Matter of Javier Campos

Case Number

24PR00552

Case Type

Hearing Date / Time

Mon, 06/09/2025 - 08:30

Nature of Proceedings

Minor's Compromise

Tentative Ruling

Probate Notes:

Personal (in-person) appearances required, including the minor. (CRC 7.952.)

The following must be submitted before petition may be approved:

Documentation re: Full Recovery.  The recent medical records filed in support of the petition’s claims that minor has recovered do not contain a sufficient evaluation of the minor’s original injury, thus do not opine if the minor made a full recovery (or will in the future). Therefore, the attachments supporting the allegation at paragraph 8 of the petition do not support a finding that the minor will fully recover.

Adequate documentation that the minor has fully recovered, or is expected to fully recover from her injuries must be filed. 

Supplement re: Insufficient reductions. Medi-Cal liens do not attach to damages for wrongful death, loss of consortium, etc. The minors in this case lost their father. Thus, the settlement amount should be considered an award for wrongful death, so the Medi-Cal lien does not attach. (Fitch v. Select Products Co. (2005) 36 Cal.4th 812, 820.)

Even if the Medi-Cal lien were to attach, it likely too high.  Medi-Cal Liens must be apportioned to a percentage consistent with the percentage of recovery of the total claim of the minor, which includes damages that are not calculated for in the petition (i.e. pain and suffering, etc.).

According to SCOTUS, DHCS violates federal law when it places a statutory lien on any amount of a settlement or judgment above an amount specifically designated as reimbursement for medical costs.  (Arkansas Dept. of Health and Human Services v. Ahlborn (2006) 547 U.S. 268, 272.)  Thus, according to California cases decided after Ahlborn, DHCS cannot seek full reimbursement for Medi-Cal payments made for medical care required to treat injuries caused by a third-party tortfeasor, unless the recipient of the medical care recovers the full value of their tort claim. (See e.g. Lopez v. Daimler Chrysler Corp. (2009) 179 Cal.App.4th 1373, 1378; Lima v. Vouis (2009) 174 Cal.App.4th 242, 260; Bolanos v. Superior Court (2008) 169 Cal.App.4th 744, 748.) Thus in a settlement, DHCS’s recovery is limited to a percentage of the portion of the settlement apportioned for reimbursement of payments made for medical care, equivalent to the percent the settlement is to the value of the full claim amount:

 

Expressed mathematically, the Ahlborn formula calculates the reimbursement due as the total settlement divided by the full value of the claim, which is then multiplied by the value of benefits provided. (Reimbursement Due = [Total Settlement ÷ Full Value of Claim] × Value of Benefits Provided.)

 

(Aguilera v. Loma Linda University Medical Center (2015) 235 Cal.App.4th 821, 828.)

IN THIS CASE, a reduction was negotiated in the amount of $8,062.59, or 60%.  In contrast, the settlement amount of $25,000 is 1.86 times the total medical expenses only.  When the pain and suffering of a spleen injury that required surgery is taken into account, the negotiated reduction is likely insufficient and should be reduced further based on the Ahlborn formula, which requires the attorney to either file an Ahlborn motion, or submit a calculation based on the Ahlborn formula and get Medi-Cal to agree to that reduction.

Appearances:

The court is open to the public for court business. The court is also conducting hearings via Zoom videoconference.

Meeting ID: 161 797 5412

Passcode: 8749009