Trial Court Precludes Opinions of Kenneth W. Reagles, PhD. of Syracuse, NY.

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In a pre-trial decision on November 1, 2016, trial judge Irene Jacobs ruled that defense expert Kenneth W. Reagles, Ph.D’s reliance upon The Healthcare Bluebook in his calculations for future medical costs of the plaintiff was inadmissible. The Healthcare Bluebook markets itself as a transparent system that can be used by all players in the health system including consumers, providers, payors, employers and partners to identify the range of costs for specific services. In the context of most personal injury claims in Connecticut as well as most other jurisdictions, a defendant found to be liable for damages is responsible for paying the reasonable cost of past and future medical care.

However, the data in The Healthcare Bluebook is a compilation of the payments made by responsible payors, usually major medical insurance companies. Under current plans, most payments reflected include reduced payments based upon system-wide contracts and other negotiated limitations, as well as insurer’s assessment of the so-called “reasonable and customary” fees, and even fees limited by “out of network” criteria that can be limited to Medicare reimbursement rates. Reagle’s life care plan relied upon rates purportedly based upon The Healthcare Bluebook. It is unlikely that any provider would agree that the reimbursement rates adequately reflect the reasonable cost of their medical services. Indeed there is no reason to believe that any reimbursement rate for an MRI of the brain would be available to a non-member/participant of a specific healthcare plan. Nor is there any reason to expect that a single victim of a motor vehicle crash or a fall would have the leverage or ability to negotiate the reduced fee available to a major medical carrier.

In addition, from an evidentiary standpoint, the use of data from The Healthcare Bluebook would necessitate a cross-examination of the source of the figures that would lead to the revelation of medical insurance coverage, an event prohibited in Connecticut.

The Court rejected the defendant’s argument that Reagles was a prominent and qualified expert in the field and that Reagles attested to the general acceptance and reliability of the source in the field.

Customarily, life care plans have been prepared by relying on surveys of costs obtained from  local healthcare providers and vendors. Any data base created from the charges actually billed by providers should be acceptable. However, once the data is manipulated by insurance contracts (negotiated contracts with groups, networks of providers or government plans), it becomes unusable in most civil trial contexts. Vizzo v. Fairfield Bedford, LLC, Superior Court, Judicial District of Stamford, Norwalk at Stamford, Dkt. No. CV -12 -6015703 S.

By Stewart Casper. Posted November 21, 2016.

 

 

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