Future Medical Expenses

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December 27, 2015
Edward Smith

Future Med Expense and Affordable Care Act


Future Medical Expenses and How Some Argue the Affordable Care Act Affects Their Calculation

I’m Ed Smith, a Sacramento Personal Injury Attorney. Most would heartily agree that the Affordable Care Act has changed the health insurance landscape. Some defense attorneys in personal injury cases are now attempting to use the provisions of the law to limit the amount of compensation plaintiffs can receive for future and ongoing medical expenses. If successfully used in your personal injury case, you may find your compensation award reduced significantly. The best way to fight back against such an attempt is to retain the services of an experienced personal injury lawyer.

How Defense Attorneys are Arguing for Reductions in Future Medical Expenses Awards

The Affordable Care Act (ACA) imposes an affirmative obligation on American citizens to purchase and maintain health insurance that complies with certain statutorily-enumerated requirements. The ACA was also instrumental in enacting several reforms that benefited patients. Some of the more notable reforms included a ban against denial of coverage on the basis of a preexisting condition as well as an annual limit on the amount of out-of-pocket expenses an individual would be required to pay in a given year. This limit on out-of-pocket expenses is fixed and determinable.

Using this fixed out-of-pocket expense limitation, defense attorneys are arguing that it is unnecessary and improper to consider future medical expenses that are in excess of this yearly amount. For example, suppose that the out-of-pocket limit is $5,000 per year and a personal injury victim is presently 42 and expected to live until he or she is 82. According to defense attorneys, it would be improper for the court to consider or allow a jury to consider a request for future medical expenses compensation that exceeded $200,000 (plus the cost of maintaining insurance each year).

How Do Plaintiffs’ Attorneys Respond to These Arguments?

Plaintiffs’ attorneys have had some success in resisting these efforts by defense attorneys. One or more arguments can be advanced by your personal injury attorney to protect your right to recover future medical expenses. One of the more persuasive arguments advanced thus far asserts that it is not guaranteed that coverage under the ACA would cover all of the future medical and life expenses that an injured plaintiff would need (or, given some of the political rhetoric lately, whether the ACA will even be in existence in the future). Without the certainty that all of your future medical expenses will always be covered under the ACA, it would be unfair to the injured plaintiff to reduce the amount of compensation he or she could receive.

How Are Future Medical Expenses Calculated in Personal Injury Cases?

When an injured plaintiff in a personal injury case claims a certain amount as compensation for some past or future loss or expense, the burden is on the plaintiff to show that the amount demanded as compensation is reasonable and supported by evidence. Calculating your future medical needs involves some measure of estimation, but a reasonable amount can be calculated by considering:

  • The testimony of your doctor or a medical expert familiar with your condition as to what additional procedures or ongoing treatments you may need;
  • The current market costs of the procedures, treatments, and/or drugs necessary to manage your condition or complete your recovery;
  • Reliable estimates as to inflation or increases in healthcare costs so that current values can be adjusted for the future.

Contact Ed Smith for Assistance in Seeking Future Medical Expenses Compensation

I’m Ed Smith, a Sacramento Personal Injury Lawyer since 1982. Call me anytime at 916-921-6400 in Sacramento or 800-404-5400 Elsewhere.

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