Texas Supreme Court allows drunk drivers and others who cause car wrecks to reduce how much they will have to pay. Drunk Drivers get benefit of your premiums for health Insurance by getting credit for the negotiated rate.
This should have been front page news in papers across Texas this past week as our Supreme Court issued its opinion in the case Haygood v. Escabedo. Did you see a single paper discuss this ruling? Have you heard any of the radio or TV talk shows discuss this case? Why not? Where is the outrage?
I hear comments from people every month who call me about a workers compensation claim, medical malpractice or other issues. I tell them I can’t handle it because the law has made it almost impossible. They almost invariably tell me that it wasn’t supposed to impact their case only those frivolous ones. When I ask them why they weren’t mad and outraged when the laws were being passed or the Supreme Court was “interpreting” them, they always say it didn’t impact me so I didn’t pay attention. The only outrage about our rights being taken away nationally and in Texas seems to be coming from the trial lawyers. I am proud to be in the outraged group.
So what has the Texas Supreme Court done in its latest piece of judicial activism? Their twists and turns distort the law so much it would make a contortionist envious.
The Court’s decision in Haywood v. Escobedo allows the person or company who harms you or your family to benefit from the health insurance you have paid premiums for all these years.
The Court argues there ruling is necessary to prevent a “windfall” to the claimant (that would be the person injured, maimed or killed by the drunk or other reckless driver to us normal people).
They also argue they are just interpreting the law as the Texas legislature wanted. Hard to believe that is the case when the legislature actually tried to repeal the law they are “interpreting” the session after they passed it as they realized what it truly was — which is a windfall for the drunks, reckless drivers and their insurance companies. However Governor Perry vetoed the repeal of the bill so it is still on the books.
So here we are with an Activist Court that needs to protect the drunks and insurance companies, but how? They have already overturned virtually every jury verdict for any Plaintiff that comes their way. So rather than wait until a jury hears all the evidence and votes to compensate the injured person, they have decided to limit what the jury can hear so the compensation will be even lower and the insurance companies will have to pay less, make more profits and be able to contribute to all the expensive political campaigns.
Here is how the Court accomplished this with their latest decision: Let’s start with a situation where you are hit by a drunk who has a policy of $50,000.00. You are taken by life flight to the hospital where you stay for a week. You then have to go through rehabilitation. After about four months you are mostly better. You missed a month of work and still can’t do everything, but hopefully you will get where you can sleep through the night and play with your kids without having to tell them Daddy needs to rest. You have worked hard for years and paid for your health insurance at the cost of some vacations you wanted to take, but you knew how important it was for you to provide coverage for you and your family in case a situation like this happened. The medical bills were over $100,000.00, but because of your group plan they managed to reduce the total to $35,000.00 and since you met your deductible earlier in the year, you don’t owe anything else.
You send the bills to the drunks’ insurance carrier and ask that they pay the $50,000.00 policy limits because your medical bills alone are over $100k. Pretty straight forward right? You shouldn’t even need to get an attorney to settle this case. The operative word there is shouldn’t.
The reality is the insurance company will tell you we don’t owe $100k in medical because we get to take credit for your health insurance premiums and negotiated rate so all we will owe is $35k and we don’t think all of that is related because we know you hurt your neck 15 years ago when you were putting in fence posts and saw a chiropractor one time so we think all your neck issues are related to that and not this head on collision. So with the paid amount being $35k and us taking out some of the neck issue which we believe is not related (and because we can), we are willing to settle your case for $28,500.00.
What gives them the right to get the benefit of your paying premiums all those years: “Home Office” which is what they consider the Texas Supreme Court. Why shouldn’t they? They have won virtually every case that makes it there. Now the Texas Supreme Court has ruled that the only evidence a jury may consider in determining medical expenses are those amounts which were actually paid or will be owed by the person injured. So all those years of paying premiums and making sacrifices for you and your family to be covered is now benefitting the person who caused the wreck. The jury is not allowed to hear about how the bills were over $100k and because you had insurance it was reduced to $35k. They are not allowed to hear about the premiums you have paid to make that reduction possible. They may not even be allowed to hear about the deductible if it was met before this wreck. All because our Supreme Court has determined that it would be a “windfall”. How is it they never seem to be have a problem when insurance companies have a windfall of profits.
So if you happen to serve on a jury or hear about someone on a jury who talks about how this person was in a wreck but only had xxx in medical you can be fairly certain that it is at least 3x that amount of actual medical charges.
For my lawyer friends we know there are also significant issues regarding how Section 18.001 will be impacted and other battles over what constitutes paid –Is a deductible to be considered? Co-pay?
Some of you may know that I spent my senior year of high school attending gymnasium in Germany (which is the German equivalent of our U.S. high school). One of the things required in history classes was a complete study of the Nazi takeover both in political and military terms, which included the apathy and violence. The rational was if you never forget you will never repeat. If you were to ask someone who lived through that time how they could let it happen they would tell you it was not a sudden change. Rights were taken away one by one and it always was something that didn’t concern them. If someone was complaining about this or that they didn’t care because it didn’t impact them. Until one day it did. Then it was too late. Everyone asked how could “they” let this have happened? And then it became clear they were the “they” who allowed it.
As always I welcome comments.
Why don’t you say what’s really bothering you? You’re just angry because the ruling hurts your personal bottom line. Like all ambulance chasers it’s more than unlikely that you’re human enough to care one whit about the poor people you sucker into your clutches.
Great insight, Brent. People also need to know that oftentimes the health insurance companies get paid back–in your $35,000 health insurance payment example, the “more than fair offer” from the drunk’s insurance company of $28,500 may result in the injured person having to pay all of it to the health insurance company in reimbursement of the bills it paid under the health insurance policy the injured person/family paid the premiums on for years.
Ahh, the justice . . .
I was hoping for some discussion with a little more thought than repetition of same tired old sayings, but as you don’t know anything about me, or the issue, I guess that is the best you could do.
Brent – thanks for the great blog – I have submitted the link to your blog and my opinions to “click2houston” KPRC – because I would like to see some PRESS on this. It makes me so mad. I was hurt by an admitted at-fault driver and this will adversely affect me. This is unfair – victimized again. 🙁
Brent doesn’t need anyone to defend him, he’s a big boy, but I will reply to your immature comments. I was injured by an admitted at-fault driver and this re-victimizes me. Perspective and maturity would help you.
I know all that I will ever need to know about you just by your post and your occupation.
As for the issue at hand, I know far more about than you would be comfortable with, and far more about the rhetoric and its source and goal.
In the hypothetical case in question the plaintiff’s medical bills were $35K, not $50K so that is what the insurance company should pay.
Even you know that. That’s why you added in the extra “not related” bit in order to sway people’s opinion.
And I won’t even go into the deliberate fallacy of describing upholding an existent statute as “judicial activism” or couching the whole thing solely in terms of “drunks and careless drivers.”
When you consider the premiums that have been paid for the health coverage and the fact that the health insurance is generally reimbursed what they paid, the person injured actually comes out owing for being hit in a car crash caused by someone else. The reason I say drunks and careless drivers is the case deals with injury claims which were caused by someone being negligent. I put drunk drivers in a whole different class (as it appears you do) which is why they are singled out, in my comments, but unfortunately not in the ruling.
Not only are the previous premiums and the reimbursement of the insurance companies irrelevant insofar as the ruling or the logic is concerned but they don’t equate to the victim owing anything.
As for “injury claims which were caused by someone being negligent,” that’s pure sophistry. All claims of this nature are the result of either negligence or malice, whether the person was drunk or a “careless” driver. An At Fault accident is an At Fault accident in these cases.
How, pray tell does not forcing the insurance company to pay you more than the actual medical costs you incurred through others’ fault re-victimize you?
I am in agreement with Brent and Anna. To begin with, even though I don’t know this Jonolan, it appears to me that Jonolan is either one of these that has been arrested for driving drunk and causing an accident that injured or killed someone or he/she is an attorney that represents these people. These two examples are the only things that would adequately explain her reactions to this blog. And Jonolan, what about all the pain, suffering, lost wages, possibly lost job, lost spouse, lost child, extra actual expenses caused the person being injured that isn’t really covered under the insurance. There is a lot of cost involved in family or even just spouse getting to see the injured party, a lot of extra cost due to the injured party being in the hospital (believe it or not, it costs a family a lot more than usual when they are in two different locations including a hospital). Jonolan there is more extra actual expense that a family with an injured family member has to pay that there is not enough space on this blog to cover it. Perhaps if people wouldn’t get drunk and then drive this would all be a non-issue and I would be willing to bet that Brent would be happy with that. I’m sure that there a lot different types of cases that he could take instead of this type of case.
So what then is the best way to prevent this? Should Texans now be advised that their better off not to claim under their health insurance policy and instead deal with Hospital liens and the Attorney Letter of Protection? This ruling flies in the face of public policy.
Unfortunately there is no good way to handle it. I would never recommend that a person not use their health insurance, but I have seen doctors refuse to treat anyone who is injured in a car crash even if they have health insurance. A letter of protection is an option, but it irritates me that a doctor will not take health insurance (due to the massive reductions) but will take a letter of protection. A hospital lien is always something that has to be dealt with so it all comes down to the person causing the wreck and injuries getting the benefit of your paying all those premiums.