Legal Question in Personal Injury in California

The actual paid bills is one factor for actual reimbursement. But under the case law that decided this and that they are referring to the court said the jury should be permitted to hear the actual amount charged by the healthcare provider for purposes of evaluating the severity ofvthe injury suffered and thus the value of pain and suffering. Based upon your question it appears that you are representing yourself and the adjustor might try to ignore that nuance of the case law. You really do take your chances by doing that. And you still have to pay Medicare back but it would reduce what is due back by formula it uses and starts by deducting both the attorney's fee and costs off the top. I was a claims person many years ago before I was an attorney and back then the carrier always felt that a claim involving attorney representation would increase the amount they paid out verses dealing direct with the claimant. You do the math. I hope this helps. Bob

There are many factors they should consider, more than the bills the issue is what did you, yourself, actully suffer. How did it affect your life. How will it affect your life in the future. And other factors.

As to the Medical Bills, the amount used was in dispute for many years. Due to a recent California decision (Howell), the issue has become somewhat clearer, and they would use the lower amount.

People will often tell you that your recovery is a function of your medical bills. As previously addressed by the other answers, California Law now posits that your recovery for your medical bills is limited to the amount actually paid versus the amount charged (the lesser amount).

However, lawyers representing injured claimants and Plaintiffs will always try to put before the jury the amount charged to help demonstrate the severity of the injury; the rationale being the higher the medical bills the more you were injured.

To recover more general damages or pain and suffering be prepared to discuss specific instances of how your life has been affected, activities your lost out on, etc. The more specific you can be with examples the more money you may stand to recover versus just saying generally you had pain and suffering.

Lastly, as you are a Medi-cal beneficiary, Medi-cal by law has a right to recover for the money they paid on your behalf if you recover any money from your claim. For the above reasons, it is smart to consult with an attorney prior to settling.