By Bridgit White, Senior Attorney, Omega Law Group · Licensed in Texas since 1998 | Last reviewed: October 2026
After a serious crash in Dallas, a hospital statement arrives showing $85,000 in charges. Months later, the health insurer’s explanation of benefits shows a very different picture. Most injured people assume the first number is what they can claim. In Texas, it usually is not.
| What one hospital bill can show | Example | Recoverable as past medical expenses? |
| Billed (“chargemaster”) amount | $85,000 | Not by itself |
| Paid by the health insurer | $28,000 | Yes, if reasonable, necessary, and caused by the injury |
| Patient’s remaining share (deductible, copays) | $7,000 | Yes, on the same conditions |
| Contractual write-off | $50,000 | No. Nobody owes it |
In this example, the recoverable past medical expense is closer to $35,000 than $85,000. The rest of this article explains why, and what an injured person still has to prove even for the smaller figure.
The “Actually Paid or Incurred” Rule
Texas Civil Practice and Remedies Code § 41.0105 is one sentence long. It limits recovery of medical or health care expenses to the amount “actually paid or incurred by or on behalf of the claimant.”
The Texas Supreme Court applied that sentence in Haygood v. De Escabedo, 356 S.W.3d 390 (Tex. 2011). The plaintiff’s providers billed about $110,000, but after required Medicare adjustments, they were legally entitled to only about $27,700. The Court held that the plaintiff could recover only the amounts the providers had a legal right to be paid. Charges that were written off, and that no one would ever pay, were never “incurred.”
The Court also held that evidence of the written-off amounts is not admissible at trial. The jury hears the paid-or-owed figures, not the inflated chargemaster totals.
The Jury Still Does Not Hear About Insurance
Haygood kept the collateral source rule intact. A defendant cannot reduce its liability because the injured person had health insurance, and the jury is not told that an insurer paid the bills.
The two rules do different jobs. Section 41.0105 limits which dollars count as medical damages. The collateral source rule keeps the defendant from benefiting from insurance the injured person paid for. So the jury sees the reduced amount, but not the reason it was reduced.
There is a practical side to this. A health insurer, Medicare, Medicaid, or an employer plan that paid for crash-related care usually has a right to be reimbursed from any recovery through subrogation or a lien. Texas hospitals can also file liens under Chapter 55 of the Property Code. Those claims come out of the settlement, which is another reason the face amount of a bill rarely matches what a family ends up with.
Owing a Bill Does Not Make It Reasonable
Legally owing a charge is necessary but not enough. Texas also requires that the medical expense be reasonable and the treatment necessary.
That issue came to a head in a Dallas County case, In re K & L Auto Crushers, LLC (Tex. 2021). Kevin Walker was hurt in a collision with a tractor-trailer and later had cervical spine and shoulder surgery. He had no health insurance. His lawyers gave his providers letters of protection, promising payment from any settlement, and the claimed medical expenses reached about $1.2 million at full chargemaster rates.
The defendants sought the providers’ negotiated rates with private insurers and public payers. The Texas Supreme Court held those rates are relevant to whether the charges to an uninsured patient were reasonable, noting it “defies logic” to say otherwise. The paid-or-incurred rule, the Court explained, works alongside the requirement that the charge be reasonable at the time and place of service.
For patients treated under a letter of protection, that means the full bill can be tested against what the same provider accepts from insurers for the same service.
Section 18.001 Affidavits: A Shortcut With Limits
Section 18.001 lets an injured person prove reasonableness and necessity with an affidavit from the provider or its records custodian, attaching an itemized bill, instead of calling a doctor or billing witness to testify.
The deadlines
After the 2019 amendments, the affidavit generally must be served by the earlier of 90 days after the defendant files an answer or the date the offering party must designate expert witnesses. A defendant who disputes the charges serves a counteraffidavit under its own deadlines in the statute. Missing these dates can cost a party the shortcut.
What the affidavit does not do
In In re Allstate Indemnity Co. (Tex. 2021), the Texas Supreme Court held that an uncontroverted affidavit is enough evidence to support a finding, but it is not conclusive. The defendant can still challenge reasonableness and necessity at trial through evidence and argument.
And since 2019, the statute says plainly that an 18.001 affidavit is not evidence of causation and cannot support a finding that the accident caused the need for treatment. If someone had back treatment before a crash, an affidavit saying a later MRI was necessary does not prove the crash caused it. That connection usually comes from treating physicians and medical records.
Four Questions for Every Medical Bill
Taken together, the cases and statutes mean each charge in a Texas injury claim has to clear four separate hurdles:
- Paid or incurred: Was the amount actually paid, or does the provider still have a legal right to collect it?
- Reasonable: Is the charge reasonable for that service at that time and place?
- Necessary: Was the treatment medically necessary?
- Caused by the injury: Did the defendant’s conduct cause the condition that required the treatment?
Insurance adjusters work through the same questions when they evaluate a claim, so they shape settlement value long before trial. For readers looking into Dallas personal injury attorney resources, this is the core of the medical damages discussion: collecting every bill matters, but adding up the totals is only the starting point. FindAttorneys.org’s guide to car accidents in Dallas covers the earlier steps, from the crash scene to insurance reporting.
Future Medical Care Is Proven Differently
The paid-or-incurred rule applies to care that has already happened. Future surgery, therapy, medication, or long-term care has no bill yet.
For future expenses, Texas requires evidence that the care is reasonably probable and a reasonable estimate of its cost. In serious cases that usually means testimony from treating doctors, and sometimes a life care planner and an economist. A jury can also consider the nature of the injuries and the medical care already given.
Large Recoveries Still Turn on the Medical Proof
Omega Law Group’s published results include a $3.7 million recovery in an auto accident case. The listing does not describe where the case arose or how the medical expenses were proven, so it is not offered as an example of § 41.0105 in action.
It does reflect a basic point about catastrophic injury claims: the medical record is usually the backbone of the damages case. In Texas, that means separating billed charges from amounts paid or owed early, documenting why each treatment was needed, and building the causation evidence an 18.001 affidavit cannot supply.
Past results do not guarantee a similar outcome. Each case depends on its own facts and the law that applies to it.
Proposed Changes That Did Not Pass
In 2025, the Texas Legislature considered Senate Bill 30, which would have changed how medical expenses are proven and limited recovery for care provided under letters of protection. The House and Senate passed different versions, and the bill died in conference committee. As of this review, § 41.0105 and § 18.001 read as described above. Similar proposals may return in a future session.
Frequently Asked Questions
Can I recover the full amount on my hospital bill in Texas?
Usually not. Past medical recovery is limited to what was actually paid or what you still legally owe. Amounts written off under insurance contracts are not recoverable.
Does the jury find out I had health insurance?
No. Under the collateral source rule, the jury is not told that insurance paid your bills. It sees the paid or owed amounts, not the reason they are lower than the billed charges.
What if I had no insurance and was treated under a letter of protection?
You may be able to claim the full charge you still owe, but the defense can challenge whether it is reasonable, including with the provider’s negotiated rates for insured patients.
Do I still need a doctor if I file an 18.001 affidavit?
Often yes. The affidavit can prove reasonableness and necessity, but not causation, and the defense can still contest the amounts at trial.
Authorities & Sources
- Tex. Civ. Prac. & Rem. Code § 41.0105: Evidence relating to amount of economic damages
- Tex. Civ. Prac. & Rem. Code § 18.001: Affidavit concerning cost and necessity of services
- In re K & L Auto Crushers, LLC, No. 19-1022 (Tex. May 28, 2021)
- In re Allstate Indemnity Co., No. 20-0071 (Tex. May 7, 2021)
Disclaimer
This article provides general information about Texas personal injury and damages law. It is not legal advice, and reading it does not create an attorney-client relationship. Laws and court interpretations change, and the result in any claim depends on its specific facts. Anyone injured in Texas should speak with a licensed Texas attorney about their situation.
