Should You Claim Medical Expenses as Damages?

It used to be that an injured person would claim as many medical expenses as possible in a lawsuit. However, changes to Missouri statutes have caused attorneys to question the wisdom of this tactic. A recent Missouri Eastern District Court of Appeals decision helps explain why.

Facts of Case

On November 17, 2011, Randy Schieffer (“Schieffer”) was in a motor vehicle collision when an automobile driven by Thomas DeCleene (“DeCleene”) struck Schieffer’s vehicle. Following the incident, Mr. Schieffer experienced increasingly severe neck, shoulder, and back pain which, despite treatment, failed to improve. On August 26, 2014, Schieffer filed suit against DeCleene  for negligence. On January 2, 2015, Schieffer filed a first amended petition adding a claim of loss of consortium by Dinah Schieffer, his wife. Both the original and first amended petitions sought the recovery of $28,760.74 in medical expenses that Schieffer incurred due to the incident.

On the morning of trial, Schieffer’s counsel obtained leave from the trial court to file a second amended petition that  omitted the claim for medical expenses. The trial court then considered whether omission of that claim prevented DeCleene’s counsel from presenting evidence of Schieffer’s medical expenses at trial.

Schieffer’s counsel asserted that such evidence would be beyond the scope of the pleadings since he abandoned the claim for the recovery of medical expenses, the trial court determined that such evidence would be admissible for two reasons. First, under section 490.715.5 RSMo 2000, as amended in 2005, any party may introduce evidence of the value of medical treatment rendered to a party that was reasonable, necessary, and a proximate result of the negligence of any party. Thus, the trial court ruled that so long as DeCleene’s counsel explained to the jury that the expenses were the reasonable, necessary, and proximate result of DeCleene’s negligence, it would permit their admission into evidence. Second, the medical expenses were admissible because they may provide the jury evidence that it could consider as to the extent and nature of the damages given the amount of expenses. Following this ruling, the parties commenced with trial.

DeCleene’s counsel sought to differentiate Schieffer’s neck injuries, which were claimed to be exacerbated by the November 2011 collision, from his low-back injuries, which purportedly predated the 2011 collision and followed an unrelated automobile accident in 2000. In doing so, DeCleene’s counsel questioned Schieffer about his treatment following the collision, and Schieffer agreed that he was charged for multiple treatment sessions specifically targeting his low-back and that the medical records for those sessions did not reference his neck.


DeCleene’s counsel then attempted to introduce evidence of Schieffer’s prior medical expenses to differentiate the costs expended upon his back and neck. Schieffer’s counsel objected, but the trial court reiterated the ruling that the bills were admissible pursuant to Section 490.715.5 so long as DeCleene’s counsel admitted to the jury that the expenses were the result of DeCleene’s negligence. Following this determination, DeCleene’s counsel stated to the jury that “the amount necessary to fully satisfy [Schieffer’s medical] bills was $14,743.75,” and that “these [expenses] were reasonable, necessary, and a proximate result of the negligence of [DeCleene].”

During closing arguments, Schieffer’s counsel suggested a verdict of $300,000. This included  $125,000 for past pain and suffering, $125,000 for future pain and suffering, and some amount for medical.  DeCleene’s counsel, however, argued that Schieffer had been receiving treatment for his low back the month before the accident and he showed the jury the medical bills to establish that a portion of the medical bills wasn’t for the neck.  DeCleene’s counsel then asserted that, should the jury find that Mr. Schieffer was entitled to damages, a more appropriate verdict would be $25,000, again noting that “I had to put the evidence on to tell you what all the bills were and then to show you that a lot of it was for the back,” not his neck. After deliberating, the jury returned a verdict of $25,000. The trial court denied Schieffer’s motion for a new trial and Schieffer appealed.

The Ruling on Appeal

The appellate court held that the admission of Schieffer’s medical bills after he had dropped his claim to recover them was error and ordered a new trial. The appellate court noted that section 490.715, RSMo., was designed to allow a defendant to address issues of collateral sources of payments of medical bills (i.e., insurance).  Because no medical expenses were being claimed by Schieffer, any collateral source payments were not at issue and the statue did not apply to allow the admission of medical bills.


Under section 490.715, plaintiffs and their attorneys are faced with the consideration of whether or not to claim past medical expenses. Even a fairly large bill can sometimes be satisfied through insurance payments that are a small fraction of the amount billed. The concern is that the jury, hearing the relatively small number paid for treatment, will conclude a plaintiff’s injury is not as significant as claimed and award lower noneconomic damages. In cases with low medical expenses, it may be better to forego claiming them in an attempt to maximize the award of noneconomic damages.

The Schieffer case illustrates this concern. Although we have no way of knowing what the jury would have awarded if evidence of the medical bills had not come into evidence, it does seem quite a coincidence that the jury awarded the exact amount suggested by defense counsel when defense counsel used those medical bills as one is his main arguments against Schieffer’s claims.

The full opinion can be found here.

How many expert witnesses is too many?

The answer for one Eastern District Court of Appeals is four.

Facts of Case

Dr. Richard Follwell performed a surgery on Saundra Beaver that involved placement of surgical mesh to repair an abdominal hernia. After surgery, she was found to have a hole in her bowel that caused her to develop a severe infection. She eventually died from sepsis.

Her survivors sued Dr. Follwell for wrongful death. They asserted that Dr. Follwell was negligent in causing a hole in Saundra’s bowel and in failing to properly recognize and treat the problem. Dr. Follwell denied that he was negligent and that he caused the hole in Saundra’s bowel.

As part of his defense, Dr. Follwell asserted a theory that the hole in Saundra’s bowel was caused when a previously undiagnosed heart arrhythmia caused a blood clot to form that restricted blood flow to a section of Saundra’s bowel. This restriction on blood flow caused a portion of her bowel wall to weaken, die and perforate.

As part of the defense, Dr. Follwell testified as his own expert that he was not negligent and that Saundra’s bowel did not perforate under his care. He also hired four experts to support his defense. These doctors were experts in the fields of critical care, cardiology, vascular surgery, and colorectal surgery.

All four of the retained experts testified that Dr. Follwell did not cause the bowel perforation. Three of the four testified that Dr. Follwell did not breach the standard of care. All four repeatedly testified that the cause of the bowel perforation was a blood clot caused by a previously undiagnosed cardiac arrhythmia.

The Trial Court Ruling

At trial, the court overruled plaintiffs’ counsel’s objection that the multiple experts testifying to the same thing was cumulative. The jury returned a verdict in favor of Dr. Follwell.

The Ruling on Appeal

The Eastern District Court of Appeals reversed the verdict and ordered a new trial.

The court of appeals noted the trial court had an obligation to determine when repetitive evidence becomes so prejudicial that is outweighs its cumulative value. The trial court has to determine when cumulative evidence should stop. It also noted that evidence must be legally relevant. To be legally relevant, the usefulness of the evidence must not be outweighed by its costs, or prejudice. This is true even if the evidence goes to the root of the matter in controversy. Here, the concern is that the parade of multiple experts offering the same opinions will result in the jury simply counting the number of witnesses rather than fairly considering the qualifications and credibility of each expert.

The court of appeals noted that there is no bright line test for this. However, here four experts offering the same opinion was too much. The court did seem to say that all the experts could testify. However, they could not all offer the same opinions. Therefore, the defense could use each of the experts to explain to the jury the aspects of the case that fell within their areas of expertise.


Plaintiffs’ attorneys may view this as a victory. It provides some relief from the concern that a defendant will simply “outman” the plaintiff with experts. However, the court does not limit the number of experts that may testify. Instead, there is a limit on the number of experts who can offer the same opinion. What that limit is, however, is not explicitly stated. The implication is that the limit may be driven by the facts and complexity of each case. Regardless, defendants run the risk of losing a defense verdict on appeal if they stack the expert deck too high.

The full opinion can be found here.