Proving Your Medical Costs Are Reasonable and Necessary to an Insurer

Posted on behalf of Peter T. Nicholl in Personal Injury Published on July 29, 2020 and updated on March 6, 2022.

medical billing statementIf you have been hurt in an accident due to negligence, you may be eligible to seek compensation to help cover your damages – including medical costs. Under Maryland law, the at-fault party would liable to pay any reasonable and necessary medical expenses incurred, as well as future expected medical expenses, caused by his or her actions or inaction.

But how can you prove that your medical costs are reasonable and necessary? This would require several different factors, including documenting your medical bills and receipts in order to pursue compensation. If not, the insurance company may say that your injuries are not as serious as your claim.

Our lawyers know how to gather and present evidence to show the necessity and reasonableness of medical costs to treat injuries as a result of an accident. An initial consultation is free and confidential.

Medical Costs in Personal Injury Cases

Medical costs have a tremendous impact in personal injury cases. Your medical costs not only help to ensure you receive the compensation you need, but they also serve as evidence. This is why is important to save every bill and receipt you receive related to your post-accident medical care.

If you are severely injured in an accident, your medical records and the costs associated with treating your injury will play a significant role in proving that. If you say that your injuries are severe but only have a several hundred dollars in medical costs to claim, the insurer may not believe that your injury requires extensive treatment. However, if you can prove that your medical costs are in the thousands, you will be more likely to receive compensation to cover treatment.

It is also important to note that even if the other party is legally liable for your damages and you have health or auto insurance coverage, you may not initially be paid up front for your medical costs. You may have to pay out-of-pocket for transportation, medications, doctor visit copays, etc., until the case is resolved. This is why you must provide acceptable evidence to establish these costs.

How a Lawyer Can Get Medical Costs into Evidence

You and your lawyer need to show that the medical costs you are attempting to collect from the at-fault party are legitimate. This means establishing your damages through medical records, receipts and bills and admitting them into evidence. These documents, however, are not enough on their own.

An important step towards proving the legitimacy of your medical costs is finding a proper witness to testify on your behalf. You would need someone who could authenticate the medical costs you are claiming. This could be more than one individual or entity, such as:

  • The person being billed – You could testify that the bills received were for treatments associated with the accident and your injuries.
  • The person issuing the bill – This could be a hospital, doctor or another health care provider who billed you for medical services.
  • The record keeper – This could be the accountant or billing firm who works for the agency that send the medical bills detailing your treatment.

A Maryland personal injury lawyer from our firm is ready to seek the maximum compensation available.

Establishing Your Medical Costs Are Reasonable And Necessary

Another important step in getting your medical costs into evidence is showing that these costs are reasonable and necessary. The other side might argue that your medical expenses are not justified to avoid paying for certain treatments.

Being able to establish these costs as reasonable and necessary means proving:

  • The amount requested is within reason – The person who sent the bill may have to justify the cost of treatment. The amount requested must have been a reasonable amount that other providers offering similar services would have charged.
  • Treatment was provided for an injury caused by the other party – The medical costs you are requesting must have come directly from the accident caused by the other party’s negligence. If your treatment is unrelated to the accident or your injury, you will not be compensated.
  • Services issued were medically necessary – The other side’s defense may argue that the treatments you received were not necessary. A medical professional will need to testify as to why the medical services are in fact necessary or what makes these services medically relevant.

Testimony Needed To Show Reasonableness and Necessity of Treatment

As the plaintiff, you have the burden of proof to show the necessity and reasonableness of your medical treatment. This can be done through testimony you provide or from a medical professional.

Your lawyer might have you testify to show the following:

  • Doctor’s appointments and payments made for treatments
  • The nature of your injury and how it affects your daily life
  • How the injury was caused by the other party’s negligence
  • Medical services you have received to treat your injury
  • Amount of bills you have paid or received for treatments

Sometimes, your testimony may not be enough. You may need a medical professional to testify about the extent of your injury, trauma experienced due to your injury, treatments prescribed and the amounts charged for these services. Another doctor may be asked to validate what your doctor says.

Learn More in a Free Consultation

Proving medical costs and getting the compensation needed to pay for those costs is difficult. You need a lawyer with experience handling personal injury cases so that maximum compensation can be sought.

Our consultations are 100 percent free and come with no obligation to hire us. At The Law Offices of Peter T. Nicholl, we operate on a contingency fee basis, so we only get paid for our services if you win.

Call 410-244-7005 for answers to your legal questions.