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The Reasonable Value of Medical Services for Injuries Suffered in an Automobile Accident

When pursuing a claim for injures suffered in a car accident, the auto insurance companies will want to talk about the reasonable value of medical services.  Isn’t this just what the hospital or other medical provider charges for their services?  Not always.

Medical providers will often accept less than the full amount of the medical bills when those bills are paid through health insurance.  This is typically a matter of contract between health insurance companies and hospitals.  Given the amount of business they do together, hospitals will often agree to accept less than the amounts they charge for services when health insurance is paying the bills.  For the person without health insurance to pay the medical bills, however, he or she is on the hook for the full amounts.

In presenting an insurance claim for injuries and the medical bills needed to treat those injuries, it used to be that only the medical bills themselves mattered.  At trial, a jury was only allowed to see those total medical bills, not the smaller amounts that health insurance actually paid.  With the decisions of the Ohio Supreme Court in the cases of Robinson v. Bates, Jaques v. Manton, and just this month in Moretz v. Muakkassa, however, Ohio juries may now see those lower amounts paid by health insurance when determining the reasonable value of medical services.  In effect, defendant drivers and their auto insurers now benefit from injured individuals’ health insurance and the premiums they pay for that coverage.  In its most recent decision, the Ohio Supreme Court held that the defendant does not even have to produce an expert to explain to juries WHY the hospital would accept less than the full amounts for medical bills; jurors are simply shown both numbers—the full medical bills and the lower amounts accepted—and asked to determine reasonable value of the medical services.

This explains why auto insurance companies are so concerned with health insurance and the amounts actually paid to the medical providers rather than merely the medical bills themselves.  They know that, in the event the claim eventually goes to trial, the jury will get to consider those lower numbers in determining how much to compensate an injured party for the reasonable value of his or her medical services.

To learn more about this subject, see our website practice area page for Auto Accidents.

Disclaimer: The information in this blog post (“post”) is provided for general informational purposes only, and may not reflect the current law in your jurisdiction. No information contained in this post should be construed as legal advice, nor is it intended to be a substitute for legal counsel on any subject matter. No reader of this post should act or refrain from acting on the basis of any information included in, or accessible through, this Post without seeking the appropriate legal or other professional advice on the particular facts and circumstances at issue from a lawyer licensed in the recipient’s state, country or other appropriate licensing jurisdiction.
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