Medical bills excluded from trial due to lack of expert testimony that they were necessary.

Plaintiffs seeking to introduce medical bills for the purpose of showing damages must present expert proof that that the medical expenses were necessary.

In Holzmer v. Estate of Walsh, No. M2022-00616-COA-R3-CV (Tenn. Ct. App. July 28, 2023), plaintiff sought to introduce her medical bills in support of claimed damages related to a car accident. Defendant admitted liability, and a jury trial was held to determine damages. At trial, plaintiff’s expert physician testified that the treatment plaintiff received was reasonable and necessary, but the physician had not reviewed the bills and did not testify as to their reasonableness and necessity.

Plaintiff had received treatment at three different facilities, and she had witnesses from those facilities testify as to the reasonableness of the bills, including a nurse auditor, an accounts receivable biller, and a senior director of revenue cycle. These witnesses, however, did not testify as to necessity. The trial court excluded the medical bills due to plaintiff’s failure to present expert testimony regarding their necessity, and that ruling was affirmed on appeal.

“A plaintiff must prove that the medical bills paid or accrued because of the defendant’s negligence were both necessary and reasonable,” and meeting this burden typically requires competent expert testimony.” (quoting Dedmon v. Steelman, 535 S.W.3d 431 (Tenn. 2017) (internal quotations and citations omitted)). Plaintiff argued that the physician’s “testimony that certain medical treatment was necessary, coupled with lay testimony that the certain medical expenses were reasonable, constituted sufficient evidence to establish that her medical expenses were necessary and reasonable and, therefore, the medical bills should have been submitted to the jury.” The Court of Appeals rejected this argument.

In its analysis, the Court focused solely on whether “Tennessee law require[s] an expert to opine that medical expenses reflected on the bills were necessary to treat the injury caused by the defendant’s negligence in order for the bills to be admissible.” The Court pointed out that plaintiff’s only medical expert did not review or testify about the medical bills. The Court stated:

This Court has interpreted Tenn. Code Ann. § 24-5-113(a)(1) and (b)(1) and has reiterated that the elements of necessity and reasonableness are distinct and must be separately proven. …[E]ven when a plaintiff is entitled to the statutory presumption of reasonableness of medical expenses, there is no presumption regarding the necessity of the care and expenses described in the bills. Distilling and applying these principles, we find that the trial court did not abuse its discretion in excluding Plaintiff’s medical bills because there was no expert testimony on the necessity of the expenses. It was Plaintiff’s burden to prove that her medical expenses were necessary. Here, Plaintiff’s care spanned nearly two years with multiple providers. …Plaintiff provided no expert testimony that the expenses reflected on the bills were necessary.

(internal citation omitted). The Court accordingly affirmed the ruling excluding the medical bills.

Notably, the Court stated in a footnote that Plaintiff had not argued that the testimony of the medical office personnel constituted expert testimony regarding necessity, so the question of “whether the necessity of the medical bills could be established through such routes [was] not before [the] court.”

This case is a reminder of the importance of having expert testimony regarding both the reasonableness and necessity of any medical bills you seek to introduce.

This opinion was released 4.5 months after oral arguments in this case.

Note:  Chapter 25, Section 6 of Day on Torts: Leading Cases in Tennessee Tort Law has been updated to include this decision.

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