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Injured Plaintiff not Required to Use Health Insurance

In a minor victory for plaintiffs in California, the Appellate Court for the Second District has ruled that an injured plaintiff who elects not to use an available health insurance plan will be treated as “uninsured” and allowed to present medical billing incurred.

In recent years, laws in California have changed such that plaintiff was allowed only to introduce medical bills for which she was actually responsible. (See e.g. Howell v. Hamilton Meats 52 Cal. 4th 541)  Thus, a plaintiff who, through her own ingenuity and regular payment of healthcare premiums got $500,000.00 worth of treatment for $125,000 (after healthcare write-offs) could only present to the jury that her treatment was worth $125,000.00 – not the reasonable $500,000 value.  In that hypothetical, the defendant gets the benefit of plaintiff’s regular healthcare premium payments and saves $275,000 ($500-$125).

A new case, Pebley v. Santa Clara Organics, LLC (May 8, 2018, No. B277893) ___Cal.App.5th___ [2018 Cal. App. LEXIS 409], could change things a bit.

In Pebley, Plaintiff was injured in a motor vehicle accident caused by a big rig truck driver. Although plaintiff had health insurance, he elected to obtain medical services outside his insurance plan. A jury found the truck driver and his employer liable for plaintiff’s injuries and awarded him $3,644,000 in damages, including $269,000 for past medical expenses and $375,000 for future medical expenses.

Defendant appealed, arguing it should have been permitted to inform he jury that Pebley had insurance and elected not to use it, thus forgoing any health insurance write-offs to which he may have been entitled.

The judgment was affirmed. The trial court properly allowed plaintiff to introduce evidence of his medical bills. The trial court did not abuse its discretion by excluding evidence of plaintiff’s insured status under Evid. Code, § 352. The plaintiff had the right to treat outside his plan. Evidence of insurance would have confused the issues or misled and prejudiced the jury. The parties properly engaged in a wide-ranging inquiry into the reasonable value of medical services provided. It was appropriate for plaintiff’s surgeons to testify regarding the reasonable cost of reasonably necessary medical care that plaintiff had received and was expected to receive in the future.

If you have been injured, call Heiting & Irwin today.

Mr. Serrano has been admitted to practice before California State and Federal Courts. He was named to the Super Lawyers’ 2012, 2013, 2014, 2015, and 2016 Southern California Rising Stars List, an honor awarded to no more than 2.5% of attorneys in Southern California each year. View Attorney Jean-Simon Serrano's Attorney Bio Here.

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