Personal Injury Law

Under Missouri Personal Injury Law, Medical Damages are Amount BILLED to patient, NOT Amount PAID by Insurance; assuming proper evidence is established by Plaintiff

By Benjamin J. Sansone, Esq.

There is an ongoing battle to determine the definition of the phrase, ?value of medical treatment rendered?, and what this means in regard to financial compensation for medical bills in Missouri Personal Injury cases. A recent unanimous decision by the Supreme Court at least puts an end to the bills paid being the only measure. Now it appears, both bills paid and amount charged will be submitted to the jury; however, many judges on the circuit level have held the statue unconstitutional and thus only amount charged has been submitted in may cases. This Supreme Court decision did not address the constitutionality of the statute; hopefully that issue will be considered int he future.

In 2003, a Missouri negligent driver rear-ended several cars. One of the Missouri personal injury and car crash victims of that car accident sustained several injuries, causing her to undergo surgery, physical therapy and other medical needs. She filed a Missouri personal injury lawsuit stemming from the car crash claiming the other driver was negligent in causing the collision and her personal injuries. She sought compensation for her medical expenses that totaled $28,000 but after adjustments, Medicare, supplemental insurance etc, only $9,900 was actually paid to the medical providers.

The Missouri car accident and personal injury claimant attempted to admit evidence which showed the full amount of her medical bills. She also had testimony of physicians to prove that her value of medical treatment was the amount billed to her, not the amount that was paid by insurance after adjustments.

The trial court would not allow this testimony on grounds that the presumption in section 490.715.5, in the RSMo Supp. 2005, (which states that the dollar amount, after adjustments, needed to pay the plaintiff?s financial obligation, constitutes the value of the medical treatment rendered), was not rebutted, and therefore the court determined that the value of the injury victim's medical treatment was what she ended up having to pay ? not what was billed.

In Deck v Teasley, The Supreme Court of Missouri reversed a portion of the trial court?s judgment regarding damages, remands the case for a new trial on the issue of damages. This unanimous decision was determined on the grounds that the trial court erred by misapplying the law by stating the statutory presumption was not rebutted, and by ruling that the claim for medical expenses was limited to the amount paid not the amount billed. The key to this is that the rebuttable presumptions requires the trial court to determine if the rebutting party has presented substantial evidence to prove that the value of the medical treatment rendered is a different amount from the amount necessary to satisfy the bill to the medical provider.

It also found that the evidence she was trying to present to the jury, was in fact admissible. By doing this, the jury was only permitted to hear evidence that the value of her treatment totaled $9,900 and was not allowed to consider evidence of the $18,100, which would naturally, affect the merits of the action. This also prevented the jury from considering the possibility of future surgeries and treatments.

Full post as published by Missouri Injury Law Blog on October 27, 2010 (boomark / email).