Medical bills are invariably one of the most important factors in valuing settlement of all personal injury claims. As one lawyer often says they are "coin of the realm". What he means is that the insurance industry uses total medical expenses as one of the most significant variables in their calculation of what a case is worth.
Thus, medical bills are a very important thing to discuss and understand the significance of.
In our last article we discussed why serious injury cases often take a long time to settle despite clear legal responsibility and severe, obvious injuries. This article should be read in conjunction with the prior one which focused on the insurance company related factors that slow down settlements, In this chapter we discuss problems associated with medical bills and medical cost estimates.
This article examines the aspects of the process that are associated with activities of the injured victim's attorneys.
Understand at the outset that at Clark and Steinhorn, LLC we care passionately about all of our clients but in particular understand the needs of catastrophically injured victims of car and truck crashes. We have seen the struggles of our clients and their families and have witnessed the economic havoc a bad car or truck accident can visit upon them.
We attempt to expedite all insurance and other processes on their behalf but despite this things often take time and often the clients can't understand the delay. I will attempt to explain.
First, many people do not understand that all cases are resolved, in general terms, in what amounts to one payment that is intended to compensate the victim or victims for all of the injuries both physical and economic that they have suffered or will suffer in their lifetimes from the event that injured them.
Many people have the illusion that they will be paid along the way for their medical bills, lost income etc.This is in large measure untrue. Yes car accidents may feature PIP payments for wages or medical bills and yes if your crash happened while in the course of your employment you should be paid workers compensation benefits but these payments are the exception rather than the rule and do not represent the all-encompassing, global settlement of a large claim.
Hearkening back two paragraphs, the settlement is meant to "compensate the victim for all of the injuries both physical and economic they have suffered or will suffer in their lifetimes." That can be an enormous task where a serious injury has taken place. It isn't merely a matter of sending the insurance company medical records and bills and saying pay me x dollars.
One must fully explore and identify all losses which can be a multi-layered process. There are different categories of "damages" which have to explored and demonstrated and in some instances quantified.
The first area involves medical expenses past, present and future. Many insurance companies require actual bills with their cpt codes reflecting the services the healthcare providers have performed. In the initial barrage of treatment and bills after a major injury some bills get lost in the shuffle. Healthcare providers including hospitals often forward their bills to health insurers, auto insurers and the patients themselves but not to the lawyers.
Thus lawyers often have to track down all the bills after the fact without clear knowledge of exactly whom their client has seen. A major crash emergency and ambulance to the hospital for surgery will have hospital bills, ambulance bills, emergency room personnel bills, anesthesiologist bills, surgeons bills and potential outside consulting physicians bills.
Herding all these bills is time-consuming and if the bills lack sufficient information of how they relate to the crash, can cause untold problems.This can take months and requires both patience and endurance. Often healthcare providers charge more per page for bills than for the actual medical records.
So lets assume that your lawyer has obtained all of your existing bills and that they pass muster with the liability insurer. The next issue involves future medical expenses. This is essential in severe injury cases and can often delay settlement for literally years.
Why you ask? Because doctors are very hesitant about projecting what a patient will need in the future until they have exhausted all treatment options today. Lets take a hypothetical example. Elvin is in bad truck crash that culminates in back surgery after a year of physical therapy and injections. Obviously this treatment regimen has delayed any settlement while it unfolds across the year.
The surgery is only partially helpful as it repairs one vertebral disc but reveals problems at a different level of the spine. This problem also gets addressed conservatively (non-surgically) but again therapy comes up short and a new surgery is set one year after the previous one.The second surgery is more completely successful than the first, but the patient will still be left with residual problems that will require intermittent therapy and prescriptions.
At this point some doctors will assist their patients by evaluating the long term prognosis and future treatment needs but getting actual numbers can be very difficult and also when provided are often not completely accurate. In large cases attorneys can hire individuals trained in making accurate future medical care cost projections, who take the treating doctor's future treatment recommendations and delineate them.
This document is often referred to as a lifecare plan. It is essential in some large cases and again is both expensive and time-consuming. If Elvin's health and future treatment needs warrant a lifecare plan it will necessarily come into existence after the all the records from the second surgery and all the post-surgical treatment has taken place which is to say more than 2 plus years after the accident that injured him.
As one can imagine this may have bankrupted Elvin and his family long ago but the alternative is seeking insufficient compensation for him.
Whether a lifecare plan is necessary or one merely relies on doctor's estimates of future medical needs and expenses, the true picture of the badly injured victim's medical costs doesn't come into accurate focus until long after the incident that gives rise to their claim.
As one can see, the medical bill/cost issue is far more complicated and important than might seem likely. It is a substantial reason for delay in settlement and no matter how severe an injury may be, the bills still need to be presented to the insurance entity to justify paying the full value of a claim.
Nest chapter: lost wages and lost income earning opportunities.