Injured Pedestrian Can Only Recover Amount Paid by Insurer

A pedestrian who was injured by a drunk driver can only recover the amount the medical providers accepted from her insurer, not the total amount billed, the California Court of Appeal has ruled.

According to People v. Bergin, Jennifer Armstrong was crossing the street when she was struck by Michael John Bergin. Armstrong subsequently suffered injuries, including a fractured knee that required two surgeries. Bergin entered a plea of nolo contendre to a charge of driving with a blood alcohol level of 0.08 percent or more, and causing injury to another person. He was convicted and placed on probation for 36 months. Conditions of the probation included making restitution to Armstrong, court documents state.

Armstrong filed a brief requesting restitution of $510,667, which included $138,667 for medical expenses. Meanwhile, she also brought a civil suit against Bergin, in which she obtained a judgement in the sum of $91,262. Of that, $36,744 was for medical expenses.

A restitution hearing was held. And after the hearing, the trial court issued an order requiring Bergin to pay restitution of $36,900 for medical expenses.

The People contended that the trial court should have set the restitution amount at the amount billed by Armstrong’s medical providers. It questioned whether the court ordered less than full restitution when it ordered Bergin to pay Armstrong the amount her insurers actually paid for medical expenses, rather than the amount actually incurred by the medical providers.

But the court disagreed.

State law “requires restitution ‘directly from [the] defendant’ of ‘any economic loss’ as a result of the defendant’s crime. … The restitution ordered is to be ‘sufficient to fully reimburse the victim … for every determined economic loss incurred as the result of the defendant’s criminal conduct,'” the court said.

The Court of Appeal said, “neither Armstrong nor her insurers incurred any economic loss beyond the amount identified in the trial court’s restitution order. Like the trial court, we find it impossible to see any basis for concluding that Armstrong has not been ‘100 percent compensated’ by payment of the amount specified in the trial court’s order.” As such, it affirmed the order.

Source: California Courts