Burn classification and severity.

Burns are classified by depth and percentage of body surface area (TBSA) burned:

By depth

  • First-degree — affects only the epidermis. Like a sunburn. Painful but heals without scarring.
  • Second-degree (partial-thickness) — affects the dermis. Blisters and significant pain. May heal with scarring depending on depth.
  • Third-degree (full-thickness) — destroys the full dermis. May not be painful because nerve endings are destroyed. Always scars; usually requires grafting.
  • Fourth-degree — extends through skin into underlying muscle, tendon, or bone. May require amputation.

By body surface area (TBSA)

Calculated using the Rule of Nines (head 9%, each arm 9%, anterior trunk 18%, posterior trunk 18%, each leg 18%, perineum 1%). TBSA correlates closely with mortality risk and treatment complexity:

  • Less than 10% TBSA — typically treated outpatient or short hospitalization
  • 10-20% TBSA — requires hospitalization, often skin grafting
  • 20-40% TBSA — major burn; requires burn center admission; substantial mortality risk
  • 40%+ TBSA — life-threatening; substantial mortality even with optimal care; extensive grafting required

Location matters as much as TBSA. Burns to the face, hands, feet, genitalia, and over major joints are categorized as major burns regardless of size because they cause disproportionate functional and cosmetic impact.

Treatment timeline — years, not months.

Severe burn treatment extends over a timeline that defendants and jurors typically don't appreciate. The arc:

Acute phase (weeks 1-4)

Burn center admission. Fluid resuscitation. Wound debridement. Initial skin grafting. Pain management (burn pain is among the worst pain in medicine). Risk of sepsis, organ failure, and death is highest in this period.

Wound closure phase (weeks 4-16)

Continued grafting procedures — often multiple skin grafts over weeks. Each graft procedure requires general anesthesia and produces significant pain. Wound care is intensive — frequent dressing changes that are themselves extremely painful.

Rehabilitation phase (months 4-24)

Physical therapy to maintain range of motion as scars contract. Pressure garments worn 23 hours per day for 12-18 months to manage scarring. Occupational therapy for functional recovery. Mental health treatment for trauma response, depression, and PTSD.

Reconstructive phase (years 2-10+)

Multiple reconstructive surgeries over years to release contractures, improve cosmetic appearance, restore function. Burns to the face, hands, and over joints commonly require 10-30+ surgical procedures over a lifetime.

Long-term phase (lifetime)

Ongoing skin care, periodic surgical revisions, mental health support, and management of secondary complications (chronic pain, heat intolerance, sun sensitivity, sleep disturbance).

Common burn case types.

Industrial fires and explosions

Refineries, chemical plants, oil and gas facilities. OSHA process safety management standards (29 CFR 1910.119) apply. Major industrial burn cases often involve catastrophic injuries to multiple workers and substantial corporate liability.

Vehicle fires

Post-collision fires from fuel system failures, lithium battery thermal runaway in EVs, and design defects in fuel tanks/lines. Product liability against vehicle manufacturer is the primary theory.

Electrical burns

Contact with overhead power lines (construction, tree work), arc flash injuries (industrial electrical work), and consumer product electrocutions. Multiple defendants typically: utility, contractor, equipment manufacturer.

Scalding injuries

Hot water heater settings too high (landlord/property owner liability), restaurant burns from hot liquids or grease (premises liability), defective coffee pot or appliance design (product liability), and child scalding from inadequate supervision in commercial settings.

Chemical burns

Industrial chemical exposure, consumer product chemicals (drain cleaner, etc.), inadequate warnings on chemical products. Often combine personal injury with product liability theories.

Hot work and welding injuries

Burns from welding, cutting, and grinding operations. Workplace setting brings the non-subscriber question and OSHA hot work regulations into play.

Damages — what burn cases recover.

Severe burn cases produce damage profiles unlike other catastrophic injuries:

Past medical expenses

Generally enormous. Burn ICU days commonly cost $5,000-15,000 per day. A patient with 40% TBSA may have $1-3 million in initial hospitalization costs.

Future medical expenses

Decades of reconstructive surgeries, pressure garments, ongoing skin care, mental health treatment. Lifetime medical projections for major burns commonly $1-4 million.

Lost wages and earning capacity

Most severe burn survivors are unable to work for at least 12-24 months. Many cannot return to their pre-injury occupation. Disfigurement to the face or hands may affect employability even after full medical recovery.

Disfigurement

A specific damages category recognized in Texas. Visible disfigurement (face, hands, neck) produces substantial damages. Permanent disfigurement that affects social interaction has its own value.

Pain and suffering

Burn pain is among the worst pain in medicine, and burn treatment (debridement, dressing changes, grafting) is itself extraordinarily painful. The pain and suffering component of burn cases is correspondingly large.

Mental anguish

PTSD rates among burn survivors are very high. Depression is common. Survivors with visible disfigurement frequently experience social withdrawal, anxiety, and identity issues that produce substantial mental anguish damages.

Typical settlement ranges

  • Minor burns with full recovery — $50,000-200,000
  • Moderate burns with permanent scarring — $300,000-1,000,000
  • Severe burns (20-40% TBSA) with disfigurement — $1,500,000-5,000,000
  • Catastrophic burns (40%+ TBSA) — $5,000,000-25,000,000+