Qaadir v. Figueroa
B306011
| Cal. Ct. App. | Aug 11, 2021Background
- Rear-end collision in 2015; defendants admitted liability and the case proceeded to a damages-only trial.
- Qaadir received initial care through Kaiser/Health First but most treatment (surgeries, injections, spinal cord stimulator, PT, chiropractic) was provided by lien physicians; at trial many lien bills remained unpaid.
- Total billed charges (paid + unpaid) were $838,320.02; plaintiff’s billing expert opined reasonable value ~$632,456; defense expert opined ~$174,111.
- Jury awarded $3,464,288 (including $532,000 past medical; $500,000 future medical; $900,000 future lost earnings).
- Defendants appealed, challenging admission of unpaid and paid bills, exclusion of attorney-referral evidence, preclusion of a mitigation argument based on insurance, denial of mistrial, and denial of a continuance.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Admission of unpaid medical bills to prove past/future medical damages | Unpaid bills admissible because plaintiff sought care outside his plan and thus is treated as uninsured; bills relevant to amount "incurred" and to reasonable value with expert support (Pebley) | Admission was improper under Howell/Ochoa; full billed amounts are irrelevant where insurer pre-negotiated rates or generally inadmissible if unpaid | Court: Trial court erred in admitting unpaid bills without requiring proof plaintiff actually incurred them, but error was harmless; Pebley controls for plaintiffs treated outside their plans so unpaid bills can be relevant if foundational proof of liability is shown |
| Admission of paid medical bills (those paid by insurer) | Plaintiff presented reasonable-value evidence; paid bills were shown and experts accounted for them | Corenbaum/Howell say paid, pre-negotiated amounts should control and full billed amounts are irrelevant and prejudicial | Court: Admission of full paid bills was error under Howell but was harmless because experts and evidence allowed jury to assess reasonable value and paid bills were a small portion of award |
| Exclusion of evidence that plaintiff’s attorney referred him to lien physicians | Such referrals are relevant to show lien-physicians’ bias/financial incentive to inflate bills | Exclusion proper under trial court’s Pebley-based ruling to avoid insurance-status confusion; referral testimony was not essential | Court: Exclusion was error (relevance recognized) but harmless; defense had other means to impeach bias and jury was aware of liens and potential incentives |
| Preclusion of mitigation argument (arguing plaintiff should have used in‑plan providers) | Plaintiff: mitigation by forcing use of insurance is not required; Pebley disallows mitigation argument based on insurance status | Defendants: plaintiff unreasonably chose out-of-plan providers and failed to mitigate damages; jury should consider that | Court: Defendants waived the mitigation argument at trial; also no authority requires plaintiff to mitigate by using in‑plan providers — mitigation argument was properly limited under Pebley/Evidence Code §352 |
| Motion for mistrial based on plaintiff counsel implying plaintiff lacked insurance | Plaintiff: comments addressed expert methodology, not plaintiff’s insurance status | Defendants: rebuttal argument implied plaintiff uninsured and opened the door to insurance evidence; prejudice warranted mistrial | Court: No abuse of discretion; remarks were fair comment on expert testimony and did not justify mistrial |
| Denial of continuance to allow live testimony of defense vocational expert (medical issues) | Plaintiff: expert deposition evidence was sufficient and Kennemur barred new opinions; continuance would unduly delay trial | Defendants: expert unavailable due to medical complications; live testimony was essential for future lost-earnings defense | Court: Denial of open-ended continuance was not an abuse of discretion; deposition testimony and other alternatives made prejudice unlikely |
| Excessiveness of award (passion, prejudice, corruption) | Plaintiff: verdict supported by medical and vocational testimony and fell between expert ranges | Defendants: cumulative errors and lost live expert testimony produced an excessive award | Held: No. Jury awards were within expert ranges and errors found were harmless; verdict did not shock conscience per Seffert standard |
Key Cases Cited
- Howell v. Hamilton Meats & Provisions, Inc., 52 Cal.4th 541 (Cal. 2011) (limits recovery to lesser of amount paid/incurred and reasonable value; full billed amount inadmissible where insurer pre-negotiated a lower rate)
- Corenbaum v. Lampkin, 215 Cal.App.4th 1308 (Cal. Ct. App. 2013) (extends Howell reasoning; treats billed amounts as inadmissible for certain damages analyses)
- Ochoa v. Dorado, 228 Cal.App.4th 120 (Cal. Ct. App. 2014) (holds unpaid full bills are not relevant to reasonable value and cannot alone support past medical awards)
- Pebley v. Santa Clara Organics, LLC, 22 Cal.App.5th 1266 (Cal. Ct. App. 2018) (insured plaintiff who elects out‑of‑plan care is treated as uninsured for damages measurement; unpaid bills admissible with expert testimony)
- Bermudez v. Ciolek, 237 Cal.App.4th 1311 (Cal. Ct. App. 2015) (uninsured plaintiffs’ billed amounts admissible to prove incurred amount and reasonable value)
- Seffert v. Los Angeles Transit Lines, 56 Cal.2d 498 (Cal. 1961) (standard for appellate review of excessive damages: verdict must "shock the conscience" to be reversed)