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High court rules on recovery issue

April 7, 2009

Under the statute governing the wrongful death of an unmarried adult with no dependents, the amount recoverable for reasonable medical and hospital expenses necessitated by the alleged wrongful conduct is the total amount ultimately accepted after contractual arrangements with an insurer, Medicare, or Medicaid, and not the total of the charges billed, the Indiana Supreme Court ruled today.

In James Butler as personal representative of the Estate of Nondis Jane Butler v. Indiana Department of Insurance as Administrator of the Patient's Compensation Fund, and Clarian Health Partners, Inc., No. 49S05-0805-CV-216, the Supreme Court addressed only the first contention of the estate's appeal of summary judgment entered in favor of the Indiana Department of Insurance: recovery for reasonable and necessary medical expenses under the applicable wrongful death statute was erroneously limited to the amounts paid and should have included the total amounts billed.

Nondis Jane Butler, an unmarried adult, initiated a medical negligence claim against Clarian Health Partners and other individual health care providers. She died before her claim was resolved and left no dependents. Her estate and Clarian settled; the estate was able to proceed for the balance of its claim for damages against the Indiana Patient's Compensation Fund.

The trial court entered summary judgment in favor of the fund, ruling the estate isn't entitled to recover money that is the difference between the total of medical bills received and the amounts actually paid and accepted as full satisfaction by the medical providers.

The Supreme Court unanimously found the language of Indiana Code Section 34-23-1-2(c)(3)(A) to be unambiguous, which specifies that damages are allowable for reasonable medical, hospital, funeral, and burial expenses necessitated by the wrongful conduct that caused the death.

The open-ended language in subsection (c)(3) permits recovery of damages other than those designated in subsection (c)(3)(A) and (c)(3)(B), but doesn't direct the expansion of the circumscribed damages defined with in (A) and (B), wrote Justice Brent Dickson.

"We hold that, with respect to damages pursuant to Indiana Code § 34-23-1-2(c)(3)(A), when medical providers provide statements of charges for health care services to the decedent but thereafter accept a reduced amount adjusted due to contractual arrangements with the insurers or government benefit providers, in full satisfaction the charges, the amount recoverable under the statute for the '[r]easonable medical . . . expenses necessitated' by the wrongful act is the portion of the billed charges ultimately accepted pursuant to such contractual adjustments," wrote Justice Dickson.

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