O'Brien and Ryan, LLP - Attorneys at Law
Legal News

Defendants Cannot Use ACA to Calculate Future Life Care Costs

Bookmark and Share

The Honorable Kim R. Gibson of the United States District Court for the Western District of Pennsylvania recently granted a plaintiffs’ motion in limine to preclude the defendant from submitting calculations of future life care costs that were based on the Affordable Care Act.

In Welker v. Carnevale,[1] the plaintiff-mother alleged that the defendant obstetrician and hospital improperly administered the drug Pitocin while she was in labor, resulting in serious and permanent neurological disabilities to her son. The plaintiffs sought to preclude the defendants’ experts from presenting calculations for future life care costs based upon the Affordable Care Act, arguing that such evidence is barred by the collateral source rule.

The collateral source rule provides that a claimant’s recovery should not be offset merely because coverage for the injury was provided by a collateral source, such as insurance. The defendants, however, argued that the Affordable Care Act was not insurance and that the Pennsylvania Supreme Court would hold that such calculations were proper in accordance with its holding in Moorhead v. Crozer Chester Med. Ctr., 765 A2d 786 (Pa. 2001). Moorhead held that a plaintiff’s recovery for past medical bills was limited to the amount actually paid by collateral sources. Thus, the plaintiff’s economic damages in that case were limited to $12,167.40, the amount that Medicare and insurance had paid to settle the $108,668.31 medical bill.

Judge Gibson was unpersuaded by the defendants’ position. He noted that several trial courts had considered this issue and held that calculations relating to the Affordable Care Act are barred by the collateral source rule.[2] Even though the Affordable Care Act is not literally insurance, the insurance it governs is still health insurance. Furthermore, the holding in Moorhead simply reduced the amount recoverable to the amount paid by the collateral source. Thus, Judge Gibson found its holding contrary to the defendants’ position because it held that the plaintiff may still recover damages paid by a collateral source. Finally, Judge Gibson noted that current events cast into doubt the continued existence of the Affordable Care Act, and this uncertainty further weighed against allowing it in calculations for future damages.

[1] U.S.D.C. W.D.Pa., 3:14-CV-149, Memorandum Opinion filed January 13, 2017.

[2] Citing Bernheisel v. Mikaya, No. 3:13-CV-01496, 2016 WL 4211897, at *4 (M.D. Pa. Aug. 9, 2016); Cordes v. United States, No. 2:13CV547, 2015 WL 10986360 (W.D. Pa. Nov. 20, 2015); Deeds v. Univ. of Pennsylvania Med. Ctr., 110 A.3d 1009, 1013, reargument denied (Apr. 7, 2015), appeal dismissed sub nom. Deeds ex rel. Renzulli v. Univ. of Pennsylvania Med. Ctr., 128 A.3d 764 (Pa. Super. Ct. 2015).

<< Back to list page

Hickory Pointe
2250 Hickory Rd, Suite 300
Plymouth Meeting, PA 19462
Phone: (610) 834-8800
Fax: (610) 834-1749