SECTIONS 22945-22948 - California Statutes

GOVERNMENT CODE

SECTION 22945-22948

22945. (a) The purpose of this chapter is to establish the rights
of the California Association of Highway Patrolmen Health Benefits
Trust, the Peace Officers Research Association of California Health
Benefits Trust, and the California Correctional Peace Officer
Association Health Benefits Trust to recover medical costs paid to a
participant for injuries, including injuries that result in death,
caused by or allegedly caused by a third party.
(b) This chapter does not apply if the participant is injured in
the course and scope of his or her employment. In those cases,
Chapter 5 (commencing with Section 3850) of Part 1 of Division 4 of
the Labor Code governs.

22946. As used in this chapter:
(a) "Health benefits trust" means the California Association of
Highway Patrolmen Health Benefits Trust, the Peace Officers Research
Association of California Health Benefits Trust, the California
Correctional Peace Officers Association Health Benefits Trust, or a
self-funded plan administered by the board under this part.
(b) "Participant" means an employee, annuitant, or family member
who is a member of a health benefits trust and who is injured by, or
due to the actions or inactions of, a third person, and includes any
other person to whom a claim accrues by reason of the injury or death
of the employee, annuitant, or family member.
(c) "Third party" means any tortfeasor or alleged tortfeasor
against whom the participant asserts a claim for injury or death.

22947. (a) A health benefits trust may assert a lien for health
benefits paid on behalf of a participant against any settlement with,
or arbitration award or judgment against, a third party. No lien
asserted by a health benefits trust under this section may exceed the
amount actually paid by the trust to any treating medical provider.
(b) The participant, if not represented by an attorney, or the
participant's attorney, shall immediately send, by certified mail,
written notice of the existence of any claim or action against a
third party, to the following:
(1) The health benefits trust.
(2) A hospital or any hospital-affiliated health facility, as
defined in Section 1250 of the Health and Safety Code, that is known
to have provided health care services to the participant.
(c) If medical costs are paid by the health benefits trust,
contract providers may not assert an independent lien against the
participant. Contract providers who agree, by contract, to a
specified rate may not seek to recover an amount that exceeds the
contracted rate against the participant.
This subdivision is not applicable to a lien for hospital services
pursuant to Chapter 4 (commencing with Section 3045.1) of Title 14
of Part 4 of Division 3 of the Civil Code.
(d) If the participant engaged an attorney, the lien for health
services asserted by a health benefits trust under subdivision (a)
may not exceed the lesser of the actual amount paid by the trust or
one-third of the moneys due to the participant under any final
judgment, compromise, arbitration, or settlement agreement.
(e) If the participant did not engage an attorney, the lien for
health services asserted by the health benefits trust under
subdivision (a) may not exceed the lesser of the actual amount paid
by the trust or one-half of the moneys due to the participant under
any final judgment, compromise, arbitration, or settlement agreement.
(f) If a final judgment includes a special finding by a judge,
jury, or arbitrator that the participant was partially at fault, the
lien asserted by the health benefits trust shall be reduced by the
same comparative fault percentage by which the participant's recovery
was reduced.
(g) The lien asserted by the health benefits trust shall be
subject to pro rata reduction, commensurate with the participant's
reasonable attorney's fees and costs, in accordance with the common
fund doctrine.
(h) The court or arbitrator may also take into account the
obligation, if any, of the health benefits trust to make future
medical payments on behalf of the participant for the medical
condition that gave rise to the claim against the third party.
(i) The provisions of this section may not be admitted into
evidence nor given in any instruction in any civil action or
proceeding between a participant and a third party.

22948. (a) A court or arbitrator having jurisdiction over a claim
by a participant against a third party shall additionally have
jurisdiction over apportionment of any recovery on the claim, if the
participant and the health benefits trust or any other party
asserting a lien cannot agree on an allocation.
(b) In the event of a settlement between the participant and the
third party where there is no agreement on proper apportionment of
the settlement between the participant and the health benefits trust
or any other party asserting a lien, the participant may petition the
court for a determination in accordance with this section. The
parties may introduce evidence with respect to the issue of
apportionment in any manner authorized by the Evidence Code,
including, but not limited to, introduction by sworn declaration or
by relevant discovery responses. The participant shall make available
to the health benefits trust all relevant discovery in a reasonable
and timely manner. The use of witness testimony shall be discouraged
and shall be allowed only by stipulation of the parties.
(c) In the event of a judgment where there is no agreement on
proper apportionment of the judgment between the participant and the
health benefits trust or any other party asserting a lien, the
participant may file a post-trial motion asking the court to
apportion the judgment in accordance with this section.