Building on Howell v. Hamilton Meats
Pebley v. Santa Clara Organics, LLC (2018) 22 Cal. App. 5th 1266 has provided further clarification to litigants seeking medical special damages based on unpaid medical bills obtained from providers outside of his/her health insurance plan.
Plaintiff Dave Pebley was injured in a motor vehicle accident caused by defendant Jose Pulido Estrada, an employee of defendant Santa Clara Organics, LLC (Santa Clara). Although Pebley has health insurance, he elected to obtain medical services outside his insurance plan.
Howell v. Hamilton meats holds that: An injured plaintiff with health insurance may not recover economic damages that exceed the amount paid by the insurer for the medical services provided. (Howell v. Hamilton Meats & Provisions, Inc. (2011) 52 Cal.4th 541, 566.
In addition, the amount of the “full bill” for past medical services is not relevant to prove past or future medical expenses and/or non-economic damages. Corenbaum v. Lampkin (2013) 215 Cal.App.4th 1308, 1330-1331.
In contrast, the amount or measure of economic damages for an uninsured plaintiff typically turns on the reasonable value of the services rendered or expected to be rendered. (Bermudez v. Ciolek (2015) 237 Cal.App.4th 1311, 1330-1331. Thus, an uninsured plaintiff may introduce evidence of the amounts billed for medical services to prove the services' reasonable value. (Id. at pp. 1330-1331, 1335.)
The Pebley Court concluded as follows:
We conclude the trial court properly allowed Pebley, as a plaintiff who is treating outside his insurance plan, to introduce evidence of his medical bills.
Pebley's medical experts confirmed these bills represent the reasonable and customary costs for the services in the Southern California community.
Pebley testified he is liable for these costs regardless of this litigation, and his treating surgeons stated they expect to be paid in full
Thus: The court ruled: The full lien amounts that were billed were admissible.
The Pebley holding is quickly changing the how litigants handle medical treatment and present medical bills to a jury. Defense counsel must carefully review Pebley for its terminology and key holdings which provide insight on countering excessive and unreasonable medical services conducted on lien basis.