50. Medical Mutual of Ohio v. deSoto 245 F.3d 2001 (6th Cir. 2001)
Sixth Circuit here held that ERISA did not preempt the CA MICRA law as applicable to an insured ERISA plan because CC 3333.1 relates to an employee benefit plan and that it regulates insurance. Therefore, the “saving” clause in ERISA 29 USC 1144 preserves to the states the power to pass such legislation. Thus, the prohibition on the collateral source paying the plaintiff’s medical expenses in a med mal case contained in CC 3333.1(b) was effective to preclude reimbursement to an insured ERISA plan. Note: The result would likely be the opposite with a self-funded ERISA plan because the saving clause would not apply and §3333.1 would be preempted by federal law.
51. Espericueta v. Shewry (2008) 164 Cal.App.4th 615
Court refused to reduce Medi-Cal’s previously ordered reimbursement from a court approved minor’s compromise (submitted 4 months after Ahlborn decision by U.S. Supreme Court) per Ahlborn because the court had already allocated the amount to be repaid to Medi-Cal. Court was very critical of counsel for failing to raise the issue in the minor’s compromise hearing or to disclose that a case counsel alleged to be worth $26M was being settled for $3.6M.
52. McMillian v. Stroud (2008) 166 Cal.App.4th 692
Ahlborn case with multiple mistakes by court and plaintiff’s counsel, detracting from opinion. Court held that Ahlborn does not require the trial courts to follow the apportionment type formula used in Ahlborn because that case was based upon a stipulation. Also placed the burden of proof on the Medi-Cal recipient to show how much of the Medi-Cal lien was recovered in the settlement. Note-w/o resort to the apportionment formula or a special verdict, this is impossible. In both McMillian and Espericueta, the original minors compromise was approved without regard to Ahlborn.
53. Bolanos v. Superior Ct. (2008) 169 Cal.App.4th 744
Ahlborn case holding that U.S. Supreme Court ruling and new W&I 14124.76, codifying Ahlborn, required the trial court hearing a Medi-Cal reduction motion on a settlement that is not allocated between past medical expenses and other damages is required to make a rational allocation of those damages. Although agreeing that the formula used in Ahlborn is not required, the court indicated that it produced a reliable approximation of the amount of the Medi-Cal lien that had been recovered and should not be lightly abandoned since it was approved by the U.S. Supreme Court. The court distinguished and refused to follow Espericueta and McMillian as standing only for the proposition of the finality of court rulings. Bolanos is directly on point and should require trial courts to follow the decision as opposed to Espericueta and McMillian, upon which Medi-Cal continues to rely.
53A. Lima v. Vous, 2d DCA (2009) 174 Cal.App.4th 242
Court of Appeal reversed the trial court for failing to apply an Ahlborn reduction to a $14M case settled for $950K. Followed Bolanos and distinguished Espericueta and McMillian. Remanded to the trial court for appropriate apportionment of past medical damages paid by Medi-Cal.
Mark C. Blane is a San Diego Auto Accident Attorney, and the managing lawyer of the Law Offices of Mark C. Blane, a San Diego, California Personal Injury Law Firm devoted to representing families of injured persons of automobile accidents. If you or someone you love, has been injured or killed in San Diego County, or Southern California, due to the negligence of another, please order your FREE copy of Mr. Blane's book, The 10 Secrets You Need To Know About Your Injury Case, BEFORE You Call A Lawyer. It is full of helpful information, insights, and secrets that will help you protect your legal rights. It normally sells for $16.95; however, it is free to all California residents, or those injured in a California accident.