Qaadir v. Figueroa: If Plaintiff sees a doctor on a lien, not covered by health insurance, can Defense argue Plaintiff is “uninsured”?

By Eric Ganci

If a Plaintiff sees a doctor on a lien, not covered by health insurance, can defense argue Plaintiff is uninsured?

Yes, this is a particular topic. But yes, this is the kind of stuff that comes up in civil trials.

Let me give an example of how this can play out:

You’re involved in a car crash (or a car accident, car collision, etc.). You hire a personal injury lawyer to sue Defendant’s insurance. You treat with your regular doctors, covered by your insurance. But then in your legal case, your lawyer advises you to see an expert doctor.

Why would you see an expert when you have your own doctor? This is a deeper California law discussion as to whether treating medical doctors can give an opinion to the incident as causing your injuries from the incident. I’ll pass on answering this question now, Dear Reader, but I love your inquisitive mind.

Ok, back to this blog topic. If you see an expert doctor, your health insurance usually does not cover that expense.

With that, can Defense try to argue you did not have health insurance? Because that may affect how some Jurors see you. And that may affect whether Jurors think you were appropriate in how you tried to treat your injuries after the incident.

Well, the answer is no: Defense should not be able to comment on this.

I’ll put the case law below, which stems this morning from me reading the 2021 decision Qaadir v. Figueroa, cited as 67 Cal.App.5th 790. Qaadir makes it holding by discussing Pebley v. Santa Clara Organics, LLC (2018) 22 Cal.App.5th 1266.

Per Pebley v. Santa Clara Organics, LLC (2018) 22 Cal.App.5th 1266: “the court held that when an insured plaintiff chooses to seek medical care outside of his or her insurance plan, such a plaintiff may be considered ‘uninsured,’ making the incurred but unpaid medical bills potentially relevant to prove past and future medical damages—so long as additional evidence, usually in the form of expert opinion testimony, is also presented on the reasonable value of the services rendered. Id. at 1269. Pebley held, “when a plaintiff is not insured, medical bills are relevant and admissible to prove both the amount incurred and the reasonable value of the medical services provided.” Id. at 1275.

“Evidence of a plaintiff’s insured status under these circumstances [in Qaadir v. Figueroa, (2021) 67 Cal.App.5th 790, 810], is properly excluded to avert confusion of the issues, or to prevent misleading or prejudicing the jury. Qaadir citing Pebley v. Santa Clara Organics, LLC (2018) 22 Cal.App.5th 1266, 1278; Evid. Code, § 352.

Qaadir further cites Pebley: “Pebley merely held an insured plaintiff who receives treatment outside of his insurance plan ‘is to be considered uninsured (or noninsured) for purposes of proving the amount of his damages for past and future medical expenses.’ [Pebley at 1277] That is, he may prove the reasonable value of the services he received by admission of the unpaid medical bills and by expert testimony.” Qaadir at 810.

The main holding in Qaadir was evidence of a medical bill is relevant to prove or disprove the “paid or incurred” prong of past medical damages if it can be established the bill is actually paid or incurred. So, meaning you must introduce those bills as evidence. But I thought the law above was interesting and wanted to write on that part of the holding instead.