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 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.

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.

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 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

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, 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—

“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).

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

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 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 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, 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 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

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.

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 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 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

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.”).

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, 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.

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

- 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.

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

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, 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 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