How much did the hospital charge?

How much did the surgery cost?

How much will future medical treatment cost?

Those are salient questions to be sure. But in a personal injury case, they may not be the most important questions. Here’s why:

• A medical record can tell you what the doctor did to treat a broken bone and a medical bill can tell you what a provider charged to do so. Neither can explain what it is like to spend the rest of your life unable to run around with your children.
• A medical record can describe the diagnosis of a shoulder surgery, and an invoice can show the cost of having that surgery performed. Neither can measure what it means to a carpenter who can no longer work with his hands the way he did before.
• A medical record can document a permanent scar, how it got there, and the efforts to minimize it. Pictures can even show what the scar looks like. But there is no record that can describe what it feels like for someone to see that scar in the mirror every morning for the rest of her life.

That is why a personal injury case is about much more than medical expenses.

The real question is:

How did the injury impact this person’s life?

A Medical Record Is Not a Biography

Certainly, medical records are essential evidence.

But they are written primarily for medical purposes, not to document every way an injury affects a patient’s life.

A doctor’s note may say:

“Patient reports continued knee pain.”

Those six words might describe someone who wakes up in pain every morning, can no longer run, gave up coaching a child’s team, struggles with stairs at work, and has stopped taking family hiking trips.

The medical record is not necessarily wrong. It is simply incomplete. It only records the medical problem.

The job of the lawyer is to help prove the human consequences of that problem.

Medical Bills Tell Only Part of the Story

Consider two people who suffer exactly the same orthopedic injury and undergo exactly the same surgery at the same facility by the same surgeon. Their medical bills might be virtually identical.

But the effect of those injuries on their lives could be dramatically different.

One person may recover completely within several months, while the other may experience permanent pain and limitations for the rest of his life. One may sit behind a desk all day long and hardly ever feel the remnants of the injury, while the other may be a teacher on her feet all day who comes home to excruciating pain at the end of the day.

The medical bills do not distinguish between them—indeed, their records may even be substantially identical. The evidence of how the injury impacted their lives, however, can create a material distinction between them.

Medical expenses are one measure of damages in a personal injury case. But Tennessee law recognizes other types of damages because an injury can affect someone’s life in ways that cannot be measured by an invoice.

Depending upon the facts of a particular case, those damages can include compensation for things such as:

• Physical pain and suffering;
• Mental and emotional suffering;
• Permanent injury;
• Disfigurement or scarring;
• Loss of enjoyment of life;
• Lost wages;
• Loss of earning capacity; and
• Future medical care.

What Is “Loss of Enjoyment of Life”?

Tennessee law recognizes loss of enjoyment of life as an element of damages in personal injury cases. Tennessee Courts have defined it as follows:

• “Loss of enjoyment compensates an injured person for impairment of the capacity to enjoy the normal pleasures of living.” Lang v. Nissan N. Am., Inc., 170 S.W.3d 564, 571–72 (Tenn. 2005);
• “Damages for loss of enjoyment of life compensate the injured person for the limitations placed on his or her ability to enjoy the pleasures and amenities of life. … This type of damage relates to daily life activities that are common to most people. … It can also compensate a victim for the loss of uncommon individual pursuits or talents.” Overstreet v. Shoney’s, Inc., 4 S.W.3d 694, 715–16 (Tenn. Ct. App. 1999) (internal citations omitted) (emphasis added).

The concept is fairly straightforward. An injury may take away—or limit—a person’s ability to participate in the ordinary activities and pleasures that made up his or her life before the injury.

Sometimes those losses are obvious.

• A runner who can no longer run;
• A golfer who can no longer play golf;
• A musician who can no longer play an instrument;

But loss of enjoyment of life is not limited to hobbies. Often, the most significant losses involve ordinary things that would never appear in a medical record, such as:

• Picking up a child;
• Working in the garden;
• Walking the dog;
• Playing on the floor with grandchildren;
• Going fishing with friends;
• Cooking dinner;
• Taking care of the house;
• Sitting through a child’s ballgame without having to leave because of pain;
• Sleeping through the night;
• Driving several hours to visit family.

Those activities may sound insignificant until an injury takes them away or limits your ability to do them, and they can become some of the most important evidence in the case.

What Is “Pain and Suffering”?

Pain and suffering encompasses the physical and mental discomfort caused by an injury. … It includes the “wide array of mental and emotional responses” that accompany the pain, characterized as suffering … such as anguish, distress, fear, humiliation, grief, shame, or worry. Overstreet, at 715; Clay v. City of Memphis Sanitation Div., 2024 Tenn. App. LEXIS 432, *16 (Tenn. Ct. App., Oct. 1, 2024).

While both categorized as “non-economic damages,” damages for pain and suffering are separate and distinct from damages for loss of enjoyment of life. Overstreet, at 715.

Importantly, “[t]he determination on such non-pecuniary losses as pain and suffering damages involves a subjective element not present in the determination of ordinary facts.” Borne v. Celadon Trucking Servs., 532 S.W.3d 274, 305 (Tenn. 2017); Smartt v. NHC Healthcare/McMinnville, LLC, 2009 Tenn. App. LEXIS 143, *62 (Tenn. Ct. App. Feb. 24, 2009).

Therefore, it is imperative that an injury victim describe precisely how his or her injury has affected him or her personally. 

Being Able to Do Something Is Not the Same as Being Able to Do It Like Before

This distinction is particularly important. An injured person does not necessarily have to be completely incapable of an activity for the injury to have affected his or her life. To wit:

• A person may still mow the lawn—but need three breaks to finish it.
• A person may still attend a child’s soccer game—but spend the entire game trying to find a position that does not hurt.
• A person may still cook—but no longer be able to lift a heavy pot, or reach a high shelf.
• A person may still go fishing—but need help getting into the boat and be unable to stay on the water as long.
• A person may still work—but come home exhausted and in pain every night.
• A person may still be able to perform the duties of her job – but it might take two hours to do what she used get done in one.

The fact that an injured person tries to continue living his or her life should not make the consequences of the injury disappear.

In many cases, the better question is not simply:

“Can you still do it?”

It is:

“How is doing it different now?”

That difference can tell an important part of the story.

Permanent Injury Changes the Equation

There is also an enormous difference between an injury that eventually heals and one that does not.

A person who suffers for six months has suffered a real loss, but a person who is left with a permanent injury faces something different: the limitation becomes part of the person’s future.

Our Courts define a permanent injury as follows: “A permanent injury differs from pain and suffering in that it is an injury from which the plaintiff cannot completely recover.  … It prevents a person from living his or her life in comfort by adding inconvenience or loss of physical vigor. … Permanent injury may relate to earning capacity, pain, impairment of physical function or loss of the use of a body part,  … or to a mental or psychological impairment.” Overstreet, at 715.

A permanent injury may mean living with pain, weakness, restricted movement, physical limitations, or other consequences for years or decades, which can and does make the person’s age and life expectancy important.

A permanent limitation imposed on someone with decades of expected life remaining is not merely a medical diagnosis. Rather, it represents years of living differently.

That is something a medical bill cannot measure. To be sure, expert proof is required to establish the existence of a permanent injury, but the impact of that injury on a person is specific to that person and that impact cannot be determined by the cost of his medical care.

Scars Have No Price Tag

Permanent scarring and disfigurement provide another example. Like scarring, “[d]isfigurement is a specific type of permanent injury that impairs a plaintiff’s beauty, symmetry, or appearance.” Overstreet at 715.

The medical expense associated with treating a wound may be relatively small compared with the permanent effect of the resulting scar. A visible scar may remain long after the medical bills have been paid, and the physical wound has healed.

Photographs can help document how a scar developed over time. Medical testimony may establish whether it is permanent and whether additional treatment is possible. Neither of those things, however, can adequately answer the question of what the scar means to the person who has to live with it.

That story often has to come from the injured person. Its effects cannot be summarized in any medical record, and its impact cannot be measured by any medical bill.

The Best Evidence Often Comes From Everyday Life

One of the challenges in presenting a serious personal injury case is that much of the damage occurs outside the doctor’s office. A physician may see a patient for fifteen minutes every few months.

The physician does not see the patient struggling to put on shoes in the morning. The physician does not see someone abandon a favorite hobby. The physician does not see the parent who can attend a child’s game but can no longer coach the team. The physician does not see the spouse taking over chores the injured person performed for twenty years, or the emotional toil it takes on the injured person to watch his or her spouse have to do those chores now. Nor does the physician see the thousand small accommodations a person makes to get through an ordinary day.

That is why proving damages involves more than collecting medical records and adding up medical bills.

Family Members and Friends May See Things the Injured Person Does Not

The injured person’s testimony can be important, but other people may also have valuable information.

A spouse may notice that someone no longer sleeps through the night.

A friend may know that the injured person stopped participating in an activity they had enjoyed together for years.

A coworker may have watched someone who previously performed physically demanding work begin asking for assistance.

A family member may see that someone who was once fiercely independent now needs help with ordinary tasks.

These witnesses can provide a perspective that medical records cannot. They knew the person before the injury, and they know the person now. The way they describe the differences in that person are meaningful and impactful.

Photographs and Videos Can Tell the Story Too

Sometimes the best evidence of someone’s life before an injury already exists.

Family photographs may show someone skiing, hiking, coaching, traveling, gardening, playing sports, working on a farm, or playing with children. Videos may be even more powerful because they show the person actually participating in those activities.

The purpose is not to create a highlight reel. Rather, the purpose is to accurately document what the person’s life looked like before the injury.

Post-injury photographs and videos may also help demonstrate physical limitations, scars, assistive devices, or changes in mobility.

Together, this evidence can show what an MRI reading cannot: Who was this person before the injury? The MRI bill only tells what that imaging study cost; it does not even remotely describe the human cost of living with the injury it helped to diagnose.

Serious Injury Cases Require Telling the Whole Story

When someone suffers an injury, the greatest loss is rarely the money spent treating the injury. Far more often, it is the ordinary pieces of life that the injury materially changes or permanently takes away.

A serious personal injury case should therefore tell the whole story—not simply what happened to someone’s body, not simply what the treatment cost. A serious personal injury case must articulate what the injury actually took from the person who has to live with it.

Contact The Hamilton Firm

At The Hamilton Firm, we believe serious personal injury cases require understanding the person behind the medical records.

That means investigating not only how an injury occurred and how it was treated, but also how it changed the injured person’s work, family life, independence, activities, and future.

If you or a loved one has suffered a serious injury because of someone else’s negligence, contact The Hamilton Firm to discuss your case.

By: Bill Rieder