Announcing a decision in favor of our client.
For details, see the decision: Brethren Mutual Ins. Co. v. Suchoza, CSA #1787, Sept. Term 2011, Reported, Filed May 29, 2013 (PDF).
Brethren Mut. Ins. Co. v. Suchoza, 212 Md. App. 43 (2013)
Teri Spradlin represented Mr. Suchoza on appeal. Mr. Suchoza was injured while driving a commercial vehicle during the course of his employment at Matrix Mechanical. He filed suit alleging breach of contract against Brethren Mutual Insurance Company for its failure to pay benefits under its uninsured motorist (UM) policy with Matrix. The jury returned a verdict for Mr. Suchoza in the amount of $535,876, which the judge reduced to $356,669 to reflect the set-off for Mr. Suchoza’s previously received workers’ compensation benefits. Brethren appealed.
One of the issues on appeal was whether the trial court erred in refusing to admit evidence of the (reduced) amount paid by workers’ compensation, which was accepted as full payment by Mr. Suchoza’s medical providers. On behalf of Mr. Suchoza, Teri Spradlin argued that the fair and reasonable value of the medical services provided to Mr. Suchoza were those amounts reflected in the medical bills and supported by the testimony of Mr. Suchoza’s expert—not the reduced amounts accepted by the medical providers based on contracts with the workers’ compensation carrier. In addition, counsel argued that Brethren had not proffered expert testimony of its own to prove that the reduced amounts were fair and reasonable. The Court of Special Appeals agreed.
The Court stated that the medical providers’ acceptance of the lesser amounts was not necessarily probative of the reasonable value of the medical services provided to Mr. Suchoza. It held that evidence of payments for Mr. Suchoza’s medical bills would not establish the reasonable value of the services for which the bills were rendered, and therefore were irrelevant in determining reasonableness. To be admissible, Brethren had to adduce expert testimony or other competent testimony that the amount of such payment was the fair and reasonable value of the medical services provided to Mr. Suchoza. Brethren had not done so at trial.
The Court of Special Appeals affirmed the decision in favor of Mr. Suchoza.