The Continued Impact of a California Appellate Ruling Allowing Evidence of Unpaid Medical Bills

Los Angeles, Calif. (April 23, 2024) - The California Court of Appeal’s decision in Qaadir v. Figueroa (2021) 67 Cal.App.5th 790 (“QAADIR”) is an important precedent for personal injury litigation. Most of these cases involve attorney-referred medical treatment on a lien basis. The medical treatment obtained by the plaintiffs is part of the contingency fee arrangement and is paid for after the conclusion of a personal injury claim. The medical treatment performed in this “borrowed” arrangement is the basis for a damages calculation in a personal injury claim.

The ruling in QAADIR addresses the admissibility of evidence concerning attorney referrals and medical treatments provided under lien arrangements, shedding light on potential biases in medical provider testimonies that could influence jury perceptions and verdicts.

Background and Legal Context

In QAADIR, plaintiff Malak Melvin Abdul Qaadir sought treatment from medical professionals who, rather than accept his personal medical insurance, treated him on a lien basis following a motor vehicle collision.

The defense challenged the impartiality of Qaadir’s medical treatment, and asserted that Qaadir’s treatment consisted of attorney-directed referrals and was obtained via medical liens, which indicate a potential financial bias on part of the treatment providers. The reasonableness of the medical treatment and the basis for the treatment provider’s recommendations and prognoses was questionable.

The pivotal issue was whether evidence of attorney referrals to medical providers and the financial nature of these treatments (i.e., liens) could be admitted to show potential bias vis-à-vis the financial incentive of the medical providers.

Detailed Analysis of the Court's Decision

The appellate court's analysis focused on the relevance of the evidence in question and decided that it showed a significant propensity for a financial bias. The evidence of attorney-referred, lien-based medical treatment was admissible to question treatment necessity and cost.

The court specifically noted:

"The referral evidence was relevant to the question of the reasonable value of the lien-physicians’ medical care because it may show bias or financial incentives on the part of the lien-physicians."

By recognizing the admissibility of this evidence, the court has effectively allowed defense attorneys to explore deeper into the relationships between plaintiffs, their legal counsel, and their medical providers. This acknowledgment permits questioning that might reveal whether the care provided was medically necessary or inflated in anticipation of litigation.

Implications for Defense Strategies in Personal Injury Litigation

This ruling is a strategic tool that affords defense attorneys a more aggressive approach in challenging the credibility of medical evidence presented in personal injury cases. It opens the door to questioning the impartiality of medical providers who treat patients based on attorney referrals and on a lien basis, which is particularly prevalent in personal injury cases.

Defense attorneys can now argue that the relationship between the plaintiff's attorney and the treating physicians may influence the medical treatment provided. This approach not only challenges the credibility of the medical evidence but also can sway a jury’s perception of a plaintiff’s claims.

A plaintiff’s choice of medical provider and the terms of such treatments should be explored thoroughly in litigation. The contractual relationships between plaintiffs and their medical providers should be examined during depositions and trials to uncover undue influences and financial arrangements. Evidence of the leveraging of such arrangements to inflate claims should be considered a fair-game topic in California litigation going forward.

Conclusion

The QAADIR decision significantly affects medical evidence and provider testimony in personal injury litigation. The application of this ruling will enhance defense attorneys’ ability to scrutinize the legitimacy of medical treatments and medical bills presented in trials. This insight is critical in ensuring that the evaluation of damages and liabilities is based on unbiased and reasonable assessments, and to cast doubt upon the reasonableness of both a plaintiff’s medical treatment’s cost and the treatment itself. Jurors have been deemed capable of analyzing the credibility of a medical treatment provider that performs lien- based, attorney-referred medical treatment.

For more information on this decision, contact the author of this alert. Visit our General Liability Practice page to learn more about Lewis Brisbois' capabilities in this area.

Author:

Markus Aloyan, Associate