Matter of Taylor Elizabeth Prendergast

Case Number

25PR00129

Case Type

Hearing Date / Time

Wed, 07/09/2025 - 08:30

Nature of Proceedings

Minor's Compromise

Tentative Ruling

Probate Notes:

Appearances required.

The following deficiencies with the petition must be rectified by amended petition filed before the hearing:

Adequate documentation that the minor has fully recovered, or is expected to fully recover from the injuries.  Adequate documentation that the minor has fully recovered, or is expected to fully recover from the injuries.  The attachment supporting the allegation at paragraph 9 of the petition is only a doctor’s note that the minor may return to school and has full range of motion. It is not an opinion on whether the minor fully recovered, or will any residual effects or limitations from the injury.

The Court needs confirmation of a full recovery, thus current/recent records showing minor suffers no symptoms from the original injury are required, or records clearly indicating a prognosis for the Court to consider.  The purpose of this requirement is to determine whether the settlement is sufficient to compensate for the minor’s future medical care needs.

Adequate evidence of sufficient investigation into the solvency of the settling defendant above the policy limits of the settling insurance company must be submitted.  Adequate evidence of sufficient investigation into the solvency of the settling defendant above the policy limits of the settling insurance company must be submitted.  There are no facts alleged that defendant cannot meet a judgment past the policy limits, and evidence on file shows the injury may be more severe than the amount of the settlement will compensate for.

Medical Liens must be apportioned to a percentage consistent with the percentage of recovery.  Petitioner proposes Medi-Cal reimbursement that is 4.2% of the alleged costs Medi-Cal has to pay ($934.85 ÷ $22,163). This means the proposed $16,000 settlement amount must be no less than 4.2% of the full value of the claim the minor could have recovered, but-for the unproven insolvency of the defendant.  Petitioner offers no allegations or evidence of the full value of the claim, but based on the proposed payout to Medi-Cal, the full value of the claim has to be, at minimum, $380,952.38.  Petitioner must provide supplement providing the full value of the claim so that the appropriateness of the Medi-Cal reimbursement ratio may be determined to be in compliance with Arkansas Dept. of Health and Human Services v. Ahlborn (2006) 547 U.S. 268.

 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.)

Appearances:

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

Meeting ID: 161 956 1423

Passcode: 137305