December 1, 2009: (Fremont, Ohio) Whether you are a Fremont Ohio personal injury lawyer or a personal injury lawyer in Port Clinton or Tiffin or any other city across Ohio, the Supreme Court of Ohio’s anticipated decision on a pending case will affect you and your clients. The potentially landmark case of Jaques v. Manton is summarized below.

Imagine your client was recently injured in a traffic accident, went to the hospital and incurred $21,874.80 in medical bills. Your client’s health insurer has a contract with the hospital wherein the hospital has agreed to greatly discount its bills. Under that contract, the insurer pays the hospital $7,483.91, which the hospital accepts as payment in full. 

The case goes to a jury trial and at a sidebar the defense attorney argues the jury should only be allowed to hear about the reduced amount of the medical bills, or $7,483.91.  You argue the jury should only be allowed to hear about the original amount of $21,874.40.  Not interested in either of you, the crusty old trial judge turns to his longtime clerk, Skippy, and asks him which lawyer is correct. 

“I believe both advocates make worthy points, Your Honor. I would rule that both amounts are admissible under a recent Supreme Court of Ohio case.”

The judge smiles and nods in approval, tells counsel to step away from his bench, allows both amounts into evidence, and instructs the jurors that they must decide the reasonable value of the medical care based upon the evidence they heard. 

Who is right?  

Robinson v. Bates, 112 Ohio St.3d 17, 2006-Ohio-6362 and Jaques v. Manton (Ohio App. 6 Dist.), 2009-Ohio-1468.

In Robinson v. Bates the Supreme Court held in its syllabus:

Both an original medical bill rendered and the amount accepted as full

payment are admissible to prove the reasonableness and necessity of

charges rendered for medical and hospital care.

Under this law, Skippy seems correct. But is he?

After the traffic accident in Robinson, the General Assembly passed R.C. §2315.20, effective April 7, 2005. That statute states in relevant part:

In any tort action, the defendant may introduce evidence of any amount payable as a benefit to the plaintiff as a result of the damages that result from an injury, death, or loss to person or property that is the subject of the claim upon which the action is based, except if the source of collateral benefits has a…contractual right of subrogation…(Emphasis added.)

In a footnote, the Robinson v. Bates court specifically stated, “This new collateral-benefits statute does not apply in this case, however, because it became effective after the cause of action accrued.” Thus, the Supreme Court left the door open as to whether Robinson v. Bates should serve as binding precedent for cases accruing after §2315.20 took effect.

This issue was recently addressed by the Sixth District in Jaques v. Manton. In that case, the trial and appellate courts held that the syllabus in Robinson v. Bates does not apply to cases accruing after §2315.20 took effect. The dollar figures at the beginning of this article were borrowed from Jaques v. Manton wherein it was undisputed that the health insurer who paid Jaques’ bills had a contractual right of subrogation. Taking note of this, the court reasoned that under §2315.20 the defendant could not introduce any amount payable as a benefit to the plaintiff. Thus, only the original billings totaling $21,874.80 was admissible.

Manton timely appealed to the Supreme Court of Ohio and the court accepted review on July 29, 2009. 

In October, Manton and several amici curiae from the medical and insurance industry filed their briefs and argued: (i) §2315.20 does not alter the syllabus in Robinson v. Bates and (ii) a hospital’s acceptance of a reduced amount from an insurer is by definition not an “amount payable as a benefit to the plaintiff” because the reduced amount is never paid. Thus, they argue that the only amount that was payable as a benefit to the plaintiff in Jaques was the $7,483.91 his insurer paid to the hospital as payment in full.  Manton maintains that he should have been able to offer this amount into evidence to show the reasonable value of Jaques’ medical treatment under both Robinson v. Bates and §2315.20. 

Going one step further, the amicus brief filed by the Ohio Association of Civil Trial Attorneys (composed of mostly insurance defense attorneys) urged the Supreme Court to rule that when a hospital accepts a reduced payment from a health insurer, then the reduced amount is the only admissible evidence regarding the reasonable value of the plaintiff’s medical treatment.  

Mr. Jaques’ brief is due by December 7, 2009. That brief and the Supreme Court of Ohio’s decision are much anticipated because this case is a landmark one that will almost certainly impact thousands of Ohio personal injury cases, big and small. 

Andy Mayle is an attorney with Mayle & Ray, Mayle, LLC, based in Fremont, Ohio. Mayle, Ray & Mayle offers the following practice areas among others: Ohio personal injury lawyer, criminal defense attorney Port Clinton, and wrongful death lawyer Tiffin Ohio.