As discussed here, damages awarded to a victim usually include the cost of medical services. Most victims who have private health insurance may have paid very little (ie. co-payment) compared to the amount the doctors or hospitals bill to the health insurer for the services. And, the health insurer also pays a lower rate than the amount that appears on the bill. For many years, attorneys representing the wrongdoer have asked the courts to award the victims the lowest amounts –the reduced sum paid by the health insurer.

Recently, the Court has ruled in favor of the victim and awarded the higher amount — what the doctor or hospital billed for the medical services. Put simply: the victim has paid a premium for the insurance and the wrongdoer should not receive a windfall for the victim’s thrift and foresight in securing insurance. The cost of medical services include "in-kind" benefits to the health insurance companies. The victim deserves the full benefit of his insurance.

The Court has found the following information helpful in allowing the victim to recover the full amount of medical expenses:

Written agreements between the victim and the medical service providers:

  • Registration Form
  • Financial Agreement
  • Conditions Admission
  • Insurance Verification
  • Amounts Collected
  • Amounts Due
  • Financial Counselor’s Notes
  • Bills from medical services providers
  • Agreements between the medical service providers and health insurance company to accept reduced payments as payment in full
  • Agreements between victim and health insurance company re payments and indemnity (benefits agreement, enrollment information, etc.)

The court may also expect the victim or a family member to present evidence of steps taken to keep track of injury-related medical bills. And a doctor will usually need to testify that the billing records were a fair and reasonable representation of the medical billings.