Is Pain and Suffering Separate From Medical Bills?

Yes. Medical bills are economic damages and pain and suffering is a noneconomic damage, and California, Texas and Washington treat them as two separate parts of the same injury claim. A settlement usually pays both in one amount under one release. You generally have two years to sue in California (CCP 335.1) and Texas, and three years in Washington.

How does the law split economic and noneconomic damages?

Each state draws the same line between losses with a price tag and losses without one.

• California. Jurors are told that the damages fall into two categories and that the verdict form will ask for them separately (CACI 3902). Medical expenses, past and future, are an item of economic damage under CACI 3903A. Pain, mental suffering, inconvenience, anxiety and similar harms are noneconomic under CACI 3905A.
• Texas. Section 41.001 defines economic damages as compensation for actual economic or pecuniary loss, and noneconomic damages as compensation for physical pain and suffering, mental anguish, impairment and similar nonpecuniary losses. Section 41.008(a) requires the fact finder to determine economic damages separately from other compensatory damages.
• Washington. The statutes use the same two terms. RCW 4.20.046 speaks of recovering economic losses and, in addition, noneconomic damages for pain and suffering, anxiety, emotional distress or humiliation. RCW 4.56.260 deals only with future economic damages, allowing periodic payments when they reach $100,000 and a party asks.

The court self-help guide on personal injury puts it in plain terms: some damages are easy to prove with bills, while others, such as emotional distress, are harder to value.

How are medical bills counted?

This is where the two categories really differ. Bills have a dollar figure, but the law decides which figure counts.

• California. The authorities listed under CACI 3903A include the Howell decision. When a health plan paid a discounted rate, past medical damages are generally limited to the amount paid or still owed, and the full billed amount is not itself relevant. The notes describe the measure as the lesser of the amount paid or incurred and the reasonable value of the care. For uninsured patients who have not paid, reasonable value is decided on the evidence.
• Texas. By statute, recovery of medical or health care expenses is limited to the amount actually paid or incurred by or on behalf of the claimant (section 41.0105).
• Washington. We did not find a Washington statute that limits past medical expenses the way Texas section 41.0105 does. Ask the adjuster in writing which figures it used.

Does a lower medical bill figure lower pain and suffering?

Not automatically. Pain and suffering is not a percentage of your bills. California jurors are told no fixed standard exists for it (CACI 3905A), and the sources listed under that instruction state that damages for bodily harm may be awarded without proof of monetary loss.

The Supreme Court of Texas said in 2023, in Gregory v. Chohan, that economic and noneconomic damages may correlate in certain situations, but are not necessarily connected in all cases, and that an unexamined ratio between them cannot justify an award. Someone with modest bills and a long, painful recovery can have a strong pain and suffering claim, and the reverse is also possible.

Why does the separation matter in my claim?

The two categories can be treated differently.

• Uninsured drivers in California. Proposition 213 bars an uninsured owner or driver from recovering non-economic losses for pain, suffering, inconvenience, physical impairment and disfigurement, with a narrow exception. Its text does not mention medical bills or other economic losses.
• Several at-fault parties in California. The sources under CACI 3902 explain that under Proposition 51 each defendant pays only its share of noneconomic damages, while economic damages keep joint liability.
• Caps. Washington’s old statute limiting noneconomic damages, RCW 4.56.250, was repealed in 2023 (chapter 4.56 dispositions).
• Fault. Your share of fault reduces the total award, both parts included, in California and Washington (RCW 4.22.005), and in Texas recovery is barred above 50 percent (Civil Practice and Remedies Code 33.001).

Does one settlement and release cover both?

Usually yes. A bodily injury settlement is often paid as one amount in exchange for one release. The Texas Department of Insurance describes liability coverage as paying other people’s medical expenses and property damage when the insured driver is at fault. Once you sign, you generally cannot come back for either category. Texas treats enforcing a full and final release after only a partial payment as an unfair practice, unless it settles a disputed claim (Insurance Code 541.060).

Repayments come out of that same settlement. Medicare’s conditional payments must be repaid when a settlement is made, and Medicare asks for the attorney fees and costs the beneficiary paid so they can be taken into account (CMS). Our page on your settlement check explains how the money is divided.

What to do now

1. Ask each provider for an itemized bill and ask your health plan for the explanation of benefits showing what was paid.
2. Keep a separate record of pain, sleep and missed activities, since bills will not show it.
3. Ask the adjuster in writing how much of the offer is for medical bills and how much for pain and suffering.
4. Do not sign a release until you know your future care needs.
5. Note your deadline: generally two years in Texas (section 16.003) and three years in Washington (RCW 4.16.080).

Ask us what your offer covers

If an offer does not say what it pays for, call Beverly Law at (310) 552-6959 and we will go through your bills, records and the release with you. Read how pain and suffering is calculated for the other half of the picture. We handle car accident cases in California, Texas and Washington. Texas cases are handled by the firm’s Texas-licensed attorneys, Joyce Ondich and John Efstathiou. You owe no fees or costs unless we win.

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Related pages

Car Accident Settlements · Car accident settlements · How is pain and suffering calculated · Does health insurance cover car accidents · Car accident settlement check · Law Blog

Important: This page is general information, not legal advice, and reading it does not create an attorney-client relationship with Beverly Law. Laws change and every case is different; talk to a lawyer about your own situation. Attorney advertising. Prior results do not guarantee a similar outcome. You owe no fees or costs unless we win. Texas cases are handled by the firm’s Texas-licensed attorneys, Joyce Ondich and John Efstathiou. Last reviewed: 2026-11-12.