The Medical Bills Maze in Florida Personal Injury Trials

maze.jpgMedical bills are a strong measure of injuries and future expenses. However, due to insurance and governmental (e.g., Medicare) discounts, bills are rarely paid in full. Where the medical provider is prohibited, by contract or law, from balance billing, Plaintiffs and Defendants contest which medical expenses, the full charges or the reduced payments, may be presented to the jury.

Plaintiffs argue that total charges give a full picture of their bodily injuries and future medical expenses. Defendants endeavor to limit admissibility to the discounted amounts. The outcome depends on who pays the bills.

Where the discounts are contractual write-downs from private insurance, the trial court should allow evidence of the total charges. In other words, Plaintiff may “board” all billed charges.

If a jury, in the face of discounted medical expenses, awards the Plaintiff the full medical expenses, doesn’t the Plaintiff derive a windfall? No. In Goble v. Frohman, 901 So.2d 830 (Fla. 2005), the Florida Supreme Court decided that such verdicts are to be reduced post-trial by the contractual discounts between the providers and private insurance company. Here is an example of how it works: if the discounted payment is $35,000 on total charges of $100,000, and the jury awards $ 100,000 for incurred medical expenses, the verdict will be reduced post-trial by $ 65,000 for a final judgment of $ 35,000.

This is fair. The jury, which does not hear about the discounted payment, is allowed to render its verdict based on relevant, probative evidence, while the judge, post-trial, adjusts the verdict so that the Defendant pays no more than was received by the medical providers.

This raises another question. If insurance has paid and the patient therefor owes the provider nothing, what is fair about a final judgment which awards the Plaintiff the amount paid by the insurance company? Simple. The Plaintiff must repay the money to the insurance company.

In essence, then, the most important aspect of boarding full medicals is for the jury to award the correct amount for pain and suffering damages and future medical expenses.

Why, then, does a different standard apply when the discount was paid by Medicare, workers’ compensation, a charity, or some other similar source? Although the judicial explanation is that these are “unearned benefits,” as opposed to private insurance for which the Plaintiff has paid a premium, the logic escapes me.

In Thyssenkrupp Elevator Corp. v. Lasky, 868 So.2d 547 (Fla. 4th DCA 2003), the court established for the first time that, where the discount was paid by Medicare, full medicals could not be boarded by the Plaintiff. To make matters worse, Thyssenkrupp added to the unfortunate precedent established in Florida Physician’s Ins. Reciprocal v. Stanley, 452 So.2d 514 (Fla. 1984) that evidence of governmental or charitable “benefits available to all citizens, regardless of wealth or status, should be admissible for the jury to consider in determining the reasonable cost of future care.” Id at 515.

Hence, not only is the Plaintiff barred from presenting the full picture, i.e., total medical expenses, to the jury, but evidence of a government or charitable benefit received in the past may be relied on to predict the uncertain receipt of the same benefit in the future. Nobody is guaranteed government benefits or charity. It is not fair that a person’s one shot – his day in court – at being fairly compensated for future medical expenses, be so unduly influenced by such tenuous evidence. At the very least, experts should be required to testify and juries allowed to decide on the likelihood of any so-called “unearned benefit” being available in the future.

Although the Defense wolves would like to extend the Thyssenkrupp and Stanley’s rules across the board to all discounted medical bills cases, the flood gates have not yet busted wide open. In Durse v. Henn, 68 So.3d 271 (Fla. 4th DCA 2011), bill reductions negotiated by the uninsured Plaintiff were considered “earned in some way” so that he was allowed to board the full amount of the charges billed by his medical provider.

A KEY REFERENCE: The Collateral Source Rule (768.76, Florida Statutes)

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Jeffrey P. Gale, P.A. is a South Florida based law firm committed to the judicial system and to representing and obtaining justice for individuals – the poor, the injured, the forgotten, the voiceless, the defenseless and the damned, and to protecting the rights of such people from corporate and government oppression. We do not represent government, corporations or large business interests.

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