Will the At-Fault Driver’s Insurance Company Have to Pay My Future Medical Bills?

Under Tennessee injury law, a person who causes harm to another is responsible for the reasonable medical costs incurred by the injured party to diagnosis and treat injuries that were caused in the incident and to pay the present day value of future medical expenses likely to be incurred in the future as a result of injuries caused in the incident.

However, the at-fault driver’s insurance company is only responsible for future medical expenses that are more likely than not to occur in the future, not those that might occur.  Thus, your ability to recover future medical expenses for injuries that arise out of car or truck accident is dependent on medical testimony that, more likely than not, an injury that happened in the accident will require medical treatment in the future.

The following example will help in understanding the law.  Assume you are hurt in a Tennessee truck  accident and suffer a fractured hip.  You undergo hip surgery and physical therapy.  Your total medical bills are $60,000.  The insurance company wants to settle your case, but you and your lawyer are concerned about the risk of future surgery because your doctor has told you that you might have to have hip replacement surgery in the future.  Hip replacement surgery is expensive, and you want to have the at-fault driver’s insurance company pay for the surgery if it occurs.  How can you make that happen?

You cannot.  The at-fault driver’s insurance company will never agree to cover medical bills that are incurred after your settlement or trial.  And your lawyer can not ask the judge or jury for a court order that requires the the at-fault driver or that driver’s insurance company to pay your future medical bills as they occur in the future.  

If you want to recover the value of the future surgery, you will have to present medical proof that, (a) your hip was fractured in the accident; (b) your hip had to be surgically repaired; (c) as a result it is likely that you will need hip replacement surgery in the future.  Here is a short-hand version of the testimony you would like to have:

In my opinion as an orthopedic surgeon, it is very likely Ms. Jones will require hip replacement surgery in 12 – 15 years.  The cost of that surgery today would be $75,000.  After that surgery, it is my opinion that Ms. Jones will require 18 – 24 physical therapy sessions to recover full mobility.  Today, those sessions cost $110 each.    In my experience, a hip replacement typically provides relief to the patient for only 15 years.  Thus, give the fact that Mrs. Jones was only 48 years old when her hip was fractured in the truck accident, she will need at least one more hip replacement in the lifetime.  After this surgery, the same number of physical therapy sessions will be necessary.  I hold these opinions to a reasonable degree of medical certainty.

With this type of evidence, a lawyer will then use an appropriate expert to estimate the costs of two hip replacement surgeries  and the future physical therapy (adjusting for inflation ) and the same (or another) expert to reduce the cost of the future treatment to current day dollars (the "present value" of the future expenses).  This number is then taken into account in determining the total settlement or, if there is no settlement, the total damages awarded by the jury.

As indicated earlier, however, medical evidence is required to prove these expenses and the need for the surgery, and the medical evidence must meet the "more likely than not" threshold.  If a doctor says that future medical expenses are only "possible," that they "could" happen, or that they "might" occur, Tennessee law will not permit those expenses to be recovered in a personal injury case.  Insurance companies are well-aware of this law, so it is important to have documentation of the this medical evidence at the time of settlement negotiations.  If there is a trial, testimony of the appropriate experts will be required to establish the need and cost of future medical expenses.

The entire issue of future medical expenses is another reason why it is important to employ an experienced person injury lawyer to assist you in Tennessee automobile and truck wreck cases and in all other types of personal injury cases.  A good lawyer not only understands the law but can work with medical expenses to present your case in the best possible light.  Of course, a lawyer cannot or will not force a doctor to give anything other than the doctor’s honest opinion, but a very good lawyer will work with your doctor to make sure he or she understands that the law does not require absolute certainty on this issue but instead only requires that an opinion on future medical expenses be held at the "more likely than not" level of certainty.