Firm Newsletter - September 2016

Photo by USGirl/iStock / Getty Images

Photo by USGirl/iStock / Getty Images

Uninsured Plaintiffs Can Recover Billed Expenses

The Fifth Circuit United States Court of Appeals recently provided more guidance on the Tex. Civ. Prac. & Rem. Code Ann. Sec-tion 41.010. This provision limits recovery of medical expenses to the amount actually paid or incurred by or on the behalf of a claimant. It was enacted in a collection of tort reform bills and was approved through voter referendum. The seminal case that provides the application of this provision is Haygood v. Escabedo, 356 S.W. 3d 390 (Tex 2012). Building on that case, the 5th Circuit court came down with Guzman v. Jones.

In Guzman v. Jones, the issue is whether or not a plaintiff who may have been eligible for insurance benefits but did not have insurance at the time of his injury is permitted to admit evidence of the full billed medical expenses he was charged and obligated to pay.

Mr. Jones caused a motor vehicle accident with another driver, Jaime Guzman. There was no liability dispute. The trial occurred to determine the amount of damages that would be awarded to Jaime Guzman. At trial, Guzman showed medical bills that evidenced he may have qualified for workers’ compensation. However, none of his medical bills were adjusted or written off to reflect workers’ compensation or Medicaid benefits. It was eventually discovered that Mr. Guzman was not a Medicaid participant and did not receive any workers’ compensation benefits despite being eligible for both. Before trial, Mr. Jones argued that based on Mr. Guzman’s circumstances he did qualify for workers’ compensation and Medicaid benefits so his medical bills should be excluded. The motion was denied.

Mr. Jones argues that the medical debt is not “actually incurred” due to the fact if Mr. Guzman had insurance, he would have been charged a reduced rate. The court disagreed and explained that Mr. Guzman had actually incurred what he was billed for and the fact that he could have had insurance benefits does not change the obligation of payment that Mr. Guzman owes now. The court explains that only evidence of medical expenses that are recoverable are permitted to be introduced as evidence, but there is no requirement that an individual take advantage of reduced rates. The appellate court looked to other courts who also permit uninsured plaintiff’s to recover billed medical expenses because there was no evidence that the providers did not have a right to be paid.

The Fifth Circuit United States Court of Appeals affirmed the district court’s judgment and ruled that the trial court did not abuse its discretion. Texas law allows consideration of billed medical charges for an uninsured claimant despite the fact that there may have been reduced rates available to the claimant had they had insurance they qualified for that the claimant did not participate in.


Downloadable .PDF - September 2016