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CA Plaintiffs Can Only Claim Actual, Not Billed, Medical Expenses

By Cynthia Hsu, Esq. on August 26, 2011 | Last updated on March 21, 2019

In a landmark win for insurers, the California Supreme Court ruled that plaintiffs in personal injury cases cannot recover billed medical expenses over actual medical expenses.

The case started from a personal injury automobile lawsuit. Rebecca Howell was injured in a car crash. She sued Hamilton Meats & Provisions, Inc., for damages including the amount of her medical expenses.

Howell's bills totaled nearly $190,000. However, due to agreements between her insurance carrier and the treating medical facilities, the total amount paid for medical expenses was closer to $60,000, according to the complaint.

Hamilton moved to have the medical expenses reduced to this lower amount. The case went up to the California Supreme Court, who ruled in Hamilton's favor.

The court decided that Howell hadn't incurred the additional expense and hadn't suffered economically in the amount of $190,000.

In summary, plaintiffs can no longer claim their "billed" medical expenses, only the actual amount they or their insurers paid.

What does this mean for attorneys specializing in personal injury cases?

For one, it could undoubtedly mean reduced damages awards for personal injury plaintiffs in California. And, it could mean clients will be confused as to why their damages may be reduced. California attorneys might need to explain the potential implications of this decision to their clients in order to manage a client's expectations. For attorneys working on a contingent-fee basis, this ruling may also impact your bottom line.

And, some attorneys think that the ruling will reduce other types of damages as well, including pain and suffering. This is because jurors might learn that the plaintiff had insurance at the time, according to Howell's attorney Gary Simms, according to the San Francisco Chronicle.

Conversely, for attorneys representing defendants in personal injury cases, this ruling could mean that defendants will no longer have to pay higher amounts in damages for medical expenses.

Personal injury damages, it seems, may soon end up being a smaller payout than expected.

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