Woodland Hills personal injury lawyer Barry P. Goldberg must value cases based at least in part on the value of the plaintiff’s past medical bills and the value of future medical expenses. Plaintiff trial lawyers struggle in estimating and proving those economic damages particularly in cases where the plaintiff does not have health insurance. Often trial lawyers attempt unsuccessfully to introduce medical bills in order to prove such damages.
With insured plaintiffs, the process is simpler. Pursuant to Howell v. Hamilton Meats & Provisions, Inc. (2011) 52 Cal.4th 541, 548 (Howell), the California Supreme Court concluded that plaintiffs are limited to recovering the amount actually paid on their behalf because the billed amounts did not represent an economic loss the plaintiff incurred. (Id. at 548-49.)
The law has no developed that a plaintiff, whether insured or uninsured, bears the burden of proving her medical damages, which are limited to the lesser of (1) the amount incurred or paid for medical services, and (2) the reasonable value of the services rendered. (Howell at pp. 555-56.) The reasonable value of a service is its market or exchange value, that is the “customary rate,” or the rate that the provider or similar providers “ha[ve] received . . . and other factors, including the reputation of the person giving the services, the skill with which the work is done and the difficulty and danger of the work, are taken into consideration.” (Id.)
When a plaintiff is not insured, medical bills are relevant, and therefore admissible, to prove both the amount incurred and the reasonable value of medical services provided, but they are not sufficient on their own to prove the reasonable value. (See Bermudez v. Ciolek (2015) 237 Cal.App.4th 1311, 1335, 1337.) Rather, the uninsured plaintiff must present additional evidence, likely in the form of expert opinion testimony, to establish that the amount billed is a reasonable value for the service rendered. (See Bermudez, supra, at 1336, 1338.) Additionally, amounts paid by third parties to purchase liens from providers may be relevant to determining the reasonable value of services provided to the uninsured, but it is not error to exclude that evidence without additional evidence establishing a nexus between the amount paid for the lien rights and the reasonable value of the service. (Uspenskaya v. Meline (2015) 241 Cal.App.4th 996, 1007.)
A plaintiff’s trial attorney must find an expert to competently testify that the amount incurred is the reasonable value of the service rendered. A jury could, based on this “wide-ranging inquiry” and in possession of ample conflicting evidence, best decide what the reasonable value of the medical treatment was, which is likely to be the cap on medical damages where the plaintiff is not insured. (Bermudez, supra. at pp. 1330-31, 1338.)
An experienced trial attorney is best equipped to hire the right kind of medical damage expert for an uninsured plaintiff. If plaintiff does not have a “damage” expert, plaintiff risks not introducing any evidence of past and future medical expenses.
