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Personal Injury Myth Exposed: The Higher My Medical Bills, The More I Will Recover

This is one of the most troubling myths and the one that probably causes the most misunderstandings during a case. Perhaps you have asked someone what determines how much money you will recover at the end of your case. Or maybe you have researched this on the internet or consulted a book from the bookstore. One of the reasons this myth is so common is that it contains some truth. The most common myths usually do.

Years ago, the value of a case could be reasonably predicted based upon the total value of the medical treatment provided. A ratio would be used wherein you would multiply the total medical bills by a number between 1 and 5, with 1 being for a minor accident and 5 for the most serious. Of course, there were other factors to this equation, but an estimate was much more likely to be accurate then than it is now. The problem is that these sources remain widely available and are primary sources of information for people who have been injured and are searching for answers to their questions and concerns.

In order to properly dispel this myth and explain why it inaccurate, we start with a brief discussion of how your medical treatment impacts your injury case. In very simple terms, as a victim of someone else's negligence, you are entitled to recover damages for all of your accident-related injuries. As mentioned earlier in this book, your medical treatment for those injuries is the primary type of damages you can recover. There is one caveat, however, and that is that you must be able prove that, one: the underlying injuries are directly related to your accident, and two: the medical treatment for those injuries was necessary and reasonable.

When you think about it, these requirements make perfect sense. You should only be able to recover damages for those expenses that are related to the other person's negligence. Anything beyond that is considered a "windfall" and is not permitted. So, as long as you can show that your injuries are the result of the accident, and the medical treatment you received was reasonable and necessary, recovery of these damages is permitted.

It is important to keep in mind the true purpose of a personal injury claim. This purpose is in line with most of the "consumer-rights" laws that were first created more than a century ago. As society developed, the need for structure and rules grew. Laws were born out of specific situations, such as two merchants arguing over the quality, or lack thereof, of a product sold from one to the other. Prior to these laws being enacted, such a disagreement would often ended in an argument, or worse, violence. As each new law was put into place, people began to recognize that there were remedies for their problematic situations and that they could rely on these laws to see that their business or personal rights were protected.

It was during this time, that new laws for what we now call personal injuries, came about. Before too long, there were answers for what to do if you were injured due to the careless or negligent behavior of another. Specific rules dictated what kind of recovery was possible, and how the value of different things would be determined. Skipping ahead to today, we are now surrounded by thousands of laws that seem to address every possible problem or "issue" that could arise in this area. Specifically, personal injury law in Maryland holds that you can only recovery for losses related to the accident, and that they must be proved to be reasonable.

So, if the more reasonable and necessary medical treatment you have results in more medical bills and therefore, higher damages, why is this myth not the truth? As with most things having to do with the law, exceptions abound. It is these exceptions that turn what seemed like a straight highway to recovery into a winding side street with hidden entrances and exits, and multiple obstacles along the way.

One of the first factors along this winding road is that the more medical bills you receive, the more money you will owe in order to pay those medical providers back for their services. Again, an entire book could be devoted to this subject alone, and you can find additional information on our website at www.marcsnyderlaw.com. But for now, suffice it to say that the more treatment you receive, the more bills there are to pay. Another factor to be mentioned is that, in today's climate of corporate "belt-tightening" and economic conservation, those in charge of the insurance companies we most often deal with are on a never-ending quest to save every single penny possible. If there is a way for the opposing insurance company to pay less on their claims, they will find a way to do it.

One method that insurance companies use in almost every case is to closely evaluate your medical treatment and related bills or determine if the treatment was necessary and the cost of that treatment was reasonable. In many cases, the insurance company must concede that the treatment was necessary. However, it is becoming more and more rare for an insurance company not to claim that the cost of your care was too high. A common tactic is to claim that your medical providers simply charge too much and, as a result, the opposing insurance company simply reduces all of your medical bills by a certain factor. The best way to look at this is to visualize the insurance company looking at your bills and concluding that your doctors charge too much, let's say by twenty percent. Once they make this conclusion, all of their calculations will not value your medical care at only eighty percent of what your own doctors claim its value to be.

One way of putting this is that the opposing insurance companies will pay your for your medical treatment, but in our example, will pay you only eighty cents on every dollar. So, if your total medical bills amounted to $10,000.00, the opposing insurance company would value your treatment at $8,000.00. You can begin to see why the actual value of your medical treatment does not easily translate to the amount your case is worth. If your case was worth $10,000.00 before we spoke to the insurance adjuster for the other side, after that conversation, we see that they have valued your case at $8,000.00.

I must mention one more factor that ties into the above example. Even though the opposing insurance company has now valued your treatment at $8,000.00, those who actually provided that care to your believe very strongly that it is worth the $10,000.00 they billed you. And since that is what they value it at, that is what you will need to pay. The problem arises when the insurance company agrees to give you $8,000.00 for your medical care but your doctors are still demanding $10,000.00. Where is the $2,000.00 difference going to come from so you can pay your medical providers?

Leaving our example for a moment, let's return to the actual myth we are trying to dispel. The myth states that the larger your medical bills are, the more money you will receive at the end of your case. You are already beginning to see why this is not always so, but there are other reasons for this that should be discussed, briefly, as well.

Insurance companies have been in the business of evaluating accident-related injuries for a long time. As a result, they have already determined what treatment is considered reasonable for what injuries. Put aside, at least for now, the obvious fact that we are talking about insurance companies and not doctors. The fact that insurance adjusters, most without any medical training are deciding whether or not your medical treatment is reasonable is a whole other problem, and perhaps a subject for another day.

According to most insurance companies, there are certain types of treatment that are considered "necessary and reasonable" for a specific injury. For a soft tissue injury (sprain or strain) it is customary to receive between fifteen and twenty sessions of physical therapy, usually two to three times a week over the course of five to ten weeks depending on the severity of the injury and the natural healing process of the individual. Of course, these figures are approximate but they give you a general idea of what kind of treatment is considered appropriate for certain injuries, at least according to the insurance company.

The problem arises when the accident victim simply does not get better as fast as the insurance company predicts they should. Let's say you had a sprain that did not heal as fast as expected, and you required forty-five therapy sessions to get better. The resulting bills would be three times more than the "reasonable amount" the insurance companies predicts. What will most likely result will be an insurance adjuster who begins closely scrutinizing your treatment to determine if you have have been receiving medical treatment you don't need. As you can see, here is an example where more treatment will not necessarily result in more money for you. In fact, if you send a signal to the insurance company that you may be receiving more treatment than you require, your entire course of medical treatment will likely be evaluated at a much closer level.

Additional Resources

The Law Offices of Marc G. Snyder represents individuals facing criminal charges throughout the State of Maryland. Accepting a limited number of cases, we are able to devote the time, energy and resources to achieve the best results possible for each one of our clients.

Please give us a call, any time, at (410) 528-1177.

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The Law Offices of Marc G. Snyder
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Baltimore, Maryland 21201

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