62 Ohio St. 3d 236 | Ohio | 1991
Lead Opinion
Appellant presents three propositions of law for the court’s consideration. The first contention is that former R.C. 2315.19 did not
I
It is questionable whether the issue of joint and several liability is properly before this court.
The constitutional issue was resolved in Morris v. Savoy (1991), 61 Ohio St.3d 684, 693, 576 N.E.2d 765, 772, where we held R.C. 2305.27 to be constitutional.
II
Hodge asserts that the trial court erred in determining that R.C. 2305.27 requires reduction of the malpractice award by the amount he received under Medicare Part A. R.C. 2305.27 reads in part: “ * * * in any medical claim, * * * an award of damages shall not be reduced by insurance proceeds or payments or other benefits paid under any insurance policy or contract where the premium or cost of such insurance policy or contract was paid either by or for the person who has obtained the award, or by his employer, or both, or by direct payments from his employer, but shall be reduced by any other collateral recovery for medical and hospital care, custodial care or rehabilitation services, and loss of earned income. * * * ”
Medicare Part A is a federal program which pays hospital and related benefits to individuals age 65 or over and certain others who meet eligibility requirements. It is financed by compulsory payroll taxes administered through the Federal Hospital Insurance Trust Fund. Medicare Part A is described as follows: “The insurance program * * * [which] provides basic protection against the costs of hospital, related post-hospital, home health services, and hospice care * * *.” Section 1395c, Title 42, U.S.Code.
Appellee directs our attention to Holaday v. Bethesda Hospital (1986), 29 Ohio App.3d 347, 29 OBR 475, 505 N.E.2d 1003, wherein it was held that
Appellee also relies on decisions from other jurisdictions, namely: Wojtkowski v. Hartford Accident & Indemnity Co. (1976), 27 Ariz.App. 497, 556 P.2d 798; Imvris v. Michigan Mut. Ins. Co. (1972), 39 Mich.App. 406, 198 N.W.2d 36; and Witherspoon v. St. Paul Fire & Marine Ins. Co. (1976), 86 Wash.2d 641, 548 P.2d 302, to support the argument that Medicare Part A benefits are not “insurance,” but part of a social welfare system. Those cases are inapposite. All three involve construction of language in insurance policies. Policy provisions are interpreted strictly against the drafter of the language and the policy language construed in those cases differs from that contained in the Ohio statute which governs our decision here. In this case, we construe a statute, not a contract of insurance.
R.C. 2305.27 was enacted as part of sweeping reform, as a response to a perceived malpractice insurance crisis. Morris v. Savoy, supra, 61 Ohio St.3d at 686-687, 576 N.E.2d at 768-769. The legislative intent behind the statute appears to be the prohibition of double recovery on medical claims for those plaintiffs whose collateral coverage was not paid for by themselves or their employers. See Morris v. Savoy, 61 Ohio St.3d at 693, 576 N.E.2d at 772; Holaday, supra, 29 Ohio App.3d at 348, 29 OBR at 477, 505 N.E.2d at 1005.
To fund Medicare Part A coverage, every employee and employer pays a portion of each paycheck into the Federal Hospital Insurance Trust Fund. In the broadest sense, then, Medicare Part A is insurance paid for by the employer and employee, for the benefit of the employee. To reduce the verdict against a tortfeasor by deducting Medicare payments would be to give the tortfeasor a benefit paid for out of the wages of the plaintiff. The argument is at cross purposes with the intent underlying R.C. 2305.27. In essence it would make the victim of a tort pay the tortfeasor’s damages.
Appellee makes much of the fact that participation in the Medicare program is not voluntary. We find this reasoning unpersuasive. Although participation is not voluntary, the General Assembly, in enacting R.C. 2305.27, did not make voluntary participation a condition to its definition of “insurance.” Insurance can be voluntary or compulsory.
Appellee also contends that because the program is not voluntary, the beneficiary cannot be said to have entered into a “contract” under R.C. 2305.27. This argument is also not persuasive. Payment into the trust fund, though involuntary, is in exchange for health care coverage, and gives rise to
In short, Medicare Part A is funded by payments made by beneficiaries and their employers, is actuarially determined, and is described by its enabling statute as insurance. Nothing in R.C. 2305.27 requires that the premium payments be voluntary. For these reasons, we hold that Medicare Part A benefits fall under the definition of “insurance” in R.C. 2305.27, and therefore do not reduce medical malpractice damage awards.
Accordingly, we reverse the judgment of the court of appeals, and remand the cause for action in accordance with this opinion.
Judgment reversed and cause remanded.
. The reduction was made solely from Dr. Peil’s estate’s portion of the liability award, Hodge has already collected from the other defendants and Hodge has appealed solely against Peil’s estate. For these reasons, Hodge is not affected by any ruling on joint and several liability.
. R.C. 2305.27 provides in full:
“Except as provided in section 2743.02 of the Revised Code, in any medical claim, as defined in division (D) of section 2305.11 of the Revised Code, an award of damages shall not be reduced by insurance proceeds or payments or other benefits paid under any insurance policy or*239 contract where the premium or cost of such insurance policy or contract was paid either by or for the person who has obtained the award, or by his employer, or both, or by direct payments from his employer, but shall be reduced by any other collateral recovery for medical and hospital care, custodial care or rehabilitation services, and loss of earned income. Unless otherwise expressly provided by statute, a collateral source of indemnity shall not be subrogated to the claimant against a physician, podiatrist, or hospital.”
. Section 1395c, Title 42, U.S.Code provides in full:
“The insurance program for which entitlement is established by sections 426 and 426-1 of this title provides basic protection against the costs of hospital, related post-hospital, home health services, and hospice care in accordance with this part for (1) individuals who are age 65 or over and are eligible for retirement benefits under subchapter II of this chapter (or would be eligible for such benefits if certain Federal employment were covered employment under such subchapter) or under the railroad retirement system, (2) individuals under age 65 who have been entitled for not less than 24 months to benefits under subchapter II of this chapter (or would have been so entitled to such benefits if certain Federal employment were covered employment under such subchapter) or under the railroad retirement system on the basis of a disability, and (3) certain individuals who did not meet the conditions specified in either clause (1) or (2) but who are medically determined to have end stage renal disease.” (Emphasis added.)
Concurrence in Part
concurring in part and dissenting in part. I concur with the syllabus, the judgment and Part II
. I concur with the discussion in Part II of the opinion with the exception that I would not describe the enactment of R.C. 2305.27 to be part of sweeping “reform.”