CROSSOVER: Texas Supreme Court: Partial §18.001 Counteraffidavit Leaves Unchallenged Medical Expenses Admissible Without Live Expert Proof

Ortiz v. Nelapatla, 23-0953, May 01, 2026.

On appeal from Court of Appeals for the Fifth District of Texas

Synopsis

A partial counteraffidavit under Texas Civil Practice and Remedies Code § 18.001 does not wipe out the entire evidentiary value of the plaintiff’s medical-expense affidavit. If the counteraffidavit challenges only specified charges, the unchallenged charges remain competent evidence and may go to the factfinder without live expert testimony on reasonableness and necessity.

Relevance to Family Law

Although Ortiz arises from a personal-injury suit, its evidentiary logic matters in family litigation wherever medical expenses, therapy bills, counseling charges, psychiatric treatment, rehabilitative services, or other health-related expenses are offered to support reimbursement claims, reimbursement-like offsets, needs-based support arguments, or best-interest evidence. In divorce, SAPCR, and modification proceedings, lawyers often confront mixed medical billing records in disputes over uninsured expenses, extraordinary expenses for a child, mental-health treatment, or a spouse’s claimed medical needs; Ortiz gives trial lawyers a strong argument that a targeted challenge should be treated as targeted only, rather than as a basis to exclude the entire category of proof.

Case Summary

Fact Summary

Ortiz sued Nelapatla over injuries allegedly sustained in a parking-lot collision. To establish past medical expenses, she used the streamlined affidavit procedure under Section 18.001 and served affidavits from three providers: Addison Interventional Pain for $2,210, LifeSciences Imaging Partners for $11,250, and Synergy Sports Rehabilitation for $6,415.

Nelapatla did not broadly controvert all of those charges. Instead, he served two counteraffidavits that challenged only portions of the LifeSciences and Synergy bills. His billing expert challenged $1,475.46 of the LifeSciences charges as exceeding usual and customary rates, and his other expert challenged $3,465 of the Synergy charges. Critically, both counteraffidavits effectively left the balance of those provider charges unchallenged.

The dispute arose when the trial court treated those partial counteraffidavits as though they nullified the entirety of Ortiz’s Section 18.001 proof as to those providers. The court excluded the LifeSciences and Synergy affidavits and bills in full unless Ortiz offered live expert testimony. Ortiz tried to rely on the counteraffidavit experts she had designated, but the trial court refused to admit the counteraffidavits themselves, characterizing them as hearsay. With only the Addison affidavit admitted, the jury awarded $2,210 in past medical expenses. The Dallas Court of Appeals affirmed, and the Supreme Court of Texas granted review.

Issues Decided

• Whether a compliant Section 18.001 counteraffidavit that controverts only part of the charges in a medical-expense affidavit destroys the affidavit’s evidentiary effect as to the entire bill or only as to the controverted portion.
• Whether the unchallenged portions of the original medical-expense affidavit remain competent evidence that may be submitted to the factfinder without additional expert testimony.
• Whether the lower courts erred by excluding the provider affidavits in their entirety based on only partial counteraffidavits.

Rules Applied

The Court worked from the text and function of Texas Civil Practice and Remedies Code § 18.001. The statute permits a claimant to offer an affidavit from a provider or records custodian stating that the charged amount was reasonable at the time and place provided and that the service was necessary. If no compliant counteraffidavit is served, that affidavit is sufficient evidence to support a factfinding on reasonableness and necessity.

The Court also relied on the statutory framework allowing a counteraffidavit to controvert “all or part” of the matters contained in the initial affidavit. That phrase was central. In the Court’s view, the statute itself contemplates partial disputes and therefore does not support an all-or-nothing evidentiary consequence when only a portion of the charges is challenged.

The opinion also builds on recent Section 18.001 precedent, including In re Chefs’ Produce of Houston, Inc., 667 S.W.3d 297 (Tex. 2023), and In re Allstate Indemnity Co., 622 S.W.3d 870 (Tex. 2021). Those cases confirm that Section 18.001 is a procedural mechanism designed to streamline proof of reasonableness and necessity and that, when a compliant counteraffidavit is filed, the claimant cannot reach the jury on the controverted matters without expert testimony. But Ortiz clarifies that this principle applies to the controverted matters, not automatically to every charge listed in the same provider affidavit.

The Court also referenced the long-settled rule that past medical expenses must be shown to be reasonable and necessary, as reflected in In re K & L Auto Crushers, LLC, 627 S.W.3d 239 (Tex. 2021), and the recovery limitation in Civil Practice and Remedies Code § 41.0105 to amounts actually paid or incurred.

Application

The Supreme Court rejected the trial court’s and court of appeals’ all-or-nothing reading of Section 18.001. The Court began with the statute’s structure. Section 18.001 creates a substitute for live expert testimony only to the extent the affidavit stands uncontroverted. A counteraffidavit does not operate as a global eraser unless it actually challenges the full substance of the provider affidavit. Where, as here, the defense experts specifically identified only certain charges as excessive or unnecessary and affirmatively left the remainder intact, the statute’s text did not justify stripping evidentiary value from the unchallenged remainder.

That textual point mattered because Nelapatla’s own experts did not place the entirety of the LifeSciences and Synergy charges in dispute. They targeted only specified sums. The Court treated that selectivity as consequential, not incidental. In practical terms, the controversy created by the counteraffidavits was limited to the identified charges. The portions not controverted remained supported by the original Section 18.001 affidavits and therefore remained competent evidence for the jury.

The Court’s reasoning also reflects the statute’s purpose. Section 18.001 was enacted to reduce unnecessary expert testimony costs, not to create a procedural trap by which a narrowly tailored defense challenge forces live expert proof on every line item in an otherwise unrebutted bill. The lower courts’ approach would have converted a partial counteraffidavit into a complete evidentiary nullification, a result the Court found inconsistent with both the statutory language and the Legislature’s streamlining objective.

The Court therefore concluded that the trial court abused its discretion by excluding the affidavits and bills in full as to the two partially challenged providers. Because the jury heard only the unchallenged Addison bill, the error was consequential and required reversal and remand.

Holding

The Court held that when a Section 18.001 counteraffidavit controverts only part of the medical charges set out in an initial affidavit, the unchallenged portions remain competent evidence. Those unchallenged charges may be submitted to the factfinder without additional live expert testimony on reasonableness and necessity.

The Court further held that the lower courts erred in treating a partial counteraffidavit as though it eliminated the evidentiary sufficiency of the entire provider affidavit. A compliant counteraffidavit affects only the matters it actually controverts; it does not automatically require expert testimony as to every charge listed in the provider’s affidavit.

Based on that construction, the Court reversed the court of appeals’ judgment and remanded the case to the trial court for further proceedings.

Practical Application

For Texas family lawyers, Ortiz is most useful in cases involving disputes over reimbursement of children’s uninsured medical expenses, psychological treatment, occupational therapy, speech therapy, inpatient treatment, addiction services, and similar charges that often appear in clustered provider billings. If opposing counsel serves a targeted challenge to only certain entries, you now have strong Supreme Court authority that the remainder of the affidavit-supported charges should still come in without requiring you to parade every provider live at final trial.

The case also has value in spousal-maintenance and disproportionate-division litigation where one spouse relies on medical or mental-health expenses to establish need, inability to meet minimum reasonable needs, or future financial strain. A narrowly framed attack on selected invoices should not permit the opponent to exclude the entire proof package. That matters especially in bench trials, where judges frequently confront partial billing objections and need a principled basis for admitting the undisputed portion while reserving credibility and weight questions for the disputed part.

In custody litigation, the decision can influence evidentiary fights over a child’s counseling, psychiatric treatment, neuropsychological evaluations, and other care relevant to best interest and allocation of expenses. If one side challenges only coding, pricing, or a subset of visits, Ortiz supports severing the disputed from the undisputed rather than excluding everything. Strategically, that allows counsel to preserve the probative force of treatment history and expense evidence even when parts of the billing record are genuinely debatable.

For the defense side in family cases, Ortiz is equally instructive. If your objective is to force live testimony or neutralize an entire provider affidavit, a selective counteraffidavit may no longer achieve that end. You will need to decide whether to controvert all material portions, develop broader admissibility objections, or prepare affirmative expert testimony directed to the precise issues you want to contest.

Checklists

Drafting and Serving Section 18.001 Affidavits

• Confirm that the affiant is a provider or proper records custodian authorized by § 18.001.
• Ensure the affidavit states both elements required by the statute: reasonableness of the amount charged and necessity of the service.
• Attach an itemized statement that clearly breaks out services and charges.
• Separate providers cleanly so the record shows what charges belong to which affidavit.
• Review the billing for internal inconsistencies, duplicate charges, and unexplained balances before service.
• Serve the affidavit within the statutory deadline and preserve proof of service.

Responding to a Partial Counteraffidavit

• Identify exactly which charges were controverted and which were not.
• Prepare a chart showing challenged versus unchallenged line items by provider.
• Argue that the unchallenged amounts remain competent evidence under Ortiz.
• Avoid conceding that a partial challenge nullifies the entire affidavit.
• Consider whether supplemental live expert testimony is needed only for the controverted portion.
• Obtain a clear pretrial ruling defining the scope of exclusion, if any.

Preserving Error at Trial

• Offer the original affidavit and billing records into evidence, expressly limiting the tender to uncontroverted charges if necessary.
• Make a precise record of which portions of the provider bill remain unchallenged.
• If the court excludes all charges, explain why Ortiz requires admission of the uncontroverted amounts.
• Make an offer of proof that identifies the excluded provider records and the dollar amounts at issue.
• Secure a ruling on the record before resting.
• Reurge the point in a motion for new trial if the exclusion affected the damages or reimbursement finding.

Using Ortiz in Family Law Hearings and Trials

• In uninsured-medical-expense disputes, segregate challenged and unchallenged pediatric, therapy, counseling, or specialist charges.
• In maintenance cases, use affidavit-backed medical expenses to support need, but be ready to prove only the controverted slice through live testimony.
• In property-division disputes, use Ortiz to preserve evidence of one spouse’s medical liabilities even where some line items are attacked.
• In custody matters, distinguish billing disputes from treatment-necessity evidence relevant to best interest.
• In bench trials, ask the court to admit the unchallenged portions and assign whatever weight it deems proper.
• Frame the issue as one of statutory scope, not merely evidentiary discretion.

Avoiding the Defense-Side Mistake

• If your strategy requires eliminating the affidavit shortcut entirely, do not assume a partial counteraffidavit will do the job.
• Decide whether to controvert all material charges rather than only isolated entries.
• Draft the counteraffidavit with precision so the record reflects the full scope of the challenge.
• Be prepared to explain why each challenged charge is unreasonable, unnecessary, or both.
• Consider separate objections under the Rules of Evidence instead of relying solely on § 18.001.
• Do not overread Chefs’ Produce; after Ortiz, its expert-testimony requirement applies to controverted matters, not automatically to every charge in the affidavit.

Citation

Ortiz v. Nelapatla, No. 23-0953, ___ S.W.3d ___ (Tex. May 1, 2026).

Full Opinion

Read the full opinion here.

Family Law Crossover

This is the kind of civil evidentiary ruling that can be weaponized effectively in divorce and custody cases because family courts routinely deal with blended invoices containing both vulnerable and unassailable charges. If your opponent attacks only selected therapy sessions, imaging charges, psychiatric evaluations, or rehabilitation bills, Ortiz gives you a clean argument that the balance remains admissible and probative without the cost and delay of calling every provider. Conversely, if you represent the challenger, Ortiz warns that a selective attack may merely narrow the dispute rather than suppress the proof; if your strategic goal is to block affidavit-based evidence wholesale, your objections and counterproof must be drafted with far greater breadth and precision.

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