V First Party Insurance (MedPay Denial)
Ark. Model Jury Instr., Civil V
Arkansas Model Jury Instructions-Civil
December 2023 Update
Chapter 36. Illustrative Sets of Instructions
V First Party Insurance (MedPay Denial)
| STATEMENT OF FACTS |
Anna Lee suffered injuries as a result of an automobile accident that occurred when Jack, Crazy Chester's dog, ran in front of her car. Ms. Lee sought and obtained chiropractic treatment as a result of this occurrence from Dr. Luke Friend. Her chiropractic bills amounted to $5,000.00. At the time of the occurrence, Ms. Lee had a policy of automobile insurance with The Insurance Company of Nazareth. The insurance policy with Nazareth provided that Nazareth would pay up to $5,000.00 of Anna Lee's medical treatment charges that are reasonable and necessary as a result of a car wreck. Nazareth's policy requires the insured to provide reasonable proof of incurred medical treatment charges. Anna Lee submitted her $5,000.00 chiropractic bill to Nazareth under the policy and Nazareth denied the claim. Anna Lee filed suit against Nazareth alleging breach of contract. Nazareth retained Dr. Fanny to offer expert testimony as to whether Dr. Friend's chiropractic treatment was reasonable and necessary.
| (AMI number) | ||
|---|---|---|
| 1. | 103. | Respective Duties of Judge and Jury—Cautionary Instructions. |
| 2. | 104. | Jury—Personal Observations and Experiences. |
| 3. | 105. | Credibility of Witnesses. |
| 4. | 107. | Expert Witnesses. |
| 5. | 108. | Circumstantial Evidence. |
| 6. | 202. | Meaning of Burden of Proof and Preponderance of the Evidence. |
| 7. | 206. | Issues—Affirmative Defenses—Burden of Proof. |
| 8. | 2401. | Issues—Breach of Contract. |
| 9. | 2403. | No Dispute As To Existence of Contract. |
| 10. | 2442. | Damages—General Rule. |
| 11. | 3501. | Closing Instructions. |
Text of Suggested Instructions
1. (AMI 103)
- (a) The faithful performance of your duties as jurors is essential to the administration of justice.
- (b) It is my duty as judge to inform you of the law applicable to this case by instructions, and it is your duty to accept and follow them as a whole, not singling out one instruction to the exclusion of others. You should not consider any rule of law with which you may be familiar unless it is included in my instructions.
- (c) It is your duty to determine the facts from the evidence produced in this trial. You are to apply the law as contained in these instructions to the facts and render your verdict upon the evidence and law. You should not permit sympathy, prejudice, or like or dislike of any party to this action or of any attorney to influence your findings in this case.
- (d) In deciding the issues, you should consider the testimony of the witnesses and the exhibits received in evidence. The introduction of evidence in court is governed by law. You should accept without question my rulings as to the admissibility or rejection of evidence, drawing no inferences that by these rulings I have in any manner indicated my views on the merits of the case.
- (e) Opening statements, remarks during the trial, and closing arguments of the attorneys are not evidence but are made only to help you in understanding the evidence and applicable law. Any argument, statements, or remarks of attorneys having no basis in the evidence should be disregarded by you. However, an admission of fact by an attorney is binding on his or her client.
- (f) I have not intended by anything I have said or done, or by any questions that I may have asked, to intimate or suggest what you should find to be the facts, or that I believe or disbelieve any witness who testified. If anything that I have done or said has seemed to so indicate, you will disregard it.
2. (AMI 104)
In considering the evidence in this case you are not required to set aside your common knowledge, but you have a right to consider all the evidence in the light of your own observations and experiences in the affairs of life.
3. (AMI 105)
You are the sole judges of the weight of the evidence and the credibility of the witnesses. In determining the credibility of any witness and the weight to be given his testimony, you may take into consideration his demeanor while on the witness stand, any prejudice for or against a party, his means of acquiring knowledge concerning any matter to which he testified, any interest he may have in the outcome of the case, and the consistency or inconsistency of his testimony, as well as its reasonableness or unreasonableness.
4. (AMI 107)
An expert witness is a person who has special knowledge, skill, experience, training, or education on the subject to which his testimony relates.
An expert witness may give an opinion on questions in controversy. You may consider the expert's opinion in the light of his qualifications and credibility, the reasons given for the opinion, and the facts and other matters upon which the opinion is based.
You are not bound to accept an expert opinion as conclusive but should give it whatever weight you think it should have. You may disregard any opinion testimony if you find it to be unreasonable.
5. (AMI 108)
A fact in dispute may be proved by circumstantial evidence as well as by direct evidence. A fact is established by direct evidence when, for example, it is proved by witnesses who testify to what they saw, heard, or experienced. A fact is established by circumstantial evidence when its existence can reasonably be inferred from other facts proved in the case.
6. (AMI 202)
A party who has the burden of proof on a proposition must establish it by a preponderance of the evidence, unless the proposition is so established by other proof in the case. “Preponderance of the evidence” means the greater weight of evidence. The greater weight of evidence is not necessarily established by the greater number of witnesses testifying to any fact or state of facts. It is the evidence which, when weighed with that opposed to it, has more convincing force and is more probably true and accurate. If, upon any issue in the case, the evidence appears to be equally balanced, or if you cannot say upon which side it weighs heavier, you must resolve that question against the party who has the burden of proving it.
7. (AMI 206) (MODIFIED)
The Insurance Company of Nazareth contends that the $5,000.00 in chiropractor charges of Anna Lee was unreasonable and unnecessary. The Insurance Company of Nazareth has the burden of proving this contention.
8. (AMI 2401) (MODIFIED)
Anna Lee claims that The Insurance Company of Nazareth breached a contract. The Parties stipulate to each of the following propositions:
- First, that Anna Lee was injured while occupying her vehicle;
- Second, that Anna Lee received chiropractic treatment for said injury; and,
- Third, that The Insurance Company of Nazareth did not pay $5,000.00 of benefits from her coverage within 30 days after proof was received by The Insurance Company of Nazareth.
Anna Lee has the burden of proving the following essential proposition:
That she gave reasonable proof of expenses for her chiropractic treatment totaling $5,000.00 to The Insurance Company of Nazareth.
If you find that Anna Lee has proved this proposition and that The Insurance Company of Nazareth has not proved that the disputed $5,000.00 in charges were unreasonable or unnecessary, then your verdict should be for Anna Lee. If, however, Anna Lee has failed to prove this proposition, then your verdict should be for The Insurance Company of Nazareth.
9. (AMI 2403)
The parties do not dispute that Anna Lee and The Insurance Company of Nazareth entered into a contract.
10. (AMI 2442)
If you decide for Anna Lee on the question of liability, you must then fix the amount of money that Anna Lee proved will reasonably and fairly compensate her for the element of damage resulting from The Insurance Company of Nazareth's breach of contract. The element of damage that Anna Lee claims is:
Whether this element of damage has been proved by the evidence is for you to determine.
11. (AMI 3501)
You have now heard all the evidence and the instructions on the law you must apply in reaching your verdict. You soon will hear the lawyers' closing arguments and then go to the jury room to decide this case. I have a few final instructions for you on how to proceed.
(a) Remember that you are to decide this case fairly, based only on the evidence presented in this courtroom and the law as instructed by me. Do not consider information from any other source. And do not allow sympathy, prejudice, or like or dislike of any party or any attorney in this case to influence your decision. Keep in mind that the Basic Rule I have explained to you throughout the trial continues to apply during your deliberations: You are to discuss the case only among yourselves. Do not communicate about this case and the places and persons involved by any means whatsoever with anyone else at all, or look for or receive any information whatsoever about this case—including through Electronic Devices—other than the evidence in this courtroom and the law as I have instructed you, until your jury duty is complete and I have discharged you.
(b) Any notes you may have taken during the trial may be taken to the jury room to use during your deliberations. Your notes are simply an aid to your own memory, and neither your notes nor those of any other juror are a substitute for your own memory or other jurors' memory. Leave your notes in the jury room when you have concluded your deliberations.
(c) Do not begin deliberations until all of you are assembled in the jury room. Once you are all there, the first thing for you to do is to elect one of you to act as foreperson during your deliberations. The foreperson should see to it that your discussions are orderly and that every one of you has a fair opportunity to be heard.
(d) If any of you needs to communicate with me for any reason, write me a note and give it to (the bailiff) (court personnel). In your note do not disclose any vote or division among yourselves.
At least nine of you must agree to arrive at a verdict.
If your verdict is unanimous, only the foreperson will sign your verdict form.
If your verdict is not unanimous, but nine or more of you agree on the verdict, then each of you who agrees must sign the verdict form. Those of you who do not agree must not sign the verdict form.
VERDICT FORM
We, the Jury find in favor of Anna Lee, the plaintiff, and against The Insurance Company of Nazareth, the defendant, and award damages in the following amount:
| $ | ||
| Foreperson | Date | |
VERDICT FORM
We, the Jury find in favor of The Insurance Company of Nazareth, the defendant and against Anna Lee, the plaintiff.
| Foreperson | Date | |
© 2023 Arkansas Supreme Court Committee on Jury Instructions-Civil
| End of Document |