Kentucky and Ohio – What Can You Present As Medical Damages To A Jury?
Posted on Tuesday, September 20th, 2016 at 1:08 pm
The following post is part of our Law Student Blog Writing Project, and is authored by Mark Ashley Hatfield, a Juris Doctor student at the University of Kentucky College of Law.
Kentucky and Ohio – What Can You Present As Medical Damages To A Jury?
Anyone who has suffered, or has had a family member suffer, a significant injury has most likely had to make a trip to the hospital. If you are anything like me and my family, you are beyond grateful for the care, but less appreciative of the mail you receive from the hospital weeks after your discharge. You know what I am talking about… Bills. Paying a hospital bill often requires calling the hospital and dealing with an automated answering machine for five minutes, and then speaking with a representative who explains to you why your bill is so high. Needless to say it is not all that fun. However, in many cases, the amount of your bill will decrease after your insurance covers its portion, or the hospital may offer a discount on the original amount if you pay in-full or pay it off before a certain deadline.
In an ordinary situation, the discounts mentioned in the last sentence are very desirable. You are out of pocket less money, and you still benefit from the treatment. The situation gets a bit stickier in the extraordinary cases where your injury involves a third-party (i.e., a drunk driver crashes into you or a doctor makes a harmful mistake in your surgery). Who is responsible for those losses? More importantly, what losses are they responsible for? Is the tortfeasor (the drunk driver and the doctor above) on the line for the amount of medical charges originally billed to you, or is he only liable to you in the amount of the bills you actually paid after discounts and insurance coverage?
This answer will often depend on what evidence you are allowed to present to the jury. In Kentucky and Ohio, the evidence you are allowed to present to a jury is quite different, and thus, will produce quite different results. This article will examine a case from each jurisdiction to explain the competing theories of thought in this area. I will also discuss fairness and share with you my opinion on which method is best for which party.
First, I will begin with the Kentucky case, Baptist Healthcare Systems, Inc. v. Golda H. Miller. This case was decided in 2005, a year earlier than the Ohio case we will discuss momentarily. In this case, Ms. Miller, an 80-year-old woman, had gone to the hospital to have her blood drawn. The phlebotomist placed a tourniquet on Ms. Miller’s arm, but was interrupted by a phone call shortly thereafter. Attending to the phone call, the phlebotomist drawing Ms. Miller’s blood left her without supervision for approximately 10-minutes. Because of this incident, Ms. Miller subsequently experienced medical complications with the arm and sought treatment. Ultimately, after seeing several doctors, it was concluded that Ms. Miller was suffering from nerve damage.
Ms. Miller then filed a negligence claim seeking damages from Central Baptist Hospital. Here is where it gets a bit complicated. At trial, Ms. Miller was awarded $22,100 for medical expenses after seeking $40,922.08 (some of the difference was deducted because the court found Ms. Miller partially at fault for not removing the tourniquet herself). The doctor billed $31,840 for the treatment, but only received $3,356.38 from Medicare. It is the hospitals position that Ms. Miller should only be entitled to recover what she (in this case her insurance, Medicare) was required to pay – $3,356.38. The Kentucky Supreme Court, citing the collateral source rule, did not buy into this argument.
The collateral source rule, put simply, allows a plaintiff (Ms. Miller) to (1) seek recovery for the reasonable value of medical services for an injury, and (2) seek recovery for the reasonable value of medical services without consideration of insurance payments made to the injured party. Central Baptist argued, in light of this rule, it should be allowed to present to the jury the evidence that Medicare had contracted for its services at a lower rate, and thus, Ms. Miller only had to pay a small portion of the actual amount billed for the services she received. This would have likely influenced the jury to lessen the amount awarded to Ms. Miller, and the court was not favorable of that position.
Now, taking a trip across the Ohio River into Ohio, we reach a somewhat different result. Robinson v. Bates, as mentioned earlier, was decided in 2006, a year after the Kentucky case and involved a landlord-tenant personal injury issue. Ms. Robinson, who rented an apartment from Ms. Bates, fell in the driveway of the residence and broke a bone in her foot. Only days before the accident occurred, Ms. Bates (the landlord) had hired a contractor to do some work around the residence, and Ms. Robinson’s fall was directly attributable to some work that had been completed. Subsequently, Ms. Robinson sued Ms. Bates for personal injury. Ms. Robinson proffered her medical bills of $1,919 at trial, and also stipulated that her insurance had negotiated the amount of $1,350.43 as payment in full. In refusing to admit the original bills, the trial court limited Ms. Robinson’s proof of damages to the amount she was actually required to pay. This decision, however, was reversed at the appellate level.
After making its way through the court system, the Ohio Supreme Court held that both the original medical bill rendered and the amount accepted as full payment for medical services should have been admitted to the jury. The Ohio court, similar to the Kentucky Supreme Court, discusses the collateral source rule, but does so in a more limited manner. The Ohio court believes that all evidence (both the original bill and the amount accepted as payment in full) is relevant and that the reasonable value of medical services “is a matter for the jury to determine.”
The Ohio case expounds on this quite a bit, but the collateral source rule, a big issue in both of these cases, is met with varying interpretations across different states. In this article, the conclusions show that the evidence presentable to juries in Kentucky is more beneficial to the claimant. By limiting the evidence to the original amount billed, the claimant will always be able to seek a higher amount of damages. In Ohio, the admission of the original amount billed and the amount accepted as payment in full, leaving the damages question up to a jury; a situation that could lead to a wide-variety of damage results.
Put into an example, in Kentucky, if the hospital bills the injured party for $100,000, the injured party can present that evidence to a jury (without the amount actually paid being presented) and seek that amount as damages. This bodes very well for the injured party because a portion of that bill may have already been covered by insurance or greatly reduced by the hospital. Adversely, Ohio allows both the original bill (in our above example, $100,000) AND the amount actually paid, let’s say $50,000 (assuming the injured party’s insurance covered half of the original bill). The jury is then allowed to use reasonable discretion in determining what damages the plaintiff will be awarded; they may decide upon the original bill amount ($100,000), the amount paid ($50,000), or somewhere in between.
Both states have their respective rationales for ruling as they have. Kentucky seeks to protect the injured parties’ right to recover the full amount of damages (original bill as the KY courts see it), essentially encouraging the public to have adequate health insurance by rewarding the injured parties’ choice of healthcare or employment. Ohio, however, with the same purpose in mind, allows the original bill and the amount actually paid to come in as evidence. This approach, I believe, is more fair to all parties involved. I take this position because it prevents injured parties from obtaining double damages. Double damages would occur when the injured party’s bill has been reduced to $50,000, but the tortfeasor is still on the hook for $100,000 (what would happen in Kentucky). Obviously as a plaintiff we would all love that outcome, but in a system where we strive for “justice for all,” it is hardly fair to make the tortfeasor cover damages that have already been paid by insurance or will never be paid because the amount was forgiven by the hospital.
Additionally, the Ohio approach is not guaranteeing that the injured party will receive less than he or she would under the Kentucky approach; it simply allows the jury to take all relevant evidence into account when calculating damages. The injured party, upon receiving a favorable decision, will always receive, at a minimum, the amount he or she has spent on medical bills. In extremely egregious cases, the jury will likely be compelled to award the injured party the maximum amount they can (the amount of the original bill). In less egregious cases, the jury will have the option of lessening the damages to the amount actually paid by the injured party or some amount in between. When looking at the problem from both perspectives, I believe the Ohio approach produces the fairest results, and those are the types of outcomes our justice system was designed to produce.
Addendum from Lawrence & Associates:
Lawrence & Associates’ law student blog writing program is an independent program designed to foster discussion among students and to prepare students to discuss legal issues with their clients. It is truly independent, in that we don’t tell our students what to write or how to think about an issue. Because of that, we sometimes disagree vehemently with our students’ opinions while recognizing our collective right to disagree, and applauding them for staking a position on a contentious issue. This is one of those times.
Lawrence & Associates disagrees that the Ohio rule is “fairer” as set forth above. There are many things a jury doesn’t get to hear, and that includes any discussion of the history of an injured plaintiff’s dealings with his or her own health insurance policy, or who bears the cost of recovering medical damages in the civil justice system. It is this kind of half-truth that our forefathers chose to combat when they designed the collateral source rule. When properly applied, the collateral source rule limits the information presented at trial to what is relevant to determine the total amount of damages, while allowing the judge to apply additional rules passed by the legislature that dictate how complex systems like the laws affecting insurance subrogation should affect the jury’s verdict. Unfortunately, the Ohio courts’ abandonment of the time honored collateral source rule makes a false showing of “fairness” by giving juries partial information to affect their decision.
For example, the Ohio rule allows in evidence of the health insurance payment toward medical bills, but not evidence about the years of premiums the injured plaintiff paid to get that health insurance. Wouldn’t you, in the shoes of a juror, like to know that an injured plaintiff paid twenty years of premiums, totaling thousands of dollars, in order to get the reduced medical bill presented at trial? Failing to allow this evidence into court when allowing evidence of the reduced bills payment gives the negligent person the benefit of the bargain between the injured plaintiff and his or her insurance company. Essentially, the Ohio rule allows a negligent person, such as a drunk driver, to leverage the premiums paid by the innocent, not-at-fault party to reduce the amount the negligent person has to pay due to his or her own negligence. Why do the innocent, injured plaintiff’s premium payments serve to reduce the negligent person’s liability? Why don’t those premiums go to the benefit of the person that paid them?
Further, health insurance companies are harmed by the Ohio rule because the civil justice system allows them to benefit from Plaintiffs’ lawsuits against negligent people. Plaintiffs bear the cost and burden of recovering medical bills at trial. If Plaintiffs are functionally unable to recover money in excess of what needs to be turned over to the medical provider, what is that injured person’s incentive to recover those medical bills? Remember that medical bills do not have to be mentioned at trial, and they have already been paid by the injured Plaintiff’s health insurance. Why should the Plaintiff shoulder the sole cost and burden of recovering money that belongs to someone else if there is no benefit to the Plaintiff? The answer is that many don’t, and as a result the health insurance company cannot get reimbursed for medical costs that the negligent person or company would otherwise have been responsible for.
Because of these issues, both the Plaintiffs and their health insurance carriers see lower recoveries from negligent people in Ohio than in Kentucky. Negligent people and/or their liability carriers win under the rule, but plaintiffs, medical providers, and health insurance companies lose. We should not encourage a system that rewards only those that hurt someone, but punishes the injured and their doctors. As a result, Lawrence & Associates believes Kentucky’s damages rule is fairer – and perhaps more importantly, more suited to the way modern healthcare works – than the Ohio rule.