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Future Medical Expenses

Future Medical Expenses

In many cases there is often a high likelihood, if not certainly, the injured party will need future medical treatment. In such cases, plaintiffs will often present the expert testimony of a life care planner who will testify to the gross amount of future medical expenses. If the injured party does not have insurance, it is clear the plaintiff will be able to offer and recover the full amount of the medical bills. However, an issue arises when the injured party has health insurance. In those cases, the defense counsel may try to have a reduced amount offered. Don’t let them. The defense counsel will rely on the fact that an insurance carrier will likely pay a reduced amount of the gross bills, and the same will be accepted as payment in full. However, for the reasons contained herein, the plaintiff is entitled to introduction evidence of and recover the gross amount of future medical expenses. Defendant is not entitled to offer evidence of any reduced medical expenses or evidence of the health insurance to possibly cover the same.

The collateral source rule provides that “payments from a collateral source shall not diminish the damages otherwise recoverable from the wrongdoer.”  Johnson v. Beane, 664 A.2d 96, 100 (Pa. 1995). This rule was intended to avoid precluding a plaintiff from recovering for injuries from the tortfeasor simply because the plaintiff was compensated from a collateral source, such as insurance. Beechwoods Flying Service, Inc. v. Al Hamilton Contracting Corp., 476 A.2d 350, 352 (Pa. 1984) (citing Boudwin v. Yellow Cab Company, 188 A.2d 259 (Pa. 1963)).  Thus, plaintiffs are entitled to damages caused by the tortfeasor’s negligence regardless of compensation obtained from insurance.  Denardo v. Carneval, 444 A.2d 135, 140 (Pa. Super. 1982) (citing Boudwin v. Yellow Cab Company, 188 A.2d 259 (Pa. 1963)). 

In Deeds v. Univ. of Pa. Med. Ctr., 110 A.3d 1009 (Pa. Super. Ct. 2015), the Pennsylvania Superior Court held the “collateral source rule” provides that payments from a collateral source shall not diminish the damages otherwise recoverable from the wrongdoer; this rule was intended to avoid precluding a claimant from obtaining redress for his or her injury merely because coverage for the injury was provided by some collateral source, such as insurance. In that case the Court held the overall effect of defense counsel's comments to jury, suggesting the plaintiff’s medical costs were being covered by Medicaid and the Affordable Care Act, and that she did not require, and accordingly could not properly seek, any additional compensation, was held to be a patent violation of collateral source rule, requiring remand for new trial. The Court held the plaintiffs were entitled to a new trial because defendants repeatedly suggested plaintiffs' medical costs were being covered by Medicaid and the Affordable Care Act, which were patent violations of the collateral source rule. Deeds v. Univ. of Pa. Med. Ctr., 110 A.3d at 1013-1014. Specifically, the Court stated that defendants' contention that the plaintiff’s “medical needs [were] being met may well have permitted [defendants] impermissibly to benefit from ‘the fortuitous existence of a collateral remedy’... The teachings of our case law are clear: such suggestions ... may have improperly influenced the jury’s determination.” Id. at 1014 (citations omitted).

In Cordes v. United States, 2015 U.S. Dist. LEXIS 178678 (WD Pa.) the collateral source rule and its viability in Pennsylvania was addressed. This Court provided and cited the Pennsylvania Supreme Court holdings on the issues, that “‘payments from a collateral source shall not diminish the damages otherwise recoverable from the wrongdoer. Johnson v. Beane, 664 A.2d 96, 100 (Pa. 1995).” It further identified this rule was intended to avoid “precluding a claimant from obtaining redress for his or her injury merely because coverage for the injury was provided by some collateral source, e.g. insurance. Beechwoods Flying Service, Inc. v. Al Hamilton Contracting Corp., 476 A.2d 350, 352 (Pa. 1984).”

Moreover, in Cleaver v. United States, 2012 U.S. Dist. LEXIS 35679 (W.D. Pa. Mar. 15, 2012), this Court denied a defense motion to preclude the introduction of medical bills and costs submitted by plaintiff’s medical care providers that exceeded the Medicare billing rates for past and future medical expenses based upon the collateral. See also Kollien v. Kmart, 2016 WL 6135646 (MD Pa. 10/21/16); and Bernheisel v. Mikaya, 2106 U.S. Dist. LEXIS 104554 (MD Pa. 8/9/16).

In addition to the above case law, Pa. SSJI §7.30 on future medical expenses agree on the point that where a “jury could reasonably infer that the plaintiff would require future medical treatment based on evidence of past medical expenses and evidence of the permanent nature of the disability,” any verdict awarding recovery for future medical expenses must be upheld in full. Pratt v. Stein, 444 A.2d 674, 697-698 (Pa. Super. 1982); Crow v. Deems, 63 A.2d 119 (Pa. Super. 1949). 

In order to eliminate the possibility that a jury’s award for future medical costs will be speculative, Pennsylvania law requires that a party seeking to recover such damages “prove, by expert testimony, not only that future medical expenses will be incurred, but also the reasonable estimated cost of such services.”  Mendralla v. Weaver Corp., 703 A.2d 480, 485 (Pa. Super. Ct. 1997).  However, a plaintiff need only provide the jurors with a reasonable amount of information sufficient to enable them to estimate damages without engaging in speculation. Slater v. Pennsylvania Power Co., 557 A.2d 368, 371 (1989). 

The only time compensation for insurance may reduce recovery is in the case of an automobile accident, as explicitly indicated by Pa. SSJI §7.30.Moreover, the previous charge on future medical expenses before the change of numbers in 2011, Pa. S. S. J. I. (Civ) 6.01B and subcommittee note of 6.14 confirm that the market value of all related future medical expenses is recoverable. The subcommittee note, citing Mooreheadsupra, confirms that is purely speculative to try to assume what amount if any insurance coverage will exist and/or the amount that would be covered, and, thus, a plaintiff is free to recover the market value of the medical expenses, regardless of the plaintiff’s insurance status at the time of the trial. As set forth in Moorhead v. Crozer Chester Medical Center, 765 A.2d 786, 789 (Pa. 2001), “when a plaintiff will continue to incur expenses for medical services, it is appropriate for the fact finder to determine the amount of damages which will compensate the plaintiff for those expenses that are reasonably necessary to be incurred.”  Id.  

Based on the above, so long as the jury can reasonably find future medical expenses will be incurred and can reasonably estimate those expenses without engaging in speculation, any verdict given by that jury must be upheld. Furthermore, the collateral source rule provides that any such verdict may not be reduced by insurance compensation.  

It is anticipated defendants may argue that a plaintiff has insurance currentlyand thus, her medical expenses should be reduced to account for the coverage. This is in direction violation of Pa Standard Jury Instructions and the collateral rule doctrine. Further, it would be speculative to argue what, if any, medical insurance coverage the plaintiff has now will carry in the future and if any future medical bills will be covered and in what amounts. Therefore, the courts in Pennsylvania must permit the recovery of gross future medical bills in order to avoid unreasonable speculation as to the value of plaintiff’s claim for future medical expenses. 

For the reasons identified above, gross amounts of medical bills, without any reduction for possible insurance coverage, are recoverable by a plaintiff if the defendant is found to be responsible for her injuries, regardless of a plaintiff’s current insurance status.

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