California Appellate Court Upholds Reasonable Value of Medical Services for Uninsured Victim of Car Accident

Recently, the California Court of Appeal reviewed an appeal involving a personal injury plaintiff’s damages for past medical expenses. At issue was the reasonable value of medical services received by the plaintiff, who, at the time of the underlying motor vehicle accident, was uninsured. The court narrowed their decision, abiding by precedent that a plaintiff is entitled to recover from the tortfeasor the reasonable value of medical services.paperwork

In this case, defendant Richard Mercer admitted he negligently collided with plaintiff Lillie Moore’s vehicle. Ms. Moore’s health and lifestyle were negatively affected, and she had not suffered any physical limitations before the accident.  At the time of the collision, Ms. Moore was uninsured.

Ms. Moore’s life changed greatly following the accident, and she eventually moved to be near additional family support.  After being unable to engage with her son or participate in full-time work, Ms. Moore agreed to undergo disk replacement surgery for her back. The court noted that disk replacement surgery is difficult, and only five or six surgeons in the Sacramento area regularly conduct these procedures. Before securing medical treatment, Ms. Moore executed medical lien agreements with her health care providers. They obligated her to pay the full amount of billed fees. Her providers sold their bills and liens to Medfin, a medical finance company.

At trial, Ms. Moore offered evidence of two summarized medical bills she incurred due to the collision injuries. Her doctors testified that the amounts they had billed reflected their ordinary and customary charges and the reasonable value of their services.

For the defense, a billing expert and registered nurse reviewed the bills and opined that the reasonable value of the services was not $175,223.52 but was $71,106.12.

The jury then awarded the plaintiff $522,689 in damages, including $122,689 for past medical expenses. The defendant challenged this amount, based on the reasonable value of services set forth by the defense expert ($51,582.88). The defendant appealed.

The appellate court framed the issue as whether a trial court has discretion under Evidence Code section 352 to exclude evidence of an injured plaintiff’s medical liens and the sale of those liens to a medical finance company, when the evidence is minimally probative and requires undue consumption of time.

First, the court stated plaintiffs have a two-step burden of proof in establishing damages for past medical services. First, plaintiffs must show they actually incurred the medical expenses, and the amount of liability for the expenses caps the potential recovery. Second, they must show the reasonable value of the medical services, and they are entitled to no more than the expenses they actually incurred.

The court looked at precedent, stating that the rule is a plaintiff’s recovery is limited to the amount he paid, or for which he incurred liability for past medical services and care.  The principle is that an award of damages cannot place the plaintiff in a better position than if the wrong had not been done.

Regarding the relevancy of the evidence, the trial court here described the evidence as irrelevant but then later recognized it may be probative. It was excluded in order to avoid the ancillary and collateral issues.  The danger of prejudice is that a jury could rely on a third-party payment to make its award. This would not represent the reasonable value of a plaintiff’s treatment and would result in a situation in which the plaintiff is not made whole because the third-party payment was not the reasonable value of a plaintiff’s treatment.

Regarding the directed verdict on causation, the appellate court stated that the defendant argued the judgment should be reversed, on the ground that the plaintiff “presumably” suffered injuries in a high-impact rollover collision 12 years before the accident with the defendant.  The court stated there was no evidence that anything other than the 2008 collision caused the plaintiff’s injuries.  Here, all the doctors had agreed it was more probable than not that the disk protrusion the plaintiff suffered was caused by her 2008 collision with the defendant.

The court made clear that the issue before the jury was whether Ms. Moore proved the reasonable cost of “reasonably necessary medical care” that she received.

Directed verdicts are granted when the court determines there is no evidence to support the claim of the party opposing the motion. Here, there was no evidence supporting the defense’s claim that the earlier accident was a substantial factor in causing Ms. Moore’s injuries. The court stated that in light of the unanimity among the experts, it was more probable than not that the 2008 collision was a substantial factor leading to Ms. Moore’s damages and the medical treatment she received.

The appellate court affirmed the judgment but reversed the order of sanctions against the defense.

The car accident attorneys at Sharifi Firm help victims throughout Southern California in personal injury claims for compensation. Call our office today for a free consultation at 866-422-7222 or complete our online form.

More Blog Posts:

Man Injured in Fall on Steps Outside Apartment Not Entitled to Future Damages; California Court Holds Jury’s Award was Supported by Substantial Evidence, Southern California Injury Lawyer Blog, October 13, 2016

California Court Finds Substantial Evidence Supported Jury’s Finding that Defendant’s Negligence Did not Cause Plaintiff’s Injuries in Rear End Collision, Southern California Injury Lawyer Blog, August 4, 2016

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