What is the legal definition of reasonable medical expenses?
What is the legal definition of reasonable medical expenses?
In the lucrative field of personal injury lawsuits and insurance claims, the matter of what constitute the "reasonable" medical expenses is always of concern. There is no single legal definition, but there are some guidelines for reasonable and necessary medical expenses in California:
Necessary vs. Please be advised - In the case of medical treatment insurance companies and court usually consider expenses which only concerned the costs of medical treatment that was necessary and appropriate for the injury. Elective or optional treatments such as the ones that the insurance rejects (for instance, the network does not fabricate an only part to remind the residents or help them in the memory treatments).
Customary Expenses - A typical expense would generally be based on the type of medical provider in a specific region, and how much he or she charges for a specific treatment. If one practitioner's fees that do not surpass the norm are higher one may not regard them as reasonable.
Industry Standards - As a whole, the medical industry will make reference to an accepted treatment protocol in place for a particular injury in order to define a proper approach to treatment. Care is provided according to these standards which makes experimental or unproven treatments inapplicable in clinical care.
Proportionality - The appropriate type and degree of treatment should match the level of injuries. The patient will usually need critical care for injuries which are major, and the cost may be higher than for the minor ones.
Opinions about the Necessity: If there is an opinion that a drug is not necessary, other doctors' opinions could be used to help make a decision to determine if such a drug meets the reasonability standards.
Itemizing Bills - Plaintiffs recovering met expenses will need to supply itemized medical bills which include a breakdown treatment, cost, and providers. Most of the non-specific and unclear expenses are generally not eligible for being reimbursed.
In a nutshell, there is no sharp legal line, but factors like the average costs in the area, the industry norms, and the medical consultations impact setting those costs limits that a person who gets injured should pay. The suitability of the type of treatment and the question of appropriateness of treatment for the particular injury become the factors considered as reasonable.