Source: http://harp.org/micra.htm
Timestamp: 2019-04-24 11:46:24+00:00

Document:
When it is impossible to sue the HMO directly, as when it is protected by ERISA, it may be possible to sue a negligent treating doctor for medical malpractice, and hold the HMO vicariously liable for the doctor's actions.
CC sec. 3333.2 says that in any action against a health care provider for professional negligence, non-economic damages, eg: for pain and suffering, may not exceed $250,000. This may make it hard to get a lawyer interested in the case.
In most tort cases the common law "Collateral Source Rule", makes it reversible error for the defendant to tell the jury how much of your damages have been paid by someone else, eg: an insurer, family member, etc.
However, CC sec. 3333.1 lets them tell the jury in MedMal cases, encouraging the jury to cut your recovery by that amount.
The initial complaint cannot ask for punitive damages. Under CCP sec. 425.13, a separate motion must be made at the earlier of 2 years after filing or 9 months before the first scheduled trial date, showing a substantial probability that you'll prevail.
What can you do to minimize the disadvantages of MICRA?
MICRA (except for its arbitration provision) doesn't apply to intentional torts.
Ancillary Services, such as orderlies, technicians, medical students, janitors, aides, clerks, or administrative staff.
"Only natural persons shall be licensed to practice medicine" (BPC sec. 2032). So a medical group is protected by MICRA only if its liability is vicariously derived from that of a physician employee.
Direct liability of the group is not protected by MICRA or CCP §425.13.
MICRA will not apply if the group's liability arises from its physician's intentional tort.
If the liability of the group arises from Utilization Review it is doing on behalf of an HMO, then it is acting as an agent of the HMO, and so has no MICRA protection, since it is then "a managed care entity" and not a "health care provider". Utilization review is a non-delegable HMO function under HSC §§1363.5(a), 1367.18, & 1370.
If the group received a periodic or fixed fee (e.g. capitation) to provide care, that would also make it a "managed care entity" under HSC §1345(f), and thus without MICRA protection per CC §3428(c).
These considerations should apply to all MICRA rules, such as arbitration (CCP §1295), statute of limitations (CCP §340.5), punitive damages (CCP §425.13).
So, be sure not to allege that the group is a medically licensed entity, and lose these advantages.
This might also include improperly performed administrative functions, such as an HMO failing to authorize a procedure deemed necessary by their own specialist, or failing to maintain safe staffing levels.
Intentional Torts. Unfortunately the Calif, Supreme Court has held that these are subject to MICRA if connected in any way with medical care.
Express Warranty. Many hospitals & HMOs are advertising the superiority of their physicians or results. A warranty cause of action should not fall under MICRA.
The plaintiff's spouse can claim an additional $250,000 for Loss of Consortium.
If the judge let's you mention the cap, stress it in summation.
If he won't let you mention it, stress the financial losses.
Make same arguments for Medicare & state rehab services.
Argue the usual reasons for the Collateral Source rule to the jury, eg: the benefit should go to the plaintiff who paid the insurance premiums, not the tortfeasor; any windfall should go to plaintiff rather than defendant; for public funds, the tortfeasor should pay, not the public.
Have the jury compute present value of the payments, and require that THAT be periodized rather than the cost of the annuity.
Require security equal to unpaid portion of judgment.
Section 1200) of the Health and Safety Code.  "Health care provider"
(commencing with Section 1010) of Title 14 of Part 2.
fictitious name, as provided in Section 474.
of a potential investigation file.
so much as remains, to the judgment debtor.
modification in the event of the death of the judgment creditor.
payments, including court costs and attorney's fees.
future damages in accordance with this subdivision.
function, or future pain and suffering of the judgment creditor.
other property to the judgment creditor at regular intervals.
includes the legal representatives of a health care provider.
losses exceed two hundred fifty thousand dollars ($250,000).
furnished to, a subscriber or enrollee.
(2) The subscriber or enrollee suffered substantial harm.
425.13, 667.7, or 1295 of the Code of Civil Procedure.
contrary in a contract with providers is void and unenforceable.
treating physician or other treating health care provider.
liability otherwise available at law.
Safety Code, in lieu of medical treatment.
but are not limited to, those set forth in Section 3333.
prior to the completion of the applicable review.
imminently occur prior to the completion of the applicable review.
six hundred thousand dollars ($600,000).
deductible disbursements or costs for such purpose.

References: §425
 §1345
 §3428
 §1295
 §340
 §425