Opinion
No. 107,277.
2012-11-9
Dee Ann BURKE, Appellant, v. UNITED SERVICES AUTOMOBILE ASSOCIATION, Appellee.
Appeal from Sedgwick District Court; Joseph Bribiesca, Judge. Patrick Turner, Craig Schultz, and Michael Schultz, of Shultz Law Office, P.A., of Wichita, for appellant. Brette S. Hart, of Harris and Hart, LLC, of Leawood, for appellee.
Appeal from Sedgwick District Court; Joseph Bribiesca, Judge.
Patrick Turner, Craig Schultz, and Michael Schultz, of Shultz Law Office, P.A., of Wichita, for appellant. Brette S. Hart, of Harris and Hart, LLC, of Leawood, for appellee.
Before GREEN, P.J., MARQUARDT, J., and BRAZIL, S.J.
MEMORANDUM OPINION
PER CURIAM.
Dee Ann Burke appeals the jury's verdict, finding that she was not entitled to a $238.08 payment under her personal injury protection insurance policy with United Services Automobile Association (USAA). Burke argues that the district court erred in denying her motion for judgment as a matter of law and in refusing to give her proposed jury instructions on the presumed reasonableness of a doctor's bills. We affirm.
In May 2010, Burke was involved in an automobile accident that resulted in bodily injury to her. A few days after the accident, Burke went to the Western Plains Medical Complex (WPMC) for treatment where her left shoulder, ribs, and sternum were x-rayed. Burke was diagnosed with a bruised shoulder, contused left ribs, and costochondritis, a condition in which the cartilage pulls away from the sternum. Burke was given a sling to wear to treat her costochondritis. The cost of the treatment that Burke received from WPMC totaled $1,204.50.
At the time of her accident, Burke's USAA policy contained a provision providing her with personal injury protection benefits in the event of an accident. Burke's policy provided that USAA would pay the cost of medical expenses in accordance with the Kansas Automobile Injury Reparations Act, K.S.A. 40–3101 et seq. Under the terms of the policy, the term “medical expenses” includes all reasonable expenses incurred for necessary health care. WPMC billed USAA for the $1,204.50 for Burke's treatment. USAA paid $966.42. Thereafter, WPMC sent Burke a statement requesting that she pay the remaining $238.08.
Burke filed a lawsuit in the Sedgwick County District Court seeking a judgment against USAA in the amount of $238.08. The matter was tried to a jury. During the trial, Burke testified about her car accident, her resulting injuries, and the treatment she received at WPMC. Burke also had copies of her medical bills from WPMC admitted into evidence. USAA presented the deposition testimony of George Crumpton, the director of the business office at WPMC. Crumpton testified that WPMC's charges for medical services are determined by the corporate office in Nashville, Tennessee. Crumpton indicated that WPMC intends to charge its customers a fair and reasonable rate for the medical services that it provides but that WPMC does not consult or consider the rates charged by other medical providers in the community in determining its rates. Crumpton also stated that very few of WPMC's bills are actually paid in full.
At the conclusion of all of the evidence, Burke moved for judgment as a matter of law, asserting that she had established that her medical bills were reasonable and that USAA had failed to present any evidence to show that her medical bills were not reasonable. The district court denied Burke's motion. The jury returned a verdict in favor of USAA. After trial, Burke renewed her motion for a judgment as a matter of law. The district court denied the motion, and Burke timely filed her notice of appeal.
Judgment as a Matter of Law
A district court's decision on a motion for judgment as a matter of law is reviewed under the former directed verdict standard of review. National Bank of Andover v. Kansas Bankers Surety Co., 290 Kan. 247, 267, 225 P.3d 707 (2010). When ruling on a motion for judgment as a matter of law, the district court must resolve all facts and inferences reasonably drawn from the evidence in favor of the party against whom the directed verdict is sought. Where reasonable minds could reach different conclusions based on the evidence, the motion must be denied. An appellate court must apply a similar analysis when reviewing the grant or denial of a motion for judgment as a matter of law. When no evidence is presented on an issue or where evidence is undisputed and the minds of reasonable persons may not draw differing inferences or arrive at opposing conclusions, it is a question of law for the court's determination. Deal v. Bowman, 286 Kan. 853, 858, 188 P.3d 941 (2008).
Burke argues that the district court should have granted her motion for judgment as a matter of law because her testimony and the admission of her medical bills triggered a presumption that her medical bills were reasonable. Burke asserts that this presumption then shifted the burden and required USAA to present evidence showing that her medical bills were not reasonable. Burke argues that USAA failed to present any evidence to show that her medical bills were unreasonable and, therefore, the evidence only supported the conclusion that her medical bills were reasonable.
K.S.A. 40–3111(a) provides, in pertinent part:
“A physician, hospital, clinic or other person or institution lawfully rendering treatment to an injured person for an injury covered by personal injury protection benefits ... may charge a reasonable amount for the products, services, and accommodations rendered. The charge shall not exceed the amount the person or institution customarily charges for like products, services and accommodations in cases not involving insurance....”
The questions of reasonableness of one's medical bills and the need for medical treatment are questions for the jury. Cansler v. Harrington, 231 Kan. 66, 69, 643 P.2d 110 (1982). Citing Cansler, Burke argues that the admission of her medical bills into evidence triggered a presumption that the medical bills were reasonable and that USAA then had the burden of proving that the bills were not reasonable. Burke's argument is without merit.
In Cansler, our Supreme Court considered what foundation evidence was sufficient to support the admission of Cansler's medical bills into evidence. During her case in chief, Cansler and two of her doctors testified about her injuries, the medical treatment she received for those injuries, and her bills for her medical treatment. The court concluded that this testimony was sufficient to show that Cansler's medical expenses were reasonable and medically necessary and supported the admission of her medical bills. Cansler, 231 Kan. at 69. Citing Bolin v. Grider, 580 S.W.2d 490 (Ky.1979), the court went on to note that “[i]t is presumed in a case such as this a doctor's charge is reasonable” and that the party opposing the admission of the medical bills has the right to challenge the reasonableness of the charges. Cansler, 231 Kan. at 69.
Burke construes the language in Cansler to mean that a doctor's charge is presumed reasonable and that the admission of her medical bills triggered a legal presumption that the medical bills were reasonable and effectively shifted the burden to USAA to prove that her medical bills were unreasonable. In Bolin, the Kentucky Supreme Court recognized that a plaintiff's medical bills must be reasonable and that once a plaintiff admits his or her medical bills into evidence, the defendant is able to avoid a directed verdict by presenting some evidence to counter those medical bills. Bolin, 580 S.W.2d at 491. However, there is no indication that the Cansler court intended to adopt this type of burden-shifting presumption. Rather, the court's analysis in Cansler was limited to determining what evidence was sufficient to establish a foundation for the admission of medical records into evidence. Cansler, 231 Kan. at 68–69; see Rood v. Kansas City Power & Light Co., 243 Kan. 14, 16–17, 755 P.2d 502 (1988), disapproved in part on other grounds in Dixon v. Prothro, 251 Kan. 767, 775, 840 P.2d 491 (1992).
Nevertheless, assuming that the admission of Burke's medical bills into evidence did shift the burden, USAA presented some evidence to challenge the reasonableness of Burke's medical bills. Through the testimony of George Crumpton, USAA established that WPMC does not establish what it charges for medical services, that the amounts it charges are not based upon what other medical providers in the area charge for comparable services, and that very few of WPMC's medical bills are ever paid in full. Based upon this evidence, it was possible for a reasonable person to conclude that WPMC could be charging a higher rate than other medical service providers in the same area and that it accepted a reduced payment on a majority of its bills because the initial billing amount was indicative of an elevated rate. Thus, the district court's denial of Burke's motion for judgment as a matter of law was appropriate because there was evidence upon which reasonable minds could reach different conclusions as to the reasonableness of the rate that WPMC charged Burke for its medical services.
Jury Instruction
In reviewing a claim of alleged error in jury instructions, an appellate court must review the instructions as a whole and determine whether the instructions fairly instruct the jury on the applicable law governing the case. If the instructions are substantially correct and the jury could not reasonably have been misled by them, the instructions will be approved on appeal. However, if an appellate court is firmly convinced that there is a real possibility that the jury would have returned a different verdict had the instructional error not occurred, then that error requires a reversal of the jury's verdict. Wood v. Groh, 269 Kan. 420, 423–24, 7 P.3d 1163 (2000).
During the instructions conference, Burke's counsel requested that the district court give a jury instruction which stated: “It is presumed that any medical bills submitted is [ sic ] reasonable under the authority of [Cansler v. Harrington,] 231 Kan. 66.” Burke's counsel also requested an alternative instruction that stated: “You may consider the medical bill itself as evidence of the reasonableness of the charges under the same authority.” The district court denied Burke's requests and did not include either proposed instruction with the final jury instructions.
The district court correctly denied Burke's requests to give these jury instructions. These instructions were not standard PIK instructions but rather were instructions crafted by Burke's counsel based upon counsel's reading of the Kansas Supreme Court's holding in Cansler. As discussed previously, the reading of Cansler advanced by Burke's counsel is based upon language from the Bolin decision that was never explicitly or implicitly adopted by our Supreme Court in Cansler. Thus, the district court correctly denied Burke's request to include the two proposed jury instructions. See State v. Dixon, 289 Kan. 46, 67, 209 P.3d 675 (2009).
Affirmed.