Health Insurance Claim Articles

Is A Surviving Spouse Liable For The Deceased Spouse's
"Uninsured" Medical Bills?

In my health insurance, life insurance, and long-term care insurance practice, I sometimes encounter the tangential issue of keeping the deceased insured’s creditors, such as hospitals and doctors, at bay from the deceased’s spouse until it is determined whether the creditors’ bills should have been paid by the insurance company. This begs the question: notwithstanding any contractual obligation the insurance company may have to pay a deceased spouse’s medical bills, is the deceased’s surviving spouse legally on the hook for such bills?

A common law doctrine called the “necessaries doctrine” addresses this question:

It has been observed that virtually all necessaries doctrine cases concern hospitals seeking to collect debts resulting from medical services rendered to a married person, often during a last illness. Medical services have been considered necessaries pursuant to the doctrine. Accordingly, if medical services a husband received were necessary and the husband maintained no separate assets, his wife would be liable for the reasonable value of such services.¹

As to necessaries, at common law an obligation is imposed on the husband to provide necessaries for his wife or family… . Even today, cases may be found which state this rule, though the courts and legislatures are unquestionably moving toward a more neutral expression of the principle, noting that either or both husband and wife may be held responsible for necessaries bestowed on the other or their offspring. A few courts, however, have refused to accept this approach, instead holding the common-law doctrine of necessaries unconstitutional on equal protection grounds and abrogating the doctrine entirely. One case, decided by the Alabama Supreme Court, squarely addressed the constitutionality of the common-law necessaries doctrine, and held that it constituted an impermissible gender-based classification, violative of the Fourteenth Amendment Equal Protection Clause, since it imposed an obligation of spousal support for necessaries on the husband without imposing a similar obligation on the wife and was not substantially related to serving any important governmental interest. The court specifically declined to expand the doctrine so as to make both spouses equally liable for necessaries provided to either, maintaining that this would usurp the legislative function. … A somewhat more appropriate view has been taken by the New Jersey Supreme Court, which also squarely addressed the constitutionality of the common-law necessaries doctrine. In that case, the question was whether a wife should be held liable under the doctrine for the last illness expenses of her husband, and the court, after reviewing the common-law roots of the doctrine, ruled that it ran ‘afoul of the equal protection clause,’ that it was ‘an anachronism that no longer fits contemporary society’ and that even if the federal and state constitutions did not mandate a change, the common law could and should ‘adapt to changes such as the movement of married women toward economic equality.’ The court then considered the alternatives available to it for establishing gender neutrality, including potential legislative solutions, and then reached its conclusion: ‘We hold that both spouses are liable for the necessary expenses incurred by either spouse. In a viable marriage, the marital partners can decide between themselves how to pay their debts. A creditor providing necessaries to one spouse can assume that the financial resources of both spouses are available for payment. However, in the absence of an agreement, the income and property of one spouse should not be exposed to satisfy a debt incurred by the other spouse unless the assets of the spouse who incurred the debt are insufficient.

‘Normally a person is not liable for the debt of another in the absence of an agreement. The imposition of liability based on marital status alone is an exception to that rule. Nonetheless, it is a justifiable exception. The reasonable expectations of marital partners are that their income and assets are held for the benefit of the marital partnership and, incidentally, for creditors who provide necessaries for either spouse. However, it would be unfair to accord the same rights to a creditor who provides necessaries on the basis of an agreement with one spouse as to a creditor who has an agreement with both spouses. In the absence of such an agreement, a creditor should have recourse to the property of both spouses only where the financial resources of the spouse who incurred the necessary expense are insufficient. Marshalling the marital resources in that manner grants some protection to a spouse who has not expressly consented to that debt.’²

Whether or not the “necessaries doctrine” applies to you (i.e., whether or not you are on the hook for your deceased spouse’s pending medical bills) revolves around where you live. As for the Sunshine State, Florida has done away with the “necessaries doctrine.” In Florida, “[n]either a husband nor a wife can now be held responsible to third parties for the necessary maintenance of his or her spouse, unless, of course, said party agrees by contract to be held liable.”³

¹ 41 C.J.S. Husband and Wife § 84 (West, Mar. 2014) (internal citations omitted).
² 5 Williston on Contracts § 11:9 (West, May 2014) (internal citations omitted).
³ 25 Fla Jur 2d Family Law § 463 (West, May 2014) (citing Connor v. SW Fla. Reg’l Med. Ctr., Inc., 668 So. 2d 175 (Fla. 1995)).

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