Escobedo Asks More Questions Than It Answers

For a Tyler injury lawyer the Texas Supreme Court’s recent decision in Haygood v. De Escabedo creates new issues for which there is no easy answer. Texas Civil Practice and Remedies Code §41.0105 provides that an injury victim may recover accident related medical expenses that are actually paid or incurred. Until last week Texas law provided that a medical debt was incurred at the point that the medical services were rendered in the amount of the medical bill. The Texas Supreme Court has now decided that the amount billed is not the amount “incurred” and that a victim is limited to recovering the total of the amount paid by an insurance company, the amount paid by the victim and the amount outstanding.

Texas statutory and case law provides that a victim may recover reasonable and necessary accident related medical expenses. Texas law contains no evidentiary standards for the admissibility of the amount that a health insurance company paid pursuant to a provider agreement. Such agreements have nothing to do with reasonable and necessary expenses, principals of jurisprudence, or the Texas Rules of Evidence. There are no evidentiary standards by which to measure the validity of health insurance payments. Furthermore, Escobedo clearly states that evidence of health insurance or the amounts written off or adjusted by an insurance company continue to be inadmissible pursuant to the Collateral Source Rule.
Texas Civil Practice and Remedies Code §18.001 provides that reasonable and necessary medical expenses may be proved up by affidavit. Health care providers across Texas have, and will continue, to argue that the amount that they bill patients for their services are both reasonable and necessary. However, Escobedo specifically held that these reasonable and necessary medical bills are neither admissible nor recoverable, arguably invalidating Section 18.001. The Texas Supreme Court has held that only the amount paid is recoverable.

The Texas Supreme Court in Haygood v. De Escabedo has likely created more uncertainty than it resolved.

For more information contact a Tyler Accident Attorney today.