Victum v. Martin
| Decision Date | 14 April 1975 |
| Citation | 367 Mass. 404,326 N.E.2d 12 |
| Parties | Willie VICTUM v. Lewis J. MARTIN. |
| Court | United States State Supreme Judicial Court of Massachusetts Supreme Court |
Philip T. Corwin, Boston, for plaintiff.
Robert D. Power, Boston (Paul R. Devin, Boston, with him) for defendant.
Before TAURO, C.J., and REARDON, QUIRICO, HENNESSEY and WILKINS, JJ.
In this case we are called on to decide the narrow issue whether G.L. c. 231, § 6D, a section of the so called no-fault insurance act, imposes a new and higher degree of proof with respect to establishing that medical expenses for an injury arising out of the operation, maintenance or use of a motor vehicle are 'reasonable and necessary expenses incurred in treating such injury.' 1 The relevance of this question bears on the plaintiff's ability to recover for pain and suffering since § 6D precludes damages for pain and suffering unless, inter alia, necessary medical expenses 'are determined to be in excess of five hundred dollars.'
In this action in tort, the plaintiff seeks to recover for personal injuries, including pain and suffering, sustained in a motor vehicle accident which occurred on or about July 17, 1971. The plaintiff alleged that the accident was a result of the negligent operation of a motor vehicle owned and operated by the defendant.
At the conclusion of the evidence presented in the District Court, the defendant submitted requests for rulings of law. The judge denied some of these requests and allowed others, holding in substance, that the plaintiff did have the burden of proof as to the necessity of medical expenses exceeding $500 but that the plaintiff had adduced sufficient evidence to meet that burden. The judge found for the plaintiff in the amount of $7,780 which included $660 for medical bills incurred. Following judgment, the defendant, claiming to be aggrieved by the judge's rulings, 2 requested a report to the Appellate Division which the trial judge allowed. The Appellate Division found that there was prejudicial error, vacated the judgment for the plaintiff, and entered judgment for the defendant. We reverse.
The basis of the Appellate Division's decision was that 'submission of a portion of the medical bills under G.L. Chapter 233, Sec. 79G by way of affidavit of a physician that the charges were fair and reasonable does not justify the conclusion that such services were necessary' (emphasis added). Therefore, according to the reasoning of the Appellate Division, 'the trial justice did not have before him evidence of sufficient probative force to justify the conclusion that the medical treatment rendered to the defendant was necessary as required by the statute.' Thus the issue before this court is: What evidence is sufficient to meet the 'jurisdictional' standard of $500 set out in § 6D?
The defendant argues that the $500 standard of § 6D was intended to have an exclusionary effect in order to further the elimination of 'nuisance' claims for pain and suffering (Pinnick v. Cleary, 360 Mass. 1, 28--29, 271 N.E.2d 592 (1971)); that given this objective, the standard of proof imposed in determining necessity in pre-no-fault cases involving the restitution of medical expenses is inapplicable as that standard is purely compensatory and not exclusionary; and, that the burden of proof for necessary expenses under § 6D requires that it be shown that the services were required in light of sound medical practice, in the defendant's words were necessary by having 'a certain quality of immediacy, importance and essentiality.' Further, the defendant argues that the burden of proving necessity may be satisfied only by introducing competent medical testimony specifically indicating the necessity of the medical services.
Since the plaintiff in this case submitted only his testimony and two affidavits pursuant to G.L. c. 233, § 79G, to prove the necessity of his medical expenses, the defendant's position would require the conclusion that the plaintiff failed to meet the jurisdictional limit of $500 prescribed by § 6D. For purposes of this decision, we need not attempt to define with black letter precision the term 'necessary.' We point out that the plaintiff must show that the treatment, which is the basis of the medical expenses, did legitimately arise out of the injury in the sense that the treatment rendered by a competent medical doctor was a bona fide effort to alleviate and ameliorate the injury.
Rather than postulate a hard and fast test for necessary medical expenses under § 6D, which is different in degree from that generally applied in negligence cases for restitution of medical expenses, we refer to our holdings in Hunt v. Boston Terminal Co., 212 Mass. 99, 101, 98 N.E. 786 (1912), where we rejected the test that a physician's services be 'in fact' necessary and further stated: 'The event may have shown them (the medical services) to be unnecessary, and yet they may have been wise in the light of facts known at the time they were rendered.'
We reject the defendant's argument that the Legislature in enacting the no-fault statute intended 'the imposition of severe restrictions upon cases in which recovery for pain and suffering would be allowed' thus rendering totally irrelevant traditional judicial standards for assessing necessity. As we made clear in Pinnick v. Cleary, supra, at 6, 28, 271 N.E.2d at 597, the no-fault statute was not intended to abrogate common law principles of damages, generally: '(t)he Legislature has acted with extreme caution in altering prior legal rights, changing in only one respect the elements of damage which are recoverable by the victim.' The purpose of the Legislature was to close off 'minor claims for pain and suffering'; it was not the purpose of the Legislature to preclude meritorious claims by imposing rigid standards and a heavy burden of proof unknown to traditional negligence suits for compensation for medical expenses.
Having determined that the Legislature did not intend to impose a standard of absolute necessity or indispensable medical need, and that prior judicial decisions on the issue of the necessity of medical expenses are relevant, we next turn to the type of evidence a plaintiff must adduce in order to satisfy his burden of proof by a preponderance of the evidence.
Under G.L. c. 233, § 79G, in an action for personal injuries or consequential damages arising therefrom, the individual injured may submit an itemized bill sworn to by a physician, dentist or agent of the hospital which 'shall be admissible as evidence of the necessary, fair and reasonable charge for such services.' In this case the plaintiff followed that procedure. The defendant argues, however, that a bill submitted under § 79G is not an attestation as to whether the medical expenses were necessary.
We note that St.1974, c. 442, amends § 79G, by providing that affidavits filed pursuant to that section shall be admissible 'as evidence of the...
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