United States District Court, W.D. North Carolina, Statesville Division
Kenneth D. Bell United States District Judge
MATTER is before the Court on Defendant's motion
in limine to exclude Plaintiff from offering any
evidence of medical expenses that contain amounts other than
the amount actually paid or the amount actually necessary to
satisfy the bill. (Doc. No. 60). As explained briefly below,
the Court GRANTS IN PART and DENIES
IN PART Defendant's motion.
seeks to exclude evidence of medical expenses beyond the
amount actually paid or actually necessary to satisfy the
bill under Rule 414 of the North Carolina Rules of Evidence.
N.C. G.S. § 8C-1, Rule 414. The parties have forecasted
evidence that the full amount of Plaintiff's medical
bills was never paid by the Plaintiff or any person or
entity. Instead, substantial portions of the bills were
“written off” by the medical providers after
State Farm denied Plaintiff's claim. Further, State Farm
and/or State Farm's denial of the claim allegedly played
a role in the medical bills being written off.
414 states, in pertinent part, that “[e]vidence offered
to prove past medical expenses shall be limited to evidence
of the amounts actually paid to satisfy the bills that have
been satisfied, regardless of the source of payment, and
evidence of the amounts actually necessary to satisfy the
bills that have been incurred but not yet satisfied.”
N.C. G.S. § 8C-1, Rule 414. Therefore, Rule 414
plainly prohibits Plaintiff from introducing evidence of his
medical bills in excess of the amount actually paid or due to
prove his past medical expenses.
Plaintiff acknowledges that the full amount of the bills
cannot be admitted to establish his past medical expenses, he
argues that evidence of the total amount charged, including
the amount written off, should come in to corroborate his
testimony of the extent of his injuries and his pain and
suffering. In other words, Plaintiff contends that the jury
will be unfairly misled into minimizing his injuries if they
are only told that he incurred a much smaller amount of
medical expenses than he actually incurred prior to the
the Court understands Plaintiff's concern,  and by its terms
Rule 414 would not prevent the amount of the medical bills
from coming in for Plaintiff's proffered purpose (which
is different than being offered to prove “past medical
expenses”) the Court does not find there is a
sufficient relevant evidentiary connection between the amount
of a person's medical bills and the extent of their
injuries to allow the evidence to be admitted. Indeed, it is
generally well known that charges for the same or similar
services in different hospitals and/or by different doctors
can vary widely. Absent proof beyond what is being offered to
show a clear relevant connection between the total amount of
Plaintiff's medical costs and the extent of
Plaintiff's injuries, the Court finds that evidence of
the full amount of medical bills cannot be admitted on the
alternate ground that the total billed amount is evidence of
the extent of Plaintiff's injuries.
as noted above, Rule 414's reach is limited to proof of
past medical expenses. Therefore, Plaintiff can introduce
evidence of the full amount of his medical bills to
establish, for example, the total amount of medical expenses
that were “written off” as part of his argument
in connection with his tort claims that he is entitled to
damages - such as pain and suffering, embarrassment, or
reputational harm - related to the alleged “bad
debt” or “uncollectible” write-offs.
See Nicholson v. Thom, 763 S.E.2d 772, 789-91 ( N.C.
Ct. App. 2014) (admitting evidence of write-offs because it
did not implicate the collateral source rule, the abrogation
of which was the reason Rule 414 was enacted). But, to fully
protect Defendant with respect to Rule 414, if Plaintiff is
permitted to offer evidence of the amount of medical bills
written off for a purpose other than to prove past medical
expenses, then the Court will, at the request of Defendant,
issue a limiting instruction informing the jury that the
amount written off cannot be considered in determining
medical expenses in accordance with Rule 414.
the Court hereby GRANTS IN PART and
DENIES IN PART Defendant's motion in
limine to exclude evidence of medical expenses pursuant to
Rule 414 of the North Carolina Rules of Evidence.
 “[W]hen a federal court
exercises diversity jurisdiction, it must apply the
substantive law of the state where it sits.”
Fairchild v. Kubota Tractor Corp., No. 1:18-cv-69,
2018 WL 4038126, at *3 (W.D. N.C. Aug. 23, 2018). The
application of Rule 414 may affect the outcome of litigation
and is substantive North Carolina law. See Lauer v.
United States, No. 1:12-cv-41, 2013 WL 566124, at *3
(W.D. N.C. Feb., 13, 2013) (defining substantive law as law
that “significantly affect[s] the result of
litigation”); Hairston v. Harward, 821 S.E.2d
384, 392 ( N.C. 2018) (stating that the North Carolina
Supreme Court has treated the collateral source rule as a
substantive rule of law concerning damages); Nicholson v.
Thom, 763 S.E.2d 772, 789 n.19 ( N.C. Ct. App. 2014)
(“In 2011, the collateral source rule was abrogated by
Rule 414 of the North Carolina Rules of Evidence with regard
to evidence of past medical expenses.”).
 Plaintiff will of course still be
permitted to introduce all his medical records and testify
fully about his injuries and pain and suffering as damages
related to his breach of contract / estoppel claim.
 With respect to the amount of medical
bills both actually paid/due and written off, the Court again
encourages the parties to stipulate to these amounts which