The defendants, however, may submit evidence that the plaintiff’s medical providers accepted less than the full bills to rebut the reasonableness of the full bills, so long as insurance is not mentioned. Schmuckler v. Creurer, 585 N.W.2d 425 (Minn. Ct. App. The differential is not an insurance benefit to the plaintiff; it is instead a benefit to the insurer that results from the insurer’s negotiations with medical providers. Arizona generally applies the collateral source rule to allow a plaintiff to recover damages even if they were not actually sustained. They remain free, however, to submit any other competent evidence to rebut the plaintiffs’ proof on the reasonableness of the medical expenses, so long as that evidence does not contravene the CSR. Appellate courts in fifteen (15) states and the District of Columbia have held that the injured plaintiff may recover the amount billed, and bar the defendant from presenting evidence of the lower amount that the health care provider accepted to satisfy the bill. The collateral source rule, or collateral source doctrine, is an American case law evidentiary rule that prohibits the admission of evidence that the plaintiff or victim has received compensation from some source other than the damages sought against the defendant. States have generally adopted one of three basic approaches to how much of a medical expense can be introduced into evidence and how much can be recovered: 1. The bill also created a “collateral source” rule in Louisiana law meant to ensure plaintiffs are compensated only for medical damages either paid or owed, as opposed to the “sticker price” of a procedure, which might be much higher. Also, understand national charges and … Ultimately, Nevada’s collateral source rule should work to your favor, because it prevents responsible parties from pointing fingers in other directions. The Propeller Monticello v. Mollison, 58 U.S. (17 How.) In plain terms, a judge may reduce a personal injury award to account for “any payments made” by an insurance company on the plaintiff’s behalf. Arizona Court of Appeals Division Two Holds That the Collateral Source Rule Applies to the Full Amount of Charged Reasonable Medical Expenses Without Any Deduction for Amounts Written Off by Healthcare Providers in the Context of a Negligence Slip and Fall Case. Bynum v. Magno, 101 P.3d 1149 (Haw. Moreover, the types and number of “collateral sources” available to plaintiffs have multiplied. Common Law / Case Decisions. A few states, including Arkansas and Kentucky, have abrogated the CSR to some degree by statute. Concerning BI claims, a plaintiff may recover the full amount billed by a medical provider, even if 2006). Only a few states have limited plaintiffs’ medical expense damages to the discounted insurance amounts, but it is a growing trend. Ever-changing circumstances in health insurance and health care billing have prompted reconsideration and modification of the CSR in many jurisdictions. The result is a confusing patchwork of laws depending on which state a case is filed in. The collateral source rule is somewhat complicated and difficult for the average person to understand. Terms Used In Arizona Laws 12-565. It eliminated a well-established feature of the common law, the collateral source rule, with clarity. While the insured/patient may only have direct interaction with the doctor, it is really a three-party relationship – the patient, the health care provider (doctor, hospital, etc. Being treated by a doctor may seem like a two-party interaction, but, it’s part of a large, complex system of information and payment. Each defendant is jointly and severally liable. The other side of the argument is that the cost of negligent behavior should be imposed on the defendant as the at-fault party, in order to reinforce the standard of reasonable care that all members of a society should adhere to. The collateral benefits are usually paid for by the plaintiff, subject to a right of subrogation, or both. Be the first and Add your Comment below. To recover damages for past medical expenses in a personal injury lawsuit, a plaintiff must present evidence and prove that the medical expenses incurred were both “reasonable” and “necessary.” For more than 100 years, this simple formula was the least complicated aspect of a plaintiff’s personal injury case. Like Texas, in Arizona it is inadmissible and improper in most personal injury cases  for the jury to be exposed to details regarding benefits either side have or will receive from a third party as a result of the lawsuit (i.e. 1998). According to the view expressed in Howell, an injured plaintiff whose medical expenses are paid through private insurance may recover as economic damages no more than the amounts paid by the plaintiff or his or her insurer for the medical services received or still owing at the time of trial. March 8, 2013. Adam S. Kutner Personal Injury Lawyer. This source is known as a collateral source and is often a health insurance company. § 36-2915. The CSR is a relatively new legal concept in the common law. They also argue that, if the CSR can be modified, allowing evidence of collateral sources, then the discounted medical bills should be considered proven as reasonable and necessary upon testimony by the patient that the bills were incurred. 1478 (1966). In the absence of any similar clarity, and in light of the consistent holdings of the Court of Appeals, I hold that the statute did not also eliminate the subrogation rights of plaintiffs' insurers…. They must invest all profit in the organization, are exempt from paying state and federal taxes on income and property, and must report “community benefits” offered by the facility. Medicare, for example, bases their reimbursement rate solely on the patient’s diagnoses. In other states, statutes act as a rule of damages, limiting recovery to discounted amounts after “write-offs.”. In the process, however, patients gave up their freedom of choice among doctors and hospitals in return for slightly better cost control. Arizona Court of Appeals Division Two Holds That the Collateral Source Rule Applies to the Full Amount of Charged Reasonable Medical Expenses Without Any Deduction for Amounts Written Off by Healthcare Providers in the Context of a Negligence Slip and Fall Case. Over time, all fifty states adopted some form of the CSR and followed the rule in its traditional form. Managed care has further distorted pricing for health care services, as the deep discounts demanded by the MCOs require providers to offset those discounts by charging higher prices to other patients. Problem The collateral source rule keeps important information relevant to the determination of damages from reaching the jury. States began to enact collateral source statutes which significantly modified or altered the common law rule. Collateral source rule is a rule of damages that benefits received by the plaintiff from a source wholly independent of and collateral to the wrongdoer will not diminish the damages otherwise recoverable. The rationale behind the rule is that if the plaintiff was himself responsible for the collateral benefit, as by maintaining his own insurance or by making advantageous employment arrangements, the law allows him to keep it for himself. Mar. Collateral Source Rule: In general, a defendant may not introduce evidence that a plaintiff’s damages were paid by a collateral source (e.g., insurance), or that a plaintiff’s bills were satisfied by a reduced amount. To get medical bills into evidence and recover them as an element of damage, plaintiffs simply needed to prove: The law in every jurisdiction allowed plaintiffs to recover the “reasonable value” of the medical services incurred. The collateral source rule “is intended to ensure that the right of an injured party to be fully compensated for all his or her damages is protected, even if in some instances it entails that party obtaining double recovery from both the insurer and the wrongdoer.” (Miller, supra, … The purpose of the collateral source rule is to exclude evidence of payments made to the plaintiff by sources other than the defendant when the evidence is offered for the purpose of diminishing the defendant tortfeasor's liability to the injured plaintiff. The final bill is created by a medical biller who looks at the balance the patient has, adds the cost of the procedure or service to that balance, deducts the amount covered by insurance, and factors in a patient’s co-pay or deductible. Some so-called “tor… 152 (1854). The collateral source rule is most often applied in cases where the injured per… Hospitals are often legally required to provide treatment for patients who either are insured by companies with whom the hospital has no contractual relationship or who have no insurance at all. Though this rule applies primarily to evidence relevant to the plaintiff's benefits, under the same rationale it is equally improper for the jury to be exposed to liability coverage that the defendant has. “The collateral source rule is well established in Arizona tort law.” Michael v. Cole, 122 Ariz. 450, 452, 595 P.2d 995, 997 (1979); see also S. Dev. Among states that use this approach, a minority defines “reasonable value” as the actual amount paid, while a majority holds that the “reasonable value” can be the plaintiff’s full, undiscounted medical bills. 2004). The collateral source rule prevents these defendants from having their judgments reduced because victims were able to obtain much-needed compensation from other sources while waiting for conclusions to their cases. Arizona applies the collateral source rule, giving plaintiffs an opportunity to secure medical expenses damages despite having healthcare insurance coverage. L. REV. Arizona generally applies the collateral source rule to allow a plaintiff to recover damages even if they were not actually sustained. Some states, including Indiana, Alabama, Ohio, and Iowa, have legislated a “hybrid” rule which allows the jury to consider evidence of both the plaintiff’s undiscounted medical bills and the discounted amounts, to assess the reasonableness of the plaintiff’s medical expenses. ), and the payer or entity which ultimately pays the bill (health insurer, government, etc.). States such as Tennessee have abrogated the CSR through legislation, but only in health care liability and workers’ compensation cases. Moreover, hospitals do all their bills the same way, no matter who the payer is. Newsroom [blog] Newsletter; CONTACT; New Ruling Highlights Evolving Collateral Source Issues In Nevada. The unpaid balance of $135,000 is either written off, billed to the patient in a practice known as “balance billing”, and/or passed on to other patients in the system in the form of inflated charges. Can the trial court reduce a plaintiff’s damages award to the amount actually paid by the collateral source? ¶21 Nevertheless, the Arizona legislature narrowed the benefit AHCCCS members may receive from the collateral source rule when it complied with the federal directive by enacting A.R.S. COLLATERAL SOURCE EVIDENCE 5 12-2321. Like Texas, in Arizona it is inadmissible and improper in most personal injury cases for the jury to be exposed to details regarding benefits either side have or will receive from a third party as a result of the lawsuit (i.e. 2. Subd. The same insurance company will also pay different doctors a different amount for the same billing code depending on the type of policy a patient has. Notwithstanding the Collateral Source Rule, “double recovery” by plaintiffs occur infrequently because, upon payment, the insurer is subrogated to the rights of the insured as against the defendants who caused the injury, or the insurer may seek a refund from its insured. “Amount Billed.” (“Benefit of the Bargain”). Under the so-called “collateral source rule” in Arizona law, a plaintiff may recover from a tortfeasor the full amount billed for their medical treatment, even if – as is often the case – the amount actually paid is less because the provider accepted a lesser amount. 1 Be it enacted by the Legislature of the State of Arizona: 2 Section 1. The billed vs. paid challenge is but one of many ways to try and reduce recoverable damages based on the amount billed by a Plaintiff’s medical provider. Title 12, chapter 13, Arizona Revised Statutes, is amended 3 by adding article 10, to read: 4 ARTICLE 10. Nearly 67% of U.S. hospitals are losing money, particularly when it comes to the treatment of Medicaid/Medicare patients. The “very purpose” of the collateral source rule is to “prevent a defendant from reaping” a windfall from benefits intended for the plaintiff. The Collateral Source Rule and Loss Allocation in Tort Law, 54 CAL. The CSR is a relatively new legal concept in the common law. Connecticut enforces what is known as a “collateral source rule” with respect to personal injury judgments. State of Arizona House of Representatives Fiftieth Legislature Second Regular Session 2012 HB 2547 Introduced by Representative Vogt: Senator Driggs AN ACT AMENDING TITLE 12, CHAPTER 13, ARIZONA REVISED STATUTES, BY ADDING ARTICLE 10; RELATING TO COLLATERAL SOURCE EVIDENCE. Therefore, further briefing is unnecessary and the motion will be denied as moot. The negotiated rate differential is not an expense “incurred” by the plaintiff, because neither the plaintiff nor the plaintiff’s insurer will be expected to pay it. Even if the insurer has a right of subrogation against the plaintiff’s recovery, that right should not inure to the benefit of the defendant. However, evidence of collateral source payments is admissible in medical negligence cases, subject to the plaintiff’s right to introduce evidence of any liens against the plaintiff’s claim. Such collateral or other source independent of the third-party tortfeasor (defendant), cannot be revealed to the jury. A few states have even declared their CSR to be unconstitutional. Such damages paid by a collateral source are also pejoratively referred to by the tort reform advocates as “phantom damages.” The Restatement of Torts, Second, defines the CSR in § 920A(2): § 920A Effect of Payments Made to Injured Party. As a rule of damages, it prohibits the tortfeasor from reducing payment of a tort judgment by the amount of money received by an injured party from other sources. IN AN ACTION TO RECOVER DAMAGES FOR PERSONAL INJURIES OR WRONGFUL Different insurance companies will also approve and disapprove of different services, so it’s difficult to know in advance what will be paid. The charges were reasonable for services of that nature. Pennsylvania, Idaho and California are examples of states whose courts have held that only evidence of the amount paid is relevant and admissible. The final amount paid on a $200,000 medical bill – $65,000 in the example above – depends on an entire medical billing industry which involves the complicated overlap of medical billing, diagnosis codes, ICD codes, medical compliance, “allowed amounts”, capitation, co-insurance, EOB’s, and utilization limits. In that earlier post the Nevada Law Blogs predicted that the Nevada Supreme Court could not allow the trial court’s decision to stand. A typical example is when the injured party uses their own medical insurance to cover … CSR doctrine states that if an injured party in a civil lawsuit receives benefits from an insurance policy those are collateral benefits. Learn more today. . n8 Specifically, the Arizona Court of Appeals [*101] reasoned that the collateral source rule was well established, and without legislative modification, it was bound to apply the doctrine. The common law CSR developed during a time when health insurance and publicly provided health benefits did not exist. In Stokes, the defendant was driving a pickup truck … $200,000? This is known as the collateral source rule. (download the opinion) Robin Houston sued Publix arising from an alleged slip-and-fall […] Title 12, chapter 13, Arizona Revised Statutes, is amended 3 by adding article 10, to read: 4 ARTICLE 10. See Lopez v. Safeway Stores, Inc. , … IN AN ACTION TO RECOVER DAMAGES FOR PERSONAL INJURIES OR WRONGFUL Get the latest insurance newssent straight to your inbox. As a result, Medical necessity may apply for a medical expert witness who understands Howell. It gives the prudent plaintiff the “benefit of the bargain” of having purchased insurance. L. REV. A diagnosis of Ataxia-Telangiectasia will get a fixed Medicare payment regardless of how long the patient stays in the hospital, what tests are ordered, or what treatment is given. Can the defense introduce evidence of the discounted amount actually paid? Home » Personal Injury Attorneys » Exploring Nevada’s Collateral Source Rule. 2018): Evidence of collateral source payments may be admissible to show a doctor’s bias as to his causation testimony about the treatment he provided. Tenn. 2016); Hall v. USF Holland, Inc., 2016 WL 361583 (W.D. Neither approach considers benefits other than private insurance, such as Medicaid, state Medicaid programs, charity, employer benevolence, or gifts. In determining the amount of damages to be presented as evidence in a personal injury trial, judges are often called on to decide whether to admit as evidence the higher, billed amount, the lesser amount actually paid as the cost of services rendered after the write-off, or both. Collateral Source Rule State Summary. This has been a brief, general overview of the Collateral Source Rule. Tennessee recently established its long-awaited rule in Dedmon v. Steelman, 2017 WL 5505409 (Tenn. 2017). In recent years, the issue of what is considered the “reasonable value” of medical services has become complicated and distorted by the deep discounts demanded by insurance companies, laws that require hospitals to treat patients who cannot pay, and benefits like Medicaid and related state programs that pay a set amount for all treatment of a patient. Or, something in between? There are 2,894 non-profit hospitals in the U.S. Some social legislation benefits eschew the traditional fee-for-service model in favor of pool payments or a set “capitation” amount for all treatment of a single patient. (2) Payments made to or benefits conferred on the injured party from other sources are not credited against the tortfeasor’s liability, although they cover all or a part of the harm for which the tortfeasor is liable. Matt's primary interest in law focuses on general personal injury and insurance bad faith. Yes No Yes for awards of future damages in excess of $150,000. They take the position that limiting plaintiffs’ recovery to the amount paid to the medical provider is not contrary to the Collateral Source Rule (CSR) because the rule is not implicated. The rise of Managed Care Organizations (MCO) in the 1980s was a partial “solution” to rising health care costs. Note that “balance billing” (insurance company sends patient bill for balance of services insurance doesn’t pay for), usually occurs when a patient goes “out-of-network” for medical services, and there is no contract between the provider and the insurance company agreeing to the discounted insurance rates. This “collateral source rule” prohibits tortfeasors from avoiding liability for damages in situations in which an injured party has been compensated by a third party. In some states, statutes act as a rule of evidence, governing what evidence is allowed in proving the reasonableness of medical expenses. There was hope within the Tennessee Defense Lawyers’ Association that the present rule, that allowed plaintiffs to submit evidence of the full, undiscounted medical bills as proof of the “reasonable” value of medical services, would finally end. The collateral source rule bars the admissibility of evidence at trial to show that a plaintiff’s losses have been compensated from other sources, such as the plaintiff’s insurance or workers compensation. This is sometimes done as part of broader tort reform legislation, as in Texas and Missouri. Required fields are marked *. Matt graduated from the James E Rogers College of Law at the University of Arizona in passing the Arizona bar exam in 2010. Stokes v. Muschinske, No. Thank you! The collateral source rule divides the different States into three broad categories, plus a very small fourth category. The impetus for changing the rule came from the perceived crisis in medical costs when medical malpractice litigation proliferated over the past three decades, and medical malpractice litigation was blamed by some as a significant cause. (TEXT OF BILL BEGINS ON NEXT PAGE) HB 2547 - 1 - 1 Be it enacted by the Legislature of the State of Arizona… In addition to the insurance and gratuitous payments that were the subject of early collateral source rules (see below), in today’s environment, plaintiffs in personal injury cases may have received benefits from unions, free treatment at a veterans’ facility, or at a reduced rate at a charity-affiliated provider. The court ordered a new trial after finding  the jury had access to an unredacted document showing that the defendant had $9 million in liability insurance coverage. In any medical malpractice action against a licensed health care provider, the defendant may introduce evidence of any amount or other benefit which is or will be payable as a benefit to the plaintiff as a result of the injury or death pursuant to the United States social security act, any state or … % of people found this article valuable. Furthermore, defendants are precluded from submitting evidence of discounted rates accepted by medical providers from the insurer to rebut the plaintiffs’ proof that the full, undiscounted charges are reasonable. In years gone by, medical billing was simple. L. REV. Where they have, the result is often dictated to some extent by statute. Statutes. Collateral Source Rule (CSR) The modern Collateral Source Rule (CSR) has been called one of “the oddities of American accident law.” John G. Fleming. States against the rule disfavor the plaintiff receiving double recovery for the same injury. In other words, the wrongdoer should not get to benefit from any contract he or she has not contributed to. Compare these against the insurance policy and coverage determinations. The actual term “collateral source” derived from language used in a Vermont decision some years later. The CSR ensures that the liability of similarly situated defendants is not dependent on the good fortune of the way each plaintiff’s medical expenses are financed. As one court noted, reducing an insured plaintiff’s recovery by the negotiated rate differential “overlooks the fundamental purpose of the [collateral source] rule, … to prevent a tortfeasor from deriving any benefit from compensation or indemnity that an injured party has received from a collateral source.” Acuar v. Letourneau, 531 S.E.2d 316 (Va. 2000). . A thorough understanding of how medical expenses are proven and recovered in civil litigation is a necessity for lawyers, legislators, claims professionals, and judges alike. Another criticism of the “benefit of the bargain” approach is that it “undermines the CSR by using the plaintiff’s relationship with a third party to measure the tortfeasor’s liability.” Leitinger v. DBart, Inc., 736 N.W.2d 1 (Wis. 2007). cmt. First, there are those States who follow the common law rule and amounts paid are generally inadmissible: Arkansas (collateral source rule statute was declared unconstitutional) Colorado (statute reinstated collateral source rule) Georgia Hawaii Kentucky (collateral source rule statute … Doctors and their liability insurers were particularly outraged when asked to pay malpractice judgments that included not only very large sums for non-economic losses, but also the doctor’s own services, corrective services, and additional health care for which the patient had been fully compensated by health insurance programs of one sort or another. . Both approaches violate the CSR and result in plaintiffs with insurance being treated quite differently from plaintiffs without insurance. The interplay between the CSR and the recovery of the full, undiscounted amount of medical expenses, can be set forth by statute, through common law and case decisions, and frequently through a combination of both. Please tell us what you liked about it. Thank you! The Key to Winning COVID Business-Interruption Claims: Say... medical expenses incurred were both “reasonable” and “necessary.”, Medical Billing, Insurance Write-Offs and the Collateral Source Rule, Company Offering Pandemic Stock Tips Accused of $137M Fraud, Family Behind Oxycontin Maker Purdue Pharma Offers 'Sadness', Suspected Russian Hacking Spree Reached Into Microsoft -Sources, Government Ordered to Pay Landowners on Lower Missouri River. To explain, Medical billing experts use the physician’s diagnosis codes and correlating procedure codes. We will get back to you shortly. The plaintiff has paid or become liable to pay the medical bills; The plaintiff necessarily incurred the medical expenses because of injuries resulting from the defendant’s negligence; and. collateral source rule, including Arizona, Colorado, Connecticut, Delaware, Georgia, Hawaii, Illinois, Kentucky, Louisiana, Mas - sachusetts, Mississippi, Nebraska, Oregon, South Carolina, South Dakota, Tennes-see, Virginia, Wisconsin, and the District of Columbia. In practice, the CSR never requires the defendant to pay twice, and rarely allows the plaintiff to retain a windfall. The emphasis in some jurisdictions began to switch from not allowing the plaintiffs’ purchase of collateral sources to become a windfall for the negligent tortfeasor, to preventing the plaintiff from recovering twice for the same element of damage (e.g., medical expenses recovered once from an insurance policy and a second time from the defendant). The modern Collateral Source Rule (CSR) has been called one of “the oddities of American accident law.” John G. Fleming. Copyright © 2020 Schmidt, Sethi & Akmajian. A few courts use a “hybrid” method, allowing the trier of fact to consider both the actual amount paid and the full bill in determining the “reasonable value” of medical services provided to the plaintiff. Some states have answered these questions, while others haven’t. One strategy to encourage the purchase of private insurance is to allow plaintiffs to recover from defendants irrespective of their own insurance coverage. The plaintiffs argued that collateral source evidence should be excluded “because it would cause unfair prejudice, confuse the issues, and mislead the jury.” The court stated the defendants “have not specified what collateral source payments they intend to introduce at trial or explained how any collateral source evidence would fall within an exception to the collateral source rule.” Co. v. Pima Capital Mgmt. States adopting this approach generally seek to avoid allowing plaintiffs any so-called “windfall” from tortfeasors. The collateral source doctrine is an evidentiary rule prohibiting admission of evidence that a plaintiff has received compensation from some source other than the damages sought against a defendant. At our Tucson personal injury law firm, our goal is to fully understand the extent of your injuries and their impact on your life so that we can expedite your case to a successful settlement or verdict. Harding v. Town of Townshend, 43 Vt. 536 (1871). History of Collateral Source Rule (CSR). The Vermont Supreme Court described the rule in terms similar to those used by the U.S. Supreme Court in Mollison, but the Vermont Court for the first time characterized insurance proceeds received by the plaintiff as “collateral” to any recovery from the wrongdoer. A few states allow defendants to use the insurance payments to reduce their liability. Connecticut’s Collateral Source Rule. EXAMPLE: A plaintiff is injured because of the defendant’s negligence and requires medical treatment for which he is billed $200,000. Most of these courts ground their decision on the common law CSR. A doctor or hospital would charge a reasonable fee for medical services, and the patient would pay it. At the time of the Dedmon decision, three federal district courts in Tennessee had concluded that the West rule applied in personal injury litigation as well. . Critics of the “reasonable value/actual-amount-paid” approach point out that § 911 of the Restatement (Second) of Torts was never intended to apply to cases involving physical harm. c(4) (Social Security and other welfare benefits are subject to collateral source rule). for an injury which the injured party receives from a collateral source wholly independent of the wrongdoer does not operate to reduce the damages recoverable from the wrongdoer.”). 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