Tatia Ortiz v. Ramu Nelapatla
Docket 23-0953
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- Filed
- Jurisdiction
- Texas
- Court
- Texas Supreme Court
- Type
- Lead Opinion
- Case type
- Civil
- Disposition
- Reversed
- Judge
- Lehrmann; Blacklock; Devine; Busby; Bland; Huddle; Young; Sullivan
- Docket
- 23-0953
Petition for review from the court of appeals affirming exclusion of partially controverted medical-cost affidavits under Tex. Civ. Prac. & Rem. Code § 18.001
Summary
The Texas Supreme Court held that when a party uses the pretrial affidavit process in Texas Civil Practice and Remedies Code § 18.001 to prove medical expenses, only those specific items or charges that are actually controverted by a compliant counteraffidavit lose the statute’s evidentiary effect. Unchallenged portions of an initial affidavit remain competent evidence and may be submitted to the factfinder. The court reversed the court of appeals and remanded because the trial court erred by excluding entire medical-cost affidavits and counteraffidavits even though only portions were controverted, which deprived the claimant of admissible evidence of certain medical expenses.
Issues Decided
- Whether a Section 18.001 medical-cost affidavit that is only partially controverted must be excluded in its entirety.
- Whether counteraffidavits that partially controvert an initial affidavit may themselves be admitted to show the reasonable portion of challenged charges.
- What evidence a claimant may present when a compliant counteraffidavit disputes only part of the claimed medical expenses.
Court's Reasoning
Section 18.001 makes otherwise-hearsay affidavits admissible evidence of the reasonableness and necessity of medical charges unless a compliant counteraffidavit properly controverts the claim. A counteraffidavit that controverts only part of an itemized statement removes the statutory evidentiary effect only as to the controverted parts; uncontroverted portions remain admissible and sufficient to support a finding. Where counteraffidavits themselves identify the reasonable portions of charges, those portions are admissible. Excluding whole affidavits solely because some parts were controverted was an abuse of discretion and prejudiced the claimant.
Authorities Cited
- Tex. Civ. Prac. & Rem. Code § 18.001
- In re Chefs’ Produce of Hou., Inc.667 S.W.3d 297 (Tex. 2023)
- In re Allstate Indem. Co.622 S.W.3d 870 (Tex. 2021)
Parties
- Petitioner
- Tatia Ortiz
- Respondent
- Ramu Nelapatla
- Justice
- Debra H. Lehrmann
- Justice
- Sullivan (dissenting)
Key Dates
- Argued
- 2025-10-07
- Decision
- 2026-05-01
What You Should Do Next
- 1
Review and Redact Affidavits for Trial
If relying on Section 18.001 after a partial counteraffidavit, redact the controverted items from the initial affidavit and submit only the uncontroverted portions (and any admissible portions of counteraffidavits) to the jury.
- 2
Consider Expert Proof for Controverted Items
If you seek recovery of amounts contested in a compliant counteraffidavit, prepare to present expert testimony at trial to establish reasonableness and necessity for those specific charges.
- 3
Prepare Offer of Proof and Preserve Rulings
At trial, obtain rulings and make offers of proof when evidence is excluded to preserve appellate review and to document what portions are contested or admitted.
- 4
Consult Counsel About Remand Strategy
On remand, consult your attorney about whether to rely on Section 18.001 evidence, present expert testimony, or seek settlement given the newly clarified admissibility rules.
Frequently Asked Questions
- What did the court decide in plain terms?
- The court said that when a medical-cost affidavit is only partially challenged, the unchallenged parts can still be used as evidence at trial; only the specific contested items lose the statute’s shortcut and require expert proof.
- Who is affected by this decision?
- Plaintiffs seeking to recover medical expenses and defendants who file counteraffidavits under Section 18.001 are affected, as are trial courts deciding admissibility of such affidavits.
- What happens next in this case?
- The Supreme Court reversed the court of appeals and remanded the case to the trial court for further proceedings consistent with this opinion, allowing Ortiz to attempt to prove uncontroverted amounts.
- Can defendants still challenge medical bills?
- Yes. A compliant counteraffidavit that controverts a specific charge removes the affidavit’s statutory effect as to that charge and the claimant must support it with expert testimony at trial or abandon it.
- Can this decision be appealed further?
- This is a Texas Supreme Court decision on state law; there is generally no further appeal within Texas courts, though limited federal review might be possible only on federal constitutional grounds.
The above suggestions and answers are AI-generated for informational purposes only. They may contain errors. NoticeRegistry assumes no responsibility for their accuracy. Consult a qualified attorney before relying on them.
Full Filing Text
Supreme Court of Texas
══════════
No. 23-0953
══════════
Tatia Ortiz,
Petitioner,
v.
Ramu Nelapatla,
Respondent
═══════════════════════════════════════
On Petition for Review from the
Court of Appeals for the Fifth District of Texas
═══════════════════════════════════════
Argued October 7, 2025
JUSTICE LEHRMANN delivered the opinion of the Court, in which
Chief Justice Blacklock, Justice Devine, Justice Busby, Justice Bland,
Justice Huddle, and Justice Young joined.
JUSTICE SULLIVAN filed a dissenting opinion.
Justice Hawkins did not participate in the decision.
Section 18.001 of the Texas Civil Practice and Remedies Code
provides a pretrial process by which a party may avoid the need to
adduce expert testimony at trial by serving affidavits attesting to the
reasonableness and necessity of medical costs the party is attempting to
recover. If the party chooses that route, the opposing party can file a
counteraffidavit challenging the reasonableness and necessity of those
medical costs. In this case, we are faced with the question of what to do
when a counteraffidavit only partially challenges the costs identified in
the initial affidavit. We hold that the unchallenged portions of the
medical costs identified in the initial affidavit remain competent
evidence and may be submitted to the factfinder. We therefore reverse
the court of appeals’ judgment and remand the case to the trial court.
I. Background
Tatia Ortiz sued Ramu Nelapatla for injuries she allegedly
sustained in a car accident in a Target parking lot in McKinney as both
parties were backing out of parking spaces. Ortiz served affidavits from
three medical-care providers to prove the reasonableness and necessity
of her medical treatment:
1) $2,210 in services from Addison Interventional Pain;
2) $11,250 in services from LifeSciences Imaging Partners, LLC;
and
3) $6,415 in services from Synergy Sports Rehabilitation.
See TEX. CIV. PRAC. & REM. CODE § 18.001(b) (“Unless a controverting
affidavit is served . . . , an affidavit that the amount a person charged
for a service was reasonable . . . and that the service was necessary is
sufficient evidence to support a finding . . . that the amount charged was
reasonable or that the service was necessary.”).
Nelapatla served two counteraffidavits controverting portions of
Ortiz’s claimed medical costs. See id. § 18.001(e), (f) (requiring a party
“intending to controvert a claim reflected by the affidavit” to serve
2
counteraffidavits giving “reasonable notice of the basis” for
controverting the claim). Specifically, Nelapatla submitted:
1) the affidavit of Rhonda R. Guitreau, “a medical billing expert
and practice management consultant,” who challenged the
services provided by LifeSciences Imaging as exceeding the
usual and customary cost of those services by a total of
$1,475.46; and
2) the affidavit of Edward Le Cara, D.C., who challenged charges
totaling $3,465 of Synergy Sports Rehabilitation’s services.
Both Guitreau and Le Cara attested that the remaining costs
reflected in the initial affidavits from LifeSciences and Synergy were
reasonable and necessary. After receiving the counteraffidavits, Ortiz
supplemented her disclosures by designating Guitreau and Le Cara as
expert witnesses, attaching and incorporating the two counteraffidavits.
During the pretrial hearing, Nelapatla objected to the admission
of Ortiz’s medical-cost affidavits from LifeSciences and Synergy as
evidence. He argued that because he countered the reasonableness and
necessity of her costs from those providers, Ortiz was required to
support the costs with expert testimony. Ortiz disagreed, claiming that
the uncontroverted portions of the affidavits were still admissible and
that she was not required to present other evidence to prove the
reasonableness and necessity of those uncontroverted charges. The trial
court sustained Nelapatla’s objection, determining that once a
counteraffidavit is served as to a medical-cost affidavit, all costs
discussed in that affidavit must be supported by expert testimony at
trial. Ortiz then attempted to submit the counteraffidavits on the
ground that she had designated Guitreau and Le Cara as expert
3
witnesses. The trial court refused, stating that the counteraffidavits
were hearsay.
At trial, Ortiz submitted her bill for $2,210 in services from
Addison Interventional Pain along with the uncontroverted affidavit
without objection. She then again attempted to submit her bills and
affidavits from LifeSciences and Synergy. Nelapatla objected, and the
trial court sustained the objection as to both bills and affidavits. Ortiz
offered no other evidence of her medical costs from LifeSciences or
Synergy.
The jury found for Ortiz and awarded her $2,210 in past medical
expenses. The trial court rendered judgment on the jury’s verdict. Ortiz
moved for a new trial on damages, arguing that the trial court erred by
excluding Ortiz’s evidence of the cost of her medical treatment from
LifeSciences and Synergy in its entirety because Nelapatla’s
controverting affidavits challenged only portions of each affidavit.
Ortiz’s motion was overruled by operation of law, and she appealed.
The court of appeals affirmed. 711 S.W.3d 1, 9 (Tex. App.—Dallas
2023). It noted Chapter 18’s statement that a medical-expense affidavit
is sufficient evidence of the reasonableness and necessity of the expenses
noted therein “‘[u]nless’ a compliant counteraffidavit is served.” Id. at 5
(quoting TEX. CIV. PRAC. & REM. CODE § 18.001(b)). And a
counteraffidavit is compliant when it is “made by a person who is
qualified . . . to testify in contravention of all or part of any of the
matters contained in the initial affidavit.” Id. (alteration in original)
(emphasis omitted) (quoting TEX. CIV. PRAC. & REM. CODE § 18.001(f)).
Because Nelapatla’s counteraffidavits were made by qualified persons,
4
the court held, they were compliant and therefore rendered Ortiz’s
affidavits insufficient on their own to establish the reasonableness and
necessity of her LifeSciences and Synergy expenses. Id. (citing In re
Chefs’ Produce of Hou., Inc., 667 S.W.3d 297, 301 (Tex. 2023) (“In the
face of a compliant counteraffidavit, the [plaintiff] may not reach the
jury on the reasonableness and necessity of her medical expenses
without expert testimony.”)).
The court of appeals also held that the trial court properly refused
to admit Nelapatla’s counteraffidavits into evidence. Id. at 8. Noting
that affidavits are generally “inadmissible hearsay . . . without
probative force,” id. (quoting Lewallen v. Hardin, 563 S.W.2d 356, 357
(Tex. App.—Dallas 1978, no writ)), and that Nelapatla served the
counteraffidavits to “give reasonable notice of the basis on which
[Nelapatla] intend[ed] at trial to controvert the claim reflected by the
initial affidavit,” id. (quoting TEX. CIV. PRAC. & REM. CODE § 18.001(f)),
the court held that Ortiz was required to introduce expert testimony to
prove the reasonableness and necessity of her medical expenses and
5
costs at trial and could not simply rely on the counteraffidavits to do so,
id. 1 Ortiz then petitioned this Court for review. 2
II. Analysis
Ortiz argues that the trial court abused its discretion by refusing
to admit the Section 18.001 affidavits and counteraffidavits. Generally,
rulings on the admissibility of evidence are reviewed for abuse of
discretion. Whirlpool Corp. v. Camacho, 298 S.W.3d 631, 638 (Tex.
2009) (citing Helena Chem. Co. v. Wilkins, 47 S.W.3d 486, 499 (Tex.
2001)). Excluding evidence “without a valid legal basis” is an abuse of
discretion. In re Allstate Indem. Co., 622 S.W.3d 870, 882 (Tex. 2021).
That a party seeking to recover its past medical expenses must
prove that the amounts paid or incurred are reasonable “has long been
well-settled.” In re K & L Auto Crushers, LLC, 627 S.W.3d 239, 249
(Tex. 2021) (citing Dall. Ry. & Terminal Co. v. Gossett, 294 S.W.2d 377,
380, 383 (Tex. 1956)); see TEX. CIV. PRAC. & REM. CODE § 41.0105 (“In
addition to any other limitation under law, recovery of medical or health
care expenses incurred is limited to the amount actually paid or incurred
1 The court of appeals further held that Ortiz failed to preserve her issue
on the trial court’s exclusion of Nelapatla’s supplemental disclosure responses
designating Guitreau and Le Cara as experts, which incorporated the
counteraffidavits by reference. 711 S.W.3d at 9. Ortiz offered the
supplemental responses during her offer of proof, after the close of evidence.
Because Ortiz failed to obtain a ruling before the parties rested, the court of
appeals held that she had not preserved her complaint. Id. Ortiz did not
challenge that holding in this Court.
2 This Court received two amicus briefs in support of Ortiz—one from
the Texas Trial Lawyers Association and one from two attorneys who practice
personal injury law—and one amicus brief in support of Nelapatla from the
Texas Association of Defense Counsel.
6
by or on behalf of the claimant.”). Before Section 18.001’s enactment,
reasonableness of medical expenses could be proven only by expert
testimony “even if the amount [wa]s undisputed.” Allstate, 622 S.W.3d
at 876; see House Comm. on Judiciary, Bill Analysis, Tex. H.B. 540, 66th
Leg., R.S. (1979) (noting that under Texas law, prior to Section 18.001’s
predecessor, “an injured party in a civil action must offer testimony that
any expenses incurred have been reasonable and necessary, even if the
opposing party offers no testimony to the contrary”). The Legislature
created Section 18.001 to “streamline” that process by allowing a party
“to avoid adducing expert testimony on those issues at trial” through
pretrial service of affidavits containing evidence sufficient to support the
claimed costs. Allstate, 622 S.W.3d at 881 (quoting Haygood v.
De Escabedo, 356 S.W.3d 390, 397 (Tex. 2011)).
To avail himself of the Section 18.001 procedure, a party must
serve an affidavit made by a medical-service provider or recordkeeper
testifying that “the amount a person charged for a service was
reasonable at the time and place that the service was provided and that
the service was necessary.” TEX. CIV. PRAC. & REM. CODE § 18.001(b),
(c)(2). The affidavit must include an itemized statement of the service
and charge. Id. § 18.001(c)(3). When an affidavit is served in accordance
with Section 18.001(d), it may be offered into evidence at trial, id.
§ 18.001(d-1), (d-2), (e-1). And “[u]nless” the other party serves a
controverting affidavit, the initial affidavit and accompanying itemized
statement are “sufficient evidence to support a finding of fact by judge
or jury that the amount charged was reasonable or that the service was
necessary.” Id. § 18.001(b); see Chefs’ Produce, 667 S.W.3d at 301 (“An
7
uncontroverted affidavit under Section 18.001(b) is sufficient evidence—
but not conclusive—that medical expenses are reasonable and
necessary.”).
However, when a counteraffidavit challenges a medical expense
in accordance with Section 18.001(e), the affidavit is no longer sufficient
evidence to support a finding of reasonableness and necessity as to the
controverted amount. TEX. CIV. PRAC. & REM. CODE § 18.001(b) (“Unless
a controverting affidavit is served as provided by this section, an
affidavit . . . is sufficient evidence to support a finding of fact by judge or
jury that the amount charged was reasonable or that the service was
necessary.”). Rather, expert testimony is required to support such a
finding. See Chefs’ Produce, 667 S.W.3d at 301 (“In the face of a
compliant counteraffidavit, the claimant may not reach the jury on the
reasonableness and necessity of her medical expenses without expert
testimony.”).
Moreover, a controverted affidavit is no longer admissible
evidence to support a finding of reasonableness and necessity as to the
controverted amount because controverting the amount effectively
wipes the pretrial-admission slate clean as to that amount. Under
Section 18.001, affidavits that would otherwise be inadmissible hearsay
are now admissible. See TEX. R. EVID. 802 (“Hearsay is not admissible
unless [a statute] provides otherwise . . . .”); Allstate, 622 S.W.3d at 882
(stating that Section 18.001 “allows claimants to introduce evidence of
reasonableness and necessity through affidavits that would otherwise
8
be hearsay”). 3 However, when an affidavit is controverted in accordance
with Section 18.001(f), the statute is no longer available to expedite
proof of the challenged matters or to provide an exception to the rule
against hearsay.
A counteraffidavit may controvert an entire itemized statement
of services and charges—or, as demonstrated by this case, affidavits may
sometimes be partially controverted. 4 For example, when a
counteraffiant challenges a claim in an initial affidavit, he may
challenge “all or part of any of the matters” as to which the claim is
made: the necessity of a service or part of a service, the reasonableness
of a cost or part of a cost, or both the necessity and reasonableness of an
itemized service charge. TEX. CIV. PRAC. & REM. CODE § 18.001(f). And
3 One of the great hazards of hearsay is that it does not afford the
opposing party the opportunity to challenge the statements. See Williamson
v. United States, 512 U.S. 594, 598 (1994) (“The hearsay rule . . . is premised
on the theory that out-of-court statements are subject to particular
hazards. . . . And the ways in which these dangers are minimized for in-court
statements—. . . most importantly, the right of the opponent to
cross-examine—are generally absent for things said out of court.”). Section
18.001 provides that opportunity to the party challenging the original affidavit
by allowing him to file a counteraffidavit, as well as to the claimant by
requiring the counteraffidavit to “give reasonable notice of the basis on which
the party serving it intends at trial to controvert the claim reflected by the
initial affidavit.” TEX. CIV. PRAC. & REM. CODE § 18.001(f).
4 Indeed, medical bills can and often do contain many services and
charges. See id. § 18.001(c)(3) (requiring the affidavit to include an itemized
statement). Section 18.001 contemplates that an opposing party can
controvert the costs and services in the statement item by item. The statute
permits a controverting party to challenge “a claim reflected by the [initial]
affidavit” and requires a counteraffiant to be qualified “to testify in
contravention of all or part of any of the matters contained in the initial
affidavit.” Id. § 18.001(e), (f) (emphases added).
9
when a counteraffidavit controverts a claim in the initial affidavit, that
claim is no longer supported by sufficient evidence through the
Section 18.001 procedure. Id. § 18.001(b).
While a compliant counteraffidavit that controverts only a portion
of the charged amounts renders the initial affidavit insufficient as to any
controverted claims, it does not render the entire affidavit
inadmissible. 5 In fact, the statute makes repeated reference to offering
both the initial affidavit and the counteraffidavit into evidence. See id.
§ 18.001(d-1) (referencing “the party offering the affidavit in evidence”),
(d-2) (same), (e-1) (referencing “the party offering the affidavit in
evidence” and “the party offering the counteraffidavit in evidence”), (g)
(referencing “the party offering the counteraffidavit in evidence”). And
the statute anticipates that portions of an itemized bill or statement
may be redacted or otherwise not presented to the jury. See id.
§ 18.002(b-2) (“If a medical bill or other itemized statement attached to
an affidavit . . . reflects a charge that is not recoverable, the reference to
that charge is not admissible.”).
5 In holding otherwise, the court of appeals placed significant emphasis
on our statement in Chefs’ Produce that “‘[i]n the face of a compliant
counteraffidavit, the [plaintiff] may not reach the jury on the reasonableness
and necessity of her medical expenses without expert testimony.’” 711 S.W.3d
at 5 (quoting Chefs’ Produce, 667 S.W.3d at 301). Although the
counteraffidavit in Chefs’ Produce challenged only portions of the plaintiff’s
medical costs, the issue there was whether the entire counteraffidavit should
be stricken for including an improper challenge to causation. 667 S.W.3d at
300. We held it should not be. In so holding, we indicated that the portion that
improperly challenged causation remained inadmissible. Id. at 302. Nothing
in Chefs’ Produce compels the conclusion that the admissibility of affidavits
and counteraffidavits cannot be determined at a claim-by-claim level.
10
As a practical matter, a claimant served with a compliant
counteraffidavit controverting the reasonableness and necessity of only
a portion of the claimed medical costs has a few options. First, he may
choose to opt out of the Section 18.001 scheme altogether and seek to
recover the claimed costs by providing expert testimony at trial. See
Chefs’ Produce, 667 S.W.3d at 301 (“[T]he claimant may not reach the
jury on the reasonableness and necessity of her medical expenses
without expert testimony.”). Or the claimant may continue to rely on
Section 18.001 as to the uncontroverted claims and provide expert
testimony to support the controverted claims. Finally, the claimant
could choose not to offer expert testimony as to the controverted claims,
thereby abandoning recovery on those claims. But while it is a
claimant’s prerogative to rely on a partially controverted affidavit, if he
chooses to do so, he must redact the controverted costs and the
statements in the affidavit regarding the reasonableness and necessity
of those costs; those portions are inadmissible because Section 18.001 no
longer excepts them from the general hearsay rule.
In this case, no one disputes that Ortiz properly filed three
Section 18.001 affidavits and that Nelapatla filed two statutorily
compliant counteraffidavits controverting claims made in two of Ortiz’s
affidavits. And no one disagrees that the claims controverted by the
counteraffidavits were not supported by sufficient evidence absent
expert testimony adduced at trial. The questions before us now are
whether Ortiz was nevertheless permitted to “offer[] the affidavit[s] in
evidence” despite their being partially controverted, id. § 18.001(d-1),
(d-2), (e-1), and whether the counteraffidavits were likewise admissible,
11
to support a finding that the uncontroverted amounts were reasonable
and necessary. The courts below said no. We disagree. Applying the
principles outlined above, we hold that the trial court erred by refusing
to admit Ortiz’s affidavits in their entirety solely because Nelapatla
served counteraffidavits challenging only some of the matters therein.
Ortiz should have been permitted to submit the uncontested portions to
the jury.
How Ortiz may have properly presented the uncontroverted
portions of her Section 18.001 affidavit at trial, however, presents
practical issues. Nelapatla’s two counteraffidavits controverted Ortiz’s
initial affidavits in different ways. The Le Cara counteraffidavit
partially controverted Synergy’s itemized statement by disputing the
medical necessity of some of the services. It did not challenge the
necessity of other services provided or the reasonableness of their costs.
Ortiz’s initial affidavit and the attached itemized statement are
therefore evidence that would be sufficient to support a finding of
reasonableness and necessity as to the uncontested items, and the
affidavit and those portions of the itemized statement that were
uncontroverted should have been admitted.
However, the portions of the affidavit and statements relating to
the controverted claims are hearsay that may not be presented to the
jury. Ortiz could have appropriately redacted the controverted services
and accompanying charges in the statement on an item-by-item basis
and submitted the redacted statement to the jury. The affidavit and
unredacted portions of the statement would be sufficient evidence of the
uncontroverted claims’ reasonableness and necessity.
12
The Guitreau affidavit, however, controverted all six charges
reflected in the LifeSciences affidavit. Although it did not dispute the
necessity of the six services reflected in the statement, the
counteraffidavit challenged the reasonableness of part of each of the six
accompanying charges. 6 The portions of the initial affidavit and
itemized statement demonstrating that the services were necessary was
thus admissible and sufficient evidence as to the necessity of those
services. But because the reasonableness of each charge was contested,
Ortiz’s affidavit was inadmissible as to the reasonableness of those
charges.
Rather than provide expert testimony, Ortiz attempted to prove
the reasonableness of the uncontroverted amount of each charge
through Guitreau’s counteraffidavit, which laid out what portion of each
cost she attested was reasonable. The trial court denied admission of
the counteraffidavit on the ground that it was hearsay. This was error.
As we have stated, Section 18.001 provides for the admission of evidence
that otherwise would be inadmissible hearsay. Allstate, 622 S.W.3d at
6 Guitreau testified that:
- For two charges of $2,200.00, $1,647.72 of each charge was
reasonable;
- For a $250 charge, $129.56 of the charge was reasonable;
- For another $2,200.00 charge, $2,090.00 of the charge was
reasonable;
- For another $2,200.00 charge, $2,111.51 of the charge was
reasonable; and
- For a final $2,200.00 charge, $2,148.03 of the charge was
reasonable.
13
881–82; see TEX. R. EVID. 802. Section 18.001 treats both affidavits and
counteraffidavits as admissible evidence; it expressly contemplates both
affidavits and counteraffidavits being offered into evidence. 7 See TEX.
CIV. PRAC. & REM. CODE § 18.001 (d-1), (d-2), (e-1), (g). As a general
matter, of course, counteraffidavits contest the reasonableness of
expenses; those counteraffidavits are, for obvious reasons, not
admissible to prove that the expenses are reasonable. However, when,
as here, a counteraffidavit affirmatively attests to what portion of the
expense is reasonable, the counteraffidavit is admissible to support
those claims. 8
As a final point, we note that the statute repeatedly references a
“party” offering a counteraffidavit, see id. § 18.001(d-1), (d-2), (e), (e-1),
rather than a “defendant,” further supporting the conclusion that a
claimant may offer a counteraffidavit into evidence. Had the
Legislature intended for counteraffidavits to be admissible only when
offered by a defendant to controvert claims, it could have specified as
much. Indeed, “defendant” is specifically referenced elsewhere in
7 Ortiz argues that the counteraffidavits are excluded from the
definition of hearsay because they are admissions by a party-opponent. See
TEX. R. EVID. 801(e)(2). She need not rely on that exclusion, however, because
the statute itself provides for their admissibility.
8 Le Cara similarly attested to the reasonable portion of the Synergy
charges, stating that the “[t]otal of reasonable and necessary chiropractic bills
at usual and customary fees [sic] was $2,950.” Accordingly, that portion of the
Le Cara counteraffidavit would be admissible to support the reasonableness
and necessity of the Synergy charges in that amount even if redaction of the
initial affidavit and accompanying statements proves unworkable.
14
Section 18.001 but not when discussing submission of a counteraffidavit
into evidence. See id. § 18.001(d)(1), (d-1), (e)(1).
In sum, if a claimant chooses to rely on Section 18.001 after being
served with partially controverting counteraffidavits rather than
present expert testimony, he may submit the unchallenged portions of
the initial affidavit—as well as, when appropriate and necessary,
portions of the counteraffidavit—to support the reasonableness and
necessity of the uncontroverted matters. Further, the uncontroverted
claims in the initial affidavit and accompanying medical bill or
statement, along with the counteraffidavit attesting to their
reasonableness and necessity, are sufficient evidence as to those
uncontested amounts. Id. § 18.001(b). In such a case, if the jury awards
past medical expenses, it can award—at most—an amount equal to the
uncontroverted charges, as anything beyond that amount is
unsupported by legally sufficient evidence. If the jury awards an
amount greater than the total uncontroverted amount, remittitur would
be appropriate.
We need not decide here all the ways a claimant may attempt to
admit evidence of uncontroverted medical expenses. And nothing in this
opinion calls into question the premise that a properly controverted
claim cannot be proven by affidavit alone and must be supported by
expert testimony. We do hold, however, that both partially controverted
affidavits and counteraffidavits may be admissible evidence, and the
trial court abused its discretion by excluding them.
In this case, the excluded Synergy affidavit and accompanying
itemized statements, along with the Le Cara counteraffidavit,
15
constituted admissible evidence that certain services Ortiz received
from Synergy were necessary and their cost of $2,950 was reasonable.
The LifeSciences affidavit and accompanying itemized statements,
taken together with the Guitreau counteraffidavit, constituted
admissible evidence that all the services Ortiz received from
LifeSciences were necessary and $9,774.54 of the associated costs was
reasonable. When erroneously excluded evidence was crucial to a key
issue, the error is likely harmful. State v. Cent. Expressway Sign
Assocs., 302 S.W.3d 866, 870 (Tex. 2009) (citing Reliance Steel &
Aluminum Co. v. Sevcik, 267 S.W.3d 867, 873 (Tex. 2008)). Had Ortiz
been permitted to rely on the affidavits and counteraffidavits at trial,
she would have had sufficient, though not conclusive, evidence of these
medical costs. But because she was prevented from relying on the
affidavits, she had no evidence. We therefore hold that the erroneous
exclusion of this evidence was harmful to Ortiz’s ability to recover her
medical costs.
Ortiz asks this Court to render judgment for the additional
$12,724.54 in medical costs reflected in the unchallenged portions of the
LifeSciences and Synergy affidavits. We decline to do so. Again, the
Section 18.001 process provides for the introduction of sufficient, but not
conclusive, evidence. The reasonableness and necessity of the additional
$12,724.54 in medical costs Ortiz seeks is solely within the province of
the factfinder. On remand, Ortiz may attempt to prove the additional
medical costs with the affidavits and counteraffidavits if she chooses,
and Nelapatla may challenge those costs. See Chefs’ Produce, 667
S.W.3d at 301 (“At trial, defendants may still challenge—through
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evidence and argument—a claimant’s assertion that medical expenses
are reasonable or necessary.” (citing Allstate, 622 S.W.3d at 881)).
III. Conclusion
Section 18.001 affidavits may be partially controverted, but a
partially controverted affidavit may not be excluded from evidence in its
entirety solely because portions are controverted. Section 18.001
authorizes claimants to submit uncontroverted evidence, including
counteraffidavits, to the jury to prove the reasonableness and necessity
of their medical costs. We therefore reverse the court of appeals’
judgment and remand to the trial court for further proceedings.
Debra H. Lehrmann
Justice
OPINION DELIVERED: May 1, 2026
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