Notice Lien ClaimantCal. Super. - 6th Dist.March 3, 20212 J 4 5 6 7 8 9 t0 ll l2 13 l4 15 l6 l7 l8 l9 20 2l 22 23 24 25 26 27 28 JAMES R. WILLIAMS, County Counsel (5.8. #271253) SARA J. PONZIO, Deputy County Counsel (5.8.#206774) OFFICE OF THE COUNTY COUNSEL 70 West Hedding Street, East Wing, 9th Floor San Jos6, California 95110-1770 Telephone: (a08) 299-5900 Facsimile: (408) 292-7240 Email: sara.ponzio@cco.sccgov.org Attorneys for Lienholder COUNTY OF SANTA CLARA SUPERIOR COURT OF CALIFORNIA, COUNTY OF SANTA CLARA NELLIE TREVINO, Plaintiff, V. OSCAR MEDRANO, et a1., Defendants. Case No. 21CY379120 NOTICE OF LIEN fCivil Code $2881 et seq., Civil Code $3045.1 et seq., and Civil Code $3040 et seq., and Government Code $23004.1 et seq.l [Exempt from Filing Fees pursuant to Government Code $61031 To Plaintift Defendants, and their attorneys of record: Notice is hereby given that Valley Health Plan (hereinafter referred to as VHP) provided medical insurance for emergency medical and ongoing medical or other services to Nellie Trevino from April 18,2019 to present. The amount of the reasonable and necessary charges incurred to date in treating Nellie Trevino is $6,048.51. Pursuant to California Civil Code section 3045.1 et seq., the County of Santa Clara gives notice of its lien on any final judgment, compromise or settlement agreement award, or his or her heirs or personal representative. Any person, firm or corporation, including, but not limited to an insurance carier, making any payment to the injured person, without payingthe hospital lien first, or as much as can be satisfied out of 50 percent of the moneys due under any final judgment, compromise, or settlement agreement after paying any prior liens, shall be liable to the hospital for the amount owed to the hospital under the lien. 1 Notice of Lien 2rcv379r20 Electronically Filed by Superior Court of CA, County of Santa Clara, on 5/6/2021 11:19 AM Reviewed By: Y. Chavez Case #21CV379120 Envelope: 6390491 21CV379120 Santa Clara - Civil Y. Chavez 2 J 4 5 6 7 8 9 10 1l t2 13 t4 l5 l6 I7 18 t9 20 2l 22 23 24 25 26 27 28 This lien is created by contract of the parties pursuant to California Civil Code section 2881 et seq. and Civil Code section 3040 et seq. In pertinent part, the VHP contract provides: "Third Party Reimbursement / Liability. In cases of injuries caused by any act or omission of a third party (including, without limitation, motor vehicle accidents and injuries, and illnesses covered by Workers' Compensation) and complications incident thereto, Plan will fumish Covered Services. However, you must inform VHP or your Provider when services performed are covered through workers' compensation laws, automobileo accidento or other liability coverage. The Plan will not duplicate coverage for such services. When a legitimate dispute exists as to third party liability, Plan will furnish Covered Services until the dispute is resolved. You must agree to supply all information and sign the appropriate documents necessary to carry out the Plan's right to recover its costs of the services provided or for VHP to obtain a lien. Otherwise VHP may deny coverage for such reimbursement. As necessary, VHP and/or its Providers will seek reimbursement up to the amount VHP has paid for any duplicate services. In the case of a monetary award, VHP or its Plan Providers must be reimbursed immediately after the award is received. You are responsible for notiffing VHP of any duplicate payment made for such services. VHP also has the option to be subrogated to your rights to the extent of the cost of Benefits provided by the Plan; meaning that VHP has the right to collect directly from any third party who is responsible for such liability when payment has been made by VHP for services. If you wish to release a third party from liability or settle a claim against a third party for which you received compensation for medical care provided through VHP, you must obtain prior written consent from VHP if such acts would limit VHP's right to reimbursement." The recovery allowed to VHP is calculated pursuant to California Civil Code section 3040, et seq. 2 Notice of Lien 21cv379t20 Pursuant to California Government Code section 23004.1 et seq., the County of Santa Clara gives notice of its lien against any judgment awarded to Nellie Trevino, his or her guardian, personal representative, estate, or survivors. Dated: MAy, 5 ?021 Respectfully submitted, By: J P Counsel Attorneys for Lienholder COUNTY OF SANTA CLARA o 1 Notice of Lien 2tcv379120 I 2 J 4 5 6 7 8 9 10 ll l2 13 t4 l5 l6 t7 l8 19 20 2l 22 23 24 25 26 27 28 PROOF OF SERVICE BY MAIL Nellie Trevino vs Oscar Medrano, et al. Superior Court Case No. 21CV379I20 I, Sonia Schilling, declare that I am employed in the County of Santa Clara; I am over the age of eighteen years and not a party to the within entitled action, and my business address is 9th Floor, East Wing, 70 West Hedding Street, San Jos6, Califomia 95110-1770. I served a true copy of the attached document on the persons listed below by placing the envelope for collection and mailing by certified mail with return receipt requested and postage prepaid on the date and at the place shown below following our ordinary business practices. I am readily^familiar with this business practice for collectilg and processing correspondence for mailing. On the same day that correspondence is placed for collection and mailing, it is deposited in the ordinary course of business with the United States Postal Service. Date of Deoosit: MAY 5 2021 Exact title of document served: NOTICE OF LIEN Addressed as follows: Plaintiff Nellie Trevino P.O. Box 2307 Gilroy, California 9 5021 Attorney for Plaintiff: Nellie Trevino Louis S. Abronson ABRONSON LAW OFFICES 332 North 2nd Street San Jos6, California 95112. I declare under penalty of perjury under the laws of the State of Califomia that the foregoing is true and correct. Executed on MAy 6 e02l , at San Jos6, California. Sonia S DTAC No. 3980856/VHP 2393914 1 Proof of Service 2rcY379120
