Court Opinion

ID: 9745765
Source: CourtListenerOpinion
Date Created: 2023-08-27 13:31:04.272042+00
Date Added: 2024-06-11T07:25:04.446269
License: Public Domain

FYBEL, J., Concurring.
Over six years ago, the Court of Appeal, First Appellate District, Division One, in Nishihama v. City and County of San Francisco (2001) 93 Cal.App.4th 298 [112 Cal.Rptr.2d 861] (Nishihama), analyzed the law and relied on a case decided by the Third Appellate District in 1988, Hanif v. Housing Authority (1988) 200 Cal.App.3d 635, 639-644 [246 Cal.Rptr. 192] (Hanif), and held: “A plaintiff in a personal injury action is entitled to recover from the defendant tortfeasor, the reasonable value of medical services rendered to the plaintiff, including the amount paid by a collateral source, such as an insurer. As medical expenses fall into the category of economic damages, they represent actual pecuniary loss caused by the defendant’s wrong. (Civ. Code, § 1431.2, subd. (b)(1); Hanif v. Housing Authority[, supra,] 200 Cal.App.3d [at p.] 641 . . . .) ‘Thus, when the evidence shows a sum certain to have been paid or incurred for past medical care and services, whether by the plaintiff or by an independent source, that sum certain is the most the plaintiff may recover for that care despite the fact that it may have been less than the prevailing market rate.’ (Hanif v. Housing Authority, supra, 200 Cal.App.3d at p. 641.)” (Nishihama, supra, 93 Cal.App.4th at p. 306.)
The Nishihama and Hanif principles were recently followed and applied by the Third Appellate District in Katiuzhinsky v. Perry (2007) 152 Cal.App.4th 1288, 1294-1295 [62 Cal.Rptr.3d 309] (Katiuzhinsky). The Katiuzhinsky court correctly distinguished Nishihama and reversed because the plaintiffs in Katiuzhinsky incorrectly recovered less at trial than the amount agreed upon by the provider and the health plan and incurred by the plaintiffs. (Id. at pp. 1296-1298.)
*215The principles explained and applied in Nishihama and Hanif are soundly based on California statutes—Civil Code sections 3281,1 3282,2 3333,3 and 1431.2, subdivision (b)(1)4—and the Restatement Second of Torts, section 911, comment h.5 I write separately principally to express my view that the analysis and holdings of Nishihama and Hanif correctly apply and enforce the collateral source rule based on California statutes. The collateral source rule was followed because the plaintiffs in those cases recovered all medical costs actually incurred, even though the costs were paid by others (e.g., a health plan).
In Nishihama, the plaintiff suffered personal injuries as a result of her fall in a crosswalk maintained by a municipality. (Nishihama, supra, 93 Cal.App.4th at p. 301.) The jury awarded her approximately $20,000 for the cost of her medical care, including approximately $17,000 for the reasonable value of care she received from her medical provider. (Id. at p. 306.) The amount of $17,000 was based on the provider’s normal rates. (Ibid.) The plaintiff participated in a health plan administered by Blue Cross which had a *216contract with the provider. (Ibid.) Under that contract, the provider agreed that Blue Cross would pay reduced rates for certain services to its members and the provider would accept Blue Cross’s payment as payment in full for those services. (Ibid.) Pursuant to that contract, the provider accepted $3,600 (instead of $17,000) as payment in full for the services it rendered to the plaintiff. (Id. at pp. 306-307.) The plaintiff did not contest the assertion the provider accepted $3,600 as payment in full. (Id. at p. 307.)
The court in Nishihama held that, by virtue of the contract between the provider and Blue Cross, the plaintiff was obligated to pay the provider only $3,600. (Nishihama, supra, 93 Cal.App.4th at p. 307.) The plaintiff had no responsibility to pay the provider more than $3,600 because the provider had been paid in full. (Id. at pp. 307-308.) As correctly and succinctly recognized by the court in Nishihama: “The amount that a hospital is entitled to receive as payment necessarily turns on any agreement it has with the injured person or the injured person’s insurer.” (Id. at p. 308.)
I agree with the analysis of Nishihama and Hanif limiting recovery by an injured plaintiff to the amount of actual damages incurred, as required by California statutes and as recognized by the Restatement Second of Torts.

The Absence of Evidence in This Record

The court in Nishihama had before it the contract between the provider and Blue Cross, the statements that showed the amount ($3,600) paid by Blue Cross to the provider, evidence of the amount accepted by the provider (and the converse, the amount written off by the provider), and, importantly, an acknowledgment by the plaintiff that the provider accepted $3,600 as payment in full for its services. As I will next explain in detail, none of this important evidence is in the record in this case.
1. The Billing Statement to Plaintiff. The billing statement in our record is a printed form with unidentified, unauthenticated handwriting on it. A portion of the handwriting reads: “* She is a retired nurse. So [crossed-out word] all the charges written off??” So, we do not even know if the amounts with the printed notation “w/o” on the statement were actually written off or whether any proposed writeoff was questioned. There was no evidence explaining the printing on the statement, much less explaining the handwriting. Plaintiff repeatedly objected to the trial court’s consideration of this statement on foundational grounds and I believe those objections had merit.
2. No Contract Between Provider and Health Plan. No contract appears in the appellate record or was presented to the trial court establishing that the provider would accept payments from the health plan in amounts less than its normal rates and charges.
*2173. No Contract Between Plaintiff and Provider. We have no record of any agreement between plaintiff and the provider. For example, we do not know if plaintiff was accepted for treatment on contractual terms under which the provider agreed to charge her rates lower than normal rates (pursuant to a contract between the provider and the health plan).
4. No Contract Between Plaintiff and Health Plan. We do not even know if there was an agreement between the health plan and plaintiff, much less what it stated.
5. No Acknowledgment by Provider, Health Plan, or Plaintiff That Plaintiff Has No Further Financial Responsibility to Provider or Health Plan. Our record contains no proof that plaintiff is protected from being charged additional amounts for any of those services by the provider or by the health plan (beyond an agreed-upon deductible or copayment). Unlike Nishihama, plaintiff in this case has not acknowledged that the provider has accepted payment in full. Indeed, in its motion to request the reduction of the jury verdict, defendant in this case stated: “However, plaintiff’s billing records reflect that at least $57,394.24 were written off by her medical provider; have not been paid; and are not currently owed by any person or entity.” (Italics added.) This equivocal statement raises insurmountable questions as to the amount of plaintiff’s liability. The judgment could not be affirmed on the basis of this statement of “current” liability by defendant alone. Furthermore, we do not know if the provider in this case was “in network” or not, or was a “preferred provider” or not. Thus, we do not know whether the provider asserts so-called “balance billing” to recover money from plaintiff (i.e., the claimed additional amount due if a patient is treated by an “out of network” provider under certain circumstances).
Nor is there any statement by the health plan that plaintiff has no further obligation to the plan itself. We do not know if the health plan will charge plaintiff for using an out-of-network provider or for other charges under the plan documents.
For all of these reasons, the trial and appellate records are woefully inadequate and we could not affirm this judgment even if we followed Nishihama.

The Hearing to Determine Whether to Reduce the Verdict to the Amount of Actual Damages

If the proper application of the collateral source rule includes reducing a verdict to the amount actually paid or incurred by the plaintiff or by a collateral source such as a health plan, a hearing is necessary and appropriate to *218determine the correct amount. If a reduction is not proper under the collateral source rule, a hearing would not be necessary or appropriate. Therefore, whether such a hearing should be held is dependent on whether a reduction to the total amount actually paid by any source or incurred by the plaintiff is proper under the collateral source rule. The propriety of such a hearing is not a separate issue. If such a hearing is to be held, the trial court has the statutory authority under Evidence Code sections 320 (order of proof) and 402 (procedure for determining evidentiary matters) to hold the hearing.
A petition for a rehearing was denied July 16, 2008.

 Civil Code section 3281 states: “Every person who suffers detriment from the unlawful act or omission of another, may recover from the person in fault a compensation therefor in money, which is called damages.”

 Civil Code section 3282 states: “Detriment is a loss or harm suffered in person or property.”

 Civil Code section 3333 states: “For the breach of an obligation not arising from contract, the measure of damages, except where otherwise expressly provided by this Code, is the amount which will compensate for all the detriment proximately caused thereby, whether it could have been anticipated or not.”

 Civil Code section 1431.2, subdivision (b)(1) states: “For purposes of this section, the term ‘economic damages’ means objectively verifiable monetary losses including medical expenses, loss of earnings, burial costs, loss of use of property, costs of repair or replacement, costs of obtaining substitute domestic services, loss of employment and loss of business or employment opportunities.”

 Restatement Second of Torts, section 911, comment h, pages 476-477 states: “The measure of recovery of a person who sues for the value of his services tortiously obtained by the defendant’s fraud or duress, or for the value of services rendered in an attempt to mitigate damages, is the reasonable exchange value of the services at the time and place. This may be distinct from and may be either greater or less than an amount that would be given for harm resulting from the loss of time by the injured person. (See § 924). [ft] If the services are rendered in a business or profession in which there is a rate for them definitely established by custom, the customary rate controls. If there is no customary rate, evidence of what the claimant has received and what other persons receive for similar services, and other factors, including the reputation of the person giving the services, the skill with which the work is done and the difficulty and danger of the work, are taken into consideration, [ft] When the plaintiff seeks to recover for expenditures made or liability incurred to third persons for services rendered, normally the amount recovered is the reasonable value of the services rather than the amount paid or charged. If, however, the injured person paid less than the exchange rate, he can recover no more than the amount paid, except when the low rate was intended as a gift to him. A person can recover even for an exorbitant amount that he was reasonable in paying in order to avert further harm. (See § 919).”