Thought Unpaid Lien Doctors’ Bills Were Admissible at Trial? Not so Fast, Plaintiff Must First Prove the Full Amount of the Bill Was Actually Incurred

Haight Brown & Bonesteel LLP
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In Qaadir v. Figueroa (“Qaadir”), the Second District Court of Appeal held it is an abuse of discretion for the trial court to admit evidence of the full amount unpaid medical bills without first requiring the plaintiff to demonstrate he actually incurred those amounts.

The plaintiff sued defendants for damages arising from a traffic collision. Except for the medical services the plaintiff initially received under his health insurance at Kaiser and Health First, plaintiff sought all of his medical treatment for his injuries, including a spinal-fusion surgery, from lien providers who did not accept his insurance plan. Defendants admitted liability and the case proceeded to trial solely on the issue of damages. The medical bills from the lien providers remained unpaid at the time of trial. The trial court denied the defendants motion in limine to exclude evidence of the plaintiff’s unpaid medical bills. The plaintiff presented evidence of his full medical bills, both paid and unpaid, which totaled $838,320.02. The plaintiff’s billing expert opined the reasonable value of his medical bills totaled $632,456. The defense expert opined the reasonable value of the plaintiff’s medical care was $174,111 based on an average of what private insurers, Medicare and workers’ compensation would agree to pay and medical providers would agree to receive for those services. The jury returned a verdict in favor of the plaintiff in the amount of $3,464,288, which included $532,000 in past medical expenses and $500,000 in future medical expenses.

On appeal, the defendants contended the trial court erred when it admitted evidence of the full unpaid medical bills. The Court of Appeal agreed and concluded that the trial court abused its discretion to admit evidence of the full unpaid medical bills without first requiring the Plaintiff to demonstrate the evidence was admissible because he actually incurred those amounts. In analyzing, Howell and its progeny, including Pebly and Ochoa, regarding the admissibility of medical bills, the court held evidence of a medical bill is relevant to prove or disprove the paid or incurred prong of past medical damages if it can be established the bill is actually paid or incurred. Thus, for a plaintiff, evidence of his unpaid medical bills is relevant to his past medical damages only if he can show he actually incurred those amounts, meaning he actually paid, or is liable for the full amount stated in the medical bills. While the Court of Appeal held it was an abuse of discretion to allow evidence of the full amount of the medical bills, it concluded the error was harmless because the record established the experts did not rely on evidence of the unpaid medical bills to reach their reasonable value determinations.

Qaadir is helpful for two reasons: (1) it will assist in excluding the full amount of medical bills at trial and (2) instructs that it is important to highlight the prejudice of improperly admitted evidence on appeal.  As a practice tip, requesting the plaintiffs’ agreements with lien doctors may be helpful to rebut evidence that the plaintiff is required to pay the full amount of the medical bills.

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