PERSONAL INJURY CASES, DAMAGES AND "REASONABLE" MEDICAL EXPENSES

In my experience, it is no longer uncommon in defending a personal injury case to open up a file and see a medical bill for date of loss treatment that totals $20,000, $30,000 or $40,000.  I've seen some higher than that for date of loss treatment alone.  Then, maybe there is physical therapy, injections and/or a surgery and the medical bills continue to climb.  

More and more often, the question is coming up in personal injury cases, "are the incurred medical charges reasonable?"  Is an emergency room bill for $20,000, $30,000 or $40,000 reasonable?  Or, is the surgery, injection or physical therapy bill reasonable?  

The reasonableness of medical expenses was recently addressed by the Tennessee Court of Appeals in the case styled Theresa Doty v. City of Johnson City, No. E2020-00054-COA-R#-CV, filed July 7, 2021.

In Doty, plaintiff was injured in a motor vehicle accident and sought medical treatment.  The nature of the injuries is not relevant to this blog.  The plaintiff incurred medical expenses totaling $204,196.  Plaintiff timely filed the medical expenses pursuant to TCA 24-5-113(b) creating the rebuttable presumption of reasonableness of the charges. 

The defendant responded, objecting to the reasonableness of the medical charges.  In an effort to support defendant's position, regarding the unreasonableness of the charges, defendant presented two (2) witnesses to give opinions consistent with the defendant's position.  

The trial court ruled the testimony of defendant's witnesses regarding the unreasonableness of the medical charges violated the collateral source rule and one of the defendant's witness' testimony regarding reasonable medical expenses was not supported because the "methodology had not been proven or tested."  In other words, the record did not have enough information to satisfy the court that the witness' opinion was reliable.  The Tennessee Court of Appeals agreed with the trial court.

Without getting into the complete analysis of the appellate court, because the entire opinion may be read here (and oral argument watched here), the appellate court stated "[t]he record is devoid of information establishing whether [defendant's witness'] methodology has been tested or has been subjected to peer review.  A potential rate of error was also not submitted and there is no indication that his methodology has been accepted in the scientific community.  Further, his methodology was largely based upon what the hospital billed versus what it regularly received as payment, a clear violation of the collateral source rule when applied specifically to plaintiff's hospital billings in the report."

In my opinion, this opinion does not close the door on a defendant's opportunity to challenge the reasonableness of medical charges.  But, I think it does mean that if a defendant is going to challenge a plaintiff's medical expenses, the record is going to have satisfy the concerns addressed in this case.  Doty is not a loss for defendants who want to challenge what are reasonable medical expenses.  Rather, it is guidance for the next case and what criteria need to be satisfied in order to present a competent defense.

Tommy Santel is a co-founding partner of Parkerson Santel PLLC. Tommy is a former government prosecutor. He is a Tennessee Supreme Court Rule 31 General Civil Mediator. Tommy’s practice areas include criminal defense and civil litigation.

This blog is made available by Parkerson Santel, PLLC for educational purposes only as well as to provide general information and a general overview of the law, not provide specific legal advice. By using this blog and website, you understand that there is no attorney-client relationship between you and Parkerson Santel, PLLC. This blog and website should not be used as a substitute for competent legal advice from a licensed attorney in your state.

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