Lead Opinion
OPINION
The issue in this case concerns the appropriate measure of compensatory damages for past medical expenses.
Appellant’s decedent Catherine Baxter (“Baxter”) fell and injured herself while she was a patient at Appellee’s facility. Appellee provided medical services to Baxter for the injuries she received. Subsequently, Baxter commenced a medical malpractice action against Appellee. Following Baxter’s death, Appellant, as administratrix of Baxter’s estate, was substituted as the plaintiff. As the case proceeded to trial, an issue arose as to the appropriate measure of compensatory damages for Baxter’s past medical expenses. The court reserved that issue for itself and submitted the case to the jury, which returned a verdict in favor of Appellant, awarding $46,500 in non-economic damages including pain and suffering.
In an “Agreed Upon Statement of Facts Pursuant to Pa. R.A.P.1925”, the parties established the following facts with regard to the issue of compensation for past medical expenses: Baxter was covered by Medicare as well as a “Blue Cross 65” supplemental plan, for wrhich she had paid premiums. R. 12a. The fair and reasonable value of the medical services rendered to Baxter was $108,668.31. Id. The Medicare allowance for those services was $12,167.40. Id. Of the $12,167.40, eighty percent was paid by Medicare and twenty percent was paid by Blue Cross 65. Id. Appellee was a voluntary participant in the Medicare program and consequently accepted the $12,167.40 as payment in full for the medical services it rendered. Id. Appellee cannot obtain the difference of the cost of its services and the Medicare allowance (i.e. $96,500.91) from Appellant or from any other source. R. 12a-13a. Conversely, Appellant never was and never will be legally obligated to pay more than $12,167.40 for the medical services. R. 13a. Appellant contended that she was entitled to the full $108,668.31, while Appellee maintained that her recovery was limited to $12,167.40. R. 12a.
Appellant contends that Appellee is not entitled to a setoff because it was contractually bound to accept the Medicare allowance and therefore made no payment to Baxter; that a setoff presupposes an existing obligation of the plaintiff which in this case is non-existent; that the collateral source rule precludes Appellee from profiting from the Medicare benefits; and that the Superior Court’s decision arbitrarily assigns second-class claimant status to senior citizens who provide for their retirement medical expenses. Appellee counters that the trial court correctly determined that the reasonable value
On appeal, conclusions of law are always subject to our review. Fiore v. Fiore,
Initially, we will address Appellant’s contention that Appellee is bound by the “Agreed Upon Statement Pursuant to Pa.R.A.P.1925,” which indicates that the fair and reasonable value of the medical services is $108,668.31. R. 12a. “Parties may by stipulation resolve questions of fact or limit the issues, and, if the stipulations do not affect the jurisdiction of the court or the due order of the business and convenience of the court, they become the law of the case.” Parsonese v. Midland Nat’l Ins. Co.,
“The expenses for which a plaintiff may recover must be such as have been actually paid, or such as, in the judgment of the jury, are reasonably necessary to be incurred.” Goodhart v. Penn. R.R. Co.,
This evaluation of the reasonable value of services is in accord with the Restatement (Second) of Torts, § 911 comment h (1977), which states: “When the plaintiff seeks to recover for expenditures made or liability incurred to third
Awarding Appellant the additional amount of $96,500.91 would provide her with a windfall and would violate fundamental tenets of just compensation. It is a basic principle of tort law that “damages are to be compensatory to the full extent of the injury sustained, but the award should be limited to compensation and compensation alone.” Incollingo v. Ewing,
Our approach is consistent with theories of fair compensation reflected in Pennsylvania case law, such as the following: remedies seek to put the injured person in a position as nearly
Additionally, we find that the collateral source rule is inapplicable to the additional amount of $96,500.91. The rule “provides that payments from a collateral source shall not diminish the damages otherwise recoverable from the wrongdoer. [Citation omitted]. The principle behind the collateral source rule is that it is better for the wronged plaintiff to receive a potential windfall that for a tortfeasor to be relieved of responsibility for the wrong.” Johnson v. Beane,
Clearly, Appellant is entitled to recover $12,167.40, the amount which was paid on her behalf by Medicare and Blue Cross, the collateral sources. See Restatement (Second) of Torts § 920A(2), supra, note 2. But the essential point to recognize is that Appellee is not seeking to diminish Appellant’s recovery by this amount. Rather, the issue is whether Appellant is entitled to collect the additional amount of $96,500.91 as an expense. Appellant did not pay $96,500.91, nor did Medicare or Blue Cross pay that amount on her behalf. The collateral source rule does not apply to the illusory “charge” of $96,500.91 since that amount was not paid by any collateral source. See McAmis v. Wallace,
Accordingly, we affirm the order of the Superior Court, but on different grounds.
. This opinion was reassigned to this author.
. We may affirm the order of the court below if the result reached is correct without regard to the grounds relied upon by that court. Pennsylvania Game Comm’n v. State Civil Service Comm'n (Toth), 561 Pa.19,
. Section 920A, entitled “Effect of Payments Made to Injured Party”, provides:
(1) A payment made by a tortfeasor or by a person acting for him to a person whom he has injured is credited against his tort liability, as are payments made by another who is, or believes he is, subject to the same tort liability.
(2) Payments made to or benefits conferred on the injured party from other sources are not credited against the tortfeasor’s liability, although they cover all or a part of the harm for which the tortfeasor is liable.
. Because of the Superior Court's reliance on Kashner v. Geisinger,
In support of this proposition, the Kashner court summarized a holding in Brown v. White,
Additionally, the Kashner court relied upon D. Dobbs, Handbook on the Law of Remedies, § 8.1 at 543 (1973) which stated: "The measure of recovery is not the cost of services ... but their reasonable value... .[Rjecovery does not depend on whether there is any bill at all, and the tortfeasor is liable for the value of medical services even if they are given without charge, since it is their value and not their cost that counts.” A more recent version of that same treatise indicates in the very next sentence that: "It has been said, however, that if the provider of medical services charges less than their value without intending a gift, the plaintiff's recovery is limited to the liability incurred.” D. Dobbs, Handbook on the Law of Remedies § 8.1(3) at 377 (1993) (footnote omitted). Thus, we do not find the quoted language in Kashner to be a complete or final authority on this issue.
Finally, the Kashner court relied on the Restatement (Second) of Torts § 924, cmt. f (1979) which states: "The value of medical services made necessary by the tort can ordinarily be recovered although they have created no liability or expense to the injured person, as when a physician donates his services (See § 920A).” As noted above, we find another provision, Restatement (Second) of Torts § 911, cmt. h, which limits the tortfeasor's liability to the amount paid if it is "less than the exchange rate” unless "the low rate was intended as a gift to [the injured party]”, to be more applicable to the instant case.
Dissenting Opinion
Because I cannot agree that the amount actually paid and accepted by Appellee (“Crozer”) as payment in full for the medical services rendered ($12,167.40) is the amount Appellant’s decedent (“Baxter”) is entitled to recover as compensatory damages, I must respectfully dissent. Instead, I would affirm that portion of the Superior Court’s decision in which it found that Baxter is entitled to the reasonable value of the medical services provided ($108,668.31).
Unlike the majority, I believe the circumstances in the instant case clearly indicate that Baxter is entitled to $108,668.31 in compensatory damages. In finding that Baxter is only entitled to $12,167.40 in compensatory damages, the majority makes much of the fact that Crozer was contractually obligated to accept that amount as payment in full. While that may be true, such reasoning fails to take into account the fact that if Baxter had not been covered by Medicare and Blue Cross 65 or some other health insurance at the time of her fall at Crozer, she would have been personally responsible to Crozer as her medical provider for her entire medical bill of $108,668.31. Perhaps more importantly, the parties actually stipulated that $108,668.31 was the reasonable value of the
In reaching a different conclusion, i.e., finding that Baxter is only entitled to $12,167.40 as compensatory damages, the majority determines that where the amount initially billed by a plaintiffs health care provider is greater than the amount
In addition, by creating this exception to the rule that injured plaintiffs are entitled to recover the reasonable value of their medical services made necessary by the wrongdoer’s tortious conduct, the majority seriously undermines the collateral source rule. This Court recently defined the collateral
The collateral source rule provides that payments from a collateral source shall not diminish the damages otherwise recoverable from the wrongdoer. See generally, Beech-woods Flying Service, Inc. v. Al Hamilton Contracting Corp.,504 Pa. 618 ,476 A.2d 350 (1984). The principle behind the collateral source rule is that it is better for the wronged plaintiff to receive a potential windfall than for a tortfeasor to be relieved of responsibility for the wrong.
By diminishing the amount of compensatory damages otherwise recoverable from a wrongdoer based on payments made to the wronged plaintiff by a collateral source, the new rule advanced by the majority clearly violates the collateral source rule. According to the majority, when a medical provider contracts with a third party payor to accept an amount less than the reasonable value of the medical services provided as payment in full, the purpose of compensatory damages is no longer served by permitting an injured plaintiff to recover the reasonable value of her past medical services made necessary by the medical provider’s tortious conduct. The majority repeatedly notes that the actual medical expenses paid on behalf of Baxter by Medicare totaled $12,167.40, and contends that any further recovery against Crozer in the nature of compensatory damages for past medical expenses would constitute a windfall. Although the majority chooses to emphasize the $12,167.40 payment that Medicare and Blue Cross 65 made to Crozer on Baxter’s behalf, that is not the proper focus. Rather, the collateral source rule prohibits the wrongdoer from diminishing the damages recoverable against it based on the payments, compensation, or benefits that a collateral source confers on a wronged plaintiff on account of her injury. See, e.g., Hileman v. Pittsburgh and Lake Erie R.R. Co.,
It can hardly be argued that the benefit conferred on Baxter by Medicare and Blue Cross 65 was equal only to $12,167.40, the amount allowed by Medicare and ultimately accepted as payment in full by Crozer. Instead, by fully covering Baxter’s post-injury medical services, Medicare and Blue Cross 65 conferred a benefit on Baxter equal to the reasonable value of the medical services provided, which the parties stipulated to be $108,668.31. The collateral source rule dictates that Crozer cannot profit from the benefit that Baxter received from her health insurers, but that is exactly what the majority allows today.
[Collateral-source benefits] do not have the effect of reducing the recovery against the defendant. The injured party’s net loss may have been reduced correspondingly, and to the extent that the defendant is required to pay the total amount there may be a double compensation for a part of the plaintiffs injury. But it is the position of the law that a benefit that is directed to the injured party should not be shifted so as to become a windfall for the tortfeasor. If the plaintiff was himself responsible for the benefit, as by maintaining his own insurance ..., the law allows him to keep it for himself. If the benefit was ... established for him by law, he should not be deprived of the benefit that it confers. 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.
Restatement (Second) of Torts § 920A cmt. b.
Furthermore, although Comment f to Section 924 of the Restatement (Second) of Torts clearly states that the “value of medical services made necessary by the tort can ordinarily be recovered although they have created no liability or expense to the injured person,” the majority inexplicably finds Section 911 “to be more applicable to the instant case.” Majority Opinion,
. It bears noting that Crozer could have litigated the reasonable value of the medical services it provided to Baxter in the trial court and could have argued to the trier of fact that the amount accepted as payment in full for such services from Medicare and Blue Cross 65 is the most accurate barometer for calculating the reasonable value of the medical services provided to Baxter. But Crozer forewent that opportunity, and instead opted to stipulate to the reasonable value of the services while arguing that: (1) Baxter’s compensatory damages should be limited to the amount of the payment from Medicare and Blue Cross 65; and (2) it was entitled to a setoff in the amount of the difference between the reasonable value of the medical services provided and the amount accepted as payment in full from Medicare and Blue Cross 65.
. As the majority notes, however, the Superior Court also found that Crozer is entitled to a setoff in the amount of the difference between the reasonable value of the medical services provided ($108,668.31) and the amount accepted as payment in full ($12,167.40). I disagree with this finding. "It is only where the tortfeasor himself makes a payment towards his tort liability that the payment will have the effect of reducing his liability.” Kashner,
. I further note that the majority ignores the fact that the underlying bases for tort recovery of medical expenses and the payment of an insured’s medical benefits are distinct. The basis for the former is liability — -an injured party is entitled to receive compensation, including the reasonable value of medical services, from a culpable tortfeasor. The basis for the latter is contractual — health insurers are contractually obligated to pay medical benefits to, or on behalf of, their insureds. See Michael F. Flynn, Private Medical Insurance and the Collateral Source Rule: A Good Bet?, 22 U. Tol. L. Rev. 39, 65 (1990). Likewise, medical providers are sometimes contractually obligated to accept as payment in full reimbursement from health insurers which is less than the reasonable value of the services actually provided to the insured. By concluding that the contractual obligations between an insured and his or her health insurer and a medical provider and that insurer diminish the insured’s recovery of compensatory damages, the majority blurs the distinction between the bases for tort recovery of medical expenses and payment of an insured’s medical benefits.
. In support of its conclusion, the majority also claims that awarding Baxter the additional amount of $96,500.91 would violate the tenets of fair compensation. The majority claims that its conclusion is consistent with several theories: that damages cannot be presumed, that damages must be reasonably precise, that duplicative recovery results in unjust, enrichment, that the injured person should be compensated with the least burden to the wrongdoer, and that a plaintiff has a duty to mitigate damages.
There were no presumed damages in this case. In fact, the parties stipulated to the exact amount of the medical expenses: $108,668.31. While it is true that an injured party cannot recover twice for one injury, under the collateral source rule, the tortfeasor is required to pay for all the harm he causes, even if this creates a double compensation for part of the plaintiff’s injuries. Restatement (Second) of Torts § 920A cmt. b. Moreover, the principle behind the collateral source rule, that it is better for the wronged plaintiff to receive a windfall than for the tortfeasor to pay less than the damages he owes, specifically refutes the majority's contention. Johnson v. Beane,
Finally, the majority finds that the principle of damage mitigation applies in the instant case. For example, the majority cites Robison v. Rupert,
