Proving Future Medical Costs After a Life-Changing Injury
A serious injury can require medical care long after the first hospital visit. Someone may need another surgery, months of rehabilitation, ongoing medication, medical equipment, or help with everyday activities. Those costs can continue for years.
A Texas personal injury claim can include future medical expenses when the evidence shows that the care will probably be needed because of the injury. The key is proving what treatment is expected, why it will be necessary, and what it is likely to cost. An experienced Houston personal injury lawyer can help develop that evidence before an insurance company argues that the future care is uncertain or unnecessary.
What to Do Now When More Treatment Is Expected
Future medical costs often begin taking shape while treatment is still underway. A doctor may recommend another procedure. A rehabilitation specialist may expect therapy to continue. Someone with a spinal cord injury, brain injury, or amputation may need long-term equipment or personal assistance.
Keeping good records can help show what the future is likely to involve.
- Ask doctors to document treatment that is expected in the future.
- Keep records of referrals to surgeons, specialists, therapists, and rehabilitation providers.
- Save information about medical equipment or home assistance that has been recommended.
- Keep copies of current medical bills and treatment records.
- Follow reasonable treatment recommendations and attend scheduled appointments.
- Document changes in mobility, independence, and daily activities.
The clearer the medical history becomes, the easier it is to explain why future care will probably be necessary.
Future Medical Costs Need More Than a Guess
Texas law allows an injured person to seek compensation for future medical expenses, but those expenses cannot be based only on speculation.
The evidence should show that the future treatment is reasonably expected. Statements that treatment “may” or “could” be needed are often less persuasive than medical evidence showing that the care is probable. Stronger evidence identifies the treatment, explains why it will likely be necessary, and provides a reasonable basis for estimating the cost.
That does not mean every detail of future care must be known with complete certainty. Serious injuries often involve changing treatment plans. The claim still needs enough evidence to show that the projected expenses are connected to the injury and are likely to occur.
Doctors Help Explain What Treatment Will Be Needed
Treating doctors can play an important role in proving future medical expenses because they understand the injury and how the patient has responded to treatment.
An orthopedic surgeon may expect another operation. A neurologist may recommend continued treatment after a traumatic brain injury. A rehabilitation doctor may anticipate long-term therapy or mobility equipment.
The most useful medical opinions are specific. Instead of simply stating that someone will need “future treatment,” the doctor may explain what type of treatment is expected, how often it may be needed, and how long the need is likely to continue.
This can be especially important after catastrophic injuries because the future medical plan may involve several different specialists and services.
A Life Care Plan Can Help in Catastrophic Injury Cases
Some injuries create medical needs that are too complicated to explain with a single treatment estimate.
A life care plan can help organize those needs. It may include future doctor visits, therapy, medication, surgery, medical equipment, home health care, transportation needs, and other support related to the injury.
Life care plans are commonly used in cases involving spinal cord injuries, serious brain injuries, amputations, severe burns, and other permanent disabilities.
The plan still needs to be based on the actual medical condition. It should reflect recommendations from treating doctors and other qualified medical professionals rather than simply listing every type of care that could possibly be needed.
Future Costs Must Also Be Reasonably Supported
Proving that treatment will probably be needed is only one part of the claim. There also needs to be a reasonable estimate of what that treatment will cost.
Current medical bills can provide useful information, especially when similar treatment is expected to continue. Other evidence may come from healthcare pricing information, medical providers, equipment suppliers, or professionals who evaluate the cost of long-term care.
The cost estimate should match the treatment being recommended. If someone is expected to receive physical therapy twice a week for a year, the projected cost should reflect that recommendation. If a wheelchair will probably need to be replaced over time, the estimate should account for the expected replacement schedule.
Clear connections between the medical recommendation and the cost estimate make the future medical claim easier to understand.
Future Medical Care Can Include More Than Surgery
Major surgeries often receive the most attention, but future medical expenses can involve many other forms of care.
A person with a permanent injury may need continued physical therapy, pain management, medication, specialist appointments, diagnostic testing, injections, or medical equipment.
More severe injuries may require help with basic daily activities. Someone may need home health care, nursing assistance, mobility devices, or modifications that make the home safer and more accessible.
Some expenses repeat over time. Medical equipment wears out. Medications continue. Therapy may be needed during different stages of recovery. A serious injury claim should look at the full pattern of expected care rather than focusing only on the next procedure.
Life Expectancy Can Affect Long-Term Medical Costs
A permanent injury may require care for the rest of a person’s life. That makes the expected duration of treatment important.
A younger person with a spinal cord injury may face decades of medical care, equipment replacement, and assistance. Someone older may need many of the same services, but over a different period of time.
Life expectancy is not a prediction of exactly how long someone will live. It can help estimate how long ongoing medical needs are reasonably expected to continue.
The person’s overall medical condition may also affect the projection. The future-care estimate should be based on the individual rather than on a generic number.
Insurance Companies Often Challenge Future Care
Future medical expenses can represent a large part of a serious injury claim. Insurance companies may challenge both the need for treatment and the projected cost.
An insurer may argue that another surgery is uncertain, therapy will not continue as long as expected, or the injured person will eventually become more independent. The insurer may also argue that the projected prices are too high.
Medical records can help answer those arguments. A history of continuing treatment, repeated procedures, rehabilitation, and specialist care can show that the future recommendations are part of an ongoing medical problem rather than a new claim created for the lawsuit.
Consistency also helps. The treating doctors, medical records, and cost estimates should tell the same basic story about the person’s future needs.
Future Medical Costs Are Only One Part of a Serious Injury Claim
Future medical expenses are different from other damages that may result from a life-changing injury.
Future medical expenses address the cost of care that will probably be needed later. Lost earning capacity addresses income the person may no longer be able to earn. Physical pain, impairment, and other non-economic damages address different effects of the injury.
Keeping those losses separate helps show the full effect of the accident without counting the same harm more than once.
A careful review by a Houston personal injury lawyer can help identify each category of loss and determine what evidence is needed to support it.
Frequently Asked Questions About Future Medical Costs
Can I recover future medical expenses if I have not had the treatment yet?
Yes. Future treatment does not have to occur before a claim is resolved. The evidence should show that the care is reasonably expected because of the injury.
Do I need a life care plan?
Not in every case. A life care plan is more common when someone has a catastrophic or permanent injury involving many types of future treatment or assistance.
What if my doctor says I might need surgery?
A possible surgery may not be enough by itself to support a future medical expense claim. The evidence is stronger when the doctor explains that the surgery will probably be needed and why.
Can home health care be included?
Yes, when the evidence shows that the injury will probably require that level of assistance. This can be especially important after spinal cord injuries, severe brain injuries, or other disabling conditions.
What if doctors are still deciding what treatment I will need?
That is common during recovery from a serious injury. Continuing medical records, specialist evaluations, and updated treatment recommendations can help clarify future needs as the medical picture develops.
Contact Our Houston Personal Injury Lawyers at The Law Office of Shane R. Kadlec
A life-changing injury can create medical needs that continue long after the first round of treatment is finished. A fair personal injury claim should consider the surgeries, rehabilitation, medication, equipment, and other care that will probably be needed in the years ahead.
The Law Office of Shane R. Kadlec represents people who have suffered serious injuries in Houston and throughout Harris County. Contact the firm to speak with an experienced Houston personal injury lawyer and learn how we can help document future medical needs and pursue compensation that reflects the injury’s long-term costs.
Sources:
- Texas Civil Practice and Remedies Code Chapter 41, Damages
statutes.capitol.texas.gov/Docs/CP/htm/CP.41.htm - State Bar of Texas, “Life Care Planners in Personal Injury Litigation”
texasbar.com/AM/Template.cfm?ContentID=70341&Section=articles&Template=%2FCM%2FHTMLDisplay.cfm