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California Court Rules Plaintiff with Medical Insurance Can Introduce Full Amount Billed As Evidence of Medical Damages

The California Court of Appeal for the Second District issued a ruling in Pebley v. Santa Clara Organics, LLC; et al. Case No. B277893, which permits a plaintiff with available medical insurance, who nonetheless elects to treat an injury on a lien basis, to introduce the full amount billed under the lien as evidence of medical damages regardless of the earlier holdings in Haniff and Howell.  The plaintiff may do so even though the same quality of care could be obtained through his or her medical insurance for substantially less.  Of great import, the Pebley Court excluded all evidence of Pebley’s available insurance under the California Evidence Code as likely to be misleading or prejudicial to the jury’s determination

Pebley derives from the California Supreme Court’s decision in Howell v. Hamilton Meats & Provisions, Inc. (2011) 52 Cal.4th 541, 566, wherein the full amount billed was not relevant to prove past, future, or noneconomic damages.  The amount for an uninsured plaintiff was later determined by the Court of Appeal to be the reasonable value of the services in Bermudez v. Ciolek (2015) 237 Cal.App.4th 1311, 1330-1331.  Application of Pebley will change the evaluation of personal injury cases involving damages claimed for medical billings drastically because plaintiffs will be viewed as “uninsured” and permitted to introduce the full amounts charged under the lien to the jury.  Notably, the Pebley jury rejected an expert opinion as to reasonable value (95% of patients pay 50% of the bill) and awarded the full amount billed.

Early efforts to identify a Pebley plaintiff are now, more than ever, part of a competent legal defense.  Should a case appear likely to go to trial, effective experts and clear evidence should be identified and prepared in a manner most likely to assist the jury in understanding the intricacies of billing amounts.  Similar, motions in limine asking the court to decline to follow Pebley as to introduction of such evidence should be sought as Pebley is contradictory to Ochoa v. Dorado (2014) 228 Cal.App.4th 120 and therefore the trial court is charged with following what it determines is the better reasoned decision. 

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