Determining and Documenting the Extent of the Injury
John D. Hadden
The following paper was prepared for a seminar sponsored by the National Business Institute. It was intended for use only by Georgia-licensed attorneys and should not be relied upon as legal advice.
“Always salt down the facts first; the law will keep."
Erickson v. Starling, 235 N.C. 625, 71 S.E.2d 384 (1952) (Ervin, J., citing his father)
Among the most crucial aspects of personal injury litigation is the timely preservation of evidence for use at trial. Although a party can rarely control the state of the law to be applied to its case, the existence and preservation of evidence is largely a factor of the parties' diligence in the early stages of a case. This is true both of liability evidence–that which demonstrates fault for the injury–and damages evidence, which is critical to a plaintiff seeking fair compensation for injuries at trial.
How can an attorney help ensure appropriate medical care for a client?
Aside from substantive considerations of preserving, documenting, and analyzing the medical evidence in a case, the question of how a client should obtain medical treatment and evaluation merits a brief discussion. The reality is that many individuals have no health insurance, and therefore face difficulties obtaining proper medical treatment. While hospital emergency departments must generally accept all patients, those departments typically provide only the necessary treatment to stabilize a life-threatening or other serious medical condition, providing the patient with a referral to another physician upon discharge.
The practice of some attorneys to routinely have clients treated (or evaluated) by certain doctors or other medical providers potentially opens the door to the defense using this fact to attack the credibility of the medical professional at trial, even where the professional's qualifications and skills are top-notch. But where the client is uninsured, the options are unfortunately far more limited than those for a client with access to a network of physicians. In some cases, doctors are willing to treat on a “lien” basis (sometimes memorialized under written “letter of protection” signed by the client, the attorney, or both), where the doctor will be paid out of the proceeds of settlement. In such situations, attorneys must be mindful of Rule 1.15 (I) of the Georgia Rules of Professional Conduct, which requires attorneys to properly safeguard the proceeds of a claim where a third party has a legitimate legal interest in them. This may be true even where the attorney never signed an agreement with the provider, and even if the client expressly forbids the attorney to pay the provider.
Where physicians are unwilling to provide treatment on a lien basis directly, it is sometimes possible to obtain funding through a third-party company that either provides a loan to the client directly for payment to the medical provider, or else has a contract with various providers allowing the client to seek treatment, paid for by the third-party funding company, that is to be paid back at the conclusion of litigation. The benefits and downsides to both liens and third-party funding should be considered carefully and discussed with the client before entering into any such agreement.
Where a client simply needs a medical evaluation in order to assist with the litigation, at least one other option, albeit a somewhat rarely-used one, is available. Under the Georgia Rules of Professional Conduct, attorneys can personally pay for some medical evaluations as part of litigation costs advanced. These allowable payments are strictly limited to medical services sought for the purpose of diagnosis and do not include the client's routine medical treatment. While it may be true that few attorneys are able or willing to pay for medical diagnostic expenses out of pocket, this does present another option in obtaining appropriate documentation of an injury.
The remainder of this paper will examine some of the issues and decisions the plaintiff's lawyer can expect to face with respect to the development of damages evidence in personal injury cases. It is important to remember that liability for a victim's medical damages are largely “fixed” at the time of the injury, barring a later, foreseeable aggravation that could be attributable to the original wrongdoer. The attorney's job therefore, is to uncover and properly document, in conjunction with the client's doctors, friends, and relatives, the true extent of her damages, including the foreseeable consequences of the tortious act.
Temporary or Permanent Injuries?
Unfortunately, the most serious damages claims often involve injuries that will last for the rest of the victim's life. But in many cases, even those that result in serious personal injuries, there are no long-term damages. This does not, of course, mean that the damages may not be extensive. A broken arm or femur, for example, may result in no long-term problems yet still cause extreme physical pain and suffering and considerable mental and emotional suffering, inconvenience, and lost income for an extended period of time. At the same time, less acutely-painful injuries, such as certain knee or back injuries, may become life-long conditions. And certain conditions, even though not permanent, may have effects that last beyond the time-frame of the lawsuit, and therefore require an analysis of at least limited future damages. Therefore, the permanency of an injury should always be considered separately from the immediate implications or severity of the injury.
The law: Tort claimants suffering either temporary or permanent injuries are, of course, entitled to compensation for the resulting medical expenses and lost income as well as the general damages provable at trial. But while temporary injuries are time-limited in the scope of compensability, a victim sustaining a permanent injury can seek damages for future pain and suffering, lost income, and medical expenses for, potentially, the rest of the victim's life.
It is important to understand the level of evidence necessary to warrant a jury's finding of future damages. In Massie v. Ross, the Georgia Court of Appeals held that “[t]o warrant future medical expenses, there must be evidence that the injury will require that future medical attention.” The court then found that the plaintiff's evidence, in the form of doctor testimony, that the plaintiff would “likely require future surgery in order to have a chance at a full recovery” was sufficient to authorize a finding of future medical expenses. It is not always necessary that a doctor testify that such future treatment is “likely,” however, and a verdict awarding future medical expenses based on a physician's testimony that the plaintiff “might even need surgery on her neck if she continued to have neck problems,” based on a chronic condition that could possibly involve re-injury, was held to be sufficient. On the other hand, the Court of Appeals has also held that a physician's testimony that “I think that further studies and/or treatment and/or surgery is indicated” was insufficient to justify future medical costs, as was a doctor's statement placing the possibility of surgery at “50/50.”
A claim for loss of income may also be supported by medical evidence of a permanent or long-term disability preventing employment or reducing a victim's ability to work. Expert testimony regarding permanency of an injury may not be required, however, if a plaintiff can submit sufficient evidence through his or her own testimony:
Contrary to [Defendant's] contentions, expert opinion testimony is not required to establish the permanency of an injury.[Plaintiff] testified that she did not have any problems with her back prior to the incident. However, since the incident, she has experienced pain while sitting for prolonged periods, reaching downward, and upon lifting heavy objects. Based upon this testimony, we conclude that there was sufficient evidence to infer that her injuries, particularly her back injury, would result in some permanent impairment.
With respect to ongoing and future pain and suffering, the law does not allow a lay witness, including a plaintiff, to testify about whether his injuries are permanent. But the plaintiff may testify about “his feelings, pains and symptoms, as well as to all of the characteristics of the injury, external and internal,” and the jury may conclude permanency based on this testimony. The award would then be based on the jury's enlightened conscience. A jury contemplating an award of future damages based on permanent injuries may refer to the mortality tables contained in the appendix to Title 24 of the Official Code of Georgia. Juries may also consider “evidence pertaining to the person's health, habits, surroundings, and method of living” in determining life expectance.
Practical considerations: Determining whether injuries are temporary or permanent is a crucial part of evaluating the claimant's damages but is often difficult, especially where the client lacks either health insurance or a doctor willing to give an opinion on whether an injury is connected with a tortious act. Unfortunately, an unhelpful doctor may leave no choice but to find other options for medical care such as those discussed earlier in this paper. As the foregoing case law demonstrates, although it is not always necessary to produce expert/physician evidence of permanent injuries, it is hard to imagine a situation where such evidence would not substantially improve the odds of a finding of future damages, particularly given Georgia's adoption of the Daubert standard under O.C.G.A. § 24-7-702 (formerly O.C.G.A. § 24-9-67.1).
Pre-Existing, Recurring, Aggravated Conditions
An injured plaintiff is not foreclosed from pursuing a personal injury claim merely because she had a pre-existing injury that was worsened by a defendant's negligence. In law school, we all learned that under the “egg shell plaintiff” rule, a defendant does not escape liability merely because the plaintiff has a particular propensity toward injury and, as a result, is more injured than might otherwise be expected. It can, unfortunately, be quite difficult to separate out which conditions are pre-existing and which are caused or aggravated by the tortious act. Therefore, while it is always prudent to seek information about prior injuries when investigating a new claim, it is especially important to obtain prior medical records reflecting the extent of a prior condition or injury in order to deal appropriately with the issue in litigation.
A brief summary of the law is set forth below, followed by a discussion of the practical aspects of handling these issues.
The law: The Georgia Court of Appeals addressed the “egg shell plaintiff” issue in the case of AT Systems Southeast, Inc. v. Carnes:
As to the charge on the “egg shell plaintiff,” there was evidence that [the plaintiff] was obese and had circulatory problems and high blood pressure, which could complicate her recovery. It has long been the rule that a tortfeasor takes a plaintiff in whatever condition he finds him. A negligent actor must bear the risk that his liability will be increased by reason of the actual physical condition of the other toward whom his act is negligent.
This rule deals particularly with the scenario where a plaintiff's physical conditions make a subsequent injury more serious or more difficult to treat. Aggravation of a pre-existing condition, on the other hand, involves either a dormant or known condition that is made worse, or made symptomatic, by virtue of subsequent tortious act. To the extent the condition is aggravated or made symptomatic, a tortfeasor may be liable to extent of the aggravation:
The sick or diseased, as well as the healthy, may recover for injuries proximately caused by the negligence of another. The recovery may be not only for those independent of, but also in aggravation of, such sickness or disease. . . . As to injuries received in aggravation of sickness or disease, the charge to the jury should be that recovery would be to the extent the jury finds the infirmity is aggravated by the injury.
Nevertheless, numerous appellate decisions have held that evidence of a pre-existing condition will justify a finding of no subsequent injury, even where there was evidence that a tortious act caused an aggravation or new injury similar to the old one. Such evidence may also support a substantially reduced damages award. Therefore, attorneys must be careful to scour the records for prior injuries, as well as to build a solid case that the tortious act did indeed aggravate the condition.
Practical considerations: Although pre-existing injuries and conditions may result in a reduction of the damages award, with proper preparation and competent medical evidence it should be rare event that a case with a legitimate subsequent injury goes completely uncompensated. In many of the cases where juries have found no damages, the appellate courts have commented on the lack of immediate medical treatment following the tortious act. Although there are certainly cases involving legitimate injuries in which a victim does not receive immediate care, these jury verdicts weigh heavily in favor of careful scrutiny of such cases. Where the medical evidence is only marginal with respect to demonstrating a subsequent injury, a delay in treatment may prove fatal to the plaintiff's case.
While the existence of known pre-existing injuries can be dealt with appropriately in many cases through proper development of evidence of the client's current injury, the presence of unknown (to the plaintiff's attorney) prior injuries presents a potentially far more serious concern. A plaintiff who testifies that she had no prior medical conditions and who is confronted with evidence to the contrary at trial can appear, fairly or not, to be a conscious liar. In many cases, the prior condition is one that the plaintiff either honestly forgot, or didn't believe to be related or relevant. Regardless, jurors cannot be counted on to accept this explanation, and such a revelation at trial may be enormously harmful. Under the current Georgia evidence code, as effective since January 1, 2013, medical records can be introduced under O.C.G.A. §§ 24-8-803(6) and 902(11) and (12) without the need for a testifying records custodian, making is substantially more likely that those records would be admitted at trial to undermine a plaintiff's own history. Under pre-2013 evidence law, plaintiffs often faced impeachment at trial through their own purported statements and histories contained in medical records under the holding of Barone v. Law. Barone remains good law and could be applicable in situations where a defendant has access to authenticated medical records but has not laid a foundation for admission of those records under an appropriate rule. Therefore, counsel should understand the requirements and limitations of that decision to ensure that information is not improperly admitted.
The bottom line is that pre-existing conditions present a difficult, but not insurmountable, obstacle in presenting a damages claim, assuming the client acknowledges the prior condition. A thorough client interview, as well as review of the client's medical records, is vital in such a case.
Present and Future Medical Expenses – What is Reasonable, Customary, and Necessary?
In Georgia courts, O.C.G.A. § 24-9-921 (formerly § 24-7-9) establishes that an injured person or a family member can authenticate and introduce medical records into evidence at trial, and therefore it is not necessary for plaintiffs to present testimony from medical providers in order to make a prima facia claim for those expenses. Medical expenses, to the extent proven, constitute compensable “necessary expenses consequent upon an injury” under O.C.G.A. § 51-12-7. Therefore, with respect to medical expenses incurred up until the time of trial, the plaintiff's job is somewhat simplified. Asserting a claim for future medical expenses, however, requires additional efforts and evidence, as discussed in Section A above.
A plaintiff introducing medical expenses under O.C.G.A. § 24-9-921 must still demonstrate that the expenses were incurred as a result of the defendant's negligence, and a defendant is entitled to a thorough and sifting cross-examination concerning the expenses. An attorney-prepared summary of medical expenses may be admissible under O.C.G.A. § 24-10-1006, but the summary and accompanying testimony must provide sufficient detail to lay a valid foundation connecting the expenses to the defendant's negligence.
A plaintiff introducing medical bills under O.C.G.A. § 24-9-921 faces two primary challenges. First, a defendant can simply argue that the medical expenses introduced were not incurred in connection with the defendant's allegedly tortious act. Second, the defense may allege that the medical expenses were simply not reasonable and necessary.
Are the claimed injuries and bills connected with the defendant's act? With respect to the first issue, the question is whether there is proximate causation for an injury claimed by the plaintiff. Although an injured plaintiff's own testimony regarding the extent of injuries may be given substantial weight (“the testimony of the plaintiff [regarding the existence of pain] may be believed by the jury over that of a whole college of physicians”), in some situations the plaintiff must produce affirmative expert medical evidence, both as to the existence of an injury as well as causation. For example, in Eberhart v. Morris Brown College, the Court of Appeals held that a plaintiff was required to present expert testimony regarding causation for injuries that were claimed to have been present three years after a traumatic event. The rationale for this ruling was that an opinion about whether a condition manifesting itself after that period of time was proximately caused by the initial trauma was not within the common knowledge of a non-expert.
On the other hand, a later decision, Jordan v. Smoot, found the plaintiff competent to testify about the pain she sustained immediately following an automobile collision, as well as about the treatment she received as a result, and the plaintiff was allowed to introduce her own medical bills without the need for expert testimony. In distinguishing Eberhart, the Jordan court explained that
[a] causal connection, requiring expert medical testimony, must be established where the potential continuance of a disease is at issue. However, where, as here, there is no significant lapse of time between the injury sustained and the onset of the physical condition for which the injured party seeks compensation, and the injury sustained is a matter which jurors must be credited with knowing by reason of common knowledge, expert medical testimony is not required in order for a plaintiff to establish a personal injury case sufficient to withstand a defendant's motion for directed verdict.
More recently, in Cowart v. Widener, the Georgia Supreme Court noted that “most 'medical questions' relating to causation are perfectly capable of resolution by ordinary people using their common knowledge and experience, without the need for expert testimony.” In Nixon v. Pierce County School District, the Court of Appeals applied a seemingly hybrid approach to analyzing the level of evidence required in a case involving a newborn infant's stroke alleged to have been caused by an automobile collision during pregnancy. Although the expert could not testify to a reasonable degree of medical certainty that causation was present, the court found sufficient evidence presented considering the totality of the evidence:
The expert concluded that it was entirely possible that the trauma inflicted on Nixon and the baby during the bus accident proximately caused Kylee's stroke. Though this testimony, standing alone, is not sufficient to overcome summary judgment, it creates a jury issue when considered in conjunction with evidence that (1) Nixon experienced a normal and healthy pregnancy with no complications prior to being involved in a serious accident (i.e., one in which her economy-sized sedan was struck from behind with considerable force by a school bus); and (2) the accident fell squarely within the time frame that the expert opined the stroke was suffered and Nixon had not been involved in any other accidents during her pregnancy.
From these opinions, a few general principles emerge. First, if there is a significant delay between the traumatic event and the onset of pain, or if a plaintiff contends that the event led to a long-term continuing condition, the courts will likely require some form of expert evidence in order to support causation, although, as noted in Nixon, the level of certainty required of an expert's opinion may be lessened depending on other facts present. Second, even where the onset of an injury is contemporaneous with the traumatic event, expert evidence may be required to explain causation that is beyond the knowledge of lay witnesses and jurors. Examples could include certain brain injuries, toxic chemical exposure, or other injuries that involve complex internal bodily processes. Finally, it is important to note that even where expert testimony on causation is not required, the testimony of a medical professional may still be required to demonstrate the presence of a specific injury. For example, in Jordan, the plaintiff was allowed to testify as to pain experienced following a wreck without the need for any medical professional testimony. But such evidence would almost certainly be required to prove specific conditions such as disc herniations, concussions, muscle injuries, or, in some circumstances, broken bones.
An attorney should also be careful to review a medical bill to ensure that all charges presented are related to the tortious act. In many cases, this will not be a concern since the plaintiff will have treated only for the condition caused by the traumatic event. In some cases, however, patients may be treated for non-related issues while being treated for a traumatic event, in which case those charges should be removed in order to avoid a defendant using the non-related expenses against the plaintiff. It is possible, though, that certain expenses connected with a pre-existing or other condition may be increased, or may not have been incurred at all, but for the necessity of treating the related condition. In such circumstances, the attorney should address these expenses directly and present evidence (either through the plaintiff or, perhaps preferably, a medical professional) that they would not have been incurred if not for the defendant's act. If that evidence is not convincing or the amount of the questionable medical expense is minimal, it may be worth excluding in order to avoid attacks on the plaintiff's credibility and, possibly, the exclusion of the entirety of the bills.
Do the charges constitute “the reasonable value of such expense as was reasonably necessary”? Prior to the enactment O.C.G.A. § 24-9-921's predecessor in 1970, medical bills were considered to be hearsay and required testimony from the appropriate medical provider for admission. As noted above, the procedure has now been substantially simplified, and testimony from a provider is not required either for admission of the documents themselves or to demonstrate that the bills were reasonable. In fact, under the current law, a plaintiff is not even required to produce the actual bills. Testimony of the plaintiff as to the amount of the bills is sufficient, although the bills are almost always produced in practice.
Ultimately, the courts have held that the plaintiff's testimony that the bills were incurred as a result of a defendant's tortious act is sufficient to meet the plaintiff's burden to prove the reasonableness and necessity of the expenses, assuming, however, that the injury was properly proven to be connected with that act in the first place, as discussed above. O.C.G.A. § 24-9-921 expressly permits the defendant “the right of a thorough and sifting cross-examination as to such items of evidence.” Somewhat surprisingly, though, there is little case law discussing situations where the reasonableness of the charges have been challenged. This may be because patients generally have no control over the medical bills charged to them, and the defense would be unlikely to successfully impeach a plaintiff over these issues. Even where a question is raised regarding whether particular bills are connected with the alleged injury at issue in the case, where there are other medical conditions present, an expert is not required to explain which were incurred in connection with the tort at issue. Nothing would appear to prevent, however, a defendant from producing an expert to challenge the reasonableness of, or causation for, the charges, and the plaintiff can certainly produce testimony of his own physicians to confirm the reasonableness of those physicians' own charges as well as those of others. In order to strengthen the case for the reasonableness of a plaintiff's medical expenses, it may be advisable to seek an opinion directly from the treating physician, although it is not uncommon for physicians to be unfamiliar with the billing and accounting areas of their practices.
Using Medical Records to Get an Accurate Assessment
This final section will set forth some further practical points to assist in development of the damages portion of a personal injury case. While the law discussed above is important in analyzing what will ultimately be admitted at trial (as well as determining whether it may be necessary for the client to obtain additional treatment or evaluation), the initial step in virtually any case is compiling an honest and thorough assessment of the client's condition, prognosis, and plan of care.
Initial client intake and assessment: Although practices differ greatly, a written form on which a client (or prospective client) lists all medical providers he or she has seen, both for the injury resulting from the tortious act as well as for any other previous or subsequent treatment, can be an invaluable tool to get a picture of the client's overall medical history. Once such a form is completed, the attorney (or a trusted assistant) can go over all such treatment to determine, first, whether it is reasonably likely that the treatment following the tortious act is related to that act, and, second, to determine whether there are any pre-existing or subsequent intervening injuries or other conditions that could prove to be relevant to the case. Even the most honest client may not immediately remember her entire medical history, however, and it is possible that a prior injury to the same body part at issue in the lawsuit may legitimately evade her memory, at least initially. Therefore, it is important to explain the importance of a thorough disclosure of the client's medical history. Clients may be reluctant to disclose a prior issue if they believe it will affect their claim, so they should be reminded that, while a pre-existing condition may indeed be relevant, it can normally be dealt with. An undisclosed prior injury that is discovered by the defense, though, may be fatal to a claim. The client should be advised that, should the case reach litigation, the defense will conduct comprehensive discovery and most likely find evidence of any prior injury.
Requesting and reviewing medical records: One of the more difficult decisions early in the case is determining how broadly to submit medical records requests. Records of all providers rendering treatment that can be clearly connected with the incident giving rise to the claim should be requested, although where there is ongoing treatment it may be worthwhile to wait until that treatment is concluded. Where there are questions about prior injuries or other pre-existing conditions, it may be prudent to go ahead and request the records reflecting those conditions, since it may be necessary to have those records when it comes time to speak with doctors or develop the case strategy. Although it likely increases costs slightly, it is the author's practice to request that the copies be certified in compliance with O.C.G.A. §§ 24-8-803 (6) and 902 (11) – (12) in order to avoid having to re-request those records in the event they are needed for trial.
Once the records are received, they should be reviewed by the attorney or a very experienced assistant to confirm that there are no problematic issues in them. The review should include making note of references to any facilities or providers that the client failed to mention previously in order to follow up with the client regarding what care was performed there (and, as necessary, requesting records from those facilities/providers). It is helpful to scan and OCR (that is, perform an optical character recognition conversion on) the records. Aside from creating a backup of the records, it will also allow a search of the records to be performed using keywords that might be relevant to the case, including uncovering any prior complaints or treatment on a body part injured due to a tort. In cases where causation or the extent of injury is unclear, or where the attorney is not familiar with the particular injury type or medical terminology, it may pay to have the records reviewed by a nurse consultant or other professional to assist with evaluating the condition.
Consultation with treating physicians and other medical professionals: In many, if not most, cases, a demand can be submitted to a tortfeasor or its insurer without the necessity of consulting with the client's doctors or with other professionals. Nevertheless, care should be taken during the records review and client consultation to ensure that there are not more serious injuries involved than what may be immediately apparent. Unexplained ongoing pain or other conditions may warrant a meeting with the treating doctor. And in some cases, a more definitive statement of causation may be required by an insurance adjuster (or, later on, by a judge or jury), consistent with the principles set forth in the discussions earlier in this paper. Such a consultation will also give the attorney an opportunity to determine whether the testimony of a treating physician alone will be sufficient to prove the case at trial, or whether it will be necessary to bring in another expert. Other medical professionals to be considered at this point could include a doctor or other qualified expert specifically retained to render an opinion on causation, a life-care planner, a rehabilitation expert, or a vocational expert. Where the client is adamant about continuing pain or other issues, and the treating physician cannot, or appears unwilling, to assist in finding a cause, it may be necessary to obtain a second opinion.
Stephen King has described the process of writing as an excavation–the story is always there, waiting for the writer to chisel and sift away the soil to reveal itself to the world. A personal-injury victim's damages are much the same, and it is the attorney's responsibility to carefully analyze and investigate the client's claim to uncover 100 percent of the relevant damages. A thorough understanding of the law and careful study of the client's medical history and progress can ensure that the jury hears the client's full story.
 This is not to suggest that this practice is inappropriate or unethical, and it may present the best option where a client is uninsured and otherwise unable to afford medical treatment. Of course, it would not be in the client's best interest for an attorney to recommend that he be treated by a doctor lacking the appropriate abilities.
 Georgia Rule of Professional Conduct 1.8. According to the comments to this Rule, permissible advancement of costs includes “medical diagnostic work connected with the matter under litigation and treatment necessary for the diagnosis.”
 Massie v. Ross, 211 Ga. App. 354 (1993).
 Id. A discussion of what is sufficient to prove the amount of those expenses is contained in Section C below.
 Food Lion v. Williams, 219 Ga. App. 352 (1995).
 Daugherty v. Vick, 127 Ga. App. 767 (1972).
 Womack v. Burgess, 200 Ga. App. 347 (1991).
 Mote v. Tomlin, 136 Ga. App. 616 (1975). See also Georgia Pattern Jury Instructions (Civil Cases) § 66.201.
 Super Disc. Mkts. v. Coney, 210 Ga. App. 659 (1993) (internal citations and formatting omitted). But see Cone v. Davis, 66 Ga. App. 229 (1941) (lay witness cannot testify as to permanency of injury).
 Everett v. Holmes, 126 Ga. App. 208 (1972).
 Georgia Pattern Jury Instructions (Civil Cases) § 66.503.
 See O.C.G.A. § 24-14-44 and 45.
 See Davis v. Whitcomb, 30 Ga. App. 497 (1923); Georgia Pattern Jury Instructions (Civil Cases) § 66.301.
 AT Sys. Southeast, Inc. v. Carnes, 272 Ga. App. 671, 674 (Ga. Ct. App. 2005) (citing Coleman v. Atlanta Obstetrics & Gynecology Group, 194 Ga. App. 508 (1990) (internal formatting omitted).
 The two types of pre-existing conditions may often overlap.
 Whatley v. Henry, 65 Ga. App. 668 (1941). See also Georgia Pattern Jury Instructions (Civil Cases) § 66.504.
 See, e.g., Fuller v. Flash Foods, Inc., 298 Ga. App. 217 (2009); Henderson v. Yokley, 265 Ga. App. 445 (2004); Butts v. Williams, 247 Ga. App. 253 (2000).
 Anderson v. L & R Smith, Inc., 265 Ga. App. 469 (2004).
 Barone v. Law, 242 Ga. App. 102 (2000). Medical records could also be admitted under the Business Records Exception to hearsay under pre-2013 law, but the requirements for doing so, including requiring a testifying custodian of records, made this a relatively uncommon occurrence.
 This procedure is not available in federal courts in Georgia. Cf. Foradori v. Harris, 523 F.3d 477 (5th Cir. 2008) (discussing federal application of state-law presumption involving reasonableness of medical expenses).
 Eberhart v. Morris Brown College, 181 Ga. App. 516, 352 S.E.2d 832 (1987).
 Atlanta Transit Sys. v. Smith, 141 Ga. App. 87, 232 S.E.2d 580 (1977).
 Hossain v. Nelson, 234 Ga. App. 792, 507 S.E.2d 243 (1998). Under O.C.G.A. § 24-10-1006, the underlying records must be made available, and the court may order their production at trial.
 Notably, however, the law establishes that expert testimony is not required for such a showing.
 Georgia Farm Bureau Mut. Ins. Co. v. Troupe, 154 Ga. App. 108 (1980) (internal quotations omitted).
 Eberhart v. Morris Brown College, 181 Ga. App. 516 (1987)
 Jordan v. Smoot, 191 Ga. App. 74 (1989).
 Id. (internal quotations and citations omitted).
 Cowart v. Widener, 287 Ga. 622 (2010).
 Nixon v. Pierce Cnty. Sch. Dist., 322 Ga. App. 745, 750 (2013).
 For further discussion of causation issues, see Safeway Ins. Co. v. Hanks, 323 Ga. App. 728 (2013); Hutcheson v. Daniels, 224 Ga. App. 560 (1997); Cooper v. Marten Transp., Ltd., 539 Fed. Appx. 963 (11th Cir. 2013). The Cooper case illustrates an important distinction, applicable at least to federal cases, between qualification of an expert to render an opinion and the necessity for such an expert to testify as to causation.
 See, e.g., Lester v. S.J. Alexander, Inc., 127 Ga. App. 470 (1972) (“Where, as here, the submitted bill included without differentiation items having no relevance to the automobile collision, the proffered evidence not only failed to meet the statutory requisites stated in [O.C.G.A. § 24-9-921] but was properly rejected under the rule that testimony offered as a whole without separating the relevant from that which is irrelevant and inadmissible is to be repelled in its entirety.”).
 Zack's Properties, Inc. v. Gafford, 241 Ga. App. 43 (1999) (discussing enactment of medical bill statute in response to exclusion of plaintiff's testimony regarding bills in Taylor v. Associated Cab Co., 110 Ga. App. 616 (1964)).
 Eberhart v. Morris Brown College, 181 Ga. App. 516 (1987).
 Emory Healthcare, Inc. v. Pardue, 328 Ga. App. 664 (2014); Daniel v. Parkins, 200 Ga. App. 710 (1991).
 Hart v. Shergold, 295 Ga. App. 94 (2008) (physician may testify as to reasonableness of other doctors' bills)
 Updated records from a certain date can certainly be requested, though this may increase overall costs slightly due to medical record copy cost schedules.
 This method should not replace a personal review of the records. Aside from possible errors in OCR conversion arising from small print or poor copies or records, which is common, the technology can generally not recognize handwriting, which may constitute a large part of medical records.
 This includes cases where the doctor simply refuses to support a client's claims. In such cases, it is always better to know as early as possible.
 See generally Stephen King, On Writing: A Memoir of the Craft (Scribner 2000).