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Welcome to Off the Record personal injury litigation with Michael Copsic.
Hey everybody, welcome in to an all new episode of Off the Record Personal Injury Litigation with Michael Copsic. I am your host Mike Leon. You know, Mike here is a trial tested Illinois injury lawyer who has taken more than 60 cases to verdict and he's handled hundreds of expert and doctor death positions. brings a clear, straightforward perspective on how personal injury cases actually work inside the courtroom.
Today's episode, we're going to be talking about medical bills. Sure, that's a topic a lot of people have medical debt or things like that, but Mike's going to explain how they get paid during a case, how they affect case value, and how they're treated, especially at trial. Michael, it's good to see you as always. So, let me ask you here at a high level, like when when someone is injured and they're starting the process of putting in a personal injury case, like what are what are some of the practical options for getting medical treatment paid early before the case is even resolved?
Yeah, thanks so much for having me, Mike. Good to see you as well. Um, medical bills, like you said, they're a hot topic, and I think they are of, you know, incredible concern at the beginning of anybody's case. you're getting bills uh into your house, maybe you're getting electronic notifications, and you want to figure out first and foremost how to get these paid. A lot of clients think that uh just because there's a personal injury case or just because they have an insurance claim, it's automatically going to take care of itself. And that really couldn't be further from the truth. Um first and foremost, I instruct my clients in no uncertain terms, you have to get your bills paid one way or another. You are responsible for these bills. your case is not responsible for these bills.
Now, sometimes we can get the bills paid at the end of a case. Sometimes we can work through insurance coverage and get certain bills paid in the middle of a case. But I always tell clients, pretend for a second that you do not have a personal injury case and that you have to get these bills paid one way or another. You talk about health insurance coverage first and foremost, right? If you have health insurance, cross your finger these days and cross your fingers that it's affordable. You have to work your medical bills through your health insurance. You have to submit to your health insurance. You have to tell the hospital and the doctors that you're that you have health insurance and what plan or group number you have and you have to get it paid through them.
If you don't have health insurance or if there's extenuating circumstances and let's say you have um an unpaid balance of some sort, the next step is to pay the minimum balance while your case is pending. And then at the end of a case, like I said, hopefully what we are able to settle, we can use that money to pay any balances that you might have. But the attention needs to go to getting your pay your bills paid right away. And it it varies client to client. But again, if you have health insurance, that's the paramount way to go about it.
So, let me ask you, let's dive into the weeds a little bit. Let's talk about like medical leans. You mentioned health insurance and having health insurance, but h how do things like medical leans, self-submitting bills to the insurance, how does that kind of change the financial pressure on somebody when a case is obviously still pending?
Yeah, in two ways, right? It changes the personal pressure, right? I mean, the the actual medical bills that have to be paid, that puts a lot of stress on on any individual. Again, personal injury case or not, medical bills, medical debt stresses people out. So, at the outset of a case, when you've got 92 things to focus on as a client, as and as an attorney, uh you really want to make sure that the clients have some peace of mind that their medical bills are getting paid. And that's all part of an initial conversation that we have.
Now, there's also a different type of pressure and a different type of stress that comes at the end of a case. When you have medical leans, when you have substantial medical bills, that ultimately is going to affect a client's bottom line. the net to the client, right? If we owe 30,000 or $40,000 at the end of a case, we're gonna have to negotiate those bills. We're gonna have to negotiate those leans, and that's going to affect uh what the client gets towards the end.
So, there's pressures and stresses up front. There's pressures and stresses toward the back end. And that's why having an attorney who who deals with these things on a daily basis is so important.
Can I can I piggyback on something you just said there? Like so the judgment at the end in terms of what'll be paid like at the front part of this like how do the minimum payments and avoiding potential collections if you can't afford this does that factor into a case as it unfolds?
It doesn't necessarily factor as it unfolds. Again there's kind of the real world way that we think about these things. the personal stresses, the financial pressure, um dealing with the bills that are physically coming in versus what your actual case facts are and whether or not we have a good case, whether or not you're paying your medical bills or whether or not they're uh you know, the the accounts are being satisfied in a timely manner that does not really affect are we going to win the case. It's two separate issues, two separate pressures um happening at the same time. We hope that towards the beginning of the case, we get those medical bills taken care of. We get those minimum payments taken care of with your health insurance company. So by the end of the case, we have a much clearer financial picture. We have less stress and we have an easier decision to make with respect to your settlement and your bottom line.
I'm sure there's a misnomer out there that if you have higher medical bills, you're going to have a higher case value. Can you kind of dispel that a little bit or or is that accurate? that assumption in Illinois's injury cases.
Well, like every attorney will say, you know, it it does vary case to case, but I think a lot of people, like you said, they would tend to think that just because my medical bills are really high, that automatically equates to a really valuable case. Insurance companies like to slice it two different ways, right? If you have high bills, then insurance companies are going to say you overtreated, right? Maybe you went to 50 physical therapy appointments when an insurance company's going to argue that you should have gone to 20. So just because your physical therapy bill is $40,000, the insurance company's going to say only 20,000 of it is related, only 20 of those 50 appointments should have happened. So it doesn't really even matter that the bills are high.
On the flip side, when you have legitimate treatment, maybe you're stuck in a hospital for two weeks, no one's going to question, no one's going to criticize you for having a surgery on your leg and staying in the hospital for two weeks. Um, so you you can make the the um you can figure out at the end of a case um whether or not the treatment is actually legitimate or not. So, the higher the bills um does equate to a high value if you have legitimate treatment.
So, let's talk about when a case actually goes to trial. Like, how does it matter whether these medical bills were paid versus unpaid? Like, explain that. And how do how do juries especially tend to look at those differences?
Yeah, there's a ton of case law, a ton of analysis that need to be done toward the end of a case, especially as we figure out what uh facts and what evidence is actually going to be admissible at trial. We have a a general concept that any bill that is paid is reasonable, right? Nobody would physically pay the dollars and cents on a bill if it were unreasonable treatment or it wasn't somehow related to the injuries of this case. So any bill that is paid is deemed reasonable.
Now, as a lot of people know, um medical bills often do not get their full balances paid. For instance, um, on a $30,000 hospital bill, Blue Cross Blue Shield, as an example, might only actually pay 8, 9 or $10,000 on that $30,000. Part of the problem with kind of today's society around health care, everything is overpriced. Everything is inflated. So, a $30,000 hospital bill might be paid fully, but only $10,000 of that was actually paid dollar for dollar. That's a problem when it comes to admissible uh bills at trial and admissibility issues for the judge.
So again, using that hypothetical of that 30,000, we still have to find that $20,000 that wasn't technically paid. We need to have expert testimony saying that it was in fact reasonable. So there is a little bit of of an unraveling. Um we have to peel back the layers of every bill. Was it paid? Yes. If so, how much of the bill was actually paid? And do we have any expert testimony to back it up? Because we need these bills coming into trial. We need the jury to be able to see dollar for dollar what our clients went through. And if we're not able to get all of the bills admissible for purposes of jury trial, we're not going to have the value of the case that we should.
Yeah, it's a great breakdown and I want to piggyback on it. So, let's talk a little bit more about the concepts. You mentioned about reasonable, right? The word reasonable in terms of the actual bill itself, customary charges, usual charges. How does all that come into into play in a trial? Like, like kind of like what you said, it doesn't actually reflect what's actually being paid in the real world. Like kind of break it down for us, the terminology.
Yeah. So, again, to in order to get bills into trial, there's kind of two general phases. We need to prove that the treatment itself, what the doctor did was reasonable and necessary and that the bill itself is usual and customary. Meaning, we need to have testimony most likely um that the bill itself was not inflated or that the client was not overcharged and that it's usually usual and customary for the geographic region with which that bill was incurred. Meaning a Cook County bill in Chicago, a big city in a big hospital city, that might be a more expensive bill than if you go to the middle of Nebraska. So, it's not apples and apples. It's apples and oranges, which is why every single bill and every single county and every single year has to be analyzed differently.
And again, when you have issues with admissibility, um, is in our world as a plaintiff, you have defense council hire experts who are going to give you the opinion, which by the way, the opinion is paid for, which we talked about on the last episode. Um, so it's not a very credible opinion, but they're going to say that the bills are not usual and customary for X, Y, and Z reasons, and they're going to try to cut into the bills. Again, using that example, $30,000 in bills. The defense is going to hire someone to say only $10,000 of that is usual and customary charges in this county in this state. So, we either have to counteract that by showing that it was paid beyond what the defense thinks or we need to bring in expert testimony of our own.
Well, let's expand on that because I I'm a legal nerd here. I I love when the defense calls their expert witness. So talk a little bit more about what kind of arguments I know you you made the physical therapy 50 versus 20 visits, but what other kind of arguments have you seen these expert witnesses make for the defense? And more importantly, what have you seen tend to resonate a little bit more to the jury when it's presented to the jury?
Right. So again, we always have to differentiate when we're talking about treatment and bills. you have a lot of um experts who want to talk about how the treatment wasn't reasonable because maybe they they uh the client reached maximum medical improvement, MMI is a big phrase, especially um in cases dealing with with work injuries and ancillary workers compensation cases.
So in a case where a client has an independent medical examination and in the medical records it says that they're recovered that they're feeling good or perhaps that they have returned to MMI maximum medical improvement meaning this is the best they're going to be able to get to. The defense is going to say right but the treatment for the next three or four months after MMI maximum medical improvement that is all unreasonable treatment. the doctor said they were good to go and your client continued to treat. Okay, that's one argument. So, that's a that's a defense expert saying the treatment wasn't reasonable.
With respect to the bills, they're going to bring in a nursing type of billing representative who all they do for their entire career is hammer out medical codes. You guys have seen it on all of the bills that you get. It'll say IC0725B um you know, left ankle fracture surgery. that's the code for the surgery. It costs $32,000 and change, etc., etc. So, you're going to have an actual expert piecemeal through every single bill to see if those charges are usual and customary within that region. And of course, as you can guess, any defense expert who goes through the bills in the manner that they do, they're always going to cut into them in one way or another and say that the value that plaintiffs claiming is not 100%, it's 70% or it's 50% or what have you. So, those are the problems you you encounter as we get closer to trial.
Yeah, it's a great breakdown and we could talk about this for forever, but I I did want to ask you as we kind of put a bow on this episode. So now everything is over, right? We've got the leans have been reimbursed, the medical providers have been paid, the case is resolved. How how do you specifically help people think about the difference between now their overall case value and what they're what they're actually going to be walking away with in their pocket?
Yeah, I think it's uh one of the issues uh in the attorney client relationship and the conversations that we have towards the end of a case. A lot of clients like to say, you know, I really would like $100,000 in my pocket all said and done. Or, you know, given the case facts, I really would like to walk away with $45,000 and that would mean that we have a good case or that we got a good settlement. I don't think that's the proper way to analyze whether or not you have a good case. The only way to analyze whether or not you have a good case is if the settlement offer is reasonable.
And the way that we know that is through the experience that the attorney has, through trial experience, through settlement experience. There is a marketplace and and I hate to kind of make it about business because this is about people and this is about injuries and what they what they have gone through, but we have a marketplace of personal injury cases in our states and in our counties and wherever we attorneys practice. And we have experience to know what that marketplace suggests. We know that if someone breaks their leg, the case isn't worth $10,000. It's probably worth a hundred or 150 or more depending on the case facts. Um, while we don't have actual price tags, we have a marketplace and we have the factors that exist within each case.
So, I always tell clients, you can't look at your bottom line to determine whether or not this was a phenomenal offer. You have to look at whether or not it was a phenomenal offer. You have to trust your attorney. You have to look at the other verdicts and other settlements that are published um in your county and in your state. And you have to look at how good of a liability case you have. Right? We might have a broken leg case that's worth $500,000 except my client was 50% at fault. Well, that 500 just turned into 250.
Um another part of this is, and I don't want to go too lengthy for you, but it's a really good question. I think we should we should tackle it. Um, a lot of people's leans sit lean situations are different u towards the end of a case. So maybe I have Blue Cross Blue Shield and Blue Cross Blue Shield pays a lot more money um on a bill than if someone has Medicare or Medicaid. One of the advantages to having Medicare or Medicaid is that they pay a very small fraction of the bill. And what that means is we have a very small amount of money to reimburse uh Medicare and Medicaid versus a Blue Cross Blue Shield as an example. So someone's health insurance situation drastically affects their bottom line in a settlement.
So, I always tell clients, look, we can't look at your result here to determine whether or not we have a great case resolution or a great settlement because everyone's health insurance and medical bill situation is individualized. What we have to go back to always, like I said, is is this a reasonable offer for the facts of your case? And that is something that you have to speak to your attorney about and use their experience to come to that conclusion.
It's great insight into it. Mike, I appreciate you uh giving us the time to break this all down as always. Thank you.
Thank you very much for having me. I appreciate it. And that's it for today's episode of Off the Record, personal injury litigation with Michael Copsic. If you want to learn more about Mike's work representing injured people all throughout the state of Illinois, do me a favor right now. Visit law-m.com. Do me one more favor before you go. Hit like, hit subscribe, leave a review, and comment, or share the episode with someone who needs to hear it. I'm Mike Leon. See everybody next time.
