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Proof of Medical Bills Will Be More Difficult

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An injured person must prove their case at trial. They must introduce pertinent evidence including proof of medical bills that are reasonably priced. The defendant can attack this evidence.

The judge rules on the admissibility of the medical bills and other damages and the jury decides how much compensation the injured party receives.

To make trials more efficient and fair, Texas law has allowed the parties to prove and disprove medical bills and records with affidavits since 1979.

The New In Re Allstate opinion

The Texas Supreme Court issued an opinion on Friday that will dramatically curb the use of these affidavits and require doctors to testify in person.

The justices directed a Corpus Christi trial court to vacate its order that struck a counter-affidavit filed by the plaintiff’s car insurance company.

The injured driver had filed a lawsuit against Allstate (her car insurer) for refusing to pay her excess damages under her underinsured motorists policy. She had already settled with the at-fault driver’s insurance company for their limits of $30,000 but she had serious injuries and large bills.

Her attorneys filed the medical affidavits proving these bills pursuant to Section 18.001 of the Texas Civil Practices & Remedies Code.

Allstate’s attorneys filed a counter-affidavit from a non-practicing nurse who was a medical billing expert. She contested $37,000 of the plaintiff’s medical expenses and said they only should have been $12,000, so the plaintiff was not entitled to further payment.

The trial judge overruled this affidavit and disallowed reference to the billing expert’s testimony.

The court of appeals affirmed the ruling. Allstate filed a writ of mandamus to reverse that order.

The Supreme Court held that the trial court committed error when it struck the company’s counter-affidavit for these reasons:

  • The expert was qualified to determine medical expenses, even though she was not a medical expert as formerly required;
  • Her opinion did not have to meet the usual requirements for expert testimony;
  • A controverting affidavit gives fair notice if the plaintiff can deduce each medical expense being attacked;
  • The plaintiff’s medical evidence can be excluded even if a controverting affidavit is not filed; and
  • A trial judge who strikes a counter-affidavit and prohibits a defendant from arguing against the plaintiff’s evidence will have that order overturned on appeal.

The law allows both sides to offer and object to proof of medical bills

Section 18.001 of the TCPRC provides a sensible way for the injured party to show the jury their medical expenses without making all of their doctors testify. This is a lengthy and expensive process without the affidavit process and even that can be hard to achieve, especially with new time limitations imposed. Further, this law allowed the defendant to file their own counter-affidavits within a reasonable period of time or have their doctors testify in rebuttal.

How this opinion changes personal injury trials

This decision will make it even harder for the injured party to recoup their medical expenses.

The insurance company is authorized to hire someone with knowledge of billing or software programs, but not of medicine, to decide what a doctor should have charged.

They can rely on unreliable and self-serving software written to slash the cost of health insurance payments — and jury verdicts.

Further, the court’s ruling relaxes the requirement that a counter-affidavit even has to be filed, let alone what it has to say to be admitted into evidence.  This will lead to lengthier, more expensive trials and appeals.

Ironically, the Supreme Court enacted new guidelines that became effective this year that it said were designed to provide for the “prompt, efficient, and cost-effective resolution of civil actions.” ‎

This opinion follows on the heels of the Supreme Court’s and State Legislature’s reducing the size of medical bills over the years. And state lawmakers are considering a new law that will further reduce the medical bills an injured person can be paid.

Getting repaid for medical bills after being in a crash or other injury-causing event is challenging, even without these new restrictions on the proof of medical bills.

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