Reasonableness and Necessity' of Past Medical Expenses
Even if the defendant fails to admit some of the other sub-parts, you will know when you receive the defendant's answers exactly what issues will be disputed at trial.
• Consider filing a motion for partial summary judgment regarding the reasonableness of the medical expenses and include the argument that allowing the issue of the reasonableness of charges to go to the jury would invite speculation on collateral sources and cause the jury to substitute its own judgment for the reasonableness of the providers' charges.
• Be prepared early on to have to lay the foundation for your records, which can be done a few ways. First, a treating doctor or retained medical expert can testify that the charges were reasonable and the care was necessary. Second, a billing and Coding specialist from the facility can testify the charges are reasonable for these services, because the specialist knows what other facilities charge. (You will want to keep in mind my cautionary note above regarding multiple witnesses for numerous providers in catastrophic injury cases). Lastly, depending on the size of your case, you may wish to consider hiring a medical billing specialist with special background, training, experience and knowledge in the areas of medical coding, medical billing and reimbursement, and medical services and administration to offer opinions regarding the fair and reasonable cost/value of the medical bills incurred by the plaintiff for accident-related care and treatment and that the accident-related medical expenses incurred by the plaintiff are usual customary and reasonable charges for their geographical area.
• Know and understand the law regarding what damages an injured party is entitled to submit to the jury and the collateral source rule in the jurisdiction in which you are trying your case. Pennsylvania has adopted the "collateral source" rule, which prohibits the introduction of evidence that an injured party has received compensation on account of the same injury from a source other than the defendant, such as social security disability benefits or other insurance payments, as in Denardo v. Carneval , 297 Pa. Super. 484 444 A.2d 135, 140 (Pa. Super. 1982 ), (and cases cited therein) (an injured party is entitled to the damages caused by the tortfeasor's negligence [or product defect] regardless of compensation the injured party receives from other sources.) Simply stated, the law in Pennsylvania is that insurance proceeds may not be used to set off a subsequent damage award and is therefore inadmissible. In addition, with one limited exception, evidence that an injured party was compensated by a collateral source for all or a portion of the damages caused by a defendant's wrongful act is generally inadmissible, see, Gallagher v. Pennsylvania Liquor Control Board , 584 Pa. 362, 375 883 A.2d 550,558 (2005 ); 88 C.J.S. TRIALSECTION138 (2004), ("The fact that the plaintiff is insured or otherwise indemnified may be shown where it is a material issue in the case, or where it is brought out as an incident to the proof of some other fact properly involved, as, for example, employment."
Despite long-standing controlling authority, defendants, relying upon, Moorhead v. Crozer Chester Medical Center, 765 A 2d 786 (Pa. 2001), now seek to limit an injured plaintiff's medical expenses and/or damages to sums "actually paid" and exclude proof of the medical charges that were billed (either written-off or paid by insurance). In Moorhead, the Pennsylvania Supreme Court held that only the amount actually accepted by the defendant-health care provider from the plaintiff's health plans (the plaintiff had both Medicare and a private insurance) as payment in full for services rendered was recoverable economic loss in a personal injury action. The amount traditionally recoverable was "the reasonable value of medical Billing services." The court held the collateral source rule was not implicated because payments were not being reduced. The plaintiff could still recover that amount actually paid.
This holding undermines the very intent of the collateral source rule: the wrongdoer should be held fully accountable for his actions or defective product rather than having that accountability reduced because of the plaintiff's foresight in procuring insurance. Moreover, subrogation and lien rights must be accounted for as any amount recovered by the plaintiff may have to be repaid to lien holders thereby preventing a plaintiff from realizing a recovery. Therefore, the plaintiff should be allowed to put before the jury all evidence of accident-related medical expenses (amount billed). The full amount of medical expenses awarded by the jury should only be reduced (if at all) in a post-verdict proceeding at which time the plaintiff should present evidence of the amount paid by or on behalf of the plaintiff to secure the collateral source benefit (i.e., insurance premiums the plaintiff paid for the health plan coverage) as well subrogation and reimbursement lien claims asserted against any third party recovery.
Anticipating, and being prepared to respond to, these challenges will help streamline the trial and maximize the injured plaintiff's recovery.
Referral Source :http://www.thelegalintelligencer.com/ id= 1202778106897/Reasonableness-and-Necessity-of-Past-Medical-Expenses?mcode=0&curindex=0&curpage=2&slreturn=20170101045451
