How Much Can I Recover for Medical Bills If I’m Injured in a California Car Accident?

medical billIf you have been injured in a car accident in California, and the accident was the other driver’s fault, you are entitled to recover for the medical bills you incurred as part of your personal injury lawsuit. This seems simple enough. And for many years, this was a simple question. But determining the amount of the medical bill that the other driver is responsible for has become a complicated question due to numerous court decisions which have come down in the recent past.

The law for many years held that a person could recover for the reasonable amount of his medical bills which were related to injuries he received in his car accident. The reasonableness of the bills was generally determined by looking at the face amount of the bill that was received from the doctor, hospital or other health care provider.

Now, however, the reasonableness of the bill is no longer determined by face amount of the bill. One has to see how the bill was paid, whether there was health insurance, whether there were any write off’s, whether there was workers compensation coverage, who was responsible for paying the bills, and whether there is a right to any so-called balance billing.

Amount recoverable when injured person is uninsured:

So here’s how you figure the medical bills out if you have been in an auto accident. If you have no health insurance, the reasonable amount of the bill, and the amount you are entitled to recover is based on what the health care provider accepts as payment in full. Hospitals will generally accept a reduced amount from the face amount of the bill itself if a person is uninsured. Doctors and ambulance companies will also often reduce their bill if there is no health insurance. However, they may seek payment of the full amount of the bill if you have a personal injury claim pending.

Amount recoverable when injured person has health insurance:

If you are covered by health insurance or workers compensation coverage, the medical bills will often be paid at pennies on the dollar. How much the doctor or hospital reduces their bill depends upon their contract with the health insurance company. So for example, a medical bill for an emergency room visit following a car crash might be $5,000.00, but due to the contract between the hospital and the health insurer, the hospital might only receive $1,000.00 in full payment of the bill. Last year, our California Supreme court, in the case of Howell v Hamilton Meats decided that generally speaking, the injured person can only recover the amount that the medical provider actually accepted as full payment for the bill. So in this example, the injured person would only be able to recover $1,000.00.

Amount recoverable when workers compensation pays the bills:

This same principle was applied in a case this year which involved workers compensation payments. In the case of Sanchez v Brooke, the court had to decide whether the Howell rule of law also applied in a workers compensation setting. The court followed Howell and held that the injured person could only recover the amount that the workers compensation carrier had actually paid the medical providers, not the amount that was billed.

Balance billing and your rights to recover:

On some occasions, the hospital or doctor may not have to accept the payment from the health insurance carrier as payment in full. This is known as balance billing. If that is the case, the injured person is responsible for paying the balance. In these instances, the person would be able to recover the entire amount which was paid to the hospital by the health insurer, plus the amount that the individual is responsible for paying.

As you can see, what was once a simple calculation has become a complicated scenario. Furthermore, all of the above are subject to negotiation and ever changing laws. Knowing which law to apply, and how best to argue the facts surrounding each case can have a tremendous impact on the recovery to the client. As an Alameda personal injury lawyer, I am constantly working with people injured in accidents and helping them get their medical bills paid. Negotiating with medical providers such as hospitals, doctors, ambulance companies, and health insurers to maximize the amount my clients recover is an integral part of my law practice.

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