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Feb 4, 2017

California law entitles plaintiffs to recover damages for their medical expenses following an injury, so long as the treatment received was reasonably necessary. Read on to learn more. A plaintiff’s medical expenses – both past and future – form a core component of most California personal injury claims.

Personal injury cases typically involve recovery of economic and noneconomic damage claims. Medical expenses qualify as economic damages. Economic damages relate to the financial losses suffered by the plaintiff in the wake of their injuries, such as wage loss and medical expenses. Noneconomic damages relate to the general losses that are not measureable through traditional means. Though noneconomic losses are compensated by financial means, the losses themselves are not financial in nature. Examples of noneconomic damages include pain and suffering, emotional distress, and loss of quality of life.

Personal injury claims are often complicated by unique circumstances. In some cases, it may be difficult to assert a significant noneconomic damages claim based on a variety of factors. Alternatively, you may not have suffered significant economic damages in the form of wage loss (i.e., if you are unemployed or only a part-time worker). Given these circumstances, medical expenses become an even more critical component of your overall damage claim. To better understand how a medical expense claim works, let’s explore the basics.  

Past Medical Expenses

Your past medical expenses claim accounts for the cost of the medical care that you have already received. It should account for the cost of consultation, testing, diagnosis, treatment and surgeries, and rehabilitative care, among other things – so long as that care has already been administered.   If your medical expenses have been paid for by your insurer (health insurance), you are only entitled to claim the medical expenses that were actually paid for by the insurer. The hospital/clinic bill you receive for your treatment is not necessarily the actual amount paid by the insurer (as the insurer typically negotiates down the costs later). In addition, your health insurance may assert their subrogation right on your recovery, so you should consult with an accident attorney in Los Angeles regarding the options available to you.  

Future Medical Expenses

Your future medical expenses are more difficult to predict, as they have not been administered yet – nor has the actual cost been determined. You are entitled to recover the reasonable cost of all reasonably necessary future medical care. Generally, personal injury plaintiffs make use of expert testimony to present the court with estimates for the cost of future treatment.  

What is “Reasonably Necessary” Medical Care?

Pursuant to California Civil Jury Instruction (CACI) 3903A, for the plaintiff to recover both past and future medical expenses, he or she must prove that the medical care received was “reasonably necessary.” If the medical care received was not reasonably necessary, then the plaintiff cannot recover for the costs of said care. The law prevents plaintiffs from using their injuries as carte blanche authorization to seek out irrelevant or unnecessary medical care. The defendant is only liable for relevant and reasonably necessary medical expenses.   What, then, constitutes reasonably necessary treatment?   Generally speaking, treatment is deemed reasonably necessary if the treatment was necessary given the nature of the injury suffered and the available medical treatments (i.e., the severity of the injury, the potential outcome of the injury without such treatment, the likelihood of recovery with alternative treatments, and whether the treatment was customary for the injury at-issue). On balance, these and many other factors are weighed to determine whether the treatment was reasonably necessary.  

To help support your medical expenses claims, an expert will likely be brought in to testify that the treatment received or sought is reasonably necessary given the balance of factors.

For example, suppose that you suffer a spinal injury due to a car accident. There is no available, customary treatment that will allow you to recover from the injury. After some months, however, your physician recommends a new experimental treatment that may help restore spinal function. The treatment has a 70% chance of success and it is costly, but you decide to sign up.   Suppose, also, that the case is litigated prior to you undergoing the experimental treatment. Thus, the treatment is a future expense. The defendant will almost certainly argue that the treatment is not reasonably necessary. You will have to argue that – on balance – given the lack of available alternative treatments, the reasonably high likelihood of the treatment working, the severity of the injury, and the outcome without treatment, the circumstances point to the treatment being deemed reasonably necessary.   To recover in full for your medical expense claims, you will need the services of a skilled personal injury attorney who is capable of persuasively arguing that your past/future treatments were and are reasonably necessary given the circumstances. Call West Coast Trial Lawyers at (888) 539-9582 for a free consultation with an experienced Los Angeles accident attorney today.

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