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Recovery of Future Medical bills in Car Accident Cases

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Can I recover for future medical bills in my Car Accident Case?

Here is one that pops up fairly regularly.    You may be nearing the end of your treatment, and the doctor has made some recommendations about some additional treatment you may need after you are discharged from his care.   These recommendations most often occur for: (1) additional chiropractic or physical therapy modalities; (2) additional facet or epidural injections, and (3) additional surgical procedures.   How does that work, and will you get credit for the future medical treatment that has been recommended?   

Georgia does allow for the recovery of future medical expenses.  Generally speaking, this means that that the future medical expenses need to be proven with a reasonable degree of medical certainty.  There is no guessing and speculation permitted. If your doctor says that the likelihood of you needing a future procedure from your car accident case is “50/50” then as a matter of law you can’t assert the claim. If your doctor says that he “thinks that further procedures are indicated” that will not qualify as a reasonable degree of medical certainty.  Instead, he needs to affirmatively state that in his opinion to a reasonable degree of medical certainty (legally speaking just means more likely yes than no) you will require the procedure in the future. If you are able to secure this sort of testimony, it will allow you to at least present the claim to the insurance company, and ultimately a jury.     

Now, just because the doctor has said you will need a future procedure does not mean that you will get credit for it when the insurance company evaluates your case down the road.   A lot of it depends upon the type of procedure recommended, the doctor who is recommending the procedure, and the amount of the future medical bills. If you have past medical bills of $10,000, and the doctor has recommended future medical procedures totaling $50,000, then the likelihood of you receiving credit for these bills is low.    In addition, there are certain doctors in the Atlanta area who always seem to make a recommendation that you will need future medical treatment. The insurance company is a for profit venture that is run by a bunch if smart cookies, and they have a list of doctors who they believe fall into this category. When they see a recommendation from these doctors about future medical treatment, they toss it in the garbage.

Even if you have a surgical recommendation from a doctor that is well respected by the insurance company, it can still be problematic.   The area that we have had the most success are in commercial cases where there has been a positive finding on imaging, our client has received chiropractic or physical therapy, and has a recommendation from a respected surgeon regarding a future back or neck procedure.   Under those circumstances, and with medical bills of $25,000-$35,000, you might expect an offer in the $100,000 – $200,000 range. The rationale here is that the insurance company has to pay a premium and buy its risk now. If the insurance company does not settle with a surgical recommendation and you do end up moving forward with the surgery, it will cost them much more to get it resolved. 

Our advice has and continues to be that in 90% of cases you are better off moving forward with the recommended procedure and then getting credit for the past medical bills.   If you end up trying your case, juries are always more receptive to past medical bills rather than future. The other problem that you can run into down the road is the recommendation getting stale.   For example, if the treating orthopaedic surgeon recommended a cervical ACDF in October 2015 and your case ultimately gets in front of the jury in October 2018, no jury will give you credit. In fact, just the opposite-you risk your credibility in even asking them to make an award.   If they think you are overreaching or asking for reimbursement for something that you are not going to have, it can tank your whole case.

Contact Ponton Law today to get all your questions answered about the recovery of future medical bills in your car accident case.