Butler v. Indiana Department of Insurance

904 N.E.2d 198, 2009 Ind. LEXIS 342, 2009 WL 944383
CourtIndiana Supreme Court
DecidedApril 7, 2009
Docket49S05-0805-CV-216
StatusPublished
Cited by14 cases

This text of 904 N.E.2d 198 (Butler v. Indiana Department of Insurance) is published on Counsel Stack Legal Research, covering Indiana Supreme Court primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Butler v. Indiana Department of Insurance, 904 N.E.2d 198, 2009 Ind. LEXIS 342, 2009 WL 944383 (Ind. 2009).

Opinion

DICKSON, Justice.

We hold that, under the statute governing actions for the wrongful death of unmarried adult persons with no dependents, Ind.Code § 34-23-1-2 (1999), in the event medical providers issue statements of charges for medical, hospital, or other health care services but thereafter accept a reduced amount in full satisfaction of the charges due to contractual arrangements with the patient's health insurers, Medicare, or Medicaid, the amount recoverable for reasonable medi¢al and hospital expenses necessitated by the alleged wrong ful conduct is the total amount ultimately accepted after such contractual adjustments, not the total of charges billed.

The facts are undisputed. Nondis Jane Butler, an unmarried adult, initiated a claim for medical negligence against Clari-an Health Partners, Inc. and several individual health care providers pursuant to the Indiana Medical Malpractice Act. Before her claim was resolved, she died leaving no dependants. Her estate ("the Estate") continued to pursue the claim as a wrongful death action. As to Clarian's liability under the Malpractice Act, the Estate and Clarian settled in December 2005 for "$250,000.00 in a structured fashion," Appellant's App'x at 26, 15, thus enabling the Estate to proceed with the balance of its claim for damages against the Indiana Patient Compensation Fund. 1 The Fund's administrator, the Indiana Department of Insurance, is the principal defendant here ("the Fund").

The Fund sought partial summary judgment claiming that the Estate is entitled to recover only the expenses the decedent and her estate actually incurred for medical services rather than the total amount of medical bills received. The Estate filed a cross motion seeking the converse. The parties then entered into a written factual stipulation that the necessary medical services to the decedent resulted in bills from the providers totaling $410,062.46, of which $122,161.18 was paid by (a) the decedent or her estate ($25,979.75), 2 (b) the decedent's insurer ($9,971.78), (c) Medicare *200 ($85,313.78), and (d) Medicaid ($895.92) 3 The parties also entered into a partial settlement whereby the Fund would pay the Estate $188,046.88 4 to settle all damage claims against the Fund except the Estate's claims for "additional medical expenses that were not paid but were billed" to the decedent or the Estate. Appellant's App'x at 64, 11 2 (Partial Settlement Agreement). The Estate agreed that it had "satisfied or will satisfy and discharge all liens or claims" on the settlement proceeds. Id. at 65, 19. Although neither the stipulation mor the Partial Settlement Agreement explicitly provide, the parties do not dispute the trial court's conclusion that all medical providers have been fully paid for their services to the decedent, and that the amount paid to the providers was not the amount billed "but a reduced amount ... based on agreements with the decedent's insurer, Medicare, and Medicaid." Id. at 8, 110-11. Likewise the parties do not challenge the trial court's findings that the difference between the bills received and the payments made for medical services, which the plaintiff seeks in damages, would not be used to pay for medical services for the decedent. Id. at 8, 112-13 5 The trial court approved the agreement, Appellant's App'x at 4, which provided that the trial court "will continue to hear evidence and arguments to determine the matter of the reasonable medical and hospital expenses necessitated by the negligent act of [Clarian], which resulted in the death of [plaintiffs decedent], over and above, if any, the amount agreed upon and paid herein," Appellant's App'x at 64, ' 4. The remaining issue thus presented by the Fund's motion for summary judgment was the legal question of whether the Estate was entitled to receive the difference between the total medical expenses charged and the total payments accepted in full satisfaction of the claims by the medical providers. The remaining issues before the trial court as to the Estate's motion for summary judgment were, first, the same legal issue, and second, in the event it prevailed, the factual issue of how much in damages it was entitled to receive beyond the agreed settlement amount.

Following a bench proceeding that considered the pleadings, the stipulation, two affidavits, and the parties' briefs and arguments, Judge Ayers issued thoughtful and extensive findings of fact and conclusions of law and entered judgment for the Fund, concluding that the Estate "is not entitled to recover $287,901.28 for medical bills that have been received by the Plaintiff," id. at 16, 136, and that it was not entitled to recover "for medical bills that it will not have to pay," id. at 20, that is, the difference between the total of medical bills received and the amounts actually paid and accepted as full satisfaction by the *201 medical providers. The trial court's final judgment represented its disposition of the parties' opposing motions for summary judgment, granting the Fund's motion and denying that of the Estate. The Court of Appeals affirmed. Butler v. Ind. Dep't of Ins., 875 N.E2d 235 (Ind.Ct.App.2007). We granted transfer.

The Estate's appeal presents two contentions: (1) recovery for reasonable and necessary medical expenses under the applicable wrongful death statute was erroneously limited to the amounts paid and should instead include the total amounts billed; and (2) the trial court erred in admitting evidence of amounts paid by the decedent's private insurance coverage, Medicare, and Medicaid, contrary to the Indiana Collateral Source Statute. The latter issue is moot, however, in light of the parties' Partial Settlement Agreement declaring the parties' agreement on issues "except for any claims for additional medical expenses that were not paid but were billed to the decedent and/or Estate," and that the trial court would "determine the matter of the reasonable medical necessitated by the negligent act ... over and above, if any, the amount agreed upon and paid herein." Appellant's App'x at 64, 112, 4. Thus only the Estate, not the Fund, had any further obligation to present evidence to establish the amount of damages appropriate to the resolution of the disputed legal question. The Estate's claim that the trial court incorrectly admitted evidence showing the amounts actually paid and accepted for the decedent's medical expenses is therefore irrelevant, and we address only the first contention in the Estate's appeal. 6

The Estate contends that the statute allows for recovery of reasonable and necessary medical expenses whether they were paid or not. The Fund argues that the plain language of the statute permits recovery only for expenses actually paid.

Indiana Code § 34-23-1-2, the statute governing actions for the wrongful death of unmarried adult persons without dependents, delineates the available damages as follows:

(c) In an action to recover damages for the death of an adult person, the damages:
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Cite This Page — Counsel Stack

Bluebook (online)
904 N.E.2d 198, 2009 Ind. LEXIS 342, 2009 WL 944383, Counsel Stack Legal Research, https://law.counselstack.com/opinion/butler-v-indiana-department-of-insurance-ind-2009.