Calculating Damages and Medical Expenses in a Personal Injury Claim

The value of your personal injury claim depends on the different types of losses you have suffered. This blog will focus on how to calculate medical expenses in a personal injury claim.  Now for medical expenses, you must consider your past medical bills, your current medical bills and any future medical bills you might incur from an ongoing problem related to a serious injury.  Then, you gather all of your medical bills, prescription medication costs, physical therapy and chiropractic care bills, and any other medical bills you received as a result of the bodily injury you sustained as a result of a car accident, a dog bite or animal attack claim, a slip and fall claim, or any other type of personal injury claim.  From there, most people think you just add them all together and presto out jumps your total medical damages.

Well over the years Texas case law has complicated the process of calculating costs and rather than quoting a bunch legal mumbo jumbo, I have provided the case reference if you want to read more.  See Haygood v. Escabedo, 09-0377 (TEX. July 1, 2011).  In the meantime, I will provide you with some examples you can understand.

Example 1.  John Doe is involved in an car accident and he rushed to the hospital from the scene.  John provides the medics with his health care information.  His healthcare plan picks up the $25,00 bill.  His insurance company has a preexisting agreement with the hospital so, it recalculates the costs and his healthcare plan only pays $9,000 for John’s hospital bill.    Now when John’s claim is evaluated by the at-fault party’s car insurance company,  it will only look at the $9,000  rather than the $25,000.

More importantly, if John’s case goes before a jury he can only provide evidence of the $9000 paid versus the $25,000 actually billed by the hospital.  This is significant because juries often look at the total medical expenses to calculate pain and suffering.  A bill of $25,000 indicates a more serious injury than a $9,000 bill.

Example 2.  Now look at Sally Doe who is involved in a similar accident and she incurred $25,000 in medical bills and has no insurance.  She is able to present evidence to show the total $25,000 in medical bills and the jury has all the medical information needed to make a decision as to the seriousness of the injury and the pain she suffered.

This is not true for John’s personal injury claim; he is essentially penalized for having insurance because the jury is not given all of the information to determine the pain and suffering John experienced as a result of the wrongdoer.

Calculating medical expenses is no longer a matter of taking all your medical bills and simply adding them together.  You must know the law surrounding medical damages and how to accurately calculate those damages in personal injury claims.  Then you must be able to provide evidence to show the seriousness of certain injuries even when the bills do not add up.

For more information, contact Farrah Martinez, PLLC at (713) 853-9296 or visit us at Farrah will evaluate your personal injury claim at no cost to you.

 I slipped and fell. Can I sue?

This is an article written by Farrah and published by The Houston Lawyer Magazine.

Ross v. St. Luke’s, is a significant case for claims by visitors, not patients, hurt while visiting hospitals or medical care facility. Personal injury lawyers, this blog is for you.

A Visitor’s Slip and Fall is not a Health Care Liability Claim
By Farrah Martinez

In Ross v. St. Luke’s Episcopal Hosp., No. 13-0439, slip op. (Tex. 2015) the Supreme Court addressed whether a slip and fall premises liability claim, by a visitor, constitutes a health care liability claim (HCLC).  Lezlea Ross, a visitor at St. Luke’s Episcopal Hospital, slipped and fell as she approached the exit doors of the hospital.  She was not a patient of the hospital and was there only to provide companionship to a friend.  As a result of the fall, Ross suffered injuries and filed suit against the hospital under a premises liability theory.  The hospital moved for summary judgment, alleging that Ross’s claim was a HCLC under the Texas Medical Liability Act and her failure to file an expert report under Chapter 74 of the Texas Civil Practice & Remedies Code required dismissal by the law.  The trial court granted the motion and Ross appealed.

The court of appeals affirmed the trial court’s decision, citing Texas West Oaks Hospital, L.P. v. Williams 312 S.W.3d 171 (Tex. 2012).  Previously, the Court decided in Williams that when a safety standards-based claim is made against a health care provider, the Texas Medical Liability Act does not require the safety standards to be directly related to the provision of health care in order for the claim to be a health care liability claim.  Ross appealed to the Texas Supreme Court.

Before the Court, the hospital advanced two primary arguments to support the lower court’s ruling that Ross’s claim is a HCLC.   First, the hospital argued that any slip and fall incident at its facility is directly related to health care because it encompasses the safety of its patients.  Secondly, the hospital asserted that Ross’s claim falls within the health care purview since she specifically alleged that the hospital breached standards applicable to maintain a safe environment for its patients. 

Ultimately, the Court rejected both arguments and concluded that there must be a substantive nexus between the safety standards allegedly violated and the provision of health care.  That nexus requires more than a “but for” relationship.  Ross was a visitor; she was not a patient and received no medical services while on the premise.  She was injured only as a result of physically being present on hospital grounds.

As noted by the Court, the lines between a safety standards-based claim that is not a HCLC and one that is a HCLC are often blurred; the Court provided a lengthy list of nonexclusive factors to consider when evaluating whether a plaintiff’s claim is related to a defendant’s provision of medical or health care and is therefore an HCLC.   

In Ross’s case, the Court held that there was “no substantive relationship to the hospital’s providing of health care,” so Ross’s claim was not a HCLC.   In light of the Court’s finding, Ross was not required to file an expert report and her case was improperly dismissed.  The Court reversed the decision of the court of appeals and remanded the case to the trial court.   
Farrah Martinez is the owner of Farrah Martinez, PLLC, where she focuses her practice on personal injury and insurance law.  She is an associate editor for the Houston Lawyer.