Thursday, December 4, 2014

Why Might Some Health Care Providers Refuse To Submit Medical Bills For Patients With Personal Injury Claims?

Joe runs a red light and crashes into Jane’s car, sending Jane to the ER.  When Jane later receives the ER bill, it lists the amount owed as $10,000.  On her behalf, the hospital submits the bill to her health insurer, who pays a reduced rate of, say, $4,000 pursuant to a previously arranged agreement with the hospital.  Jane eventually files a personal injury lawsuit against Joe seeking recovery for, among other things, her medical bills.  Can Jane introduce evidence at trial that her bills were $10,000, or is she limited to the $4,000 figure?  Until recently, Jane would have been entitled to recover the entire “billed” amount of $10,000.  Since 2011, however, due to the legislature’s enactment of Rule of Evidence 414, Jane is only entitled to introduce evidence of the “paid” amount – in this example, $4,000.  Rule 414, sometimes called the "billed v. paid" rule, reads:

Evidence offered to prove past medical expenses shall be limited to evidence of the amounts actually paid to satisfy the bills that have been satisfied, regardless of the source of payment, and evidence of the amounts actually necessary to satisfy the bills that have been incurred but not yet satisfied.  This rule does not impose upon any party an affirmative duty to seek a reduction in billed charges to which the party is not contractually entitled.

Because Rule 414 only applies to claims that arose on or after October 1, 2011, and given the length of time it takes for a plaintiff to file suit and for the case to work its way through the litigation process, we have only recently begun to see how Rule 414 works in practice.  A perhaps unanticipated development in the implementation of Rule 414 has been a trend among certain medical care providers to refuse to submit bills to a patient’s health insurer in cases involving the potential for third party liability. 

At first glance, it is difficult to understand why a provider would refuse to submit its own bill to be paid by a health insurer.  Don’t the providers want to get paid?  Of course they do – in fact, counter-intuitively, the likely explanation for this trend is the providers’ desire to maximize their recovery.

Tuesday, October 28, 2014

Jury Verdict For The Defense In Halifax County Superior Court

I was very pleased earlier this month to win a jury verdict for my client, a defendant in a personal injury lawsuit pending in Halifax County.  The case arose out of a rear-end auto collision in which my client struck the rear of the plaintiff's vehicle at approximately 40 miles per hour.  The plaintiff was placed on a backboard by EMS and taken to the emergency room complaining of neck and back pain.  He subsequently received treatment from his family physician, physical therapists, a neurologist at Duke, a psychiatrist, an orthopaedist, and pain management specialists.  

Two years after the accident, the plaintiff was deemed to be totally disabled and was awarded Social Security Disability benefits due, in part, to his neck and back pain.  In addition to extensive medical bills, the plaintiff claimed lost wages in excess of $500,000.

Sunday, September 28, 2014

Hosting a Panel at NCADA Fall Conference

I'm pleased to announce that I will be hosting a panel presentation at the NCADA Fall Conference later this week.  The panel will focus on the impact that the 2011 tort reform measures have had on the practice of law in North Carolina.  The panelists will address the impact of Rule 414 (the "billed vs. paid" rule), changes to the workers compensation statute, and medical malpractice reform, including the cap on non-economic damages.  The panelists themselves have a wealth of knowledge and experience, and I am really looking forward to hearing their thoughts on how tort reform has changed the litigation landscape.

The Fall Conference will be held at the Grandover Resort in Greensboro on Friday, October 4.  For more information about the Fall Conference, click here.

Thursday, February 27, 2014

Insurance Commissioner Wayne Goodwin Makes Strong Showing In Early Fundraising For 2016 Reelection Campaign

For North Carolina Council of State members, the race for reelection in 2016 began as soon as the election results were formally announced in November 2012.  Those reelection efforts include, of course, the need to raise campaign funds sufficient to compete on a statewide level.  Although it is early in the campaign cycle, year-end finance reports for the current Council of State members reveal some interesting results.

Sunday, February 16, 2014

Upcoming Presentation to the Eastern North Carolina CPCU Society Chapter

I am very pleased to have been asked to give a presentation to the Eastern North Carolina chapter of the CPCU Society on the topic of extra-contractual claims against insurance companies.  The presentation will take place on Wednesday, February 19, and the meeting will be held at North Carolina Farm Bureau's office here in Raleigh.

Tuesday, January 28, 2014

North Carolina Insurance Law Newsletter - Winter 2014

The Winter 2014 issue of the North Carolina Insurance Law newsletter is out.  Click here to check it out!

If you would like to subscribe to the email newsletter, which comes out quarterly, please use the sign-up box in the right column of this blog.  ==>

Saturday, January 25, 2014

North Carolina Court of Appeals Affirms Bost, Clarifies How UIM Carriers Apportion Their Respective Liability

When a claimant has valid claims against multiple UIM carriers as a result of the same auto accident, how do the carriers go about apportioning their respective liabilities?  That was the issue facing the North Carolina Court of Appeals in Nationwide v. Integon and State National, a case in which the trial court's summary judgment order in favor of Defendants was reversed, in a unanimous decision authored by Judge Robert N. Hunter and joined by Judges Robert C. Hunter and Ann Marie Calabria