Metropolitan News-Enterprise


Monday, October 24, 2016


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C.A. Takes Pro-Plaintiff View on Proof of Medical Damages

Panel Reaffirms Rule Allowing Full Amount of Doctor Bills to Be Admitted as Evidence




A plaintiff may present evidence of the full amount billed for medical services, rather than what was ultimately accepted, in order to prove the reasonable value of the services rendered, the Third District Court of Appeal ruled Friday.

The panel rejected arguments by a defendant involved in an auto collision, Richard Mercer, and by defense counsel groups that filed an amicus brief, that a 2011 state Supreme Court decision caps recoverable medical damages at the amount actually paid to the doctors by a medical finance company.

In that 6-1 decision, Howell v. Hamilton Meats and Provisions, Inc. (2011) 52 Cal.4th 541, the justices said a San Diego-area woman, who was insured, could not recover the full amount billed by the doctors and hospitals which treated her after a car accident, since her medical providers accepted a reduced payment from her insurance company.

The plaintiff in the case decided on Friday was uninsured.

Writing for the appeals court, Presiding Justice Vance Raye said:

“To resolve this defense appeal, we descend down a rabbit hole into the upside-down world of health care billing, where different payers pay different prices for the same services and those least equipped to pay, pay the most, yet an injured, uninsured plaintiff, Lillie Moore, must somehow prove the reasonable value of the medical services she incurred following a motor vehicle collision.”

Explains Procedures

Moore, the jurist explained, is among a rising number of uninsured plaintiffs whose medical bills are paid by medical finance companies. Doctors obtain liens against the patients’ personal injury recoveries, then sell those liens to companies like MedFinManager California, L.L.C.

Such companies generally work with the doctors and the plaintiffs’ lawyers to determine whether the claim is worth investing in. If it is, the company will generally offer the doctors about 50 percent of the reasonable value of the services, as determined on the basis of a standard fee schedule.

In Moore’s case, she executed medial lien agreements requiring her to pay the full amount of fees billed. The providers subsequently sold their bills and liens to MedFin.

At trial, her attorneys moved in limine to exclude all evidence related to MedFin and how much it was paid. Sacramento Superior Court Judge David DeAlba granted the motion, saying the introduction of such evidence would require litigation of collateral issues not relevant to the value of the services.

Moore presented evidence that the reasonable value of medical services rendered was more than $190,000. A defense expert countered that the hospital and three other medical providers billed about $100,000 in excess of the reasonable value of the services.

The judge directed a verdict for the plaintiff on negligence and causation. The jury awarded $522,000 in damages, including $122,000 for past medical expenses.

The sole issue on appeal was whether the medical damages were excessive.

The defense argued that the “amount that Moore’s healthcare providers accepted in full payment for their services is the only evidence that is relevant to prove Moore’s economic damages for medical expenses.”

Stance Termed ‘Radical’

Raye called the argument “radical,” explaining:

“The difficulty of the procedure, or surgery; the expertise of the surgeons; the number of surgeons competent to perform an intricate, high-risk surgery; and the multitude of other factors that would ordinarily help a jury assess reasonable value would, under defendant’s restrictive view of admissibility, be deemed irrelevant,” he said. “To accept defendant’s application of Howell would require us to disavow the contrary rationale we adopted in Katiuzhinsky [v. Perry (2007)] 152 Cal.App.4th 1288.”

In Katiuzhinsky, which was also a MedFin case, the appellate panel overruled a trial court ruling limiting medical damages to the amount MedFin had paid for the lien. Howell did not overrule that case, Raye insisted, concluding that DeAlba’s §352 ruling was within his discretion.

The case is Moore v. Mercer, 16 S.O.S. 5112.


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