622 S.W.3d 870
Tex.2021Background
- Norma Alaniz sued Allstate for breach of UIM benefits and claimed roughly $41,000 in past medical expenses supported by multiple §18.001 initial affidavits.
- Allstate served a timely counteraffidavit by Christine Dickison, a registered nurse and certified medical coder/auditor, contesting the reasonableness (not necessity) of three providers’ charges totaling about $37,000.
- Dickison’s counteraffidavit described her credentials, review methodology (comparing CPT-coded charges to Context4Healthcare median charges by ZIP/date), itemized challenged amounts, and attached report and spreadsheets.
- The trial court struck Dickison’s counteraffidavit, found her unqualified to controvert the charges, faulted her methodology as unreliable and insufficiently descriptive, and barred Allstate from contesting the challenged bills at trial.
- Allstate sought mandamus; the court of appeals denied relief. The Texas Supreme Court granted conditional mandamus, holding the trial court abused its discretion.
Issues
| Issue | Plaintiff's Argument (Alaniz) | Defendant's Argument (Allstate) | Held |
|---|---|---|---|
| Whether Dickison is "qualified" under §18.001(f) to controvert the initial affidavits | Counteraffiant must have expertise in the specific medical field providing the billed services | Dickison’s nursing, coding, auditing experience and use of pricing databases qualify her to challenge reasonableness | Qualified: §18.001(f) tracks Rule 702’s qualification inquiry; Dickison’s background sufficed to controvert reasonableness |
| Whether the counteraffidavit provided "reasonable notice" of bases to controvert | Dickison’s median-based methodology is conclusory and doesn’t show familiarity with services | Counteraffidavit itemized challenged charges and explained methodology (CPT comparison and database medians) | Provided reasonable notice: the affidavit enabled Alaniz to prepare rebuttal; trial court erred to strike on notice grounds |
| Whether §18.001(f) requires a court to assess reliability/admissibility (Robinson/Daubert-type) before accepting a counteraffidavit | "To testify" requires admissibility screening; counteraffidavit must meet Robinson reliability | §18.001(f) concerns only affiant qualifications and notice; reliability is for admissibility at trial | No reliability gatekeeping under §18.001(f): trial courts should not impose a Robinson reliability requirement when evaluating compliance with §18.001(f) |
| Whether striking a counteraffidavit permits excluding all contrary evidence, cross-examining, and jury argument on reasonableness | Failure to file a proper counteraffidavit means defendant waived right to contest bills at trial | Striking a defective counteraffidavit is procedural; statute does not authorize wholesale exclusion or preclusion of trial evidence/argument | Striking is not a basis to preclude all evidence or argument; trial court abused discretion by barring testimony, cross-exam, and jury argument |
Key Cases Cited
- Gunn v. McCoy, 554 S.W.3d 645 (Tex. 2018) (vendors of pricing data can be qualified to testify about reasonableness of medical expenses)
- Broders v. Heise, 924 S.W.2d 148 (Tex. 1996) (expert qualification depends on specific knowledge, not title alone)
- E.I. du Pont de Nemours & Co. v. Robinson, 923 S.W.2d 549 (Tex. 1995) (standards for admissibility of expert testimony)
- Haygood v. De Escabedo, 356 S.W.3d 390 (Tex. 2011) (§18.001 is procedural and streamlines proof of medical expenses)
- In re Prudential Ins. Co. of Am., 148 S.W.3d 124 (Tex. 2004) (mandamus standards)
- Walker v. Packer, 827 S.W.2d 833 (Tex. 1992) (mandamus standard re: absence of discretion to misapply law)
- Beauchamp v. Hambrick, 901 S.W.2d 747 (Tex. App.—Eastland 1995) (earlier appellate decision holding exclusionary sanction for lack of counteraffidavit but of no statutory basis per Court)