Colorado Court Allows Medical Billing Expert Testimony in Personal Injury Case

In Colorado, a recent court decision is poised to significantly impact how personal injury cases involving medical billing disputes are handled. The ruling, concerning the admissibility of expert testimony on medical billing, could change the way courts evaluate the reasonableness of medical charges in litigation across the state. This development highlights the crucial role of medical billing experts in personal injury claims and offers new avenues for both plaintiffs and defendants to substantiate their arguments regarding medical expenses.

The Core of the Matter: Medical Billing Expert Testimony

At the heart of this issue is the question of whether a qualified expert can provide testimony on the “usual, customary, and reasonable” (UCR) charges for medical services. In personal injury cases, medical expenses often form a significant portion of the damages claimed. However, the billed amounts may not always reflect the actual value or appropriateness of the services rendered. This is where medical billing experts step in.

A medical billing expert is someone with specialized knowledge of medical billing practices, regulations, and the healthcare economy. They can analyze medical records, billing statements, and coding systems to determine if the charges are justified and in line with industry standards. Their expertise can shed light on issues such as:

Reasonableness of charges: Are the billed amounts consistent with what is typically charged for similar services in the same geographic area?
Medical necessity: Were all the procedures and treatments necessary for the patient’s condition?
Coding accuracy: Were the correct billing codes used to represent the services provided?
Billing practices: Do the billing practices comply with applicable regulations and ethical standards?

The Recent Ruling: A Closer Look

In July 2025, District Court Judge Don Jesse Tusant in Arapahoe County denied a motion to exclude the testimony of expert witness Michael Arrigo in the case of Brent Nelson and Cara Merittz v. Benyam Cha Bud Tips Incorporated D/B/Domino’s Pizza and Domino’s Pizza LLC. Arrigo, an authority on medical billing and healthcare economics, was admitted to provide analysis on UCR charges for the plaintiff’s medical care. The court’s decision, citing Colorado Rules of Evidence 702 and referencing the Colorado Supreme Court decision in People v. Shreck, emphasized the importance of ensuring that expert testimony is relevant and based on reliable principles and methods.

Arrigo’s testimony will address the appropriateness of the plaintiff’s medical bills using methodologies that compare current procedural terminology (CPT) codes, diagnosis-related groupings (DRGs), resource utilization groups (RUGs), and healthcare common procedure coding system (HCPCS) codes. His analysis will also include comparing charges for hospital stays and episodes of care using DRG algorithms, reviewing inpatient and skilled nursing facility (SNF) charges, and examining billing practices without factoring in collateral sources such as insurance payments.

Why This Matters: Implications for Personal Injury Cases

This ruling has several important implications for personal injury cases in Colorado:

Increased Scrutiny of Medical Bills: The admissibility of expert testimony means that medical bills will likely face greater scrutiny in personal injury cases. Both plaintiffs and defendants will have the opportunity to challenge the reasonableness and necessity of medical expenses with the help of qualified experts.
Leveling the Playing Field: Medical billing can be complex and confusing, even for those familiar with the healthcare system. Expert testimony can help level the playing field by providing clear, objective analysis of medical charges.
Potential for Cost Savings: By challenging inflated or unreasonable medical bills, defendants may be able to reduce the amount of damages they are required to pay. Plaintiffs, on the other hand, can use expert testimony to justify the full extent of their medical expenses and ensure they are fairly compensated.
Guidance for Attorneys and Insurers: As the litigation advances, Judge Tusant’s ruling is expected to serve as a reference point for attorneys and insurers handling cases involving complex medical billing and coding matters.

The Daubert Standard and Expert Testimony

Colorado adheres to the Daubert standard for determining the admissibility of expert testimony, as established in Daubert v. Merrell Dow Pharmaceuticals, Inc. and adopted by the Colorado Supreme Court in People v. Shreck. This standard requires trial judges to act as “gatekeepers,” ensuring that expert testimony is both relevant and reliable.

Under Colorado Rule of Evidence 702, a qualified expert may testify if:

Their specialized knowledge will assist the trier of fact (i.e., the jury or judge) to understand the evidence or determine a fact in issue.
The testimony is based on sufficient facts or data.
The testimony is the product of reliable principles and methods.
The expert has reliably applied the principles and methods to the facts of the case.

In the Nelson and Merittz v. Cha Bud Tips Incorporated case, the court found that Arrigo’s qualifications and methodologies satisfied these standards, paving the way for his testimony on medical billing.

Challenges to Expert Admissibility

Despite the recent ruling, challenges to the admissibility of medical billing expert testimony are still possible. Common challenges include:

Qualifications: Opposing counsel may argue that the expert lacks the necessary qualifications or experience to provide reliable testimony.
Methodology: The expert’s methodology may be challenged as unreliable or not generally accepted in the relevant scientific community.
Relevance: Opposing counsel may argue that the expert’s testimony is not relevant to the issues in the case or will not assist the trier of fact.

To overcome these challenges, it is crucial to:

Establish the expert’s qualifications: Thoroughly vet the expert’s credentials, experience, and expertise in medical billing and coding.
Demonstrate the reliability of the methodology: Ensure that the expert’s methodology is based on sound principles and methods that are generally accepted in the field.
Show relevance to the case: Clearly explain how the expert’s testimony will assist the jury or judge in understanding the issues and determining the facts.

The Role of Lay Witnesses

While expert testimony can be invaluable in complex medical billing cases, it is also worth noting that lay witnesses can sometimes provide testimony on the reasonable value of medical expenses. In Mullins v. Medical Lien Management, Inc., the Colorado Court of Appeals held that a lay witness with “familiarity” with medical billing costs could offer opinion testimony on the reasonableness and necessity of medical expenses.

This ruling suggests that individuals who regularly review medical bills as part of their job duties such as insurance adjusters can testify about the reasonable value of medical procedures based on their familiarity with billing practices in the relevant geographic area.

Finding a Qualified Medical Billing Expert

Given the increasing importance of medical billing expert testimony in personal injury cases, finding a qualified expert is essential. Some resources for locating medical billing experts in Colorado include:

Professional organizations: Organizations such as the American Medical Billing Association (AMBA) and the Healthcare Financial Management Association (HFMA) may offer directories of qualified members.
Expert witness directories: Online directories such as JurisPro and ExpertLaw list expert witnesses in various fields, including medical billing.
Referrals from attorneys: Personal injury attorneys who handle medical billing disputes may be able to recommend qualified experts.
Colorado Trial Lawyers Association (CTLA): CTLA provides resources and listings of medical expert witnesses.

When selecting a medical billing expert, consider their qualifications, experience, methodology, and communication skills. It is also important to ensure that the expert is independent and unbiased.

Conclusion

The Colorado court’s decision to allow medical billing expert testimony in personal injury cases marks a significant development in how these cases are litigated. By providing a mechanism for scrutinizing medical bills and challenging unreasonable charges, this ruling has the potential to promote fairness and accuracy in personal injury settlements and verdicts. Both plaintiffs and defendants should be aware of this development and consider consulting with a qualified medical billing expert to assess the reasonableness of medical expenses in their cases.

Do you have questions about how this ruling might impact your personal injury case? Contact us today for a consultation.