A few exceptions to the collateral source rule apply against an injured party concerning third-party payments made on their behalf to hospitals and other care providers, especially when dealing with a private health plan.
Medical Malpractice Claims
The first exception applies to such evidence involving medical malpractice lawsuit claims. In these cases, a defendant can present evidence of the plaintiff’s receipt of payments related to the injury, such as Social Security benefits or workers’ compensation covering a disability. Suppose the defendant introduces this evidence in defending against the personal injury claim. In that case, the plaintiff is then allowed to present evidence of any amounts already paid to secure the right to those benefits and services, such as monthly premiums.
Medical Bills in a Personal Injury Case
The second exception involves unpaid medical bills. If an injured person seeks damages for medical expenses, they cannot recover any amount that was billed but not paid due to reduced fees. Damages are meant to compensate for actual loss or harm suffered by the plaintiff, so they can only recover the amount paid by their insurer. Any additional costs not paid by the insurer would fall outside the scope of what the plaintiff actually suffered, as this is now considered a windfall recovery.