Another Reason You Need an Experienced Attorney: In California, Accident Victims can Only Recover the 'Reasonable Value' of Their Medical Treatment

October 27, 2014

by Tanya P. Tambling

In California, a plaintiff is only able to recover the reasonable value of medical services provided. Howell v. Hamilton Meats & Provisions, Inc. (2011) 52 Cal.4th 541.  The reasonable value of medical services generally equates to the actual amount paid for past medical services versus the amount billed.   Id. at 556.  This means that a plaintiff can usually recover the expenses paid by a private insurance carrier for past medical bills that relate to an accident that a provider accepts as payment in full. Id. at 566.

To justify this holding, Howell reasoned that there are significant disparities between the amounts charged and the cost of providing services from hospital to hospital in California. Id. at 560- 564.  As a result, the amount billed for a service does not accurately represent its market value or the actual cost of providing that service. Id.

Howell led to a later determination that the full amount billed for a plaintiff’s medical care is irrelevant to show the value of past and future medical services. Corenbaum v. Lampkin (2013) 215 Cal.App.4th 1308, 1328-1331.  The full amount billed for a service is also inadmissible if the plaintiff’s medical providers agreed to accept less than the billed amount for services provided. Id.

A recent case before California Court of Appeal applied the reasoning in Howell and Corenbaum even when no prior agreement existed between the health care providers and the insurance carriers involved.  See Ochoa v. Dorado (2014) B240595 (filed 7/22/14).  The Ochoa court relied on existing case law to conclude that unpaid medical bills do not provide evidence of the reasonable value of services rendered.  It cited the Gimbel case for the general rule that the cost of medical treatment does not govern the actual recovery of expenses for medical treatment and hospitalization.  See Gimbel v. Laramie (1960) 181 Cal.App.2d 77.  The Ochoa court further reasoned that a plaintiff needed some evidence that the amounts charged on unpaid medical bills represented the reasonable value of services provided.

The Ochoa court declined to follow unpersuasive opinions to the contrary.  It concluded that evidence of unpaid medical bills cannot support an award for damages for past medical expenses.

What does this mean for you? If you have been involved in an accident and received medical treatment, you may not be able to recover your medical expenses unless you can show the reasonable value of the services provided.  If you have medical bills that were not paid, a court may not look to them as evidence of the reasonable value of the service provided.

If you have been involved in an accident and need help, please feel free to email us at inquire@ssrplaw.com. Or you may call our office for a free consultation at 510-663-9240 (our Oakland office) or 818-575-6002 (our Southern California office).  We handle these types of cases on a contingency basis, which means no attorneys’ fees unless you win.

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