# authority.md — mva-case-evaluation

Canonical text lives in `mo-authority.md` (bundled). This file is the valuation slice.
**Verified July 16, 2026.** Legend: ✅ verified · 🔶 new · ⚠️ corrected · ⛔ open, do not state.

## 🔶 Liens: ask the right question first

**Missouri is an ANTI-SUBROGATION state, not a made-whole state.** Public policy bars assignment of a
PI claim in whole or in part; an insurer's subrogation interest in an insured's PI claim against a
third-party tortfeasor is **void**.

- *Hays v. Missouri Highways & Transportation Commission*, **62 S.W.3d 538, 540** (Mo. App. W.D.
  2001) ✅
- *Buatte v. Gencare Health Systems, Inc.*, 939 S.W.2d 440 (Mo. App. 1996) ✅
- *Benton House, LLC v. Cook & Younts Insurance, Inc.*, 249 S.W.3d 878 (Mo. App. 2008) ✅

**The first lien question is not "how far do we negotiate this down." It is "does this entity have
any right to be paid at all." For a fully-insured non-ERISA health plan the answer is frequently no.**

| | Rule |
|---|---|
| **Default** | No subrogation of a Missouri PI recovery. |
| **ERISA self-funded** | Preempts. *US Airways v. McCutchen*, 569 U.S. 88 (2013) ✅ — plan terms override made-whole, **but a silent plan lets the common-fund doctrine reduce the lien** → get the plan document (29 U.S.C. § 1024(b)(4) ✅; penalty at § 1132(c)(1)(B) ✅). *Montanile v. Bd. of Trustees*, 577 U.S. 136 (2016) ✅ — **cannot reach general assets once the fund is dissipated**. *Great-West v. Knudson*, 534 U.S. 204 (2002) ✅. |
| **FEHBA** | *Nevils*, 418 S.W.3d 451 (Mo. banc 2014) ✅ held no preemption — **REVERSED** by *Coventry Health Care of Mo. v. Nevils*, 581 U.S. 87 (2017) ✅. **FEHBA preempts.** Citing *Nevils I* as good law is two steps behind. |
| **Medicare** | 42 U.S.C. § 1395y(b)(2) ✅. **42 C.F.R. § 411.24(g)** ✅ — right of action against the **attorney**. § 411.24(h) ✅ — 60 days. **§ 411.24(i)(1)** ✅ — primary payer **pays twice** if Medicare isn't reimbursed. That is the lever. § 1395y(b)(8) ✅ Section 111 reporting. |
| **Medicaid / MO HealthNet** | *Ahlborn*, 547 U.S. 268 (2006) ✅; *Wos*, 568 U.S. 627 (2013) ✅; ***Gallardo v. Marstiller*, 596 U.S. 420 (2022)** ✅ — reaches **future** medicals. **Any allocation on pre-2022 assumptions is wrong.** |
| **Hospital & ambulance** | Statutory liens, not subrogation — which is why they survive. |

### ⚠️ Hospital liens: TWO different 50% rules

**§ 430.225.3** ✅ — the **sharing** rule: liens share "in up to fifty percent of the **net proceeds**
due the patient," where net proceeds = "the amount remaining after the payment of **contractual
attorney fees, if any, and other expenses of recovery**."

**§ 430.250** ✅ — **enforcement**, on a **different base**: a payor paying over a noticed lien is
liable for one year, measured against "fifty percent of the moneys due to such patient… after paying
the amount of **attorneys' liens, federal and Missouri workers' compensation liens, and any prior
liens**."

**Two formulations, two denominators.** That is why it is misstated. §§ 430.230, 430.240 ⛔ not pulled.
**§ 190.250** ✅ — **ambulance liens**, same rights. In nearly every file. § 537.675 ⛔.

## 🔶 Government defendant: the cap does not reach the driver

**Name the individual employee-driver.** Driving is **ministerial** → no official immunity → the
§ 537.610.2 cap runs only to the entity.

*State ex rel. Trimble v. Ryan*, 745 S.W.2d 672, 675 (Mo. banc 1988) ✅ · *Cottey v. Schmitter*,
24 S.W.3d 126, 128 (Mo. App. W.D. 2000) ✅ · *Cole ex rel. Cole v. Warren County R-III Sch. Dist.*,
23 S.W.3d 756, 761 (Mo. App. E.D. 2000) ✅ (⚠️ ambiguous reporter page — cite by full name) ·
*Brancati v. Bi-State Dev. Agency*, 571 S.W.3d 625 (Mo. App. E.D. 2018) ✅ — **entity capped at
$414,418; driver liable for the full $625,000.**

**Ask what policy the entity bought before asking about the cap** — § 537.610.1; *Kunzie v. City of
Olivette*, 184 S.W.3d 570, 574 (Mo. banc 2006) ✅ (insurance waives immunity to the extent of
coverage). § 537.600.1(1) ✅ · *Southers v. City of Farmington*, 263 S.W.3d 603, 610 (Mo. banc 2008) ✅.
**§ 537.610.3** ✅ — **no punitives against a public entity.**
⛔ **Current cap figure unverified.** § 537.610.5 indexes annually to the BEA Implicit Price Deflator,
published in the *Missouri Register*. **Pull it. Do not hardcode. Do not extrapolate.**

## Specials: four numbers, not one

**§ 490.715.5** ✅ — **actual cost** is the operative measure since 8/28/2017; the 2017 amendment
**deleted the rebuttable presumption** that existed in the 2005 version. *Deck v. Teasley*, 322
S.W.3d 536, **539** (Mo. banc 2010) ✅ construed the **former** statute. *Brancati* ✅ — the amendment
is **one-directional**: it added a defense tool without subtracting the plaintiff's charges evidence.
Carry **billed / adjusted / paid / outstanding**.

## Punitive damages — § 510.261 ✅

SB 591, eff. **Aug. 28, 2020**; applies **only to actions filed on or after** that date.
- **§ 510.261.1** — clear and convincing: defendant "intentionally harmed the plaintiff without just
  cause **or acted with a deliberate and flagrant disregard for the safety of others**." Replaces the
  complete-indifference formulation from *Rodriguez v. Suzuki Motor Corp.*, 936 S.W.2d 104 (Mo. banc
  1996) ✅; see also *Schroeder v. Lester E. Cox Med. Ctr.*, 833 S.W.2d 411 (Mo. App. 1992) ✅.
- ⚠️ **§ 510.261.5** — leave on written motion **no later than 120 days prior to the FINAL PRETRIAL
  CONFERENCE** (or 120 days before trial only if none is scheduled). **Not "120 days before trial."**
- ⛔ Whether .1 raises the bar in a **DWI** case is **unlitigated**. Present as unsettled.
- 🔶 *Werremeyer v. KC Auto Salvage Co.*, 134 S.W.3d 633 (Mo. banc 2004) ✅ — **prejudgment interest
  reaches the punitive award.** Couples the § 408.040 compliance block to the punitive analysis.

**§ 538.210** ⛔ caps non-economic damages in **med mal**, **not** ordinary negligence; *Watts* struck
the common-law-claim cap. **Do not import a cap that does not exist in MVA.**

## Coverage and the limited-limits path

- *Scottsdale Ins. Co. v. Addison Ins. Co.*, 448 S.W.3d 818 (Mo. banc 2014) ✅ — duty to settle.
- *Zumwalt v. Utilities Ins. Co.*, 228 S.W.2d 750 (Mo. 1950) ✅.
- **§ 537.065** ✅ (SS HB 345, eff. 8/28/2021): **.1** available only where the insurer had the chance
  to defend without reservation and refused; **.2** notice + contract copy **within 30 days of
  execution**; **.3** no judgment for **30 days** after notice; **.4** **unconditional right to
  intervene within 30 days**, with full defendant rights and **not bound by prior agreements or
  orders**; **.5** applies **regardless of the label**. **§ 435.415.2** ✅ — arbitration awards not
  binding on a non-consenting insurer, and declining is **not bad faith**.
  *Allen v. Bryers*, 512 S.W.3d 17, 35–36 (Mo. banc 2016) ✅. ⛔ A 2026 W.D. decision (*Lyda*) on the
  2021 rights is reported but unverified.
- **UM/UIM:** *Ritchie*, 307 S.W.3d 132 ✅ · *Floyd-Tunnell*, 439 S.W.3d 215 ✅ (anti-stacking) ·
  *Gulf Ins. v. Noble Broadcast*, 936 S.W.2d 810, 814 (Mo. banc 1997) ✅ (contra proferentem) ·
  *Columbia Mut. v. Epstein*, 239 S.W.3d 667 (Mo. App. 2007) ✅ (**insurer** bears the burden on an
  exclusion) · *Standard Artificial Limb v. Allianz*, 895 S.W.2d 205, 209 (Mo. App. 1995) ✅.
  **The waterfall must handle the UIM offset** — that is where a serious-injury limited-limits case
  actually resolves.

## Venue is a line item, not a vibe

**§ 508.010** ⛔ (rewritten 2005) — not pulled. The spread between the City of St. Louis and a rural
county is not a rounding error. *Ford Motor Co. v. Mont. Eighth Jud. Dist. Ct.*, 592 U.S. 351 (2021)
✅ for the manufacturer-defendant crashworthiness case.

## Comparative fault

*Gustafson v. Benda*, 661 S.W.2d 11 (Mo. banc **1983**) ✅ — pure; reduces, does not bar. ⛔ pin cite.

## Medicare beneficiaries — the branch the waterfall forgets

If the client is on Medicare or approaching eligibility, the net-to-client is not
computable until three things are resolved, and none of them are the model's call:
- **Conditional payments** through the BCRC. 42 C.F.R. § 411.24(h) ✅ — 60 days to
  reimburse; § 411.24(i)(1) ✅ — the primary payer pays **twice** if it isn't.
- **A Medicare Set-Aside**, where future injury-related care is expected. There is
  no MVA-specific CMS review threshold analogous to the workers' compensation
  program ⛔ — the practice is unsettled and the exposure is the beneficiary's.
- **Section 111 reporting** by the payer. 42 U.S.C. § 1395y(b)(8) ✅.

**Flag it and route it. Never model a Medicare beneficiary's net as if it were
clean.** A structured settlement may be the vehicle; that is a decision, not a
calculation.