# authority.md — mva-medical-chronology

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

## Billed amount has not been the operative number since 2017

### § 490.715 RSMo ✅ VERIFIED — current version eff. Aug. 28, 2017 (S.B. 31)

- **§ 490.715.5(1)** — "parties **may** introduce evidence of the **actual cost** of the medical care
  or treatment rendered." Actual cost must be reasonable, necessary, and a proximate result of the
  negligence or fault of any party.
- **§ 490.715.5(2)** — **"actual cost"** = "a sum of money not to exceed the dollar amounts paid by
  or on behalf of a plaintiff… plus any remaining dollar amount necessary to satisfy the financial
  obligation… after adjustment for any contractual discounts, price reduction, or **write-off** by
  any person or entity." *(singular — quote it correctly)*
- **§ 490.715.1** — bars collateral-source evidence. **§ 490.715.4** — "does not require the
  exclusion of evidence admissible for another proper purpose."

### 🔶 The 2017 amendment DELETED the rebuttable presumption

The 2005 version created "a rebuttable presumption that the dollar amount necessary to satisfy the
financial obligation… represents the value of the medical treatment rendered." **The current version
has no presumption at all.** It is a bare permission. This is why *Deck* is a construction case about
a statute that no longer exists in that form.

### *Deck v. Teasley*, 322 S.W.3d 536 (Mo. banc 2010) ✅

Construed the **former** § 490.715.5 — **say so every time it is cited.**
⚠️ **Pin cite conflict: use 539**, which is what *Brancati* cites for the holding that the trial court
erred in limiting past medicals to the amount paid and that the plaintiff could present the amount
**charged** as additional evidence of value. ⛔ Confirm 538 before using it for anything.

### *Brancati v. Bi-State Dev. Agency*, 571 S.W.3d 625 (Mo. App. E.D. 2018) ✅

Transfer denied Apr. 30, 2019. ⚠️ **571 S.W.3d 625 is an ambiguous reporter page** (also *Hurd v.
State*) — cite by full case name.

⚠️ **The "amendment rendered inert" framing is the defense bar's spin and it is wrong.** The court's
reasoning is structural: § .1 bars collateral-source evidence; §§ .2–.3 address defendant-side
payments and "have no application to the collateral source rule"; § .4 preserves evidence admissible
for another proper purpose; **§ .5 is an *exception* to the collateral-source bar**, letting in
actual-cost evidence the rule would otherwise exclude. "**May**" shows actual cost is not the only
permissible evidence. "Nowhere does the statute state that the 'actual cost' of medical bills is the
'only' evidence of medical bills that may be introduced."

**Correct teaching: the amendment ADDED a defense tool without SUBTRACTING the plaintiff's**, because
§ 490.715 never barred **charges** — the collateral source rule bars evidence of collateral
**payments**, not of **charges**. **One-directional, not inert.** Eastern District only; the Supreme
Court has not spoken.

**Worked numbers:** charged $77,515.48; paid or owed $40,842.95; verdict $625,000.

### Collateral source rule

*Roberts v. BJC Health System*, 391 S.W.3d 433, 439 (Mo. banc 2013) ✅ — a wrongdoer should not enjoy
reduced liability because the injured person was protected by insurance or payment from another
source.

## ⇒ Operational rule

**Carry billed / adjusted / paid / outstanding per provider, with separate subtotals.** Never collapse
to one column. mva-records-request already requests all four; the demand-builder damages table
inherits all four. A single "Amount" column propagates an error from here into the letter.

## Gap taxonomy 🔶 — a flat 30-day rule is too crude

| Gap location | What it actually is | Argument |
|---|---|---|
| Injury → first treatment | **Causation** problem | adrenaline, delayed onset, access |
| Mid-course | **Mitigation** problem | work, childcare, cost, insurance |
| Before a scheduled study | **Scheduling artifact** | not a gap at all — say so |

## Also track

- **Pre-existing condition to the same body part.** First thing the adjuster runs in the ISO
  ClaimSearch index. Nothing currently tracks it.
- **Causation language.** Flag records that do or do not contain "related to the motor vehicle
  accident of [date]." Its absence is the soft spot; surface it here, not in the demand.
- **Provider-type flags:** LOP/lien treatment, chiropractic-heavy courses, referral relationships.
  All get attacked at valuation.
- 🔶 **Chiropractors and physical therapists are § 516.105 defendants — 2 years, not 5.** If the
  chronology shows a treatment injury, the SOL is different from the case's. Flag it.