NYC Personal Injury Lawyer » New York Personal Injury Resources » What are Out-of-Pocket Expenses?

What are Out-of-Pocket Expenses?

In a personal injury case, out-of-pocket expenses cover a broad range of expenses related to an accident and injury. They do not include your medical costs or lost wages. Out-of-pocket expenses are other costs you may pay during your recovery that you would not have incurred had it not been for the accident.

Many people overlook out-of-pocket costs when negotiating a settlement for their car accident claim or other personal injury claim or lawsuit. Unfortunately, that means they do not receive the full value of their personal injury claim.

Examples of Out-of-Pocket Expenses

Your out-of-pocket costs are expenses that you pay from your funds. They are not bills your health insurance company pays for medical care or income that you lose because you cannot work due to your injuries.

These costs are related to your accident, injury, or recovery. They could be related to your medical treatment, transportation, or personal care. It could be a medical service that your doctor recommends, but is not considered a traditional medical treatment.

Out-of-pocket costs that you might incur after an accident or injury include, but are not limited to:

• Necessary medical equipment, such as wheelchairs, crutches, bedside toilets, respirators, slings, etc.
• Prescription medications and over-the-counter medications
• Medical supplies, including bandages, swabs, alcohol, Ace bandages, etc.
• Mileage to and from medical appointments
• Cost of public transportation, such as bus fares, taxi fees, and rideshare services
• Cost of hotel stays and meals if you are required to travel out-of-town for medical treatments
• Parking fees
• Modifications to your home or car because of permanent impairment, such as a wheelchair ramp
• The cost of someone to help you perform activities of daily living, including bathing, feeding, dressing, etc.
• Help with household chores and child care
• The amount you pay toward your annual health insurance deductible
• Bills for covered services under a family plan, individual plan, or another health plan until you reach your out-of-pocket limits
• Medical services that aren’t covered by your health care coverage

Out-of-pocket expenses are a catch-all category. However, you are not guaranteed reimbursement for all out-of-pocket costs in a personal injury case.

Is the Insurance Company for the At-Fault Party Required to Reimburse Me for Out-of-Pocket Costs?

No, the insurance company is not required by law to compensate you for the out-of-pocket costs.

If you incur expenses because of an accident or injury, it is your responsibility to pay those amounts. However, a jury or judge could include those costs in an award. Typically, reimbursement for out-of-pocket expenses is something that you negotiate as part of your settlement agreement.

An insurance company reviews the expenses to determine if they were “necessary and reasonable.” It denies any costs that it determines do not fit within that category. Unfortunately, the decision to approve an out-of-pocket cost lies with the claims adjuster and is a highly subjective process.

One claims adjuster may decide that an expense was not necessary, while another adjuster might approve the expense. If you have a personal injury lawyer, your attorney takes care of the back-and-forth negotiations for out-of-pocket expenses.

How Can I Improve My Chance of Receiving Out-of-Pocket Costs for an Injury Claim?

Careful documentation of each expense increases your chance of receiving reimbursement from the insurance company. Keep copies of bills, receipts, and all other documentation that proves you incurred the expense.

Write notes that explain why you incurred the cost. If a medical provider directed you to purchase medical supplies or equipment, ask the doctor for a written statement explaining why the purchase was necessary.

If a claims adjuster questions a specific cost, research the cost from other stores or providers. Provide documentation that the cost you paid was reasonable based on the same or similar item offered by another company.

What About My Other Expenses and Damages?

A personal injury claim includes your economic and non-economic damages. Out-of-pocket expenses are just one type of economic expense. Your attorney also prepares a demand for reimbursement for the cost of your medical treatment and care, including surgery, therapy, doctor’s visits, and other medical procedures.

In addition to medical costs, your lost wages are included in your settlement demand. Therefore, you may receive reimbursement for all income and benefits you would have earned had you not been injured. In addition, if you sustained a permanent impairment, you could also receive compensation for future lost wages and reduced earning potential.

Your non-economic damages cover the pain and suffering you experienced because of the accident and your injury. Your personal injury attorneys work with you to develop a compelling narrative that explains why you are entitled to maximum compensation for pain and suffering damages.

An accident or injury can result in significant out-of-pocket expenses. Having an experienced Manhattan personal injury lawyer on your side can increase your chances of recovering the compensation you deserve. Many personal injury attorneys offer free consultations, so you have nothing to lose.