Which Medical Expense Damages Can You Get in California if You Receive Medical Care Outside Your Health Insurance Plan?

doctorHealth insurance is an everyday part of life for many of us. The Affordable Care Act was passed and signed into law due to the federal government’s recognition of just how interwoven health insurance is with health care in this country. One of those aspects in which health insurance interweaves with health care is the idea of an insurer’s “network” and a treatment carrying different prices, depending on whether the provider was “in network” or “out of network.” Thus, what if you are significantly injured in an auto accident? You likely will require a substantial amount of medical care, but, if you sue and receive compensation for your injuries, you won’t be responsible for paying the bills you rack up. Are you still responsible for limiting yourself to providers within your network? If you’ve been injured in an auto accident and find yourself in need of answers to these and other questions, contact a knowledgeable California truck accident attorney to discuss your options.

A recent case involving an injured passenger named Dave explored this scenario and provided some helpful guidance for people injured in California vehicle accidents. Dave was injured in a Ventura County auto accident caused by Jose, who was, at the time of the accident, an employee of an organics company. The RV driven by Dave’s wife developed a flat tire on a freeway, and the semi truck driven by Jose slammed into the rear of the RV, causing serious injuries to Dave’s face, teeth, neck, and lower back. He ultimately underwent a three-level spinal fusion surgery to address his back problems. Dave had insurance, and his insurer had a “network” of preferred providers. Dave, however, decided to seek care from providers who were outside his plan.

Eventually, Dave sued the organics company for Jose’s negligent driving. In his case, Dave sought a substantial award of medical expense damages. At trial, the injured man had documented proof of the medical bills he had amassed. At the trial’s end, the jury ruled in favor of Dave and awarded him $3.6 million in damages, including $269,000 in past medical expenses. With regard to medical expense damages, the jury awarded Dave the full billed amount that he established in his case.

The defendant appealed, but the appeals court largely upheld the compensation award in favor of Dave. The court stated in its decision that, when a person injured in a vehicle accident has insurance but chooses to obtain medical care from providers outside that plan, the law will treat his claim for damages in the same way it would an uninsured person. In California, you are entitled to recover the reasonable value of the medical services you received. The law allows an uninsured person to prove the true reasonable value of the medical services he received by presenting to the court “evidence of the amounts billed for medical services” actually received.

To make sure that your truck accident case gets the diligent advocacy you deserve, talk to the skilled San Mateo personal injury attorneys at the Law Offices of Galine, Frye, Fitting & Frangos. Our attorneys have been helping injured drivers and passengers pursue their legal cases for many years. To set up a free consultation with one of our experienced attorneys, contact us at 650-345-8484 or through our website.

More Blog Posts:

Dealing With a California Injury Case When the Person Who Hit You Dies Shortly After the Accident, San Mateo Injury Lawyers Blog, published May 9, 2018

Southern California Driver Injured in Intersection Crash Wins Appeal in Legal Action Against Her Underinsured Motorist Insurer, San Mateo Injury Lawyers Blog, published August 23, 2017

Photo Credit: Free-Photos, [CC0 License], via Pixabay