When determining damages, juries are often presented with medical billing records as well as expert testimony about the need for — and cost of — various past and future medical treatments. In Ochoa v. Dorado, (2014) 228 Cal. App. 4th 120, the Second District Court of Appeal in California held that evidence of unpaid medical bills cannot support an award of damages for past medical expenses. The Court describes this holding as the necessary conclusion to draw from cases such as Howell v. Hamilton Meats & Provisions, Inc., (2011) 52 Cal. 4th 541 (finding the full amount billed by medical providers is not an accurate measure of the value of the services provided), and Corenbaum v. Lampkin, (2013) 215 Cal. App. 4th 1308 (holding the full amount billed for a plaintiff’s medical care is not relevant to the determination of damages for past or future medical expenses, and therefore is inadmissible, if the plaintiff’s medical providers have agreed to accept a lesser amount as full payment for the services provided).
The Howell and Corenbaum court previously explained that because there can be significant disparities between the amounts medical providers bill a patient and the actual cost to the patient for the services, the full amount billed is not relevant to determining the reasonable value of medical services. Additionally, the cost of various medical services varies widely across institutions throughout California. The Ochoa opinion is significant because the court decides, for the first time, that “this rule is not limited to the circumstance where the medical providers had previously agreed to accept a lesser amount as full payment for the services provided . . . . [T]he same rule applies equally in circumstances where there was no such prior agreement.” Ochoa, supra at 135-36. While in Corenbaum the Court held that the amount billed for plaintiff’s medical care is not relevant to determining damages, the conclusions was qualified with the caveat that it applied where medical providers had agreed to accept, as full payment, a lesser amount then they billed the patient. In Ochoa, the Second District instructs that unpaid medical bills are not relevant to determining damages whether or not the medical provider has agreed to accept a lesser amount as full payment.
This decision reinforces plaintiffs’ obligation to demonstrate what medical expenses were actually incurred and can reasonably expect to be incurred in the future rather than merely relying on medical bills as evidence of damages.