Articles

Why Can’t The Jury Consider All Of My Medical Bills?

Prior to October of 2011, juries could consider the full amount of an injured person’s medical bills; however, that was changed when Rule 414 of the North Carolina Rules of Evidence was amended to read as follows:

“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.” (2011-283, s. 1.1; 2011-317, s. 1.1.)

Said slightly differently, evidence of medical expenses is limited to the amounts actually paid to satisfy the bills, and the amounts actually necessary to satisfy the bills not yet paid. This rule has become to be known as “Billed vs. Paid.”

This is important because the State Health Plan, Private Health Insurance, Medicaid, and Medicare all receive significant discounts when paying medical bills.

Before October of 2011, evidence of payments made by health insurance, Medicare or Medicaid were not admissible in trial and were not to be considered by a jury in determining damages for medical expenses.

Now, Plaintiffs generally can only present to a jury the amounts paid by health insurance or other collateral sources to satisfy medical bills.

To illustrate this with an example, Bob is crossing in a crosswalk, when a vehicle suddenly runs a red light and breaks Bob’s legs.  Bob is insured with Blue Cross Blue Shield of North Carolina.  Bob incurs $50,000 in medical bills at a local hospital for reconstructive surgery to his legs.  Blue Cross Blue Shield of North Carolina receives 50% off Bob’s medical bills pursuant to its provider agreement with the local hospital.  Therefore, under Rule 414, Bob can only present $25,000 of medical expenses to the jury.  Before October of 2011, Bob could present the full $50,000 of bills to the jury.

You may think that Rule 414 will not affect the pre-litigation value of a claim because it is a Rule of Evidence. This is not the case. The insurance companies calculate medical damages in settlement negotiations in the same way that the courts do during trial. They are adjusting what you may ultimately recover in Court, so they are using Billed vs. Paid. Over the past 6 years, Billed vs. Paid has significantly reduced the average value of personal injury claims.

Robby JessupWhy Can’t The Jury Consider All Of My Medical Bills?
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Contributory Negligence: The All or Nothing Doctrine

Currently, only three States in the United States follow the doctrine of “Contributory Negligence,” and North Carolina is one of them.

What this doctrine says is that if an injured or wrongfully deceased person is found to be even as little as 1% at fault for his or her injuries or death, then the plaintiff gets nothing from the defendant, despite the fact that the defendant was still 99% at fault for the subject injuries or death.

Most people believe that the doctrine of “Contributory Negligence” is unfair, and as a result, the vast majority of states have implemented a “Comparative Negligence” system.

With “Comparative Negligence,” a plaintiff’s total amount of recovery is decreased according to the percentage of fault assigned to the injured or deceased person. Whether the plaintiff is denied recovery once he or she (or his or her decedent) has reached a certain percentage of fault depends on which type of “Comparative Negligence” system the State has adopted. In pure “Comparative Negligence” jurisdictions, plaintiffs are entitled to recover some damages, even if they are assigned the greater portion of fault for causing the accident. For example, if the plaintiff is found to be 90% at fault and the defendant is found to be 10% at fault, the plaintiff still can recover 10% of the total damages from the defendant. Thirteen states have pure “Comparative Negligence” rules. Thirty-three states have a modified “Comparative Negligence” rule. Twelve of the states follow a 50% rule in which plaintiffs are barred recovery if they are found to be 50% or greater at fault for their injuries. Twenty-one states follow a 51% rule in which plaintiffs are not barred recovery unless they have been found 51% or greater at fault for their injuries.

In rare North Carolina cases, the “Contributory Negligence” defense can be overcome. If the plaintiff can prove that the defendant’s willful and wanton acts caused the injury, then the defendant cannot prevent the plaintiff from recovery. Likewise, if the plaintiff can show that the defendant had the last clear chance to avoid an accident and did not do so, then the defendant can still be held accountable even if a plaintiff is found to be one or more percent at fault.

Robby JessupContributory Negligence: The All or Nothing Doctrine
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You Can’t Say “Insurance” In The Courtroom

After an automobile negligence trial, jurors always ask, “[w]hy didn’t you tell us whether the Defendant had insurance?”

Generally, in North Carolina civil trials, lawyers are not allowed to present evidence as to whether or not the Defendant is insured.

Rule 411 of the North Carolina Rules of Evidence provides that evidence that a person was or was not insured against liability is generally not admissible.

In Fincher v. Rhyne, 266 N.C. 64 (1965), our Supreme Court stated: “[w]here testimony is given, or reference is made, indicating directly and as an independent fact that the defendant has liability insurance, it is prejudicial, and the court should, upon motion therefor aptly made, withdraw a juror and order a mistrial.”

Our Supreme Court explained its rationale as follows: “[t]he existence of insurance covering defendant’s liability in a negligence case is irrelevant to the issues involved. It has no tendency to prove negligence or the quantum of damages. It suggests to the jury that the outcome of the case is immaterial to defendant and the insurer is the real defendant and will have to pay the judgment. It withdraws the real defendant from the case and leads the jury to regard carelessly the legal rights of the real defendant. No circumstance is more surely calculated to cause a jury to render a verdict against a defendant, without regard to the sufficiency of the evidence, than proof that the person against whom such verdict is sought is amply protected by indemnity insurance.”

Needless to say, most individuals I represent don’t like this logic. For the most part, the reason my clients are mad and suing is not because someone hit them with a car, but because Allstate, State Farm or some other insurance company treated them unfairly after the accident. My clients want juries to hear about the years of delay and heartache insurance adjusters have put them through.

There are a number of States where juries are told about the existence of insurance in automobile negligence cases; although this is the exception and not the rule. What do you think about this?

Robby JessupYou Can’t Say “Insurance” In The Courtroom
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Nursing Home Negligence In The News

As news unfolds about the deplorable conditions found in a Florida nursing home in the wake of Hurricane Irma, our thoughts and prayers turn to those who are suffering and those who have lost loved ones as a result of nursing home negligence or abuse.  So much of our nation’s elderly population lives in residential facilities, and while some are exemplary in the care that they provide, others are cutting costs at the expense of appropriate care.  In our practice, we see the impact that understaffing and cutting corners can have on the elderly and disabled residents, who are the mercy of the decisions of medical staff and administrators.  But these stories rarely make the news. 

With the national spotlight on The Rehabilitation Center at Hollywood Hills, and people are asking what went wrong, we think it is a good time to reflect upon the law and how to deal with nursing home negligence.

Nursing homes and rehabilitation facilities are required by state and federal law to meet certain minimum standards.  The Federal Nursing Home Reform Act and the North Carolina’s Licensure and Certification Protocols include specific regulations and provide for a detailed list of patient rights.  Nevertheless, we see a large number of nursing home residents who are injured or even killed as a result of abuse and neglect in such facilities. 

Our firm has handled claims involving all kinds of problems, including physical and sexual assaults, mishandled medications, bed sores, infections, sepsis, dietary issues, choking hazards, slip/trip and fall hazards, etc., that have occurred in nursing homes and residential care facilities.  When these tragic incidents happen, the victims and their family members have many questions.  Our job is to find the answers that can bring about accountability, prevention and compensation, as the case may be.  We help to gather medical records, interview friends, family and other witnesses, and consult with medical experts to determine what went wrong and why.  If appropriate, we can advise the victim or their loved ones on when, where and how to report nursing home abuse or negligence to the proper officials.  We can also file a lawsuit if the facts warrant taking legal action.  Such lawsuits often end with an agreed upon settlement or go to arbitration or a jury trial depending on the circumstances.  We advise our clients on the right steps to take to help resolve their case to their satisfaction.

If you or a loved one has a question about nursing home abuse or negligence.  Give us a call.  We are here to help.

 

Robby JessupNursing Home Negligence In The News
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Is Adultery against the Law?

In North Carolina, a spouse may sue a third-party for interfering with his or her marital relationship. Suit is usually brought against the adulterous spouse’s lover for “Alienation of Affection.” (Although, North Carolina law also allows for such claims to be filed against an in-law, relative, counselor, therapist, or clergy member who has talked someone into leaving his or her marriage.)

“Criminal conversation” is a legal claim closely related to Alienation of Affection. It is basically a civil claim for adultery. With Criminal Conversation, it is not necessary to prove that adultery had any effect on a marriage; only that intercourse occurred between a spouse and a third-party. Adultery must be proven to win on a Criminal Conversation claim; whereas it is not required to be proven to prevail upon a claim for Alienation of Affection.

Alienation of Affection claims are not necessarily about physical infidelity, but about someone destroying the love between husband and wife, by any type of conduct.

North Carolina law recognizes marriage as one of the most sacred social institutions, and as of late, a string of large verdicts show the people of North Carolina continue to believe this to be so. Recent judgments across North Carolina in Alienation of Affection and Criminal Conversation cases range from $1.1 Million to $30 Million Dollars.

While all but seven states in the United States have abolished civil claims to enforce the sanctity of marriage, these legal claims remain alive and well in the Old North State.

If you have any questions about this article, or if you wish to have a confidential conversation, please feel free to call Robby Jessup at (252) 531-7555 or email him at rjessup@hsfh.com.

Robby JessupIs Adultery against the Law?
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