ACA Benefits and MediCal Service Discounts Admissible at Trial as Evidence of Market Value of Future Medical Benefits

In a case certified for publication by the first Appellate District, division one (Contra Costa County), the appellate court determined the trial court erred in ruling that evidence of future ACA benefits is inadmissible.

Brian Cuevas, Plaintiff through his G.A.L., filed a medical malpractice action against the County of Contra Costa based on injuries he sustained at birth. Plaintiffs life care planner, Jan Roughan, based her estimate of future costs for plaintiff’s medical care by referencing a national database that reflects the average charges billed for each type of service. Ms. Roughan specifically ignored service discounts associated with Medi-Cal, even though plaintiff is currently receiving Medi-Cal benefits, and specifically ignored negotiated discounts that would potentially be available under insurance procured through the ACA.

As a result of motions in limine granted by the court, defendant’s life care planner, Linda Olzack, was prohibited from presenting three alternate cost scenarios: 1) plaintiff would continue to be covered by Medi-Cal, 2) plaintiff would procure private insurance under the ACA, and/or 3) would pay for his expenses out of pocket. Ms. Olzack’s Medi-Cal life care plan showed reimbursement rates that appeared to be substantially lower than the rates paid by persons without insurance, with a more than 60 percent difference between charges based on private pay rates and the Medi-Cal rates (for certain services). In addition, Ms. Olzack was prepared to show the life care plan costs estimated by Ms. Roughan were four to six times higher than the corresponding Medi-Cal and/or ACA rates for certain services.

Because Ms. Olzack’s evidence was never presented, the jury awarded $100 million for future medical, hospital, surgical, and rehabilitation care expenses, which the jury reduced to $9,577,000 in present cash value.

Relying on the Howell case, the Corenbaum case, and the Markow case, the Court of Appeal came to the conclusion the collateral source rule is not violated when a defendant is allowed to offer evidence of the market value of future medical benefits. The appellate court also concluded the defense presented sufficient evidence to support the continued viability of the ACA, as well as its application to plaintiff’s circumstances, and that it was error for the trial court to exclude evidence of future insurance benefits that might be available under the ACA.

  • Ranae Hawkins

    Excellent analysis – I Appreciate the details , Does anyone know where I could grab a sample NJ CN 10148 copy to complete ?

  • Ranae Hawkins

    Excellent analysis – I Appreciate the details , Does anyone know where I could grab a sample NJ CN 10148 copy to complete ?