OVER 400 Legal Answers to Frequently Asked Questions to a Variety of California Injury Issues and Legal Problems Associated with California Accidents

What is my case worth? What should I do after a bicycle accident? My car's brakes didn't function properly, do I have a case? Should I sign the insurance company's proposal? Some of your questions may have been answered already on Mark Blane's website. However, San Diego county accidents happen all the time, and all sorts of different questions about different injury scenarios can be raised by a person who is injured. As a result, this personal injury website is dedicated to answering your frequently asked questions about a variety of injuries, your legal rights, and what procedures you should follow. Just browse our frequently asked questions (FAQ) section (below) and look them up. If you have other or more specific questions, just send an email (Contact Us) and you will receive a reply without delay!

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  • CALIFORNIA MEDI-CAL HEALTH LIEN REDUCTION: What the heck is an "Ahlborn Reduction," and why or how is it relevant to my personal injury case settlement?

     

    An "Ahlborn Reduction" is an argument a good injury lawyer will use on a client's injury case to reduce any MediCal health lien interest that needs to be paid back to MediCal at time of a personal injury settlement.  The more the lawyer can reduce the MediCal lien interest, the more the injured client will net in monetary recovery from the settlement.  So it is very important and very relevant to a personal injury case that utilized MediCal funds to pay for part or all of the medical care (for an injured person).  If this is you, then this FAQ is very important to be aware of!

    LEGAL AUTHORITY FOR AN "AHLBORN REDUCTION"

     

    As you know, the Supreme Court’s holding in the Ahlborn case was codified in California in W&I 14124.76. Said section provides in pertinent part that, “Recovery of the director’s lien from an injured beneficiary’s action or claim is limited to that portion of a settlement...that represents payment for medical expenses...” (emphasis supplied).

    AHLBORN CALCULATION (THE FORMULA)

    The following is a case example: 

    "Given a total value of $11.3 million, it is a simple calculation to determine what percentage of his total injuries that Mr. XX actually recovered, as follows:

    Total Settlement/Total Value (you divide the two numbers together), or

    $465,000/$11.3 million = .0412

    In other words, Mr. XX recovered no more than 4.12% of his total damages. It therefore stands to reason that he only collected 4.12% of his medical expenses paid by Medi- Cal. Therefore, Medi-Cal’s lien must be reduced to:

    Total Lien X Percentage of recovery, or

    $157,980 X .0412 = $6,509
     

    This is the exact amount of Mr. XX’s medical expenses that Medi-Cal paid that he recovered in his settlement. Notably, Mr. VV already offered to pay this amount in his last letter. Also, please note that if we had used the $15 million total value figure expressed by Mediator Justice Dossee (Ret.), versus the more conservative average figure of $11.3 million, the Ahlborn figure would be more than 25% lower.

     

    We agree with Medi-Cal’s position as stated in its letters that no further reduction is allowable for attorneys fees or costs, per W&I 14124.785.

    Medi-Cal has routinely granted large reductions in Medi-Cal liens to this office, when they are supported by the evidence. Attached as Exhibit 5 is a redacted letter from Supervisor Diana Ghilarducci confirming an 85% reduction of a lien based upon a jury verdict finding plaintiff 75% comparatively negligent. Attached as Exhibit 6 is redacted recent letter from Medi-Cal agreeing to a 69% reduction of its lien for a woman who had recovered $8.56 million in settlement. In that case, the evidence supported and we had requested a 71% reduction. In another case, we obtained from the court the 84% reduction we had proposed when Medi-Cal failed to stipulate to same.

    For all of these reasons, we are offering the sum of $6,509 in full satisfaction of Medi-Cal’s lien against our client. This offer will remain open for 20 days from the date of this letter. If we have not reached a satisfactory settlement within that period, we will file a motion with the court."

    Conclusion:

    An "Ahlborn Reduction" is just another way a California personal injury attorney can advocate for their clients position when negotiating a reduction to MediCal for an injured party(s) personal injury case.  For more information, you can check other articles and blog postings on the subject or call me directly at (619) 813-7955.


    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.

     

  • CALIFORNIA "MEDI-CAL" HEALTH LIENS: If my medical care was paid by California MediCal, do I have to pay back MediCal from my settlement, and how does the fact that I used MediCal affect my California personal injury case? (Also known as the " Hanif Rule" )

    Yes, a person who had part or all of their medical care covered under California MediCal has to pay back MediCal at the time of settlement from the settlement funds.  If not, then MediCal can go after the person legally to pursue those funds.  MediCal can also go after the attorney handling the injured party's person injury case is this is not done!  In fact, it is said the injury attorney has constructive notice (means he or she "should have known") of the California MediCal potential lien interest if his or her client was simply a California MediCal lien recipient!

    Also, a defense lawyer will argue that a jury only gets to see the medical bills that were actually paid out by MediCal (which is always a lower amount) as opposed to the jury seeing the actual, or true, medical bills (which is always a higher amount). This impacts a person's personal injury case, if part or all medical bills were covered under MediCal because the defense lawyer is trying to lower the chances of what a jury would give that injured person in pain and suffering damages if they see a lower amount of medical bills (what California MediCal paid out). Make sense?  So a good injury lawyer is needed on these cases to fight this aspect.  Here is the law on this: 

     
    In the California court case called Hanif v. Housing Authority, 200 Cal.App.3d 635 (1988) The Court held that where there was a Medi-Cal lien, the recovery was limited to the amount which Medi-Cal actually paid or for which the plaintiff incurred liability.

    Also, remember, a good injury lawyer not only has to fight the above issues, but he or she has got to know how to reduce MediCal's lien interest when a settlement or verdict is received (Also known as a "Ahlborn Reduction")!  Just another reason why good California personal injury lawyers are needed to help those injured!  For more information, you can call me directly at (619) 813-7955.

     

    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.

     

     

  • CALIFORNIA MEDI-CAL HEALTH LIEN: Can California MediCal come after a lawsuit for wrongful death to try and get paid back what they paid out in the underlying wrongful death action?

    No, MediCal cannot seek reimbursement in a wrongful death action - only in survival actions. Special rules applies to MediCal and their reimbursement lien seeking powers.  I suspect this may have something to do with the fact that pain and suffering damages are altered in a wrongful death action - the suit is filed by the survivors of the person who was wrongfully killed and this affects how MediCal cannot get reimbursed on such legal actions.

    Here is the law on this FAQ:
     

    Fitch v. Select Products, 36 Cal.4th 812 (2005)  Although Medi-Cal is authorized to file suit against a third party liable for the death of a Medi-Cal beneficiary who received benefits, the controlling statutes do not authorize Medi-Cal to recover such benefits from the plaintiffs in the action for beneficiary's wrongful death. Medical expenses are not recoverable in a wrongful death action—only in a survival action.
     

    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.