John Joerg, Jr., etc. v. State Farm Mutual Automobile Insurance Co.John Joerg, Jr., etc. v. State Farm Mutual Automobile Insurance Co.
Lead Opinion
Pеtitioner John Joerg, Jr. (Joerg), on behalf of himself and as the natural father and guardian - of his son Luke Joerg (Luke), seeks review of the decision of the Second District Court of Appeal in State Farm Mutual Automobile Insurance Co. v. Joerg, - So.3d -,
BACKGROUND
The Collateral Source Rule
At common law, the collateral source rule governed both evidence and damages. See, e.g., Gormley v. GTE Prods. Corp.,
There are certain exceptions to this rule. For example, there are no reductions “for collateral sources for which a subrogation or reimbursement right exists.” § 768.76(1), Fla. Stat. The statute also explicitly states:
[Bjenefits received under Medicare, or any other federal program providing for a Federal Government lien on or right of reimbursement from the plaintiffs recovery, the Worker’s Compensation Law, the Medicaid Program of Title XIX of the Social Security Act or from any medical services program administered by the Department of Health shall not be considered a collateral source.
§ 768.76(2)(b), Fla. Stat. This exception does not result in a windfall to plaintiffs because Medicare and similar collateral sources retain a right of subrogation or reimbursement. See Pollo Ops., Inc. v. Tripp,
As an evidentiary rule, payments from collateral source benefits are not admissible because such evidence may confuse the jury with respect to both liability and damages. Sheffield v. Superior Ins. Co.,
[Ijntroduction оf collateral source evidence misleads the jury on the issue of liability and, thus, subverts the jury process. Because a jury’s fair assessment of liability is fundamental to justice, its verdict on. liability must be free from doubt, based on conviction, and not a function of compromise. Evidence of collateral source benefits may lead the jury to believe that the plaintiff is trying to obtain a double or triple payment for one injury, ... or to believe that com*1250 pensation already received is sufficient recompense.
Gormley,
Unlike the common law damages aspect of the collateral source rule, the evidentia-ry collateral source rule remains largely intact. See Gormley,
[Ejvidence of free or low cost services from governmental or charitable agencies available to anyone with specific disabilities is admissible on the issue of future damages.... Such evidence violates neither the statutory nor the common-law collateral source rule and does not, therefore, require a new trial.
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We believe that the common-law collateral source rule should be limited to those benefits earned in some way by the plaintiff. Governmental or charitable benefits available to all citizens, regardless of wealth or status, should be admissible for the jury to consider in determining the reasonable cost of necessary future care. Keeping such evidence from the jury may provide an undeserved and unnecessary windfall to the plaintiff.
Id. The Court emphasized that such evidence should not limit how the jury calculates damages:
The jury remains free to find that the publicly available services do not meet the plaintiffs future needs. The jury may find private care at higher cost more appropriate in some circumstances, but the jury should considеr those future services available to all, regardless of wealth or status, when deciding on the proper award of future damages.
Id. at 516.
In support of this holding, the Court relied at that time exclusively upon the
[T]he policy behind the collateral-source rule simply is not applicable if the plaintiff has incurred no expense, obligation, or liability in obtaining the services for which he seeks compensation.... It is a well-settled rule of damages that thе amount recoverable for tortious personal injuries is not decreased by the fact that the injured party has been wholly or partly indemnified for the loss by proceeds from accident insurance where the tortfeasor did not contribute to the payment of the premiums of such insurance. This rule is usually justified on the basis that the wrongdoer should not benefit from the expenditures made by the injured party in procuring the insurance coverage.... In a situation in which the injured party incurs no expense, obligation, or liability, we see no justification for applying the rule.
Id. at 515-16 (citing Peterson v. Lou Bachrodt Chevrolet Co.,
There is simply no assurance that public assistance will continue, that the injured victim will continue to be eligible for such assistance if it continues, or that the assistance, if it continues, will continue at the sаme level. By denying the victim full compensation for the cost of future care, the majority opinion transfers the responsibility for the tort from the tortfeasor, where it legally and morally belongs, to the victim and the community. I cannot agree that an injured victim should be required to seek charity or public aid, or that the compassion of charitable contributors and taxpayers should become a device for reducing the legal liability of a tortfeasor.
Id.
The courts of this state have struggled to apply Stanley. Rather, courts have frequently limited Stanley to its facts and usually concluded that Stanley -does not apply. See Gormley,
Florida courts have particularly wrestled with whether Stanley requires the admission of Medicare or Medicaid benefits. In Velilla, the Fourth District Court of Appeal reversed and remanded for a new trial after it determined that the admission of past Medicaid benefits was erroneous because of its prejudicial effect.
While there is dicta in Stanley that the “common-law collaterаl source rule [excluding testimony about benefits received by a plaintiff] should be limited to those benefits earned in some way by the plaintiff,”452 So.2d at 515 , the term “collateral sources” has never been limited to those benefits that a plaintiff has earned or paid for.
Parker,
This Case
Luke Joerg is a developmentally disabled adult who has lived with his parents his entire life and has never worked. As a result of his disabilities, Luke is entitled to reimbursement from Medicare for his medical bills. On November 19, 2007, Luke was riding his bicycle in Venice, Florida, when he was struck by a car. Joerg filed á negligence action against the driver arid Respondent State Farm Mutual Automobile Insurance Company (State Farm), Joerg’s uninsured motorist carrier. Prior to trial, Joerg withdrew his action against the driver-and proceeded against State Farm exclusively.
' Joerg filed a motion in limine to exclude evidence of any .collateral source benefits to which Luke was entitled, including discounted benefits under Medicare and" Medicaid. The trial court initially granted Joerg’s motion, but only with respect to past medical bills. After Joerg moved for reconsideration, the trial court vacated its prior ruling and allowed State Farm to introduce еvidence of “future medical bills for specific treatment or services that are available ... to all citizens regardless of their wealth or status.” However, it precluded State Farm from introducing evidence of Luke’s future Medicare or Medicaid benefits. After a four-day trial, the jury returned a verdict in favor of Joerg. The jury awarded a total of $1,491,875.54 in damages, including $469,076 for future medical expenses.
State Farm appealed to the Second District regarding several evidentiary matters. The Second District affirmed the trial court’s rulings on аll evidentiary issues without explanation, with the exception of the admissibility of Luke’s future Medicare benefits. Joerg, - So.3d at -, 38 Fla. L. Weekly at D1378. The district court noted that section 768.76, Florida Statutes, which statutorily amended the damages aspect' of the common law collateral source rule two years after the decision in Stanley, left the viability of Stanley in question. Id. at -, D1378-79. However, the court determined that neither the setoff statute nor the decision of this Court in Rudnick,
ANALYSIS
Whether the exception to the collateral source rule created in Stanley applies to future benefits provided by social legislation such as Medicare is a .purely legal question. Therefore, we review this issue de novo. See, e.g., Bakerman v. The Bombay Co.,
In 1980, Congress passed the Medicare Secondary Payer Act (MSPA) to reduce Medicare spending. See, e.g., Stalley v. Methodist Healthcare,
The way the system is set up the beneficiary gets the health care [he or] she neеds, but Medicare is entitled to reimbursement if and when the primary payer pays [him or] her. Among other avenues of reimbursement, Medicare is subrogated to the beneficiary’s right to recover from the primary payer.42 U.S.C. § 1395y(b)(2)(B)(iii) . Medicare regulations extend that subrogation right to any judgments or settlements “related to” injuries for which Medicare*1254 paid medical costs, thereby casting the tortfeasor as the primary payer.42 C.F.R. § 411.37 (2002).
Cochran v. U.S. Health Care Fin. Admin.,
The Centers for Medicare and Medicaid Services (CMS) may employ several tools to enforce the MSPA. CMS may file an independent cause of action “against any or all entities that are or werе required or responsible ... to make payment ... under a primary plan.”
With such enforcement tools, future Medicare benefits constitute a serious liability for all beneficiaries. See Black’s Law Dictionary 1053 (10th ed. 2014) (defining liability as either “1. The quality, state, or condition of being legally obligated or accountable; legal responsibility to another or to society, enforceable by civil remedy or criminal punishment — ” or “2. A financial or pecuniary obligation in a specific amount.”). Regardless of whether an individual has directly paid for his or her Medicare benefits, a factual matter which is unclear from the record befоre this Court, all Medicare beneficiaries who receive an award for future medical damages will be liable to reimburse Medicare, if Medicare makes a conditional payment on their behalf. Therefore, the assertion by State Farm that any Medicare and Medicaid benefits provided to Luke are free and admissible under Stanley is unsupported under the law.
Moreover, CMS’s ability to enforce the right of reimbursement of Medicare benefits makes it apparent that the exclusion of evidence of Medicare and similar collateral source benefits will not result in undue windfalls to plaintiffs such as Joerg. Florida courts have recognized that the exemption for Medicare in the collateral source damages statute does not create undue windfalls for plaintiffs. Pollo Ops., Inc.,
Additional policy concerns support our conclusion today. First, our holding is consistent with the recognition of the inherently prejudicial effect of evidence of collateral source benefits. See Eichel,
Moreover, it is absolutely speculative tо attempt to calculate damage awards based on benefits that a plaintiff has not yet received and may never receive, should either the plaintiffs eligibility or the benefits themselves become insufficient or cease to continue. Even where very particular benefits exist, extensive waiting lists may prevent an individual from actually receiving the benefit.
Finally, to consider Medicare, Medicаid, and other similar social legislation benefits as exceptions to the general rule that precludes admission of collateral sources circumvents the purpose of the collateral source rule. It is a basic principle of law that tortfeasors should not receive a windfall due to benefits available to the injured party, however those benefits were accrued. See Restatement (Second) of Torts § 920A cmt.b (1979) (“The law does not differentiate between the nature of the benefits, so long as they did not come from the defendant or a person acting for him.”); see also Gormley,
At this point, we recognize the need to reсede from our previous position articulated in Stanley. As discussed, no court, of this state has successfully applied Stanley. Moreover, Stanley has become the minority rule in this country. See Wills,
CONCLUSION
To affirm the decision below would result in a new trial in which State Farm would be permitted to present confusing, prejudicial, and speculative evidence of Luke Joerg’s future entitlement to Medicare benefits, when' State Farm would not otherwise be permitted to seek a reduction of the value of these benefits from any award Joerg might receive. This we cannot allow. We conclude that the trial court properly excluded evidence of Luke Joerg’s eligibility for future benefits from Medicare, Medicaid, and other social legislation as collateral sources. We therefore quash the decision below and remand for further proceedings consistent with this opinion.
It is so ordered.
Notes
. Additionally, district courts have noted that evidence of collateral payments may be admitted on a limited basis to rebut a party's theory of a case, establish liability in non-negligence actions, or prevent attempts to mislead the jury. E.g., Citizens Prop. Ins. Corp. v. Ashe,
. Other district courts have disagreed with this position. See Joerg, - So.3d at - n. 2, 38 Fla. L. Weekly at D1378 n. 2; Harrell,
. The record contains no direct evidence in the form of pay stubs, Social Security checks with itemized deductions, Or testimony as to Luke’s specific benefits, because the trial court excluded such evidence. There are several unchallenged arguments that Luke’s Social Security benefits were assessed to pay Medicare, and that Medicare retains a right of reimbursement with regard to any resulting settlement. State Farm, as the proponent of the argument that Luke’s benefits were free and therefore admissible under Stanley, bore the burden of establishing such. See Weaver,
This issue arose several times before and during trial. State Farm hád ample opportunity to seek further discovery and controvert Joerg’s assertion that a portion of Luke’s Social Security benefits were assessed to pay Medicare and that his benefits were therefore not free. Our review of the record leads us to conclude that State Farm failed to establish the Medicare benefits here were free. See id.
. We also reject the cramped interpretation of the Second District regarding future setoffs under section 768.76. Section 768.76 requires a judge to set off the value of most collateral source benefits from a damages award; however, the statute excludes benefits received under Medicare or programs with a right of reimbursement from the definition of collateral sources for the purpose of the setoff statute. § 768.76, Fla. Stat. The district court below concluded that section 768.76(2)(b) creates an exception only for previously earned Medicare benefits, not for future unearned benefits. Joerg, - So.3d at -, 38 Fla. L. Weekly at D1379. However, in Rudnick, we held that although benefits that have been received by the plaintiff must be set off against an award for damages, future collateral benefits are not subject to setoff.
. For example, the Agency for Persons with Disabilities maintains an extensive waiting list for services available to individuals with particular disabilities. See § 393.065, Fla. Stat. (2014). Some never receive the benefits which otherwise appear to be available in theory only.
. Although the court in Cates considered a variety of collateral source benefits, including - free special education such as was at issue in Stanley, thе North Carolina Supreme Court ultimately held that the admission of Medicaid and state welfare benefits and child support payments alone required a new trial. Cates,
. Like Peterson, the Illinois Supreme Court in Wills also considered the admissibility of past Medicare benefits, not the future benefits at issue here. Wills, 323 Ill.Dec. 26,
Dissenting Opinion
dissenting.
This Court does not have the constitutional authority to review this, case'because the Second District’s decision in State Farm Mutual Automobile Insurance Co. v. Joerg, - So.3d -,
In Stanley,
I respectfully dissent.
CANADY, J., concurs.