Adding up the numbers on the bills won’t prove past medical expenses in a Texas injury case. The evidence has to tie each service to the injury. It has to show the care was necessary and the charge reasonable. And it has to pin down what the law lets the claimant recover.
Texas Civil Practice and Remedies Code § 41.0105 limits recovery of medical or health care expenses incurred to the amounts actually paid or incurred by or for the claimant. What matters is the provider’s legal right to payment. The face amount on the bill doesn’t settle it. (Fault is a separate reduction; see how comparative responsibility changes a Texas injury recovery.)
Build the record service by service
Get an itemized statement from each provider, then read it slowly.
Every line should tell you the date, the service, its code and units. It should show the original charge and what came off by contract, any payments or credits, and the balance. Then figure out how much of that balance is legally owed.
Check those figures against the explanation-of-benefits records, remittance advices, patient ledgers, receipts and provider statements. Was the account transferred, adjusted, assigned or sent to a collection agency? Get the records showing what happened and who now holds the right to collect.
Use separate columns for the original bill, payments, adjustments and the amount the claimant still legally owes.
What does “adjustment” mean on this account? Ask the provider. If a contract required a reduction, nobody necessarily paid that amount. Read the provider agreement and benefit documents, plus any lien or letter of protection. Check for later entries, too; yesterday’s statement may not reflect today’s payment. The remaining question is what the patient can legally be required to pay.
Connect the treatment to the collision
Each service has to earn its place in the claim. Compare its date and the body part treated with the medical history, the diagnostic findings, the referral and what the treating provider says.
Look for prior symptoms, later events, gaps in care and treatment for unrelated conditions. Where they show up in the record, deal with them head-on. A billing affidavit won’t prove the collision caused an injury, or that a particular service was related to it.
Different records cover different parts of that story: medical records, imaging, operative reports, prescriptions, therapy notes, provider testimony.
The doctor who can say why a procedure was medically indicated may not be the person who can explain how the charge was calculated, or what the provider is still entitled to collect. Match each witness to the point you need proved.
Reasonableness and necessity require a foundation
Texas Civil Practice and Remedies Code § 18.001 provides a way to offer evidence about whether a service was necessary and whether its charge was reasonable at the time and place it was provided. The statute requires an itemized statement and an affidavit from the provider or the person in charge of records showing the services and charges. A compliant, uncontroverted affidavit is sufficient evidence to support a finding on those issues, but it is not conclusive and is not evidence of causation.
The statute also lets a qualified counteraffiant state the basis for disputing whether the charges were reasonable or necessary.
According to In re Allstate Indemnity Co., the procedure doesn’t automatically stop a party from challenging those issues at trial. Check the current statute and the court’s rules for service requirements and deadlines in your case. A generic calendar or an old checklist won’t do.
Section 18.001 doesn’t get you around § 41.0105.
In Haygood v. De Escabedo, the Supreme Court of Texas explained that § 41.0105 limits recovery, and the evidence offered to support it, to expenses the provider has a legal right to be paid. How that plays out can depend on who paid, the provider agreements, liens and other obligations. Trace the real account. Don’t assume every write-off or unpaid balance has the same legal effect.
Test alternative figures, not just totals
Suppose the other side’s expert or auditor comes in lower. Ask for the records, codes, units, time period and geographic market behind each adjustment.
Is the comparison using the same service in the same setting? Does it account for the provider’s specialty, acuity and locality? Can the witness explain the data and the method, and is the witness qualified to give the opinion? A spreadsheet total with no inputs is hard to evaluate.
Say a hospital lists a $100,000 charge, a $60,000 contractual adjustment and a $40,000 payment. Those entries shouldn’t be presented as if the claimant simply paid, or owes, $100,000.
The ledger has to show where each entry came from, what it did, and whether anything is still enforceably due. This isn’t a universal formula. The controlling contracts and payment records decide what the numbers mean.
A practical records checklist
- For each provider, request the itemized bill showing what was done, on what date, and under which code and number of units.
- Ask for the account history as well as the latest statement. Keep receipts and entries for refunds or credits so you can reconcile the balance.
- Collect the insurance paperwork: explanations of benefits, remittance records, contractual adjustments, benefit documents.
- Find the contracts. Provider agreements, assignments, liens and letters of protection show who has a right to collect.
- Keep the records that explain the medical reason for each disputed service and tie it to the claimed injury.
- Keep any § 18.001 affidavit and counteraffidavit with the proof of service and the current scheduling order.
- For a competing valuation, ask which services were compared and why. Keep the underlying codes, units and source data with the evaluator’s qualifications.
Try rebuilding the total without looking at the demand letter. Can you get the same number from the underlying records? Mark any duplicate charge or code that does not agree with the treatment notes. Put unexplained balances on a separate list for the provider. A service with a disputed connection to the injury may need medical testimony even after the arithmetic checks out.
Questions people often ask
Is the amount printed on a bill the recoverable amount? No. The billed charge by itself doesn’t show what was paid or legally incurred, whether it was reasonable or necessary, or whether the event caused it.
Does an affidavit under § 18.001 prove the accident caused the treatment? No. The statute expressly says the affidavit does not prove causation.
Does an uncontroverted affidavit conclusively establish the charge? No. It is sufficient evidence to support a finding on reasonableness and necessity, but it is not conclusive.
What if a provider still shows a balance? Find out whether the claimant is legally responsible for it, and which agreements or payment rules govern the account. The balance line alone won’t tell you.
Legal sources
- Texas Civil Practice and Remedies Code § 41.0105
- Texas Civil Practice and Remedies Code § 18.001
- Haygood v. De Escabedo, 356 S.W.3d 390 (Tex. 2011)
- In re Allstate Indemnity Co., 622 S.W.3d 870 (Tex. 2021)
Founding Attorney
Aaron A. Herbert is a Texas attorney, Board Certified in Personal Injury Trial Law by the Texas Board of Legal Specialization.
Education
- Texas A&M University (B.S. Criminal Justice, 1999)
- University of Oklahoma College of Law (J.D., 2002)
Professional background
For over a decade he has shown an unwavering commitment to clients who were seriously injured by major accidents and industrial catastrophes. During that time he has earned the reputation as one of America’s most aggressive trial lawyers by achieving noteworthy recoveries from judges and juries, as well as substantial settlements prior to trial, the majority of which contained negotiated confidentiality agreements at the request of the defense. When asked about these cases, Mr. Herbert has said that each case not only justified the recovery level, but that no one would trade places with any one of these victims in return for any amount of money, once they know the facts and severity of the injuries and tragedy involved. According to Mr. Herbert, “there can be no substitute for passion, preparation and persistence in the practice of law.” He is known not only for this tenacious preparation, but also for his imagination in the courtroom. He is passionate and persistent in seeking to obtain the maximum case value for each individual client at trial or through settlement, while reducing the stress of litigation on his clients.
Born and raised in Dallas, Texas, Mr. Herbert enlisted in the United States Marine Corps after high school and later received an Honorable Discharge. After the Marines, he obtained a Bachelor of Science in Criminal Justice from Texas A&M University, then a Juris Doctorate from the University of Oklahoma College of Law. There he graduated in the top of his class and became an eternal Sooners Football fan. Aaron has worked as a zealous advocate for injured clients at several boutique personal injury litigation firms where he amassed numerous jury verdicts. After spending a year as the top earning litigation attorney at a firm that frequently tops verdict search as one with the highest number of trial wins in Texas, Aaron accepted a position as the managing pre-litigation attorney at another Dallas personal injury firm. Over the next seven years he transitioned to the managing litigation attorney, and that firm grew to one of the largest personal injury firms in Dallas. In 2010 he formed the Law Firm of Aaron A. Herbert, to get back to a focus on developing each individual case and maximizing case value for each client.
Mr. Herbert practices law with the belief that a well taken care of, highly engaged and motivated team of employees working in a cooperative team environment will result in superior representation and great results for the firm clients. He believes in always setting a goal of achieving the best possible results for each and every client.
Professional affiliations and publication
Professional Associations
- Licensed to practice in Texas (2002)
- Board Certified in Personal Injury Trial Law, Texas Board of Legal Specialization (2008)
Publications
- Litigating Dog Bite Cases, Texas Dog Law Seminar, Dallas 2009
Member
- State Bar of Texas
- American Bar Association
- American Trial Lawyer Association
- Texas Trial Lawyers Association
- Dallas Trial Lawyers Association
- Dallas County Bar Association
- Tarrant County Bar Association
- Million Dollar Advocates Forum
- National Trial Lawyers – Top 100 Trial Lawyers
Texas Bar #24036761 · The Law Firm of Aaron A. Herbert, P.C. · Dallas, Texas
This article provides general information about Texas personal injury claims. It is not legal advice for a particular case. Medical expense proof and recovery depend on the records, applicable law, and the facts. Consult a Texas attorney about a specific claim.