Arthur v. Catour

803 N.E.2d 647, 345 Ill. App. 3d 804, 281 Ill. Dec. 243
CourtAppellate Court of Illinois
DecidedJanuary 16, 2004
Docket3-02-0810
StatusPublished
Cited by19 cases

This text of 803 N.E.2d 647 (Arthur v. Catour) is published on Counsel Stack Legal Research, covering Appellate Court of Illinois primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Arthur v. Catour, 803 N.E.2d 647, 345 Ill. App. 3d 804, 281 Ill. Dec. 243 (Ill. Ct. App. 2004).

Opinions

JUSTICE SLATER

delivered the opinion of the court:

In this case we must determine whether an injured plaintiff may recover as damages the entire amount billed for medical services, or if she is limited to the discounted amount paid by her insurance carrier. We find that the rationale underlying the collateral source rule supports allowing recovery of the full amount billed.

Facts

Plaintiff Joyce Arthur alleged in her complaint that she fractured her leg after stepping in a hole on a farm owned by defendant Laurie Catour. Plaintiff was attending an auction at the farm which was conducted by Stenzel Brothers Auction Services, Inc. Plaintiff incurred $19,355.25 in medical bills for treatment of her injuries. Plaintiff had group medical insurance with Blue Cross/Blue Shield through her husband’s employer. Because of the insurer’s contractual agreements with the healthcare provider, only $13,577.97 was required to pay off the medical bills. Defendants thereafter filed a motion for partial summary judgment seeking to limit plaintiffs claim for medical expenses to the amount paid rather than the amount billed. The trial court granted defendant’s motion, finding that allowing plaintiff to recover the larger amount “would only serve to punish the defendants *** and provide a windfall for the plaintiff.” We allowed plaintiffs application for leave to appeal pursuant to Supreme Court Rule 308 (155 Ill. 2d R. 308), and we now reverse and remand.

Analysis

Because of the importance of the issue presented by this case, we allowed the Illinois Association of Defense Trial Counsel (hereinafter amicus) to present an amicus brief in support of the defendants. That brief, and those pf the defendants, present various arguments for affirming the trial court’s order, all of which we have considered. Two primary themes underlie defendants’ position: (1) plaintiff is not entitled to damages greater than the amount she was obligated to pay and any additional sums would be a windfall; and (2) the difference between the amount charged and the amount paid is “illusory” and is not subject to the collateral source rule.

With respect to the first contention, it is of course true that “[t]he purpose of compensatory tort damages is to compensate the plaintiff for [her] injuries, not to punish defendants or bestow a windfall upon plaintiffs.” Wilson v. Hoffman Group, Inc., 131 Ill. 2d 308, 321, 546 N.E.2d 524, 530 (1989). Defendants maintain that because plaintiff was never obligated to pay the full amount billed, the amount paid by her insurer is the true measure of her damages. We disagree. Although “discounting” of medical bills is a common practice in modern healthcare (Mitchell v. Hayes, 72 F. Supp. 2d 635, 637 (W.D. Va. 1999); see M. Beard, The Impact of Changes in Health Care Provider Reimbursements Systems on the Recovery of Damages for Medical Expenses in Personal Injury Suits, 21 Am. J. Trial Advoc. 453 (1998) (hereinafter Impact)), it is a consequence of the power wielded by those entities, such as insurance companies, employers and governmental bodies, that pay the bills. See 21 Am. J. Trial Advoc. 453. While large “consumers” of health care such as insurance companies can negotiate favorable rates, those who are uninsured are often charged the full, undiscounted price. See B. Hewitt, M. Harrington & C. Clark, Target: Medical Bills, People, October 6, 2003, at 159-60. In other words, simply because medical bills are often discounted does not mean that the plaintiff is not obligated to pay the billed amount. Defendants may, if they choose, dispute the amount billed as unreasonable, but it does not become so merely because plaintiffs insurance company was able to negotiate a lesser charge. For the same reasons, plaintiff receives no “windfall” when she is compensated for her reasonable medical expenses. To the extent that she receives an amount greater than that paid by her insurer in satisfaction of the bill, that difference is a benefit of her contract with the insurer, not one bestowed on her by defendants.

We also disagree with defendants’ contention that the collateral source rule does not apply to the “illusory” difference between the amount billed and the amount paid. The nature and purpose of the collateral source rule was explained in Wilson:

“Under the collateral source rule, benefits received by the injured party from a source wholly independent of, and collateral to, the tortfeasor will not diminish damages otherwise recoverable from the tortfeasor. [Citations.] A situation in which the collateral source rule is frequently applied is one in which the injured plaintiff has been partly or wholly indemnified for the loss by proceeds from his accident insurance. In such a situation, the damages recovered by the plaintiff from the tortfeasor are not decreased by the amounts received from insurance proceeds. The justification for this rule is that the wrongdoer should not benefit from the expenditures made by the injured party or take advantage of contracts or other relations that may exist between the injured party and third persons.” Wilson, 131 Ill. 2d at 320, 546 N.E.2d at 530.

The defendants do not dispute that the collateral source rule is applicable to the $13,577.97 that was paid to satisfy plaintiffs medical bills. They maintain, however, that the rule does not apply to the “illusory” $5,777.28 difference between the billed amount and the amount paid because no one paid or was liable for that amount. We disagree. Plaintiff was billed over $19,000 and, but for her insurance coverage, she was liable for that amount. Limiting plaintiffs damages to the amount paid by her insurer confers a significant benefit of that coverage on the defendants. This result is directly contrary to the collateral source rule’s goal of ensuring “that the wrongdoer should not benefit from the expenditures made by the injured party or take advantage of contracts or other relations that may exist between the injured party and third persons.” Wilson, 131 Ill. 2d at 320, 546 N.E.2d at 530.

Amicus contends that the defendants are not seeking to take advantage of plaintiffs contract with her insurer, but instead seek the benefit of the relationship between two third parties — the health-care provider and the insurer. We believe that this argument incorporates an overly narrow view of plaintiffs relationship with her insurer. In Acuar v. Letourneau, 260 Va. 180, 531 S.E.2d 316 (2000), the Supreme Court of Virginia held that a plaintiff was entitled to recover the full amount of his medical expenses, including the amounts “written off’ pursuant to contractual agreements between the health-care providers and the insurance carrier. The court stated: “Those amounts written off are as much of a benefit for which [plaintiff] paid consideration as are the actual cash payments made by his health insurance carrier to the healthcare providers.” Acuar, 260 Va. at 192, 531 S.E.2d at 322. Similarly in this case, the lower charges negotiated by plaintiffs insurance company are as much a benefit of the insurance contract as the payments themselves. Under the collateral source rule, that benefit should inure to plaintiff, not to the defendant tortfeasors.

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Bluebook (online)
803 N.E.2d 647, 345 Ill. App. 3d 804, 281 Ill. Dec. 243, Counsel Stack Legal Research, https://law.counselstack.com/opinion/arthur-v-catour-illappct-2004.