Under the old rule, a plaintiff could claim medical expenses for services that were reasonably necessary due to the injury event the defendant allegedly caused. The only limitation was that the medical expenses had to be reasonable in amount. But Rule 414 states:
“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.”
Consequently, no longer may a plaintiff present a bill that reflects the fair market value of medical services. If a plaintiff has private insurance, Medicare or Medicaid, which by contract or by law reduces the amount a provider receives for services, it is that lower amount the plaintiff must claim. Anyone who has compared what a hospital generally charges for an MRI to what Medicare reimburses for an MRI can understand just how drastic a reduction Rule 414 imposes. The rule may potentially disadvantage elderly and poor patients who receive the greatest reductions for services under Medicare and Medicaid.
But it gets worse, because the insurer, whether a private company, Medicare or Medicaid, has a right of subrogation. In other words, they have a lien on the injured party’s recovery. If the injured party can only recover amounts equal to what insurance has paid, the insurer could claim the entirety of the victim’s recovery.
Finally, victims also sue for noneconomic damages such as pain and suffering. Because these are intangible amounts, it is often difficult to set a baseline for a settlement or jury award. One negotiating tactic is to discuss pain and suffering as a multiple of medical expenses. But, if Rule 414 has already reduced medical expenses, then any multiple would be reduced proportionately. In this way, Rule 414 could do more than simply reduce recovery for medical expenses; it could reduce a plaintiff’s overall recovery substantially.
Given the limitations Rule 414 puts on your potential recovery, it is more important than ever that you consult an experienced personal injury attorney with a track record of success. To schedule a free initial consultationat the Law Offices of Brian deBrun, call us at 704-405-5505 or contact our office online.