Tuesday, August 23, 2011

Judge Amesbury of Luzerne County Addresses Future Medical Expenses Claims in Auto Accident Case

In his April 15, 2011 Opinion in the case of Ferraro v. Knies, 101 Luz. Reg. Reports 94, No. 9543-Civil-2008 (Luz. Co. April 15, 2011, Amesbury, J.), Luzerne County Court of Common Pleas Judge William Amesbury addressed the issue of the handling of future medical expenses claims in automobile accident civil litigation.

In this matter, the limited tort Plaintiff was injured as a result of a motor vehicle accident. After a trial, a Luzerne County jury returned a verdict in favor of the Plaintiff awarding damages totaling $200,000.00. Part of that award consisted of a $140,000.00 in damages for future medical expenses.

The defense relied upon 75 Pa. C.S. §1722 of the Pennsylvania Motor Vehicle Financial Responsibility Law to argue that the Plaintiff’s recovery of future medical expenses should be precluded based upon the fact that the Plaintiff was using health coverage that was provided by her current employer to pay for her medical expenses.

Plaintiff’s counsel initially argued that §1722 was not applicable because the Plaintiff’s healthcare provider was either an ERISA Plan or an HMO, which exempted it from the statutory preclusion of recovering medical expenses and gave the health insurance provider a right of subrogation which would justify and permit a recovery of an award for future medical expenses in this matter.

The Court noted, however, that it was subsequently determined that the healthcare plan was neither an ERISA plan nor an HMO and, therefore, Plaintiff’s argument was reduced to the determination of whether the future medical expenses were precluded under the argument that they were “paid or payable” as that term is defined under §1722.  Section 1722 provides that were an injured party's medical expenses are "paid or payable" by certain entities or carriers, they are not recoverable in motor vehicle accident cases.

At an evidentiary hearing on whether the Plaintiff's future medical expenses would be "payable," the Plaintiff testified that she incurred out-of-pocket expenses of $40.00 per treatment because the healthcare plan treated that expense as a co-pay. The Plaintiff additionally produced documents and testimony to confirm that there was an annual $7,500.00 deductible before payment for the healthcare services would be covered by the health insurance.

In his Opinion, Judge Amesbury noted the Plaintiff’s treating physician gave testimony that provided a range as to expected future medical expenses. The jury was also instructed that the Plaintiff had an additional 40 year life expectancy according to the accepted statistical tables. As such, Judge Amesbury noted that the $140,000.00 awarded by the jury for future medical expenses divided by 40 years was approximately $4,500.00 per year.

Judge Amesbury went on to note that, based upon the testimony provided by the Plaintiff at the evidentiary hearing regarding her co-pay and the deductible of $7,500.00, the Plaintiff’s out-of-pocket payments would exceed the future projections of the jury. Accordingly, Judge Amesbury held that accepting a jury’s verdict would not result in a windfall or a double recovery to the Plaintiff.

Judge Amesbury found that “the future medical damage award of $140,000.00 [was] purely compensatory, not providing a windfall or dual recovery and specifically not “payable” so as to be precluded by §1722 of the Motor Vehicle Financial Responsibility Law.” See Opinion at p. 103.

Although the Court allowed the Plaintiff’s jury award of future medical expenses to stand, the Court rejected the Plaintiff’s request for delay damages on that portion of the verdict. Having not been provided with any legal authority to support delay damages on an award for future medical expenses, Judge Amesbury declined to award the same.

He did, however, allow for delay damages on the jury’s award for future pain and suffering as that has previously been permitted by the Pennsylvania Superior Court in the case of Gross v. Johns-Manville Corp., 600 A.2d 558 (Pa. Super. 1991), appeal denied, Fiberboard Corp. v. Gross, 613 A.2d 559 (Pa. 1992).

Anyone desiring a copy of Judge Amesbury’s Opinion in the case of Ferraro v. Knies may contact me at dancummins@comcast.net.

For more analysis on this future medical expenses issue in another Tort Talk post, including a review of decisions by Judge Terrence Nealon of Lackawanna County and Judge James Munley of the Federal Middle District Court of Pennsylvania, click here.

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