Howell v. Hamilton Meats: Questions & Answers

The California Supreme Court dealt the injured a serious blow in August when it handed down Howell v. Hamilton Meats and Provisions, Inc.  It is certainly one of the most pro-insurance company cases ever. 

Gary Simms and I collaborated on a couple of articles explaining how Howell will change the legal landscape in the years to come.  Gary Simms brings a unique perspective to the discussion.  Not only did he argue the case before the Supreme Court, but he spent nine years of his career as a senior judicial attorney writing the Court's opinions. 

Our latest article is Supreme Court Put Plaintiffs Through the Hamilton Meat Grinder.

Here are our views on some key issues.  See the article for how we get there:

Does Howell apply only when there is a contract between the plaintiff's medical providers and her insurer?

A: It seems so but the court's opinion is unclear.  Plaintiff has asked the court to clarify.

How does the defendant prove that there is a contract between the insurer and the provider?

A: Unclear but plaintiff should be able to argue that oral evidence doesn't suffice.

Who has the burden of proving what was paid or owing and what is reasonable?

A: Plaintiff will bear the initial burden of submitting evidence of the amounts paid or owing.  Evidence of reasonable value will not be sufficient.

Are billed charges relevant to noneconomic damages?

A: Generally not.

Are billed charges relevant to future medical expenses?

A: Defendants will certainly argue that they are not.  But that argument will be difficult to carry.

Is evidence of the amount paid by the insurer admissible?

A: Yes.

How is the amount paid or owing to be determined?

A: Unclear.

Do HMO patients recover no medical expenses?

A: The opinion isn't clear.

Do malpractice victims recover nothing?

A: The opinion isn't clear.

Is evidence of medical insurance now admissible?

A: As a practical matter, yes.

Can Howell be dealt with by post-trial motion?

A: Unlikely that a defendant would so agree.

 

Howell v. Hamilton Meats & Provisions, Inc.
 


Howell v. Hamilton Meats: Candid Interview With Appellate Attorney Gary Simms

Last Thursday, the California Supreme Court handed down its decision in Howell v. Hamilton Meats.  The ruling favors those who cause injury to others (such as people who get into accidents while texting) over their victims. The Court decided that it is those who cause injuries, and not their victims, who will benefit from the health insurance that the victim has paid for.

I attended the oral argument before the Supreme Court back in May.  I wrote about that here.  Today, Gary Simms, who argued the case for Rebecca HowGary Simms, Appellate Specialistell, provided me his perspective on the Court's decision.  

Q: Were you surprised by the 6-to-1 decision against the plaintiff?

A: Unfortunately, I wasn’t surprised by the result. The Court is deeply conservative (six Republican appointees) and predictably anti-plaintiff in most personal-injury cases, so I knew from the outset of being retained for the Supreme Court briefing that I would face a very uphill battle. I was working at the margins; in other words; three justices would never vote for my position, and I knew it. I expected to get Justice Pro Tem Klein’s vote, though, and she very clearly signaled it at oral argument. I hoped to get three other votes, but I knew it would be difficult.

Q: Were you surprised by the new Chief Justice’s vote with the majority after she had taken the opposite view in her Court of Appeal opinion in King v. Willmett very shortly before she was appointed to the Supreme Court?

A: Yes, but after the oral argument, I sensed that she would flip-flop, so I was only mildly surprised. I can only speculate why she reversed her position. But I think the most likely reason was that she knew her vote would not change the outcome, so she chose to join the majority to make it unanimous. (Because Justice Klein was sitting pro tem by designation, her dissent does not matter in that regard; all the permanent Justices joined in the majority opinion.) This allowed the Chief Justice to establish herself as being a collegial and open minded consensus-builder. That’s a very important quality for a Chief Justice. And perhaps

Continue Reading...

California Supreme Court Hears Argument in Howell v. Hamilton Meats

When a wrongdoer causes injury, he must pay the victim’s hospital bills. If the victim happens to have insurance, the insurance company will often settle those bills before trial. Should the wrongdoer be required to pay the victim for the full amount of the hospital bills? Or only the amount the insurer paid to settle the bills? That was the issue argued today before the California Supreme Court, in Howell v. Hamilton Meats.

The question is a difficult one. Plaintiffs note that, under the collateral source rule, the one who caused the injury shouldn’t benefit simply because the person he injured maintains insurance. On the other hand, defendants argue that they shouldn’t have to pay for medical bills for which the victim was never on the hook. 

The Court’s decision is due in 90 days.

Here are some of the questions that the justices asked and the answers that the lawyers gave. (I’ve paraphrased liberally.)

To the Defense (Represented by Mr. Tyson and Mr. Olsen):

Q: Isn’t the part of the bill that a hospital writes-off for the insurer properly included as “damages” that that the injured party has suffered?

A: No, because the hospital agreed with the health care insurer to write off those amounts before the victim ever arrived at the hospital. Because the victim never incurred those amounts in the first place, they aren’t “damages.”

Q: Why should victims who have never paid premiums and who are thus uninsured be entitled to recover the full amount of their medical bills, while those who have shelled out for insurance for their whole lives recover less? It seems like we’d be treating the uninsured victim better than victims who are insured, no?  Isn’t that the reason for the collateral source rule, to make sure people aren’t penalized for having insurance?  

A:  Were the Court to limit recovery to the amount of the medical bills that were actually paid, it would not be penalizing people for having insurance. The person who has insurance never had to worry about paying his medical bills. That benefit is preserved. 

Q: Wouldn’t allowing the wrongdoer to get off paying less than the full amount of the bills when the victim has insurance be a windfall to the wrongdoer? Wouldn’t he be getting a benefit that the victim, not the wrongdoer, paid for?

A: There would be no windfall because the wrongdoer is in each case paying the actual amount for which the victim is responsible to pay. No more, no less.

To the plaintiff (Represented by Mr. Simms):

Q:  A plaintiff can recover only “damages suffered.” That means harm to plaintiff. If the plaintiff is not required to pay the full amount of the bills, because insurance negotiates them down, how can you say the plaintiff has suffered damages in the full amount of the bill?

A: The plaintiff signs a contract when he walks in the hospital to pay the full amount of the bills. The fact that his insurer later pays less than the full amount to settle the bills doesn’t mean the plaintiff never incurred them. 

Q: But if the plaintiff doesn’t actually come out of pocket to pay them, how is that damages under the Civil Code?

A: When an injured party files bankruptcy, he is no longer obligated to repay the bills, either. But we don’t let the wrongdoer off the hook in that case. Why should we here?

Q: Why should plaintiff be allowed to collect and keep the amount that the hospital has written off due to its agreement with the insurer? Isn’t that a windfall to the plaintiff?

A: There is no evidence in the record that the injured party will keep the amounts written off if that amount is awarded as damages. The insurer may still have a right of reimbursement and the health care provider may have a lien against the recovery.

 Update: Supreme Court Decides:Interview with Gary Simms

Is a Worker Limited to Worker's Comp Benefits When Injured On The Job?

When a worker is injured on-the-job in California, his rights are limited by the workers’ compensation laws. Workers’ compensation is a “no-fault” system.  That means the employee is entitled to compensation from the employer's insurance carrier without having to prove the employer was at fault.   However, the workers compensation benefits are quite limited, and they seldom fully compensate an accident victim for his injuries.     

In an appropriate case, an injured worker can seek compensation for his on-the-job injury from other sources. For example:

  • If a co-worker causes the injury, the injured worker may be permitted to seek compensation from the co-worker, but only (1) when co-worker’s actions are malicious with an intent to cause injury or (2) when co-worker is intoxicated.
  • If someone other than the employer or co-worker (also known as third party) causes the injury, the worker may seek compensation from the third party.  The victim's lawsuit against the third party can proceed at the same time as the workers’ compensation claim against the employer.  In his third party lawsuit, the worker is not restricted to the limited benefits of worker's comp.   However, if the worker recovers against the third party, the employer is entitled to reimbursement for any benefits paid to the injured worker.

In some cases there may be multiple causes of a worker's injury and he should proceed against his employer, a co-worker and a third party.

 

Repayment of the lien

After the lawsuit is settled or a judgment is awarded, the liens must be paid. Dealing with the liens is usually the job of the victim’s attorney, but it may differ depending on the agreement between the victim and the attorney.

When our office recovers funds on behalf of our clients, we will negotiate with the insurers the amount of payment on the lien. Because various fees and costs must be factored into the client’s recovery, I will negotiate with the insurer so that it will usually accept only a portion of the bills as full repayment.

Each lien is different. Dealing with them is my job, not the victim.
 

Health Care Liens

An accident victim’s health care costs pile up fast. For those who are fortunate enough to have good insurance, a lot of the bills will be paid by an insurance company.  

The victim’s health insurer always expects the victim’s attorney to recover the health care costs from the wrongdoer, and to pay back the insurer. The insurer protects its legal right to repayment by filing a lien against the proceeds of the client’s lawsuit. 

After the lawsuit is settled, the liens must be paid. Frequently the insurer will accept less than full amount of the lien, allowing the client to keep the rest.  But that has to be negotiated, and each lien is different. Negotiating with the lien holders on my client's behalf is an important part of my job.