Tennessee Law On Medical Treatment and Medical Bills In A Personal Injury Case
Tennessee Law on Medical Treatment and Bills in a Personal Injury Case
Medical treatment is often essential after an accident. As a plaintiff you must prove that your medical treatment was “necessary” and your medical bills are “reasonable.” It should be no surprise that what constitutes necessity and reasonableness are often disputed by the parties in personal injury cases. Tennessee law provides some protections for medical providers and plaintiffs following an injury. For your convenience, here is the relevant statute:
(1) Proof in any civil action that medical, hospital or doctor bills were paid or incurred because of any illness, disease, or injury may be itemized in the complaint or civil warrant with a copy of bills paid or incurred attached as an exhibit to the complaint or civil warrant. The bills itemized and attached as an exhibit shall be prima facie evidence that the bills so paid or incurred were necessary and reasonable.
(2) This section shall apply only in personal injury actions brought in any court by injured parties against the persons responsible for causing such injuries.
(3) This prima facie presumption shall apply to the medical, hospital and doctor bills itemized with copies of bills attached to the complaint or civil warrant; provided, that the total amount of such bills does not exceed the sum of four thousand dollars ($4,000).
(b)
(1) In addition to the procedure described in subsection (a), in any civil action for personal injury brought by an injured party against the person or persons alleged to be responsible for causing the injury, if an itemization of or copies of the medical, hospital or doctor bills which were paid or incurred because of such personal injury are served upon the other parties at least ninety (90) days prior to the date set for trial, there shall be a rebuttable presumption that such medical, hospital or doctor bills are reasonable.
(2) Any party desiring to offer evidence at trial to rebut the presumption shall serve upon the other parties, at least forty-five (45) days prior to the date set for trial, a statement of that party’s intention to rebut the presumption. Such statement shall specify which bill or bills the party believes to be unreasonable.
Establishing Your Medical Bills Are Reasonable And Your Medical Treatment Was Necessary
§ T.C.A. 24-5-1131(a) is of particular importance for medical providers seeking reimbursement for services following an injury-accident. If the total medical bills are $4,000 (or under) a plaintiff can simply attach an itemization of those bills to the initial filing to create an “automatic” presumption that those medical bills are reasonable and their medical treatment was necessary. One objective of this presumption is to help facilitate settlement or adjudication of smaller personal injury claims. Plaintiffs benefit from this presumption by not having to incur the costs associated with establishing reasonableness and necessity. Now, this doesn’t mean defendants can’t attack that presumption, but to do so can be an obstacle and one that will likely require them to spend money. In personal injury cases where the amount of medical bills are less than $4,000 incurring defense costs isn’t ideal from a financial standpoint. Additionally, the $4,000 presumption can also be a helpful pre-litigation tool. Informing insurance companies that the total medical bills are entitled to the statutory presumption of reasonableness and necessity, establishes the foundation for economic damages. If the insurance company wants to negotiate in good faith, accepting the full charges based on the statutory presumption of § T.C.A. 24-5-1131(a) allows the parties to then work on noneconomic damages.
Statutory Rebuttable Presumption on Medical Bills
In addition to the $4,000 statutory presumption, § T.C.A. 24-5-1131(b) affords a plaintiff, who serves medical bills on the defendant, a rebuttable presumption of reasonableness as to those bills. Even if a plaintiff’s total medical bills exceed $4,000, providing those bills at least 90 days before trial, creates the rebuttable presumption. Defense counsel must file an intent to rebut the reasonableness of those bills. In cases where medical bills are really high, very often one defense strategy is to contest their reasonableness. Most often, defense counsel pay an expert to review the medical bills in an effort to reduce the amount of damages. This happens sometimes during negotiations or mediation, where defense counsel provides a report alleging the plaintiff’s “actual” medical bills.
Last, with the high costs of goods and services, the statutory presumption of $4,000 on medical bills is incredibly low. We believe that amount should be much higher. In January 2023, H.B. 1349 was introduced by Representative Andrew Farmer. His bill seeks to raise the statutory presumption, contained in § T.C.A. 24-5-1131(a), from $4,000 to $25,000. The $25,000 amount is also the statutory minimum for car insurance in Tennessee. The bill made some progress, but was tabled by the relevant subcommittee in March of 2023. For nearly twenty three years, the statutory presumption has been $4,000. It’s well past time to increase the amount to reflect current economic realities.
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