Rodriguez v. Diede

2025 UT App 68

THE UTAH COURT OF APPEALS

DOLORES RODRIGUEZ AND LAURA RAMIREZ,
Appellants,
v.
MILES DIEDE,
Appellee.

Opinion
No. 20230833-CA
Filed May 15, 2025

Third District Court, Salt Lake Department
The Honorable Linda M. Jones
No. 190909222

Brandon C. Stone, Attorney for Appellants
Joseph J. Joyce, Bryan J. Stoddard, and
Jonathan P. Barnes Jr., Attorneys for Appellee

JUDGE JOHN D. LUTHY authored this Opinion, in which
JUDGES GREGORY K. ORME and RYAN M. HARRIS concurred.

LUTHY, Judge:

¶1 Dolores Rodriguez and Laura Ramirez sued Miles Diede,
alleging that an auto accident for which he admitted fault caused
them to suffer injuries and incur damages. The jury returned a
verdict in favor of Diede. Rodriguez and Ramirez appeal, arguing
that references at trial to their use of medical liens and other credit
financing to obtain treatment, and to their general unawareness
of the amount of medical expenses they had incurred, violated the
collateral source rule. We disagree and affirm the judgment
below.
Rodriguez v. Diede

BACKGROUND 1

The Accident and Alleged Injuries

¶2 In January 2018, Rodriguez was driving a 2017 Chevrolet
Silverado truck at about thirty miles per hour eastbound on 6200
South in West Jordan, Utah, with her seventeen-year-old
daughter, Ramirez, riding as a passenger. At the same time,
Diede, who was driving a 2006 Chevrolet Silverado truck, made a
lefthand turn to also go eastbound on 6200 South. As Diede made
his turn and accelerated to about sixteen miles per hour, the right
front corner of his truck struck the left rear wheel area of
Rodriguez’s truck.

¶3 Rodriguez reported that the day after the accident, she
began to experience headaches and pain in her neck, shoulder,
and arm. She stated that she had trouble sleeping and that her
shoulder, neck, and head pain made it difficult for her to do
ordinary household tasks. Accordingly, she sought care from a
chiropractor (Chiropractor). During his treatment of Rodriguez,
Chiropractor sent her for an MRI scan and to a pain specialist
(Pain Specialist) for injections in her neck. After some months,
Rodriguez felt that Chiropractor’s treatment was not helping, and
Chiropractor referred her to a different doctor (Doctor). Doctor
immediately recommended neck surgery. Knowing that the
“surgery was going to keep [her] away from work for a while,”
Rodriguez explained, she continued working at her job—which
entailed doing “tiny soldering” under a microscope—and waited
to have surgery because she “wanted to make sure [her] children
were okay financially” before she underwent surgery. Eventually,

1. “On appeal, we review the record facts in a light most favorable
to the jury’s verdict and recite the facts accordingly. We present
conflicting evidence only as necessary to understand issues raised
on appeal.” USA Power, LLC v. PacifiCorp, 2016 UT 20, ¶ 8 n.3, 372
P.3d 629 (cleaned up).

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in July 2021, Rodriguez had neck surgery. The “surgery was
successful,” and she has experienced no lasting neck pain,
shoulder pain, or headaches since. The medical expenses
Rodriguez incurred for the foregoing care totaled $87,855.08.

¶4 Ramirez reported that she too experienced neck and
shoulder pain starting the day after the accident, and she went to
Chiropractor for care as well. As with Rodriguez, Chiropractor
sent Ramirez for an MRI scan and to Pain Specialist for injections
in her neck. And like Rodriguez, after receiving care from
Chiropractor for some months, Ramirez “didn’t feel any better.”
She was then seen once by Doctor, after which she visited a
physical therapist twice. At her second physical therapy visit, she
reported a pain level of two out of ten. At that point, she stopped
going to physical therapy. The medical expenses Ramirez
incurred for her care to that point totaled $10,636.25.

Payments Toward Rodriguez’s and Ramirez’s Medical Bills

¶5 Rodriguez’s auto insurance carrier paid $3,000 from
personal injury protection (PIP) coverage toward Rodriguez’s
bills from Chiropractor and $3,000 from PIP coverage toward
Ramirez’s bills from Chiropractor. Rodriguez’s auto insurance
carrier held subrogation rights against Diede’s auto insurance
carrier for reimbursement of those payments in the event that
Diede was found liable for Rodriguez’s and Ramirez’s injuries. See
Utah Code § 31A-22-309(6)(a)(i) (stating that “the insurer of the
person who would be held legally liable [for personal injuries
sustained in an auto accident] shall reimburse the [injured
person’s] insurer for” PIP payments made by the injured person’s
insurer).

¶6 To finance her neck surgery, Rodriguez entered into an
agreement with a medical financing company, Intermountain
Surgical (Intermountain). Under that agreement, Intermountain
agreed to pay the bills associated with Rodriguez’s surgery in

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exchange for both a promise from Rodriguez to repay
Intermountain the amount it fronted for the surgery and a lien
against any recovery Rodriguez might receive from Diede in
litigation. Rodriguez’s and Ramirez’s various medical providers
otherwise did not require immediate payment for their services
but, instead, agreed to deferred payments while taking liens
against any recovery Rodriguez and Ramirez might receive in
litigation. Because of the foregoing arrangements, Rodriguez and
Ramirez were able to obtain the medical care outlined above
without making any out-of-pocket payments prior to the trial in
this case.

The Lawsuit

¶7 Rodriguez and Ramirez sued Diede, alleging that he was
at fault for the accident and that the accident caused the injuries
and damages described above as well as pain and suffering
damages. Diede acknowledged that the accident was solely his
fault. But he disputed the nature and extent of Rodriguez’s and
Ramirez’s injuries and damages. The case therefore proceeded to
a jury trial on the issues of causation and damages.

Rodriguez and Ramirez’s Motion in Limine

¶8 Prior to trial, Rodriguez and Ramirez filed a motion in
limine to prevent Diede “from discussing collateral sources at
trial,” including “discussion of the use of liens by [their] medical
providers” and “discussion of amounts that [they had] paid or
[had] not paid out of pocket for their treatment.” Diede responded
by saying that he did “not intend to present evidence or argument
regarding out-of-pocket expenses.” But he asserted that he
“should not be precluded from raising the issue . . . that some of
[Rodriguez’s and Ramirez’s] medical care was provided on a lien
basis for this personal injury case, some with the involvement of
a lienholder company specializing in personal injury cases,”
namely, Intermountain. Diede argued that he was “entitled to

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expose, through impeachment, the potential for bias” on the part
of medical providers who “hold a litigation lien . . . because they
have an interest in helping plaintiffs maximize their financial
recovery in [litigation].” He also contended that he should be able
to expose Doctor’s potential bias based on the notion that because
Intermountain referred cases to Doctor both before and after this
one, Doctor had an incentive to provide testimony favorable to
Rodriguez so that Intermountain would continue to send him
cases.

¶9 Rodriguez and Ramirez replied by saying, among other
things, that while Diede had “stated that he [did] not plan to
discuss out-of-pocket expenses or the lack thereof at trial,” he had
“not explain[ed] how he could discuss the existence of liens . . .
without stating or implying that [Rodriguez and Ramirez had] not
paid those expenses out of pocket.” They asserted that Utah’s
collateral source rule prohibits the admission of evidence
regarding “how much [plaintiffs have] paid out of pocket or
whether they ever paid anything out of pocket” because the lack
of out-of-pocket payments could suggest to a jury that the
plaintiff’s medical bills had been covered by a collateral source.
Additionally, they characterized Intermountain’s and the medical
providers’ liens as “subrogation right[s]” and asserted that Utah’s
collateral source rule prohibits the mention of “subrogation rights
because juries don’t understand subrogation rights.”

¶10 The court ruled that “while the amounts from a collateral
source would not be admissible to reduce what [Rodriguez and
Ramirez] are allowed to recover,” that did not mean that the
evidence Rodriguez and Ramirez asked to be excluded was
“inadmissible for all purposes.” The court explained that “so long
as [Diede did] not intend to offer collateral source evidence for the
purpose of limiting damages but rather . . . to impeach the
credibility of a witness by asking about medical care on a lien
basis, that evidence goes to bias, prejudice, or motive, and may be
admissible.” It also ruled that “to demonstrate bias,” Doctor could

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be asked about Intermountain paying for Rodriguez’s surgery.
The court did not specifically address the admissibility of
evidence related to out-of-pocket expenses.

The Trial

¶11 At trial, Rodriguez, Ramirez, Chiropractor, Doctor, and
witnesses familiar with the respective medical providers’ bills and
billing practices all testified during Rodriguez and Ramirez’s
case-in-chief, detailing Rodriguez’s and Ramirez’s symptoms and
treatment and the total amount of medical expenses they had
incurred. Chiropractor and Doctor each also opined that
Rodriguez’s and Ramirez’s injuries and symptoms were caused
by the accident.

¶12 During his cross-examination of Rodriguez, Diede’s
counsel asked her whether the MRIs she and Ramirez had
received had been “performed . . . on a lien basis, L-I-E-N.”
Rodriguez answered, “I don’t know. . . . [T]o be honest with you,
I don’t . . . know that information.” Diede’s counsel then asked,
“Were you paying attention to what you were getting charged at
all?” Rodriguez’s counsel objected, explaining in a bench
conference that because Rodriguez was “not a medical provider,”
the question did not go to bias but, instead, was aimed at showing
that Rodriguez was “not paying anything out of pocket” and
“didn’t have to pay anything for this.” Diede’s counsel contended
that questioning Rodriguez about whether she was “paying
attention or not paying attention to [what she was] being
charged” properly sought to “show[] her attitude and motivation
during the process.” The court overruled the objection, and
Rodriguez answered the question by acknowledging that she had
not been “paying attention to what [she was] being charged.”

¶13 Diede’s counsel also asked Rodriguez whether Pain
Specialist’s clinic “told [her] that [it] would treat [her] on a lien.”
Rodriguez answered both, “No,” and, shortly thereafter, “I don’t

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know.” Diede’s counsel asked Rodriguez if she was aware that
Pain Specialist charged her “over $5,000.” Rodriguez said that she
was not aware of that amount and that she had not been “paying
attention to that.” Finally, Diede’s counsel asked Rodriguez,
“[W]ere you paying attention to what you were charged for your
surgery?” Rodriguez responded, “No.”

¶14 Diede’s counsel later engaged in the following exchange
with Doctor:

Q. And in this case you were paid by a company
called Intermountain . . . ; is that right?

A. (No audible response.)

Q. So you don’t know if Intermountain . . . paid
you? Or do you know?

A. I mean, I’ve been paid, and . . . they had paid
me before for surgeries. So if you’re telling
me that it was Intermountain, then, yeah, it
probably was.

Q. Okay. And that’s a company that coordinates
with and pays for surgeries for people with
personal injury claims. Is that your
understanding?

A. Yeah, I don’t know what their exact business
model is, but, yes, I think that’s accurate.

Q. And they’ve sent you patients with personal
injury claims before Ms. Rodriguez . . .
correct?

....

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A. Yes.

Q. And they’ve sent you ones after hers, right?

A. Yes.

Q. And is it your understanding that they take a
financial interest in the outcome of the
personal injury case?

A. I would assume so.

Q. So in other words, if the personal injury claim
is successful, they . . . make their money, is
that right?

A. I would assume, or they probably wouldn’t
be doing it. But, yeah.

Q. Okay. So your testimony on the causation
issue for the personal injury case helps
Intermountain . . . make their money, correct?

A. Yeah.

¶15 No other evidence was presented regarding liens held by
Rodriguez’s medical providers, the financing agreement between
Intermountain and Rodriguez, or out-of-pocket payments made
by Rodriguez and Ramirez toward their medical expenses. And
no mention was made of Rodriguez’s insurance carrier, her PIP
coverage, or the fact that the payments that had been made to
Chiropractor had come from Rodriguez’s insurance carrier.

¶16 In his defense, Diede called a biomechanical engineer, who
testified that the accident caused “a speed transfer of about 1.6
miles per hour on [Diede’s] vehicle and about 2.1 miles per hour
on [Rodriguez’s] vehicle.” The biomechanical engineer opined

20230833-CA 8 2025 UT App 68
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that the impact on Rodriguez and Ramirez was “basically
comparable to [traveling at] a very slow walking speed” and
“bump[ing] against a wall.” Diede also called a physician
specializing in physical medicine and rehabilitation who opined
that Ramirez’s need for initial chiropractic visits was likely
attributable to the accident but that her MRI scans and injections
were not and that the accident did not cause Ramirez any
permanent injury. Diede then called a radiologist who reviewed
Rodriguez’s and Ramirez’s MRI scans and x-rays and said he saw
no “objective evidence” to suggest that the accident caused injury
to Rodriguez’s spine or disc herniations to Ramirez. Finally, Diede
called an “academic orthopedic spine surgeon” who opined that
Doctor’s recommendation for Rodriguez to have neck surgery
was “way below the standard of care” because there were no
medical indications to support a need for surgery.

¶17 After deliberating, the jury found that “Diede’s fault [was
not] a cause of the harm claimed by [Rodriguez and Ramirez],”
and it therefore did not reach the question of damages. The court
entered judgment in favor of Diede, and Rodriguez and Ramirez
now appeal. Because the arguments Rodriguez asserts on appeal
and the arguments Ramirez asserts on appeal are the same, for
simplicity, we hereafter refer to the appellants collectively as
Rodriguez.

ISSUE AND STANDARD OF REVIEW

¶18 Rodriguez contends that the district court erred by
violating the collateral source rule when it allowed Diede “to elicit
testimony . . . regarding liens, subrogation rights, and a lack of
out-of-pocket medical expenses paid by” Rodriguez. “The
question of whether the [district] court was correct in its
application of the collateral source rule is a question of law that
we review for correctness, without deference to the [district]

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court’s conclusions.” Wilson v. IHC Hosps., Inc., 2012 UT 43, ¶ 24,
289 P.3d 369 (cleaned up). 2

ANALYSIS

¶19 “Under the common law collateral source rule, a
wrongdoer is not entitled to have damages, for which he is liable,
reduced by proof that the plaintiff has received or will receive
compensation or indemnity for the loss from an independent
collateral source.” Wilson v. IHC Hosps., Inc., 2012 UT 43, ¶ 31, 289
P.3d 369 (cleaned up). Rodriguez contends that the district court

2. Rodriguez raises a second issue on appeal: “[Whether] the fact
that a specific amount was actually charged for medical treatment
provided ‘some evidence’ sufficient to satisfy the ‘reasonableness’
prong of laying foundation for a medical bill pursuant to the
standard laid out in Stevenett v. Wal-Mart Stores, Inc., 1999 UT App
80, ¶¶ 31‒32, 977 P.2d 508.” At trial, Rodriguez offered more than
medical bills to prove that the amounts she was charged were
reasonable; “in the interest of caution,” she also called “five live
witnesses . . . to establish the reasonableness of the charges.” She
now asks us, in the event that we reverse and remand this case
based on the collateral source issue, to clarify whether evidence of
“the amount of the actual charges incurred . . . constitutes at least
some evidence to establish . . . the reasonable value of medical
services provided.” Because the collateral source issue does not
prompt us to remand this case, and because Rodriguez submitted
evidence beyond mere medical bills to establish the
reasonableness of those bills at trial, we decline to address this
issue. See Velasquez v. Harman–Mont & Theda, Inc., 2014 UT App 6,
¶ 21, 318 P.3d 1188 (“The authority to provide guidance on
remand is limited to matters necessary to resolution of the case on
remand. If . . . the direction we give may ultimately prove to be
irrelevant . . . , any guidance this court offered on those questions
would be an impermissible advisory opinion.”(cleaned up)).

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violated this rule by allowing Diede to elicit testimony regarding
the payments made by Intermountain, liens held by Rodriguez’s
medical providers, and Rodriguez’s general unawareness of the
amount of medical expenses she had incurred. We disagree.

¶20 As an initial matter, we observe that neither
Intermountain’s payment to Doctor under a medical financing
agreement with Rodriguez nor the willingness of Rodriguez’s
other medical providers to allow deferred payments in exchange
for liens against Rodriguez’s potential recovery in litigation
qualify as collateral source benefits. Our supreme court’s
articulation of the common law collateral source rule indicates
that the type of benefits to which it refers are “compensation” and
“indemnity” that a plaintiff receives to pay for his or her loss. Id.
(cleaned up); accord Mahana v. Onyx Acceptance Corp., 2004 UT 59,
¶ 37, 96 P.3d 893; Gibbs M. Smith, Inc. v. U.S. Fid. & Guar. Co., 949
P.2d 337, 345 (Utah 1997); DuBois v. Nye, 584 P.2d 823, 825 (Utah
1978). Extending credit does not amount to providing
compensation or indemnity because the debtor must still pay the
cost of the expenses incurred. Likewise, “the existence of a
medical lien does not suggest a third-party source of payment;
rather, it evidences an unpaid bill.” Lee v. Dennison, No. 19-cv-
01332, 2023 WL 221358, at *1 (D. Nev. Jan. 17, 2023) (cleaned up).
And a medical financing company is not a collateral source;
instead, it is “an investor in the lawsuit.” Rangel v. Anderson, 202
F. Supp. 3d 1361, 1373 (S.D. Ga. 2016) (cleaned up); see also
Ronquillo v. EcoClean Home Services, Inc., 500 P.3d 1130, 1132 (Colo.
2021) (holding that a medical financing company was not a
collateral source under Colorado’s statutory collateral source rule
because the plaintiff remained “individually liable to [the
financing company] for the full amounts billed by her healthcare
providers whether or not she obtain[ed] a favorable verdict”
against the alleged tortfeasor). Accordingly, evidence that a
medical financing company has advanced funds to cover medical
expenses does not, by itself, violate the collateral source rule. Nor

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does evidence that a plaintiff was treated by a healthcare provider
who has not demanded immediate payment but holds a lien on
the plaintiff’s potential recovery in litigation violate the rule.

¶21 Consistent with the foregoing, Rodriguez does not argue
that she received collateral source benefits from Intermountain or
her medical providers. Instead, she argues that “even if none of
[her] bills [were] paid through collateral sources, [the district
court’s decision to allow testimony] highlighting a lack of out-of-
pocket expenses paid by [her] still” violated the collateral source
rule. For this proposition, she relies on our supreme court’s
decision in Wilson v. IHC Hospitals, Inc., 2012 UT 43, 289 P.3d 369.

¶22 Wilson involved a medical malpractice lawsuit. See id. ¶ 1.
The plaintiffs—a father, mother, and child—alleged that hospital
employees had breached their duty of care during the mother’s
labor and delivery, “resulting in permanent and severe brain
damage” to the child. Id. ¶¶ 1, 8. Following the child’s birth, the
parents received collateral source benefits from “the Utah
Division of Service for People with Disabilities (DSPD), Medicaid,
and other community, state, and federal assistance programs” to
help address the child’s resulting disabilities. Id. ¶ 12. Thus, prior
to trial, the plaintiffs “sought, and received, an in limine order
excluding collateral source evidence at trial.” Id. ¶ 2.

¶23 Notwithstanding the order in limine, the defendants made
“four explicit references” during trial to the collateral source
benefits the plaintiffs had received. Id. ¶ 12. For instance, they
asked the plaintiffs’ life care planner “if she was aware that the
[plaintiffs were] already getting respite care from the State of
Utah.” Id. (cleaned up). The life care planner acknowledged, “The
parents are getting an annual stipend of money from DSPD,
[which] they can use for respite care.” Id. (cleaned up).

¶24 The defendants also “made ten references” to “the fact that
the [parents] had not incurred any out-of-pocket costs in

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providing care for [their child].” Id. ¶ 13. For example, they asked
the plaintiffs’ economist whether he had been “informed that the
plaintiffs [had] stipulated that there [were] not out-of-pocket
expenses for medical in [the plaintiffs’] case.” Id. ¶ 44. Over an
objection, the economist answered, “I’m aware that insurance
and/or Medicaid have paid most of the expenses.” Id. (cleaned
up). Additionally, in cross-examining the father, the defendants’
counsel stated, “We have your medical expenses, but we don’t have
the amount that you’ve paid for out-of-pocket expenses.” Id.
(cleaned up). He then elicited a concession from the father that
“he had paid nothing” for the child’s “special wheelchair.” Id. The
defendants’ “most blatant reference to out-of-pocket expenses
occurred during closing argument, when [the defendants] told the
jury, ‘[The child] is getting the hospital and medical care he
needs[,] and you have also heard that it’s not costing the parents.
They’re not claiming one cent of out-of-pocket expenses.’” Id. ¶ 14
(cleaned up).

¶25 The jury in Wilson “returned a verdict finding no
negligence on the part of [the defendants],” and the plaintiffs
appealed. Id. ¶ 22. On appeal, our supreme court first determined
that the payments made by DSPD, Medicaid, and private health
insurance toward the child’s care all qualified as collateral source
benefits. See id. ¶ 35. It then held that the defendants had violated
the collateral source rule, both by referencing those benefits
“directly” and by “repeatedly [making] reference to the fact that
the [parents] had not incurred any out-of-pocket expenses for
[their child’s] care.” Id. ¶ 36. Regarding the references to out-of-
pocket expenses, the supreme court explained:

[O]ut-of-pocket expenses and collateral source
payments bear an inverse relationship to each other.
That is, where third-party sources pay a portion of a
plaintiff’s medical expenses, the plaintiff will
necessarily have paid a smaller portion of those
expenses out-of-pocket. In short, reference to the

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absence of any significant out-of-pocket medical
expenses necessarily implies that the expenses have
been paid by collateral sources.

Id. ¶ 39. The court then observed that its conclusion that the
collateral source rule had been violated was “bolstered by [the
defendants’] inability to offer a legitimate purpose for the
evidence.” Id. ¶ 44.

¶26 After concluding that the defendants had repeatedly
violated the collateral source rule, the court determined that those
violations prejudiced the plaintiffs’ case. See id. ¶¶ 46‒51. As a
backdrop for its analysis on this point, the court observed that in
the medical malpractice context, “the Legislature has passed a
statute mandating that, ‘[u]pon a finding of liability and an
awarding of damages by the trier of fact,’ [district] courts ‘shall
reduce the amount of the award by the total of all amounts paid
to the plaintiff from all collateral sources which are available to
him.’” Id. ¶ 32 (quoting Utah Code § 78B-3-405(1), (2)). It further
noted, however, that “the statute limits these reductions by
prohibiting any reduction in a damages award for collateral
sources that have subrogation rights.” Id. (citing Utah Code § 78B-
3-405(1)). Against that backdrop, the court explained that the
prejudicial impact of collateral source evidence “is two-fold”:
“first, the evidence suggests to the jury that the plaintiff is already
receiving the care that he needs,” thus potentially leading the jury
to believe “that the outcome of the trial is immaterial to the party
benefitting from the collateral source,” and, “second, because
most jurors do not understand the concept of subrogation rights,
they will erroneously conclude that the plaintiff is seeking a
windfall.” Id. ¶ 47 (cleaned up). Jurors’ general inability to
understand the subrogation rights at play, the court explained, “is
highly prejudicial because the jury will believe that the plaintiff
has already been fully compensated and is trying to obtain a
double recovery.” Id. (cleaned up).

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¶27 Because the Wilson defendants had violated the collateral
source rule—including by “repeatedly referencing the fact that
the [parents] had not incurred any out-of-pocket costs in
providing care for [their child]”—and because the prejudice from
that violation could not be cured by explaining to the jury the
subrogation rights at play, the Wilson court vacated the jury’s
verdict and remanded the case for a new trial. Id. ¶¶ 13, 47, 78.

¶28 Rodriguez now asserts that Diede’s counsel’s references to
liens held by some of Rodriguez’s medical providers; Doctor’s
testimony regarding Intermountain paying for Rodriguez’s neck
surgery; and Rodriguez’s testimony about her lack of knowledge
of, or attention to, the amount of medical expenses she was
incurring all suggested to the jury a lack of out-of-pocket
payments by Rodriguez for her medical expenses. And, pointing
to Wilson, she contends that those allusions to a lack of out-of-
pocket payments toward medical expenses violated the collateral
source rule. We are not persuaded.

¶29 In Wilson, the jury was explicitly and repeatedly informed
that the plaintiffs had received collateral source benefits—
payments from government programs and private insurance to
cover the expenses occasioned by the harms allegedly caused by
the defendants. The jury was not informed of any debt incurred
by the plaintiffs to pay for those expenses. In that context, the
supreme court rightfully reasoned that repeated direct references
to the absence of any significant out-of-pocket medical expenses
necessarily implied that the plaintiffs’ expenses had been covered
by the collateral sources of which the jury had been informed.

¶30 In contrast, the jurors in this case were informed of no
collateral source benefits Rodriguez received. Instead, Diede’s
counsel accurately suggested—through his questioning of both
Rodriguez and Doctor—that Rodriguez had financed her medical
expenses through liens and an agreement with Intermountain.
Under these facts, any resulting inference regarding an absence of

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out-of-pocket payments did not necessarily imply that
Rodriguez’s expenses had been covered by collateral sources.
Instead, because the type of subrogation arrangement alluded to
here—debt secured by a lien—is within the ken of average jurors,
a lack of out-of-pocket payments by Rodriguez was likely to lead
the jury to infer only that Rodriguez had obtained credit financing
but remained ultimately responsible for the cost of her expenses.
And to the extent that Rodriguez’s failure to confirm her use of
medical liens or Doctor’s inability to provide the details of
Intermountain’s agreement with Rodriguez may have left room
for ambiguity as to whether Rodriguez’s lack of out-of-pocket
payments was attributable to debt or to collateral source benefits,
that ambiguity was within Rodriguez’s control to clarify. For
these reasons, we conclude that the district court’s admission of
testimony regarding Rodriguez’s lack of awareness regarding the
cost of her medical treatments and Doctor’s testimony about
receiving payment from Intermountain did not violate the
collateral source rule.

¶31 And, just as the Wilson court’s conclusion that the collateral
source rule had been violated was bolstered by the defendants’
inability to offer a legitimate purpose for the evidence at issue
there, our conclusion is bolstered by the fact that Diede has
offered a legitimate purpose for admitting the evidence at issue
here. Specifically, we agree with Diede that questions of whether
Rodriguez was treated on a lien basis, whether she was paying
attention to her medical bills, and whether she knew the specific
amounts of those bills “were all relevant to the question [of]
whether [she] incurred those expenses in bad faith.” As Diede
explains, “a jury reasonably could have inferred that incurring
medical expenses on credit without paying attention to the
specific amounts billed [might] signal[] bad faith, or in other
words, that Rodriguez was merely attempting to increase
potential damages for this lawsuit.” Similarly, Doctor’s testimony
that he receives referrals and payments from Intermountain was

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also relevant because a jury reasonably could have inferred bias
based on the notion that if Doctor offered a causation opinion
helpful to Rodriguez, Intermountain would be more likely to send
him additional referrals.

¶32 In sum, we recognize the rule established in Wilson that
when a jury is explicitly informed that a plaintiff has received
collateral source benefits, then “methodical allusion” to those
benefits through repeated references to “the absence of any
significant out-of-pocket medical expenses” is a violation of the
collateral source rule. Wilson v. IHC Hosps., Inc., 2012 UT 43, ¶¶ 2,
39, 289 P.3d 369. But when a jury is informed of no collateral
source benefits and the defendant correctly suggests, instead—for
a legitimate purpose such as showing potential bias or bad faith—
that the plaintiff used liens or medical financing to obtain
treatment, there is no violation of the collateral source rule.

CONCLUSION

¶33 The district court’s admission of evidence suggesting that
Rodriguez used medical liens and payments from a medical
financing company to avoid the need to make out-of-pocket
payments toward the medical expenses she allegedly incurred as
a result of an accident caused by Diede did not violate the
collateral source rule. Accordingly, we affirm.

20230833-CA 17 2025 UT App 68