So often I am asked this question..."What medical expenses can I get from the insurance company now that we know the collision wasn't my fault?" This is really an easy question to answer, because state law dictates what you are entitled to. However, just because you might be claiming a medical expense doesn't mean that you automatically get the money for those medical expenses. It is still up to you and your attorney to provide the insurance company with the facts and evidence to prove the damage.
Under the law of the state of New Mexico and most other states, medical expenses must be reasonable, necessary and a direct result of the injuries sustained in the collision.
The medical expenses must be reasonable in price compared to charges made by othere health care providers in the same community. This can be easily proven, and our firm has the annually published medical fees to help prove the reasonableness of the charges.
The medical expenses must be necessaryand needed because of the injury from the collision. No one would expect the insurance company to pay for a medical expense that you really didn't need. You are, however, required to mitigate your damage. That means that you are allowed to have diagnostic tests and examinations to determine whether you have an injury. If you have some pain that you didn't have before the collision, you are expected to take reasonable precaution to determine if you have an injury. If you ultimately determine that you don't have any injury, the insurance company will still pay for the cost of the examination and diagnostic x-rays and other tests.
The medical expenses must be a direct result of the injuries sustained in the collision. You can't ask the insurance company to pay for anything that their driver didn't cause. However, they must also pay for the aggravation of a previous injury. As an example, let's say that your leg already had degenerative problems because of your age. It really didn't cause you any problems before the accident, but the twisting of the leg in the accident required you to now have physical therapy and ultimately a surgery. You aggravated the degenerative condition so now you must have the extra medical care. This would be a valid claim against the insurance company. The medical records provided by your doctor should clearly indicate that the medical care was needed as a result of the collision. If it doesn't state this on the records, then you should contact your doctor or his/her staff immediately to determine what he/she believes was the cause of the injury in the first place.
Once you have finished all of your treatment, it is realitively easy to determine your total medical expenses. You need to use the retail price of the medical expenses, not the amount paid by your health insurance or the amount you paid as a deductible or co-pay. It is usually a simple addition of the charges.
Sometimes doctors will state that you need to get extra money from the insurance company for future medical expenses. An example would be a doctor stating that you need one physical therapy visit per month for a total of 12 more months. You would need to calculate the cost of each visit and multiply times the number of visits the doctor says that you need and you then have an additional number for future medical care. Again, the same rules apply to future medical expenses that apply to the past medical expenses. The future medical expenses must be reasonable, necessary and a direct result of the collision.