In a case that had garnered interest across the country, a California appellate court has held that a defendant in a medical professional liability trial may introduce evidence of future health insurance benefits available to the injured plaintiff.
The national interest derives from the fact that the future insurance benefits in question involve those available via the Patient Protection and Affordable Care Act (ACA).
In a birth injury case alleging medical malpractice –Cuevas v. Contra Costa County – the plaintiff’s attorney put on the stand an expert to testify on the young plaintiff’s life care plan. That expert used a national database that reflects the average charges billed for the kind of medical services the plaintiff will need over the course of his life.
Defendant County of Contra Costa’s life care plan expert also testified on expected costs of the plaintiff’s medical care, based on her own investigation into the cost of medical services.
The trial court judge, however, denied the County’s request to introduce evidence on future medical benefits available to the plaintiff under an insurance policy under the ACA. The judge’s denial was based not only on his interpretation of California’s Medical Injury Compensation Reform Act (MICRA), but also on the viability of the ACA itself:
“I believe there is no reasonable certainty that that benefit will be in place . . . .”
The County argued unsuccessfully to the trial court judge that introducing such evidence of reduced costs to the plaintiff “would assist the jury in evaluating the reasonable value of plaintiff’s future medical care.” The jury found for the plaintiff and awarded $100 million for future medical, hospital, surgical, and rehabilitation expenses. The present cash value of that award is $9.6 million.
On appeal, the County did not challenge the finding on medical liability, but argued that under California’s MICRA, it should have been permitted to introduce evidence of “any amount payable as a benefit to the plaintiff as a result of the personal injury pursuant to the U.S. Social Security Act, any state or federal income disability or workers’ compensation act, any health, sickness or income-disability insurance, accident insurance that provides health benefits or income-disability coverage, and any contract or agreement of any group, organization, partnership, or corporation to provide, pay for, or reimburse the cost of medical, hospital, dental, or other health care services.”
In opposition, plaintiff's attorneys argued that MICRA’s permitting evidence of “any amount payable” applied only to past payments, not payments for future medical expenses.
In granting the defendant County a new trial, the Northern California-based First District Court of Appeal found that allowing such evidence “with respect to future medical benefits as well as past benefits is consistent with the legislative purpose (of MICRA) of reducing malpractice insurance costs.”
As to the continued availability of insurance to cover the plaintiff’s injuries under the ACA, the Court of Appeal cited evidence proffered by the County’s expert that the ACA is reasonably certain to continue well into the future and that plaintiff will able to acquire comprehensive health insurance notwithstanding his disability.
“Defendant presented evidence sufficient to support the continued viability of the ACA, as well as its application to plaintiff’s circumstances. Accordingly, we conclude that the trial court’s decision to exclude evidence of future insurance benefits that might be available under the ACA on the basis that the ACA is unlikely to continue was an abuse of discretion.”
Gordon Ownby is CAP’s General Counsel. Comments on Case of the Month may be directed to gownby@CAPphysicians.com. Legal guidance for individual matters should be obtained from a retained attorney.