Brethren mutual

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About Brethren Mutual Insurance Co. Brethren Mutual Insurance Co is located at 149 N Edgewood Dr in Hagerstown, Maryland . Brethren Mutual Insurance Co can be Brethren Mutual Aid Agency, Inc. Filing Date: J: File Number: : Contact Us About The Company Profile For Brethren Mutual Aid Agency, Inc. BRETHREN MUTUAL AID

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Download PDF REPORTED IN THE COURT OF SPECIAL APPEALS OF MARYLAND No. 1787 September Term, 2011 BRETHREN MUTUAL INSURANCE CO. v. KENNETH SUCHOZA Meredith, Woodward, Matricciani, JJ. Opinion by Woodward, J. Filed: May 29, 2013 The instant appeal arises from a lawsuit filed on March 12, 2010, in the Circuit Court for Prince George s County by appellee, Kenneth Suchoza, against appellant, Brethren Mutual Insurance Company ( Brethren ), alleging that Brethren failed to pay benefits under an uninsured motorist ( UM ) policy between Brethren and appellee s employer, Matrix Mechanical, Inc. ( Matrix ). Appellee s UM claim resulted from injuries sustained during a May 29, 2007 motor vehicle accident caused by an uninsured motorist while appellee was driving within the scope of his employment with Matrix. On August 15 and 16, 2011, a trial was held in circuit court, at the conclusion of which a jury returned a verdict in favor of appellee for $535,876.00. Following the entry of judgment, Brethren filed a Motion for New Trial and to Alter or Amend Judgment, seeking, among other things, to have the judgment reduced by the amount of workers compensation benefits previously received by appellee. On January 19, 2012, the circuit court denied Brethren s motion for a new trial but amended the judgment by reducing the amount thereof from $535,876.00 to $356,669.03 to reflect the amount of workers compensation benefits received by appellee as of the time of trial. On appeal, Brethren presents three questions for our review, which we have slightly rephrased: I. Did the trial court err or abuse its discretion by refusing to admit testimony of the payment of appellee s medical expenses by his workers compensation carrier and the acceptance thereof as full payment by his health care providers? II. Did the trial court err by failing to reduce the judgment in favor of appellee by the amount of workers compensation benefits received by appellee from the trial date to the date of the court s ruling on Brethren s post-trial motion? III. Did the trial court err by entering judgment in favor of

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Version1Paul, a servant of Jesus Christ, called to be an apostle, separated unto the gospel of God, 2Which he had promised afore by his prophets in the holy scriptures,) 3Concerning his Son Jesus Christ our Lord, which was made of the seed of David according to the flesh; 4And declared to be the Son of God with power, according to the spirit of holiness, by the resurrection from the dead: 5By whom we have received grace and apostleship, for obedience to the faith among all nations, for his name: 6Among whom are ye also the called of Jesus Christ: 7To all that be in Rome, beloved of God, called to be saints: Grace to you and peace from God our Father, and the Lord Jesus Christ. 9For God is my witness, whom I serve with my spirit in the gospel of his Son, that without ceasing I make mention of you always in my prayers; 10Making request, if by any means now at length I might have a prosperous journey by the will of God to come unto you. 11For I long to see you, that I may impart unto you some spiritual gift, to the end ye may be established; 12That is, that I may be comforted together with you by the mutual faith both of you and me. 13Now I would not have you ignorant, brethren, that oftentimes I purposed to come unto you, (but was let hitherto,) that I might have some fruit among you also, even

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1 Then Joseph came and told Pharaoh, and said , My father and my brethren, and their flocks, and their herds, and all that they have, are come out of the land of Canaan; and, behold, they are in the land of Goshen. 2 And he took some of his brethren, even five men, and presented them unto Pharaoh. 3 And Pharaoh said unto his brethren, What is your occupation? And they said unto Pharaoh, Thy servants are shepherds * , both we, and also our fathers. 4 They said moreover unto Pharaoh, For to sojourn in the land are we come ; for thy servants have no pasture for their flocks; for the famine is sore in the land of Canaan: now therefore, we pray thee, let thy servants dwell in the land of Goshen. 5 And Pharaoh spake unto Joseph, saying , Thy father and thy brethren are come unto thee: 6 The land of Egypt is before thee; in the best of the land make thy father and brethren to dwell ; in the land of Goshen let them dwell : and if thou knowest * any men of activity among them, then make them rulers over my cattle. 7 And Joseph brought in Jacob his father, and set him before Pharaoh: and Jacob blessed Pharaoh. 8 And Pharaoh said unto Jacob, How old * art thou? 9 And Jacob said unto Pharaoh, The days of the years of my pilgrimage are an hundred and thirty years:. About Brethren Mutual Insurance Co. Brethren Mutual Insurance Co is located at 149 N Edgewood Dr in Hagerstown, Maryland . Brethren Mutual Insurance Co can be

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Compensation carrier to and accepted as full payment by appellee s health care providers. Brethren s counsel made the following proffer to the court: [A]t this point the defense would offer testimony of Lori Shook. She is the workers[ ] compensation adjuster for [appellee] s claim. We would elicit testimony from Ms. Shook concerning [appellee] s workers[ ] compensation claim, his entitlement to recover under workers[ ] compensation, the amounts paid by workers[ ] compensation, the amounts accepted by providers from workers[ ] compensation, [] testimony concerning the pending status of the matter [] that [appellee] is still entitled to recover additional funds pursuant to workers[ ] compensation and that there has been no reimbursement. (Emphasis added). Brethren did not proffer any expert testimony or other competent evidence regarding the reasonableness of the amounts actually paid for appellee s medical treatment. The court ruled that Brethren s proffered evidence was not admissible, finding that it was a collateral source, and thus would violate the collateral source rule. In the instant appeal, Brethren contends that the trial court abused its discretion by excluding evidence concerning amounts accepted as full payment by [appellee s] health care providers. According to Brethren, [t]he dollar amount written on the invoice [submitted by appellee] bears little relation to the value of the service or the amount these providers actually accept[ed]. Brethren further asserts that the collateral source rule is not applicable 2 Brethren objected to the admission of appellee s medical bills, but on the sole ground that Dr. Urban could testify only to the reasonableness of his own bills. Brethren does not seek this Court s review of the trial court s overruling of that objection. 6 in contract cases, such as the instant matter. Even if the collateral source rule is applicable, according to Brethren, the admission of lesser amounts accepted as full payment of medical bills is not violative of such rule. Brethren concludes that the trial court s exclusion of evidence concerning payment actually accepted for appellee s medical treatment prejudiced Brethren by affecting the jury s decision concerning the reasonable value

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The judgment for the workers compensation benefits awarded to appellee after trial.8 Although its argument may have some merit,9 Brethren is not entitled to the relief it requests, because of the procedural posture of the instant case. We shall explain. On September 6, 2011, the circuit court entered judgment on the jury s verdict in favor of appellee in the amount of $535,876.00. On September 19, 2011, Brethren filed its motion to alter or amend.10 Because Brethren s motion was not filed within ten days after the entry of the judgment, the time for filing a notice of appeal was not extended to 30 days 8 Appellee does not respond to this argument. 9 For the reasons set forth infra, we hold that Brethren is not entitled to have the judgment entered against it under its UM policy reduced by any future workers compensation benefits that will be received by appellee. Accordingly, any merit to Brethren s argument on post-trial workers compensation benefits is limited to the amount of such benefits ($9,339.00) actually received by appellee between the time of trial and the time of the court s ruling on Brethren s motion to alter or amend, not the workers compensation award of $56,639.00 to appellee after trial. 10 On October 13, 2011, Brethren filed a motion to establish the filing date for the motion to alter or amend as September 16, 2011, instead of September 19, 2011, claiming that the motion had been delivered to the circuit court at 5:55 p.m. on Friday, September 16, 2011, and had been placed in the court s after-hours box, but the clerk s office incorrectly stamped the motion as filed on Monday, September 19, 2011, and entered the incorrect date in the docket entries for the instant case. There is no indication in the record that the trial court ever ruled on Brethren s motion. In the absence of a court order changing the filing date from September 19 to September 16, we must accept the date of filing as the one entered in the docket entries of the case, namely, September

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Was received by appellee. Appellee s Uninsured Motorist Claim Matrix maintained a UM policy with Brethren that, according to appellee, was specifically contracted for by [Matrix] to provide for all medical treatment, lost wages, and any other relevant damages and injuries rendered to their employees as a result of an uninsured driver. The insurance policy contained a provision limiting Brethren s liability in the event that an employee recovered workers compensation benefits stemming from the same accident for which UM benefits were sought. The relevant provision states: We will not pay for any element of loss [i]f a person is entitled to receive payment for the same element of loss under any workers compensation, disability or similar law. However, this applies only to that amount for which the provider of the workers compensations [sic] benefits has not been reimbursed. Appellee filed a claim with Brethren under its UM policy, which Brethren denied. On March 12, 2010, appellee filed a complaint in circuit court, asserting that Brethren s 3 denial of UM benefits pursuant to Brethren s UM insurance policy with Matrix constituted a breach of contract. In light of the UM provision limiting Brethren s liability based upon workers compensation recovery by appellee, the parties filed a Consent Motion to Stay Proceedings on January 11, 2011, requesting that the circuit court case be stayed pending the resolution of appellee s workers compensation claim. On January 25, 2011, the trial court entered an order denying the request. On August 15 and 16, 2011, a jury trial was held in the circuit court. At trial, appellee introduced into evidence the medical bills, totaling $129,876.00, that he incurred as a result of the accident, along with the testimony of his treating physician that such bills were fair, reasonable, and necessary. Brethren sought to introduce evidence of the reasonable value of the medical services rendered to appellee by proffering evidence of the actual payments made by appellee s workers compensation carrier1 and accepted as full payment by the health care providers. The trial court did not allow the admission of the evidence of such. About Brethren Mutual Insurance Co. Brethren Mutual Insurance Co is located at 149 N Edgewood Dr in Hagerstown, Maryland . Brethren Mutual Insurance Co can be

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Payments, stating that it was a collateral source. The jury returned a verdict in favor of appellee for a total of $535,876.00, comprised of: $156,000.00 in lost wages, $129,876.00 in medical expenses, and $250,000.00 in non-economic damages. On September 6, 2011, the circuit court entered judgment in favor of appellee in the amount of $535,876.00. Following the trial court s entry of judgment, Brethren filed a Motion for New Trial 1 Brethren was also appellee s workers compensation carrier. 4 and to Alter or Amend Judgment on September 19, 2011. Brethren s motion was based upon (1) the exclusion of evidence of the actual amounts accepted by [appellee] s doctors in full payment for treatment, (2) the trial court s failure to reduce the Judgment by the amount of workers compensation benefits paid, and (3) the entry of Judgment for [appellee] absent a prima facie showing that [Brethren] breached the applicable contract of insurance. On January 13, 2012, the circuit court heard argument on Brethren s motion. On January 19, 2012, the circuit court denied Brethren s motion for a new trial but reduced the amount of the judgment from $535,876.00 to $356,669.03 to reflect the amount of workers compensation benefits received by appellee as of the date of trial. Brethren noted a timely appeal to this Court. DISCUSSION Reasonable Value of Medical Services Rendered At trial on August 15 and 16, 2011, the trial court ruled on the admissibility of evidence regarding the fair and reasonable value of medical services rendered by health care providers in treating appellee for injuries sustained as a result of the accident. Appellee offered medical bills totaling $129,876.00 as evidence of the expenses incurred by him for medical treatment rendered for such injuries. Appellee played portions of the videotaped deposition of Dr. Christopher Urban for the jury, in which Dr. Urban testified that he had reviewed such medical bills and that the amounts of those bills were fair and reasonable. The 5 court admitted appellee s medical bills into evidence.2 Brethren sought to introduce evidence of the payments actually made by appellee s workers

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Standard VersionI have applied all this to Apollos and myself for your benefit, brothers and sisters, so that you may learn through us the meaning of the saying, “Nothing beyond what is written,” so that none of you will be puffed up in favor of one against another.Translations from AramaicLamsa BibleThese things, my brethren, concerning myself and Apollos I have pictured for your sakes; that in our example you may learn not to think beyond that which is written, and let no one exalt himself over his fellow man, on account of any man.Aramaic Bible in Plain EnglishBut I have established these things, my brethren, for your sakes concerning my person and that of Apollo, that you may learn by us not to suppose more than whatever is written and that a man should not be lifted up against his fellow man because of anyone.NT TranslationsAnderson New TestamentAnd these things, brethren, I have, in figure, applied to myself and Apollos, for your sakes, that you may learn in us not to think more of teachers than what has been written; and that no one of you be vain of one to the injury of another.Godbey New TestamentBut, brethren, I have transferred these things to myself and Apollos on your account: that you may learn among us not to be wise above what is written; in order that you may not be puffed up one in behalf of one against another.Haweis New TestamentBut these things, brethren, I have figuratively applied to. About Brethren Mutual Insurance Co. Brethren Mutual Insurance Co is located at 149 N Edgewood Dr in Hagerstown, Maryland . Brethren Mutual Insurance Co can be

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Not shown to the jury. Brethren did not request that such cross-examination be played for the jury in the absence of the admission of Brethren s proffered evidence. 12 charges are what I should get paid for [the medical service provided]. We have horrible contracts with our companies and I think that we are actually right now redoing our contracts because we don t get paid enough for what we do. Dr. Urban elaborated on the notion of reasonableness pertaining to a bill for anesthesia services provided to appellee in the amount of $2,070.00, upon which the workers compensation carrier paid only $444.00: The amount of the adjustment is I would say criminal in that they are paying someone $400 to put someone to sleep and wake them up for a complex spine surgery, so I would say that the amount that s, again, accepted is well under what I would consider reasonable. Thus, the admission of evidence of a medical provider s acceptance of a lesser amount as full payment for medical services rendered does little to assist the trier of fact in determining the reasonable value of such services. See Md. Rule 5-401. Therefore, we hold that the trial court did not err in excluding Brethren s proffered evidence of payments made on appellee s medical bills that were accepted as full payment by his health care providers. Without expert testimony or other competent evidence to establish the fairness and reasonableness of such payments, Brethren s evidence was inadmissible. Nevertheless, Brethren looks to cases from Ohio, Indiana, and Kansas, to support its contention that both the amount originally billed by a medical care provider and the lesser amount paid by an insurer are admissible to prove the reasonable value of medical treatment. A careful reading of each case relied on by Brethren reveals critical legal dissimilarities, distinguishing them from the matter sub judice. 13 In Robinson v. Bates, 857 N.E.2d 1195 (Ohio 2006) and Stanley v. Walker, 906 N.E.2d 852 (Ind. 2009), the Supreme Court of Ohio and the Supreme Court of Indiana, respectively, held that both the