This article focuses on how your past medical expenses affect a personal injury settlement.
When does this article apply?
This article applies when someone else’s negligence caused your accident in Florida, or on a cruise ship or boat. This article does not apply if you are injured while working and your only case is against your employer and you aren’t able to sue your employer for personal injury.
In Florida, you may be entitled to recover many types of damages if you’re injured by someone’s negligence, but this article focuses on getting your medical bills paid. In Florida, you are only entitled to recover your out of pocket costs, and any liens paid by any first party coverage.
What are out of pocket costs?
Let me give you an example. You go to the hospital and the hospital bills your health insurance company $10,000. Your health insurance company has a contract with the hospital that says that only $3,000 of the $10,000 is reasonable (known as the “contracted rate”).
Therefore, your health insurer would pay the hospital $3,000. Let’s say that your health insurance plan requires you to pay 10% of the contracted rate. Since the contracted rate is $3,000, then 10% of $3,000 is $300. Your out of pocket cost is $300.
So if you can prove that the negligent party was 100% at fault for causing your injuries, you should be able to recover the medical bills of $300 that you owe the hospital. You should also be able to recover the $3,000 that your health insurance paid the hospital if your health insurer has a right of subrogation, which most do.
But don’t assume that the health insurer has a right of subrogation, and DO NOT LISTEN TO THE SUBROGATION ADJUSTER! Their goal is to recover as much money as possible. Always read the health insurance contract.
Back to the above example. You will not be able to recover the total billed charges of $10,000 since you did not pay and you don’t owe this $10,000.
So how do the total billed charges affect the value of your case in this scenario?
Although most cases don’t go to trial, a liability insurer uses past verdicts (and now it is becoming more common for them to use past settlement values) to evaluate the settlement value and makes an educated guess about the amount of money that a jury may award you.
In Florida, if your health insurer has a right to recover payments that it has made for your medical treatment, then the jury will get to hear the total amount of charges that were billed by your medical providers.
Total Billed Charges Implies Bigger Injury and More Pain and Suffering
A jury may conclude that someone with large medical bills if more badly injured than someone with smaller bills. This may often be the case. An adjuster may think the same thing.
A jury is thus more likely to award a larger amount of money for the pain and suffering component of your claim, which will increase the total verdict.
In a demand letter to the liability insurer, you can tell the adjuster that the jury will get to hear the total billed charges which may result in a higher pain and suffering award. Tell the adjuster that he or she therefore should make a large offer.
Total Billed Charges May Result in Higher Future Medical Bills
Again, most cases do not go trial. But you can argue to the adjuster that the jury will get to hear the total amount of your past medical bills.
If the jury hears that the plaintiff (injured person) has a large amount of past medical bills, the jury is more likely to believe your treating doctors when they give their estimation of your future medical expenses.
The defendant can hire a doctor who will most likely minimize your future medical expenses, if any.
Now, whether the jury will get to hear the amount of your total medical depends upon the type of first party coverage or insurance, if any, that you have.
Let’s go over a how the your total medical bills affect your recovery of future medical bills and the pain and suffering component if you have one the most common types of first party coverage.
1. Health Insurance (May result in higher settlement)
In Florida, if your health insurer has a right to recover payments that it has made for your medical treatment, then the jury will get to hear the total amount of charges that were billed by your medical providers. Thus, all things equal, this is may result in a jury awarding you a higher figure for future medical expenses and pain and suffering.
Your health insurance will generally pay a fraction of the full billed charges.
2. Medicare (May result in either smaller or higher settlement)
In Florida, if Medicare paid for your medical expenses then the jury may get to hear about your total medical bills. Defense attorneys will argue this. We have collected court orders that we can use to try to persuade the judge to allow the jury to hear the full medical bills. Medicare’s payments will generally be much smaller than the total billed charges.
3. Medicaid (May result in smaller settlement)
In Florida, if you have Medicaid, then the jury will NOT get to hear the total amount of charges that were billed by your medical providers. The jury will only hear about the payments that Medicaid made for your medical expenses. Medicaid’s payments will generally be much smaller than the total billed charges. Thus, all things equal, this is may result in a jury awarding you a smaller figure for future medical expenses and pain and suffering.
4. No health insurance (May result in higher settlement)
In Florida, if you don’t have health insurance, then the jury will get to hear the total amount of charges that were billed by your medical providers. Thus, all things equal, this is may result in a jury awarding you a higher figure for future medical expenses and pain and suffering.
5. Workers’ Compensation
If an employee is hurt while working, and he/she has a a personal injury case, an employer or workers’ compensation carrier has a right of subrogation to the rights of the employee. Florida Statute 440.39(2).
At least one Florida court has said that the jury should not get to hear the total medical expenses, before they were credited, adjusted, or written off by the health care providers and not paid neither by claimant nor the workers’ compensation carrier. Blanco v. Capform, Inc. Dist. Court, SD Florida 2013 citing Thyssenkrupp Elevator Corp. v. Lasky,868 So. 2d 547, 549 (Fla. Dist. Ct. App. 2003) (finding that it was error to present to the jury evidence of medical expenses charged instead of the medical expenses actually paid in full satisfaction of the total charge).
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