Texas Spinal Cord Injury Claims: Proving Future Costs

Beverly Law. Updated November 2026.

Why future costs carry these claims

Most of the money in a spinal cord injury claim is for care, equipment and lost work that stretch over decades, and a Texas jury has to see evidence for each piece.

The National Spinal Cord Injury Statistical Center (NSCISC) at the University of Alabama at Birmingham tracks people treated at federally funded SCI Model Systems centers. Its 2026 data sheet reports:

The sheet also lists care costs by injury level, which our page on how spinal cord injury damages are built sets out. Those cost figures come from a 2011 study restated in 2025 dollars, and the defense may raise that.

Proving the injury: the ASIA Impairment Scale

Doctors classify spinal cord injuries with the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI), published by the American Spinal Injury Association (ASIA). The exam tests sensation and strength level by level, including the lowest sacral segments, S4-S5, and yields a neurological level of injury and an ASIA Impairment Scale (AIS) grade (ASIA ISNCSCI worksheet; Kirshblum et al., NIH National Library of Medicine).

Grade and level drive cost. A Neurosurgery study using NSCISC data estimated lifetime hospitalization costs after a thoracic injury at age 35 at $321,534 for AIS A and $68,120 for AIS D, in 2015 dollars (Dukes et al., NIH National Library of Medicine).

Future medical care: the life care plan

Texas allows recovery of future medical expenses when the evidence shows a reasonable probability they will be incurred. In Gunn v. McCoy, 554 S.W.3d 645 (Tex. 2018), the Texas Supreme Court restated that standard and noted that such an award, by its nature, evades certainty.

In a spinal cord injury case, that proof usually comes from a life care plan. Working from the treating doctors’ recommendations, the planner lists each future need, how often it recurs and its cost: attendant care, wheelchairs and replacements, home and vehicle changes, medications, bladder and skin supplies, therapy, and treatment of expected complications. An item without medical support is an easy target.

An economist then converts the plan to present value over the person’s life expectancy, for which NSCISC publishes tables by injury level and age. The defense may answer with its own experts. In Gunn, a defense expert marked items in the plaintiff’s plan as not reasonably necessary or as tied to later, unrelated conditions.

Lost earning capacity

When an injury reduces a person’s capacity to earn a living, Texas allows damages for the loss. The injured person does not have to prove an exact amount, only facts from which the jury can set a proper one.

In W&T Offshore, Inc. v. Fredieu, 610 S.W.3d 884 (Tex. 2020), the Texas Supreme Court upheld an award supported by an economist’s projections. Actual earnings at the time of trial are the best evidence of future earning capacity, the Court said, but not the only evidence when the inquiry looks decades ahead. The jury could also weigh the worker’s medical restrictions and history of physical jobs.

Useful proof includes tax returns, pay records, evidence of expected raises or promotions, and a vocational expert’s view of what work remains possible. In NSCISC’s database, 64.5% of people were employed when injured and 17.8% one year later.

Past medical bills: the paid or incurred rule

Under Texas Civil Practice and Remedies Code § 41.0105, recovery of medical or health care expenses is “limited to the amount actually paid or incurred by or on behalf of the claimant.” In Haygood v. De Escabedo, 356 S.W.3d 390 (Tex. 2011), the Texas Supreme Court held that the statute limits recovery to expenses that have been or must be paid by or for the claimant, and that only evidence of recoverable medical expenses is admissible at trial.

When an insurer pays a reduced rate and the provider writes off the rest, the written-off amount cannot be recovered. The collateral source rule still applies, so the jury should not be told that insurance covered the bills or that a provider adjusted its charges because of insurance.

Medical bill affidavits under § 18.001

Under § 18.001, an affidavit from the provider or the person in charge of its records of the service and charge, with an itemized statement, is sufficient evidence to support a finding that a charge was reasonable or the service necessary, unless a counteraffidavit is served. A 2019 amendment set these deadlines:

In In re Allstate Indemnity Co., 622 S.W.3d 870 (Tex. 2021), the Texas Supreme Court held that a trial court abused its discretion by striking a billing expert’s counteraffidavit and barring the defense from contesting the charges. A counteraffidavit needs reasonable notice of the basis for the challenge, and doubts about the admissibility of the expert’s opinions are no reason to strike it. Even an uncontroverted affidavit is not conclusive, and the defense can still contest the bills at trial.

Discovery of what providers accept from insurers

Under a lawyer’s letter of protection, a provider waits to be paid from any recovery and may bill its full chargemaster rate. In In re K & L Auto Crushers, LLC, 627 S.W.3d 239 (Tex. 2021), the Texas Supreme Court held that the rates such providers negotiate with private insurers and public payors, and their own costs, are at least relevant to whether chargemaster rates are reasonable and can be obtained in discovery.

The Court set limits: not every document on those topics is automatically discoverable, proportionality controls the scope, and trial courts may protect confidential information. A plaintiff treated on a letter of protection should expect the defense to seek this information from the providers.

Fault, filing deadlines and health care cases

Texas uses modified comparative fault. Under § 33.001, a claimant whose share of responsibility is greater than 50% recovers nothing. Under § 33.012, a smaller share reduces the damages by that percentage, and the court also credits settlements with other parties. Our comparative fault page explains how fault is assigned.

Most personal injury suits must be filed within two years after the claim accrues under § 16.003. Time while the injured person is under 18 does not count (§ 16.001). Claims against doctors and other health care providers follow § 74.251 instead.

Those health care liability claims also have a periodic payment rule. When future damages have a present value of $100,000 or more (§ 74.502), and a party asks, § 74.503 requires the court to order that awarded medical, health care or custodial services be paid in whole or in part over time. It does not reach a typical crash case.

What this means for your case

Future cost claims depend on records gathered early. Steps that help:

• Request every ISNCSCI exam with its AIS grade, plus imaging and rehabilitation discharge summaries.
• List every provider, including equipment suppliers and home health agencies, so § 18.001 affidavits go out on time.
• Ask your treating doctors to put long-term recommendations in writing.
• Save tax returns and pay records from before the injury.
• Keep explanations of benefits and any letter of protection.

If you are also applying for benefits, see disability benefits for a spinal cord injury. Texas cases are handled by the firm’s Texas-licensed attorneys. You owe no fees or costs unless we win. Call (310) 552-6959 for a free consultation.

Common questions

Related pages

Legal guides · Texas injury lawyers · Austin injury lawyers · How much is a spinal cord injury case worth? · General and special damages · Hurt at work for a Texas employer with no workers’ comp

Important: This page is general information, not legal or medical advice, and reading it does not create an attorney-client relationship. Every case is different; talk to a lawyer about yours. Texas cases are handled by the firm’s Texas-licensed attorneys. Last reviewed: November 7, 2026.