Source: https://www.bruerlaw.com/read/plaintiffs-personal-injury-from-start-to-finish-basics-of-civil-procedure
Timestamp: 2019-04-21 06:37:45+00:00

Document:
In the assessment of all types of cases, items to be considered include: (1) medical bills under the new Mo.Rev.Stat. § 490.715; (2) and venue under the new Mo.Rev.Stat. § 508.010.
With respect to medical bills under the new Mo.Rev.Stat. § 490.715 (attached), the language of this (relatively) new statute essentially allows for the possibility that a trial court can decide the amount of medical expenses which will be submitted to the jury for consideration. Among the factors that the trial court can consider are: (a) The medical bills incurred by a party; (b) The amount actually paid for medical treatment rendered to a party; (c) The amount or estimate of the amount of medical bills not paid which such party is obligated to pay to any entity in the event of a recovery.
Not surprisingly, the plaintiffs’ side generally favors submitting the medical bills “incurred” by a party, and the defendants’ side generally favors submitting the amount “actually paid” for medical treatment. The trial courts in Missouri’s Judicial Circuits are replete with conflicting decisions about the intent and application of this statute, and even some judges within a particular circuit have conflicting decisions. There has been little caselaw to aid in the construction of this statute, although suffice it to say from the plaintiffs’ side that this statute does not unilaterally require a trial court to submit the amount actually paid for medical treatment. See Klotz v. St. Anthony’s Medical Center, No. SC90107 (March 23, 2010) and Berra v. Danter, No. ED92279 (October 27, 2009). In the investigation phase, two things to consider with respect to this statute are: (1) whether there is a significant discrepancy between the amount of bills your client has incurred versus the amount actually paid (usually by insurance companies), such that this could be the source of dispute at trial; and (2) whether the judges in the likely venue for the case have already ruled on this issue.
For tort actions where the injury occurred outside the state of Missouri, the second inquiry focuses on whether the defendant is an individual or a corporation. The statute does not give guidance on a situation in which there are multiple defendants with at least one individual and one corporation.
When the defendant is a corporation, the statute lays out the appropriate venue, but the statute does not give guidance on a situation in which the corporate defendant does not have a registered agent in Missouri.
When the defendant is an individual, the statute lays out the appropriate venue, but the statute does not give guidance on a situation in which the individual resides outside the State of Missouri.
In all tort cases EXCEPT medical malpractice cases, the assessment and investigation phase may call for a prejudgment interest demand under the new Mo.Rev.Stat. § 408.040.
The new Mo.Rev.Stat. § 408.040 (attached) is different than the prior prejudgment interest procedure primarily in the technical hurdles of making a demand for prejudgment interest.
Among other things, the demand is to be sent certified mail, accompanied by a thorough affidavit describing the nature of the claim. For injury claims, the demand must include a list of medical providers, medical bills, a list of employers if lost wages are sought, and authorizations for all medical providers and employers.
As far as timing, the demand must reference § 408.040, and be left open for 90 days. Thereafter, suit must be filed within 120 days after the demand is received.
In medical malpractice cases, the assessment and investigation phase may involve the selection of a reviewing expert upon consideration of the new Mo.Rev.Stat. § 538.225.
Under the new medical malpractice statutes, the new Mo.Rev.Stat. § 538.225 (attached) creates new and different barriers to filing an action which should be considered during the investigation phase. The new statute creates a decision in terms of: (1) the selection of an expert; and (2) the timing of filing an action.
With respect to selecting an expert, the new statute requires the plaintiff’s attorney to actually disclose the name, address, and qualifications of an expert who has certified the case as having merit, and the expert must be within the same profession as the defendant and either actively practicing or within five years of retirement from actively practicing the same specialty as the defendant.
In the investigation phase, one decision to be made is whether the reviewing expert will also be the testifying expert. This new statute creates a possible advantage to the defendants which was not available under the older law in that if the reviewing expert will also be the testifying expert, the defendant can begin doing background research into that expert much earlier than under the older law. Accordingly, if the budget and the cooperation of multiple experts permits, one can consider whether the reviewing expert should not be the testifying expert, so as to neutralize that advantage.
With respect to timing, the new statute indicates that the affidavit of merit must be filed within 90 days unless the court, for good cause shown, extends that time for an additional 90 days. If the plaintiff fails to file an affidavit, the court shall dismiss the action without prejudice.
In nursing home cases, the investigation phase may involve a complaint to the Attorney General under Mo.Rev.Stat. § 198.093 (attached). It is important to consider this during the investigation phase because, unlike the longer two-year statute of limitations for injury and three-year statute of limitations for death, a complaint must be made to the Attorney General within 180 days of the deprivation or injury.
If a complaint is made to the Attorney General within 180 days, and the Attorney General does not initiate legal action, the complainant may then bring a civil action within 240 days and the trial court may, in its discretion, award punitive damages if applicable and attorney’s fees based on the time reasonably expended.
In investigating a wrongful death case, it may be helpful to get the client oriented early on regarding the nature of damages in a wrongful death action – that is, not grief and bereavement by reason of the death, but instead, the loss of companionship, society, guidance, counsel, and training – especially in a medical malpractice case where noneconomic damages are capped.
Many economic experts are able to put a dollar figure on the losses, but the thoughts and input of the client are essential to this process. To foster the process, part of the client interviews and investigation can involve the client’s participation in estimating the losses on an hourly or itemized basis. A sample form will be available upon request to the author, and can provide a framework for building the evidence for the damages aspects of the case.
Under this statute, if a primary plan (perhaps the tortfeasor’s insurance plan) fails to pay the claim, the injured party may take the case to trial and, if an award is made, then may potentially sue the tortfeasor and the tortfeasor’s insurance company for double damages. In attempting to resolve the claim early in the investigation process, the threat of double damages after a favorable plaintiff’s verdict may influence the possibility of early resolution.
In the process of informal discovery, gathering medical records and bills can become, unfortunately, a challenge. When requesting records, our office generally requests that the health care provider provide records and execute a business records affidavit in the form set forth in Mo.Rev.Stat. § 490.692 (attached).
By obtaining the business records affidavit, the party can then be in a position, without the need for any cooperation or stipulation from the opposing side, to offer the records into evidence under Mo.Rev.Stat. § 490.692. Note that under this statute, the affidavit and records must be provided to the other side at least 7 days prior to trial.
When requesting bills, consider whether to request a medical bills affidavit in preparation for a potential dispute over the amount of the medical bills under Mo.Rev.Stat. § 490.715 (see discussion above and attached statute). A sample affidavit form is attached.
In situations where the patient is deceased, health care providers have increasingly resisted a standard records request from an attorney accompanied by an authorization from a family member. In such situations, a typical response from the health care provider is to demand some sort of probate order indicating that the family member is a personal representative or an executor of the deceased’s estate, citing HIPAA as authority for this position.
In many instances, there is no will or probate estate, and there may not be motivation or time to open up any court proceeding to appoint a personal representative, thus the attempts to gather records may be initially stalled.
On occasions where the medical records request is met with this resistance, our office has found some success in pointing out that HIPAA does not require the family member to be a court-appointed personal representative or executor.
If under applicable law an executor, administrator, or other person has authority to act on behalf of a deceased individual or of the individual’s estate, a covered entity must treat such person as a personal representative under this subchapter, with respect to protected health information relevant to such personal representation. 45 C.F.R. § 164.502(g)(1) (emphasis added).
A sample letter to a health care provider is attached.
On rare occasions, the health care provider does not respond at all to an informal records request from an attorney. Where there is no response from the provider, a letter citing Wear v. Walker, 800 S.W.2d 99 (Mo. App. 1990), can help remove the roadblock. A sample letter is attached.
In taking expert depositions, a subscription to TrialSmith can be invaluable. TrialSmith provides deposition transcripts provided by other attorneys, organized by witness names. The website address is www.trialsmith.com.
In defending depositions, our office spends a fair amount of time preparing the client – usually two or three meetings over the two to three weeks prior to the deposition. The meetings should not be too far out in time before the deposition, because the client may forget much of the reminders; and the meetings should not be too close to the deposition, because it may feel too “last minute” for the client’s comfort level. During an early meeting, our office usually utilizes a checklist to go over the reminders for depositions. A sample checklist will be provided upon request to the author.
1. No evidence of collateral sources shall be admissible other than such evidence provided for in this section.
2. If prior to trial a defendant or his or her insurer or authorized representative, or any combination of them, pays all or any part of a plaintiff's special damages, the defendant may introduce evidence that some other person other than the plaintiff has paid those amounts. The evidence shall not identify any person having made such payments.
3. If a defendant introduces evidence described in subsection 2 of this section, such introduction shall constitute a waiver of any right to a credit against a judgment pursuant to section 490.710.
4. This section does not require the exclusion of evidence admissible for another proper purpose.
5. (1) Parties may introduce evidence of the value of the medical treatment rendered to a party that was reasonable, necessary, and a proximate result of the negligence of any party.
(c) The amount or estimate of the amount of medical bills not paid which such party is obligated to pay to any entity in the event of a recovery.
Notwithstanding the foregoing, no evidence of collateral sources shall be made known to the jury in presenting the evidence of the value of the medical treatment rendered.
1. As used in this section, "principal place of residence" shall mean the county which is the main place where an individual resides in the state of Missouri. There shall be a rebuttable presumption that the county of voter registration at the time of injury is the principal place of residence. There shall be only one principal place of residence.
(2) If the defendant is an individual, then venue shall be in any county of the individual defendant's principal place of residence in the state of Missouri or, if the plaintiff's principal place of residence was in the state of Missouri on the date the plaintiff was first injured, then venue may be in the county containing the plaintiff's principal place of residence on the date the plaintiff was first injured.
8. In any action for defamation or for invasion of privacy, the plaintiff shall be considered first injured in the county in which the defamation or invasion was first published.
9. In all actions, venue shall be determined as of the date the plaintiff was first injured.
10. All motions to dismiss or to transfer based upon a claim of improper venue shall be deemed granted if not denied within ninety days of filing of the motion unless such time period is waived in writing by all parties.
11. In a wrongful death action, the plaintiff shall be considered first injured where the decedent was first injured by the wrongful acts or negligent conduct alleged in the action. In any spouse's claim for loss of consortium, the plaintiff claiming consortium shall be considered first injured where the other spouse was first injured by the wrongful acts or negligent conduct alleged in the action.
(4) Reference this section and be left open for ninety days.
Unless the parties agree in writing to a longer period of time, if the claimant fails to file a cause of action in circuit court prior to a date one hundred twenty days after the demand or offer was received, then the court shall not award prejudgment interest to the claimant. If the claimant is a minor or incompetent or deceased, the affidavit may be signed by any person who reasonably appears to be qualified to act as next friend or conservator or personal representative. If the claim is one for wrongful death, the affidavit may be signed by any person qualified pursuant to section 537.080, RSMo, to make claim for the death. Nothing contained herein shall limit the right of a claimant, in actions other than tort actions, to recover prejudgment interest as otherwise provided by law or contract. . . .
1. In any action against a health care provider for damages for personal injury or death on account of the rendering of or failure to render health care services, the plaintiff or the plaintiff's attorney shall file an affidavit with the court stating that he or she has obtained the written opinion of a legally qualified health care provider which states that the defendant health care provider failed to use such care as a reasonably prudent and careful health care provider would have under similar circumstances and that such failure to use such reasonable care directly caused or directly contributed to cause the damages claimed in the petition.
2. As used in this section, the term "legally qualified health care provider" shall mean a health care provider licensed in this state or any other state in the same profession as the defendant and either actively practicing or within five years of retirement from actively practicing substantially the same specialty as the defendant.
3. The affidavit shall state the name, address, and qualifications of such health care providers to offer such opinion.
4. A separate affidavit shall be filed for each defendant named in the petition.
5. Such affidavit shall be filed no later than ninety days after the filing of the petition unless the court, for good cause shown, orders that such time be extended for a period of time not to exceed an additional ninety days.
6. If the plaintiff or his attorney fails to file such affidavit the court shall, upon motion of any party, dismiss the action against such moving party without prejudice.
7. Within one hundred eighty days after the filing of the petition, any defendant may file a motion to have the court examine in camera the aforesaid opinion and if the court determines that the opinion fails to meet the requirements of this section, then the court shall conduct a hearing within thirty days to determine whether there is probable cause to believe that one or more qualified and competent health care providers will testify that the plaintiff was injured due to medical negligence by a defendant. If the court finds that there is no such probable cause, the court shall dismiss the petition and hold the plaintiff responsible for the payment of the defendant's reasonable attorney fees and costs.
1. Any resident or former resident who is deprived of any right created by sections 198.088 and 198.090, or the estate of a former resident so deprived, may file a written complaint within one hundred eighty days of the alleged deprivation or injury with the office of the attorney general describing the facts surrounding the alleged deprivation. A copy of the complaint shall be sent to the department by the attorney general.
2. The attorney general shall review each complaint and may initiate legal action as provided under sections 198.003 to 198.186.
3. If the attorney general fails to initiate a legal action within sixty days of receipt of the complaint, the complainant may, within two hundred forty days of filing the complaint with the attorney general, bring a civil action in an appropriate court against any owner, operator or the agent of any owner or operator to recover actual damages. The court may, in its discretion, award punitive damages which shall be limited to the larger of five hundred dollars or five times the amount of special damages, unless the deprivation complained of is the result of an intentional act or omission causing physical or emotional injury to the resident, and may award to the prevailing party attorney's fees based on the amount of time reasonably expended, and may provide such equitable relief as it deems necessary and proper; except that, an attorney who is paid in whole or part from public funds for his representation in any cause arising under this section shall not be awarded any attorney fees.
4. No owner or operator who pleads and proves as an affirmative defense that he exercised all care reasonably necessary to prevent the deprivation and injury for which liability is asserted shall be liable under this section.
5. Persons bringing suit to recover against a bond for personal funds pursuant to section 198.096 shall not be required to first file a complaint with the attorney general pursuant to subsection 1 of this section, nor shall subsection 1 be construed to limit in any way the right to recover on such bond.
6. Nothing contained in sections 198.003 to 198.186 shall be construed as abrogating, abridging or otherwise limiting the right of any person to bring appropriate legal actions in any court of competent jurisdiction to insure or enforce any legal right or to seek damages, nor shall any provision of the above-named sections be construed as preventing or discouraging any person from filing a complaint with the department or notifying the department of any alleged deficiency or noncompliance on the part of any facility.
1. Any records or copies of records reproduced in the ordinary course of business by any photographic, photostatic, microfilm, microcard, miniature photographic, optical disk imaging, or other process which accurately reproduces or forms a durable medium for so reproducing the original that would be admissible under sections 490.660 to 490.690 shall be admissible as a business record, subject to other substantive or procedural objections, in any court in this state upon the affidavit of the person who would otherwise provide the prerequisites of sections 490.660 to 490.690, that the records attached to the affidavit were kept as required by section 490.680.
2. No party shall be permitted to offer such business records into evidence pursuant to this section unless all other parties to the action have been served with copies of such records and such affidavit at least seven days prior to the day upon which trial of the cause commences.
I am the custodian of the records of ......... . Attached hereto are ............. pages of records from ......... . These .......... pages of records are kept by ................ in the regular course of business, and it was the regular course of business of .......... for an employee or representative of ........ with knowledge of the act, event, condition, opinion, or diagnosis recorded to make the record or to transmit information thereof to be included in such record; and the record was made at or near the time of the act, event, condition, opinion or diagnosis. The records attached hereto are the original or exact duplicates of the original.
1. I am an employee of _____________________________.(hereinafter, “this facility”) and my position/title there is . In that capacity, I participate in the process of billing patients for services provided at this medical facility and I am knowledgeable about the amounts billed for various services and the value of those services. I have access to and am one of the custodians of the facility’s records related to patient billing. I am authorized by this facility to make this affidavit concerning the identity of billing records and the value of services rendered.
2. Business Records. Attached hereto is a collection of _______ pages, representing copies of records from this facility that relate to billing by this facility for services rendered to a patient, ______________________, during __________________. These records are kept by this facility in the regular course of its business. It was in the regular course of this facility’s business for employees to make and create these billing records, and these records were made at or near the time of the acts, events, and services described therein. The copies attached here are exact duplicates of the original records maintained by this facility.
3. Reasonable and Necessary. The amounts set out in these billing records are the amounts routinely charged by this facility during the relevant time period for the services described therein. These amounts are reasonable in that they are similar to and competitive with the amounts that similar medical facilities charge for similar services at this time and place. The services rendered here were necessary as a result of the medical conditions with which this patient presented; therefore, these bills were necessarily incurred.
4. Value of Services Rendered. The amounts set out in these billing records are based upon this facility’s determination of the costs associated with providing the services described, plus a reasonable operating margin. These amounts represent the value of the services described. In some circumstances, with respect to some patients, this facility does choose to negotiate or otherwise allow some discounts of the amounts billed for services like those described in these records, and does accept less than the total amount billed in satisfaction of the obligation represented by these bills. Such discounts may be allowed in order to obtain prompt payment, avoid the costs of collection, encourage group usage of this medical facility through insurance or benefit plan programs, participate in government-assisted payment programs, or for a variety of other practical business reasons. The fact that this facility does sometimes accept less than the amount billed in satisfaction of the obligation does not mean that the discounted amount represents the value of the services rendered; to the contrary, this facility considers the amount billed to be the value of the services rendered.
SUBSCRIBED and SWORN to before me this day of , 2010.
In response to our correspondence to you dated August 18, 2009, we received the attached document from HealthPort and Smart Document Solutions. The document does not contain contact information, so we are forwarding this to you. In the document, the author seeks “a copy of the power of attorney.” It is our position that a power of attorney need not be provided in this situation.
If under applicable law an executor, administrator, or other person has authority to act on behalf of a deceased individual or of the individual’s estate, a covered entity must treat such person as a personal representative under this subchapter, with respect to protected health information relevant to such personal representation.
45 C.F.R. § 164.502(g)(1) (emphasis added).
Under Missouri law, a deceased person’s natural child has the authority to act on behalf of deceased person. The child may investigate, maintain, and settle an action for the wrongful death of their parent. Mo.Rev.Stat. §§ 537.080 and 537.095. In authorizing the child to act on behalf of the parent, Missouri law does not require the child to be an executor of an estate, nor have a power of attorney. Accordingly, a child authorized to bring a wrongful death action under state law is considered a personal representative for purposes of these regulations.
Federal law is consistent with this position. Deference is appropriate when the issue involves an agency interpretation of its own law. Collins v. Dept. of Social Services, 141 S.W.3d 501, 503 (Mo. App. 2004). The above regulations are promulgated by the United States Department of Health and Human Services, and within that Department, the Office of Civil Rights (“OCR”) is charged with protecting the privacy of individually identifiable health information.
Under this Privacy statement, in a situation involving a deceased patient, the personal representative is a person with legal authority to act on behalf of the decedent or the estate – meaning that an estate is not necessary. In addition, that person’s authority is not restricted to health care decisions – meaning that a power of attorney is not necessary. Finally, the statement expressly mentions the example of a next of kin or other family member, which applies to the authorization we forwarded to you from the decedent’s next of kin.
In light of the above information, we request that the records be released as set forth in the attached request and authorization. If necessary, we would welcome a call from the legal department of Research Medical Center to find an acceptable method of obtaining the records.
Thank you for your courtesies in this matter.
On ______________________, our office requested copies of medical records for ____________________. Enclosed with that letter was a signed medical authorization permitting the release of ______________’s records to us. We received no response to this request and issued a second written request on __________________. Again we received no reply. Enclosed are copies of the two letters.
My assistant has placed several phone calls to you and was given the promise of the documents being sent, which has not occurred. We need you to cooperate in providing _______________’s records to our office.
On rare occasions, we have run into healthcare providers who are simply unwilling to cooperate with a request for medical records. We have advised them that the Missouri statutes, Section 191.227, provide that health care providers will make copies of records available upon request. The Missouri Court of Appeals, in Wear v. Walker, 800 S.W.2d 99 (Mo. App. 1990), held that a patient has a private cause of action for damages against a health care provider for failure to supply records in accordance with the statute. You may wish to consult an attorney or your insurance carrier with respect to this situation, and they can also contact us if they choose to do so.
It is distasteful for us to think we may have to file a lawsuit in order to gain access to our client’s medical records. We are hopeful that this course of action will not be necessary. If we do not hear from you by March 4, 2010 with a firm commitment as to when we can expect to receive the records, we will commence the lawsuit.

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