You probably know that if you are injured due to someone else’s negligence, you can sue that person to recover your medical expenses. But defining the precise scope of medical expenses can get complicated, particularly in the U.S. healthcare system. For instance, are you entitled to recover the full amount you were billed by your doctor or hospital, or just what your insurance company agreed to pay?
Higgs v. Costa Crociere Spa Company
A federal appeals court recently confronted this question in the context of a maritime law dispute. While personal injury cases that arise on land normally fall under state law, if are you injured on a cruise ship or elsewhere on the “high seas,” you typically need to sue the negligent party under federal maritime law.
In this particular case, Higgs v. Costa Crociere Spa Company, the plaintiff was on a Caribbean cruise with her family. One morning, the plaintiff went to breakfast and, as she stepped toward a busboy station to avoid some other diners, she tripped over a cleaning bucket. The plaintiff sustained a fractured arm and even now–some five years after the accident–she requires some ongoing medical care and physical therapy.
The plaintiff sued the cruise operator in federal court under maritime law. The case was tried before a jury, which ruled in the plaintiff’s favor and awarded her over $1.1 million in damages. This figure included $61,000 for medical expenses related to the accident. The trial judge, however, reduced this part of the award to just over $16,000, which was the amount the court said that the plaintiff and her insurer actually paid to her medical providers.
Both sides appealed to the U.S. 11th Circuit Court of Appeals in Atlanta. The cruise operator appealed the entire verdict, insisting that it never had notice of the “hazard posed by the bucket” prior to the plaintiff’s accident. The appellate court rejected this argument outright, noting the plaintiff produced “sufficient evidence” at trial permitting the jury to conclude that a cruise employee “placed a bucket–more than one foot tall and filled with dirty water–behind a blind corner in a highly-trafficked breakfast buffet pathway.” This placement clearly created a “danger of tripping” that “would have been obvious to anyone.”
Separately, the plaintiff appealed the trial judge’s decision to reduce the jury’s award for medical expenses. Here, the 11th Circuit agreed the judge acted contrary to law. The Court noted this was the first time it had ever addressed this specific question, i.e., “how to calculate past medical expense damages in a maritime tort action where, as has become common, there is a dramatic disparity” between what a victim is billed and what her insurer actually paid.
The 11th Circuit’s answer to this question was that “the appropriate measure of medical damages is a reasonable value determined by the jury upon consideration of all relevant evidence.” The jury may consider both the amount billed as well as the amount paid. And since the jury in this case did properly consider this evidence, the Court of Appeals said the original verdict should be reinstated.