More clarity (and not in a good way) regarding medical bill evidence

Two years ago, the California Supreme Court issued its landmark opinion in Howell v. Hamilton Meats & Provisions, Inc. (2011) 52 Cal.4th 541, holding that a plaintiff in a personal injury case can only recover, as damages for her past medical bills, the discounted amount that was paid by her health insurer, rather than the total amount that was billed by her medical providers.

However, the Howell court left open the issue of whether the larger, nondiscounted medical bill figure could still be presented to the jury.  Pursuant to Greer v. Buzgheia (2006) 141 Cal.App.4th 1150, many trial courts had been ruling that the larger figure was admissible, on the theory that it was relevant to the jury’s determination of the amount of future medical expenses and non-economic damages.  If the plaintiff then obtained a verdict in his favor, the trial court would reduce the amount of past medical bills awarded to the amount that was paid by the plaintiff’s health insurer.

Unfortunately, the Court of Appeal for the 2nd District has recently issued an opinion which resoundingly rejects the Greer approach and extends the Howell holding to make the nondiscounted medical bill figure inadmissible for any purpose.  Corenbaum v. Lampkin(2013) 215 Cal.App.4th 1308.  The basic rationale of the Corenbaum holding is that the standard rates charged by medical care providers are grossly inflated and bear no relationship whatsoever to the reasonable value of their services.  Therefore, according to the court, those rates have no relevance in determining what the reasonable value of the plaintiff’s future medical bills will be or as an “anchor” for determining general damages.

The court’s reasoning ignores, however, the fact that providers’ nondiscounted charges are anything but meaningless for those patients who are uninsured.  Time magazine recently ran a lengthy expose on the burdens faced by such patients.  As plaintiff’s lawyers, we frequently see providers assert liens for the total, nondiscounted amount of their charges.

The practical impact of the Corenbaum opinion is quite simply to reduce the amount that plaintiffs will recover in personal injury cases.  It is well known that juries, for better or worse, often use the amount of the economic damages as an anchor in determining the amount of non- economic damages to award.  Under the Greer approach, even if the past medical bill amount gets reduced by the trial judge post-verdict from the nondiscounted to the discounted figure, the larger general damages award remains.  In short, Corenbaum is a gift to defendants.

Corenbaum cites Greer, but does not discuss it in any detail.  Theoretically, there is now a conflict between two Courts of Appeal on this issue, but since the reasoning of theCorenbaum court is based upon Howell and since Greer pre-dated Howell, it is likely thatCorenbaum will be widely followed, unless the Supreme Court enters the fray again, and that seems unlikely.

Neither Howell nor Corenbaum really explain how evidence of the amount paid by the plaintiff’s health insurer can be admitted at trial without disclosing to the jury (in contravention of the collateral source rule) the existence of health insurance.  The simplest solution, if both sides are agreeable, is to stipulate to the amount of the past medical bills that were “incurred” (not “paid”).  If you state that the medical bills have been paid, that will likely lead to speculation by jurors as to how the plaintiff managed to make those payments, particularly if the amounts are large.

The more cumbersome approach, if a stipulation is not forthcoming, is to introduce a set of medical bills with any reference to health insurance redacted and/or have the plaintiff testify to the amount of bills that he “incurred.”