What is Robinson v. Bates and How Does it Relate to Your Claim?

What is Robinson v. Bates and How Does it Relate to Your Claim?

Robinson v. Bates was an Ohio Supreme Court case that drastically changed what evidence a jury was allowed to see regarding the cost of medical treatment in a personal injury case. It also drastically changed how insurance companies evaluated personal injury claims and not in a good way.

Before Robinson v. Bates, the only evidence of the cost of medical care that a jury would see was the amount charged by medical care providers or, in other words, “the bill.” If a hospital charged $20,000 for a particular surgery, that is what the jury saw. Juries were not allowed to see evidence of health insurance, Medicaid or Medicare write-offs, payments, or other adjustments. It was as simple as this: the only evidence a jury would see is what the doctors, hospitals, or other medical facilities charged and, if a jury believed all of the medical care was necessary, that is what the at-fault party was responsible for.

Robinson v. Bates changed all of that. This court decision changed decades of Ohio law and said that now a jury could see the amount actually accepted by a medical care provider as full payment which, under all health insurance and Medicaid and Medicare policies, is less than what was charged. Even though the case said that juries still could not “see” the various health insurance write-offs, payments, and other adjustments, as a practical matter, it did allow juries to see these various adjustments.

Using the $20,000 surgery example above, in the pre-Robinson v. Bates days, a jury would only be allowed to see the bill, or the portion of the bill, showing that the hospital charged $20,000. Post-Robinson v. Bates, the jury was allowed to see that, although the hospital charged $20,000, the hospital actually accepted as full payment, only $5,000. Even though the jury did not actually “see” the various insurance write-offs, patient co-pays, etc., the jury would see that although the hospital charged $20,000, the hospital accepted $5,000 so $15,000 was written off.

As you can imagine, this decision drastically changed how insurance companies evaluated personal injury claims. Again, using the example above, in the pre-Robinson v. Bates days, the insurance company knew they were on the hook for the $20,000 surgery because that is the only amount a jury would see. Post-Robinson v. Bates, the insurance company was, typically, only on the hook for $5,000 because a jury would “see” that this is the amount that was actually paid for the surgery. This drastically REDUCED the amounts insurance companies would have to pay on injury claims.

In other words, insurance companies got the benefit of health insurance contacts between doctors, hospitals, and other medical care providers, as well as the benefit of the health insurance premiums paid by Ohioans and Ohio employers.

In the end, Robinson v. Bates was a huge windfall for the liability insurance industry. Using the example above, instead of now paying at minimum $20,000 for a claim, they were now starting out at paying only $5,000. In addition, the injured party oftentimes has to reimburse the insurance company what they paid towards accident-related medical care so the injured party, who has been paying the health insurance premiums, gets zero benefit from this decision.

The Robinson v. Bates decision did nothing but embolden an already aggressive liability insurance industry. Since Robinson v. Bates, health insurance companies offer even less money to fairly compensate those injured by reckless persons or businesses. That is why, now more than ever, it is important to hire professional, competent, and dedicated attorneys such as those at GB Law to protect your rights.