In recent years, insurance companies have been able to grab more and more leeway when it comes to paying less for the negligence of the people who buy their policies. The increasing intersection of liability law, healthcare system complications, and insurance company protections keeps building up the hurdles a plaintiff will face when seeking compensation. However, as Attorney Daniel Del Rio recently discussed in an article he wrote for The Litigator — titled “The ‘Pebley’ Choice and its Practical Application” — not every legal decision in recent years has been completely out of favor of plaintiffs. In particular, Pebley v. Santa Clara Organics, LLC (2018) has reaffirmed that a plaintiff should have the choice to decide their own healthcare provider after suffering injuries caused by a negligent third party.
Key Details of the Pebley Case
Dave Pebley suffered serious injuries in a motor vehicle accident caused by an employee of Santa Clara Organics, LLC. Pebley decided to use medical services not covered by his health insurance for his recovery, with the total cost of his healthcare forwarded as a lien against any settlement or verdict award the case could grant him. After a jury did find the defendant to be liable for the plaintiff’s injuries, and therefore his damages, the defendant appealed. It was claimed they should not have to pay for Pebley’s medical costs because he failed to use medical services provided by his health insurance and therefore accrued inflated costs.
As Del Rio explained in his Litigator article, the defendants depended on a history of case law that argues a defendant should not be ordered to pay damages that the plaintiff should have been able to avoid. For example, imagine a scenario in which you are hurt in a car accident but knowingly refuse medical treatment afterwards. If your injuries worsen in the coming days due to a lack of treatment, the defendant would likely not be responsible for most or all of your eventual medical costs.
However, the Court of Appeal sided with Pebley, noting “a tortfeasor cannot force a plaintiff to use his or her insurance to obtain medical treatment for injuries caused by the tortfeasor. That choice belongs to the plaintiff.” The language of that statement from the Court of Appeal is quite clear and striking.
How the Pebley Case Will Resonate Throughout Liability Law
Insurance defense attorneys are already hard at work to try to contest Pebley’s application to other cases. Del Rio & Caraway, P.C. recently handled a claim for a car accident client — The Litigator included a short description of this case within the same publication as Del Rio’s article — who decided upon their own medical provider after the accident and who also asserted those costs as a lien against the jury award. The defense tried to convince the court that Pebley should be ignored, basically arguing it was “unfair” to defendants as it opened up the possibility of medical providers to raise their prices unwarrantedly in hopes to get more from the insurer.
The attorneys of Del Rio & Caraway, P.C. got to work to shut down the opposition’s complaints of Pebley’s application by citing three key points:
- Pebley is an extension of preexisting law, not a newly created piece of case law, based on numerous decisions, such as Hanif v. Housing Authority (1988).
- A person’s decision to protect their health and wellbeing by seeking the best possible medical care is a basic right that should not be infringed upon to merely protect insurance company profits. Indeed, it is adjacent to a person’s right to privacy.
- Plaintiffs must still show that all medical expenses related to their injury case are “reasonable and customary,” and this requirement has not been altered by Pebley. The defendants also did not lose the right to try to contest the validity of the costs.
Final Legal Takeaway from Pebley
Attorney Del Rio ended his article with a final reaffirmation that Pebley does uphold a plaintiff’s right to decide where to get medical treatment after an accident, regardless of the defense’s complaints. To make certain its application is not quashed, though, the injury attorney managing the case should anticipate the need to apply furthered arguments and evidence to show the incurred medical costs are reasonable and justified.
Would you like to know more about the Pebley article written by Attorney Del Rio? You can click hereto view the full Litigatorpublication. On page 31 and 32, you can find the Pebley article, and on page 43, you can learn about two recent case victories attained by our law firm. If you want a highly-experienced and insightful Sacramento personal injury lawyer on your side for a claim of your own, call (916) 229-6755 to place a free case evaluationon your calendar. We look forward to hearing from you!
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