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Mike Damaso
Mike Damaso
Attorney • (800) 235-7060

How Medical Expenses are Handled in a Personal Injury Trial

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Many personal injury attorneys never step foot into a courtroom. They represent clients from behind desks in their office and settle cases. Some lawyers who never step foot into a courtroom settle their clients' cases for pennies on the dollar, failing to recover fair compensation given the type of injury and how the injury occurred. In some circumstances, settlement may be the best option for the client depending on the facts and circumstances of the case. However, other times settlement is not the client's best interest, especially when the terms of the potential settlement short change the client.

Many times the general public when choosing a lawyer to hire does not know the difference- they do not know whether their attorney is willing to go to court for them from the billboard on the side of the highway. But, the public should know which attorneys go to court and which attorneys have not tried a case in years.

Our firm specializes in personal injury and wrongful death case and work on every case to prove it for trial. Lawyers, judges, insurance companies and people in the community know it. This article is the first in a series on subjects you should know about regarding personal injury and wrongful death trials.

This particular article is to help explain how medical bills are handled in a civil jury trial for personal injuries.

When a person is injured as a result of the acts of another person and receives medical treatment to care for that injury, there is a difference from the total of medical expense incurred versus the medical expenses which can been recovered by an injured plaintiff in a court case. When the doctor who treats you for your personal injuries, submits the bill to your health insurance for reimbursement, that insurance company usually pays the doctor at a "contract rate" and you usually pay a co-pay. For example, if the doctors charges $200 in total for the visit, your health insurance pays 30% and you pay a $10 copay, the doctor gets paid $70 for that visit – the total from you and the insurance company. For that doctor visit, the total charge is $200 but in a personal injury case you are only allowed to recover the $70 from the jury. The reason for this is that the only expense to you is $70, not $200. You are not allow to recover the 70% discount the insurance company gets under the health insurance contract with the doctor ($140 discount in our example).

Some people might say, why is the injured plaintiff allowed to recover the part that was paid by the health insurance. That does not seem fair as that amount was not paid by the plaintiff out of their pocket. But, what most people are not aware of is that the insurance company virtually always has a contractual right of reimbursement against the injured plaintiff if that plaintiff makes a recovery. So, using the same example, if the $70 actually incurred after the discount is recovered from the injury case (the $60 or 30% of the doctor's charge plus the $10 the injured person pay out of their own pocket), the injured is contractually obligated to pay back the amount the health insurance carrier paid to that health insurance company. So, if the jury verdict give the injured plaintiff that $200 bill, after reductions by the judge and paying back the health insurance company, that injured person in reality only recovers $10 for that bill.

Juries need to know that when there is a verdict to compensate an injured person and there is a portion of that verdict specifically for medical expenses, most of that money goes to other people. Most of that money goes to payback doctors, payback health insurance companies, and only a small part goes to payback the injured person for that they paid out of their pocket. This is important to clear up any misconceptions about verdicts and jury trials and so that people in the community realize there is rarely a windfall if to the injured person If when the jury follows the law and applies it to the evidence.