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Court of Appeal Holds "Billed" Amount May Be Recovered By Insured Plaintiff Who Bypasses Insurance and Seeks Treatment from Lien Doctor

May 9, 2018

Pebley v. Santa Clara Organics, LLC
(B277893, May 8, 2018) 

In Pebley v. Santa Clara Organics, LLC, a personal injury plaintiff who had private medical insurance, rather than seeking treatment paid by the plaintiff’s insurer, sought medical treatment from a doctor who accepted a lien against any tort recovery as payment. The Court of Appeal held that because the plaintiff did not seek treatment through the insurer, he should be treated as an uninsured plaintiff for purposes of determining the recovery of medical damages under Howell v. Hamilton Meats & Provisions, Inc. (2011) 52 Cal.4th 541. (Howell holds that “an injured plaintiff whose medical expenses are paid through private insurance may recover as economic damages no more than the amounts paid by the plaintiff or his or her insurer for the medical services received or still owing at the time of trial.” (Id. at 567.)) As a result, the plaintiff in Pebley was allowed to introduce evidence of, and collect as damages, the amounts “billed” by the lien doctor, without showing how much is normally accepted in the medical care marketplace for the same services.

Pebley deepens the split of authority among various panels of the Court of Appeal regarding the measure of damages and admissibility of amounts “billed” for medical services.

Horvitz & Levy was appellate counsel for defendant.

More Information

For more information, please contact Steven Fleischman, H. Thomas Watson, Lisa Perrochet and Robert H. Wright .

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