20 Sep 2016

Using the Affordable Care Act in Defense of Catastrophic Personal Injury Cases

Courts across the country are beginning to consider the argument that the Affordable Care Act (ACA) serves as a vehicle to limit a plaintiff’s claim for future medical damages. Plaintiffs often use exaggerated life care plans with significant damage calculations to support their future medical damages in catastrophic injury cases. In general, life care plans do not fairly consider a plaintiff’s entitlement to health insurance coverage, and assume that the alleged future medical care expenses are to be paid out-of-pocket by the plaintiff.

To combat these exaggerated forecasts by plaintiffs, defendants are relying on the mandates under the ACA to persuade the courts to fairly limit these inflated claims. Defendants are well served to argue that courts should not continue to force this fiction on the jury and allow a plaintiff to obtain a double recovery − from a jury’s damages award and from the plaintiff’s mandated health insurance. The purpose of tort damages is to make the claimant whole. As a result of the ACA mandates, individuals are now required to maintain insurance andinsurance companies are prohibited from excluding coverage based on a preexisting condition.

The framework that may have prevented injured plaintiffs from obtaining insurance coverage for potential future damages simply does not exist in the post-ACA environment, so it follows that public policy supports limiting a plaintiff’s future medical damages. To do otherwise, arguably would provide a windfall to plaintiffs.

The Collateral Source Rule

Texas, like many states, enforces the collateral source rule, which precludes any reduction in a tortfeasor’s liability because of benefits received by the plaintiff from someone else − a collateral source. The Texas Supreme Court has held that Texas Civil Practice and Remedies Code § 41.0105 limits a plaintiff’s past medical damages to those amounts actually paid or incurred (and prevents plaintiffs from recovering amounts initially charged but subsequently written off by a health care provider, that neither the claimant nor anyone on claimant’s behalf will ultimately be liable for paying). See Haygood v. De Escabedo, 356 S.W.3d 390 (Tex. 2010) (“To impose liability for medical expenses that a health care provider is not entitled to charge does not prevent a windfall to a tortfeasor; it creates one for a claimant….”). The ACA potentially provides a basis to further limit a plaintiff’s recovery of future medical expenses, as mandatory insurance under the ACA will cover all costs except the amount of the plaintiff’s premium and annual maximum out-of-pocket cost.

Read more about it here: http://bit.ly/2cGE4uq

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