Personal Injury: Past Medical Services: As a general rule, a plaintiff in a tort action is not to be placed in a better position than he would have had if the wrong had not been done. (Valdez v. Taylor Automobile Co. (1954) 129 Cal.App.2d 810, 821-822.)
Thus, a plaintiff typically may not recover more than the actual amounts paid by him or on his behalf for past medical services, even though the amounts billed for those services were greater. (Howell, supra, 52 Cal.4th at pp. 555, 566 [plaintiff may recover as economic damages the lesser of the reasonable value of the medical services received and the amount paid by the plaintiff or private insurance on the plaintiff’s behalf, not the amount billed]; Hanif, supra, 200 Cal.App.3d at pp. 639-644 [plaintiff’s recovery should have been limited to amount Medi-Cal paid medical providers on plaintiff’s behalf, even if substantially lower than the reasonable value of the treatment, because the plaintiff’s detriment and pecuniary loss was only what Medi-Cal paid]; Nishihama v. City and County of San Francisco (2001) 93 Cal.App.4th 298, 306 [plaintiff could recover only amounts paid to medical providers on his behalf by private insurer]; Sanchez v. Brooke (2012) 204 Cal.App.4th 126, 131, 142 [injured employee’s recovery limited to amounts paid to medical providers by employer under workers’ compensation law, where employee not liable for balance of billed amount].)
In this particular case. Medicare and Medi-Cal had pre-existing contractual relationships with plaintiff’s medical providers, by which the providers agreed to accept a sum less than their usual and customary charges as payment in full for their services. Those providers may not seek reimbursement over the amount that Medicare and Medi-Cal was contractually obligated to pay. (See Parnell v. Adventist Health System/West (2005) 35 Cal.4th 595, 609.) Because Plaintiffs liability to medical providers for their past medical services is limited to the amounts Medicare and Medi-Cal actually paid, therefore Plaintiff’s recovery from Defendant(s) for past medical services must be limited to those amounts actually paid. (Howell, supra, 52 Cal.4th at p. 567.)
About the Author
Attorney Steven Peck has been practicing law since 1981. A former successful business owner, Mr. Peck initially focused his legal career on business law. Within the first three years, after some colleagues and friend’s parents endured nursing home neglect and elder abuse, he continued his education to begin practicing elder law and nursing home abuse law.