Goble v. Frohman

• Decision Date: 28 April 2005
• Docket Number: No. SC03-1245.,SC03-1245.
• Citation: 901 So.2d 830
• Parties: Albert GOBLE, Petitioner, v. Mark E. FROHMAN, Respondent.
• Court: Florida Supreme Court

901 So.2d 830

Albert GOBLE, Petitioner, v. Mark E. FROHMAN, Respondent.

No. SC03-1245.

Supreme Court of Florida.

April 28, 2005.

Charles P. Schropp, Amy S. Farrior and Raymond T. Elligett, Jr. of Schropp, Buell and Elligett, P.A., Tampa, FL and Theodore E. Karatinos and Timothy F. Prugh of Prugh, Holliday, Deem and Karatinos, P.L., Tampa, FL, for Petitioner.

Daniel P. Mitchell of Gray, Harris and Robinson, P.A., Tampa, FL, for Respondent.

Roy D. Wasson of Wasson and Associates, Miami, FL on behalf of the Academy of Florida Trial Lawyers; Warren B. Kwavnick of Cooney, Mattson, Lance, Blackburn, Richards and O'Conner, P.A., Fort Lauderdale, Florida, Jeremy S. Sloane of Rice, Rose and Snell, Daytona Beach, FL, and Tracy Raffles Gunn, Tampa, FL of Fowler, White, Boggs and Banker, P.A., on behalf of the Florida Defense Lawyers' Association and Charles W. Hall of Fowler, White, Boggs, and Banker, P.A., St. Petersburg, FL on behalf of the Allstate Insurance Company, for Amici Curiae.

PER CURIAM.

We have for review Goble v. Frohman, 848 So.2d 406 (Fla. 2d DCA 2003), in which the Second District Court of Appeal certified the following question as one of great public importance:

UNDER SECTION 768.76, FLORIDA STATUTES (1999), IS IT APPROPRIATE TO SETOFF AGAINST THE DAMAGES PORTION OF AN AWARD THE AMOUNTS OF REASONABLE AND NECESSARY MEDICAL BILLS THAT WERE WRITTEN OFF BY MEDICAL PROVIDERS PURSUANT TO THEIR CONTRACTS WITH A HEALTH MAINTENANCE ORGANIZATION?

Id. at 410. We have jurisdiction under article V, section 3(b)(4) of the Florida Constitution. For the reasons stated below, we answer the certified question in the affirmative. We approve the district court's decision affirming the trial court's setoff under section 768.76 of contractual discounts negotiated by the plaintiff's HMO and written off by the plaintiff's medical providers.

BACKGROUND

Albert Goble was severely injured when Mark Frohman's vehicle hit Goble's motorcycle. Goble's injuries required extensive medical treatment, for which Goble's medical providers billed him $574,554.31. However, Goble was a member of Aetna U.S. Healthcare, an HMO. Pursuant to the preexisting fee schedules in contracts between Aetna and the medical providers, Aetna paid and the medical providers accepted just $145,970.76 for the medical services rendered to Goble.

Under the medical providers' contracts with Aetna, the providers have no right to seek reimbursement from Goble or from any third party for the contractual "discount" of over $400,000, the difference between the amounts billed and the amounts paid. Aetna has a right of subrogation; however, Aetna's subrogation right is limited to the sum of $145,970.76 that Aetna paid under the contracts.

Goble sued Frohman, and the jury awarded Goble $574,554.31 for past medical expenses, reflecting the amount Goble's medical providers had billed. Frohman filed a posttrial motion to reduce this award by the amount of the contractual discounts. The trial court granted Frohman's motion for setoff under section 768.76, Florida Statutes (1999).

On appeal, the Second District Court of Appeal affirmed the trial court's order of setoff. Goble v. Frohman, 848 So.2d 406, 410 (Fla. 2d DCA 2003). The district court held that contractual discounts off medical bills are "collateral sources" subject to setoff under section 768.76. The district court reasoned that "collateral sources" are defined by the statute as "payments made" on the claimant's behalf, and that the dictionary definition of "payment" is not limited to the actual remitting of cash but includes any act that discharges a debt or obligation. Goble, 848 So.2d at 409. In this case, the contractual discounts discharged Goble's obligation to his medical providers; therefore, the discounts are "payments made" on Goble's behalf and so are "collateral sources" under section 768.76. Id. The district court also reasoned that permitting a setoff for contractual discounts is consistent with the Legislature's intent to reduce "the litigation costs that arise when insurers are required to pay damages beyond what the injured party actually incurred." Id. at 410. The alternative, forcing an insurer to pay for damages that have not been incurred, would result in a windfall to the injured party. Id. The allowance of a windfall would undermine the legislative purpose of controlling liability insurance rates because "insurers will be sure to pass the cost for these phantom damages on to Floridians." Id.

DISCUSSION

We agree with the conclusion reached by the Second District Court of Appeal. Section 768.76 provides in relevant part:

(1) In any action to which this part applies in which liability is admitted or is determined by the trier of fact and in which damages are awarded to compensate the claimant for losses sustained, the court shall reduce the amount of such award by the total of all amounts which have been paid for the benefit of the claimant, or which are otherwise available to the claimant, from all collateral sources; however, there shall be no reduction for collateral sources for which a subrogation or reimbursement right exists....

(2) For purposes of this section:

(a) "Collateral sources" means any payments made to the claimant, or made on the claimant's behalf, by or pursuant to:

....

3. Any contract or agreement of any group, organization, partnership, or corporation to provide, pay for, or reimburse the costs of hospital, medical, dental, or other health care services.

§ 768.76, Fla. Stat. (1999).

Our guiding purpose in construing this statute is to give effect to the Legislature's intent. State v. J.M., 824 So.2d 105, 109 (Fla.2002). In attempting to discern legislative intent, we first look to the language used in the statute. Joshua v. City of Gainesville, 768 So.2d 432, 435 (Fla.2000). If the statutory language is unclear, we apply rules of statutory construction to determine legislative intent. Id. If a statutory term is not defined, its plain and ordinary meaning generally can be ascertained by reference to a dictionary. Seagrave v. State, 802 So.2d 281, 286 (Fla.2001).

We conclude, as the Second District did, that the contractual discounts fit within the statutory definition of collateral sources. Section 768.76 defines collateral sources as "payments made" on a claimant's behalf. Virtually all dictionaries include, among the first three definitions of "payment" or "pay," the concept of discharge of a debt. See, e.g., Merriam-Webster's Collegiate Dictionary 851 (10th ed.1993) ("to discharge a debt or obligation"); Webster's Third New Int'l Dictionary 1659 (1981) ("discharge of a debt or obligation"). In this case, the discounts negotiated by Goble's HMO fully discharged Goble's obligation to his medical providers. Because of the medical providers' contracts with Goble's HMO, Goble was obligated to pay the claimants $145,970.76, rather than the billed charges of $574,554.31. In this light, the discounts negotiated by Goble's HMO are as much a benefit to Goble as the HMO's remittance of $145,970.76 to satisfy the remaining charges on Goble's medical bills. The contractual discounts, therefore, constitute "amounts which have been paid for the benefit of the claimant, or which are otherwise available to the claimant, from [a] collateral source[]." Therefore, under section 768.76, the amount of the contractual discount, for which no right of reimbursement or subrogation exists, is an amount that should be set off against an award of compensatory damages.

CONCLUSION

We agree with the conclusion reached by the Second District Court of Appeal that contractual discounts negotiated by an HMO fall within the statutory definition of collateral sources subject to setoff. The trial court, therefore, properly applied section 768.76 to reduce Goble's damages by the amount of the discounts. We answer the certified question in the affirmative and approve the decision of the Second District Court of Appeal.

It is so ordered.

PARIENTE, C.J., and WELLS, ANSTEAD, QUINCE, and CANTERO, JJ., concur.

BELL, J., specially concurs with an opinion, in which WELLS and CANTERO, JJ., concur.

LEWIS, J., concurs in result only with an opinion.

BELL, J., specially concurring.

I agree with the majority's reasoning and conclusion. The contractual discounts negotiated by Goble's HMO fall under the statutory definition of "collateral sources" that are to be set off against an award of compensatory damages under section 768.76. There is, however, another reason why Goble is not entitled to recover, as compensatory damages, the full (prediscount) amount of his medical bills; and it lies wholly outside the question of "collateral sources" either as defined by statute or at common law. The reason is simple: Goble has not paid, nor is he obligated to pay, the prediscount amount of his medical bills. And, absent any evidence that the discount was intended as a gift, Goble can recover no more than the amount he paid or is obligated to pay.

Under common-law principles of compensatory damages, Goble can recover only the discounted portion of his medical bills—the only portion that he actually was obligated to pay. The amount of the full (prediscount) bill that was written off pursuant to the contractual agreement between Goble's HMO and Goble's medical-services provider was an amount that Goble never was obligated to pay. This amount, therefore, does not represent Goble's actual damages. To allow for the recovery of this full amount, under the guise of "compensatory damages," would allow for the recovery of what the district court aptly described as "phantom damages." Goble v. Frohman, 848 So.2d 406, 410 (Fla. 2d DCA 2003).

It has long been established as a fundamental principle of Florida law that the measure of compensatory damages in a tort case is limited to the actual damages sustained by the aggrieved party. Hanna v. Martin, 49 So.2d 585, 587 (Fla.1950). The Fourth District Court of Appeal...