Woodland Hills personal injury lawyer Barry P. Goldberg is frequently challenged to establish the reasonable value of his client’s medical bills even though they are not paid by health insurance. The “challenge” is presenting a trial without incurring large and arguably unnecessary expert fees merely to have someone testify that medical bills in a particular case are “reasonable.” The insurance defense attorneys are skilled at moving to exclude both the medical bills and the testimony of treating doctors and basically destroying a plaintiff’s entire case.
Pre-trial planning is required to establish past medical expenses. It is dangerous to simply expect the treating doctor to be able to talk about the reasonableness of medical bills without “retaining” and expert on the issue.
“A person who undergoes necessary medical treatment for tortiously caused injuries suffers an economic loss by taking on liability for the costs of treatment. Hence, any reasonable charges for treatment the injured person has paid or, having incurred, still owes the medical provider are recoverable as economic damages.” (Howell v. Hamilton Meats & Provisions, Inc. (2011) 52 Cal. 4th 541, 551 (Howell).) A plaintiff’s recovery for past medical expenses is limited, however, by the reasonable value of the services provided. (Id. at p. 555.) Thus, “[d]amages for past medical expenses are limited to the lesser of (1) the amount paid or incurred for past medical expenses and (2) the reasonable value of the services.” (Corenbaum v. Lampkin (2013) 215 Cal. App. 4th 1308, 1325-1326 (Corenbaum), citing Howell, 52 Cal.4th at p. 556.)
Prior to trial, defendants often move for an order precluding plaintiff from presenting “any evidence through an expert as to the reasonable value of medical care and services provided to plaintiff” on the ground that “such testimony goes beyond the scope of what would be anticipated of a nonretained expert and plaintiff did not disclose any retained expert to testify on that issue.” Defendants argue that only a properly retained and disclosed expert could opine at trial on the reasonable value of plaintiff’s medical treatment, relying on Schreiber v. Estate of Kiser (1999) 22 Cal.4th 31.
However, in Katiuzhinsky v. Perry (2007) 152 Cal.App.4th 1288, 1295-1296, the court held that evidence of the full amount billed is admissible to determine the reasonable value of past medical services, on the ground that “the plaintiffs in that case, who apparently had no health insurance, remained fully liable to their medical providers for the full amount billed despite the providers’ sale of their accounts to a medical finance company at a discount.” (Corenbaum, supra, at p. 1328, fn. 10.)
In Bermudez v. Ciolek, 237 Cal.App.4th 1311, a case involving an uninsured plaintiff, the court emphasized the difference between the admissibility of medical bills and sufficiency of the evidence to establish the reasonable value of medical services. The court observed, “To be clear, . . . neither Howell, supra, 52 Cal.4th 541, nor Corenbaum, supra, 215 Cal.App.4th 1308, holds that billed amounts are inadmissible in cases involving uninsured plaintiffs. Bermudez’s uninsured status meant that billed amounts were relevant to the amount he incurred (unlike insured plaintiffs, who really only incur the lower amount negotiated by their insurer). The billed amounts are also relevant and admissible with regard to the reasonable value of Bermudez’s medical expenses . . . . [Citation.] The admissibility of the billed amount is consistent with the ‘full range of fees’ being relevant in determining the reasonable value of services in the health care marketplace.” (Bermudez, supra, at p. 1335.) The court advised however, “initial medical bills are generally insufficient on their own as a basis for determining the reasonable value of medical services. . . . [A] plaintiff who relies solely on evidence of unpaid medical charges will not meet his burden of proving the reasonable value of medical damages with substantial evidence.” (Id.)
In addition, treating doctors should be given an opportunity to discuss whether there bills are reasonable and those amounts are within their knowledge. However, the “safer” approach is to provide a Declaration with the expert disclosure that the particular treating doctor will be testifying as to the reasonableness of his medical bills. Further, it is advisable to have a separate expert testify as to the reasonableness of all the various medical services. Sometimes, certain doctors, like rehabilitation medicine doctors and pain doctors will have peculiar knowledge concerning medical billing and reasonableness of charges. It is best practice to have a disclosed expert that will testify concerning the reasonableness of unpaid medical charges.