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What Medical Costs Are Considered Reasonable and Necessary?

billing statement for hospital visitOften the largest portion of a settlement for a personal injury is the victim’s medical bills for past and future treatment. However, you can only recover compensation for reasonable and necessary treatment of your injuries. This raises the question: what does reasonable and necessary mean?

The answer depends on the type of claim you are filing. Below, learn more about how reasonable and necessary medical expenses are defined.

If you have questions about your medical bills after suffering an injury, you can contact Schmidt Kramer’s experienced Harrisburg personal injury attorneys for a free consultation. We have helped many injury victims obtain compensation to cover their medical bills and other damages.

Reasonable and Necessary Car Crash Medical Bills

Most Pennsylvania car crash claims are resolved by recovering money from the victim’s insurance company, as this state requires drivers to purchase medical benefits coverage. According to Title 75 Chapter 16 of Pennsylvania Consolidated Statutes, this coverage pays for reasonable and necessary medical treatment and rehabilitative services. This includes, but is not limited to:

  • Hospital care
  • Dental services
  • Surgery
  • Psychiatric care
  • Psychological care
  • Osteopathic services
  • Transportation in an ambulance
  • Chiropractic care
  • Licensed physical therapy
  • Nursing services
  • Vocational rehabilitation
  • Occupational therapy
  • Speech pathology and audiology
  • Optometric services
  • Medications
  • Medical supplies
  • Prosthetic devices

The cost of these and other reasonable and necessary medical services are covered without limitation, if, within 18 months of the date of the injury, a reasonable determination is made that further treatment may be needed.

As there are a wide range of medical services your car insurance may cover, you should be able to recover compensation for most of your expenses if your claim is successful. That said, the insurance company may claim some of your treatments are not covered – they are looking for any reason to pay out the least possible amount of compensation.

Recovering full compensation for medical bills can be difficult without help from an experienced attorney. Those who hire a lawyer often recover more compensation than those who do not.

Reasonable and Necessary Bills for a Work Injury

Pennsylvania’s workers’ compensation system provides compensation for any reasonable and necessary medical bills related to your work injuries. This may include the cost of:

  • Doctor visits
  • Medical supplies
  • Medical devices
  • Physical therapy
  • Prescription medications
  • Surgeries
  • Travel to get to and from doctor’s appointments
  • Orthopedic supplies
  • X-rays
  • Hospital bills

Unlike in a personal injury or car accident claim, these expenses are generally paid up front. In those other claims, you get reimbursed if your claim is successful and a settlement is reached.

Proving Medical Bills Are Reasonable and Necessary

It is important to keep track of bills and receipts for the treatments you have received so your lawyer can pursue compensation for all of it. Even though hospitals and medical facilities keep records, you never know when something could get lost or there could be a computer error. That is why it is good to keep your own records.

Be sure to tell doctors when you first see them why you are being treated. That way your treatment will be linked to your personal injury and not something else.

Our firm has access to medical experts who can help us establish that your treatments were reasonable and necessary and based on accepted medical guidelines and standards.

Call Schmidt Kramer for Legal Help Today

A personal injury can be disastrous to not only your health, but also your finances. You may need medical treatment long after your claim has been settled, and these costs can add up quickly.

It can be very difficult to recover fair compensation for medical expenses on your own without the help of a licensed attorney. The other parties and insurance companies are focused on their best interests, not yours.

At Schmidt Kramer, we have recovered millions on behalf of our clients. We work on contingency, so there are no upfront costs for hiring us to represent you.

Schmidt Kramer. No upfront fees. Call (717) 888-8888.