White v. Jubitz Corp.White v. Jubitz Corp.
- Reporters:
- , , ,
- Before:
- Armstrong
In this рersonal injury case, defendant appeals from a judgment awarding plaintiff the full value of his medical expenses, including the portion of those expenses that were “written off” by plaintiff’s medical providers under an agreement with Medicare. We affirm.
The facts are undisputed. Plaintiff, a patron at defendant’s establishment, sustained injuries when the bar stool on which he was sitting collapsed under him. Plaintiff received medical treatment for his injuries, for which medical providers billed him a cumulative amount of $38,977. However, because plaintiff had Medicare cоverage, his medical providers subsequently “wrote off” $25,551 of those expenses as a condition of their agreement to accept Medicare payments. Medicare then paid the remaining $13,426, thus discharging plaintiffs obligation to pay his medical providers.
Plaintiff filed a negligence action against defendant that sought economic and noneconomic damages for the injuries that plaintiff had sustained. Before trial, defendant made a motion in limine asking the court either (1) to exclude evidence of the expenses that had been written off, thаt is, to limit plaintiff’s recoverable economic damages to the $13,426 that Medicare had paid to the medical providers, or (2) to allow defendant to present evidence that portions of plaintiff’s medical expenses had been written off. The court denied that motion but allowed defendant leave to submit a post-verdict motion regarding the expenses that had been written off.
After the jury returned a verdict awarding plaintiff economic damages totaling $37,600, which represented plaintiff’s medical expenses without reduction for the Mediсare write-offs, defendant filed a motion to reduce that amount by the portion of the expenses that the medical providers had written off. The court denied that motion, concluding that, under Oregon’s collateral source statute,
On appeal, defendant assigns error to the trial court’s denial of its motion
in limine
and its post-verdict motion to reduce the amount of recoverable medical expenses. In essence, defendant’s assignments raise three interrelated questions:
First,
are billed amounts that a medical provider writes off pursuant to an arrangement with an insurer (write-offs) recoverable “economic damages,” as defined by
Thus, with regard to the first question — whether write-offs are recoverable economic damages as defined by
“objectively verifiable monetary losses including but not limited to reasonable сharges necessarily incurred for medical, hospital, nursing and rehabilitative services and other health care services, burial and memorial expenses, loss of income and past and future impairment of earning capacity, reasonable and necessary expenses incurred for substitute domestic services, recurring loss to an estate, damage to reputation that is economically verifiable, reasonable and necessarily incurred costs due to loss of use of property and reasonable costs incurred for repair or for replacement of damaged property, whichever is less.”
In contrast, noneconomic damages consist of “subjective, non-monetary losses” such as those for pain, suffering, and emotional distress, among other things.
Our initial focus centers on whether write-offs are “objectively verifiable monetary losses” that are “reasonable charges necessarily incurred” by a plaintiff. The key term here is “incurred.” Defendant urges us to define “incur” as used in
The legislature does not explicitly define the word “incur” as used in
The context of
At common law, as under
“the value of services reasonably made necessary by the harm. * * * The value of medical services made necessary by the tort can ordinarily be recovered although [those expenses] have created no liability or expense to the injured person, as when a physician donates his services.”
It was in light of that underlying law that the legislature enacted
As a practical matter, that conclusion appears to be the only plausible construction of
Indeed, the Supreme Court reached a similar conclusion in
Seibel v. Liberty Homes,
Inc.,
“A trial of the employee’s contract action should not be turned into a trial of the employee’s potential claims for benefits from some administrative program, nor should the outcome depend simply on whatever cash benefits happen to have been paid before the trial.
“It is argued that to disregard payments of social benefits in the action against the employer gives a successful plaintiff an unjustified windfall. But whether to save or recapture those costs is properly an issue between the provider of the benefits and its beneficiaries, a policy choice in the design of the program. Absence of a recoupment provision does not help the employer who causes the costs by improperly terminating the employee’s regular source of compensation.”
Id.
In summary, we conclude that “reasonable charges necessarily incurred,” as used in
Our second inquiry — whether written-off amounts for medical care are collateral benefits under
“(1) In a civil action, when a party is awarded damages for bodily injury or death of a person which are to be paid by another party to the action, and the party awarded damages or person injured or deceased received benefits for the injury or death other than from the party who is to pay the damages, the court may deduct from the amount of damages awarded, before the entry of a judgment, the total amount of those collateral benefits оther than:
“(a) Benefits which the party awarded damages, the person injured or that person’s estate is obligated to repay;
“(b) Life insurance or other death benefits;
“(c) Insurance benefits for which the person injured or deceased or members of that person’s family paid premiums; and
“(d) Retirement, disability and pension plan benefits, and federal Social Security benefits.
“(2) Evidence of the benefit described in subsection (1) of this section and the cost of obtaining it is not admissible at trial, but shall be received by the court by affidavit submitted after the verdict by any party to the action.”
(Emphasis added.) In short,
Our inquiry turns on the meaning of the word “benefits.” As a term of common usage, we give the word its common meaning,
Smurfit Newsprint Corp. v. Dept. of Rev.,
Thus, we begin by looking at the term benefit in its common usage, and then refine that definition through the context of the enumerated benefits in paragraphs (a) through (d).
See Lane County v. LCDC,
As a term of common usage, a relevant definition of benefits is “3 : payment, gift: as a : financial help in time of sickness, old age, or unemployment * * * c : a cash payment or service provided for under an annuity, pension plan, or insurance policyU” Webster’s at 204 (boldface in original). Thus, by its common usage, benefits need not be limited to cash payments made to a plaintiff. Rather, a benefit can take other forms, such as a “service,” “gift,” and “financial help.”
Further, in the four exemptiоns delineated in paragraphs (a) through (d), the legislature provides some clues about the characteristics that it deemed collateral source benefits to share in common. We begin by noting certain characteristics to which benefits under
We then look to the text of the exceptions themselves to determine what the legislature determined definitively to be collateral source benefits. In particular, paragraph (c), which provides for “[insurance benefits for which the person injured or deceased or members of the family paid premiums,” is relevant to our analysis. There is no dispute that amounts that an insurer pays directly to a medical рrovider are collateral source benefits under paragraph (c). We cannot detect a relevant distinction between the manner in which the legislature intended to treat payments made by an insurer to a medical provider and amounts that are “written off’ as a result of the plaintiffs medical coverage. The former is a payment made directly to the provider; the latter is an indirect benefit extended to the plaintiff in the form of a discharge of debt. Both forms of benefit come about as a result of a plaintiff paying premiums for insurаnce or otherwise being in a class that lawmakers deemed to be eligible to receive that benefit, and both, ultimately, are “benefits” to a plaintiff because they discharge an obligation that the plaintiff otherwise would have to pay the medical providers.
Indeed, in this case, defendant does not dispute plaintiffs right to recover the $13,426 that his insurer (Medicare) paid to his medical providers to cover the reduced charges for medical services. 7 However, but for his insurance coverage, plaintiff presumably would have been liable for the full, billed amount of $38,977 for his injuries. In other words, plaintiff was going to pay either nothing out of his own pocket as a result of his coverage, or $38,977 if he were uninsured. Nothing suggests that, had plaintiff lacked medical coverage, his medical bills would have totaled only the discounted amount of $13,426.
Hence, we conclude that the term “benefit” is unambiguous on that point; billed amounts later written off by a
medical provider are collateral source benefits as contemplated by
Our remaining inquiry focuses on whether Medicare write-offs are “federal Social Sеcurity benefits” under
To start, a brief explanation of the Medicare program provides helpful context. Medicare was established as Title XVIII of the Social Security Amendments of 1965 and is operated under the purview of the Social Security Administration. Pub L 89-97, Title I, § 102(a), 79 Stat 291 (1965);
We begin our final exercise in statutory construction with, again, an analysis of the text in context. At first blush, it appears that the text “federal Social Security benefits” in paragraph (d) encompasses all programs stemming from the Social Security Act. No language specifically modifies “federal Social Security benefits” to suggest a legislative intent to limit that category to particular types of Social Security benefits, such as retirement, disability, or Medicare. To conclude that the legislature intended such a limit would appear to
require us to insert what has been omitted from the statute, which would violate the prohibition in
Arguably, however, if we were to consider each of paragraphs (a) through (d) as describing an individual category of exclusions, we might arrive at a different conclusion. Under the principle of
noscitur a sociis,
tеrms in a list are considered to share the same quality or common characteristics.
See State v. Moen,
Nevertheless, we note that the second construction appears to be untenable. First, to adopt that construction would require us to ignore the initial serial grouping of “Retirement, disability and pension plan benefits,” and punctuation separating it from “federal Social Security benefits.”
See Brock v. State Farm Mutual Auto. Ins. Co.,
195 Or
App 519, 526,
Hence, we do not believe that the phrase “federal Social Security benefits” as used in
In summary, we conclude that billed amounts later written off by a medical provider pursuant to an arrangement with the plaintiffs insurer are recoverable economic damages under
Affirmed.
Notes
Or Laws 1987, ch 774, § 6.
Defendant quotes our holding in
King
to support its proposed definition of incur, but that reliance is misplaced. In
King,
we addressed “incur” as it was used in
We concluded that, for purposes of
Indeed, a plaintiff need not even have received all of the necessary care nor have been billed for those services by the time of trial to have “incurred” expenses under
If a defendant is allowed to present evidence of write-offs, presumably the plaintiff would correspondingly seek to introduce evidence of the premiums or taxes he or she paid for the health coverage that led to the write-offs. Such an approach would almost inevitably reveal the extent of plaintiffs insurance coverage to the jury.
See Benton v. Johnson,
Because
Seibel
was a contract, not tort, action,
To avoid any misunderstanding, we note that the principle also applies to future medical expenses that a plaintiff will incur and, hence, can recоver as economic damages.
Additionally, Medicare has a right to reimbursement of the amount it pays on behalf of a beneficiary.
Accordingly, consistent with our conclusion on the first question that we addressed,
Consider, for example, the subtle difference in meaning if paragraph (d) read: “Retirement, disability, pension plan and federal Social Security benefits.”
In all events, the legislative history relevant to this question is sparse and does not contradict our conclusion.