Recovering compensation for medical costs in a personal injury claim is a complicated and challenging legal process. Under state law, injured victims are only permitted to claim related damages that are medically necessary and reasonable.
Who decides what care is reasonable and necessary? What evidence do you need to support your claim?
Read on to learn how Tennessee defines medical treatment as reasonable and necessary and the impact of the collateral source rule recently decided by the Tennessee Supreme Court.
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What Are Reasonable and Necessary Medical Costs?
To prove your medical costs are reasonable and necessary in a personal injury claim, the plaintiff - or his or her attorney - must establish:
- The services obtained were medically necessary
- The treatment was the direct result of injuries caused by the at-fault party
- The compensation you are requesting is within reason
Doing this without the help of a knowledgeable attorney can be challenging, especially when you are still recovering from your injuries. Often victims are vulnerable to insurance companies who may try to devalue your claim by saying that the care you received was not medically necessary. Having legal representation on your side helps to protect your interests and the value of your claim throughout the legal process.
What is Needed to Prove Medical Costs as Reasonable and Necessary?
According to state law, the evidence only needs to show the medical treatment was likely reasonable, rather than to an exact degree of certainty. That does not mean a plaintiff can exaggerate damages, present them as reasonable and expect to be compensated for them. If the evidence presented does not adequately support the medical goals needed to help a victim recover, then the damages being sought could be denied.
What Evidence May Be Used to Support Your Claim?
There are various types of evidence that can be used to show the medical care you received was necessary and reasonable. Our experienced attorneys have been handling cases like these for decades. Not only are we familiar with the evidence that is needed to support your claim, but we can help you to gather this evidence.
Injured victims can also help by:
- Carefully documenting medical treatments related to their injury: Document all doctor appointments, diagnostic tests (such as X-rays or MRIs), physical therapy and other care as prescribed by your doctor, keeping a calendar record of your appointments and treatments received.
- Keeping accurate billing records: Save all invoices, receipts for medical bills paid and transportation costs to doctor’s appointments. For each expense, relate it back to the appropriate appointment in your records.
- Obtaining copies of your medical records: Your records should include the date you were originally seen, the cause of your injuries, your physician’s diagnosis and recommended treatment plan.
Additionally, you may also be required to give testimony about your injuries and care, such as describing;
- The negligence of the other party and how it led to your injury
- Your doctor's diagnosis
- Treatments you have already received
- How your injuries limit or impact you daily
- Pain levels you may still suffer
- How much you have paid for care received
Sometimes, your attorney may also bring in a medical professional to give testimony about your injuries and care, which could help to strengthen your claim further.
Impact of Tennessee’s 2017 Collateral Source Rule
The collateral source rule is, simply said, a rule of evidence. This rule prohibits defendants from submitting evidence that a plaintiff has received compensation from a source other than damages he or she is seeking from a defendant.
One of the most common examples of a collateral source involves the payment of medical costs. Health care providers routinely bill for considerably more than what they receive as per their agreed-upon contracts.
An argument was recently put before the Tennessee Supreme Court where defendants were seeking to change the ruling to only allow injured victims to sue for the discounted damages. However, the Supreme Court did not agree with the argument and issued a ruling on November 17, 2017 to uphold the original collateral source rule in Tennessee.
Going forward, evidence of a provider’s discounted rates may not be submitted by defendants. However, defendants may still present arguments and provide other non-conflicting evidence as to whether a medical expense is reasonable.
Call an Experienced Attorney for Legal Help with Your Injury Claim
Establishing proof of your medical costs – and getting the compensation you need to pay for those expenses – is challenging. Having a lawyer who understands this and has extensive experience handling personal injury cases can be beneficial to the outcome of your claim.
At Greg Coleman Law, we are well-versed in the many complexities that are often a part of the legal process, and we are prepared to fight for maximum compensation on your behalf. Contact our law offices anytime, night or day, to get started.
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