In a case that will most likely affect every Buckeye who has health insurance, the Ohio Supreme Court has agreed to accept Robinson v Bates. This case is important because it will establish, at least here in the home of the 2006 Fiesta Bowl champions, whether a defendant in a personal injury case can use evidence about how much the victim’s insurance company actually paid.
Okay, again, but in English: Ms Robinson twisted her foot, and sued her landlord to recover treatment costs. During the trial, she produced bills amounting to a little over $1900, but then indicated that the providers had agreed to accept her insurance company’s payment of $1300, a savings of about 30% for the carriers, and a relatively routine transaction.
As an aside, I’m frankly dumbfounded that she could twist her foot in her own apartment, but still successfully sue her landlord for her injuries. What a country!
Anyway, the trial court ruled that she couldn’t be reimbursed for the full, non-discounted amount, only for what was actually paid out. Seems reasonable to me.
Of course, the Appeals court reversed the ruling, with a twist: they said that the landlord should have been prohibited from even introducing any evidence that the medical providers accepted less than what was billed. In other words, the original (trial) court judge shouldn’t have even been able to show that Ms Robinson “got a deal.” Hunh?!
So the question before the court now is pretty simple, but far-reaching: “What is the reasonable value of a plaintiff’s medical treatment if the plaintiff’s insurance company gets a discount on the final bill? Is it the amount that was originally billed by the provider, or ultimately paid by the insurer?”
The dollars involved – about $600 – aren’t exactly groundbreaking; but the stakes, as far as insurers are concerned, certainly are.