Re-Examining the Admissibility of Unpaid Medical Bills as Evidence

In Bermudez v. Ciolek (No. G049510, filed June 22, 2015), the California Court of Appeal, Fourth District, held unpaid medical bills, joined with expert testimony regarding their reasonableness, were properly admitted and sufficient to support an award of damages.

In Bermudez, two defendants, Faith Ciolek and Nathan Heacox, were involved in a motor vehicle accident, wherein Heacox’s vehicle veered off the road and struck plaintiff, Omar Bermudez, who had been riding his bike nearby. Bermudez suffered serious bodily injuries as a result of the incident. Bermudez was uninsured at the time of the incident. Bermudez filed suit against both defendants for negligence. Prior to trial, neither defendant filed a motion in limine to exclude Bermudez’s medical bills, which remained entirely unpaid as of the time of trial.

At trial, Bermudez offered a compilation of the amounts billed by his health care providers, all of which were unpaid, into evidence. Although the parties stipulated to the admissibility of this summary, defendants disputed the reasonableness of the amounts, and the necessity of the services rendered. Bermudez also offered the testimony of two treating physicians, who testified in their capacity as experts, that some of the amounts incurred for treatment were reasonable while other amounts should be reduced. The plaintiff’s experts laid the foundation for this testimony by noting they were familiar with the “market value” of the medical services in their respective practices. Defendants did not object to this testimony.

The jury returned a verdict against Ciolek in the amount of $3,751,969, including an award for past medical special damages. Ciolek appealed, contending the admitted summary and expert testimony were insufficient to establish the reasonable value of the services rendered. Ciolek contended the experts needed to do more to establish that their testimony was rooted in the market value of the medical services.

The Court of Appeal affirmed, holding that under Howell v. Hamilton Meats & Provisions, Inc. (2011) 52 Cal.4th 541 (“Howell”), and subsequent case law: (1) evidence of unpaid medical expenses was admissible when offered by an uninsured plaintiff; and (2) the admitted summary of medical bills and expert testimony were sufficient to support the jury’s conclusion that the awarded medical special damages represented the reasonable value of the services.

After recounting the history of Howell, and its progeny, the Court clarified its holding by noting that evidence of unpaid medical bills, alone, is insufficient to demonstrate the reasonable value of the services. Citing Ochoa v. Dorado (2014) 228 Cal.App.4th 120 (“Ochoa”). The Bermudez Court distinguished Ochoa, noting that Bermudez offered expert testimony about the reasonable value of the services rendered, in conjunction with the summary of unpaid medical bills. The Court also rejected Ciolek’s contention that the proper foundation had not been laid for the plaintiff’s expert’s testimony. The Court noted that no objection was made to the testimony when it was offered, thereby precluding Ciolek from raising the issue on appeal.

This case is significant because it affirms that unpaid medical bills, alone, cannot support an award of medical special damages. It further highlights the importance of conducting expert discovery regarding the basis for an expert’s knowledge as to the reasonable value of services, and of carefully drafted pre-trial motions in limine on Howell issues.

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June 24, 2015