Case Title: Weborg v. Jenny

Citation: 2012 WI 67

Docket Number: 2010AP000258

State: wisconsin

Court: Wisconsin Supreme Court

Date: 2012-06-28T00:00:00Z

Document:
2012 WI 67 
 
SUPREME COURT OF WISCONSIN 
 
 
 
 
 
CASE NO.: 
2010AP258   
COMPLETE TITLE: 
Theresa C. Weborg, individually and as Personal  
Representative of the Estate of William N. 
Weborg, deceased, Nicholas Weborg, by his 
Guardian ad Litem, J. Michael End, Mitchell 
Weborg, by his Guardian ad Litem, J. Michael End 
and Michael Weborg, by his Guardian ad Litem,  
J. Michael End, 
          Plaintiffs-Appellants-Petitioners, 
     v. 
Donald B. Jenny, M.D., Erik M. Borgnes, M.D., 
Joseph J. Rebhan, M.D. and Physicians Insurance 
Company of Wisconsin, Inc., 
          Defendants-Respondents. 
 
 
 
 
REVIEW OF A DECISION OF THE COURT OF APPEALS 
Reported at 336 Wis. 2d 473, 801 N.W.2d 348 
(Ct. App. 2011-Unpublished)     
 
 
OPINION FILED: 
June 28, 2012   
SUBMITTED ON BRIEFS: 
        
ORAL ARGUMENT: 
March 13, 2012   
 
 
SOURCE OF APPEAL: 
 
 
COURT: 
Circuit   
 
COUNTY: 
Door   
 
JUDGE: 
D. Todd Ehlers   
 
 
 
JUSTICES: 
 
 
CONCURRED: 
ABRAHAMSON, C.J., concurs in part and dissents 
in part (Opinion filed).  
BRADLEY, J., joins concurrence/dissent.   
 
DISSENTED: 
        
 
NOT PARTICIPATING:         
 
 
 
ATTORNEYS: 
 
For the plaintiffs-appellants-petitioners, there briefs by 
J. Michael End, End, Hierseman & Crain, LLC, Milwaukee, and oral 
argument by J. Michael End.    
For the defendants-respondents, there was a brief filed by 
Michael Van Sicklen and Krista Sterken, Foley & Lardner, LLP, 
Madison, with oral argument by Michael Van Sicklen. 
 
 
2
Amicus curiae briefs were filed by Guy DuBeau and Axley 
Brynelson, LLP, Madison, for the Wisconsin Medical Society, 
Inc., and the Wisconsin Hospital Association, Inc., and Martha 
Heidt, Bye, Goff & Rohde, Ltd., River Falls, for the Wisconsin 
Association for Justice. 
 
 
2012 WI 67
NOTICE 
This opinion is subject to further 
editing and modification.  The final 
version will appear in the bound 
volume of the official reports.   
No.   2010AP258 
(L.C. No. 
2007CV59) 
STATE OF WISCONSIN  
 
 
   : 
IN SUPREME COURT 
 
 
Theresa C. Weborg, individually and as Personal 
Representative of the Estate of William N. 
Weborg, deceased, Nicholas Weborg, by his 
Guardian ad Litem, J. Michael End, Mitchell 
Weborg, by his Guardian ad Litem, J. Michael 
End and Michael Weborg, by his Guardian ad 
Litem, J. Michael End, 
 
          Plaintiffs-Appellants-Petitioners, 
 
     v. 
 
Donald B. Jenny, M.D., Erik M. Borgnes, M.D., 
Joseph J. Rebhan, M.D. and Physicians Insurance 
Company of Wisconsin, Inc., 
 
          Defendants-Respondents. 
 
FILED 
 
JUN 28, 2012 
 
Diane M. Fremgen 
Clerk of Supreme Court 
 
 
 
 
REVIEW of a decision of the Court of Appeals.  Affirmed.   
 
¶1 
ANNETTE KINGSLAND ZIEGLER, J.   This is a review of an 
unpublished decision of the court of appeals, Weborg v. Jenny, 
No. 2010AP258, unpublished slip op. (Wis. Ct. App. June 2, 
2011), that affirmed three judgments entered on a jury verdict 
by the Door County Circuit Court, D. Todd Ehlers, Judge.   
No. 
2010AP258   
 
2 
 
¶2 
On September 26, 2004, at the age of 42, William 
Weborg died of severe coronary artery disease.  His surviving 
wife, Theresa Weborg, and three minor sons, by their guardian ad 
litem, 
(collectively, 
the 
Weborgs) 
commenced 
a 
medical 
malpractice action against Dr. Donald B. Jenny; Dr. Erik M. 
Borgnes; Dr. Joseph J. Rebhan; their insurer, Physicians 
Insurance Company of Wisconsin, Inc.; and the Injured Patients 
and Families Compensation Fund (collectively, the physicians), 
claiming that the three physicians were negligent in their care 
and treatment of William, resulting in his death.  
¶3 
The case proceeded to a jury trial.  Over the Weborgs' 
objection, the circuit court granted the physicians' motion in 
limine under Wis. Stat. § 893.55(7) (2009-10)1 to introduce at 
trial evidence that Theresa Weborg received over $1.4 million in 
life insurance proceeds and $3,300 per month in social security 
benefits as a result of her husband's death.  Subsequent to the 
admission of such evidence, however, the parties stipulated to 
the amount of damages, leaving the jury to decide only questions 
                                                 
1 Wisconsin Stat. § 893.55(7) (2009-10) states:  
Evidence of any compensation for bodily injury 
received from sources other than the defendant to 
compensate the claimant for the injury is admissible 
in 
an 
action 
to 
recover 
damages 
for 
medical 
malpractice. 
 
This 
section 
does 
not 
limit 
the 
substantive or procedural rights of persons who have 
claims based upon subrogation. 
All subsequent references to the Wisconsin Statutes are to 
the 2009-10 version unless otherwise indicated.  
No. 
2010AP258   
 
3 
 
of liability.2  Also relevant to this appeal, the circuit court 
granted the physicians' request to modify the standard jury 
instruction on expert testimony. 
¶4 
The 
jury 
returned 
a 
verdict 
in 
favor 
of 
the 
physicians, finding that neither Dr. Jenny, Dr. Borgnes, nor Dr. 
Rebhan was negligent in his care and treatment of William 
Weborg.  The circuit court entered three judgments on the jury 
verdict and dismissed the Weborgs' complaint against the 
physicians. 
¶5 
The Weborgs appealed, arguing that the circuit court 
committed reversible error in admitting the evidence of life 
insurance proceeds and social security benefits and in modifying 
the standard jury instruction on expert testimony.  The court of 
appeals assumed, without deciding, that the circuit court erred 
in admitting the evidence of collateral source payments and 
agreed that the circuit court erred in modifying the jury 
instruction.  Nevertheless, the court of appeals affirmed the 
judgments, concluding that both errors were harmless.   
¶6 
We granted the Weborgs' petition for review and now 
affirm. 
¶7 
First, we hold that evidence of collateral source 
payments is admissible under Wis. Stat. § 893.55(7) only if the 
evidence is relevant.  In a medical malpractice action, evidence 
                                                 
2 As part of the stipulation, the Weborgs agreed to dismiss 
with prejudice their claims against the Injured Patients and 
Families Compensation Fund.  The Fund is therefore not party to 
this appeal. 
No. 
2010AP258   
 
4 
 
of collateral source payments is relevant if it is probative of 
any fact that is of consequence to the determination of damages.  
In this case, the circuit court admitted the evidence of life 
insurance proceeds and social security benefits without first 
determining in its discretion whether either piece of evidence 
was relevant to the jury's determination of damages.  Because 
the circuit court applied an improper legal standard in 
admitting the evidence of life insurance proceeds and social 
security 
benefits, 
we 
conclude 
that 
the 
circuit 
court 
erroneously exercised its discretion. 
¶8 
However, considering the trial as a whole, we conclude 
that the circuit court's error in admitting the evidence of life 
insurance proceeds and social security benefits did not affect 
the Weborgs' substantial rights and was therefore harmless.   
¶9 
Second, we conclude that the circuit court erroneously 
exercised 
its 
discretion 
in 
modifying 
the 
standard 
jury 
instruction on expert testimony.  Again, however, we determine 
that the error was harmless. 
I. FACTUAL BACKGROUND 
¶10 Prior to his death, William Weborg lived with his wife 
and their three sons in the Village of Ephraim in Door County.  
Since graduating from high school, William worked at a small 
machine shop in Egg Harbor.  William purchased the shop in 
October 2003, nearly one year before he died. 
¶11 On March 22, 2004, William developed heaviness in his 
chest while exercising.  Two days later, he was evaluated by Dr. 
Rebhan, a family practitioner.  Dr. Rebhan performed a physical 
No. 
2010AP258   
 
5 
 
examination and an electrocardiogram (EKG).3  The EKG revealed a 
normal sinus rhythm without acute wave changes.  Dr. Rebhan 
prescribed a cholesterol-lowering medication and advised William 
to begin a daily aspirin regimen.  Dr. Rebhan also scheduled 
William for an exercise stress test. 
¶12 The exercise stress test was administered on April 1, 
2004, and consisted of an EKG before, during, and after 
treadmill exercise.  In addition, a nuclear isotope was injected 
into William's body to measure his blood flow both at rest and 
with stress. 
¶13 The results of the nuclear scan were interpreted by 
Dr. Borgnes, a radiologist, as showing a mildly enlarged left 
ventricle and a small fixed defect consistent with an old 
infarct.4   
¶14 Upon receiving the results of the exercise stress 
test, Dr. Rebhan prescribed nitroglycerin and referred William 
to Dr. Jenny, a cardiologist, for further evaluation.  Dr. Jenny 
                                                 
3 An EKG (also known as an ECG) is "[a] record of the 
variations in electric potential which occur in the heart as it 
contracts and relaxes."  Black's Medical Dictionary 226 (Dr. 
Harvey Marcovitch ed., 41st ed. 2006).  An EKG is "recorded by 
connecting the outside of the body by electrodes with an 
instrument known as an electrocardiograph. . . .  The normal 
electrocardiogram of each heartbeat shows one wave corresponding 
to the activity of the atria and four waves corresponding to the 
phases of each ventricular beat."  Id. 
4 An "infarction" is defined as "[t]he changes in an organ 
when an artery is suddenly blocked, leading to the formation of 
a dense, wedge-shaped mass of dead tissue in the part of the 
organ supplied by the artery."  Black's Medical Dictionary, 
supra note 3, at 362. 
No. 
2010AP258   
 
6 
 
interpreted the results of William's EKG and performed a 
physical 
examination 
and 
chest 
x-ray 
on 
April 
7, 
2004.  
According to Dr. Jenny, William's resting EKG was normal, but 
his 
EKG 
under 
stress 
demonstrated 
"definitive 
convincing 
evidence of ischemia."5  Further observing that William's chest 
x-ray was "unremarkable," Dr. Jenny ultimately opined that 
William suffered from "[p]robable musculoskeletal chest wall 
pain." 
¶15 On June 25, 2004, William returned to Dr. Rebhan for a 
physical examination.  William expressed no specific concerns at 
that time but advised that he continued to experience occasional 
chest pain while exercising.  Noting that William's chest pain 
was "ruled out from a cardiac standpoint," Dr. Rebhan referred 
William to a physical therapist. 
¶16 The physical therapist evaluated William on August 27, 
2004, but detected "[n]o signs of musculoskeletal impairment." 
¶17 Upon receiving the physical therapist's report, Dr. 
Rebhan suggested that William's chest pain may be related to 
acid reflux and so directed William to take heartburn medication 
for a ten-day trial period. 
¶18 On September 9, 2004, William telephoned Dr. Rebhan's 
office, complaining that the heartburn medication did not help.  
                                                 
5 "Ischaemia" is defined as "[b]loodlessness of a part of 
the body, due to contraction, spasm, constriction or blocking 
(by embolus or by thrombus) of the arteries: for example, of the 
heart."  Black's Medical Dictionary, supra note 3, at 381. 
No. 
2010AP258   
 
7 
 
Dr. Rebhan responded the next day, advising that William's chest 
pain was "[m]ost likely musculoskeletal."  
¶19 William Weborg died on September 26, 2004, prior to 
his next scheduled appointment with Dr. Rebhan.  The Door County 
Medical Examiner determined that William's cause of death was 
"severe 
coronary 
artery 
disease 
due 
to 
arteriosclerotic 
cardiovascular disease (hardening of the arteries)." 
II. PROCEDURAL POSTURE 
¶20 On March 6, 2007, the Weborgs filed a medical 
malpractice action against the physicians, claiming that William 
died as a result of the negligence of Dr. Jenny, Dr. Borgnes, 
and Dr. Rebhan.  The Weborgs sought damages for pain and 
suffering endured by William, funeral and burial expenses 
incurred by William's estate, and pecuniary losses and the loss 
of society and companionship sustained by William's surviving 
wife and three sons. 
¶21 On September 8, 2009, the physicians filed motions in 
limine, seeking, inter alia, an order permitting the physicians 
to introduce at trial evidence of collateral source payments, 
namely, life insurance proceeds and social security benefits 
received by Theresa Weborg as a result of her husband's death.  
The physicians argued that Wis. Stat. § 893.55(7), clarified by 
this court in Lagerstrom v. Myrtle Werth Hospital-Mayo Health 
System, 2005 WI 124, 285 Wis. 2d 1, 700 N.W.2d 201, expressly 
allows evidence of collateral source payments to be introduced 
in medical malpractice actions. 
No. 
2010AP258   
 
8 
 
¶22 The Weborgs objected to the physicians' motion at a 
hearing on September 14, 2009.  Relying on Lagerstrom, the 
Weborgs contended that the jury is not permitted to use evidence 
of collateral source payments to reduce its award of damages, 
and consequently, Theresa Weborg's receipt of life insurance 
proceeds and social security benefits has no relevance.  In any 
case, the Weborgs argued, the evidence should be excluded under 
Wis. Stat. § 904.03 on the grounds of confusion and unfair 
prejudice. 
¶23 The physicians countered that "the language of [Wis. 
Stat. § 893.55(7)] is directory," taking the admission of 
collateral source payments in medical malpractice actions out of 
the circuit court's discretion.  Furthermore, the physicians 
maintained, the Lagerstrom court specifically mentioned life 
insurance 
proceeds 
as 
a 
type 
of 
payment 
encompassed 
by 
§ 893.55(7). 
¶24 The circuit court agreed.  By a letter decision dated 
September 17, 2009, the circuit court granted the physicians' 
motion in limine, permitting the physicians to introduce at 
trial evidence of collateral source payments, including life 
insurance proceeds and social security benefits received by 
Theresa Weborg as a result of her husband's death. 
¶25 The case proceeded to a jury trial beginning on 
October 6, 2009.  The trial lasted eight days.  The evidence of 
life insurance proceeds and social security benefits was first 
introduced 
by 
the 
Weborgs' 
counsel 
through 
his 
direct 
examination of Theresa Weborg.  Theresa Weborg testified that 
No. 
2010AP258   
 
9 
 
she received life insurance proceeds as a result of her 
husband's death and that she and her husband paid premiums for 
the insurance.  She similarly testified that she received $3,300 
per month in social security benefits as a result of her 
husband's death. 
¶26 The amount of the life insurance proceeds was elicited 
by counsel for the Injured Patients and Families Compensation 
Fund through his cross-examination of Theresa Weborg.  Theresa 
Weborg acknowledged that the life insurance proceeds totaled 
over $1.4 million.  She also repeated that she received $3,300 
per month in social security benefits.   
¶27 The jury never heard another mention of the life 
insurance proceeds or social security benefits. 
¶28 At the close of the Weborgs' case, the parties 
informed the circuit court that they had entered into a 
stipulation in regard to damages.  Specifically, the parties 
stipulated that if the jury finds liability as to one or more of 
the three physicians, then the Weborgs' damages will be set at 
exactly $1 million.  As part of the stipulation, the Weborgs 
agreed to dismiss with prejudice their claims against the 
Injured Patients and Families Compensation Fund. 
¶29 The physicians then advised the circuit court that 
pursuant to the parties' agreement, the jury is to be "told 
nothing" about the stipulation: "[T]he jury will not be told 
about 
the 
stipulation 
for 
one 
thing, 
that 
there 
is 
a 
stipulation, and [] they won't be even told that they don't need 
to find damages."  The circuit court twice asked counsel for the 
No. 
2010AP258   
 
10 
 
Weborgs whether he agreed.  Counsel for the Weborgs responded, 
"Fine with me." 
¶30 The circuit court entered an order on the stipulation 
on October 13, 2009. 
¶31 At the close of the physicians' case, the circuit 
court conducted a conference on jury instructions.  Relevant to 
this appeal, the physicians requested the circuit court to 
modify the standard jury instruction on expert testimony, Wis 
JI——Civil 260,6 by adding the following emphasized language: "You 
are not bound by any expert's opinion, except with regard to the 
standard of care exercised by medical doctors."  (Emphasis 
added.)  Absent that addition, the physicians argued, Wis JI——
Civil 260 is inconsistent with Wis JI——Civil 1023, the standard 
jury instruction on medical negligence, which instructs that the 
standard of care, skill, and judgment exercised by medical 
doctors must be determined from expert testimony.7 
                                                 
6 Wisconsin JI——Civil 260 states, in relevant part:  
Usually witnesses can testify only to facts they 
know.   
But, a witness with expertise in a calling 
(specialty) may give an opinion in that calling 
(specialty).  In determining the weight to be given an 
opinion, you should consider the qualifications and 
credibility of the expert and whether reasons for the 
opinion are based on facts in the case.  Opinion 
evidence was admitted in this case to help you reach a 
conclusion.  You are not bound by any expert's 
opinion. 
7 Wisconsin JI——Civil 1023 states, in relevant part:  
No. 
2010AP258   
 
11 
 
¶32 The Weborgs objected to the modified jury instruction, 
contending that Wis JI——Civil 1023 does not change the fact that 
the jury is not bound by any one expert's opinion. 
¶33 The circuit court agreed with the physicians and 
granted their request to modify Wis JI——Civil 260.  The circuit 
court explained that the modified jury instruction "just 
reaffirm[s]" that the jury must rely on expert testimony in 
order to find that the physicians violated the standard of care. 
¶34 The jury returned its verdict on October 16, 2009, 
finding that neither Dr. Jenny, Dr. Borgnes, nor Dr. Rebhan was 
negligent in his care and treatment of William Weborg.  At the 
same time, the jury found that William was negligent with regard 
to his own health but that his negligence was not a cause of his 
death.  Pursuant to the parties' stipulation, the jury was not 
asked any questions pertaining to damages. 
¶35 On November 5, 2009, the Weborgs filed a motion after 
verdict, seeking a new trial on the grounds that, inter alia, 
the circuit court erroneously admitted the evidence of life 
                                                                                                                                                             
You have heard testimony during this trial from 
doctors who have testified as expert witnesses.  The 
reason for this is because the degree of care, skill, 
and judgment which a reasonable doctor would exercise 
is not a matter within the common knowledge of 
laypersons.  This standard is within the special 
knowledge of experts in the field of medicine and can 
only be established by the testimony of experts.  You, 
therefore, may not speculate or guess what the 
standard of care, skill and judgment is in deciding 
this case but rather must attempt to determine it from 
the expert testimony that you heard during this trial. 
No. 
2010AP258   
 
12 
 
insurance proceeds and social security benefits and erroneously 
modified the standard jury instruction on expert testimony.   
¶36 The circuit court denied the Weborgs' motion at a 
hearing on December 10, 2009.  While expressing that the 
evidence 
of collateral source payments was unquestionably 
prejudicial to the Weborgs, the circuit court nevertheless 
concluded that the evidence was properly admitted, citing both 
Wis. Stat. § 893.55(7) and Lagerstrom.  The circuit court 
further determined that the modified jury instruction was not 
erroneous or confusing, reiterating its previous ruling that the 
added language merely rendered Wis JI——Civil 260 consistent with 
Wis JI——Civil 1023. 
¶37 Accordingly, on December 10, 2009, December 23, 2009, 
and January 11, 2010, respectively, the circuit court entered 
three judgments dismissing the Weborgs' claims against Dr. 
Rebhan, Dr. Borgnes, and Dr. Jenny. 
¶38 The Weborgs appealed, and the court of appeals 
affirmed.  Weborg, No. 2010AP258, unpublished slip op.  The 
court of appeals assumed, without deciding, that the circuit 
court erred in admitting the evidence of collateral source 
payments.  Id., ¶12.  The court of appeals concluded, however, 
that the error was harmless.  Id., ¶¶12, 15.  To conclude 
otherwise, the court reasoned, would be to assume that the jury 
acted improperly by considering evidence of the Weborgs' 
finances in determining whether the three physicians were 
negligent.  Id., ¶15. 
No. 
2010AP258   
 
13 
 
¶39 The court of appeals agreed with the Weborgs that the 
circuit court erroneously exercised its discretion in modifying 
the standard jury instruction on expert testimony.  Id., ¶30.  
Again, however, the court of appeals concluded that the error 
was harmless, explaining that the jury could not have reasonably 
believed 
that 
it 
was 
expected 
to 
simultaneously 
adopt 
conflicting expert opinions on the standard of care.8  Id., ¶30-
31. 
¶40 The Weborgs petitioned this court for review, which we 
granted on December 1, 2011. 
III. STANDARD OF REVIEW 
¶41 This court will not disturb a circuit court's decision 
to 
admit 
or 
exclude 
evidence 
unless 
the 
circuit 
court 
erroneously exercised its discretion.  State v. Ringer, 2010 WI 
69, ¶24, 326 Wis. 2d 351, 785 N.W.2d 448.  "'A circuit court 
erroneously exercises its discretion if it applies an improper 
legal standard or makes a decision not reasonably supported by 
the facts of record.'"  Johnson v. Cintas Corp. No. 2, 2012 WI 
31, ¶22, 339 Wis. 2d 493, 811 N.W.2d 756 (quoting 260 N. 12th 
St., LLC v. DOT, 2011 WI 103, ¶38, 338 Wis. 2d 34, 808 
N.W.2d 372).  In this case, the circuit court's decision to 
                                                 
8 The Weborgs appealed to the court of appeals on the 
additional ground that the circuit court erroneously exercised 
its discretion in including the optional third paragraph in Wis 
JI——Civil 1023.  See Weborg v. Jenny, No. 2010AP258, unpublished 
slip op., ¶¶16-28 (Wis. Ct. App. June 2, 2011).  The Weborgs 
have abandoned that argument before this court, and we therefore 
do not address it. 
No. 
2010AP258   
 
14 
 
admit the evidence of life insurance proceeds and social 
security 
benefits 
was 
based 
upon 
its 
interpretation 
and 
application of Wis. Stat. § 893.55(7).  Statutory interpretation 
and application present questions of law that this court reviews 
de novo while benefitting from the analyses of the court of 
appeals and circuit court.  Heritage Farms, Inc. v. Markel Ins. 
Co., 
2012 
WI 
26, 
¶24, 
339 
Wis. 2d 125, 
810 
N.W.2d 125; 
Lagerstrom, 285 Wis. 2d 1, ¶24.  
¶42 A circuit court likewise has broad discretion in 
instructing a jury.  Nommensen v. Am. Cont'l Ins. Co., 2001 WI 
112, ¶50, 246 Wis. 2d 132, 629 N.W.2d 301.  A circuit court 
appropriately exercises its discretion in administering a jury 
instruction so long as the instruction as a whole correctly 
states the law and comports with the facts of the case.  Id.  
This court independently reviews whether a jury instruction is a 
correct statement of the law.  State v. Fonte, 2005 WI 77, ¶9, 
281 Wis. 2d 654, 698 N.W.2d 594. 
¶43 Still, 
a 
circuit 
court's 
erroneous 
exercise 
of 
discretion does not warrant a new trial if the error was 
harmless.  See State v. Harris, 2008 WI 15, ¶85, 307 
Wis. 2d 555, 745 N.W.2d 397; Martindale v. Ripp, 2001 WI 113, 
¶30, 246 Wis. 2d 67, 629 N.W.2d 698; State v. Ziebart, 2003 WI 
App 258, ¶26, 268 Wis. 2d 468, 673 N.W.2d 369.  Application of 
the harmless error rule presents a question of law that this 
court reviews de novo.  Ziebart, 268 Wis. 2d 468, ¶26. 
IV. ANALYSIS 
No. 
2010AP258   
 
15 
 
A. Admission of the Evidence of Life Insurance Proceeds and 
Social Security Benefits 
¶44 Pursuant to the common law collateral source rule, an 
injured party's recovery cannot be reduced by payments or 
benefits from sources collateral to, or aside from, the 
tortfeasor.  Koffman v. Leichtfuss, 2001 WI 111, ¶29, 246 
Wis. 2d 31, 630 N.W.2d 201.  "The rule is grounded in the long-
standing policy decision that should a windfall arise as a 
consequence of an outside payment, the party to profit from that 
collateral source is the person who has been injured, not the 
one whose wrongful acts caused the injury."  Id. (internal 
quotations omitted); see also Ellsworth v. Schelbrock, 2000 WI 
63, ¶7, 235 Wis. 2d 678, 611 N.W.2d 764 ("The tortfeasor who is 
legally responsible for causing injury is not relieved of his 
obligation to the victim simply because the victim had the 
foresight to arrange, or good fortune to receive, benefits from 
a collateral source for injuries and expenses."). 
¶45 In the context of damages for medical expenses, the 
collateral source rule permits the plaintiff to recover the 
reasonable 
value 
of 
medical 
services, 
without 
regard 
to 
gratuitous medical services rendered or payments made on the 
plaintiff's behalf by outside sources, including insurance 
payments. 
 
Lagerstrom, 
285 
Wis. 2d 1, 
¶56; 
Koffman, 
246 
Wis. 2d 31, ¶30.  Stated otherwise, a tortfeasor is liable for 
the reasonable value of medical services, "without limitation to 
the amounts actually paid by the victim."  Lagerstrom, 285 
Wis. 2d 1, ¶56. 
No. 
2010AP258   
 
16 
 
¶46 The collateral source rule also operates as an 
evidentiary rule, 
precluding the introduction of evidence 
pertaining to payments or benefits received by a plaintiff from 
sources collateral to the tortfeasor.  Leitinger v. DBart, Inc., 
2007 WI 84, ¶30, 302 Wis. 2d 110, 736 N.W.2d 1.  The rule 
thereby "protects plaintiffs by guarding against the potential 
misuse of collateral source evidence to deny the plaintiff [the] 
full recovery to which he is entitled."  Id., ¶31. 
¶47 The collateral source rule ordinarily works in tandem 
with the legal principle of subrogation.  Lagerstrom, 285 
Wis. 2d 1, ¶65; Koffman, 246 Wis. 2d 31, ¶33.  By virtue and to 
the extent of payments made on behalf of the injured party, the 
payor, or subrogated party, generally obtains a right of 
recovery in an action against the tortfeasor and is a necessary 
party in such action.  Lagerstrom, 285 Wis. 2d 1, ¶64; Koffman, 
246 Wis. 2d 31, ¶33.  Alternatively, the payor may waive its 
right to subrogation in favor of reimbursement.  Lagerstrom, 285 
Wis. 2d 1, ¶64.  In either case, the policy goals are the same: 
subrogation helps to ensure that the loss is ultimately placed 
upon the tortfeasor and prevents the injured party from being 
unjustly enriched through a double recovery, i.e., recovery from 
both the subrogated party and the tortfeasor.  Lagerstrom, 285 
Wis. 2d 1, ¶64; Koffman, 246 Wis. 2d 31, ¶33. 
¶48 Through its enactment of Wis. Stat. § 893.55(7), the 
legislature expressly modified the evidentiary aspect of the 
collateral source rule, while retaining the rights of subrogated 
No. 
2010AP258   
 
17 
 
parties, in medical malpractice actions.  See Lagerstrom, 285 
Wis. 2d 1, ¶¶31, 46.  Section 893.55(7) provides: 
Evidence of any compensation for bodily injury 
received from sources other than the defendant to 
compensate the claimant for the injury is admissible 
in 
an 
action 
to 
recover 
damages 
for 
medical 
malpractice. 
 
This 
section 
does 
not 
limit 
the 
substantive or procedural rights of persons who have 
claims based upon subrogation. 
As this court observed in Lagerstrom, § 893.55(7) "is only 50 
words long, yet covers a large area of the law of damages in 
medical malpractice cases."  285 Wis. 2d 1, ¶28.  Interpreting 
§ 893.55(7) for the first time, see id., ¶25, the Lagerstrom 
court concluded that the statute "explicitly allows evidence of 
collateral 
source 
payments 
to 
be 
introduced 
in 
medical 
malpractice actions" but fails to state the purpose for which 
the evidence of collateral source payments is admissible and 
fails to direct how the fact-finder may use the evidence of 
collateral source payments.  Id., ¶5; see also id., ¶¶27, 32, 
69. 
¶49 In 
Lagerstrom, 
the 
decedent's 
surviving 
wife, 
individually and as special administrator of the decedent's 
estate, commenced a medical malpractice action against the 
Myrtle Werth Hospital, Red Cedar Clinic, and their insurers, 
alleging that the decedent died as a result of one of the 
defendants' physicians negligently inserting a feeding tube into 
the passageway of the decedent's lungs rather than into his 
stomach.  Id., ¶¶9, 15.  The defendants conceded that the 
No. 
2010AP258   
 
18 
 
physician was negligent but denied that his negligence caused 
the decedent's death.  Id., ¶¶9-10. 
¶50 At trial, the plaintiff introduced evidence that the 
medical services rendered to the decedent were reasonably valued 
at $89,000.  Id., ¶17.  Over the plaintiff's objection, however, 
the circuit court permitted the defendants to introduce evidence 
that the decedent's estate incurred only $755 in out-of-pocket 
expenses for medical services, while the remaining amount was 
paid by collateral sources, including Medicare and private 
insurance.  Id. 
¶51 The circuit court instructed the jury that it may, but 
is not required to, reduce its award for the reasonable value of 
medical services by the amount of the collateral source 
payments.  Id., ¶18.  In addition, the circuit court limited the 
plaintiff's arguments concerning the estate's obligation to 
reimburse Medicare, permitting the plaintiff to argue only that 
the estate could, if it wished, voluntarily reimburse Medicare.  
Id., ¶19. 
¶52 The jury returned a verdict in favor of the plaintiff, 
finding that the physician's negligence was a cause of the 
decedent's death.  Id., ¶10.  The jury awarded the plaintiff 
$20,000 for the pain and suffering endured by the decedent and 
$35,000 for the loss of society and companionship sustained by 
the decedent's surviving wife.  Id., ¶20.  The jury further 
awarded the plaintiff $755 for medical expenses and $0 for 
funeral expenses incurred by the decedent's estate.  Id. 
No. 
2010AP258   
 
19 
 
¶53 The circuit court entered judgment on the jury 
verdict, 
and 
the 
plaintiff 
appealed, 
challenging 
the 
constitutionality of Wis. Stat. § 893.55(7).  See id., ¶¶1, 22.  
On certification from the court of appeals, id., ¶1, this court 
reversed the judgment entered by the circuit court and remanded 
the cause to the circuit court for, inter alia, a new trial on 
the issue of medical expenses, id., ¶¶7, 100. 
¶54 The Lagerstrom court began its analysis by concluding 
that the text of Wis. Stat. § 893.55(7) "explicitly allows 
evidence of collateral source payments to be introduced in 
medical malpractice actions."  Id., ¶27.  While the Lagerstrom 
appeal concerned only medical expenses, the court acknowledged 
that § 893.55(7) is not so limited, noting that "the statute 
appears to encompass all damages in a medical malpractice 
action . . . ."  Id., ¶28.  The court further acknowledged that 
§ 893.55(7) does not impose any limits upon the type of 
collateral source payments; rather, the statute, "on its face," 
appears to contemplate that evidence of all collateral source 
payments is admissible in medical malpractice actions, including 
evidence of "payments such as those from federal and state 
governments, life insurance, income continuation plans, and 
volunteer services . . . ."  Id., ¶30.  Finally, while noting 
that § 893.55(7) concerns only "[e]vidence of any compensation 
for bodily injury" (emphasis added), the court concluded that 
the statute "is broad enough to include wrongful death actions."  
Id., ¶29. 
No. 
2010AP258   
 
20 
 
¶55 Despite the breadth of Wis. Stat. § 893.55(7), as the 
Lagerstrom court observed, the statute is noticeably silent as 
to many of the issues that accompany the admission of evidence 
of collateral source payments, including the purpose for which 
the evidence may be admitted, how the fact-finder may use the 
evidence, and whether the plaintiff may introduce evidence of 
the expenses he or she incurred in acquiring the collateral 
source payments or evidence of his or her obligations to 
reimburse the collateral sources.  See id., ¶¶32-35.   
¶56 Given the statute's silence on these issues, the court 
turned to the legislative history of Wis. Stat. § 893.55(7).  
See id., ¶¶37-48.  Of note, the court identified an earlier 
draft of the statute that would have required an award of 
damages in a medical malpractice action to be reduced by 
collateral source payments.  Id., ¶38.  The drafting records 
indicated that the earlier draft was not adopted out of a 
concern that an offset or reduction in an award of damages would 
negatively affect the subrogation rights of health insurers.  
See id., ¶¶42-43.  Indeed, as adopted, § 893.55(7) expressly 
provides that "[t]his section does not limit the substantive or 
procedural rights of persons who have claims based upon 
subrogation."  See also id., ¶¶40-43.   
¶57 Considering the text and legislative history of Wis. 
Stat. § 893.55(7), the Lagerstrom court ultimately concluded 
that the statute modifies only the evidentiary aspect of the 
collateral source rule, not the substantive aspect.  Id., ¶46.  
That is, in the context of medical expenses, § 893.55(7) 
No. 
2010AP258   
 
21 
 
modifies, but does not abrogate, the common law collateral 
source rule that the plaintiff is entitled to recover the 
reasonable value of medical services, without regard to the 
amount actually paid by the plaintiff.  See id., ¶70.  The court 
determined that the jury "may hear evidence of collateral source 
payments 
and 
evidence 
relevant 
thereto 
to 
determine 
the 
reasonable value of the medical services but must not use the 
collateral source payments as an offset to determine the 
reasonable value of the medical services."  Id., ¶76. 
¶58 An 
alternative 
interpretation 
of 
Wis. 
Stat. 
§ 893.55(7), the court reasoned, would impair subrogation 
rights.  See id., ¶¶71-73.  Applying its holding to the facts in 
Lagerstrom, the court explained:  
If the estate recovers an award for the value of 
the medical services rendered, the estate would not 
necessarily have a double recovery because it would 
have 
an 
obligation 
to 
reimburse 
Medicare. . . .  
Because Medicare may seek reimbursement, to protect 
Medicare's 
right 
of 
reimbursement 
the 
collateral 
source rule should apply.  That is, the fact-finder 
should be advised of the estate's potential obligation 
to Medicare and the fact-finder should not reduce an 
award to the estate by the collateral source payments 
by Medicare because of the potential obligation to 
repay 
Medicare. . . .  
It 
does 
not 
appear 
that 
§ 893.55(7) can at the same time allow an offset for 
collateral source payments, protect the parties to the 
action, and protect the rights of Medicare, which 
provided collateral source payments.   
Id., ¶76.  The court further advised that its interpretation of 
§ 893.55(7) obviates the constitutional concerns raised by the 
plaintiff.  See id., ¶22.   
No. 
2010AP258   
 
22 
 
¶59 In Lagerstrom, because the circuit court failed to 
instruct the jury that it must not reduce its award for the 
reasonable value of medical services by the amount of the 
collateral source payments, this court reversed the judgment and 
remanded the cause to the circuit for a new trial on the issue 
of medical expenses.  Id., ¶77. 
¶60 Turning now to the instant case, the Weborgs argue 
that the circuit court committed reversible error in admitting 
at trial evidence that Theresa Weborg received over $1.4 million 
in life insurance proceeds and $3,300 per month in social 
security 
benefits 
as 
a 
result 
of 
her 
husband's 
death.  
Specifically, the Weborgs assert that evidence of collateral 
source payments is admissible under Wis. Stat. § 893.55(7) only 
if the evidence is relevant.  In this case, the Weborgs submit, 
the evidence of life insurance proceeds and social security 
benefits 
"could 
not 
have 
been 
relevant," 
even 
if 
the 
determination of damages had remained with the jury.  Relying on 
Lagerstrom, the Weborgs reason that the jury would not have been 
permitted to use the evidence of collateral source payments to 
reduce its award for the Weborgs' financial loss, and therefore, 
there was no reason to admit the evidence in the first place. 
¶61 In response, the physicians maintain that the plain 
language of Wis. Stat. § 893.55(7) "affirmatively directs" the 
circuit court to admit evidence of collateral source payments in 
medical 
malpractice 
actions, 
reflecting 
a 
legislative 
determination that such evidence is "always relevant" in medical 
No. 
2010AP258   
 
23 
 
malpractice actions.9  The physicians contend that their 
interpretation of § 893.55(7) is consistent with the statute's 
policy objectives as set forth by this court in Lagerstrom.  
Even assuming, arguendo, that we agree with the Weborgs that 
§ 893.55(7) contemplates a separate relevancy determination, the 
physicians assert that, in this case, we should not upset the 
circuit 
court's 
discretionary 
determination 
to 
admit 
the 
evidence of life insurance proceeds and social security benefits 
because the evidence was relevant to the jury's determination of 
damages.  In any event, the physicians argue, the court of 
appeals correctly concluded that the admission of the evidence 
of life insurance proceeds and social security benefits was 
harmless. 
¶62 We agree with the Weborgs that evidence of collateral 
source payments is admissible under Wis. Stat. § 893.55(7) only 
if the evidence is relevant.  In Wisconsin, "[a]ll relevant 
evidence is admissible, except as otherwise provided by the 
constitutions of the United States and the state of Wisconsin, 
by statute, by these rules, or by other rules adopted by the 
supreme court."  Wis. Stat. § 904.02.  At the same time, 
                                                 
9 Citing State v. Williamson, 84 Wis. 2d 370, 391, 267 
N.W.2d 337 (1978), the physicians alternatively argue that the 
Weborgs forfeited their right to challenge the circuit court's 
admission of the evidence of collateral source payments by 
failing to strike Theresa Weborg's objectionable testimony and 
by failing to ask for a curative instruction.  We disagree.  The 
Weborgs preserved their objection by challenging the physicians' 
motion in limine at the September 14, 2009, hearing; nothing 
more was required. 
No. 
2010AP258   
 
24 
 
"[e]vidence which is not relevant is not admissible," § 904.02, 
with no exception.  In other words, irrelevant evidence "must be 
excluded."  7 Daniel D. Blinka, Wisconsin Practice Series: 
Wisconsin Evidence § 401.1, at 96 (3d ed. 2008).  Relevancy, 
therefore, is the "first hurdle" that any evidence must 
overcome.  Id.   
¶63 Evidence is relevant if it has "any tendency to make 
the existence of any fact that is of consequence to the 
determination of the action more probable or less probable than 
it would be without the evidence."  Wis. Stat. § 904.01.  Thus, 
in a medical malpractice action, evidence of collateral source 
payments is relevant if it is probative of any fact that is of 
consequence to the determination of damages.  See Blinka, supra, 
§ 401.1, at 96-97.  Damages recoverable in a medical malpractice 
action include pain, suffering, and noneconomic effects of 
disability; loss of consortium, society, and companionship or 
loss of love and affection; loss of earnings or earning 
capacity; medical expenses; and any "[o]ther economic injuries 
and damages."  Wis. Stat. § 893.55(5).  For example, in 
Lagerstrom, this court concluded that evidence of collateral 
source payments may be relevant to the jury's determination of 
the reasonable value of medical services.  See 285 Wis. 2d 1, 
¶76. 
¶64 Still, whether a particular piece of evidence is 
relevant is committed to the sound discretion of the circuit 
court.  State v. Moran, 2005 WI 115, ¶45, 284 Wis. 2d 24, 700 
N.W.2d 884.  Contrary to the physicians' suggestion, Wis. Stat. 
No. 
2010AP258   
 
25 
 
§ 893.55(7) does not direct that evidence of collateral source 
payments is inherently relevant in medical malpractice actions, 
thereby overriding the circuit court's discretionary authority.  
Section 893.55(7) states only that evidence of collateral source 
payments "is admissible in an action to recover damages for 
medical malpractice."  That evidence of collateral source 
payments "is admissible" in medical malpractice actions does not 
mean that evidence of collateral source payments is always 
relevant in every medical malpractice action.  Rather, as this 
court explained in Lagerstrom, § 893.55(7) merely modifies the 
evidentiary 
aspect 
of 
the 
collateral 
source 
rule. 
 
285 
Wis. 2d 1, ¶46.  That is, in the context of medical malpractice 
actions, § 893.55(7) renders "admissible" evidence that would 
otherwise be precluded under the common law collateral source 
rule, namely, evidence of payments or benefits received by the 
plaintiff from sources collateral to the tortfeasor.  As in any 
other case, however, "whether such evidence should be admitted 
lies within the discretion of the circuit court."  State v. 
Doss, 2008 WI 93, ¶75, 312 Wis. 2d 570, 754 N.W.2d 150 (emphasis 
added).  As Professor Blinka explains, the word "admissible" 
simply refers to a larger "process of regulating the disclosure 
of evidence to the trier of fact."  Blinka, supra, § 402.1, at 
130.   
¶65 Moreover, 
pursuant to Wis. Stat. § 904.03, even 
relevant evidence "may be excluded if its probative value is 
substantially outweighed by the danger of unfair prejudice, 
confusion of the issues, or misleading the jury, or by 
No. 
2010AP258   
 
26 
 
considerations of undue delay, waste of time, or needless 
presentation of cumulative evidence."  The decision to exclude 
evidence under § 904.03, like the determination of relevancy, 
rests in the discretion of the circuit court.  State v. 
Franklin, 2004 WI 38, ¶65, 270 Wis. 2d 271, 677 N.W.2d 276; 
Blinka, supra, § 403.1, at 134. 
¶66 In this case, we conclude that the circuit court 
applied an improper legal standard in admitting the evidence of 
life insurance proceeds and social security benefits and 
therefore erroneously exercised its discretion.  Specifically, 
the circuit court admitted the evidence of life insurance 
proceeds and social security benefits without first determining 
in its discretion whether either piece of evidence was relevant 
to the jury's determination of damages.  In doing so, the 
circuit court adopted the physicians' interpretation of Wis. 
Stat. § 893.55(7)——an interpretation that we reject today. 
¶67 When a circuit court fails to exercise its discretion 
on the erroneous ground that the discretionary authority does 
not exist, our ordinary practice is to reverse and remand the 
cause to the circuit court so that the court may exercise the 
discretion it previously failed to exercise.  Werner v. Hendree, 
2011 WI 10, ¶82, 331 Wis. 2d 511, 795 N.W.2d 423; Farmers & 
Merchs. Bank v. Reedsburg Bank, 12 Wis. 2d 212, 228, 107 
N.W.2d 169 (1961).  In this case, however, we determine that a 
remand is unnecessary.  We, like the court of appeals, conclude 
that the circuit court's error in admitting the evidence of life 
insurance proceeds and social security benefits was harmless. 
No. 
2010AP258   
 
27 
 
¶68 A circuit court's erroneous exercise of discretion in 
admitting or excluding evidence does not necessarily constitute 
reversible error.  See Green v. Smith & Nephew AHP, Inc., 2001 
WI 109, ¶96, 245 Wis. 2d 772, 629 N.W.2d 727; Martindale, 246 
Wis. 2d 67, ¶30.  Pursuant to Wis. Stat. § 805.18(2), the 
improper admission of evidence is not grounds for reversing a 
judgment or granting a new trial unless, after an examination of 
the entire action, it shall appear that the error "affected the 
substantial rights of the party" seeking to reverse the judgment 
or secure a new trial.10  See also Wis. Stat. § 901.03(1) ("Error 
may not be predicated upon a ruling which admits or excludes 
evidence unless a substantial right of the party is affected.").  
In order for an error to affect the substantial rights of a 
party within the meaning of Wis. Stat. § 805.18(2), "there must 
be a reasonable possibility that the error contributed to the 
outcome of the action or proceeding at issue."  Martindale, 246 
Wis. 2d 67, ¶32; Nommensen, 246 Wis. 2d 132, ¶52; see also State 
v. Harvey, 2002 WI 93, ¶41, 254 Wis. 2d 442, 647 N.W.2d 189 
                                                 
10 In its entirety, Wis. Stat. § 805.18(2) states:  
No judgment shall be reversed or set aside or new 
trial granted in any action or proceeding on the 
ground of selection or misdirection of the jury, or 
the improper admission of evidence, or for error as to 
any matter of pleading or procedure, unless in the 
opinion of the court to which the application is made, 
after 
an 
examination 
of 
the 
entire 
action 
or 
proceeding, it shall appear that the error complained 
of has affected the substantial rights of the party 
seeking to reverse or set aside the judgment, or to 
secure a new trial. 
No. 
2010AP258   
 
28 
 
(clarifying that the phrase "reasonable possibility" has the 
same substantive meaning as the phrase "reasonable probability" 
used by the United States Supreme Court in Strickland v. 
Washington, 
466 
U.S. 
668, 
694 
(1984)). 
 
"A 
reasonable 
possibility of a different outcome is a possibility sufficient 
to 'undermine confidence in the outcome.'"  Martindale, 246 
Wis. 2d 67, ¶32 (quoting State v. Dyess, 124 Wis. 2d 525, 545, 
370 N.W.2d 222 (1985)). 
¶69 In this case, considering the trial as a whole, we 
agree with the physicians that the circuit court's error in 
admitting the evidence of life insurance proceeds and social 
security benefits did not affect the Weborgs' substantial 
rights.  That is, the admission of the evidence of collateral 
source payments does not undermine our confidence in the jury's 
determination that neither Dr. Jenny, Dr. Borgnes, nor Dr. 
Rebhan was negligent in his care and treatment of William 
Weborg.  The fact that Theresa Weborg received life insurance 
proceeds and social security benefits as a result of her 
husband's death was first introduced on the third day of the 
eight-day trial by counsel for the Weborgs through his direct 
examination of Theresa Weborg.  The amount of the life insurance 
proceeds was then elicited by counsel for the Injured Patients 
and Families Compensation Fund through his cross-examination of 
Theresa Weborg.  Neither the life insurance proceeds nor social 
security benefits were ever mentioned again.  Indeed, on the 
fifth day of trial, at the close of the Weborgs' case, the 
parties stipulated to the amount of damages.  As a result, the 
No. 
2010AP258   
 
29 
 
physicians made no mention of damages during their case, and 
neither the Weborgs nor the physicians mentioned damages, let 
alone 
the 
collateral 
source 
payments, 
in 
their 
closing 
arguments.  Moreover, pursuant to the parties' stipulation, the 
jury received no instructions pertaining to damages and was not 
asked to determine damages; rather, the jury was instructed on 
and asked to determine only negligence and causation.  In 
particular, consistent with Wis JI——Civil 1023, the jury was 
instructed that the standard it must apply in determining if 
either Dr. Jenny, Dr. Borgnes, or Dr. Rebhan was negligent is 
whether the respective physician failed to conform to the 
standard of care.  The standard of care, the circuit court 
explained, is "the degree of care, skill and judgment which a 
reasonable 
cardiologist, 
family 
practitioner, 
and 
general 
diagnostic radiologist, respectively, would exercise in the same 
or similar circumstances, having due regard for the state of 
medical science at the time William Weborg was treated and 
diagnosed."  Thus, in order for us to conclude, as the Weborgs 
submit, that there is a reasonable possibility that the evidence 
of collateral source payments contributed to the outcome of the 
trial, we would have to assume that the jury disregarded its 
instructions 
and 
based 
its 
determination 
that 
the 
three 
physicians were not negligent on evidence that had no bearing on 
the standard of care.  While that may be a possibility, it is 
not a reasonable one.  As the court of appeals aptly noted, see 
Weborg, No. 2010AP258, unpublished slip op., ¶15, we must 
presume that the jury followed the circuit court's instructions.  
No. 
2010AP258   
 
30 
 
State v. Johnston, 184 Wis. 2d 794, 822, 518 N.W.2d 759 (1994); 
Curkeet v. Joint Sch. Dist. No. 2, 159 Wis. 149, 153, 149 
N.W. 708 (1914); State v. Deer, 125 Wis. 2d 357, 364, 372 
N.W.2d 176 (Ct. App. 1985). 
B. Modification of the Standard Jury Instruction on Expert 
Testimony 
¶70 "The purpose of a jury instruction is to fully and 
fairly inform the jury of a rule or principle of law applicable 
to a particular case."  Nommensen, 246 Wis. 2d 132, ¶36.  In 
short, jury instructions "explain what the law means to persons 
who usually do not possess law degrees."  Id. (internal 
quotations omitted).  Jury instructions should therefore "be as 
clear and simple as reasonably possible."  Id.  Indeed, the 
validity of the jury's verdict may depend upon it.  Fonte, 281 
Wis. 2d 654, ¶15. 
¶71 In this case, the Weborgs argue that the circuit court 
committed reversible error in modifying the standard jury 
instruction on expert testimony.  The circuit court modified Wis 
JI——Civil 260 by adding the following emphasized language: "You 
are not bound by any expert's opinion, except with regard to the 
standard of care exercised by medical doctors."  (Emphasis 
added.)  The Weborgs contend that the modified jury instruction 
is inherently inconsistent: while the standard jury instruction 
informs the jury that it is not bound by any expert's opinion, 
the modified jury instruction informs the jury just the 
opposite, namely, that it is bound by an expert's opinion on the 
standard of care. 
No. 
2010AP258   
 
31 
 
¶72 The 
physicians 
respond 
that 
the 
modified 
jury 
instruction accurately states the principles of law applicable 
to medical malpractice actions.  Specifically, the physicians 
maintain, and the circuit court agreed, that the modified jury 
instruction merely aligns Wis JI——Civil 260 with Wis JI——Civil 
1023, the standard jury instruction on medical negligence, which 
instructs that the standard of care exercised by medical doctors 
must be determined from expert testimony. 
¶73 We 
conclude 
that 
the 
circuit 
court 
erroneously 
exercised 
its 
discretion 
in 
modifying 
the 
standard 
jury 
instruction on expert testimony.  We agree with the Weborgs that 
the modified jury instruction is inherently inconsistent.  While 
Wis JI——Civil 260 instructs the jury that it is "not bound by 
any expert's opinion" (emphasis added), the modified jury 
instruction can reasonably be read to suggest that the jury is 
bound by an expert's opinion on the standard of care exercised 
by medical doctors.  It is true, as the physicians point out, 
that Wis JI——Civil 1023 instructs that the standard of care 
exercised by medical doctors must be determined from expert 
testimony.  See Wis JI——Civil 1023 (providing that the standard 
of care exercised by medical doctors "is within the special 
knowledge of experts in the field of medicine and can only be 
established by the testimony of experts").  However, that the 
jury must determine the standard of care from expert testimony 
does not mean that the jury is bound by any one expert's opinion 
on 
the 
standard 
of 
care. 
 
Rather, 
by 
evaluating 
the 
qualifications and credibility of each expert, the jury may 
No. 
2010AP258   
 
32 
 
still accept one expert's opinion on the standard of care over 
another's.  Because the modified jury instruction suggested 
otherwise, we conclude that the instruction was an incorrect 
statement of the law. 
¶74 Again, however, we conclude that the circuit court's 
error in modifying the standard jury instruction on expert 
testimony did not affect the Weborgs' substantial rights and was 
therefore harmless.  Jury instructions are evaluated in their 
entirety, not in isolation.  State v. Paulson, 106 Wis. 2d 96, 
108, 315 N.W.2d 350 (1982).  Here, as previously mentioned, the 
jury 
was 
appropriately 
instructed 
on 
the 
standard 
for 
determining medical negligence, in accordance with Wis JI——Civil 
1023.  In addition, while the modified jury instruction on 
expert testimony erroneously suggested that the jury is bound by 
an expert's opinion on the standard of care, the immediately 
succeeding instruction clarified that the jury is to "weigh the 
different expert opinions against each other and consider the 
relative qualifications and credibility of the experts and the 
reasons and facts supporting their opinions."  Absent any 
indication to the contrary, we presume that the jury did just 
that: the jury weighed the different expert opinions on standard 
of care against each other; accepted certain experts' opinions 
over others; and ultimately determined that Dr. Jenny, Dr. 
Borgnes, and Dr. Rebhan each used the standard of care that a 
reasonable 
cardiologist, 
family 
practitioner, 
and 
general 
diagnostic radiologist, respectively, would exercise in the same 
or similar circumstances.  Accordingly, we are satisfied that 
No. 
2010AP258   
 
33 
 
there is no reasonable possibility that the circuit court's 
error in modifying the standard jury instruction on expert 
testimony contributed to the outcome of the trial. 
V. CONCLUSION 
¶75 First, we hold that evidence of collateral source 
payments is admissible under Wis. Stat. § 893.55(7) only if the 
evidence is relevant.  In a medical malpractice action, evidence 
of collateral source payments is relevant if it is probative of 
any fact that is of consequence to the determination of damages.  
In this case, the circuit court admitted the evidence of life 
insurance proceeds and social security benefits without first 
determining in its discretion whether either piece of evidence 
was relevant to the jury's determination of damages.  Because 
the circuit court applied an improper legal standard in 
admitting the evidence of life insurance proceeds and social 
security 
benefits, 
we 
conclude 
that 
the 
circuit 
court 
erroneously exercised its discretion. 
¶76 However, considering the trial as a whole, we conclude 
that the circuit court's error in admitting the evidence of life 
insurance proceeds and social security benefits did not affect 
the Weborgs' substantial rights and was therefore harmless.   
¶77 Second, we conclude that the circuit court erroneously 
exercised 
its 
discretion 
in 
modifying 
the 
standard 
jury 
instruction on expert testimony.  Again, however, we determine 
that the error was harmless. 
By the Court.—The decision of the court of appeals is 
affirmed. 
No.  2010AP258.ssa 
 
1 
 
¶78 SHIRLEY S. ABRAHAMSON, C.J.   (concurring in part and 
dissenting in part).  I agree with the majority that the circuit 
court erred when it granted the physicians' motion in limine and 
allowed the jury to learn that the plaintiffs received over $1.4 
million in life insurance proceeds and $3,300 per month in 
social security benefits as a result of Mr. Weborg's untimely 
death.  See, e.g., majority op., ¶¶7, 66.  The evidence was not 
relevant to any disputed issue in the present case.  
¶79 I dissent, however, because I cannot assuredly say, as 
the majority does (¶69), that the error does not undermine my 
confidence in the jury's determination that not one of the three 
physicians was negligent in the care and treatment of William 
Weborg. 
¶80 The proceeds of the life insurance in the present case 
are unusually large, and jurors would very likely remember these 
sums.  Considering the nature of the error and the evidence in 
the record supporting a finding of negligence, I conclude that 
the error affected the plaintiffs' substantial rights and was 
not harmless.1 
¶81 Reading the majority opinion at ¶¶3 and 69, one might 
think that only one or two questions and answers in a long trial 
involved life insurance proceeds.  Not so.  
                                                 
1 This court has frequently set forth various factors that 
may be relevant to determining whether a particular error was 
harmless in a given case.  See, e.g., State v. Jorgensen, 2008 
WI 60, ¶23, 310 Wis. 2d 138, 754 N.W.2d 77; State v. Billings, 
110 Wis. 2d 661, 668-69, 329 N.W.2d 192 (1983). 
No.  2010AP258.ssa 
 
2 
 
¶82 In fact, the defense pressed evidence about the life 
insurance proceeds on the jury.  The defense fought to introduce 
the evidence (and still claims the evidence was properly 
admitted).  The defense then meticulously elicited testimony 
about the proceeds of each life insurance policy, extracting 
specific dollar amounts relating to each policy.  The defense 
repeatedly drew attention to the numerous, substantial sums Mrs. 
Weborg had already received as a result of Mr. Weborg's death 
and hammered home to the jury what to many (including myself) 
appears to be an unusual and astronomical total.  Although the 
evidence was put before the jury on the third day of an eight-
day trial, as the majority explains at ¶69, the trial transcript 
demonstrates the very heavy emphasis the defense placed on the 
life insurance proceeds.   
¶83 Here is how the evidence of the life insurance 
proceeds was presented to the jury.  During his direct 
examination 
of 
Mrs. 
Weborg, 
the 
plaintiffs' 
attorney 
preemptively 
introduced 
evidence 
that 
the 
plaintiffs 
had 
received life insurance proceeds and social security benefits 
due to Mr. Weborg's death, to reduce the possibility of 
prejudice2: 
                                                 
2 It seems clear that the plaintiffs' attorney chose to 
preemptively introduce the evidence of the plaintiffs' life 
insurance proceeds and social security benefits in an effort to 
reduce the potential prejudicial impact of the evidence that the 
circuit court ruled was admissible.  Cf. Porter v. Vista Bldg. 
Maint. Servs., Inc., 630 So. 2d 205, 206 (Fla. Dist. Ct. App. 
1993) 
("Plaintiff's 
counsel's 
attempt 
to 
diminish 
the 
prejudicial impact of the damaging evidence did not, contrary to 
appellee's contentions, waive the error, or render the error 
harmless.  A party cannot be penalized for his good-faith 
reliance on a trial court's incorrect ruling.").  
No.  2010AP258.ssa 
 
3 
 
[Plaintiffs' Counsel]: You received life insurance 
proceeds after your husband died, did you not? 
Mrs. Weborg: Yes, I did. 
[Plaintiffs' Counsel]: You received proceeds from 
Northwestern Mutual Life Insurance Company.  Did you 
and your husband pay the premiums in order to have 
that life insurance in force when your husband died? 
Mrs. Weborg: Yes, we did. 
[Plaintiffs' 
Counsel]: 
You 
also 
received 
life 
insurance from Valley Forge Life Insurance Company.  
Did you and your husband pay the premiums in order to 
have that life insurance in force? 
Mrs. Weborg: Yes.  
[Plaintiffs' 
Counsel]: 
You 
also 
received 
life 
insurance from Crown Life.  Did you and your husband 
pay the premiums in order to have that life insurance 
in force? 
Mrs. Weborg: Yes, we did. 
[Plaintiffs' Counsel]: There was also a payment made 
to you for life insurance from Jackson National Life 
Insurance Company.  Did you and your husband pay the 
premiums to have that life insurance in force? 
Mrs. Weborg: I think that is the life insurance policy 
through Itasca Systems.  When Bill became the owner, 
he took out that policy, and the company paid that 
policy, or it was paid through the company. 
[Plaintiffs' Counsel]: And then you also received a 
one-time death benefit from social security; is that 
correct? 
                                                                                                                                                             
The fact that the plaintiffs' attorney first introduced the 
evidence does not strengthen the physicians' argument that the 
evidentiary error was harmless.  In fact, the attorney's 
decision demonstrates just how prejudicial he feared the 
evidence would be.  The plaintiffs' attorney took pains to 
emphasize that Mrs. Weborg and her husband had paid premiums for 
these benefits and avoided eliciting the exact dollar figures 
recovered from the various policies. 
No.  2010AP258.ssa 
 
4 
 
Mrs. Weborg: Yes. 
[Plaintiffs' Counsel]: And you also receive is it 
$3,300 
per 
month 
from 
the 
social 
security 
administration? 
Mrs. Weborg: Yes.  
[Plaintiffs' Counsel]: As a result of your husband's 
death? 
Mrs. Weborg: Yes.  
¶84 Although the plaintiffs' counsel avoided soliciting 
information about the exact amount of the proceeds of the life 
insurance policies, on cross-examination counsel for the Injured 
Patients and Families Compensation Fund systematically elicited 
the precise amount of life insurance proceeds the plaintiffs had 
received: 
[Fund's Counsel]: There were several life insurance 
policies insuring your husband's life, correct? 
Mrs. Weborg: Yes, there were. 
[Fund's Counsel]: And there are four insurers that 
made payments to you because of his death, correct? 
Mrs. Weborg: Yes.  
[Fund's Counsel]: And the first payment you received 
was for a hundred thousand dollars from Northwestern 
Mutual, correct? 
Mrs. Weborg: Yes. 
[Fund's Counsel]: And then you received payment of a 
little over a million dollars from Crown Life, 
correct? 
Mrs. Weborg: No. It says Valley Forge payment of a 
million dollars.  
[Fund's Counsel]: I'm sorry.  I misread it.  Let me 
start from the top.  You received a payment of 
$100,000 on October 10th. 
No.  2010AP258.ssa 
 
5 
 
Mrs. Weborg: Yes. That was Northwestern Mutual. 
[Fund's Counsel]: Okay. 
Mrs. Weborg: And that was——it was an annuity that Bill 
had bought, and although it was from Northwestern 
Mutual Life Insurance Company, and I guess that's 
technically——but it was an annuity.  That's a little 
bit different than insurance. 
[Fund's Counsel]: Okay. But in any event, it was a 
hundred thousand dollars-plus check made out to you? 
Mrs. Weborg: Yes. 
[Fund's Counsel]: And then you received a payment of 
$1 million on October 25 of 2004 and that was from 
Valley Forge Life Insurance Company, correct? 
Mrs. Weborg: Yes.  And that was the insurance that I 
mentioned when I was talking to Mr. End that Bill 
purchased when he purchased the company to insure 
that——to insure himself, his family, his company in 
the event of, obviously, his death. 
[Fund's Counsel]: But in any event, after he died, you 
received a check from Valley Forge for over a million 
dollars? 
Mrs. Weborg: Yes, I did. 
[Fund's Counsel]: And then there was a claim for life 
insurance benefits made to Crown Life on October 10th 
of 2004, correct?  
Mrs. Weborg: Yes. 
[Fund's Counsel]: And they paid out $75,184? 
Mrs. Weborg: Yes. 
[Fund's Counsel]: And there was also a claim made 
under a policy issued by Jackson National Life 
Insurance Company? 
Mrs. Weborg: Yes. 
[Fund's Counsel]: And that policy paid out a death 
benefit of $250,000? 
No.  2010AP258.ssa 
 
6 
 
Mrs. Weborg: Yes. 
[Fund's Counsel]: And all of those life insurance 
proceeds added together are more than $1,400,000, 
correct? 
Mrs. Weborg: Yes. 
[Fund's Counsel]: And then you also receive $3,300 per 
month from social security?  
Mrs. Weborg: Yes, I do.  Not me personally, for myself 
and my children.  
 
¶85 The majority rationalizes that the jury was asked to 
decide the physicians' liability only, not the amount of 
damages.  Thus, the majority asserts that the admitted evidence 
could have affected the outcome of the trial only if "the jury 
disregarded its instructions and based its determination that 
the three physicians were not negligent on evidence that had no 
bearing on the standard of care."  Majority op., ¶69. 
¶86 While courts expect juries to follow instructions, 
courts also recognize that jurors (like any individual or group 
of individuals processing information) may misuse information 
and may succumb to emotion or bias, either consciously or 
unconsciously.  It is no secret that evidence can be unfairly 
prejudicial to a party if it risks arousing jurors' emotions.3  
                                                 
3 Circuit courts may exclude otherwise admissible evidence 
"if its probative value is substantially outweighed by the 
danger of unfair prejudice . . . ."  Wis. Stat. § 904.03.   
No.  2010AP258.ssa 
 
7 
 
Evidence that a plaintiff has already recovered a dramatic sum 
of money from a collateral source might elicit a variety of 
emotional reactions in a juror that may directly or subliminally 
affect a juror's decision on the issue of liability.4 
¶87 Indeed, 
there 
are 
several 
reasons 
that 
the 
introduction of evidence of life insurance proceeds could 
influence the jury in processing the evidence on negligence and 
liability.  Jurors might feel unsympathetic to the plaintiffs 
given the substantial "recovery" they have already received.  
                                                                                                                                                             
See also 1 McCormick on Evidence § 185 (6th ed. 2006) ("In 
this context, prejudice (or, as the rule puts it, 'unfair 
prejudice') does not simply mean damage to the opponent's cause—
for that can be a sign of probative value, not prejudice. 
Neither does it necessarily mean an appeal to emotion. Prejudice 
can arise, however, from facts that arouse the jury's hostility 
or sympathy for one side without regard to the probative value 
of the evidence.") (Emphasis added); 7 Daniel D. Blinka, 
Wisconsin Practice Series: Wisconsin Evidence § 403.1 (3d ed. 
2008) 
("'Unfair 
prejudice' 
is 
concerned 
with 
appeals 
to 
illegitimate 
or 
improper 
bases 
for 
decision. . . . The 
focus . . . is on emotions or factors that are deemed improper 
bases for a finding by the trier of fact.  To illustrate, 
gruesome photos or the inappropriate display of grotesque 
injuries for the sole purpose of horrifying the trier of fact, 
as opposed to edifying it on some point in dispute, are prime 
examples of unfair prejudice justifying the exclusion of the 
evidence."). 
A body of scholarship has developed studying the ways in 
which emotions, such as anger, affect jury decision making.  See 
Reid Hastie, Emotions in Jurors' Decisions, 66 Brook. L. Rev. 
991, 1005-06 (2001) (compiling studies).   
4 See Howell v. Hamilton Meats & Provisions, Inc., 257 
P.3d 1130, 1135 (Cal. 2011) ("Even if relevant on another 
issue . . . the probative value of a collateral payment must be 
'carefully weigh[ed] . . . against the inevitable prejudicial 
impact 
such 
evidence 
is 
likely 
to 
have 
on 
the 
jury's 
deliberations.'" (quoting Hrnjak v. Graymar, Inc., 484 P.2d 599, 
604 (Cal. 1971))).  
No.  2010AP258.ssa 
 
8 
 
Also, in light of the large life insurance sums involved, jurors 
might even infer that Mr. Weborg was in poor health, was 
concerned about impending death, and opted to purchase a large 
life 
insurance 
policy 
to 
protect 
the 
family's 
financial 
security.  Or jurors might infer that Mrs. Weborg was avaricious 
and 
undeserving 
of 
additional 
monetary 
compensation, 
notwithstanding evidence revealing the doctors' negligence.5  Or 
jurors might conclude that because the plaintiffs had already 
received generous compensation for the loss of Mr. Weborg, a 
finding of negligence would result in unnecessary additional 
recovery for the plaintiffs and there was no reason to saddle 
the physicians with liability.  All of these emotional reactions 
and inferences may play a role as jurors view conflicting 
evidence about negligence and liability.6  
                                                 
5 See Jennifer Howard, Alabama's New Collateral Source Rule: 
Observations from the Plaintiff's Perspective, 32 Cumb. L. Rev. 
573, 575 (2002) ("Just as courts fear that a jury might be more 
likely to find a defendant liable if he is insured, courts fear 
that a jury might be more likely to find no liability if they 
know the plaintiff received some compensation.  Courts believe 
that juries might be prejudiced against a plaintiff who has 
already received some compensation by believing that the 
plaintiff is overly litigious or merely greedy.") (Citations 
omitted.) 
6 The jury was instructed, "Draw your own conclusions and 
your own inferences from the evidence and answer the questions 
in the verdict according to the evidence and my instructions on 
the law."  
No.  2010AP258.ssa 
 
9 
 
¶88 I agree with those courts that have recognized the 
risk that erroneously admitted collateral source evidence can 
influence a jury on issues of liability depending on the 
specific facts and circumstances in the case at hand.   
¶89 For example, in Gormley v. GTE Products Corp., 587 
So. 2d 455 (Fla. 1991), the Supreme Court of Florida held that a 
new trial was warranted when a jury was informed that the 
plaintiffs had already received insurance proceeds after their 
house burned down.  The court reasoned:  
[I]ntroduction of collateral source evidence misleads 
the jury on the issue of liability and, thus, subverts 
the jury process.  Because a jury's fair assessment of 
liability is fundamental to justice, its verdict on 
liability 
must 
be 
free 
from 
doubt, 
based 
on 
conviction, 
and 
not 
a 
function 
of 
compromise.  
Evidence of collateral source benefits may lead the 
jury to believe that the plaintiff is trying to obtain 
a double or triple payment for one injury, or to 
believe 
that 
compensation 
already 
received 
is 
sufficient recompense.7 
                                                                                                                                                             
Among other instructions, the jury was also instructed that 
"[t]he standard [of care] is within the special knowledge of 
experts in the field of medicine and can only be established by 
the testimony of experts.  You, therefore, may not speculate or 
guess what the standard of care, skill and judgment is in 
deciding this case but must——but, rather, must attempt to 
determine it from the expert testimony that you have heard 
during this trial." 
7 Gormley v. GTE Prods. Corp., 587 So. 2d 455, 458 (Fla. 
1991) (internal quotation marks and citations omitted).   
No.  2010AP258.ssa 
 
10 
 
¶90 The Supreme Judicial Court of Maine reached a similar 
conclusion in Werner v. Lane, 393 A.2d 1329 (Me. 1978).  During 
a personal injury trial, defense counsel indicated to the jury 
that 
the 
plaintiff 
was 
receiving 
free 
medical 
and 
hospitalization care, which was covered by taxpayer dollars.8  
The court was unwilling to find the error harmless with respect 
to the issue of liability, stating:  
Defense counsel's statement to the jury respecting the 
free medical and hospitalization care furnished [the 
plaintiff] . . . was so highly prejudicial to the 
plaintiff's case . . . that it cannot be said with any 
degree of certainty that the jury did not conclude 
that, since the plaintiff was otherwise being taken 
care of, there should be no recovery at all against 
[the defendant], notwithstanding the uncontradicted 
aspect of the evidence pointing to negligence on the 
part 
of 
the 
defendant 
proximately 
causing 
the 
accident.9 
                                                                                                                                                             
In Cook v. Eney, 277 So. 2d 848, 850 (Fla. Ct. App. 1973), 
the court of appeals concluded that evidence of receipt of 
collateral benefits affected the determination of liability and 
was prejudicial error, as follows: "It cannot be said with any 
degree of certainty that the jury did not determine that since 
the appellant was otherwise being taken care of, there should be 
no recovery against appellee in tort.  The admission of evidence 
of receipt of other benefits may indeed have led the jury to 
believe that appellant was trying to obtain a double or triple 
payment for one injury." 
8 Werner v. Lane, 393 A.2d 1329, 1332 (Me. 1978). 
9 Id. at 1138.  The United States Supreme Court has 
acknowledged 
that 
erroneously 
admitted 
collateral 
source 
evidence may, under the circumstances of a case, be prejudicial 
on the issue of liability.  Tipton v. Socony Mobil Oil Co., 375 
U.S. 34, 37 (1963) ("We disagree with the suggestion of the 
Court of Appeals that the prejudicial effect of the evidence of 
other compensation would be restricted to the issue of damages 
and would not affect the determination of liability."). 
No.  2010AP258.ssa 
 
11 
 
¶91 In the present case, the life insurance policy 
proceeds and social security benefits were erroneously admitted 
at the behest of the defense10; the number of policies and the 
                                                                                                                                                             
Other state courts have reached similar conclusions.  See, 
e.g., John's Heating Serv. v. Lamb, 46 P.3d 1024, 1043 (Alaska 
2002) ("[The collateral source rule] precludes the introduction 
of 'evidence of other compensation on the theory that such 
evidence would affect the jury's judgment unfavorably to the 
plaintiff on the issues of liability and damages.'" (quoting 
Tolan v. ERA Helicopters, Inc., 699 P.2d 1265, 1267 (Alaska 
1985))); Evans v. Breeden, 330 N.E.2d 116, 118 (Ind. 1975) ("It 
is held that admission of evidence of benefits from a collateral 
source tends to prejudice the jury and influence their verdict, 
not only as to damages, but also as to liability."); Mickelson 
v. Montana Rail Link, Inc., 999 P.2d 985, 992 (Mont. 2000) 
("'[I]ntroduction of collateral source evidence may be much more 
damaging to a plaintiff's case than just affecting the jury's 
judgment regarding damages. . . . [S]uch evidence can have an 
impact upon a jury's verdict on the issue of liability, as well 
as damages.'" (quoting Thomsen v. State Dep't of Highways, 833 
P.2d 1076 (Mont. 1992))). 
10 The 
majority 
and 
I 
agree 
that 
the 
evidence 
was 
erroneously admitted.  Majority op., ¶¶7, 66.  Although the 
legislature 
deemed 
collateral 
source 
evidence 
potentially 
admissible in certain actions when it created Wis. Stat. 
§ 893.55(7), it did not deprive circuit courts of their 
discretion to bar the admission of irrelevant evidence.  
Once it is established that the evidence should have been 
barred despite Wis. Stat. § 893.55(7), the statute is not 
relevant to determining whether the evidentiary error was 
harmless.  The statute does not say: "Even if irrelevant 
collateral source rule evidence is erroneously admitted, the 
evidentiary error shall be deemed harmless." 
Many states, including Alaska, Florida, Indiana, Maine, and 
Montana (jurisdictions I have cited), have enacted statutes 
attempting to modify the collateral source rule in various ways. 
See Alaska Stat. § 09.55.548 (2010); Fla. Stat. § 768.76 (2011); 
Ind. Code § 34-44-1-2 (2011); Me. Rev. Stat. Ann. tit. 24, 
§ 2906 (2000); Mont. Code. Ann. § 27-1-308 (2009).  See 
generally James J. Watson, Annotation, Validity and Construction 
of State Statute Abrogating Collateral Source Rule as to Medical 
Malpractice Actions, 74 A.L.R. 4th 32 (1989). 
No.  2010AP258.ssa 
 
12 
 
sum total of the life insurance proceeds were particularly 
memorable; and the evidence presented all the risks of prejudice 
ordinarily associated with collateral source payments.  On the 
basis of the record in the present case, I conclude that the 
erroneously admitted evidence was not harmless error.   
 
¶92 For the reasons set forth, I dissent. 
¶93 I am authorized to state that Justice ANN WALSH 
BRADLEY joins this opinion. 
                                                                                                                                                             
Some of the statutes modify the evidentiary aspect of the 
collateral source rule, with various limitations.  Others modify 
the substantive component of the collateral source rule, with 
various limitations.  None of the statutes address whether, once 
a 
court 
determines 
that 
collateral 
source 
evidence 
was 
erroneously admitted, the error should be considered harmless. 
No.  2010AP258.ssa 
 
1