Health Care Claims Disputes: Individual Funded Healthcare Coverage

 Secondary Discussion of Medical Insurance Purchased as an Individual Coverage Policy, 77 A.L.R.3d 415 (Originally published in 1977)

 

This annotation discusses the cases dealing with the application of the collateral source rule where the plaintiff is a direct contractual beneficiary under a hospitalization or medical insurance policy, and where the premiums are paid by the plaintiff or a member of his family. Thus, cases dealing with hospitalization or medical insurance plans paid for by employers are excluded.

 

The term "insurance" includes not only insurance under the usual hospitalization and medical insurance provisions of policies issued by insurance companies as such, but also contractual benefits in the nature of insurance available to members of mutual benefit associations and other organizations providing such benefits to their members.

 

The term "medical insurance" includes medical payment coverage in an automobile insurance policy where the direct contractual beneficiary plaintiff is the individual paying for the premiums or a member of his immediate family. However, the annotation does not include cases decided under uninsured motorist provisions. The term "hospitalization or medical insurance" has been used herein to embrace any contracts specifically protecting the beneficiary against expenditures for hospital or medical expenses, including contracts or agreements with benefit societies and other organizations of that class providing for such protection, and the phrase "insurance effected by him" includes insurance effected by the plaintiff which extends coverage to members of his family as well as to himself. This annotation does not discuss the question whether a claimant may recover for the same expenses from his insurer under both the liability and medical payments provisions of a policy.

 

The payments discussed in this annotation are presumed to be from a truly collateral source, and cases are not included where the court held that the nature of the payment made, which the defendants sought to have deducted from the amount of damages, was not from a truly collateral source.