When someone is injured in a car crash or other traumatic event, it is easy to assume that every medical bill resulting from treatment after the accident can simply be added to the personal injury claim. California law is more complicated.
It is not enough to show that a medical service was provided after an accident or even that the treatment was related to the injuries caused by the accident. California law places additional requirements on a plaintiff seeking compensation for medical expenses.
CACI 3903A: The Starting Point
California Civil Jury Instruction CACI 3903A — Medical Expenses—Past and Future explains what a plaintiff must prove to recover medical expenses.
For past medical expenses, the plaintiff must establish the reasonable cost of reasonably necessary medical care that the plaintiff has received.
For future medical expenses, the plaintiff must establish the reasonable cost of reasonably necessary medical care that the plaintiff is reasonably certain to need in the future.
Those requirements are important.
Past Medical Treatment: Three Questions
When evaluating past medical expenses, there are essentially three separate issues:
1. Was the treatment related to the injury caused by the defendant?
There must first be a causal connection between the defendant's conduct, the injury, and the medical treatment.
2. Was the treatment reasonably necessary?
The fact that a doctor, chiropractor, therapist, imaging center, or other provider performed a service does not necessarily establish that the service was reasonably necessary.
For example, the defense may argue that treatment continued for too long, diagnostic testing was unnecessary, a particular procedure was not medically indicated, or the frequency of treatment was excessive. This is why medical testimony can become so important in a personal injury case.
3. Was the cost reasonable?
Even medically necessary treatment does not automatically establish that the amount charged for that treatment is reasonable. The plaintiff must be prepared to establish the reasonable cost of the reasonably necessary medical care.
These are separate concepts. A defendant may concede that an MRI was medically necessary but dispute the amount charged for it. Conversely, the defense might concede that the amount charged was reasonable for that particular procedure while arguing that the procedure itself was unnecessary.
A Medical Bill Is Evidence—But It Is Not the Entire Analysis
One of the mistakes people sometimes make when evaluating a personal injury case is simply adding up the medical bills.Suppose an injured person has received $150,000 in medical treatment.
That does not necessarily mean the plaintiff has automatically established $150,000 in recoverable medical expenses. The plaintiff still has to establish the legal foundation for recovering those expenses.
California cases concerning medical expenses also recognize that the amount billed is not necessarily synonymous with the legally recoverable amount. The analysis may depend upon such things as whether the bills were paid through health insurance, whether amounts were written off, whether the plaintiff remains responsible for the charges, and whether treatment was obtained outside an available insurance plan.
Future Medical Expenses Have an Additional Requirement
Future medical expenses present a different problem because the treatment has not happened yet. CACI 3903A therefore requires something more.
The plaintiff must prove not only that future medical treatment would be reasonable and necessary, but that the plaintiff is reasonably certain to need that treatment in the future. That distinction matters.
There can be a significant difference between a physician testifying:
"The patient might need surgery someday."
and:
"Based upon the patient's injuries and condition, it is reasonably certain that the patient will require this surgery in the future."
The first describes a possibility. The second addresses the legal standard for future medical damages.
The Cost of Future Treatment Must Also Be Proven
Establishing the need for future treatment is only part of the equation. The plaintiff must also establish its reasonable cost.
For example, if medical evidence establishes that an injured plaintiff is reasonably certain to require a future lumbar fusion, the damages analysis does not end there.
Evidence may also be necessary to establish the reasonable cost of the surgeon, hospital or surgical facility, anesthesia, imaging, rehabilitation, medications, follow-up care, and other reasonably necessary services associated with that procedure.
Depending upon the case, this evidence may come from treating physicians, medical experts, life-care planners, economists, billing experts, or other qualified witnesses.
Why This Matters When Building a Personal Injury Case
A well-prepared personal injury case should not wait until trial to ask whether the medical expenses can actually be proven. For significant medical expenses, the evidence should be developed throughout the case.
The questions should include:
- Was the treatment caused by the accident?
- Was the treatment reasonably necessary?
- Was its cost reasonable?
And for future care:
- Is the plaintiff reasonably certain to need it?
These issues can be especially important when the case involves expensive surgery, lengthy rehabilitation, treatment on a lien, substantial diagnostic testing, or significant future medical needs.
The Bottom Line
In a California personal injury case, "I received the treatment because of the accident" is not necessarily the end of the medical-damages analysis. CACI 3903A requires proof of the reasonable cost of reasonably necessary medical care. And when compensation is sought for medical treatment that has not yet occurred, the plaintiff faces an additional requirement: proving that the future treatment is reasonably certain to be needed.
Understanding those distinctions—and developing the evidence necessary to prove them—can make an enormous difference in properly presenting the damages portion of a personal injury case.
Law Office of Adam Sorrells
California Personal Injury Attorney
530-893-9900
www.chicopersonalinjury.com
This article provides general information concerning California law and is not legal advice regarding any particular case.