My Medical Bill Should be Paid as Part of my Injury Case, But What are They Worth?

In 2005, the Missouri General Assembly passed tort reform in Missouri.  Prior to the enactment of the law, the amount charged by a medical provider was presumed to be the fair and reasonable amount of the injured party’s medical bills.  Medical testimony was also permitted to establish that the amount the medical provider charged was fair, reasonable and appropriate for the medical services provided.

Tort reform significantly changed this portion of Missouri law.  Section 490.715(5)(2) RSMo. was passed and stated:

In determining the value of the medical treatment rendered, there shall be a rebuttable presumption that the dollar amount necessary to satisfy the financial obligation to the health care provider represents the value of the medical treatment rendered. Upon motion of any party, the court may determine, outside the hearing of the jury, the value of the medical treatment rendered based upon additional evidence, including but not limited to:

(a) The medical bills incurred by a party;

(b) The amount actually paid for medical treatment rendered to a party;

(c) The amount or estimate of the amount of medical bills not paid which such party is obligated to pay to any entity in the event of a recovery.

The change in the law clearly shifted the focus to the amount of the medical bills actually paid by the plaintiff’s medical insurance company and by the plaintiff.  The prior presumption that the amount charged was the amount that was to be presented to the jury as fair, reasonable and appropriate was abrogated.  Section 490.715 also placed a burden on the Court to determine the amount that represents the value of the medical bills at issue based upon the factors contained within the Statute.

The law clearly placed a particular burden on the court and different Judges interpreted the statute differently.  Following continued confusion over interpretation of the Statute, St. Louis County Circuit Court Judge Stephen Goldman ruled in September 2009 that the Statue was unconstitutionally void for vagueness.  The court found that the Statute “sets out arbitrary vague standards to rebut a presumption of value” based upon “the dollar amount necessary to satisfy the financial obligation to the health care provider.”  Judge Goldman further noted that “[c]ourts with evidence similar to that in this case allow evidence to be presented to jurors of non-insurance bill, only amounts billed to plaintiff’s insurance companies, or a splitting of the difference.”

Based upon the continuing changes and developments in the this area of the law, it is important to have legal counsel that will fight to ensure that you are fully compensated for your injuries and to ensure that all of your damages are presented to the Court and Jury at the time of trial.