Code Details

Civil Code – CIV
DIVISION 4. GENERAL PROVISIONS [3274 – 9566] ( Heading of Division 4 amended by Stats. 1988, Ch. 160, Sec. 16. )
PART 1. RELIEF [3274 – 3428] ( Part 1 enacted 1872. )
TITLE 2. COMPENSATORY RELIEF [3281 – 3361] ( Title 2 enacted 1872. )
CHAPTER 2. Measure of Damages [[3300.] – 3361] ( Chapter 2 enacted 1872. )

ARTICLE 2. Damages for Wrongs [3333 – 3343.7] ( Article 2 enacted 1872. )

Exact Statute Text

(a) In any action for injury against a health care provider or health care institution based on professional negligence, the injured plaintiff shall be entitled to recover noneconomic losses to compensate for pain, suffering, inconvenience, physical impairment, disfigurement and other nonpecuniary damage, subject to the limitations in this section.

(b) In any action for injury that does not involve wrongful death against one or more health care providers or health care institutions based on professional negligence, the following limitations shall apply:

(1) Civil liability for damages for noneconomic losses against one or more health care providers, collectively, shall not exceed three hundred fifty thousand dollars ($350,000), regardless of the number of health care providers, which does not include any unaffiliated health care providers that are responsible for noneconomic losses pursuant to paragraph (3).

(2) Civil liability for damages for noneconomic losses against one or more health care institutions, collectively, shall not exceed three hundred fifty thousand dollars ($350,000), regardless of the number of health care institutions, which does not include any unaffiliated health care institutions that are responsible for noneconomic losses pursuant to paragraph (3).

(3) Civil liability for damages for noneconomic losses against one or more health care providers or health care institutions that are unaffiliated with a defendant described in paragraph (1) or (2) based on acts of professional negligence separate and independent from the acts of professional negligence of a defendant described in paragraph (1) or (2) and that occurred at, or in relation to medical transport to, a health care institution unaffiliated with a health care institution described in paragraph (2), collectively, shall not exceed three hundred fifty thousand dollars ($350,000), regardless of the number of defendants described in this paragraph, which does not include any unaffiliated health care providers or unaffiliated health care institutions that are responsible for noneconomic losses pursuant to paragraph (1) or (2).

(c) In any action for wrongful death against one or more health care providers or health care institutions based on professional negligence, the following limitations shall apply:

(1) Civil liability for damages for noneconomic losses against one or more health care providers, collectively, shall not exceed five hundred thousand dollars ($500,000), regardless of the number of health care providers, which does not include any unaffiliated health care providers that are responsible for noneconomic losses pursuant to paragraph (3).

(2) Civil liability for damages for noneconomic losses against one or more health care institutions, collectively, shall not exceed five hundred thousand dollars ($500,000), regardless of the number of health care institutions, which does not include any unaffiliated health care institutions that are responsible for noneconomic losses pursuant to paragraph (3).

(3) Civil liability for damages for noneconomic losses against one or more health care providers or health care institutions that are unaffiliated with a defendant described in paragraph (1) or (2) based on acts of professional negligence separate and independent from the acts of professional negligence of a defendant described in paragraph (1) or (2) that occurred at, or in relation to medical transport to, a health care institution unaffiliated with a health care institution described in paragraph (2), collectively, shall not exceed five hundred thousand dollars ($500,000), regardless of the number of defendants described in this paragraph, which does not include any unaffiliated health care providers or unaffiliated health care institutions that are responsible for noneconomic losses pursuant to paragraph (1) or (2).

(d) No health care provider defendant shall be liable for damages for noneconomic losses in more than one of the categories set forth in this section, regardless of the application or combined application thereof.

(e) No health care institution defendant shall be liable for damages for noneconomic losses in more than one of the categories set forth in this section, regardless of the application or combined application thereof.

(f) The applicable dollar amounts set forth in this section apply regardless of the number of defendant health care providers or health care institutions against whom the claim is asserted or the number of separate causes of actions on which the claim is based. For a claim subject to subdivision (b), the applicable dollar amounts set forth in subdivisions (b), (g), and (h) provide three separate limits of liability that may apply. For a claim subject to subdivision (c), the applicable dollar amounts set forth in subdivisions (c), (g), and (h) provide three separate limits of liability that may apply.

(g) This section shall be deemed effective as of, and shall apply to all cases filed or arbitrations demanded on or after, January 1, 2023. Thereafter, the dollar amounts set forth in subdivision (b) shall increase by forty thousand dollars ($40,000) each January 1st for 10 years up to seven hundred fifty thousand dollars ($750,000), and the dollar amounts set forth in subdivision (c) shall increase each January 1st by fifty thousand dollars ($50,000) for 10 years up to one million dollars ($1,000,000). The dollar amount in effect at the time of judgment, arbitration award, or settlement shall apply to an action, subject to subdivision (h).

(h) The applicable amounts for noneconomic damages for personal injury of $750,000, and for wrongful death of $1,000,000, as set forth in subdivision (g), shall be adjusted for inflation on January 1 of each year by 2 percent beginning on January 1, 2034.

(i) In no action shall the amount of damages for noneconomic losses exceed the applicable dollar amounts set forth in subdivisions (b), (c), (g), or (h).

(j) For the purposes of this section:

(1) “Health care provider” means any person licensed or certified pursuant to Division 2 (commencing with Section 500) of the Business and Professions Code, or licensed pursuant to the Osteopathic Initiative Act, or the Chiropractic Initiative Act, or licensed pursuant to Chapter 2.5 (commencing with Section 1440) of Division 2 of the Health and Safety Code; and any clinic, health dispensary, or health facility, licensed pursuant to Chapter 1 (commencing with Section 1200) or Chapter 1.3 (commencing with Section 1248) of Division 2 of the Health and Safety Code, and does not include health care institutions that are defined in paragraph (2). “Health care provider” includes the legal representatives of a health care provider and the health care provider’s employer, professional corporation, partnership, or other form of legally recognized professional practice organization.

(2) “Health care institution” means one or more health care facilities licensed pursuant to Chapter 2 (commencing with Section 1250) of Division 2 of the Health and Safety Code owned or operated by the same entity or its affiliates and includes all persons and entities for which vicarious liability theories, including, but not limited to, the doctrines of respondeat superior, actual agency, and ostensible agency, may apply.

(3) “Unaffiliated” means a specified health care provider, health care institution, or other entity not covered by the definition of affiliated, or affiliated with, as defined in Section 150 of the Corporations Code, or that is not employed by, performing under a contract with, an owner of, or in a joint venture with another specified entity, health care institution, health care provider, organized medical group, professional corporation, or partnership, or that is otherwise not in the same health system with that health care provider, health care institution, or other entity. Whether a health care provider, health care institution, or other entity is unaffiliated is determined at the time of the professional negligence.

(4) “Professional negligence” means a negligent act or omission to act by a health care provider in the rendering of professional services, which act or omission is the proximate cause of a personal injury or wrongful death, provided that such services are within the scope of services for which the provider is licensed and which are not within any restriction imposed by the licensing agency or licensed hospital.

(Amended by Stats. 2022, Ch. 17, Sec. 3. (AB 35) Effective January 1, 2023.)

Civil Code § 3333.2 Summary

California Civil Code § 3333.2 sets a cap, or limit, on the amount of non-economic damages an injured plaintiff can recover in a medical malpractice lawsuit. This statute applies specifically to cases based on “professional negligence” against “health care providers” or “health care institutions.” Non-economic damages refer to subjective, non-financial losses such as pain, suffering, inconvenience, physical impairment, and disfigurement.

The cap varies depending on whether the case involves wrongful death:

• For cases not involving wrongful death (personal injury): The initial cap on non-economic damages is $350,000. This cap applies collectively to all “health care providers” involved, all “health care institutions” involved, and potentially a separate cap for “unaffiliated” providers or institutions whose negligence was separate and independent.
• For wrongful death cases: The initial cap on non-economic damages is $500,000. Similar to personal injury cases, this cap applies collectively to all “health care providers” involved, all “health care institutions” involved, and potentially a separate cap for “unaffiliated” entities.

It’s important to note that these caps apply regardless of the number of defendants or separate causes of action. The statute also includes an escalator clause: starting January 1, 2023, the non-wrongful death cap increases by $40,000 each January 1st for 10 years, reaching $750,000. The wrongful death cap increases by $50,000 each January 1st for 10 years, reaching $1,000,000. After these 10 years, beginning January 1, 2034, the caps will be adjusted annually for inflation by 2 percent. The cap in effect at the time of judgment, arbitration award, or settlement is the one that applies.

Key terms like “health care provider,” “health care institution,” “unaffiliated,” and “professional negligence” are precisely defined within the statute to clarify its scope and application.

Purpose of Civil Code § 3333.2

California Civil Code § 3333.2 is a cornerstone of the state’s medical malpractice reform legislation, historically known as the Medical Injury Compensation Reform Act (MICRA) of 1975. The original purpose of MICRA, and specifically the cap on non-economic damages, was multifaceted. In the mid-1970s, California faced a perceived crisis in the medical malpractice insurance market, with claims of skyrocketing insurance premiums threatening the availability and affordability of healthcare services.

Lawmakers designed the cap to address this “crisis” by:

1. Reducing Medical Malpractice Insurance Premiums: By limiting the potential payout for subjective damages like pain and suffering, the legislature aimed to make medical malpractice claims more predictable and less costly for insurance companies, thereby stabilizing and lowering premiums.
2. Ensuring Access to Healthcare: The fear was that high insurance costs would force doctors to leave California or stop practicing in high-risk specialties, leading to a shortage of healthcare providers. The cap was intended to mitigate this risk by making the practice of medicine more financially viable.
3. Controlling Overall Healthcare Costs: Reducing the cost of malpractice litigation was seen as a way to indirectly control the broader costs within the healthcare system, as defensive medicine (ordering unnecessary tests to avoid lawsuits) and insurance premiums are factored into healthcare expenses.

While the original cap of $250,000 remained unchanged for nearly five decades, the landscape shifted with the passage of Assembly Bill 35 (AB 35), effective January 1, 2023. This amendment significantly updated Civil Code § 3333.2, raising the initial cap amounts and introducing a scheduled increase and inflation adjustment. This legislative update reflects a modern effort to balance the original goals of MICRA with the need to provide more equitable compensation for severely injured patients, acknowledging that the real value of the original cap had significantly eroded over time due to inflation.

Real-World Example of Civil Code § 3333.2

Consider the case of Maria, a 45-year-old active professional who undergoes a routine knee surgery. Due to a surgeon’s negligence during the operation, Maria suffers severe nerve damage, resulting in permanent chronic pain, a significant limp, and the inability to continue her favorite hobby, hiking. She also experiences deep emotional distress, depression, and a loss of enjoyment of life.

Maria files a medical malpractice lawsuit against her surgeon (a health care provider) and the hospital where the surgery took place (a health care institution).

During the trial, the jury finds the surgeon and hospital professionally negligent and awards Maria the following damages:

• Economic Damages: This includes her medical bills, lost wages from being unable to work for several months, and future costs for ongoing physical therapy and medication. Let’s say these total $800,000.
• Non-Economic Damages: This covers her pain, suffering, emotional distress, physical impairment, and loss of enjoyment of life. The jury, empathizing with her significant losses, awards $1,500,000 for non-economic damages.

However, because Maria’s case does not involve wrongful death and was filed after January 1, 2023, Civil Code § 3333.2 applies. Assuming the judgment is rendered in 2023 (the initial year of the new cap), the cap on non-economic damages for personal injury is $350,000.

Even though the jury awarded $1,500,000 for Maria’s pain and suffering, the court must reduce this amount to the statutory cap of $350,000. Maria will receive the full $800,000 in economic damages, but her non-economic damages will be limited. If the negligence also involved an “unaffiliated” entity, such as an independent anesthesiologist working at the hospital under separate contract and whose negligence was separate and independent, Maria could potentially recover an additional $350,000 from that unaffiliated entity.

This example illustrates how the statute directly impacts the compensation available to victims of medical negligence, particularly for the subjective, non-financial aspects of their suffering.

Related Statutes

Civil Code § 3333.2 is part of a larger legislative package known as the Medical Injury Compensation Reform Act (MICRA) of 1975, which also underwent significant amendments through AB 35 (effective January 1, 2023). Other key statutes related to California medical malpractice cases include:

• California Code of Civil Procedure § 340.5 – Statute of Limitations for Medical Malpractice: This statute sets strict deadlines for filing medical malpractice lawsuits, generally three years after the injury or one year after the plaintiff discovers, or reasonably should have discovered, the injury, whichever occurs first. It often works in conjunction with Civil Code § 3333.2 by defining the timeframe within which a claim subject to the cap must be brought.
• California Civil Code § 3333.1 – Collateral Source Rule in Medical Malpractice Actions: This statute modifies the traditional “collateral source rule” for medical malpractice cases. It allows defendants to introduce evidence of payments for medical expenses received by the plaintiff from “collateral sources” (like health insurance or disability benefits). If such evidence is introduced, the plaintiff can then present evidence of amounts they paid to secure those benefits (e.g., insurance premiums). This impacts the calculation of economic damages, which are not capped by § 3333.2.
• California Business and Professions Code § 6146 – Attorneys’ Fees in Medical Malpractice Actions: This section limits the contingent fee percentage an attorney can charge in medical malpractice cases. The sliding scale caps fees at 25% of the first $500,000 recovered, 20% of the next $500,000, 15% of the next $500,000, and 10% of any amount over $1,500,000. This statute directly impacts the plaintiff’s net recovery and their attorney’s compensation in cases subject to Civil Code § 3333.2.
• California Code of Civil Procedure § 364 – Notice of Intent to Sue: This statute requires a plaintiff to provide a healthcare provider with at least 90 days’ written notice of their intent to file a medical malpractice lawsuit before the complaint is filed. This mandatory notice period can impact the timing of a lawsuit and its interaction with the statute of limitations under CCP § 340.5.

Why Civil Code § 3333.2 Matters in Personal Injury Litigation

Civil Code § 3333.2 plays a critical and often controversial role in California personal injury litigation, particularly for victims of medical malpractice. Its impact is profound for both plaintiffs and defendants:

For Plaintiffs and Their Attorneys:

• Limited Recovery for Suffering: The most direct impact is the hard limit on compensation for pain, suffering, emotional distress, and other non-economic damages. For individuals who suffer catastrophic, life-altering injuries that result in immense, lifelong pain but might have limited economic losses (e.g., a retired person or a child), the cap can severely diminish their overall recovery and may not fully reflect their true suffering.
• Strategic Focus on Economic Damages: Attorneys representing medical malpractice plaintiffs must shift their strategy to meticulously document and maximize economic damages (medical bills, lost wages, future care costs) since these are not capped. This requires extensive expert testimony and financial analysis.
• Impact on Settlement Negotiations: The cap heavily influences settlement discussions. Defense attorneys and insurance companies will rarely offer more than the statutory cap for non-economic damages, knowing that a jury award exceeding it will be reduced by the court. This can pressure plaintiffs to accept settlements that are lower than what they might otherwise receive in non-medical malpractice cases.
• Access to Justice: For cases with potentially high non-economic damages but lower economic damages (making the overall recovery under the cap less attractive), attorneys may be less willing to take on the case due to the reduced potential for a reasonable contingent fee, potentially limiting access to legal representation for some victims.
• The AB 35 Update: The 2023 amendments, increasing the cap and adding a cost-of-living adjustment, represent a significant change. While still a cap, the increased amounts offer more potential relief to injured patients than the prior, long-stagnant cap. This may slightly alter settlement dynamics and the feasibility of certain claims.

For Defendants and Their Attorneys:

• Predictability and Risk Management: The cap provides a degree of predictability for healthcare providers and their insurers regarding their maximum exposure for non-economic damages. This aids in risk assessment, setting insurance premiums, and budgeting for potential liabilities.
• Strong Defense Argument: The cap is a powerful tool for the defense, as it sets an absolute ceiling on a major component of potential damages. This reduces uncertainty at trial and strengthens their position in settlement negotiations.
• Protection for Healthcare Providers: The original intent of MICRA, reinforced by this cap, was to stabilize the medical profession by keeping malpractice insurance affordable and ensuring the availability of healthcare services in California.

In essence, Civil Code § 3333.2 creates a unique legal landscape for medical malpractice claims in California, distinguishing them sharply from other types of personal injury cases. It requires a specialized understanding of both the law and its practical implications to navigate successfully for all parties involved.