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You can recover any medical expenses for treatment that is caused by the at-fault party.
This seems straightforward, but it can be tricky.
Defendants and insurance adjusters often dispute the reasonableness or necessity of the treatment and expenses. Alternatively, they argue that the medical treatment did not follow conservative medical treatment measures or that the treatment was needed for pre-existing injuries.
1) What medical expenses can I recover?
Conservative medical treatment means that the treating physician followed a treatment protocol that first utilized antiinvasive treatment options before progressing to more invasive measures.
Conservative medical treatment is usually characterized by the use of simple, cheaper, and less risky treatment options that gradually escalate to more complex, expensive, and more risky medical treatment measures.
For instance, a physician may want to treat back pain by first prescribing a muscle relaxer and bed rest. If that does not relieve the symptoms, the physician may then prescribe some physical therapy. If your pain symptoms persist, the physician may request an MRI to further understand what's causing the symptoms. If bulging discs are identified, the physician may recommend that steroid injections may be attempted. Finally, if no other treatment options are available, the physician may recommend surgery.
2) What is meant by "conservative" medical treatment?
In theory and in Georgia, reasonable medical expenses are those that the medical provider charged for your treatment.
This approach ignores any payments made by health insurance.
However, this does not stop defense attorneys and adjusters from challenging the medical bills.
In recent years, it’s become more common for insurance adjusters and defense attorneys to hire their own medical experts to argue that medical providers are overbilling and charging unreasonably high medical expenses.
3) What is a reasonable medical expense?
A necessary medical expense is one medically required to address your personal injuries and symptoms.
Defense attorneys and adjusters will use several tactics to argue your medical treatment and expenses were not necessary for your recovery.
First, they may argue that your treating physicians did not follow conservative medical treatment protocols and that your injuries did not warrant the treatment prescribed. Alternatively, they may argue that you are not really injured, have achieved maximum medical improvement, and that the continued treatment is not justified.
Defense attorneys and adjusters will hire medical experts to review your medical records and bills to bolster these theories. They may ask the court to allow their experts to conduct an Independent Medical Examination (“IME”) of you, which may be permitted.
4) What is a necessary medical expense?
Defense attorneys and adjusters do not usually want to dignify chiropractic treatment as part of necessary medical treatment and expense unless it’s been deemed as medically necessary by an “M.D.” doctor.
The training and certification requirements required to by a doctor of chiropractic (“D.C.”) is different from that required to be a doctor of medicine (“M.D.”).
So, chiropractic treatment has not historically been treated as necessary medical treatment to address injuries for a personal injury claim. Instead, it is treated as elective, optional treatment.
As a rule of thumb, you can expect a defense attorney or adjuster won’t dignify any medical treatment or expenses that your own health insurance recognize and cover. This is usually true for chiropractic treatment.
5) Is chiropractic treatment considered a necessary medical expense?
Personal injury victims can recover for future medical expenses to the extent that they can be proven.
Future medical expenses can usually be expected for catastrophic injuries such as amputations or brain injuries.
Either way, future medical expenses are proven by obtaining testimony from treating medical physicians who can project likely future medical treatment and expenses.
Defense attorneys and adjusters can argue that future medical expenses are not necessary, likely, or speculative. This often occurs when an injured client does not pursue recommended medical treatment.
For instance, if you have been recommended for surgery to treat a bulging disc in your spine, you may not be able to claim future medical expenses if you refuse to undergo surgery. That’s because the defense attorney and insurance adjuster will argue that the surgery likely could resolve all of your symptoms.
6) Can I recover for future medical expenses?
Future medical expenses can include anything that a treating physician is able to testify you need, within a reasonable degree of probability.
This can include:
Lab tests and other diagnostic testing (i.e. x-rays, MRI’s, etc.);
Medication and Pain Management;
Medical supplies and equipment needs (i.e. wheelchair, crutches, prosthetics, etc.);
Home modifications (i.e. wheelchair ramps, accessible showers, handicap beds);
Nursing home care; and/or
Counseling and psychiatric treatment;
7) What do future medical expenses include?
Future medical expenses are usually calculated by using a lifecare planning expert.
Once a physician has provided admissible opinions as to your future medical treatment needs, a lifecare planner estimates the costs of this treatment based on the market rates.
Other variables that influence these costs include your age, prior medical history, lifestyle, and the availability of treatment methods in your area.
Then, an economist expert would need to convert these projected expenses to their present value.
8) How are future medical expenses calculated?
Several factors can influence the value of your future medical expenses, including:
Alternative and more affordable treatment options;
Current medical treatment status;
Likelihood that current or future treatment may resolve your symptoms and/or injuries;
Age and life expectancy;
Lifestyle choices and medical history (i.e. smoker with prior cancer history);
Calculation methods by the lifecare planner to estimate future expenses; and/or
Inflation rates (when an economist reduces future estimates to present value).
Predictably, insurance adjusters and defense attorneys often hire their own experts to attack one or more of these factors in an attempt to minimize your projected future treatment needs and expenses.
9) What factors influence the value of future medical expenses?
Although health insurance may cover your medical expenses, it does not affect the value of your medical expenses that you can assert in your personal injury claim, in Georgia.
Whenever you settle a personal injury claim, you are required to pay back all medical expenses. This includes reimbursing your health insurance when they pay for your medical expenses. So, even though health insurance may have paid for your medical treatment already, it does not mean you are off the hook.
In theory, the amount a medical provider originally charged for a medical treatment is presumed to be reasonable and necessary. Therefore, Georgia law allows these expenses to be used as evidence of your injuries, even though health insurance may have covered the bill.
In other words, the at-fault party does not get a discount for the negligence just because you have health insurance.
10) Does health insurance affect the value of my medical expenses that I can recover?
A life care plan is a document that provide a projection of the injured person’s current and anticipated health care needs.
It’s often used when a person has suffered a catastrophic injury or other permanent and chronic medical condition.
Life care plans are put together by a qualified experts, relying on published standards and who conduct a comprehensive evaluation of the evidence of your current and future medical needs. It holistic, detailed report that provides an accounting of likely future costs needed to deal with your injury.