|
|
| 2007 | 2006 | 2005 | 2004 | 2003 | 2002 | 2001 | 2000 | Search | Upcoming cases |
Public Information Home
Court Holds Evidence of Medical Bill ‘Write-Offs’ Not Barred by Collateral Source Rule
2005-0998. Robinson v. Bates, 2006-Ohio-6362.
Hamilton App. No. C-040063, 160 Ohio App.3d 668, 2005-Ohio-1879. Judgment affirmed and cause remanded to the trial court.
Moyer, C.J., Resnick, Pfeifer, O'Connor and Lanzinger, JJ., concur.
O'Donnell, J., concurs in judgment only.
Lundberg Stratton, J., concurs in part and dissents in part.
Opinion: http://www.supremecourtofohio.gov/rod/newpdf/0/2006/2006-Ohio-6362.pdf
(Dec. 20, 2006) The Supreme Court of Ohio ruled today that, in personal injury cases, a jury considering the reasonable value of a plaintiff's medical treatment may hear evidence of both the amount originally billed by a medical care provider for treatment, and a lesser amount accepted by the care provider from an insurance company as full payment for the billed services. In its decision, written by Justice Judith Ann Lanzinger, the Court affirmed a ruling by the 1st District Court of Appeals, but disagreed with the portion of its holding that evidence of a “write-off” granted by a health care provider to a plaintiff's insurer was inadmissible at trial under the “collateral source rule.”
The collateral source rule is a common law doctrine recognized by Ohio courts since 1970. Under the rule, jurors in a personal injury case are not informed about any recovery made by the plaintiff from sources other than the person who caused a plaintiff's injury or loss (the tortfeasor), so that the tortfeasor does not benefit from the plaintiff's own efforts by having his liability to the plaintiff reduced by any amount the plaintiff was able to recover from another source (such as the plaintiff's own insurance).
In this case, Caroline Robinson of Cincinnati suffered foot injuries in April 2001 when she stepped on to an uneven concrete footer in the driveway of her rental home. The footer was exposed by repair work the property owner, Helen Bates, had hired a contractor to perform. While the repair job was in progress, the contractor had left the footer exposed and had left debris laying in the driveway for several days. Robinson sued Bates to recover her damages, including the costs of her medical care.
At trial, Robinson's attorney attempted to introduce medical bills she had received from various health care providers totaling $1,919 as evidence of the “reasonable cost” of her medical treatment. The trial judge ruled that, because most of Robinson's medical bills had been paid by her own private insurance, and her health care providers had accepted lesser amounts from the insurer than they had initially billed Robinson, Robinson could not introduce the original, undiscounted medical bills as evidence of damages but rather could submit documentation only for the actual amounts her insurer had paid out to satisfy her obligations.
At the close of Robinson's evidence, attorneys for Bates moved for a directed verdict denying all of Robinson's damage claims. They argued that the exposed concrete footer was an “open and obvious” hazard that Robinson knew was present, and cited prior Supreme Court decisions holding that a property owner owes no legal duty to protect guests from a hazard that is open and obvious. The trial court granted Bates' motion, and entered a directed verdict holding that Bates had no liability for Robinson's injury.
Robinson appealed both the trial court's refusal to admit evidence of her undiscounted medical bills and its directed verdict based on the open and obvious nature of the hazard. The 1st District Court of Appeals reversed the trial court's rulings on both issues and remanded the case for a new trial. In ruling on the evidence of Robinson's medical costs, the 1st District held that the providers' original medical bills should have been admitted as evidence of her reasonable costs of treatment, and held that the collateral source rule barred the trial court from admitting evidence of any discounts or write-offs granted by those providers as a result of Robinson's own insurance coverage. Bates appealed the 1st District's rulings to the Supreme Court.
Writing for the Court in today's decision, Justice Lanzinger noted that, after the date of Robinson's injury and complaint, the General Assembly enacted a specific statute, R.C. 2315.20, that now allows defendants in personal injury cases to introduce evidence at trial of “any amount payable as a benefit to the plaintiff” as a result of his or her injury. While acknowledging that this statute limits the collateral source rule for claims arising after its effective date (April 7, 2005), Justice Lanzinger said Robinson's claim against Bates must be resolved under the law in effect at the time of her injury.
She wrote that: “Bates urges us to hold that a plaintiff should recover only the amount of medical expenses actually paid, while Robinson contends that under the collateral-source rule, a plaintiff should have been permitted to introduce evidence of the original amount of billed medical expenses, regardless of what was actually paid. In deciding this issue, the court of appeals concluded that “the collateral-source rule applies to any written-off amount agreed to by a plaintiff's health-care provider and insurer. We disagree. The collateral-source rule does not apply to write-offs of expenses that are never paid. The collateral-source rule excludes only ‘evidence of benefits paid by a collateral source.' Because no one pays the write-off, it cannot possibly constitute payment of any benefit from a collateral source. Because no one pays the negotiated reduction, admitting evidence of write-offs does not violate the purpose behind the collateral-source rule. The tortfeasor does not obtain a credit because of payments made by a third party on behalf of the plaintiff.”
In light of widely divergent insurance plans, managed care contracts and other variables, Justice Lanzinger wrote that rather than identifying either the amount billed by medical providers or the discounted amount paid by an insurer as a presumptive “reasonable value” of medical treatment, the Court believed a better approach was to allow juries to make that determination on a case-by-case basis. “The jury may decide that the reasonable value of medical care is the amount originally billed, the amount the medical provider accepted as payment, or some amount in between.” Lanzinger wrote. “Any difference between the original amount of a medical bill and the amount accepted as the bill's full payment is not a “benefit” under the collateral-source rule because it is not a payment, but both the original bill and the amount accepted are evidence relevant to the reasonable value of medical expenses.”
With regard to the trial court's directed verdict holding that Bates owed no duty to protect Robinson from an “open and obvious hazard,” the Court affirmed the 1st District's reversal and remand of the case for further proceedings. Justice Lanzinger noted that Bates had a statutory duty as a landlord to keep her rental property free of hazards, and said the trial court erred in granting a directed verdict because the issue of whether leaving exposed footers and debris in the driveway violated that statutory duty was a question for a jury to decide.
Justice Lanzinger's decision was joined by Chief Justice Thomas J. Moyer and Justices Alice Robie Resnick, Paul E. Pfeifer and Maureen O'Connor. Justice Terrence O'Donnell concurred in judgment only.
Justice Evelyn Lundberg Stratton entered a separate opinion concurring with the majority holding that trial courts may admit evidence of both the amount billed by medical providers and the amount actually paid by an insurer, but said she would limit a plaintiff's recovery for medical expenses to the amount actually paid for treatment or any additional amount for which the plaintiff remains liable after insurance payments. She wrote that, in her view, the majority opinion “creates confusion” by failing to provide criteria or identify factors that trial courts should consider in determining whether to apply “the amount billed, the amount paid, or ‘some amount in between'” as the reasonable value of the plaintiffs medical treatment.
Contacts
Marvin L. Karp, 216.931.6000, for
Helen Gist Bates.
Scott A. Best, 513.241.6748, for Caroline Robinson.
Please note: Opinion summaries are prepared by the Office of Public Information for the general public and news media. Opinion summaries are not prepared for every opinion released by the Court, but only for those cases considered noteworthy or of great public interest. Opinion summaries are not to be considered as official headnotes or syllabi of Court opinions. The full text of this and other Court opinions from 1992 to the present are available online from the Reporter of Decisions: http://www.supremecourtofohio.gov/ROD/newpdf/. In the Full Text search box, enter the eight-digit case number at the top of this summary and click "Submit."