Alterauge et al v. FedEx Ground Package System, Inc.
MEMORANDUM AND ORDER: IT IS HEREBY ORDERED that defendant FedEx Ground Package Systems Motion to Determine the Value of Medical Treatment is GRANTED in part and DENIED in part, as follows: Plaintiffs evidence of the value of medical treatment rende red, except as to provider Hand Therapy of Central Missouri, and FedExs evidence of the amount necessary to satisfy Mr. Alterauges financial obligations, will be admitted at trial for the jurys consideration. With respect to provider Hand Therapy, only FedExs evidence of the dollar amount necessary to satisfy the financial obligation to that provider will be admitted. Doc. 29 Signed by District Judge Charles A. Shaw on 4/7/2014. (RAK)
UNITED STATES DISTRICT COURT
EASTERN DISTRICT OF MISSOURI
E. REBECCA CASE, Trustee of In Re:
Wesley Alterauge, et al.,
FEDEX GROUND PACKAGE SYSTEM,
No. 4:12-CV-2213 CAS
MEMORANDUM AND ORDER
This is a personal injury case that was removed from state court based on diversity
jurisdiction, 28 U.S.C. § 1332(a). The petition alleges that Wesley Alterauge, who worked for an
independent trucking company that contracted with defendant FedEx Ground Package System, Inc.
(“FedEx”), was injured on February 27, 2008 while attempting to remove a heavy package that had
been incorrectly loaded in a truck by a FedEx employee. Trial is set for May 12, 2014 and FedEx
has filed a motion to determine the value of the medical treatment Mr. Alterauge received.
FedEx asks the Court to determine under Missouri Revised Statute § 490.715.5 (Cum. Supp.
2013) that the value of Mr. Alterauge’s medical treatment is equal to the dollar amounts actually
paid to his medical providers in satisfaction of their bills. FedEx also asserts that some of the
charges for Mr. Alterauge’s medical care and prescription medications are unrelated to any treatment
he received as a result of the injury alleged in the case, and instead were related to evaluations for
purposes of workers’ compensation. FedEx argues that plaintiffs should not be permitted to
introduce evidence of those charges.
In opposing the motion, plaintiffs submit seventeen affidavits from health care provider
designees that attest, in all but one instance, to the reasonableness of the fees charged at the time and
place that services were provided, and the necessity of the services rendered. Plaintiffs assert that
the affidavits are sufficient to rebut the presumption created by § 490.715.5. Plaintiffs also respond
that all of the charges submitted are directly related to Mr. Alterauge’s physical condition and
treatment following the injury he suffered on February 27, 2008.
Section § 490.715.5, Mo. Rev. Stat., states as follows:
(1) Parties may introduce evidence of the value of the medical treatment rendered to
a party that was reasonable, necessary, and a proximate result of the negligence of
(2) In determining the value of the medical treatment rendered, there shall be a
rebuttable presumption that the dollar amount necessary to satisfy the financial
obligation to the health care provider represents the value of the medical treatment
rendered. Upon motion of any party, the court may determine, outside the hearing
of the jury, the value of the medical treatment rendered based upon additional
evidence, including but not limited to:
(a) The medical bills incurred by a party;
(b) The amount actually paid for medical treatment rendered to a
(c) The amount or estimate of the amount of medical bills not paid
which such party is obligated to pay to any entity in the event of a
Notwithstanding the foregoing, no evidence of collateral sources shall be made
known to the jury in presenting the evidence of the value of the medical treatment
Mo. Rev. Stat. § 490.715.5. The statute establishes a rebuttable presumption that the amounts
actually paid to a medical provider represent the value of a plaintiff’s medical treatment. See id.
A plaintiff may rebut the presumption, however, by presenting other evidence, including medical
bills showing the amounts actually billed by medical providers. See id.
If a plaintiff submits affidavits from medical providers in an effort to rebut the statutory
presumption, Mo. Rev. Stat. § 490.525 establishes the requirements for those affidavits:
2. Unless a controverting affidavit is filed as provided by this section, an affidavit
that the amount a person charged for a service was reasonable at the time and place
that the service was provided and that the service was necessary is sufficient
evidence to support a finding of fact by judge or jury that the amount charged was
reasonable or that the service was necessary.
3. The affidavit shall:
(1) Be taken before an officer with authority to administer oaths;
(2) Be made by the person or that person’s designee who provided
(3) Include an itemized statement of the service and charge.
Mo. Rev. Stat. § 490.525.
The Missouri Supreme Court has instructed that the trial court’s role is limited to
determining whether the plaintiff has submitted substantial evidence to rebut the presumption
created by § 490.715.5. Deck v. Teasley, 322 S.W.3d 536, 537 (Mo. 2010) (en banc). “To decide
whether a presumption is rebutted, the trial judge need only determine that the evidence introduced
in rebuttal is sufficient to support a finding contrary to the presumed fact.” Id. at 539 (internal
quotation marks and quoted source omitted).
Missouri courts have held that the statutory presumption is rebutted when, for example, (1)
the plaintiff presented substantial evidence that he or she was responsible for paying either the
difference between the amount charged and the amount paid by insurance, or the full amount
charged if insurance paid nothing, see Klotz v. St. Anthony’s Medical Center, 311 S.W.3d 752, 771
(Mo. 2010) (en banc); or (2) the plaintiff submitted health care provider affidavits attesting to the
reasonableness of the amounts the plaintiff was billed for medical treatment rendered and the
necessity of that treatment, see Berra v. Danter, 299 S.W.3d 690, 695-98 (Mo. Ct. App. 2009); see
also Wheeler ex rel. Wheeler v. Phenix, 335 S.W.3d 504, 517-18 (Mo. Ct. App. 2011) (affidavits
of custodian of records designated by healthcare provider were sufficient to rebut presumption); but
see Hall v. Wal-Mart Stores, East, LP, 316 S.W.3d 428, 430 (Mo. Ct. App. 2010) (plaintiff’s
affidavits from medical providers submitted pursuant to Mo. Rev. Stat. § 490.525 failed to rebut
§ 490.715’s presumption when “some of [the] affidavits make no mention of the charges or their
reasonableness, and some of her charges have no affidavit at all” and because § 490.525 permits a
court or jury to find the amounts billed were reasonable in accordance with an affidavit, but “it does
not so require.”)
With the exception of the affidavit submitted with the billing records of provider Hand
Therapy of Central Missouri, plaintiffs’ affidavits meet the standard set by § 490.525.2, because
each affidavit was made by a designee of the person who provided the service, and each avers that
the amount charged for services rendered was reasonable at the time and place it was provided, and
that the service was necessary. Because FedEx did not file controverting affidavits under §
490.525.2, plaintiffs’ affidavits are sufficient evidence to support a finding of fact by the jury with
respect to the reasonableness and necessity of the charges. See Wheeler, 335 S.W.3d at 518 (where
no controverting affidavits were filed, plaintiffs’ affidavits that met the requirements of § 490.525
were sufficient evidence to support a finding of fact that the amount charged was reasonable or the
Plaintiffs’ affidavit from Hand Therapy of Central Missouri’s custodian of records purports
only to authenticate the billing records as business records, and does not contain any statement that
the amounts charged were reasonable at the time and place that the services were provided or that
the services were necessary. While it is arguable that medical bills alone could be sufficient
evidence under § 490.715.5(2)(a) to rebut the statutory presumption, the Court declines to so hold
in this case.
Because plaintiffs have submitted sufficient evidence that the amounts billed by certain
medical providers were reasonable and necessary, the Court determines that plaintiffs have rebutted
the statutory presumption that the dollar amounts paid to satisfy the financial obligations to those
providers represents the value of Mr. Alterauge’s medical treatment. Plaintiffs fail to present
evidence, however, that the amounts billed by Hand Therapy were reasonable and necessary, so the
Court determines that the statutory presumption applies to the value of the medical treatment by that
provider. As a result, plaintiffs’ evidence of the value of medical treatment rendered, except as to
Hand Therapy, and FedEx’s evidence of the amount necessary to satisfy the financial obligations,
will be admitted at trial for the jury’s consideration. With respect to Hand Therapy, only evidence
of the dollar amount necessary to satisfy Mr. Alterauge’s financial obligation to that provider will
FedEx fails to cite any authority for the proposition that exclusion of unrelated medical bills
is an issue for the Court to decide on a motion to determine the value of medical treatment under
§ 490.715.5, and the Court declines to address the issue at this time.
IT IS HEREBY ORDERED that defendant FedEx Ground Package System’s Motion to
Determine the Value of Medical Treatment is GRANTED in part and DENIED in part, as follows:
Plaintiffs’ evidence of the value of medical treatment rendered, except as to provider Hand Therapy
of Central Missouri, and FedEx’s evidence of the amount necessary to satisfy Mr. Alterauge’s
financial obligations, will be admitted at trial for the jury’s consideration. With respect to provider
Hand Therapy, only FedEx’s evidence of the dollar amount necessary to satisfy the financial
obligation to that provider will be admitted. [Doc. 29]
CHARLES A. SHAW
UNITED STATES DISTRICT JUDGE
Dated this 7th day of April, 2014.
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