Medical Bills in a Texas Injury Case

Section 41.0105 limits your recovery of medical expenses to the amounts actually paid or still owed on your behalf, not the amounts providers originally billed.^[1] The Texas Supreme Court locked the rule in place in Haygood v. De Escabedo, holding that the billed-but-adjusted portion of a medical charge is neither recoverable nor even shown to the jury.^[2]

The gap is bigger than most people expect. In Haygood itself, providers billed over 110,000 dollars and the amount owed after adjustments was about 27,000. When health insurance or Medicare pays your bills, the negotiated write-offs vanish from the case, and the "medical specials" driving your settlement number shrink with them.

Adjusters know this rule cold, and offers on Texas claims are routinely priced off the discounted figures from day one. What the rule does not shrink is everything else: the future care, the lost earnings, and the pain and impairment are all valued independently of what the past bills settled for. A claim priced only off paid bills is a claim priced wrong, and catching that is one of the first things we look for in an offer.

Texas gives injury claimants a shortcut for proving medical expenses. Under Section 18.001, an affidavit from the provider or its records custodian, with an itemized statement attached, is enough to establish that the charges were reasonable and the care necessary, without putting a doctor on the stand.^[3] The affidavits run on a clock: they are generally due by 90 days after the defendant answers.

The defense has a counterpunch, and it uses it constantly. A counteraffidavit, due by roughly 120 days after the answer, lets the insurer contest your charges through a hired reviewer, typically a billing-audit nurse or consultant who opines that the going rate for your MRI is a fraction of what you were charged. The statute requires the counteraffiant to be qualified and bars them from attacking causation, but a served counteraffidavit still forces the reasonableness fight into open court.

These are paperwork deadlines with real money attached. An affidavit missed means proving every charge the long way; a counteraffidavit unanswered means the jury hears the insurer's discounted version of your care unrebutted. This layer of a Texas case is won on the calendar.

A letter of protection is a promise from your lawyer to a medical provider: treat this patient now, and the bill gets paid out of the settlement or verdict. For an injured Texan with no health insurance, or with an injury their plan will not fully cover, an LOP is often the only way to get the surgery, the injections, or the therapy the case and the body both need.

It comes with trade-offs, and honest lawyers say so. LOP charges are full billed rates rather than insurance-adjusted ones, so the defense attacks them as inflated, and the counteraffidavit fight above lands hardest here. The balance is also a real debt. If the case resolves low, the provider still expects payment, which is why the negotiation with LOP providers at settlement is part of the representation, not an afterthought.

The right call depends on your coverage. When health insurance is available, running the bills through it first usually protects the settlement better, because adjusted balances beat billed ones under the paid-or-incurred rule. The LOP is the tool for the care insurance will not reach, used deliberately rather than by default.

The rules above interact, and the table puts them side by side. Every one of them is in play in an ordinary Texas injury case, usually all at once.

Two of these rules shrink what comes in and two govern what goes out, which is why the same settlement number can put very different amounts in two different clients' pockets. Handling the outbound side well is part of what a lawyer is for.

The order in which your bills get paid changes what you keep. Health insurance should usually go first: the plan's negotiated rates turn a 40,000 dollar sticker bill into a fraction of that, and under the paid-or-incurred rule the smaller adjusted balance is also what the lien and the providers can claim against. Your plan will usually assert reimbursement rights from the settlement, and how much it can actually take back depends on the plan type, a negotiation we handle as part of the case.

Texas auto policies add two first-party tools. Personal injury protection, which insurers must offer and many drivers carry at a basic 2,500 dollar limit, pays medical bills and lost income regardless of fault, and Texas law bars your insurer from raising rates for using it. MedPay does similar work for medical bills alone. Both pay fast, both are yours, and both are covered alongside the state's minimum insurance requirements on our coverage pages.

What you should not do is let bills run to collections while waiting on the liability insurer, or sign the hospital's payment plan under pressure. How the whole picture fits into a settlement number is laid out on our page about the average Texas car accident settlement, and a free review of your bills and coverage tells you which of these rules is currently costing you money.