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Can the Insurance Company Exclude Certain Medical Expenses from My Claim?

Posted on behalf of Phillips Law Group on Mar 31, 2021 in Auto Accidents

table with medical bills below moneyGenerally, car insurance companies will only cover reasonable and necessary medical bills injury victims incur. If you underwent a new treatment that was experimental or unproven, the insurance company may deny compensation for the cost of this treatment.

Contacting a lawyer to review your claim may be an important step, as he or she may be able to help explain the medical expenses that may be included in your claim. Phillips Law Group has been helping crash victims secure compensation for medical bills and other expenses for nearly 30 years.

Below, learn more about what reasonable and necessary means when it comes to medical expenses. If you have questions about including medical bills in your claim, give us a call to schedule a free consultation.

What are Reasonable and Necessary Medical Bills?

This phrase may be up for some level of interpretation. For example, it would be difficult to dispute you needed surgery after suffering internal injuries in a crash.

However, reasonable medical professionals may disagree about the steps needed to recover from the injury and resulting surgical procedure. The insurance company may dispute the duration of certain prescription medications or follow-up visits with doctors.   

In these situations, you and your attorney may need to have a medical professional testify about why these expenses were necessary, and why the treatment was needed.

If you choose to undergo a risky medical procedure that has the same likelihood of improving your symptoms or injury than a cheaper, more traditional surgery, the insurance company is likely to dispute this part of your claim. That said, if you suffered a life-altering injury, risky surgery may be your only option. In these situations, you may be able to get the insurance company to cover the full cost of your claim.

The other part of reasonable and necessary that may be up for interpretation is whether the cost of a particular treatment was reasonable.

Typically, you need to establish the price you paid is comparative to what another provider would have charged for similar services. If the cost of a treatment or service is significantly higher than what other providers would charge, the insurance company may only cover part of the bill.

Expenses Often Considered Reasonable and Necessary

There are many medical expenses you may be able to include in your claim. While each claim is unique, crash victims can generally seek compensation for expenses like these:

  • Transportation in an ambulance
  • Surgery (particularly surgery right after the crash)
  • Physical therapy recommended by a doctor
  • X-rays and other testing necessary to diagnose your injuries
  • Visits with doctors, particularly follow-up visits with specialists you were referred to
  • Medical devices prescribed by a doctor
  • Prescription pain medication and other medications meant to treat your injuries or help relieve your symptoms
  • Stays in the hospital
  • And more

What About Future Medical Expenses?

If you suffered a permanent injury or disability because of the accident, you may be able to secure compensation for future medical expenses.

However, you will probably need to establish these future expenses are reasonable and necessary. In other words, you will likely need to show these expenses are for a standard type of treatment for people who have a diagnosis like yours.

If you seek a treatment or have a procedure that is not typically done for someone in your condition, or a procedure that has not been shown to provide much benefit, you might not be able to include these expenses in your claim.

When you have a permanent or long-term injury, you are likely going to need medical experts to help assess the cost of future treatment. That is why it is important to hire an experienced attorney who regularly works with medical experts and other experts to help validate injury claims.

Without an experienced attorney it may be difficult to secure maximum compensation for your injury. If you accept a lowball offer, you may not be able to afford all the treatment your doctors recommend. This could greatly impact your quality of life and make it more difficult to do the things you did before your injury.

Injured in a Crash? Schedule a Free Consultation

Do you know what your car crash claim may be worth?   

It can be difficult to determine the full value of a claim without talking to an experienced Phoenix auto accident lawyer. You cannot rely on the insurance company to make a fair assessment of the damages you suffered.

At Phillips Law Group, we take cases on contingency, which means there are no upfront fees for our services and no obligations. Our attorneys do not get paid unless you get paid.

Phillips Law Group. Millions Recovered. Phone: 1-800-706-3000.

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