TLA Feature Articles and Case Notes
Florida Supreme Court Takes the Air Out of Inflated Medical Damages: Elaine Dial v. Calusa Palms Master Association, Inc. J.W. Taylor*
Whether you prefer to call the issue “Truth in Damages”, “Transparency in Damages”, “Phantom Damages,” or even “Inflated Medical Damages,” a great debate has persisted across the nation as attorneys and industry professionals alike attempt to explain frequently inexplicable Nuclear and now Thermonuclear Verdicts. Medicare providers routinely bill patients for services in amounts that greatly exceed what Medicare will ultimately pay for those services. Those providers must accept the amount that Medicare pays in order to participate in the program. Based on previously unclear case law, a jury in a personal injury or wrongful death suit could hear the amounts the provider initially billed, the amounts the provider actually accepted as full and final payment from Medicare for services, or both. On April 28, 2022, with its decision in Dial v. Calusa Palms Master Association, Inc.,1 the Florida Supreme Court made clear that, moving forward, a jury should only have the ability to hear and consider the amount the provider accepted as payment from Medicare and not the grossly inflated amount that was initially billed. Prior to this decision, there was legislation proposed in Florida’s State Congress directed at both limiting the nature of past * Taylor Johnson PL (Winter Haven, FL)
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medical expenses a plaintiff may present to a jury and curtailing inflated verdicts. House Bill 561 and Senate Bill 846, however, died the slow agonizing legislative death in the 2021 legislative session in early May. All was not lost though - enter Dial. Elaine Dial was injured in a trip-andfall incident which occurred on property owned by Calusa Palms Master Association, Inc. (“Calusa Palms”). At the time of the incident, Ms. Dial had private health insurance, but thereafter became eligible for Medicare. As is the standard protocol in Florida for such litigation involving past medical expenses, both Ms. Dial and Calusa Palms filed motions in limine arguing the admissibility of her past medical expenses and collateral sources of payment. With regard to medical expenses handled by Ms. Dial’s private health insurer, Calusa Palms conceded that Ms. Dial could admit the full past medical expense amounts, even though they had been paid at the private insurer’s discounted rates. With regard to the medical expenses covered by Medicare, however, Calusa Palms argued that Ms. Dial should only present the amount actually paid by Medicare, rather than the figures presented in the provider’s initial billing. Interestingly, Ms. Dial argued that by paying monthly premiums for Medicare, Medicare should be considered a collateral source and the full amounts of her past medical expenses should be admissible. Notwithstanding Ms. Dial’s argument, the trial court granted Calusa Palms’ motion in limine and denied Ms. Dial’s motion. The resulting calculation of damages, factoring in the Medicare discounted amounts, totaled $34,641.69. Had Ms. Dial been
permitted to admit the full amounts, her past medical expenses would have totaled approximately $120,000.00. At the conclusion of trial, the jury awarded Ms. Dial $34,641.69 for past medical expenses, representing a reduction of her potential past medical damages of roughly $85,000! Of course, Ms. Dial appealed and asked Florida’s Second District Court of Appeals for the full amount of her medical damages to be awarded rather than the discounted Medicare amount. The Second District Court of Appeals upheld the lower court’s determination, stating it was bound by its prior holding in Cooperative Leasing, Inc. v. Johnson.2 In that case, the Second DCA held that “the appropriate measure of compensatory damages for past medical expenses when a plaintiff has received Medicare benefits does not include the difference between the amount the Medicare providers agreed to accept and the total amount of the plaintiff’s medical bills.”3 While the holding in Johnson appears clear enough, the Second District Court of Appeals had to address the decision in Joerg v. State Farm Mutual Automobile Insurance Co.4 where the Florida Supreme Court held that the plaintiff, a developmentally disabled adult who was struck by a car while riding his bicycle, could not present the jury with potential eligibility for future Medicare benefits for the purpose of determining future medical expenses. The reasoning behind the Florida Supreme Court’s holding in Joerg noted that a jury should not be prejudiced by speculative benefits which a plaintiff may or may not receive in the future, as it might prompt the jury to return an artificially low judgment if
Transportation Lawyers Association • Canadian Transport Lawyers Association • July 2022, Vol. 24, No. 1
