Your Cape Cod Personal Injury Case and Knowing the Rules of Evidence — NE Physical Therapy Plus, Inc. v. Liberty Mutual Insurance Company

In order to preserve evidence in your Cape Cod personal injury case, it is critical to talk to an experienced Hyannis Personal Injury Lawyer. Personal injury cases usually require the need of expert testimony and compiled works as evidence to prove a case. The rules of evidence used to bring this type of evidence can be complicated and have been developed by the courts over hundreds of years in order to prevent bias and unfairness.

In a recent decision, the Supreme Judicial Court of Massachusetts ruled on (1) whether a trial judge abused discretion to consider the reliability of evidence offered under Massachusetts General Laws Chapter § 79B (“§ 79B”) where the evidence otherwise satisfies the requirements of § 79B. And, if so, (2) whether the judge here abused such discretion by excluding pricing data.

Facts of NE Physical Therapy Plus v. Liberty Mutual Insurance Company In this case, a Ms. Dalencourt was harmed in a motor vehicle accident. Dalencourt had an auto insurance policy through Liberty Mutual Insurance Company (“Liberty Mutual”) with $8,000 in PIP protection. Dalencourt received $4,465 in medical care from NE Physical Therapy Plus, Inc. (“NEPT”) for injuries from the accident. However, Liberty Mutual only offered to pay $3,730, stating that the requested costs of the procedure was over priced. NEPT brought suit against the Liberty Mutual for the full amount of the medical treatment. The dispute at trial was whether the amount charged were reasonable.

At trial, Liberty Mutual filed a motion in limine to admit statistical pricing data they believed showed that NEPT’s charges exceeded the national average for the same procedure. In support of their motion, defendants submitted an affidavit from a senior director of the organization, Ingenix, that compiled the data and a trial transcript, Davekos vs. Liberty Mutual Ins. Co., where the trial judge had admitted the same pricing data. In opposition to the motion, plaintiffs brought an appellate court decision from the same case reversing the trial judge’s ruling admitting the statistical evidence. Based upon, the appellate decision and other reports the trial judge denied the motion and ruled the pricing data to be inadmissible because it was unreliable.

§ 79B Exception Outlined § 79B is an exception to the hearsay rule. Hearsay, Rule 801, “is a statement, other than one made by the declarant while testifying at the trial or hearing, offered in evidence to prove the truth of the matter asserted.” Hearsay is a bar to evidence because the statement or report is not made under oath and cannot be observed by the judge or jury for signs of honesty or reliability. The reasoning for the § 79B exception to hearsay is to allow for a compilation where it would be impossible to bring in all the experts of the compiled data, and also, the work requires those in the field to verify its reliability. The § 79B exception allows for compilations of data if the “proposed exhibit is (1) issued to the public, (2) published for persons engaged in the applicable occupation, and (3) commonly used and relied on by such persons.” Liberty Mutual claimed that the statistical pricing evidence satisfied these three requirements and should be allowed.

Whether Trial Judge Can Consider Reliability Where Requirements Satisfied The Supreme Judicial Court noted the importance and tradition of the trial judge as gatekeeper of reliability. To simply allow evidence when it meets the three requirements would allow lots of unreliable data, and it would create a perverse incentive to utilize unreliable data by an industry because of the legal result. Overturning a trial judge’s determination concerning reliability under § 79B would require an appellate court finding of “whimsy, caprice, or arbitrary or idiosyncratic notions.” Given this the appellate court found that the trial court had discretion to determine § 79B unreliable even if it meets the three requirements.

Whether Trial Judge Abused Discretion Furthermore, the court held that the trial judge did not abuse discretion in ruling the evidence unreliable and thus inadmissible. The court stated that, “this evidence demonstrated that Ingenix is a sister company to one of the largest insurance providers in the country; it relies on the voluntary submission of data on medical costs from the limited universe of insurance companies who choose to participate in the program; it applies a proprietary relative value and conversion factor to the raw data; and it has never verified that the data produced as a result of this formula accurately correspond with actual charges for medical procedures.” And, “there is nothing in the record to establish the accuracy or reliability of Ingenix’s raw data and, thus, its statistical extrapolations.”

What To Do If You Have Been Injured by the Negligence of Others If you have been injured by the negligence of another, we highly recommend speaking with a local personal injury attorney with extensive experience. Presenting Rules of evidence can be decisive to a personal injury case. The appropriate evidence can help win a case and determine damages. Speaking with an experienced personal injury lawyer that understands rules of evidence is critical to getting you the compensation you deserve.

Local attorney, John C. Manoog III, has extensive experience handling Personal Injury claims. For a free initial consultation, call the office at 888-262-6664 or reach us by email. There is always someone available to talk to you about your case. Related Blog Posts: Massachusetts Supreme Judicial Court Rules Auto Accident Victim Should Have Received MedPay Coverage — Golchin v. Liberty Mutual Ins. Co. Massachusetts Supreme Court Upheld $18 Million Punitive Damages Award in Wrongful Death Action