Tatia Ortiz v. Ramu Nelapatla

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
═══════════════════════════════════════

JUSTICE SULLIVAN, dissenting.

With Section 18.001 of the Civil Practice and Remedies
Code, the Legislature opened a limited exception to two general
rules. The first rule is that affidavits are inadmissible hearsay.
The second is that a party needs something more than copies of
medical bills to prove up medical expenses; usually, perhaps
always, that something is expert testimony. Section 18.001 cuts
through both rules, allowing claimants to prove the necessity and
reasonableness of their medical expenses by affidavit—“[u]nless a
controverting affidavit is served.” Tex. Civ. Prac. & Rem. Code
§ 18.001(b) (emphasis added). This case is about the scope of that
italicized exception-to-the-exception.
The unless clause was met here. Ramu Nelapatla served a
controverting affidavit, so Tatia Ortiz was required to follow the
two general rules: she can’t rely on hearsay, and she must submit
more than medical bills. Because Ortiz didn’t have the goods, the
district court didn’t err in refusing to give her a new trial on
damages and preventing her from relying on the hearsay
affidavits.
The Court reads the unless clause differently. Though the
Court concedes that Nelapatla served a controverting affidavit, it
gives great weight to the fact that this counteraffidavit didn’t
controvert every one of Ortiz’s claims. According to the Court, this
means the uncontroverted portions of Ortiz’s affidavits were still
admissible. That may be good policy, but that’s not how I read the
statute. It doesn’t say, for example, that affidavits are admissible
“unless a counteraffidavit is served that contests the affidavit in
full.” Language like that would call for deciding admissibility
claim by claim, not affidavit by affidavit. But the statute speaks
of the admissibility of “affidavits,” not of claims.
I agree with the Court that this system doesn’t make a great
deal of sense. Section 18.001’s all-or-nothing approach creates
strange results. A defendant need only contest a single dollar or
line item in a medical bill to force his opponent to spend untold

2
sums on experts defending the entire affidavit, even if most of the
claims contained in the affidavit are uncontroverted. That means
juries will have to hear expert testimony about the reasonableness
and necessity of charges that no party contests. It’s also strange
that a plaintiff would be able to rely on Section 18.001 if they filed
a different affidavit for each charge, and the defendant
controverted only one of them. But it’s not our role to repair a
statutory scheme the Legislature has built. Our task is to apply
the text as written, and the statute withdraws the hearsay
exception “to an affidavit” if it’s controverted—not a “claim” or a
“part” or a “matter.” Reluctantly and respectfully, I dissent.

I

To understand why Section 18.001 exists, it helps to put it
in historical context. Since time out of mind, we’ve said that it’s
not enough for plaintiffs to submit their medical bills. To prove
that the medical services rendered were reasonable and necessary,
something more is required. See Dall. Ry. & Terminal Co. v.
Gossett, 294 S.W.2d 377, 383 (Tex. 1956); Wheeler v. Tyler Se. Ry.
Co., 43 S.W. 876, 877 (Tex. 1898); Hou. E. & W. Tex. Ry. Co. v.
Jones, 1 S.W.2d 743, 748–49 (Tex. App.—Beaumont 1927, writ
ref’d). More recently, we’ve gone so far as to suggest that only one
form of evidence will suffice: expert testimony. See In re Allstate
Indem. Co., 622 S.W.3d 870, 876 (Tex. 2021) (citing Hong v.

3
Bennett, 209 S.W.3d 795, 801 (Tex. App.—Fort Worth 2006, no
pet.)).1
With that background in mind, the need for Section 18.001
is clear. Proving one’s medical expenses is not always easy, and
we’ve only made it more difficult over time. Section 18.001

1 The expert requirement described in Allstate is probably dicta. At
issue there was whether a counteraffidavit complied with Section 18.001(f).
622 S.W.3d at 877. Because we decided only what was necessary to satisfy
Section 18.001, any discussion of what the plaintiff would’ve needed to prove if
Section 18.001 didn’t apply was dicta. See Fed. Sign v. Tex. S. Univ., 951
S.W.2d 401, 406 (Tex. 1997).
Dicta or no, it seems to me that Allstate was probably wrong. Our aside
in that case was offered with little to no explanation, citing only a court of
appeals opinion, with no rationale for why that court was right that expert
testimony was always required. See 622 S.W.3d at 876 (citing Hong, 209
S.W.3d at 801). True, we’ve previously said that expert testimony may at least
sometimes be necessary to determine medical expenses. See, e.g., Texarkana
Mem’l Hosp., Inc. v. Murdock, 946 S.W.2d 836, 841 (Tex. 1997); Gunn v. McCoy,
554 S.W.3d 645, 672 (Tex. 2018). But our earlier cases never said that expert
testimony was required as a matter of law. At most, each indicated that
because the issues were complex and beyond the ken of a lay juror, experts
were necessary in that particular case. See Texarkana Mem’l. Hosp., 946
S.W.2d at 841 (requiring expert testimony about meconium aspiration).
There’s nothing magical about medical treatments; damages issues outside the
personal-injury context may also be so complex as to render expert testimony
necessary. Surely a jury can decide whether $400 spent to set a broken arm
was reasonable and necessary without hearing from an expert.
A rule like that might so intrude on the jury’s exclusive function as the
finder of fact as to raise constitutional problems. Cf. Stephens v. State, 774
P.2d 60, 67 (Wyo. 1989) (“A clear delegation of the decision of the jury to the
expert witnesses surely would deprive a defendant of his constitutional rights
to a jury trial.”), overruled on other grounds by Large v. State, 177 P.3d 807
(Wyo. 2008). While I’m open to contrary originalist research, I doubt that
experts were required to recover medical expenses in 1876 when we adopted the
twin civil jury-trial rights. See Tex. Const. arts. I, § 15, V § 10. This issue is not
presented in this case, so I do not suggest that the Court ought to reach it here.

4
provides a (potentially) less complicated avenue to prove these
expenses. Section 18.001(b) allows a claimant to provide an
uncontroverted affidavit that 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.” Tex. Civ. Prac. &
Rem. Code § 18.001(b). The statute further allows a non-claimant
to serve a counteraffidavit to challenge “all or part of any of the
matters contained in the initial affidavit.” Id. § 18.001(f ). If they
do so, “the claimant may not reach the jury on the reasonableness
and necessity of her medical expenses.” In re Chefs’ Produce of
Houston, Inc., 667 S.W.3d 297, 301 (Tex. 2023) (per curiam). This
is consistent with the text of Subsection (b), which says that an
affidavit may be sufficient evidence, “[u]nless a controverting
affidavit is served as provided by this section.” Tex. Civ. Prac. &
Rem. Code § 18.001(b) (emphasis added).

II

The plain text of this statute does not allow partial
admission of partially controverted affidavits. Section 18.001 says
that medical damages affidavits are admissible “unless a
controverting affidavit is served as provided by this section.” Id.
In other words, the Section 18.001 exception to hearsay doesn’t
apply if the affidavit is controverted.
The Court says things aren’t so simple. It reasons that
Section 18.001’s exception-to-the-exception does not operate on the

5
affidavit as a unit, but on the discrete “matters” and “claims”
embedded within it. Because the statute permits a
counteraffidavit to be made “in contravention of all or part of any
of the matters contained in the initial affidavit,” the Court reasons
that a compliant counteraffidavit disables the statutory hearsay
exception only for those “parts” that the counteraffidavit actually
reaches. From that premise, the Court constructs an item-by-item
admissibility regime: Where a defendant’s expert contests only
certain services, line items, or components of the affidavit’s
attestation, the affidavit remains admissible as to everything the
counteraffidavit left untouched.
The Court puts great weight on Subsection (f ), which
requires the 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(f ) (emphases added). But
Subsection (f ) speaks to a different issue than Subsection (b). If
anything, Subsection (f ) undermines the Court’s argument
because it shows that the Legislature knew how to differentiate
between an “affidavit” and the “claims” or “matters” as to which
the affidavit opines. If the Legislature wanted the Court’s
preferred result, all it would have to do is swap the word “affidavit”
for one of these narrower terms. Subsection (b) instead uses the
broader term, which means that courts must consider Section

6
18.001’s applicability affidavit by affidavit, not claim by claim (or
matter by matter).
But don’t take my word for it. A few years ago, we described
what happens when a party files a compliant counteraffidavit: “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. In effect, the claimant’s
evidentiary burden on that issue is the same as if the initial
affidavit had never been served.” Chefs’ Produce, 667 S.W.3d at
301. Moreover, the counteraffidavit in Chefs’ Produce challenged
only portions of the plaintiff’s medical costs, so this language was
no mere throwaway line. The Court insists that “[n]othing in
Chefs’ Produce compels the conclusion that the admissibility of
affidavits and counteraffidavits cannot be determined at a claim-
by-claim level.” Ante at 10 n.5. I don’t see any other way of reading
our opinion in Chefs’ Produce.
To be sure, it seems unfair (and a bit bizarre) that a
defendant could frustrate Section 18.001’s application to a million-
dollar claim by controverting a single penny from each affidavit.
But we’re in the law business, so our job is “to apply the statute as
it is written—even if we think some other approach might ‘accor[d]
with good policy.’ ” Burrage v. United States, 571 U.S. 204, 218
(2014) (quoting Commissioner v. Lundy, 516 U.S. 235, 252 (1996)).
And even were we tasked with deciding cases based on efficiency,

7
the Court’s legislative rewrite effects at best a partial cure. Even
on its claim-by-claim reading, all a defendant has to do is partially
controvert each claim. It’s not too hard to rustle up a so-called
expert who’ll say just about anything in exchange for enough
money. Consider an affidavit that supports claims for three
charges, and a counteraffidavit that says each service exceeded the
usual and customary cost by 10%. Even though 90% of the
damages are uncontroverted, the Court’s approach would still
require expert testimony as to every claim.
Indeed, a claim-by-claim approach could easily yield its own
absurdities. Plaintiffs may well respond to the Court’s opinion by
making each “claim” as granular as possible. Instead of
submitting a single bill for surgery, plaintiffs could ask their
medical provider to split up the bill into many tiny pieces: one for
pre-operative consultations, one for the surgery itself, another for
any medications received while in inpatient care, another for
painkillers purchased from a pharmacy, one for the first four
weeks of physical therapy, and another for the rest of the physical
therapy (perhaps with a new provider to make the game less
obvious). Nothing in the statute (or the Court’s opinion) describes
the proper level of generality at which to define a claim, and so
nothing prevents plaintiffs from getting as granular as possible.
The defendant, in turn, will have to follow the Pokémon creed—

8
“gotta catch ’em all.”2 If one claim (however narrowly defined) isn’t
controverted (even just a little), then the plaintiff can use the
Section 18.001 procedure.
There are a variety of plausible policies, each with their own
pros and cons. One, of course, is to go claim-by-claim like the Court
suggests. Perhaps better still would be something analogous to
how insurance disputes work. Under such a system, the jury could
award the uncontroverted amount but no more absent expert
testimony. So even if the defendant found a way to flyspeck every
claim, if it could find an expert willing to controvert only 30% of
the total damages figure, the plaintiff could recover only 70%
without an expert. Or the Legislature could do away with the
requirement for expert testimony altogether (assuming such a
requirement exists). Or maybe we could go halfway there and only
get rid of the requirement for certain types of claims (does a jury
really need to hear from a $1000-an-hour expert to decide that a
$400 bill for setting a broken arm was reasonable?). Or perhaps
the Legislature could conclude that the statute it passed struck
exactly the right balance between fairness and administrability,
and that it’s better to have parties abide by the default rules
whenever reasonableness or necessity are controverted.

2 Pokémon Theme (CD, Robbins Entertainment, Oct. 26, 1999).

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But however interesting these debates are, they don’t really
matter. Because what matters to me is that the Legislature
decided, not that it decided correctly, I respectfully dissent.

James P. Sullivan
Justice

OPINION FILED: May 1, 2026

10

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,

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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.

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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.

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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.

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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

16
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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