How JustAnswer Works:
  • Ask an Expert
    Experts are full of valuable knowledge and are ready to help with any question. Credentials confirmed by a Fortune 500 verification firm.
  • Get a Professional Answer
    Via email, text message, or notification as you wait on our site.
    Ask follow up questions if you need to.
  • 100% Satisfaction Guarantee
    Rate the answer you receive.
Ask Law Educator, Esq. Your Own Question
Law Educator, Esq.
Law Educator, Esq., Attorney
Category: Legal
Satisfied Customers: 111605
Experience:  JA Mentor -Attorney Labor/employment, corporate, sports law, admiralty/maritime and civil rights law
10285032
Type Your Legal Question Here...
Law Educator, Esq. is online now
A new question is answered every 9 seconds

Broke hand on a slip and fall on black ice in a big box

Customer Question

Broke hand on a slip and fall on black ice in a big box retailer's parking lot. Required surgery, lots of pain and 2 months of OT. Surgery center billed Medicare $50,000. Medicare paid $6,000. Is medical damages the amount billed or paid? Is the pain and suffering multiplier, say 3, times the $50,000 or the $6,000?
Submitted: 1 year ago.
Category: Legal
Expert:  Law Educator, Esq. replied 1 year ago.

Thank you for your question. I look forward to working with you to provide you the information you are seeking for educational purposes only.

What would you specifically like to know about the collateral source rule? Please tell us specifically so we do not tell you what you may already know. Thank you.

Customer: replied 1 year ago.
Specifically how does the collateral rule impact the amount of a settlement in NJ? How does the fact that Medicare paid $6000 on $50,000 submitted impact the settlement? I know that the first part of damages are the medical bills. Would I receive only the amount Medicare paid or the amount that was billed? I am repeating myself but on pain and suffering would I receive 3 times $50,000 or 3 times $6000?
Expert:  Law Educator, Esq. replied 1 year ago.

Thank you for your question. I look forward to working with you to provide you the information you are seeking for educational purposes only.

New Jersey’s collateral source rule is codified in N.J.S.A. 2A:15-97 and applies to civil actions “brought for personal injury or death." The “primary effect was to eliminate double recovery to plaintiffs.” See: Perreira v. Rediger, 169 N.J. 399, 409 (2001). The statute requires that you must disclose to the court any “benefits [received] for the injuries allegedly incurred from any other source other than a joint tortfeasor[,]” and, where the amount of those “benefits” “duplicatesany benefit contained in the award[,]” the court should deduct it from plaintiff’s recovery. N.J.S.A.2A:15-97.

So, anything your insurance paid must be deducted from any award that you receive, since NJ law prohibits your insurer for recovering what they paid out on your injury through subrogation as they do in most normal states. So if Medicare paid $6000 and nothing else was due on that $50,000 bill.

Pain and suffering is calculated based on your actual damages, not based on the collateral source rule. The collateral source rule is just something that reduces your medical reimbursement expenses. Pain and suffering is based on what is reasonable to compensate you for the extent of your injury.

Customer: replied 1 year ago.
Re your last sentence. I have read pain and suffering is calculated by using a multipler from 1.5 to 5. In cases of catastrophic injuries could go above 5. Mean would be three. In this case is it three times $50,000 or three times $6,000? Looking at it from a plantiff's perspective doesn't seem right to receive $18,000 rather than $150,000 for almost a full year of broken bone, pain, surgery and therapy simply because Medicare low balled what they paid the provider. Would I be better off pushing for a jury trial?
Expert:  Law Educator, Esq. replied 1 year ago.

Thank you for your reply.

Generally it would be for a wrist injury about 2-3 times the $50,000, but for settlement it would likely be about 1 to 1.5 by the time you are done settling.