If you’ve been injured in a car accident in San Antonio, one of the most challenging aspects of negotiating a fair settlement is getting the other driver’s insurance company to properly account for your future medical needs. Insurance companies are notorious for minimizing their payouts by focusing only on immediate medical expenses while disregarding ongoing and future care requirements.
Understanding Why Insurance Companies Resist Paying for Future Medical Expenses
Insurance companies operate with profit in mind. Their business model depends on collecting premiums and minimizing payouts. When it comes to future medical expenses, they have several common strategies:
- They claim your injuries will heal completely, despite medical evidence suggesting otherwise
- They argue that future treatments are “speculative” or “unnecessary”
- They dispute the connection between the accident and your ongoing medical issues
- They significantly undervalue the cost of future care
This approach can leave accident victims with insufficient funds to cover critical ongoing medical care, potentially resulting in significant financial hardship down the road.
What Texas Law Says About Future Medical Expenses
In Texas, you are legally entitled to compensation for both current and future medical expenses resulting from an accident caused by another driver’s negligence. The Texas Civil Practice and Remedies Code recognizes that injury victims deserve compensation for the full scope of their damages, including reasonably anticipated future medical care.
The Texas Supreme Court has established that plaintiffs must prove future medical expenses with “reasonable probability,” not absolute certainty. This means your attorney needs to demonstrate that you will likely need specific medical treatments in the future because of your accident-related injuries.
Documentation Required to Prove Future Medical Needs
To successfully include future medical expenses in your settlement, you’ll need substantial evidence:
Medical Expert Testimony
Healthcare providers who can testify about your prognosis and future treatment needs are essential. This typically includes:
- Treating physicians who can explain why ongoing care is necessary
- Medical specialists who can outline specific future treatments
- Rehabilitation experts who can detail physical therapy requirements
Comprehensive Medical Records
Your medical records must clearly document:
- The severity and permanence of your injuries
- Any long-term or permanent disabilities
- Recommendations for future care
- Connections between the accident and your ongoing medical issues
Life Care Plans
For severe injuries, a life care plan prepared by a certified life care planner can be invaluable. This detailed document outlines:
- All anticipated future medical treatments
- Medication requirements
- Therapy sessions
- Medical equipment needs
- Home modifications
- Long-term care costs
Economic Expert Analysis
Financial experts can calculate the present value of your future medical expenses, accounting for:
- Medical inflation rates
- Life expectancy adjustments
- Discounting to present value as required by Texas law
Common Injuries That Require Future Medical Care
Some injuries frequently result in ongoing medical needs:
Traumatic Brain Injuries (TBIs)
TBIs often require long-term:
- Cognitive rehabilitation therapy
- Neuropsychological treatment
- Medication management
- Occupational therapy
- Possible future surgeries
Spinal Cord Injuries
These devastating injuries may necessitate:
- Multiple surgeries
- Specialized mobility equipment
- Home modifications
- Personal care assistance
- Ongoing physical therapy
Severe Orthopedic Injuries
Complex fractures or joint injuries might require:
- Joint replacement surgeries
- Revision surgeries years later
- Physical therapy
- Pain management
- Assistive devices
Chronic Pain Conditions
Persistent pain conditions may need:
- Pain management specialists
- Medication regimens
- Alternative therapies
- Psychological support
- Periodic medical procedures
Strategies When Insurance Companies Deny Future Medical Needs
1. Get Second (or Third) Medical Opinions
When an insurance company disputes your need for future care, obtaining additional medical opinions can strengthen your case. San Antonio has numerous medical specialists across the Methodist Healthcare System, Baptist Health System, and University Health who can provide expert assessments of your long-term medical needs.
2. File a Bad Faith Insurance Claim
If an insurance company unreasonably refuses to consider well-documented future medical needs, you may have grounds for a bad faith insurance claim. Under the Texas Insurance Code, insurance companies must conduct fair and reasonable investigations of claims and cannot knowingly misrepresent policy provisions.
3. Be Prepared to Litigate
Sometimes the only way to get fair compensation for future medical needs is to file a lawsuit. While most personal injury cases settle before trial, preparing as if you’re going to court sends a message to the insurance company that you’re serious about receiving fair compensation.
4. Understand the Statute of Limitations
In Texas, you generally have two years from the date of the accident to file a personal injury lawsuit. Missing this deadline could mean losing your right to pursue compensation for your future medical needs. Don’t delay in consulting with an attorney.
The Role of Pre-Existing Conditions
Insurance companies often try to attribute your ongoing medical needs to pre-existing conditions rather than the accident. This is where experienced legal representation becomes crucial.
In Texas, the “eggshell plaintiff” rule recognizes that defendants must take plaintiffs as they find them. This means that even if you had a pre-existing condition that made you more susceptible to injury, the at-fault driver is still responsible for all resulting damages—including aggravation of your pre-existing condition.
Understanding the “Made Whole” Doctrine in Texas
The “made whole” doctrine is an important legal principle in Texas personal injury cases. It holds that injured parties should be fully compensated for their losses before other parties (like health insurance companies seeking reimbursement) can recover from the settlement.
When applied to future medical needs, this doctrine supports the argument that your settlement should include sufficient funds to cover all anticipated medical expenses before any other considerations.
How an Experienced San Antonio Personal Injury Attorney Makes a Difference
When insurance companies refuse to consider future medical needs, having skilled legal representation is essential. An experienced San Antonio personal injury attorney will:
- Work with medical experts to document your future care needs thoroughly
- Calculate the true value of your future medical expenses
- Negotiate aggressively with insurance companies
- Prepare compelling evidence for trial if necessary
- Protect you from tactics designed to minimize your recovery
Case Study: Successful Recovery for Future Medical Needs
In a recent San Antonio case, a driver suffered a severe spinal injury requiring multiple surgeries. The insurance company initially offered compensation only for the first surgery, claiming future procedures were “speculative.” Through expert medical testimony and a comprehensive life care plan, the victim’s attorney demonstrated the medical necessity of future surgeries and obtained a settlement that included provisions for all anticipated medical care.
The Impact of Texas Comparative Negligence Laws
Texas follows a “modified comparative negligence” rule with a 51% bar. This means you can recover damages as long as you’re not more than 50% responsible for the accident. However, your compensation will be reduced by your percentage of fault.
When negotiating for future medical expenses, it’s important to understand how comparative negligence might affect your recovery. Insurance companies often try to assign a higher percentage of fault to injured parties to reduce their payout obligations.
Documenting Your Daily Pain and Limitations
While medical records are critical, your personal documentation of pain, limitations, and how your injuries affect daily life can substantially impact your claim for future medical needs. Keep a detailed journal recording:
- Pain levels throughout the day
- Activities you can no longer perform
- Medication effects
- Treatment responses
- Mental health impacts
This documentation helps connect clinical findings with real-life limitations, strengthening your case for ongoing care needs.
Taking Action: Next Steps
If you’re facing resistance from an insurance company regarding your future medical needs after a San Antonio accident, consider these steps:
- Don’t accept a quick settlement that ignores future care needs
- Consult with medical specialists about your long-term prognosis
- Keep detailed records of all discussions with insurance adjusters
- Gather documentation from employers about work limitations
- Meet with an experienced personal injury attorney who understands the complexities of proving future medical expenses
Conclusion
When the other driver’s insurance refuses to consider future medical needs in your San Antonio settlement, they’re trying to minimize their financial responsibility at your expense. Understanding your rights under Texas law and working with knowledgeable legal representation can make the difference between a settlement that leaves you financially vulnerable and one that provides security for your future medical care.
Remember that insurance companies have teams of adjusters and attorneys working to minimize payouts. Having experienced legal representation levels the playing field and ensures your future medical needs receive proper consideration in any settlement negotiations.
By carefully documenting your injuries, working with medical experts, and partnering with a knowledgeable San Antonio personal injury attorney, you can overcome insurance company resistance and secure the compensation you deserve for all your accident-related medical needs—both current and future.