph Linnehan, Jr. today at 617-275-4200.

Sources:

lexology.com/library/detail.aspx?g=f2ffb1f5-cf7a-4052-89fa-544c2bb84f33

dc.suffolk.edu/cgi/viewcontent.cgi?article=1296&context=jtaa-suffolk