California Personal Injury Law

Published on: February 10, 2022

Hospital Not Allowed to Collect from Auto Insurance Benefits

When people are injured in accidents in California and pursue auto accident claims against the other drivers who caused their accidents, their medical providers might place liens against any settlements or awards they might receive in their lawsuits. However, there are limits to the ability of medical providers to place liens against certain types of recoveries. In Dameron Hospital Assn. v. AAA Northern California, Utah, and Nevada Insurance Exchange, Cal. Ct. App. Case No. C086518, the California Court of Appeal held that a hospital cannot place a lien against an insured’s uninsured or underinsured motorist’s coverage or their medical payments coverage through their auto insurance policies when they have health insurance.

Factual and Procedural Background

Five different people were insured by AAA for automobile insurance. Each of these five individuals was injured in accidents caused by others and sought treatment at Dameron Hospital. The patients were required to sign an agreement with the hospital upon their discharge assigning any UM/UIM or MedPay benefits to the hospital. Each of the five people had UM/UIM and/or MedPay coverage on their auto insurance policies. Dameron requested direct payments from the patients’ auto insurance carriers at the hospital’s full rates. However, AAA evaluated the bills sent by the hospital and paid significantly lower rates than what the hospital had billed. The auto insurer paid the balances to the insureds, and the hospital filed a lawsuit against the insurance company to recover the difference.

Published on: April 4, 2018

Emergency room medical billing after a personal injury

by Steven M. Sweat

Emergency-Room-Bills-Personal-Injury-Accident

When people in California have health insurance through health management organizations, they normally will go to their in-network providers for care. However, when people are injured in accidents and are forced to seek care in emergency departments, the hospitals may not have pre-negotiated contracts with the HMOs. This might mean that the HMOs may refuse to pay the full amount that they are billed for the provided services. In some cases, doctors have subsequently billed the patients for the balance between what they billed the HMOs and the amounts that they received, which is a practice called balance billing. The Supreme Court of California ruled that balance billing is not allowed in the state in Prospect Health Source Medical Group, Plaintiff and Appellant, v. Saint John’s Emergency Medicine Specialists, Inc., et al., Defendants and Respondents, 45 Cal.4th 497 (2009).

Factual background of the case

Prospect Health Source Medical Group is an individual practice care association that manages care through written contracts with health plans. It contracts with medical providers and hospitals to provide patient care to its members at contracted rates. When people go to one of the providers in the network, Prospect pays the provider the agreed-upon rate. However, patients who have to go to the emergency department might go to a hospital that does not have a contract with Prospect.

Published on: September 6, 2017

California Appeals Court Rules Against Person Injured in Hot Air Balloon Ride

by Steven M. Sweat

When people in California decide to participate in inherently risky activities, they assume the risk that they will be injured unless the operators of the activities engaged in conduct that was grossly negligent. In Grotheer v. Escape Adventures, Cal. Ct. App. 4D, Case no. E0634449, the court examined the concept in the context of a hot-air balloon ride in which a female passenger was injured after signing an express waiver of liability.

Issue: Is a balloon company a common carrier, and was the express waiver of liability sufficient to preclude a finding of liability?

Grotheer, a 78-year-old German woman, was a passenger on a hot-air balloon ride that had been purchased for her by her son while she was visiting California. Grotheer could not speak English. Prior to the ride, her son explained that she could not speak or understand English to the balloon operator but was apparently waved off. Grotheer signed an express waiver of liability prior to the balloon’s takeoff. The trip was apparently uneventful until the landing. The balloon descended too rapidly and crashed through a fence before crashing forcefully to the ground. The force of the landing caused the balloon’s basket to skip across the ground before it came to rest on its side. Grotheer landed at the bottom, and her leg was broken in the crash-landing. She filed a lawsuit against the balloon’s operator, the balloon company and the vineyard from where the balloon launched, alleging negligence. The defendants filed a motion for summary judgment, arguing that Grotheer assumed the risk when she chose to go on the hot-air balloon ride, that the company was not negligent or that if it was, it was not grossly negligent to the extent that the assumption of the risk standard would not apply.

Published on: January 5, 2016

California Personal Injury Laws New in 2016

by Steven M. Sweat

California Personal Injury Laws are constantly being updated and 2016 is no exeption. The State of California is revamping some of its laws to cut down the number of citizens that fall victim to traffic and pedestrian accidents. The following are some of the top laws that California intends to pass for 2016:

Safe Skateboarding Law: AB 604

A rise of electric skateboards has been occurring over the past five years, and a rise in skateboarding accidents has followed. The new law will demand that young riders wear helmets when they ride, stay on the sidewalk, and keep their speed under 35 miles per hour. Furthermore, electronic skateboard riders must be at least 16 years of age.

Published on: May 4, 2015

Could Apple Watch Data Prove Your Personal Injury Case?

by Steven M. Sweat

Trial attorneys learn early in their careers that each group of jurors is a blank canvas waiting for the evidence that will paint a picture of events as their clients seek to portray them. It is the task of the attorney to convince the jury that allegations are facts that can be believed and relied upon.

Needless to say, personal injury cases offer the greatest challenge to lawyers who must prove the effect an accident had on a client’s ability to go about his or her daily activities. In the past, attorneys resorted to commissioning professionally prepared videos portraying what purported to be an average day-in-the-life of the accident victim. The video could be played in court to offer jurors visual proof to support the testimony of the victim.

Wearable Data Offers an Alternative to Videos

Published on: January 21, 2015

California Hazing Assault Lawsuit Attorney

by Steven M. Sweat

As a California hazing assault lawsuit attorney, I am glad that hazing, of all sorts, is rare, however, it still happens too often in our schools, universities and other institutional settings. Recent events show that assault and battery as a “rite of passage” is still taking place. What do the laws of the State of California provide with regard to victim’s rights in these cases?

Hazing Is Both Criminal Conduct and Can Result in Civil Liability for Money Damages Under California Law

California Penal Code 245.6 defines “hazing” as a crime in California and sets forth the legal definition as follows:

Published on: December 3, 2014

Los Angeles Jury Verdicts Nov. ’14

by Steven M. Sweat

In what will be a continuing series highlighting personal injury jury verdicts in Los Angeles, I wanted to discuss two cases were jury verdicts rendered in L.A. Superior Court were reported in November as follows:

Verdict of Almost $70,000 After State Farm Insurance Offers Only $30,000 for Settlement

Villalobos v. Aranda, Los Angeles Superior Court Case No. MC023611

Published on: October 21, 2014

Personal Injury Insurance Settlement Negotiations in CA

by Steven M. Sweat

Personal injury insurance settlement negotiations in CA can be tricky without the right advice and assistance of legal counsel. Having negotiated hundreds of claims throughout the Golden State ranging from traffic collisions to injuries on commercial and residential property to all manner of claims involving bodily harm, I thought I would share some of my tips on effective negotiation tactics. Being able to resolve a claim without having to file a lawsuit can save a client both attorney’s fees and costs. Most personal injury lawyers have a “graduated” scale on their contingency fee agreements. Oftentimes, the percentage of the gross recovery charged as lawyer fees increases the longer the case drags on and the more work the attorney has to do in filing a formal lawsuit in court, conducting discovery (including sending out and responding to requests for information and documents, taking and defending depositions) and preparing for mediation, arbitration or trial of the case. In addition, litigation of claims costs money! There are court filing fees, fees to have the lawsuit served on the defendant(s) by a certified process server or constable, costs of court reporters to record deposition proceedings, costs of expert witnesses and many other expenses. Therefore, it is most often in the economic interest of a personal injury client to try to have their claim resolved sooner rather than later from a net proceeds standpoint unless the offer to settle is so low that the risks and costs of proceeding forward are outweighed by the potential for greater recovery.

Top Five Strategies Used by Attorneys to Maximize the Settlement Offer From An Insurance Claims Adjuster Prior to Filing a Lawsuit

There are many tactics and approaches used by lawyers who represent injury claimants to maximize value and increase the chances of settling a claim “pre-litigation.” I thought I would share my top five methods as follows:

Published on: September 25, 2014

CHP to Pay $1.5 Million For Police Brutality

by Steven M. Sweat

The Los Angeles Times reported today (see article here) that the California Highway Patrol has agreed to settle a civil rights police brutality claim for $1.5 Million. The plaintiff, Marlene Pinnock, was a 51 year old woman who was held on the ground and repeatedly punched by a CHP officer on the side of the 10 freeway near Los Angeles. The beating was videotaped by a passing motorist and the videotape sparked widespread protest. I thought I would use this incident to explore the legal aspects of such claims.

What is the legal standard for a civil rights violation or other claims for personal injury in California and under Federal Law related to police brutality?

The main statute pertinent to these types of claims is a federal statute found in chapter 42 of the United States Code at section 1983 which states, in pertinent part, as follows:

Published on: September 18, 2014

Res Ipsa Loquitur – Can Negligence Be Presumed in California Injury Claims?

by Steven M. Sweat

“Res Ipsa Loquitur” is a Latin phrase which, literally, translates to, “the thing speaks for itself.” Under California personal injury laws, its meaning is that there are times when evidence cannot necessarily be shown to determine if there was negligence but, the facts and circumstances surrounding an injury show that the person hurt would not normally be harmed in the manner in which they were in the absence of a negligent act. In other words, where the accident giving rise to injury is probably the result of someone’s negligence because such things usually do not happen absent legal culpability, then the trier of fact [judge or jury] may infer that negligence occurred and the burden would shift to the defendant to show evidence to the contrary. Brown v. Poway Unified School District (1993) 4 Cal.4th 820 .

The law is set out in California Evidence Code §646 as follows:

“(b) The judicial doctrine of res ipsa loquitur is a presumption affecting the burden of producing evidence.