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Usually not. In Texas, the at-fault party’s liability insurer usually pays once, at the end, in a settlement or after a judgment. In the meantime, your treatment gets paid for by your own health insurance, by medical payments coverage on your auto policy, under a letter of protection, or by you.
Which of those you use is not a neutral administrative detail. It can change what you are legally allowed to recover, and how much of any settlement you keep, because some payers get repaid out of it. What cannot wait is the paper trail, since it has to be kept while you are being treated. Call 713-521-0059.
Texas measures medical damages by what was actually paid or incurred on your behalf, not by the number a provider first printed on a bill. That is Section 41.0105 of the Civil Practice and Remedies Code. How a bill was paid can change that figure. The amount first billed is not the measure.
The amounts actually paid or incurred sit in different places. They include what a health insurer paid, what you paid out of pocket, and what a provider is still owed under a letter of protection. They also include what a hospital is asserting through a lien. Future care is a separate element of damages, for the care this injury may require after the case ends.
A demand assembled from a summary, rather than from the underlying records and bills, is easy to argue with. A demand that leaves out future care can leave out a large part of the claim. So the record has to be built while your treatment is happening, not reconstructed afterward. Keep every bill, every explanation of benefits and every receipt, and tell your lawyer about every provider you have seen.
In many cases, yes, where you have it. The provider is paid at the negotiated rate, you pay a copay or deductible, and the treatment happens without a dispute over payment. People are often told not to use it, on the theory that it reduces the claim. It generally does not reduce what you keep, and it can avoid a discovery fight over whether billed charges were reasonable.
The cost is subrogation. Your plan will generally assert a right to be reimbursed out of any recovery. How strong that right is depends on the plan, and an ERISA self-funded plan is treated differently from a state-regulated policy. Negotiating that reimbursement is ordinary work in a personal injury case.
Med-Pay or personal injury protection on your own auto policy pays medical bills regardless of fault, up to its limit, and usually quickly. Texas insurers generally must offer PIP, and it generally has to be rejected in writing. So many people have it without knowing. Check the declarations page of your own policy.
A letter of protection is an agreement under which a provider treats you now and is paid from the recovery later. It exists because uninsured injured people otherwise often go untreated. It also carries consequences you should hear about in advance.
In re K & L Auto Crushers, LLC, 627 S.W.3d 239 (Tex. 2021) addressed a plaintiff who treated under a letter of protection, where the reasonableness of the billed charges was disputed. The court held that the defendant may discover the provider’s negotiated rates with insurers and public payors. The discovery allowed may also reach the provider’s costs for devices and services. That information is at least relevant to whether the full rates are reasonable, which the plaintiff must prove. It is not dispositive, and the trial court can address burden and confidentiality through a protective order.
So a letter of protection makes the reasonableness of the charge a live and discoverable issue. The provider is also paid out of your recovery. A large letter of protection balance can consume much of a settlement, which is why the balance should be negotiated before the case resolves rather than after.
Chapter 55 of the Property Code gives a hospital a lien on the cause of action of a person who received hospital services for injuries caused by an accident attributed to another’s negligence. For the lien to attach, the individual generally must be admitted to a hospital not later than 72 hours after the accident. The lien generally extends to the admitting hospital and to a hospital to which the person is transferred.
Section 55.004 limits the amount of the lien, generally to the lesser of the hospital’s charges for the first 100 days or half of the recovery, and excludes some charges. Those limits are worth applying, rather than assuming the filed figure is correct. A hospital lien is generally filed in the county records and attaches to the claim itself, so it usually has to be resolved before a case can be closed.
Section 18.001 allows an affidavit, unless it is properly controverted, to be sufficient evidence that a charge was reasonable and a service necessary. That can replace live testimony from every provider. The affidavit must meet the section’s requirements. The statute states expressly that it is not evidence of causation and does not support a finding on that element.
Future medical care is recoverable, but it has to be proven with evidence of reasonable medical probability and reasonable cost. It should not be estimated at the end from your past bills.
Every statute and case linked above was read at its primary source. Texas statutes change every legislative session and case law is constantly changing.
This page is general information about Texas law. It is not legal advice about your situation, and reading it does not create an attorney-client relationship.
Keep every bill and every explanation of benefits. The explanation of benefits shows what was actually paid, which helps show the amount actually paid or incurred that Section 41.0105 limits recovery to. When a settlement is discussed, ask what the net looks like, meaning what would reach you after the fee, the expenses, the liens and the subrogation claims.
If you are being treated now and do not know who is going to pay for it, we can usually talk it through with you in one call. That includes whether your own policy has coverage you did not know about. Send us the declarations page, because medical payments coverage, personal injury protection and underinsured motorist coverage are often overlooked.
Schiffer Law Firm is a Houston personal injury firm with 50 plus years of combined experience representing injured people and survivors across Texas.
There is no charge to talk, and no attorney’s fee unless there is a recovery.
Written by Jacob Schiffer, Attorney, Schiffer Law Firm. State Bar of Texas No. 24105175.
Call 713-521-0059.
Usually not. A liability insurer usually pays once, at settlement or after judgment. In the meantime, treatment is paid for by your health insurance, by medical payments coverage on your own policy, under a letter of protection, or by you.
In many cases, yes. The provider is paid at the negotiated rate and treatment happens without a dispute over payment. Your plan will generally assert a right to reimbursement from any recovery, and that amount is often negotiable.
It is an agreement under which a provider treats you now and is paid from the recovery later. It makes care possible for uninsured people. It also makes the reasonableness of the charges a discoverable issue, and the balance comes out of your settlement.
It may. In re K & L Auto Crushers addressed a plaintiff who treated under a letter of protection, where the reasonableness of the billed charges was disputed. The court held that a defendant may discover the provider's negotiated rates with insurers and public payors, and the discovery may also reach its costs. A protective order can address confidentiality.
Under Chapter 55 of the Property Code, a hospital generally has a lien on the injured person's claim if the person was admitted within 72 hours of the accident. It attaches to the claim itself and usually must be resolved before the case closes. Section 55.004 limits the amount, generally to the lesser of the first 100 days of hospital charges or half of the recovery.
In a crime case, Crime Victims' Compensation is one of the ways a bill can be handled. Our page on Crime Victims Compensation in Texas explains how it works.