Chris Patton presented at the Northern California Fraud Investigators/Anti-Fraud Alliance Conference in Monterey California in March 2019 on the Pebley decision.
The presentation covered in part, how Plaintiffs have historically attempted to claim the full amount of their medical bills as damages. However, most medical bills from auto accident claims were discounted based on contractual billing agreements between the medical providers and health insurance carriers or Medicare. The courts have ruled that plaintiffs cannot recover more than the amount the medical provider accepted as payment (the Hanif decision). This paid amount is often pennies on the dollar to the billed amount.
Since the Hanif decision limited the amount of medical bills a plaintiff can claim as damages, plaintiffs have been increasingly treating outside their health plans, or failing to give medical providers their health insurance so they can claim the inflated gross bills as part of their damages.
The California Supreme Court and the various Courts of Appeals have made numerous rulings over the last two decades affecting how these claimed gross “damages” can be presented to a jury, and more importantly, the scope and latitude the defense may use in challenging the gross (unpaid) bills.
In 2018 the Pebley decision found that a plaintiff who has insurance, yet choses to treat “outside” their plan, shall be treated as “uninsured” for purposes of trial. As one might guess, the possibilities of abuse and outright fraud have surfaced with this new case decision. Plaintiff attorneys are now even more likely to direct their clients to facilities who will inflate charges, thus increasing over all medical bills and subsequently increasing the cost of the claim.
The Presentation addressed “Recoverable” medical liens including a history of the Hanif decision and the subsequent cases concluding with the case of Pebley v. Santa Clara Organics. The discussion also included strategies for the defense in addressing the Pebley decision and contesting unreasonable medical liens through the discovery process up to trial.
Phaidra M. Garcia has been invited to participate on a panel to discuss Conducting an SIU Investigation of a Carrier’s Own Insured at the 2020 CLM Conference in Dallas, Texas.
Phaidra M. Garcia gave a legal ethics presentation at the 2017 NCFIA conference.
News Article: A federal district court in California has ruled that an insurance company could void a homeowner’s insurance policy based on the insured’s “significant and unexplained misrepresentations” about an alleged burglary at his home — notwithstanding his alleged “memory problems” stemming from a previous “brain injury.” READ ENTIRE ARTICLE
Phaidra Garcia presents at the 2016 NCFIA Conference in Monterey March 23-26, 2016. The topics: Investigating and Litigating Fraudulent Arson Claims.
Gianna A. Dimitriou presents at the 2016 CLM insurance Fraud Conference in Atlanta, Ga on May 19-20, 2016. The topic: The use of cell phone records in suspicious claims investigations.
Phaidra Garcia gave a presentation on the topic A to Z Guide on Investigating Questionable Auto Claims from an SIU and Attorney Perspective at the 26th Annual Anti-Fraud Training Conference (previously the NCFIA conference) in Monterey on April 1, 2015.
Phaidra Garcia gave a presentation on the topic Claims Management – Effectively Using Examinations Under Oath in Claims Investigations at the annual CLM Conference in Palm Desert on March 25-27.
Paula Shaw and Gia Dimitriou gave a presentation on the topic the use of cell phone records in claims investigations at the Combined Claims Conference in Orange County on March 9-11, 2015 and the IASIU conference in Orlando, Florida on September 13-16, 2014.
Marissa Nebenzahl Sinha and Sumair Sandhu gave a presentation on the topic of “Effective Examinations Under Oath” at the 25th Annual Anti-Fraud Training Conference (previously the NCFIA Conference) in Monterey, CA in April 2014.
Gianina Dimitriou became a member of the Northern California Fraud Investigators Association (NCFIA), March, 2014.
McDowell Shaw & Garcia Attorney Sumair Sandhu obtains Summary Judgment in favor of Roofing Contractor:
MSG clients and Defendants, Tomlinson Construction, Inc. and R.V. Tomlinson Construction (“Tomlinson”) were sued for negligence resulting in personal injury to an apartment tenant. Plaintiff contends that the insured was negligent in bird abatement efforts it undertook and disturbed pigeon feathers while working on the roof causing particles to enter the apartment via roof mounted HVAC units. Tomlinson construction had been hired to perform yearly roof maintenance work at the apartment building that included cleaning and repairs.
Plaintiff made CCP 998 demands of $2 million against the Tomlinson entities. This offer was rejected and MSCG attorney Sumair Sandhu filed a Motion for Summary Judgment which was heard in October 2013. After reviewing all papers and oral argument, the Court granted Summary Judgment in favor of Tomlinson against Plaintiff.
The Court agreed with Defendant’s arguments in that an exception to the general duty of care applied as articulated in Rowland v. Christian. In applying Rowland, the Court concluded that a roofing contractor owes no general duty to ensure particles do not enter a HVAC unit when it is designed to exclude particles and outside air from entering the complex. The Court ruled that there is no evidence that a roofing contractor hired to clean a roof must adhere to a standard of care used within the pest control industry. As such the Court granted Summary Judgment in Tomlinson’s favor with costs.
McDowell Shaw & Garcia were the Casino Night Title Sponsor for the 2014 Combined Claims Conference held March 4-5, 2014 in Anaheim, CA.
Phaidra Garcia and Phil Pereira gave a presentation on the topic of “Mock Examinations Under Oath”, at the California Casualty Conference in Colorado July 14 – 18, 2014.
Marissa Nebenzahl-Sinha was the Co-Chair of the Contra Costa County Bar Association Litigation Section in December 2013.
Phaidra Garcia was the 2014 Conference Chair for the 25th Annual Anti-Fraud Training Conference (previously the NCFIA Conference) in Monterey, CA, April 16-18, 2014.
McDowell Shaw & Garcia attorneys became members of Claims & Litigation Management Alliance in April 2013.
David McDowell, Phaidra Garcia and Sumair Sandhu gave a presentation titled “Mock Examinations Under Oath” at the 28th Annual IASIU Conference in Atlanta, GA, September 10-12, 2013.
David McDowell and Phaidra Garcia gave a presentation to Farmer’s Insurance on the topic of “SIU Investigation in the Medical Field” in May, 2013.
Paula Shaw, Phaidra Garcia and Sumair Sandhu gave a presentation at the Western States Auto Theft Investigators Association Training Seminar on the topic, “Auto Theft Investigation: Interviewing from Insurance/SIU Perspective - Key Points When Getting a Claim Ready for Referral to Counsel Handling the Examination Under Oath”, in Sacramento, CA on April 18, 2013.
David McDowell, Paula Shaw and Phaidra Garcia gave a presentation on the topic of “Mock Examinations Under Oath”, at the 24th Annual Anti-Fraud Training Conference (previously the NCFIA Conference) in Monterey, CA on March 28, 2013.
McDowell Shaw & Garcia were the Official Title Sponsors of Casino Night at the 25th Annual Combined Claim Conference in Long Beach, CA on March 12, 2013.
David McDowell, Paula Shaw and Phaidra Garcia gave a presentation on the topic of “Mock Examinations Under Oath”, at the 25th Annual Combined Claim Conference in Long Beach, CA on March 12, 2013.
Sumair Sandhu was named Director of the Northern Chapter of the Western States Auto Theft Investigators Association, this position helps promote the goals of the non-profit organization that is comprised of professionals representing law enforcement, rental car, and insurance companies, and other individuals whose goal is to reduce vehicle theft, January 2013.
David McDowell,Phaidra Garcia and Sumair Sandhu gave a presentation titled “Mock Examinations Under Oath” at the 27th Annual IASIU Conference in Palm Desert, CA on September 11, 2012.
Phaidra Garcia gave a presentation to Esurance on the topic of “Effective Interviews” in Rocklin, CA on August 29, 2012.
Paula Shaw gave a presentation to ANPAC on the topic of “Social Networking Research & Investigations – The Legal, Ethical & Evidentiary Issues” in Springfield, MO on June 6, 2012.
David McDowell and Paula Shaw gave a presentation to SIU for Oregon Mutual Insurance Company on the topic of “Underwriting & Premium Fraud” in McMinnville, OR on June 4, 2012.
McDowell Shaw & Garcia sponsored the Educational Networking Seminar for Claims Adjusters, SIU Investigators and Other Claims Professionals Seminar on Waging War on Medical Fraud at Il Fornaio Restaurant in Roseville, CA on May 9, 2012.
Phaidra Garcia gave a presentation on the topic of “Factoring & Lawsuit Finance” for the SIU Department at Liberty Mutual Insurance in Portland, OR on April 25, 2012.
Sumair Sandhu became a member of the Western States Auto Theft Investigators Association, Northern Chapter (April 2012).
Phaidra Garcia was the 2012 Conference Chair for the 23rd Annual Anti-Fraud Training Conference (previously the NCFIA Conference) in Monterey, CA, April 4-6, 2012.
David McDowell gave a seminar on the topic of “The Perfect Examination Under Oath”, at the 23rd Annual Anti-Fraud Training Conference (previously the NCFIA Conference) in Monterey, CA, April 4, 2012.
David McDowell gave a seminar on the topic of “Civil Prosecution of Fraudulent Claims” at Geico Insurance Company in San Diego, CA on January 31, 2012.
Marissa Nebenzahl Sinha became a member of NCFIA (in October 2011) and the Contra Costa County Bar Association (December 2011).
David McDowell, Paula Shaw and Phaidra Garcia hosted and attended a seminar on Social Media at Scott’s in Walnut Creek, CA on October 19, 2011.
Phaidra Garcia attended the IASIU Conference in San Antonio, TX on September 12-14, 2011.
David McDowell, Paula Shaw and Phaidra Garcia became members of the Risk Management Society (September 2011).
Paula Shaw co-presented with Tom Anderson on the topic of “Underwriting and Fraudulent Insurance Claims” at Oregon Mutual Insurance Company on August 9, 2011.
David McDowell, Paula Shaw and Phaidra Garcia gave a presentation at the 2011 Anti-Fraud Conference (formerly NCFIA Conference) on the topic of “Liens, Brokering and Fraudulent Billing” on April 21, 2011.
Phaidra Garcia gave seminar on “Examinations Under Oath” at ESURANCE Property and Casualty Insurance Company in Rocklin, CA on February 23, 2011.Back To Top