Billed vs. Paid: How Five States Moved Medical Damages Onto the Paper Trail
In California, Texas, Florida and Georgia, the jury's view of past medical damages now depends on what was actually paid or incurred, not only on the provider's billed charges. Florida and Georgia also opened letters of protection to discovery. New York took a different route in 2026, repealing its 90/180-day serious-injury category and adding a comparative-fault bar for motor-vehicle claims. On both sides, the case now turns on how well the records and bills are organised.
By OASIS Legal Operations
Last updated
- billed vs paid medical damages
- Howell rule California
- Florida 768.0427
- letter of protection disclosure
- Georgia SB 68 phantom damages
- Texas 41.0105 paid or incurred
- Texas 18.001 affidavit
- New York 90/180 repeal
Short answer
In California, Texas, Florida and Georgia, the jury's view of past medical damages now depends on what was actually paid or incurred, not only on the provider's billed charges. Florida and Georgia also opened letters of protection to discovery. New York took a different route in 2026, repealing its 90/180-day serious-injury category and adding a comparative-fault bar for motor-vehicle claims. On both sides, the case now turns on how well the records and bills are organised.
Key takeaways
- California (Howell, 2011) and Texas (§41.0105) limit past medical recovery to amounts paid or incurred.
- Florida (§768.0427, 2023) and Georgia (SB 68, 2025) let paid amounts in and require or permit disclosure of letter-of-protection arrangements.
- New York's 2026 reforms make objective, documented injury proof more important than ever.
- The record work changes from "list the visits" to "reconcile every bill, payment and referral to a page".
Which states limit medical damages to amounts paid?
| State | Rule | Source | Record work it creates |
|---|---|---|---|
| California | A plaintiff may recover as economic damages "no more than the amounts paid by the plaintiff or his or her insurer" (and amounts incurred and still owed) | Howell v. Hamilton Meats & Provisions, Inc. (2011) 52 Cal.4th 541 | Paid and owed schedule per provider; insurer EOBs; lien balances |
| Texas | Recovery of medical expenses "is limited to the amount actually paid or incurred by or on behalf of the claimant" | Tex. Civ. Prac. & Rem. Code §41.0105 | Paid or incurred schedule; §18.001 affidavits and counteraffidavits on tight deadlines |
| Florida | Evidence of amounts paid and owed is admissible; letter-of-protection treatment triggers detailed disclosures | Fla. Stat. §768.0427 (HB 837, 2023) | Billed, paid, adjusted and owed by provider; coded itemised bills; referral disclosures |
| Georgia | "Reasonable value" of care can be shown through billed and paid amounts; letter-of-protection expenses are discoverable | SB 68 (signed April 21, 2025); the medical-damages change applies to claims arising after that date | Same reconciliation; tracking which claims pre-date the change |
| New York | 90/180-day non-permanent category removed from the serious-injury definition; fault decided before serious injury; new comparative-fault bar for covered claims | Part EE of Chapter 58, Laws of 2026, for actions commenced on or after May 26, 2026 | Objective, quantified injury proof; treatment-gap explanations; fault evidence |
Why does this change the medical record work?
Under a billed-charges regime, a chronology could stop at dates, providers and treatment. Under a paid-or-incurred regime, every line needs a money trail: - what was billed; - what each payer paid; - what was written off; - what is still owed, and to whom.
Where letters of protection are involved, Florida's statute also requires the billing to be itemised and coded so it can be compared, and requires disclosure of who referred the plaintiff for treatment.
Texas adds a procedural clock. Under §18.001, a party serving an affidavit on the reasonableness and necessity of charges must serve it by the earlier of 90 days after the defendant answers or the expert-designation deadline. A counteraffidavit is due by the earlier of 120 days after the answer or the corresponding expert deadline. Missing those dates costs evidence.
What does it mean for plaintiff firms?
The demand must show the damages the jury will actually hear. A demand built on billed charges alone invites an easy discount from the adjuster and, in Florida, a fight over whether the demand gave the carrier enough to evaluate. Plaintiff firms need a schedule that reconciles every provider before the demand goes out, plus a referral and letter-of-protection disclosure file that is ready when discovery asks.
What does it mean for insurance defense firms?
The same schedule is the defense's first damages tool. Paid amounts, write-offs, lien-based providers and coding anomalies are now admissible or discoverable in more places. A defense review that reconciles billing early lets counsel value the case and choose experts before the plaintiff's expert disclosures arrive.
What should a medical-damages schedule contain?
One row per provider and date range, with these columns: - billed; - paid by each payer; - contractual adjustment; - balance owed; - payer type (health plan, Medicare, Medicaid, PIP, letter of protection); - CPT or billing codes present (yes or no); - referral source; - source pages.
Totals must reconcile: billed minus adjustments equals paid plus owed. Our demand package specimen shows a worked schedule.
How OASIS supports damages work in these states
OASIS paralegals build provider-by-provider schedules that reconcile to the cent, tie every figure to a source page, and flag gaps in coding or payer data for counsel. We work for plaintiff and defense firms. The first 12 working hours are free, then $12 an hour.
FAQ
What is the Howell rule in California?
From Howell v. Hamilton Meats (2011) 52 Cal.4th 541: a plaintiff's recovery of past medical expenses is limited to amounts paid, or incurred and still owed, not the full billed charges.
What does Florida's §768.0427 require for letters of protection?
Disclosure of the letter of protection, itemised and coded billing, any sale of the receivable and the price paid, health coverage at the time of treatment, and who referred the claimant for treatment.
Does Georgia's SB 68 apply to pending cases?
The medical-damages ("phantom damages") change applies to claims arising after April 21, 2025. Commentators report that several other provisions, such as anchoring limits, seat-belt evidence and bifurcation, apply to pending cases. Check the enacted text for your case.
What is a Texas §18.001 affidavit?
A sworn statement that charges were reasonable and services necessary. It is sufficient evidence of those points unless properly countered, and both the affidavit and the counteraffidavit have strict service deadlines.
What changed in New York in 2026?
For actions commenced on or after May 26, 2026, the 90/180-day category was removed from the serious-injury definition, fault is decided before serious injury, and a new modified comparative-fault rule (CPLR 1411(b)) applies to covered claims.
Sources
- Howell v. Hamilton Meats (2011) 52 Cal.4th 541
- Tex. Civ. Prac. & Rem. Code §41.0105
- Tex. Civ. Prac. & Rem. Code ch. 18
- Holland & Knight on Florida HB 837
- Kennedys on Georgia SB 68
- NY DFS Insurance Circular Letter No. 3 (2026)
ADD-ON — SCOPE CLARIFICATION: New York’s CPLR 1411(b) rule concerns covered motor-vehicle personal-injury actions, not all tort claims; actions solely for wrongful death or property damage are excluded. Counsel should check the enacted provision for the particular claim.
Related services and reading
- Demand packages
- Medical chronologies
- Florida 768 0427 medical damages schedule
- New york 2026 serious injury reform 90 180 repeal
- Medical record review for insurance defense
- Contact
View specimen: Time-Limited Demand Package: Calloway v. Vance
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