PA 12-142—sHB 5545

Judiciary Committee

AN ACT CONCERNING FINANCIAL LIABILITY FOR AMBULANCE SERVICES, EVIDENCE OF COLLATERAL SOURCE PAYMENTS AND EVIDENCE OF BILLS FROM TREATING HEALTHCARE PROVIDERS

SUMMARY: This act generally provides that anyone who receives emergency medical treatment or transportation services from a licensed or certified ambulance service is liable for the reasonable and necessary cost of those services, even if the person did not agree or consent to the liability.

Under the act, this provision is subject to certain conditions in existing law, including the Department of Public Health (DPH) commissioner's rate setting for ambulance services and requirements that insurers cover medically necessary ambulance services. Also, the provision does not apply to anyone receiving services for injuries arising out of and in the course of his or her employment, as defined in the workers' compensation law (see BACKGROUND).

The act also makes changes to the law on determining economic damages in personal injury or wrongful death cases. It makes evidence that a specified health care provider accepted payment from a claimant that is less than the total amount billed, or evidence that an insurer paid less than that total amount, admissible for purposes of the collateral source rule (the requirement that courts reduce economic damage awards by the amount the claimant received from health insurance or other collateral sources). This provision applies to bills by state-licensed physicians, physician assistants, dentists, chiropractors, natureopaths, physical therapists, podiatrists, psychologists, optometrists, advanced practice registered nurses, and state-certified emergency medical technicians.

Under the act, in cases in which the law allows such health care providers' signed reports and bills for treatment to be introduced as business entry evidence without the provider testifying (see BACKGROUND), the total amount of the provider's bill is admissible evidence of the cost of reasonable and necessary medical care. The calculation of the total amount of the bill must not be reduced because (1) the provider accepts less than the total bill or (2) an insurer pays less than that amount.

Existing law provides that its provisions allowing certain business entry evidence to be introduced without such providers testifying do not preclude either party or the court from calling the treating provider as a witness. The act specifies that the purposes for which they may be called to testify include giving testimony on the reasonableness of their bills for treatment.

EFFECTIVE DATE: October 1, 2012, and the provisions on collateral sources and business entry evidence are applicable to actions pending on or filed on or after that date.

LIABILITY FOR AMBULANCE PAYMENTS

The act's provisions on liability for ambulance services are subject to the following provisions in existing law:

1. the general requirement that health insurance policies provide coverage for medically necessary ambulance services (CGS 38a-498 and 38a-525) and

2. the DPH commissioner's duties regarding emergency medical services including, among other things, setting rates for ambulance services (CGS 19a-177).

By law, insurers are not required to provide ambulance benefits in excess of the maximum rates set by DPH.

EVIDENCE OF COLLATERAL SOURCE PAYMENTS

In personal injury or wrongful death cases, the law generally requires courts to reduce economic damages by the amount paid to the claimant by collateral sources (e. g. , health insurance), less the amount paid, contributed, or forfeited by the claimant to secure the collateral source benefit. (Both the amount of collateral sources, and the amount paid to secure them, also include amounts paid on the claimant's behalf. )

After the jury or court finds liability and awards damages, and before the court enters judgment, the court must receive evidence on the total amount of collateral sources that have been paid for the claimant's benefit as of the date the court enters judgment. Under the act, evidence that a specified health care provider accepted an amount less than the provider's total bill, or evidence that an insurer paid less than the total bill, is admissible for this purpose.

By law, there is no reduction for (1) collateral sources for which a right of subrogation exists or (2) the amount of collateral sources equal to the reduction in the claimant's economic damages due to his or her percentage of negligence (CGS 52-225a(a)).

BACKGROUND

Injuries Arising out of and in the Course of Employment

State workers' compensation law defines “arising out of and in the course of employment” as an accidental injury to, or an occupational disease of, an employee originating while the employee was engaged in the line of his or her duty in the business or affairs of the employer upon the employer's premises, or while engaged elsewhere upon the employer's business or affairs by the employer's express or implied direction. There are additional provisions related to specific employees (e. g. , police officers and firefighters) as well as other conditions and exceptions (e. g. , injuries due to alcohol or narcotic use) (CGS 31-275).

Business Entry Evidence

The law allows signed reports and bills of the treating health care providers listed above to be introduced in any civil action as business entry evidence without calling the provider to testify. It is presumed that the signature on the report is that of the treating provider, and that the report and bill were made in the ordinary course of business. The use of such evidence must not give rise to an adverse inference concerning the provider's testimony or lack thereof.

In personal injury cases, the law also allows the records and reports of such providers, as well as certain other professionals, to be admitted into evidence if the provider or other professional has (1) died before trial or (2) is physically or mentally disabled and thus no longer practicing. For such evidence to be introduced, the court must determine that the person is disabled to such an extent that he or she cannot testify (CGS 52-174).

OLR Tracking: JO: KS: PF: ro: eh