Amount Of Medical Insurance Coverage At Issue

The following blog entry is written to illustrate a common motion filed during the pre-trial stage of civil litigation. Reviewing this kind of briefing should help potential plaintiffs and clients better understand how parties in personal injury cases present such issues to the court.

(Please also note: the names and locations of all parties have been changed to protect the confidentiality of the participants in this car accident case and its proceedings.)

LEGAL ARGUMENT

A plaintiff in a personal injury action is entitled to recover from the defendant tortfeasor the “reasonable value” of medical services rendered to the plaintiff, including the amount paid by a collateral source, such as an insurer. Nishihama v. City & County of San Francisco (2001) 93 Cal.App.4th 298. As medical expenses fall into the category of economic damages, they represent actual pecuniary loss caused by the defendants’ wrong. (Civil Code Section 1431.2(b)(1); Hanif v Housing Authority (1988) 200 Cal.App.3d 635, 641.) Thus, when the evidence shows a sum certain to have been paid or incurred for past medical care and services, whether by the plaintiff or by an independent source, that sum certain is the most the plaintiff may recover for that care despite the fact that it may have been less than the prevailing market rate. (Hanif v. Housing Authority, supra, 200 Cal.App. at 641.)

For more information you are welcome to contact Sacramento personal injury lawyer, Moseley Collins.

In this case, the set amount of plaintiff’s reasonable medical services is that which was actually paid by Aetna Blue Cross in facilitating CMSP under which plaintiff was covered. These actual payment figures are attached as Exhibit A as Amount Paid. By virtue of this resolved amount, and pursuant to Hanif and Nishihama, these amounts paid reflect the objectively verifiable monetary losses for the plaintiff’s treatment. (Civil Code § 1431.2(b)(1)

CONCLUSION

Defendants seek to preclude plaintiff from introducing additional amounts beyond the Amount Paid as found in Exhibit A as the measure of damages in this case at trial. An instruction to the jury advising that the objectively verifiable monetary losses are what is noted in Exhibit A as Amount Paid and represents the true measure of damages in this case per Civil Code § 1431.2 and the Hanif/Nishihama line of cases.

For more information you are welcome to contact Sacramento personal injury lawyer, Moseley Collins.