Jim Adler | The Tough, Smart Lawyer
By Jim Adler February 28, 2017

paid and incurred medical expenses
Photo by Gubcio (iStock by Getty Images)

Under a badly worded Texas law passed in 2003, victims seeking payments for losses after injury due to someone’s negligence face a challenge: the murky concept of only “paid and incurred medical expenses” being admissible at trial. But what are paid and incurred medical expenses, and how does that apply to you?

Jim “The Texas Hammer” Adler has answers. Those begin with a review of the 2003 law in question: Texas Civil Practice & Remedies CODE §41.0105.

It held that, in an injury lawsuit, plaintiffs’ or claimants’ recovery or payments for medical care costs “is limited to the amount actually paid or incurred by or on behalf of the claimant.” The trouble is, that can fail to take into account the often vast difference between a hospital’s full rate and its actual, discounted rate.

Hospital Charges

Hospital charges can mean different things. A hospital may charge its full rate for services, as when a patient lacks health insurance. Or a hospital may charge a discounted rate, as when contracts with providers or coverage from Medicare or private insurance is involved. Which rate is admissible at trial?

Due to the 2003 “paid and incurred” law and later Texas court decisions, when plaintiffs seek payments for medical costs which already have been paid, the basis of their claim and the amount which can be recovered cannot be a hospital’s full charge, but rather only the costs already paid or incurred.

This means that in some cases only the actual payments or legal obligations to pay hospitals are admissible at trial. Submitting evidence of the full rate of a hospital’s charge is only admissible if the bill has not been paid and is due in full.

Eliminating hospitals’ full charges at trial works against plaintiffs. First, it fails to underscore the severity of their injuries. Also, barring hospitals’ full charges as evidence hurts plaintiffs when juries assess payments for non-economic losses, such as victims’ pain and suffering.

In reality, the law and its interpretation by some Texas courts benefits only insurance companies. Their exposure can be reduced at trial by allowing in evidence only the costs actually due or paid to a hospital and not the greater initial value of such costs — that is, a hospital’s full charges. To put it simply: Plaintiffs’ lawyers believe the law’s “paid or incurred” language should include any amount billed by a hospital or medical provider. Defense lawyers hold that “paid or incurred” means only the amount actually due or paid to such hospitals or medical providers.

De Escabedo Case

Along with the badly worded 2003 law, a 2011 Texas Supreme Court case has led to the controversy. That case was Haygood v. de Escabedo, 356 S.W.3d 390, 392.

It involved Aaron Haygood suing Margarita Escabedo for injuries he suffered in a car crash. His health care providers billed $110,069.12 for their services, though that was adjusted to $27,739.43 due to a Medicare agreement.

The trial court admitted as evidence the full costs charged, but an appeals court and later the Texas Supreme Court held otherwise.

Since those rulings, cases brought before courts of appeals in Houston, Dallas, San Antonio and other Texas cities have addressed the 2003 law’s ambiguity, caused by errors in its wording. That wording was meant to apply only to medical negligence claims and not all medical claims, such as those arising in a car wreck injury lawsuit.

It’s believed that the Haygood v. de Escabedo ruling on the paid and incurred medical expenses law will spur additional motions and discovery in recovering past medical expenses, via claims made in appellate courts. Other issues with the law will be raised in trial courts.

Indeed, many questions about the “paid and incurred” law and the de Escabedo case still haven’t been answered — or perhaps even addressed. And they can be extremely important to your injury claim.

Get an Experienced Injury Lawyer

In view of these things, it’s vital that you engage a knowledgeable and experienced personal injury lawyer for your claim — a lawyer who can work to ensure that the “paid and incurred” law is properly interpreted and applied in court.

You can find such help at veteran Texas law firm Jim Adler & Associates. Jim Adler’s lawyers can fight for your legal rights by seeking the maximum amount you are legally due when someone else caused your injury. Contact us today for a free legal review of your case.

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Testimonials

Erick Becker
Erick Becker
01:20 06 May 17
I am a Patrol Deputy for the Sheriff Office and while working one night, a drunk driver crossed the center stripe on the highway and struck my patrol vehicle head on with his pick up truck. Needless to say we (the drunk driver and I) were both lucky to survive, as the accident occurred at highway speeds. Following my release from the hospital, I knew that I would need to have someone represent me. My employer was happy to represent me in regards to prosecuting the driver for criminal charges but, can do little in respect to the recovery of financial losses for medical bills, pain and discomfort, time lost from work etc... This is how my relationship with Jim Adler and Associates began. Yep, you probably guessed correctly when you think of what made me choose the "Texas Hammer" to represent me. Those half obnoxious, half way entertaining commercials and radio announcements most Texans have been seeing and hearing on the TV and radio for years instantly came to mind. Yes, I wanted to "hammer" this S.O.B. for trying to kill me but, more importantly I was worried about the costs associated with the life long injuries I had sustained as a result of this drunk driver's negligent behavior. I contacted Jim Adler and Associates and so began our relationship. I was immediately surprised by the prompt attention and the expression of genuine concern for my well being that I received from the employees of Jim Adler's office. Now as you can imagine, lawyers are not a breed that is held in very high regard by people in my profession but, my experiences with Jim Adler's office and his employees have forced me to amend my way of thinking, at least on the civil side of the house anyway. I have to chuckle when I say that because my experience as a client of Jim Adler's firm has been exceptionally pleasant. So before I venture down one of the stereotypical and infinite number of rabbit holes associated with the relationship between members of law enforcement and lawyers; I will do my best to stay focused on my experience with Jim Adler & Associates. Upon being informed that my case had been accepted by Jim Adler's office; I was contacted by Iris Sanchez who informed me that she was to be my case manager and any questions, comments and concerns could be directed to her. I was pleasantly surprised to receive regular calls from Iris assisting with my medical appointments and future follow up appointments. Iris had informed me that Jim Adler's son, Bill Adler would be handling my case and I was even more surprised to receive several calls from Bill to discuss my case. Now you might be thinking "what's the big deal" with the person who is representing you contacting you? In reality, you are correct in that it isn't a big deal but, what is noteworthy and what separates Jim Adler's Office from the multitude of other lawyers is the genuine expressions of concern and the desire Bill Adler conveyed to me to do their best to help me. I felt an immediate connection and instantly realized I had made the correct choice in contacting Jim Adler & Associates to handle my case. One thing I think lawyers and police officers can agree on is the proverbial wheels of justice turn very slowly. Months go by and our professional relationship is never neglected. Through the unwavering attention of Iris Sanchez and Bill Adler himself, I never felt "out of the loop" so to speak and always had a clear understanding of where my case was at in regards to the legal process. In conclusion, I know my brief description of my experiences with Bill Adler and, his assistant Iris Sanchez, cannot provide the credit they deserve. Together they have done an outstanding job representing their firm/employer. If you are seeking a great firm to represent your legal interests and, take comfort in establishing a professional relationship that feels more like a friendship than a casual business acquaintance, then I highly suggest Jim Adler & Associates.
Tierra Clark
Tierra Clark
18:52 19 May 17
My lawyer Bill Adler and case manager Iris Sanchez are amazing! They constantly call and check on you . They keep you up to date through the process. They care about you as a person and not just a client. The wreck was a life changing experience that I've never been through before. I'm just glad I had the right people like Bill Adler and Iris Sanchez to help me through it. Truly satisfied.Thanks and God bless y'all!
Lorenzo Preston
Lorenzo Preston
17:23 26 Jan 17
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Tori Barroga
Tori Barroga
14:17 11 May 17
I was dropped from a previous law firm regarding my case before I called Jim Adler. They immediately took up my case and worked hard on it - I was always up to date with each step they took and the benefits or consequences of each. In the end, I am highly satisfied with the outcome and would not have it any other way. It took some time but I truly appreciate and want to thank everybody who helped me on this journey and worked tirelessly on it.
Bernard Orozco
Bernard Orozco
17:16 23 Feb 17
I am very happy with Jim Adler & Associates. I did not know anyone who has ever used the Law Firm before. The staff is very friendly and treated me as if I were family. At times it got very stressful being without a job. They helped me when I was confused about the process. Mrs. Theresa Rodriguez stayed in contact with me constantly. Checking on me to see how I was doing and to let me know how things were going on there end. The Attorneys that handled my case know exactly what they are doing to take good care of me. Thank You so much Attorney's Mr.Michael Gomez and Mr.Trey Smith.
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