Separating Charges, Causation and Recoverable Expenses
After a crash, you may receive a hospital bill, a separate physician’s bill and an explanation of benefits for the same visit. Start by matching the dates and services. Adding the totals on every envelope can double-count the same expense.
An explanation of benefits may account for an adjustment on the provider’s bill. It does not describe the appointment. Save that statement alongside the clinical notes, which may explain why a scan or course of therapy was ordered.
Audit the past expense record
Keep the original statements, even when a later statement changes the balance. Give your lawyer the itemized bill and the health plan’s explanation of benefits for each visit. Include receipts, collection letters and agreements with the provider. Mark a bill you do not recognize; do not discard it or quietly leave it out.
For each service, make a row showing the provider and date, initial charge, adjustments, payments and remaining balance. Then attach the corresponding records. A second invoice may be a duplicate, a separate professional fee or an updated balance. Find out which before adding it.
An initial charge of $1,000 does not establish that $1,000 is recoverable. There may have been a contractual adjustment, an insurance payment or a patient payment. Section 41.0105 limits incurred medical-expense recovery to amounts actually paid or incurred by or on behalf of the claimant. Reconcile the account before using it.
Haygood v. Escabedo, 356 S.W.3d 390 (Tex. 2011), is discussed in the Rule 902(10) commentary. Its treatment of amounts a provider cannot collect makes the adjustments important. An unpaid balance also needs an explanation. Is it still owed, under review or subject to a required credit?
Build four separate medical expense questions
- Connection to the crash: Which condition required treatment, and what evidence connects it to the collision?
- Necessity: Why was this service needed? Match it to the recommendation or treatment record.
- Reasonableness: What supports the amount charged for that service, in that place and at that time?
- Recoverable amount: What was paid or remains legally incurred after the applicable adjustments?
Bring prior medical records when the same body part was treated before the crash. Your lawyer needs to understand the earlier condition, what changed and the treating doctor’s explanation. A billing ledger cannot supply that medical opinion.
Use affidavits for the questions they address
Section 18.001 provides a procedure for affidavits about the reasonableness of a charge and the necessity of a service. Subject to the statute’s requirements, an uncontroverted affidavit can support those findings. The statute expressly says it does not prove causation.
For the litigation file, keep one packet for each provider: the affidavit, its itemized records, the service record and any counteraffidavit. Counsel needs the answer date, expert deadlines and applicable orders to calculate the service timetable. Later treatment can require supplementation. Do not reuse the dates printed on a form from another case.
The insurer in In re Allstate Indemnity Co., 622 S.W.3d 870 (Tex. 2021) challenged an order striking its counteraffidavit and preventing it from contesting medical expenses. The Supreme Court rejected the order. Section 18.001 is not an automatic exclusion rule for defense expense evidence when a counteraffidavit is absent or deficient. The parties must still prepare their expense evidence.
Who can explain how the records were kept? Who can explain the treatment? Those may be different witnesses. Rules of Evidence 803(6) and 902(10) concern business records and authentication. Admitting a ledger into evidence does not make its custodian a medical expert on the need for surgery.
Check deferred-payment arrangements and disputed rates
A deferred bill still needs a file review. Obtain any letter of protection or other payment agreement and read what the patient promised to pay. Then examine the treatment and rates. The agreement cannot establish their necessity or reasonableness. Deferred payment is not, by itself, a reason to disregard appropriate care either.
When an insurer challenges a rate, ask what comparison it used. The service code, location, date and payment circumstances may differ from those in your bill. Counsel can investigate those differences and any permitted discovery into billing practices or relationships. Neither side’s total should be accepted without examining how it was calculated.
Project future care from medical support
Take the latest treatment recommendation to your lawyer. Does the doctor expect more therapy, recommend surgery now or suggest revisiting surgery if symptoms persist? Those are different opinions. Ask for clarification when the record says only that a procedure may be considered.
- Recommended care: Identify the service and the medical reason for it.
- Timing: Record when it is expected to begin, how often it will occur and when it should end.
- Conditions: Note what must happen before a different treatment would be recommended.
- Cost: Match the estimate to the procedure, facility and professional services actually proposed.
For a lasting injury, a life-care planner may organize needs supported by medical input. An economist may address financial assumptions. Put the reports side by side. If one assumes a year of assistance and another assumes lifelong assistance, ask the experts to explain the difference before using either total.
Two estimates may charge for the same ride to a therapy appointment. Before adding a separate travel allowance, check whether the therapy package already includes transportation. Review household help and attendant services for the same problem, and have the preparers resolve any duplication.
Hypothetical expense proof failure and repair
Here is a hypothetical example. The file contains $80,000 in original bills, later adjustments and a note about possible surgery. The note says to try rehabilitation first. Nobody has yet reconciled the balances or asked the doctor when surgery would become likely. Neither the original bill total nor the surgery price is ready to be presented as a certain loss.
First reconcile the bill with payments and credits. Then ask the doctor to explain the condition’s connection to the crash, the expected course of rehabilitation and the circumstances that would support surgery. Obtain a cost estimate for the care actually recommended. The resulting presentation may include different supported scenarios; it should not label all of them certain.
Account for liens, reimbursement and estimated net recovery
An offer’s headline number is not the amount you necessarily take home. Ask for a written calculation showing the settlement, attorney fee, case expenses and amounts proposed for providers or other repayment claims. Each deduction should have a name, an amount and supporting paperwork.
Send counsel every reimbursement notice you receive. A health plan, Medicare, a hospital and a workers’ compensation carrier may rely on different rights. An ordinary unpaid provider bill may raise yet another obligation. Your lawyer needs the applicable documents to determine validity, scope, priority and any available reduction.
A proposed provider reduction is still a proposal until accepted. Have counsel show the current balance alongside the hoped-for compromise. That lets you see how much your estimated distribution would change if the negotiation fails. Use the same deductions when comparing two settlement offers.
At the settlement meeting, have the release, current treatment recommendation and unpaid bills in front of you. Ask counsel to identify what the release ends and what remains payable. If your prognosis is uncertain, discuss the risk of paying for additional care after the injury claim is closed.
Before distribution, ask for the written accounting and final balances. It should show each deduction and what you receive. Counsel must handle any disputed money under the applicable trust-account and professional rules; an unresolved claim to the funds cannot be answered merely by depositing the settlement check.
Prepare experts and challenge opinions on their merits
For each expert in the proposed budget, ask for the assignment and estimated cost. A medical causation opinion, a billing reconciliation and an economic projection are different jobs. Discuss which are needed in your case and whether the proposed team is proportionate to the issues and potential recovery.
Give experts the records that complicate the claim as well as those that support it. Report new treatment, another accident or a change in work duties promptly. A report based on an old chronology may need correction or supplementation.
Tell counsel promptly if an expert is missing a scan or other record. The deadline may arrive before the missing material does. Designations and supplementation must comply with the court’s order and Texas Rules of Civil Procedure, even while the parties negotiate.
Read an opposing report against the underlying file. A calculation using a different service date or missing a treatment record calls for follow-up. Counsel then has to decide whether the problem concerns reliability or a point to test through cross-examination. An opinion is not inadmissible merely because the parties disagree with it.
Questions clients often ask
Is the amount on my bill the amount my case is worth?
No. The bill is one record in the expense analysis. Other damages, responsibility for the crash, coverage and collectibility also affect the claim. Ask your lawyer to explain each part of the valuation rather than applying a multiplier to the bill.
Must I have surgery to prove a serious claim?
No. Tell your clinician about your symptoms and discuss the available treatment. Surgery is a medical decision, not a step to take for a lawsuit. Your lawyer can investigate the documented injury and limitations whether or not surgery is recommended.
Can future care be included before I receive it?
It may be, with the required evidence. Ask who will explain the likely need and who will estimate its cost. Also ask what remains uncertain. A list of procedures that might someday be available is not enough.
How specialized trial preparation can help your claim
Bring the bills and treatment recommendations to the consultation, including anything you do not understand. The firm can identify missing records and examine a disputed expense. It can also discuss the proof that would be needed in court. You should leave knowing the next questions to resolve, rather than relying on a medical-bill total alone.
Aaron A. Herbert is Board Certified in Personal Injury Trial Law by the Texas Board of Legal Specialization. You can read the firm’s published background and case results before a consultation. Ask how that experience relates to the disputed expenses in your file. A past recovery for another client does not predict yours.
If you are considering hiring counsel after a Texas crash, request a free consultation with The Law Firm of Aaron A. Herbert PC or call 214 200 4878. Tell the office about the issue addressed in this article and any approaching deadline. Ask who would handle the case, what work is needed, and how fees and expenses are addressed before signing an agreement.
Referring counsel can arrange a discussion through the contact page. Include the upcoming procedural dates. Responsibility should not be transferred until the firm confirms acceptance. An inquiry does not establish representation.
Read the Texas car accident claims and litigation guide or return to the Texas Car Accident Knowledge Hub for related resources.
Related car accident resources
- Preexisting Injuries and Medical Causation After a Texas Car Accident
- Serious and Catastrophic Car Accident Injuries in Texas
- Evaluating a Texas Car Accident Settlement Offer (Coming soon)
Legal sources
Texas Civil Practice and Remedies Code chapter 41.
Texas Civil Practice and Remedies Code chapter 18.
In re Allstate Indemnity Co 622 SW3d 870 Tex. 2021.
Texas Civil Practice and Remedies Code chapter 71.
Texas Rules of Evidence Rule 902 10 commentary discussing Haygood.
Texas Rules of Civil Procedure effective October 1, 2026.
This article provides general information about Texas law. Application depends on the facts, policy, court orders, and law governing the particular claim. Hypothetical examples are illustrations rather than reported firm cases.
ABOUT THE ATTORNEY
Aaron A. Herbert
Founding Attorney
Board Certified in Personal Injury Trial Law
Aaron founded The Law Firm of Aaron A. Herbert in 2010 to focus on developing each client's case and seeking its maximum value. For over a decade, he has represented people seriously injured in major accidents and industrial catastrophes, pursuing trial verdicts and settlements while working to reduce the stress of litigation.
Education
- Texas A&M University · B.S., Criminal Justice, 1999
- University of Oklahoma College of Law · J.D., 2002; graduated in the top of his class
Trial experience & approach
Aaron earned numerous jury verdicts at boutique personal injury litigation firms. According to his biography, he spent a year as the top-earning litigation attorney at a firm that frequently appeared in verdict searches as having one of the highest numbers of trial wins in Texas. At another Dallas personal injury firm, he moved from managing pre-litigation attorney to managing litigation attorney over seven years as the firm grew into one of Dallas's largest personal injury firms.
His biography describes a reputation as one of America's most aggressive trial lawyers, with noteworthy recoveries from judges and juries and substantial pretrial settlements. Most of those settlements included confidentiality agreements requested by the defense. Aaron has said the recoveries were justified by the injuries and losses involved, which no amount of money could make someone choose to experience.
His approach combines passion, preparation, persistence and courtroom imagination. He believes a well-supported, engaged and motivated team working cooperatively helps deliver strong representation, with the goal of achieving the best possible result for every client.
Dallas roots, military service & publication
Born and raised in Dallas, Aaron enlisted in the United States Marine Corps after high school and later received an Honorable Discharge. He completed his university and law degrees after his military service and became a lifelong Sooners football fan in law school.
Publication: “Litigating Dog Bite Cases,” Texas Dog Law Seminar, Dallas, 2009.
Professional affiliations & recognition
Professional affiliations and recognition listed in Aaron’s biography:
- State Bar of Texas
- American Bar Association
- Association of Trial Lawyers of America (now American Association for Justice)
- Texas Trial Lawyers Association
- Dallas Trial Lawyers Association
- Dallas Bar Association
- Tarrant County Bar Association
- Million Dollar Advocates Forum
- The National Trial Lawyers – Top 100 Trial Lawyers
Trial experience & approach
Aaron earned numerous jury verdicts at boutique personal injury litigation firms. According to his biography, he spent a year as the top-earning litigation attorney at a firm that frequently appeared in verdict searches as having one of the highest numbers of trial wins in Texas. At another Dallas personal injury firm, he moved from managing pre-litigation attorney to managing litigation attorney over seven years as the firm grew into one of Dallas's largest personal injury firms.
His biography describes a reputation as one of America's most aggressive trial lawyers, with noteworthy recoveries from judges and juries and substantial pretrial settlements. Most of those settlements included confidentiality agreements requested by the defense. Aaron has said the recoveries were justified by the injuries and losses involved, which no amount of money could make someone choose to experience.
His approach combines passion, preparation, persistence and courtroom imagination. He believes a well-supported, engaged and motivated team working cooperatively helps deliver strong representation, with the goal of achieving the best possible result for every client.
Dallas roots, military service & publication
Born and raised in Dallas, Aaron enlisted in the United States Marine Corps after high school and later received an Honorable Discharge. He completed his university and law degrees after his military service and became a lifelong Sooners football fan in law school.
Publication: “Litigating Dog Bite Cases,” Texas Dog Law Seminar, Dallas, 2009.
Professional affiliations & recognition
Professional affiliations and recognition listed in Aaron’s biography:
- State Bar of Texas
- American Bar Association
- Association of Trial Lawyers of America (now American Association for Justice)
- Texas Trial Lawyers Association
- Dallas Trial Lawyers Association
- Dallas Bar Association
- Tarrant County Bar Association
- Million Dollar Advocates Forum
- The National Trial Lawyers – Top 100 Trial Lawyers