Damages

August 4, 2016

Reasonable Medical Expenses – Billed Amount or Negotiated Amount?

Understanding medical billing and medical expenses can be quite difficult in today’s healthcare system, and courts across the country have been grappling with how to determine the reasonable amount of medical expenses in court cases. In a recent Tennessee case, the Court of Appeals declined to extend a Tennessee Supreme Court decision which held that reasonable medical expenses were those that the medical provider actually accepted as payment from an insurance company, as the Supreme Court decision was a hospital lien case and the Court of Appeals was reviewing a personal injury matter.

The underlying facts in Dedmon v. Steelman, No. W2015-01462-COA-R9-CV (Tenn. Ct. App. June 2, 2016) were that plaintiff was seeking recovery for injuries sustained in a car accident. Plaintiff claimed medical expenses of $52,482.87, and plaintiff provided medical bills and the deposition of a treating physician who testified that the expenses were “appropriate, reasonable, and necessary[.]”

After this suit was filed, the Tennessee Supreme Court issued a decision in a case about hospital liens, West v. Shelby County Healthcare Corp., 459 S.W.3d 33 (Tenn. 2014). Tennessee law gives hospitals a lien “for all reasonable and necessary charges for hospital care, treatment and maintenance of ill or injured persons[.]” The West court tackled the issue of what exactly constituted reasonable charges, in light of the fact that the amount a patient is billed and the amount an insurance company actually pays is often vastly different. The Court in West eventually determined that, “with regard to an insurance company’s customers,” reasonable expenses were “the charges agreed to by the insurance company and the hospital,” not the billed amount. The Court stated:

The hospital’s non-discounted charges reflected in the amount of the liens it filed against the plaintiffs should not be considered reasonable charges for the purpose of [the Hospital Lien Act] for two reasons. First, the amount of these charges is unreasonable because it does not ‘reflect what is [actually] being paid in the market place.’ …[A] more realistic standard is what insurers actually pay and what the hospitals [are] willing to accept.’ …The second basis for concluding that the [hospital’s] non-discounted charges are not reasonable stems from its contracts with [the insurers]. The [hospital] furthered its own economic interest when it agreed in these contracts to discount its charges for patients insured by [the insurers]. …The [hospital’s] contract with [the insurers] defined what the reasonable charges for the medical services provided to [the plaintiffs] would be.

(Internal citations and quotations omitted).

June 2, 2016

The Court of Appeals addressed an issue of first impression regarding the interpretation of a wrongful death statute related to a surviving spouse who has outstanding child support obligations.

by The Law Offices of John Day, P.C.

In Spires v. Simpson, No. E2015-00697-COA-R3-CV (Tenn. Ct. App. April 26, 2016), the Court of Appeals addressed an issue of first impression regarding the interpretation of a wrongful death statute related to a surviving spouse who has outstanding child support obligations.

In this case, decedent mother was killed in a car accident, leaving behind a surviving spouse and one child, whose biological father was the surviving spouse. At the time of the accident, the decedent and surviving spouse had been living apart and the child had been living only with the decedent. The spouse instituted a wrongful death action on behalf of himself, the child, and the decedent. When he instituted the suit, the spouse owed child support to children of four other women (though he did not owe any regarding the child at issue in this case because there was no court order regarding that child). While the wrongful death litigation was ongoing, a maternal uncle adopted the child, and the uncle petitioned to intervene on behalf of the child. Ultimately, the trial court held that Tenn. Code Ann. § 20-5-107(b) disqualified the surviving spouse from commencing the action or collecting proceeds due to his outstanding child support arrearages. The trial court substituted the child’s uncle as plaintiff and awarded the agreed damages in trust solely to the child. The Court of Appeals, however, reversed.

February 10, 2016

2014-15 Tennessee Tort Filings and Damage Awards Data

by The Law Offices of John Day, P.C.

Here are some of the most recent statistics concerning tort claims and trials in the Tennessee court system for the fiscal year ending June 30, 2015:

There were 9777 tort filings in state court, with 9695 tort cases concluded. Only 339 of those cases were tried to a judge or jury.
There were 356 health care liability actions filed, with 346 such cases concluded. Only 28 of those cases were tried.

February 9, 2016

Plaintiff Wins Case Involving Crash With Fire Rescue Vehicle

by The Law Offices of John Day, P.C.

In Jones v. Bradley County, No. E2015-00204-COA-R3-CV (Tenn. Ct. App. Jan. 15, 2016), plaintiff sued Bradley County after she collided with a truck responding to a fire at a red-light intersection. Plaintiff had the green light at the intersection. Defendant, a fire rescue employee, was driving a Ford F-250 truck that was equipped with a siren and emergency lights. Defendant proceeded to turn left against a red-light, at which time plaintiff’s car collided with defendant’s truck, causing plaintiff significant injuries.

Bradley County relied on Tenn. Code Ann. § 55-8-108, which “provides privileges to emergency vehicle drivers under certain circumstances.” This statute allows emergency vehicle drivers to “proceed past a red or stop signal[,]” but still requires the driver “to drive with due regard for the safety of all persons[.]” While analyzing this case, though, the Court pointed out that that “[t]he obligation to exercise due care is, thus, not excused by the fact that the [emergency] driver is responding to an emergency call.” (citation omitted).

Bradley County further asserted that the sole cause of this accident was plaintiff’s failure to comply with Tenn. Code Ann. § 55-8-132, which provides that “upon the immediate approach of an authorized emergency vehicle making use of audible and visual signals…the driver of every other vehicle shall yield the right-of-way.” The Court pointed out that, when previously applying this statute, the Court has “noted the requirement of due care when entering an intersection even under authority of a green light” and “observed that if plaintiff should have heard the siren or should have seen the blue lights flashing, she…cannot evade her duty to yield to an emergency vehicle by saying that she did not hear and did not see because she did not look.” (citation and internal quotations omitted). In response to this argument, plaintiff pointed to the County Rescue Service operations manual, claiming that defendant violated the portions of the manual that stated that emergency drivers should “slow to a safe speed at which a stop could be made, and insure that all traffic has yielded” and “change the siren mode” when approaching an intersection. Plaintiff further argued that the evidence showed that defendant did not drive with due care through the intersection.

December 21, 2015

Low Damage Award Set Aside by Appellate Court

by The Law Offices of John Day, P.C.

The Tennessee Court of Appeals recently vacated a judgment in a car accident case after finding that the “jury’s damages award [was] not supported by material evidence.” In Naraghian v. Wilson, No. W2014-02002-COA-R3-CV (Tenn. Ct. App. Nov. 12, 2015), plaintiff’s car was struck from behind by defendant’s vehicle. According to plaintiff, she had come to a complete stop at a red light and was then hit. Defendant asserted, though, that he slowed down for the red light, but the light then changed to green and plaintiff began driving off, only to suddenly stop and cause the accident.

At trial, plaintiff presented evidence regarding her medical damages. Her treating chiropractor testified that “the treatments he provided were reasonable and necessary and stated that [plaintiff’s] injuries were the result of the traffic accident involving [defendant].” The total bill for plaintiff’s treatment was $13,440, and there was no real dispute at trial regarding the reasonableness or necessity of the charges. “Defense counsel did not submit any witness controverting the reasonableness of the charges that were billed, nor did defense counsel submit any proof rebutting the medical opinions testified to by [the chiropractor] as to the reasonableness or necessity of the treatment or as to the medical causation as a result of this accident.”

The jury found in favor of plaintiff and found her damages to be $7,831.67. Although the jury found defendant to be responsible, they also apportioned 44.58% of the fault to plaintiff, so her damages were accordingly decreased. After having her motion for a new trial denied, plaintiff appealed, asserting that “the damages awarded by the jury were disproportionate to the amount of damages proven at trial.”

October 16, 2015

Constitutional Challenge to Damage Cap Must Award Verdict

by The Law Offices of John Day, P.C.

The Tennessee Supreme Court has ruled that the constitutionality of the artifical cap on non-economic damages in tort cases should not be examined by the courts until after a plaintiff receives a verdict in excess of the cap.

The decision comes in the Clark case out of Chattanooga. The trial judge in that case ruled that the caps were unconstitutional. Tennesssee’s High Court said the ruling was premature. The Order can be reviewed by clicking on the link below

From a practical standpoint, this means that a supreme court review of the caps is at least two years off. Why? Because that is how long it takes, on average, from a verdict to go through the entire appellate process. It is possible that a case with a verdict over the caps is in the pipeline right now but I have not heard of such a pending case. Please let me know via a comment if you are aware of one.

September 16, 2015

Intentional Interference With Business Relations Requires Proof of Damages

by The Law Offices of John Day, P.C.

In Springfield Investments, LLC v. Global Investments, LLC, No. E2014-01703-COA-R3-CV (Tenn. Ct. App. Aug. 27, 2015), plaintiffs sued defendants for intentional interference with business relationships related to plaintiffs’ opening of a Wendy’s restaurant in Cleveland, Tennessee. Defendants already owned and operated a Wendy’s in Cleveland, and in 1998 one of plaintiff’s brothers signed a non-compete agreement with defendants agreeing not to open a Wendy’s in Cleveland. A later “Clarification and Confirmation” document signed by the brother included that no entities he was associated with would open a Wendy’s, including Springfield Investments, LLC (a plaintiff in this case). The individual plaintiff in this case was never a party to the non-compete, and by the time that the pertinent events took place the brother signing the non-compete was not the owner of Springfield Investments.

In January 2010, plaintiffs began the process of seeking approval from Wendy’s to build and open a restaurant in Cleveland. Because it would be 4.8 miles from defendants’ existing Wendy’s, the restaurant chain’s procedures required defendants to be notified and have the opportunity to oppose the new franchise. Over the course of the next several months, defendants followed the standard procedures allowed by Wendy’s to oppose the new restaurant. At one point Wendy’s, using its own discretion, allowed for additional time for defendants to submit certain requests, but otherwise the normal course of action provided for in Wendy’s franchise guidelines was followed.

August 13, 2015

Right of Non-Primary Residential Parent to Bring Claim for Child

by The Law Offices of John Day, P.C.

The Court of Appeals recently addressed the issue of which claims a parent who is not the primary residential parent may bring when his or her child has been injured. In Neale B/N/F Russell v. United Way of Greater Kingsport, No. E2014-01334-COA-R3-CV (Tenn. Ct. App. July 28, 2015), a child was injured at an activity at defendant’s facility. The mother and father initially filed a joint action as next friends of the child, but they voluntarily dismissed that case and father subsequently filed alone. Father, as next friend of child, sought damages for permanent impairment, paint and suffering, medical expenses, and loss of earning capacity. Pursuant to the family’s parenting plan, father was not the primary residential parent.

Defendants filed a motion for summary judgment asserting that father lacked standing to bring the claims. The trial court agreed and granted summary judgment, which the Court of Appeals reversed in part and affirmed in part.

Tenn. Code Ann. § 20-1-105(b) states:

In case the father and mother of the minor child are living apart and one parent has exclusive legal custody of the child, the parent with legal custody has the sole right to maintain an action for the expenses and the actual loss of service resulting from an injury to the child, except that the noncustodial parent in such case shall have a right to maintain or join an action brought under this section, for the expenses resulting from an injury to the minor child to the extent the noncustodial parent has paid those expenses.

April 23, 2015

Is Plaintiff’s Fault Percentage Applied Before or After Tort Reform Damage Cap?

by The Law Offices of John Day, P.C.

The Court of Appeals recently released an extensive opinion in a Tennessee car accident case, full of issues regarding evidence and trial questions. Three of the findings in this opinion are critical for tort lawyers to familiarize themselves with: (1) that where there is evidence that a plaintiff could not see an approaching car, a directed verdict for the defendant was not negligent would not be appropriate; (2) that long-term care damages can be causally related to the accident and recoverable, despite the age of the plaintiff; and (3) that an award of non-economic damages should be reduced by any comparative fault finding before the statutory cap is applied.

In Monypeny v. Kheiv, No. W2014-00656-COA-R3-CV (Tenn. Ct App. April 1, 2015), a married couple who were 82 and 90 years old were driving in a vehicle that was struck by defendant. Evidence showed that prior to the accident, the husband and wife were both quite active and lived completely independently. Following the accident, however, the wife died a few months later in the hospital as a result of injuries sustained therein, and the husband went through the hospital, rehabilitation facility, and then an assisted living center, never able to live independently again. Plaintiffs filed suit for economic and non-economic damages, asserting that defendant’s driving caused the crash, while defendant responded that plaintiff husband (the driver at the time) was at fault. Because the driver of the other car was not insured, plaintiffs’ uninsured motorist carrier acted as defendant. At trial, the jury found for plaintiffs, and the Court of Appeals affirmed.

November 1, 2013

Widow Loses Right to Wrongful Death Proceeds Because of Tennessee Postnuptial Agreement

by The Law Offices of John Day, P.C.

Under Tennessee wrongful death law, the distribution of proceeds obtained after a settlement for wrongful death are governed by common law not statute. Basically, the law provides that the wrongful death proceeds are distributed under the law of intestate succession.

Thus, if a decedent left behind a surviving spouse and one child, each would receive one-half of the proceeds. If the wrongful death decedent left behind a surviving spouse and two children, each of them would receive one-third of the wrongful death proceeds. A surviving spouse would never receive less than a one-third share of the recovery, even if there were three or more surviving children.

A recent case from the Tennessee Court of Appeals faced a question never addressed before in Tennessee: what happens to wrongful death proceeds when the surviving spouse entered into a postnuptial agreement agreeing to waive all rights which she acquired as a result of her marriage to the defendant?