Medical Expenses

Medical expenses in an injury claim generally cover anything reasonably necessary to diagnose or treat the injury. Common categories:

• Ambulance and emergency room charges
• Hospitalization, including surgery and inpatient care
• Follow-up visits with primary care or specialists
• Diagnostic imaging — X-ray, MRI, CT scan
• Physical therapy, occupational therapy, chiropractic care
• Prescription medications and medical devices (crutches, braces, etc.)
• Mental health treatment related to the injury
• Mileage and transportation costs to medical appointments

Past expenses are bills already generated at the time the claim is settled. Future expenses are projected costs for treatment the person will likely need. Future costs require a medical basis — usually a treating doctor or a life-care planner saying what treatment is reasonably expected and how much it will cost. Insurers heavily scrutinize future costs, so they need solid documentation to be recoverable.

Hospitals bill one number but accept a lower negotiated rate from health insurance. States handle this differently. Some let the injured person recover the full billed amount; some limit recovery to what was actually paid; some use a middle approach. This one legal question can change the value of a medical-expense claim substantially.

If health insurance, Medicare, or Medicaid paid medical bills, those payers usually have a right to be reimbursed from any settlement. These liens have to be resolved before the injured person gets their share. Resolving a Medicare lien can take months, and it's one reason settlement disbursement can take weeks after the release is signed.