What is Reasonable and Necessary?
The legal standard requiring that medical treatment and expenses be both medically appropriate for the condition and charged at a fair rate to be recoverable in a personal injury claim.
Understanding Reasonable and Necessary
Insurance companies and defendants often challenge medical expenses by arguing they were not reasonable and necessary. "Reasonable" refers to the cost being in line with what other providers charge in the area for similar services. "Necessary" means the treatment was medically required given the patient's condition. Excessive or unrelated treatment may be excluded from damages.
Examples
- 1Insurer disputing that 50 chiropractic visits were necessary
- 2Defense arguing surgical costs exceed reasonable rates for the area
- 3Expert testifying that physical therapy was medically necessary for recovery
Related Terms
Future Medical Expenses
The projected cost of medical treatment, therapy, medication, and care that an injured person will need in the future as a result of their injuries.
Economic Damages
Compensation for financial losses that can be calculated with specificity, including medical bills, lost wages, property damage, and future expenses.
Treating Physician
The doctor who provides ongoing medical care and treatment to an injured person, as opposed to a doctor who only performs an independent examination.
Letter of Protection (LOP)
A written agreement where an attorney promises to pay a medical provider from the client's eventual settlement or verdict, allowing treatment without upfront payment.
Defense Medical Exam
A medical examination arranged and paid for by the defendant or their insurance company to independently evaluate the plaintiff's injuries and medical claims.
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