collateral source rule arizona

Moreover, the types and number of “collateral sources” available to plaintiffs have multiplied. However, courts that follow this approach do not allow plaintiffs to recover the amount of their full bills if they did not pay for the benefit of discounted rates and write-offs. Lopez v. Safeway Stores, Inc., 212 Ariz. 198, 202, ¶ 13, 129 P.3d 487, 491 (App. Matt graduated from the James E Rogers College of Law at the University of Arizona in passing the Arizona bar exam in 2010. Arizona Legislature Looks To Limit Collateral Source Rule. If the plaintiff has obtained and paid for medical insurance, he should receive the benefit of that bargain: the plaintiff’s insurance should not indemnify the defendant. Critics of the collateral source rule argue that an injured person should not receive a double recovery. A. The plaintiffs argued that collateral source evidence should be excluded “because it would cause unfair prejudice, confuse the issues, and mislead the jury.” The court stated the defendants “have not specified what collateral source payments they intend to introduce at trial or explained how any collateral source evidence would fall within an exception to the collateral source rule.” . Share This Post. The means and methods of pleading, proving, and recovering medical expenses, however, remain inextricably tethered to the CSR. It gives the prudent plaintiff the “benefit of the bargain” of having purchased insurance. State of Arizona House of Representatives Fiftieth Legislature Second Regular Session 2012 HB 2547 Introduced by Representative Vogt: Senator Driggs AN ACT AMENDING TITLE 12, CHAPTER 13, ARIZONA REVISED STATUTES, BY ADDING ARTICLE 10; RELATING TO COLLATERAL SOURCE EVIDENCE. In plain terms, a judge may reduce a personal injury award to account for “any payments made” by an insurance company on the plaintiff’s behalf. They must invest all profit in the organization, are exempt from paying state and federal taxes on income and property, and must report “community benefits” offered by the facility. ), and the payer or entity which ultimately pays the bill (health insurer, government, etc.). View chart (begins on page 7) that provides an overview as to the law in all 50 states regarding the treatment of “reasonable” medical expenses, write-offs, and the collateral source rule. As one court noted, reducing an insured plaintiff’s recovery by the negotiated rate differential “overlooks the fundamental purpose of the [collateral source] rule, … to prevent a tortfeasor from deriving any benefit from compensation or indemnity that an injured party has received from a collateral source.” Acuar v. Letourneau, 531 S.E.2d 316 (Va. 2000). 1 Be it enacted by the Legislature of the State of Arizona: 2 Section 1. $65,000? In that earlier post the Nevada Law Blogs predicted that the Nevada Supreme Court could not allow the trial court’s decision to stand. . health insurance, worker's comp., defense and liability insurance, etc.). Recently, an appellate court in Texas overruled a $9 million jury verdict in favor of an injured worker against a drilling company. States began to enact collateral source statutes which significantly modified or altered the common law rule. On November 11, 2017, the Supreme Court declined to alter existing law in Tennessee, holding that the CSR applies to the proof and recovery of past medical expenses in personal injury cases, despite deep write-offs and the payment of the bill by private health insurance. Matt's primary interest in law focuses on general personal injury and insurance bad faith. The final bill is created by a medical biller who looks at the balance the patient has, adds the cost of the procedure or service to that balance, deducts the amount covered by insurance, and factors in a patient’s co-pay or deductible. The CSR ensures that the liability of similarly situated defendants is not dependent on the good fortune of the way each plaintiff’s medical expenses are financed. The bill also created a “collateral source” rule in Louisiana law meant to ensure plaintiffs are compensated only for medical damages either paid or owed, as opposed to the “sticker price” of a procedure, which might be much higher. See Lopez v. Safeway Stores, Inc. , … House approves collateral source rule on civil cases By: Hank Stephenson March 4, 2013 With no debate, the House on Monday approved a controversial tort reform bill that would require plaintiffs in civil action cases involving personal injury, wrongful death or destruction of property to disclose other benefits paid through their insurance. States adopting this approach generally seek to avoid allowing plaintiffs any so-called “windfall” from tortfeasors. ¶21 Nevertheless, the Arizona legislature narrowed the benefit AHCCCS members may receive from the collateral source rule when it complied with the federal directive by enacting A.R.S. While the insured/patient may only have direct interaction with the doctor, it is really a three-party relationship – the patient, the health care provider (doctor, hospital, etc. Where they have, the result is often dictated to some extent by statute. Simply put, the CSR requires the party responsible for causing the injury to compensate the victim of the accident for all harm caused and not merely the net loss suffered by a victim. 2. Arizona; NEWS. It depends on the contractual deal they have in place with the providers. Likewise, the jury should evaluate the full value of the plaintiff's injuries without being influenced by how much insurance the defendant does or does not have; the plaintiff should not benefit from the fact that defendant has "plenty of insurance" to cover her loss. In determining the amount of damages to be presented as evidence in a personal injury trial, judges are often called on to decide whether to admit as evidence the higher, billed amount, the lesser amount actually paid as the cost of services rendered after the write-off, or both. Mar. Health care actions; collateral source evidence. A typical example is when the injured party uses their own medical insurance to cover … The bill also created a “collateral source” rule in Louisiana law meant to ensure plaintiffs are compensated only for medical damages either paid or owed, as opposed to the “sticker price” of a procedure, which might be much higher. Nearly 67% of U.S. hospitals are losing money, particularly when it comes to the treatment of Medicaid/Medicare patients. This source is known as a collateral source and is often a health insurance company. Co. v. Pima Capital Mgmt. Despite becoming a firmly established principle of tort law in most states, many questions have arisen concerning the scope of the CSR: Does it apply to free medical services? Collateral Source Rule Not Violated by References to Medical Insurance, Medicare and Social Security Arizona Limits Failure to Warn Claims Against Medical Device Manufacturers Product Liability Litigation Group Ranked in 2019 “Best Law Firms” The other side of the argument is that the cost of negligent behavior should be imposed on the defendant as the at-fault party, in order to reinforce the standard of reasonable care that all members of a society should adhere to. Posted by Matt Schmidt | Oct 15, 2019 | 0 Comments. The plaintiff has paid or become liable to pay the medical bills; The plaintiff necessarily incurred the medical expenses because of injuries resulting from the defendant’s negligence; and. 205 (Winter 1985). Therefore, further briefing is unnecessary and the motion will be denied as moot. A few states, including Arkansas and Kentucky, have abrogated the CSR to some degree by statute. The court ordered a new trial after finding  the jury had access to an unredacted document showing that the defendant had $9 million in liability insurance coverage. ; Corporation: A legal entity owned by the holders of shares of stock that have been issued, and that can own, receive, and transfer property, and carry on business in its own name. 2004). Your email address will not be published. Yes No Yes for awards of future damages in excess of $150,000. In Nevada, the collateral source rule provides that when “an injured party [has] received some compensation for his injuries from a source wholly independent of the tortfeasor, such payment should not be deducted from the damages … While the collateral source rule typically prevents damages from being reduced, a victim may still be required to repay compensation in some cases. The CSR is a relatively new legal concept in the common law. $ " Jack and Michaela were friendly and professional while my case was ongoing. Under Connecticut law, the answer is yes, with certain qualifications. Can a plaintiff submit to the jury the amount initially billed for medical services, as opposed to a discounted amount that her private insurance company paid to her health care providers? The amount beyond what is accepted in full satisfaction of the bill is considered a “discount”, “write-down”, or “write-off.”. The CSR is a relatively new legal concept in the common law. Thank you! Please tell us what we can do to improve this article. The purpose of the collateral source rule is to exclude evidence of payments made to the plaintiff by sources other than the defendant when the evidence is offered for the purpose of diminishing the defendant tortfeasor's liability to the injured plaintiff. In states which have eliminated the CSR or modified it by statute, trial lawyers argue that the existence and amount of liability insurance should also be admissible in civil trials, putting all the cards on the table for a jury. Castelletti, 112 Nev. 88, 911 P.2d 853 (1996) and its strict reading of the collateral source rule is still the law in Nevada as the Nevada Law Blogs had predicted. Terms Used In Arizona Laws 12-565. Both approaches violate the CSR and result in plaintiffs with insurance being treated quite differently from plaintiffs without insurance. Some jurisdictions have not formulated a clear view, while others have taken inconsistent approaches depending on the facts involved or the court rendering the decision. As applied to personal injury lawsuits, for example, some states exclude evidence that a plaintiff’s medical bills were paid by medical insurance or by workers’ compensation. Required fields are marked *. A thorough understanding of how medical expenses are proven and recovered in civil litigation is a necessity for lawyers, legislators, claims professionals, and judges alike. A few courts use a “hybrid” method, allowing the trier of fact to consider both the actual amount paid and the full bill in determining the “reasonable value” of medical services provided to the plaintiff. History of Collateral Source Rule (CSR). One strategy to encourage the purchase of private insurance is to allow plaintiffs to recover from defendants irrespective of their own insurance coverage. Thank you! They also argue that, if the CSR can be modified, allowing evidence of collateral sources, then the discounted medical bills should be considered proven as reasonable and necessary upon testimony by the patient that the bills were incurred. ); id. (2) Payments made to or benefits conferred on the injured party from other sources are not credited against the tortfeasor’s liability, although they cover all or a part of the harm for which the tortfeasor is liable. cmt. The defendant files a motion asking the judge to limit the plaintiff’s recovery of medical expenses to the $65,000 that the health care providers accepted as payment. . Collateral Source Rule (CSR) The modern Collateral Source Rule (CSR) has been called one of “the oddities of American accident law.” John G. Fleming. Thankfully, the plaintiff has private health insurance, and the doctor and hospital accept $65,000 from the insurance company in satisfaction of the bill. Statutes. “Amount Paid.” The “actual amount paid” approach limits a plaintiff’s recovery to the amount paid to the medical provider, either by insurance or otherwise. A “collateral source” is benefits received by the plaintiff from a source wholly independent of and collateral to the wrongdoer. This is sometimes done as part of broader tort reform legislation, as in Texas and Missouri. Arizona generally applies the collateral source rule to allow a plaintiff to recover damages even if they were not actually sustained. To get medical bills into evidence and recover them as an element of damage, plaintiffs simply needed to prove: 1. L. REV. When a person injured in an automobile crash receives medical treatment, the provider may accept $700 from the patient’s health insurance carrier for that care even though the provider’s “normal” charge would be $1,500. States against the rule disfavor the plaintiff receiving double recovery for the same injury. In some states, statutes act as a rule of evidence, governing what evidence is allowed in proving the reasonableness of medical expenses. The Collateral Source Rule is a concept in common law that prohibits the admission of evidence that a injured party’s damages were or will be compensated from some source other than the damages awarded against the Defendant. One final thing about the CSR: it does not apply in medical malpractice cases. medical provider and the insurer - was a collateral source benefit and applied the common-law collateral source rule. Note that “balance billing” (insurance company sends patient bill for balance of services insurance doesn’t pay for), usually occurs when a patient goes “out-of-network” for medical services, and there is no contract between the provider and the insurance company agreeing to the discounted insurance rates. The Key to Winning COVID Business-Interruption Claims: Say... medical expenses incurred were both “reasonable” and “necessary.”, Medical Billing, Insurance Write-Offs and the Collateral Source Rule, Company Offering Pandemic Stock Tips Accused of $137M Fraud, Family Behind Oxycontin Maker Purdue Pharma Offers 'Sadness', Suspected Russian Hacking Spree Reached Into Microsoft -Sources, Government Ordered to Pay Landowners on Lower Missouri River. The underlying rationale for this plaintiff-friendly rule is that if the law must choose between allowing the plaintiff to receive more than his actual loss or allowing the defendant to pay less than the damage he inflicted, then the more equitable choice is to allow the plaintiff to receive more than his loss, rather than giving the defendant the windfall of the prudent plaintiff. Stated another way, this approach promotes inherent discrimination among beneficiaries from different programs and insurance companies. (TEXT OF BILL BEGINS ON NEXT PAGE) HB 2547 - 1 - 1 Be it enacted by the Legislature of the State of Arizona… This is especially true with regard to recovering reasonable and necessary damages in personal injury litigation. Please complete all required fields below. As a rule of damages, it prohibits the tortfeasor from reducing payment of a tort judgment by the amount of money received by an injured party from other sources. Thus, such compensation will not be deducted from the damages which the plaintiff would otherwise collect from the tortfeasor/defendant. Can the trial court reduce a plaintiff’s damages award to the amount actually paid by the collateral source? Arizona generally applies the collateral source rule to allow a plaintiff to recover damages even if they were not actually sustained. In this example, what is the reasonable value of medical services? States have generally adopted one of three basic approaches to how much of a medical expense can be introduced into evidence and how much can be recovered: 1. However, evidence of collateral source payments is admissible in medical negligence cases, subject to the plaintiff’s right to introduce evidence of any liens against the plaintiff’s claim. % of people found this article valuable. for an injury which the injured party receives from a collateral source wholly independent of the wrongdoer does not operate to reduce the damages recoverable from the wrongdoer.”). An injury victim should understand when certain compensation sources do not affect their injury claim. L. REV. The charges were reasonable for services of that nature. They feel that limiting damages will help the liability insurance industry and help the business economy of their state. Subd. In other states, statutes act as a rule of damages, limiting recovery to discounted amounts after “write-offs.”. These courts adhere to the traditional CSR. Certain exceptions exist to the collateral source rule, however. Such damages paid by a collateral source are also pejoratively referred to by the tort reform advocates as “phantom damages.” The Restatement of Torts, Second, defines the CSR in § 920A(2): § 920A Effect of Payments Made to Injured Party. 152 (1854). At our Tucson personal injury law firm, our goal is to fully understand the extent of your injuries and their impact on your life so that we can expedite your case to a successful settlement or verdict. A. Justification for the Collateral Source Rule Those who support the collateral source rule generally believe it is a justifiable double recovery for plaintiffs. health insurance, worker's comp., defense and liability insurance, etc.). The result is a confusing patchwork of laws depending on which state a case is filed in. If the benefit was a gift to the plaintiff from a third party or established for him by law, he should not be deprived of the advantage that it confers. Some states still allow the jury and/or judge to evaluate benefits obtained by plaintiff from collateral sources and apply that information to their decision-making, but most states are in favor of some version of the Collateral Source Rule. The billed vs. paid challenge is but one of many ways to try and reduce recoverable damages based on the amount billed by a Plaintiff’s medical provider. While this case helps to clarify what does and does not violate the collateral source rule, it may prove impactful in more significant ways. The pl… The plaintiff sues the defendant and wants to recover $200,000 as the reasonable and necessary medical expenses which he “incurred” and was billed for. To explain, Medical billing experts use the physician’s diagnosis codes and correlating procedure codes. The collateral source doctrine is an evidentiary rule prohibiting admission of evidence that a plaintiff has received compensation from some source other than the damages sought against a defendant. § 36-2915. Tenn. 2016); Hall v. USF Holland, Inc., 2016 WL 361583 (W.D. Federal statutes prohibiting “patient dumping” also complicate the valuation of medical expenses. Appellate courts in fifteen (15) states and the District of Columbia have held that the injured plaintiff may recover the amount billed, and bar the defendant from presenting evidence of the lower amount that the health care provider accepted to satisfy the bill. Compare these against the insurance policy and coverage determinations. Collateral source rule is a rule of damages that benefits received by the plaintiff from a source wholly independent of and collateral to the wrongdoer will not diminish the damages otherwise recoverable. Some states have answered these questions, while others haven’t. ARIZONA Collateral source evidence is not admissible in general bodily injury claims, but it is admissible in medical malpractice claims. The concept behind the rule originated from common law in England as early as 1823. Universal Citation: AZ Rev Stat § 12-565 (2014) 12-565. The Howell reasoning – that the CSR is inapplicable to third-party payment of the plaintiff’s medical debts, but is still in force for third-party forgiveness of the same debt – has been called “schizophrenic” and “incoherent.” McConnell v. Wal-Mart Stores, Inc., 995 F. Supp.2d 1164 (D. Nev. 2014). The CSR is a relatively new legal concept in the common law. Other payers might pay by the day, or based on each individual service the patient receives. Different insurance companies will also approve and disapprove of different services, so it’s difficult to know in advance what will be paid. Co., 201 Ariz. 10, ¶ 33, 31 P.3d 123, 134 (App.2001); Hall, 119 Ariz. at 74, 579 P.2d at 578. He seeks to clarify the German law on the collateral source rule. COLLATERAL SOURCE EVIDENCE 5 12-2321. 1 Be it enacted by the Legislature of the State of Arizona: 2 Section 1. At the time of the Dedmon decision, three federal district courts in Tennessee had concluded that the West rule applied in personal injury litigation as well. Established in 1995, our firm has a long history of success, as seen in our many victories. IN AN ACTION TO RECOVER DAMAGES FOR PERSONAL INJURIES OR WRONGFUL A few states allow defendants to use the insurance payments to reduce their liability. The collateral benefits are usually paid for by the plaintiff, subject to a right of subrogation, or both. A medical billing expert witness should have a strong basis for their opinion. It has become a language unto itself. Stokes v. Muschinske, No. In practice, the CSR never requires the defendant to pay twice, and rarely allows the plaintiff to retain a windfall. Does it apply to services paid by Medicare or Medicaid? The collateral source rule divides the different States into three broad categories, plus a very small fourth category. (1) A payment made by a tortfeasor or by a person acting for him to a person whom he has injured is credited against his tort liability, as are payments made by another who is, or believes he is, subject to the same tort liability. This is known as the collateral source rule. In recent years, the issue of what is considered the “reasonable value” of medical services has become complicated and distorted by the deep discounts demanded by insurance companies, laws that require hospitals to treat patients who cannot pay, and benefits like Medicaid and related state programs that pay a set amount for all treatment of a patient. Collateral Source Rule State Summary. Admissibility of collateral source evidence 6 A. A doctor or hospital would charge a reasonable fee for medical services, and the patient would pay it. The Collateral Source Rule and Loss Allocation in Tort Law, 54 CAL. This approach permits recovery of the full, undiscounted medical bills, including the write-off amounts, only where the plaintiff paid consideration for the insurance benefits. In Stokes, the defendant was driving a pickup truck … Also, understand national charges and … The negligent tortfeasor wins the lottery when the victim he injures happens to be prudent and has bought insurance, but is punished when the victim has no insurance. Pennsylvania, Idaho and California are examples of states whose courts have held that only evidence of the amount paid is relevant and admissible. This “collateral source rule” prohibits tortfeasors from avoiding liability for damages in situations in which an injured party has been compensated by a third party. The collateral source rule bars the admissibility of evidence at trial to show that a plaintiff’s losses have been compensated from other sources, such as the plaintiff’s insurance or workers compensation. Any subrogated provider of a collateral source not separately represented by counsel shall pay the same percentage of attorney fees as paid by the plaintiff and shall pay its proportionate share of the costs. Managed care has further distorted pricing for health care services, as the deep discounts demanded by the MCOs require providers to offset those discounts by charging higher prices to other patients. It eliminated a well-established feature of the common law, the collateral source rule, with clarity. Furthermore, defendants are precluded from submitting evidence of discounted rates accepted by medical providers from the insurer to rebut the plaintiffs’ proof that the full, undiscounted charges are reasonable. The defendants, however, may submit evidence that the plaintiff’s medical providers accepted less than the full bills to rebut the reasonableness of the full bills, so long as insurance is not mentioned. . Arizona Court of Appeals Division Two Holds That the Collateral Source Rule Applies to the Full Amount of Charged Reasonable Medical Expenses Without Any Deduction for Amounts Written Off by Healthcare Providers in the Context of a Negligence Slip and Fall Case. Most of these courts ground their decision on the common law CSR. Some states that permit plaintiffs to recover their full, undiscounted medical bills, believe that plaintiffs are entitled to claim and recover the full amount of reasonable medical expenses charged, based on the reasonable value of medical services rendered, including amounts written off from the bills pursuant to contractual rate reductions. Lawyers for defendants across the country are now frequently arguing that the bills were not actually “incurred” by the plaintiff because they were paid by a collateral source (e.g., private health insurance, state Medicaid, Medicare, workers’ compensation, governmental assistance programs, etc.). It’s not just that the rate is different for each service, but that different payers will reimburse different services. Tucson, Arizona 85718 Phone: (520) 790-5600. “The collateral source rule is well established in Arizona tort law.” Michael v. Cole, 122 Ariz. 450, 452, 595 P.2d 995, 997 (1979); see also S. Dev. Jury not informed of collateral sources. In the absence of any similar clarity, and in light of the consistent holdings of the Court of Appeals, I hold that the statute did not also eliminate the subrogation rights of plaintiffs' insurers…. “The collateral source rule is well established in Arizona tort law.” Michael v. The collateral source doctrine is an evidentiary rule prohibiting admission of evidence that a plaintiff has received compensation from some source other than the damages sought against a defendant. The “actual amount paid” approach has been heavily criticized. 2006). COLLATERAL SOURCE EVIDENCE 5 12-2321. 5. 3. Like Texas, in Arizona it is inadmissible and improper in most personal injury cases for the jury to be exposed to details regarding benefits either side have or will receive from a third party as a result of the lawsuit (i.e. Tenn. 2016); Keltner v. U.S., 2015 WL 3688461 (W.D. The actual term “collateral source” derived from language used in a Vermont decision some years later. In addition, the court ruled that the liens were a collateral source and could not be introduced into evidence without violating Proctor v. Castelletti, 112 Nev. 88, 911 P.2d 853 (1996). There are no comments for this post. There was hope within the Tennessee Defense Lawyers’ Association that the present rule, that allowed plaintiffs to submit evidence of the full, undiscounted medical bills as proof of the “reasonable” value of medical services, would finally end. When insurance payments are used to compensate the plaintiff’s medical providers, they reason, limiting the plaintiff’s recovery to only the amount paid by the insurance company to the medical provider simply permits the plaintiff to recover no more than he has expended. The same insurance company might have several different methods of payment depending on the patient’s type of policy. The collateral source rule is a law that applies in Nevada personal injury cases.It helps victims reasonably recover when they’re hurt. The “benefit of the bargain” approach has been criticized as protecting the rich and hurting the poor, since persons who can pay for insurance are the only personal injury plaintiffs who may recover the negotiated rate differential. Banks McDowell, The Collateral Source Rule—The American Medical Association and Tort Reform, 24 Washburn L.J. Consequently, plaintiffs may continue to submit evidence of the plaintiff’s full, undiscounted medical bills as proof of reasonable medical expenses. Proving the reasonable value of medical services has become both controversial and confusing; and every state has gone its own way in dealing with the issue. By continuing to use our site, you accept our revised Privacy Policy. An Example of the Collateral Source Rule. 14, 2019) (awaiting official publication) begs the question, does reference to a plaintiff’s membership in a health care plan, like Kaiser Permanente, or Medicare eligibility violate the collateral source rule? The Collateral Source Rule allows an injured person to make a full and complete recovery from the responsible party without regard for payments made by a secondary source. Under the so-called “collateral source rule” in Arizona law, a plaintiff may recover from a tortfeasor the full amount billed for their medical treatment, even if – as is often the case – the amount actually paid is less because the provider accepted a lesser amount. Home » Personal Injury Attorneys » Exploring Nevada’s Collateral Source Rule. States such as Tennessee have abrogated the CSR through legislation, but only in health care liability and workers’ compensation cases. The collateral source rule, or collateral source doctrine, is an American case law evidentiary rule that prohibits the admission of evidence that the plaintiff or victim has received compensation from some source other than the damages sought against the defendant. This is a very common occurrence and one that is governed by Arizona’s Collateral Source Rule. West v. Shelby County Healthcare Corp., 459 S.W.3d 33 (Tenn. 2014). Lopez v. Safeway Stores, Inc., 212 Ariz. 198, 202, ¶ 13, 129 P.3d 487, 491 (App.2006). The result has been an ever-widening gap between hospitals’ standard rates for uninsured patients and the discounted amounts hospitals accept from insurance companies. Admissibility of collateral source evidence 6 A. The leading case on the “actual amount paid” approach is the California case of Howell v. Hamilton Meats & Provisions, Inc., 257 P.3d 1130 (Cal. Few other courts have chosen to follow this approach. collateral source rule.13 This comment will serve to clarify the state of the rule across the country, the attempts to reform of the rule and the impact of reform on multistate litigation. Allows the plaintiff from a source wholly independent of the CSR reimburse different.... Accident law. ” John G. 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