Silvester v. Estate of Niparko CA2/7 ( 2022 )


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  • Filed 6/20/22 Silvester v. Estate of Niparko CA2/7
    NOT TO BE PUBLISHED IN THE OFFICIAL REPORTS
    California Rules of Court, rule 8.1115(a), prohibits courts and parties from citing or relying on opinions
    not certified for publication or ordered published, except as specified by rule 8.1115(b). This opinion
    has not been certified for publication or ordered published for purposes of rule 8.1115.
    IN THE COURT OF APPEAL OF THE STATE OF CALIFORNIA
    SECOND APPELLATE DISTRICT
    DIVISION SEVEN
    DOMINIC SILVESTER,                                           B301926
    Plaintiff and Appellant,                               (Los Angeles County
    Super. Ct. No. BC574789)
    v.
    ESTATE OF JOHN KIM
    NIPARKO et al.,
    Defendants and Respondents.
    APPEAL from a judgment of the Superior Court of Los
    Angeles County. Holly J. Fujie, Judge. Reversed and remanded.
    Dentons US LLP, Ronald D. Kent, Michael J. Duvall,
    Susan M. Walker, for Plaintiff and Appellant.
    Berkes Crane Robinson & Seal LLP, Robert H. Berkes,
    Steven M. Crane, Steven M. Haskell, for Defendants and
    Respondents.
    _______________________
    INTRODUCTION
    Appellant Dominic Silvester is a former patient of
    physician John Kim Niparko, an ear specialist who treated
    Silvester over several months for tinnitus (ringing in his ears).
    Silvester contends that while he was in a vulnerable state during
    treatment, Dr. Niparko, now deceased, improperly solicited
    Silvester to make charitable donations to Johns Hopkins
    Hospital. Silvester further asserts Niparko concealed that
    Silvester’s condition had worsened under Niparko’s care because
    Niparko wanted Silvester to continue donating large sums of
    money.
    Silvester sued Niparko’s estate and the personal
    representative of Niparko’s estate for fraud and constructive
    fraud. After an eight-day trial, the jury entered a general verdict
    in favor of the personal representative. Silvester appeals the
    judgment on numerous grounds, including the trial court’s
    refusal to give a constructive fraud jury instruction requested by
    Silvester, several evidentiary rulings made by the trial court and
    the summary adjudication order precluding Silvester’s punitive
    damages claim, which he contended was limited to the estate’s
    insurance policy limits. We conclude that although there was no
    instructional error, evidentiary error by the trial court requires a
    new trial, and we reverse.
    FACTUAL AND PROCEDURAL BACKGROUND
    1. Niparko Begins To Treat Silvester for Tinnitus
    Silvester is the CEO and founder of Enstar Group, a
    publicly-traded international insurance company. In 2010, he
    2
    was 50 years old and resided in Cape Town, South Africa.1
    Niparko was an otolaryngologist (ear, nose and throat specialist)
    sub-specializing in diseases of the ear. In 2010 Niparko was a
    professor and interim chair of the Department of Otolaryngology
    at Johns Hopkins Hospital in Baltimore, Maryland.
    In October 2010, Silvester began experiencing persistent
    ringing in his ears. A general practitioner diagnosed him with
    post-viral tinnitus. On November 4, 2010, Silvester traveled to
    Johns Hopkins for a previously-scheduled “executive physical”—a
    concierge service provided by Johns Hopkins for busy executives
    who need to coordinate multiple tests and examinations. While
    there, Silvester conferred with Niparko and another
    otolaryngologist, Dr. Agrawal, who both concurred with the
    diagnosis of post-viral tinnitus and prescribed an over-the-
    counter nasal decongestant. Silvester emailed Niparko and
    Agrawal several times in November 2010 with concerns and
    questions about his condition and asked Niparko to be his
    primary medical provider.
    Johns Hopkins identified Silvester as a potential donor
    with an “extremely large” financial capacity, and Niparko
    provided one of Silvester’s emails to the principal development
    officer of Johns Hopkins’ Department of Otolaryngology for the
    department’s donor list.
    In December 2010, Silvester returned to Johns Hopkins to
    see Niparko about his continuing tinnitus. Niparko
    recommended Silvester regularly use steroid dexamethasone
    drops in his middle ear via grommet tubes that would be placed
    in his eardrums. Silvester underwent a procedure to have the
    1    He also maintained residences in England, Bermuda,
    Dublin, New York City and Aspen, Colorado.
    3
    grommet tubes placed in his ears. His wife and a doctor in Cape
    Town assisted him with administering the dexamethasone drops.
    2. Silvester Pledges a Charitable Donation to Johns Hopkins
    and Makes an Initial Payment
    In December 2010 Silvester sent Niparko two cases of wine.
    Niparko responded by email thanking him and asked if Silvester
    would consider making “a tax-deductible, charitable contribution
    to help support our work. We want to offer more effective
    treatments of inner-ear disease.”
    James Kelley, principal development officer for the Johns
    Hopkins Otolaryngology Department, spoke with Silvester about
    making a philanthropic donation to the Department. On
    December 18, 2010, Silvester wrote to Niparko: “I am 100%
    committed to supporting your work. . . . When I reflect on the
    work you and your colleagues do, it makes me feel quite
    unfulfilled in what I have done. . . . Jamie provided me with a
    document on the research you do and the funds needed. I have
    already spoken with our CFO on how the company can make tax
    efficient donations but I will donate personally as well . . . it will
    be my absolute pleasure to support you and your work. Actions
    always speak louder than words and you will see action!”
    Silvester added that the tinnitus was the “most traumatic thing
    that ha[d] ever happened to [him]” and that he had “hit depths of
    despair on a few occasions over the past few months that [he]
    never thought was possible for [him].” Niparko responded: “We
    would be honored to partner with you on our research programs,
    but know that getting your present symptoms addressed is our
    first priority. Let’s focus on that right now.” Niparko forwarded
    Silvester’s email to Kelley, who responded, “Sounds like we’ve got
    some success coming in the future. Great job!”
    4
    On January 6, 2011, Silvester wrote to Niparko: “[T]hank
    you as always for your help and advice. I really enjoyed our
    conversation and thank you for your hospitality. You have my
    total 100% commitment to fund the $2.5 million dollars and I
    fully expect it will be more. Forget my ears, seeing you in action
    has opened my eyes to a number of things that I was blind to
    before.” Silvester expressed that he felt “hugely appreciative”
    and “lucky” to have Niparko helping him at this time.
    On January 10, 2011, Silvester entered into a donor
    agreement with Johns Hopkins to fund a chair for the
    Department of Otolaryngology for $2.5 million. Silvester then
    made what was supposed to be the first of seven annual $357,000
    payments to Johns Hopkins.2 On January 27, 2011, Silvester
    wrote to Niparko: “I now look upon it as one of my missions in
    life that I will help your funding and to further your research.
    My plan is that the funds for the chair that I have committed to
    already will be substantially increased.”
    3. Niparko Performs Surgery on Silvester and Diagnoses Him
    With Wegener’s Granulamotisis, and the Two Discuss
    Further Charitable Donations
    In the first quarter of 2011, Silvester returned to Niparko
    for dozens of treatments. By February 2011, the ringing in
    Silvester’s left ear had subsided considerably. However, pus
    began draining from Silvester’s right ear and his hearing in that
    ear—which had been his better-hearing ear—diminished. He
    was put on oral antibiotics in Cape Town and, on March 11, 2011,
    was treated at Johns Hopkins with intravenous antibiotics. The
    2    Silvester never made another payment or donation to
    Johns Hopkins or to Niparko.
    5
    apparent infection ceased but was replaced with an idiosyncratic,
    intractable inflammation in his right middle ear (polypoid
    disease), which did not respond to further antibiotics.
    In early 2011, Niparko was a candidate to become
    permanent chair of the Department of Otolaryngology. During
    Silvester’s visits to Johns Hopkins for treatment, he and Niparko
    regularly discussed Niparko’s pending candidacy for department
    chair and strategized on how to direct Silvester’s donations to
    Niparko’s work. In March 2011, Niparko told Silvester he had
    not been promoted. Silvester responded that he had been
    awaiting Johns Hopkins’ decision on Niparko’s promotion to
    announce his plan to donate $10 million toward a program or
    facility directed by Niparko, regardless of location.
    On March 16, 2011, Niparko performed a mastoidectomy of
    Silvester’s right ear to surgically remove the inflammation. This
    surgery was ultimately repeated five more times because the
    inflammation did not subside and threatened to further diminish
    Silvester’s hearing. Niparko also continued to treat Silvester
    with dexamethasone drops. Neither the surgery nor the
    injections improved Silvester’s tinnitus or hearing loss. Niparko
    told Silvester the steroid injections were not the cause of his right
    ear problems.
    In August 2011, Silvester wrote to Niparko and said he was
    thinking about potential places Niparko might practice if he left
    Johns Hopkins. Silvester also noted he had an idea for additional
    funding.
    In late 2011, after consulting with other doctors at Johns
    Hopkins, Niparko told Silvester his condition might be due to
    Wegener’s Granulamotisis, an uncommon autoimmune disease.
    In January 2012, Niparko consulted with rheumatologist
    6
    Dr. Philp Seo at Johns Hopkins. In February 2012, Seo began to
    treat Silvester with an anti-cancer drug, methotrexate, to
    restrain the inflammation.
    In mid-January 2012, Niparko sent Silvester a proposal for
    an ear research institute that Niparko would oversee and which
    Silvester would fund. Niparko asked Silvester to send a letter
    supporting the proposed institute to Johns Hopkins’ leadership;
    Niparko and his friend Nancy Mellon drafted the letter, which
    Silvester signed.
    Between November 2010 and January 2013, Silvester
    consulted with and obtained second opinions from approximately
    a dozen other doctors around the world regarding his tinnitus,
    ear inflammation and treatment protocol. Niparko provided
    many of those physicians with copies of Silvester’s medical
    records and information about his diagnosis and course of
    treatment. In February 2012, Silvester was referred to Dr.
    Subinoy Das, an ear, nose and throat doctor who had experience
    treating patients with Wegener’s. Das concluded Silvester’s
    condition was caused by an infection, not by Wegener’s. Silvester
    spoke with Niparko about Das’s opinion but decided to continue
    with Niparko’s recommended course of treatment.
    In April 2012, pathologist Dr. Edward McCarthy at Johns
    Hopkins identified a “vasculitis” in Silvester’s middle ear tissue
    sample. Niparko concluded this finding confirmed a working
    diagnosis of atypical Wagener’s. Niparko told Silvester,
    “Wegener’s is notoriously difficult to diagnose⎯you do not have
    systemic Wegener’s.” Seo agreed that atypical Wegener’s was a
    reasonable working diagnosis and prescribed cytoxin and
    prednisone instead of methotrexate, telling Silvester that this
    was the “big gun” treatment.
    7
    In August 2012, Silvester saw Dr. Gary Hoffman, a
    rheumatologist at the Cleveland Clinic, for a second opinion
    Niparko forwarded a summary of Silvester’s medical records to
    Hoffman, who examined Silvester and conducted lab testing of
    his blood. Hoffman told Silvester he did not have Wegener’s or
    any autoimmune disorder. On August 13, 2012, Silvester and
    Drs. Niparko, Hoffman, McCarthy, Seo and Brendan Venter (a
    Cape Town general practitioner and Silvester’s personal friend)
    had a conference call. Hoffman opined the various surgeries had
    caused the vasculitis identified by McCarthy. Hoffman concluded
    Silvester did not have any form of Wegener’s and advised that he
    should stop taking medication for it. Hoffman also discovered
    Silvester’s mercury blood level was “alarmingly high” and
    informed Niparko that neurologic symptoms, including auditory
    impairment such as tinnitus, could result from mercury
    poisoning. Silvester’s elevated mercury levels resulted from his
    “generous fish diet.” He followed Hoffman’s advice and
    underwent chelation therapy to rid himself of the mercury;
    Silvester’s physical symptoms improved. By December 2012,
    Niparko concluded Silvester did not have Wegener’s.
    From December 2012 through January 2013, Silvester
    exchanged several emails with Niparko and asked for
    clarification regarding Niparko’s treatment decisions and queried
    why Niparko’s medical opinions differed from other opinions
    Silvester received.
    In 2013, Silvester’s right ear was repaired at Harvard
    Hospital, though he still suffers from a hearing impairment in
    that ear.
    8
    4. Silvester Sues Johns Hopkins and Niparko
    On June 23, 2014, Silvester sued Johns Hopkins and its
    physicians and employees for medical negligence in Maryland
    state court. On March 6, 2015, Silvester filed the underlying
    action in the Los Angeles Superior Court for
    “fraud/deceit/concealment/misrepresentation” and constructive
    fraud against Niparko. On December 7, 2015, Silvester settled
    the Maryland action and released Johns Hopkins and its
    employees, including Niparko, from all medical negligence
    claims, though the settlement carved out the California fraud
    claims against Niparko. Two months later, Johns Hopkins wrote
    to Silvester that they were refunding him $357,143 and relieving
    him of any financial obligations for further donations. Silvester
    refused the return of his money to ensure he could obtain the
    documents he had subpoenaed.
    Niparko died from cancer on April 25, 2016. On July 29,
    2016, Silvester filed his second amended complaint against “the
    Estate of John Kim Niparko, Deceased.” Pursuant to Probate
    Code sections 550 and 552 and Code of Civil Procedure section
    9390, Silvester served the second amended complaint on MCIC
    Vermont LLC, Attorney-in-Fact for MCIC Vermont (a Reciprocal
    Risk Retention Group) (MCIC), the insurer providing the defense
    for Niparko before he died. MCIC thereafter appeared in the
    action as the “Estate.”
    Niparko’s spouse, Angela Niparko, filed a probate case on
    July 29, 2016, and the court named her the personal
    representative of the estate. Silvester then filed his operative
    third amended complaint, which proceeded against both “the
    Estate of John Kim Niparko, Deceased,” and “Angela Niparko, as
    9
    the Personal Representative of the Estate of John Kim Niparko,
    Deceased.” Angela as the personal representative appealed.
    On October 12, 2016, Silvester filed a claim against the
    estate in probate court, which Angela rejected. On January 11,
    2017, the parties stipulated Silvester would not seek to recover
    punitive and/or exemplary damages from Angela.
    The parties agreed to trifurcate the trial into phase I on
    liability and compensatory damages; then, if Silvester prevailed
    in phase I, phase II would involve Silvester’s claim for punitive
    damages against the estate; and phase III would involve his
    claim against MCIC and/or any other insurers or indemnitors for
    insurance coverage or indemnification for any damages awarded.
    5. Summary Adjudication
    On March 9, 2018, the trial court issued its Order on
    Respondent’s Motion for Summary Adjudication, holding, in part,
    that no punitive damages may be awarded against either
    Respondent or MCIC.
    6. Jury Trial and Verdict
    The court ruled on the parties’ proposed jury instructions
    and motions in limine during pretrial hearings on November 27,
    2018, May 15, 2019, and June 6, 2019.
    The eight-day jury trial began on June 10, 2019.
    Respondent agreed to a general verdict form in exchange for
    Silvester’s written agreement that he would not seek to execute
    on any estate assets other than insurance and indemnity
    protection.
    The jury was instructed on three claims: constructive fraud,
    actual fraud by intentional misrepresentation, and actual fraud
    by concealment. The jury began deliberating on June 21, 2019,
    10
    and returned a unanimous general verdict in favor of Respondent
    the same day.
    Judgment was entered on July 23, 2019. Silvester timely
    filed a motion for a new trial, which the court denied.
    This appeal followed.
    DISCUSSION
    1. The Trial Court Did Not Err in Refusing To Give Silvester’s
    Proposed Constructive Fraud Jury Instruction
    a. Silvester’s proposed constructive fraud instruction
    Silvester’s primary contention on appeal is that the trial
    court erred in refusing to use the following constructive fraud
    jury instruction that he proposed before the final pre-trial
    hearing:
    “Dominic Silvester claims that he was harmed because
    Dr. Niparko took advantage of their fiduciary (doctor-patient)
    relationship. To establish this claim, Dominic Silvester must
    prove the following:
    1. a. Dominic Silvester was vulnerable, and
    b. Dr. Niparko took advantage of Dominic Silvester’s
    vulnerability in soliciting money from him; or
    2. Dr. Niparko misled Dominic Silvester by providing
    Dominic Silvester with inaccurate and/or incomplete information
    or by failing to disclose some or all of the information that:
    Dominic Silvester did not need the medical treatment he was
    receiving or that Dominic Silvester did not have the disease for
    which he was being treated, or that Dominic Silvester’s
    medical treatment was harming and not helping him, or that
    Dr. Niparko’s treatment had caused Dominic Silvester harm, or
    11
    that Dr. Niparko was not acting in Dominic Silvester’s best
    interests;
    3. Dominic Silvester was harmed; and
    4. Dr. Niparko’s conduct was a substantial factor in causing
    Dominic Silvester’s harm.”
    Respondent objected to the proposed inclusion of language
    that would allow the jury to find Silvester was “vulnerable,”
    given the parties’ undisputed fiduciary relationship as doctor and
    patient, which established Niparko owed a fiduciary duty to
    Silvester as a matter of law. In response, Silvester asserted that
    he and Niparko had a separate “confidential relationship which is
    driven by the vulnerability and the taking advantage of the
    vulnerability of the other party” and that this was “a subset of
    constructive fraud.” Respondent argued there was no need to ask
    the jury to decide the factual question whether there was a
    confidential relationship between Niparko and Silvester.
    Respondent explained that inquiry would only serve as an
    alternate path to establishing a fiduciary duty if no legally
    recognized fiduciary relationship exists between the parties, and
    “they’ve already satisfied the duty issue by virtue of the fact that
    there is a fiduciary duty owed by Dr. Niparko to Mr. Silvester
    because of the physician patient relationship.”
    The trial court delayed its decision to conduct further
    research, stating: “I don’t know that you need to prove [a
    confidential relationship] if you’ve already got the fiduciary
    relationship. That’s what I’m going to be looking at. . . . But what
    I’m saying is that, if you are required to have one or the other
    and you’ve got one, and you don’t need to prove the other, why do
    you need to have it in there?”
    12
    b. The final constructive fraud, fiduciary duty and
    reasonable reliance jury instructions
    Over Silvester’s continued objections, the trial court gave
    the jury the following constructive fraud instruction, which
    omitted the alternative instruction for the jury to determine
    whether Silvester was “vulnerable”:
    “It is stipulated that Dominic Silvester and Dr. Niparko
    were in a fiduciary (doctor-patient) relationship. Dominic
    Silvester claims he was harmed because Dr. Niparko misused the
    fiduciary relationship, which constitutes constructive fraud. To
    establish this claim, Dominic Silvester must prove the following:
    1. That Dr. Niparko knew or should have known that
    Dominic Silvester did not need the medical treatment he was
    receiving; or that Dominic Silvester did not have the disease for
    which he was being treated; or that Dominic Silvester’s medical
    treatment was harming and not helping him; or that Dr.
    Niparko’s treatment had caused Dominic Silvester harm; or that
    Dr. Niparko was not acting in Dominic Silvester’s best interests.
    2. Dr. Niparko misled Dominic Silvester by providing him
    with inaccurate or incomplete information; or by failing to
    disclose some or all of the above information.
    3. That if accurate and complete information had been
    provided, or omitted information had been disclosed, Dominic
    Silvester reasonably would have behaved differently.
    4. Dominic Silvester was harmed; and
    5. Dr. Niparko’s conduct was a substantial factor in
    causing Dominic Silvester’s harm.”
    The trial court separately gave an explanatory instruction
    on fiduciary duty (CACI No. 4100), stating, “A doctor owes what
    is known as a fiduciary duty to his or her patient. A fiduciary
    13
    duty imposes on a doctor a duty to act with the utmost good faith
    in the best interests of his or her patient.” The court also stated
    in its reasonable reliance instruction (CACI No. 1908): “Because
    of their doctor/patient fiduciary relationship, it is presumed that
    Dominic Silvester reasonably relied on Dr. Niparko’s misleading
    actions, statements and omissions, though this presumption may
    be overcome by other evidence. The defendant bears the burden
    of rebutting this presumption by proving with substantial
    evidence that Dominic Silvester could not have reasonably relied
    on Dr. Niparko’s misleading actions, statements and omissions.”
    c. Standard of review
    “Appellate courts apply a de novo standard of review when
    determining whether the trial court’s jury instructions were
    proper because the propriety of a jury instruction is a question of
    law.” (Harb v. City of Bakersfield (2015) 
    233 Cal.App.4th 606
    ,
    617.)
    d. Law of constructive fraud
    Constructive fraud is distinct from actual fraud as “a
    unique species of fraud applicable only to a fiduciary or
    confidential relationship.” (Assilzadeh v. California Federal
    Bank (2000) 
    82 Cal.App.4th 399
    , 415 (Assilzadeh); accord,
    Prakashpalan v. Engstrom, Lipscomb & Lack (2014) 
    223 Cal.App.4th 1105
    , 1131 (Prakashpalan).) “‘Fiduciary’ and
    ‘confidential’ relationships are relationships existing between
    parties to a transaction wherein one party is duty-bound to act
    with the utmost good faith for the benefit of the other.” (Brown v.
    Wells Fargo Bank, N.A. (2008) 
    168 Cal.App.4th 938
    , 959-960
    (Brown).) “‘The essence of a fiduciary or confidential relationship
    is that the parties do not deal on equal terms because the person
    14
    in whom trust and confidence is reposed and who accepts
    that trust and confidence is in a superior position to exert
    unique influence over the dependent party.’” (Richelle L. v.
    Roman Catholic Archbishop (2003) 
    106 Cal.App.4th 257
    , 271
    (Richelle L.).)
    Constructive fraud “‘arises on a breach of duty by one in a
    confidential or fiduciary relationship to another which induces
    justifiable reliance by the latter to his prejudice.’” (Estate of
    Gump (1991) 
    1 Cal.App.4th 582
    , 601 (Gump), quoting Odorizzi v.
    Bloomfield School Dist. (1966) 
    246 Cal.App.2d 123
    , 129, italics in
    Gump.) Civil Code section 1573, subdivision (1), defines
    constructive fraud as “any breach of duty which, without an
    actually fraudulent intent, gains an advantage to the person in
    fault, or anyone claiming under him, by misleading another to his
    prejudice, or to the prejudice of anyone claiming under him[.]”
    (Civ. Code, § 1573, subd. (1); see Engalla v. Permanente Medical
    Group, Inc. (1997) 
    15 Cal.4th 951
    , 981, fn. 13 (Engalla); Barrett v.
    Bank of America (1986) 
    183 Cal.App.3d 1362
    , 1368 (Barrett).)
    “The breach of duty referred to in section 1573 must be one
    created by the confidential relationship, which is one of the facts
    constituting the fraud.” (Byrum v. Brand (1990) 
    219 Cal.App.3d 926
    , 937.) “‘“In its generic sense, constructive fraud comprises all
    acts, omissions and concealments involving a breach of legal or
    equitable duty, trust, or confidence, and resulting in damages to
    another. [Citations.] Constructive fraud exists in cases in which
    conduct, although not actually fraudulent, ought to be so
    treated—that is, in which such conduct is a constructive or quasi
    fraud, having all the actual consequences and all the legal effects
    of actual fraud.” [Citation.]’ [Citations.]” (Prakashpalan, supra,
    223 Cal.App.4th at p. 1131.)
    15
    The special relationship of the parties is what establishes
    the duty and forms the basis for constructive fraud, which
    “‘usually arises from a breach of duty where a relation of trust
    and confidence exists.’” (Gump, supra, 1 Cal.App.4th at p. 601,
    quoting Barrett, supra, 183 Cal.App.3d at p. 1369.)
    “‘Constructive fraud allows conduct insufficient to constitute
    actual fraud to be treated as such where the parties stand in a
    fiduciary relationship.’” (Engalla, 
    supra,
     15 Cal.4th at p. 981, fn.
    13.) It differs from actual fraud “primarily in the type of conduct
    which may be treated as fraudulent, such as a failure to disclose
    material facts within the knowledge of the fiduciary.” (Gump, at
    p. 601; see Michel v. Moore & Associates, Inc. (2007) 
    156 Cal.App.4th 756
    , 762 [“A fiduciary’s failure to share material
    information with the principal is constructive fraud, a term of art
    obviating actual fraudulent intent”]; Tyler v. Children’s Home
    Society (1994) 
    29 Cal.App.4th 511
    , 519-520 (Tyler) [“Unlike
    actual fraud and undue influence, which generally involve active
    misconduct, such as an intent to deceive or misrepresentation by
    the defendant, a constructive fraud claim allows relief for
    negligent omissions constituting breach of duty in a confidential
    relationship”].)
    Additionally, in a fiduciary relationship it is presumed that
    a beneficiary reasonably relies on the fiduciary. (Edmunds v.
    Valley Circle Estates (1993) 
    16 Cal.App.4th 1290
    , 1302
    (Edmunds) [“a representation in the context of a trust or
    fiduciary relationship creates a rebuttable presumption of
    reasonable reliance subject to being overcome by substantial
    evidence to the contrary”]; Gump, supra, 1 Cal.App.4th at p. 602
    [“the reliance element is relaxed in constructive fraud to the
    extent we may presume reasonable reliance upon the
    16
    misrepresentation or nondisclosure of the fiduciary, absent direct
    evidence of a lack of reliance”].) Thus, “[i]n its application,
    constructive fraud not only expands the range of conduct which
    may be characterized as fraudulent, it also presumes the element
    of reliance absent substantial evidence to the contrary.”
    (Edmunds, at p. 1302, citing Gump, at pp. 601–602.)
    e. Because Niparko had an undisputed fiduciary duty to
    Silvester, the jury did not need to find the parties had a
    confidential relationship giving rise to a fiduciary duty
    Silvester argues that he and Niparko had a fiduciary
    relationship arising from their doctor-patient relationship and a
    legally distinct confidential relationship based on Silvester’s
    particular vulnerability and intense trust in Niparko. Silvester
    argues their interactions reflected a relationship that was “far
    more than an ordinary doctor-patient relationship,” providing an
    “alternative legal basis” for a constructive fraud claim based on
    confidential relationship. We reject Silvester’s contention that
    the jury’s independent finding of a confidential relationship
    would have provided an alternative path to establishing liability
    for his constructive fraud claim.
    Fiduciary and confidential relationships each “ordinarily
    arise[] when one party reposes a confidence in the integrity of the
    other, and the other voluntarily accepts that confidence.”
    (Brown, supra, 168 Cal.App.4th at pp. 959-960.) “Both
    relationships give rise to a fiduciary duty, that is, a duty ‘to act
    with the utmost good faith for the benefit of the other party.’”
    (Persson v. Smart Inventions, Inc. (2005) 
    125 Cal.App.4th 1141
    ,
    1160 (Persson).) However, they differ in that “fiduciary relations
    arise out of certain canonical relationships that are legally
    defined and regulated,” whereas confidential relations “do not fall
    17
    into well-defined categories of law” but nevertheless “give[] rise to
    a fiduciary duty” due to the vulnerability of one party to the other
    under the circumstances. (Richelle L., supra, 106 Cal.App.4th at
    p. 270.) “Technically, a fiduciary relationship is a recognized
    legal relationship such as guardian and ward, trustee and
    beneficiary, principal and agent, or attorney and client
    [Citation.], whereas a ‘confidential relationship’ may be founded
    on a moral, social, domestic, or merely personal relationship as
    well as on a legal relationship.” (Id. at p. 271; accord, Hudson v.
    Foster (2021) 
    68 Cal.App.5th 640
    , 663.)
    Accordingly, although “a fiduciary relation in law is
    ordinarily synonymous with a confidential relation” (Herbert v.
    Lankershim (1937) 
    9 Cal.2d 409
    , 483; Wolf v. Superior Court
    (2003) 
    107 Cal.App.4th 25
    , 29 (Wolf)), the converse is less
    straightforward. Rather, “[a] confidential relation may exist
    where there is no fiduciary relation” (Persson, supra, 125
    Cal.App.4th at p. 1160; see Oakland Raiders v. National Football
    League (2005) 
    131 Cal.App.4th 621
    , 631, fn. 7 [noting “a fiduciary
    duty may arise out of a confidential relationship that is not one
    that is considered a legally recognized fiduciary relationship”].).
    In the absence of a recognized fiduciary relationship, the
    existence of a confidential relationship giving rise to a fiduciary
    duty is determined by the factfinder. (Persson, supra, 125
    Cal.App.4th at pp. 1160-1162.)
    The doctor-patient relationship is an archetypal fiduciary
    relationship. (See Hahn v. Mirda (2007) 
    147 Cal.App.4th 740
    ,
    748 [“The doctor-patient relationship is a fiduciary one and as a
    consequence of the physician’s ‘fiducial’ obligations, the physician
    is prohibited from misrepresenting the nature of the patient’s
    medical condition”]; Mathis v. Morrissey (1992) 
    11 Cal.App.4th 18
    332, 339 [“a physician has a fiduciary duty to disclose all
    information material to the patient’s decision” to consent to
    treatment]; Moore v. Regents of the Univ. of California (1990) 
    51 Cal.3d 120
    , 129 [recognizing doctor-patient relationship is a
    fiduciary relationship].) By its nature, the fiduciary relationship
    between doctor and patient is inherently a “confidential
    relationship,” as courts have long recognized. (See Gutierrez v.
    Mofid (1985) 
    39 Cal.3d 892
    , 899 [physician has a “fiduciary and
    confidential relationship with his client or patient”]; Sanchez v.
    South Hoover Hospital (1976) 
    18 Cal.3d 93
    , 97 [“the fiduciary and
    confidential relationship created between physician and patient”
    imposes duty of disclosure]; Stafford v. Shultz (1954) 
    42 Cal.2d 767
    , 777 (Stafford) [“the confidence growing out of the
    relationship of doctor and patient” imposes fiduciary duty to
    disclose material medical information].) Thus, “[t]he duty of
    disclosure is fiduciary in nature because of the confidential
    patient-physician relationship, the duty of disclosure is measured
    by fiduciary standards (not limited by medical standards), and
    the physician subjects himself to liability should he withhold
    facts necessary to a total disclosure [Citation.].” (Nelson v.
    Gaunt (1981) 
    125 Cal.App.3d 623
    , 634, italics added.)
    Distilled to its essential elements, a claim for constructive
    fraud requires (1) a fiduciary or confidential relationship giving
    rise to a fiduciary duty; (2) breach of fiduciary duty; (3) justifiable
    reliance; and (4) resulting injury. (See Tyler v. Children’s Home
    Society (1994) 
    29 Cal.App.4th 511
     at p. 520 [“Constructive fraud
    arises on a breach of duty by one in a confidential or fiduciary
    relationship to another that induces justifiable reliance by the
    latter to his or her prejudice. Actual reliance and causation of
    19
    injury must be shown.”].)3 As a result, to prove constructive
    fraud a plaintiff must establish a fiduciary relationship with the
    defendant⎯either because that relationship is already legally
    recognized (e.g., the doctor patient fiduciary relationship) or
    because the parties had a confidential relationship that created a
    fiduciary relationship.
    Here, given the inherent “confidential relationship existing
    between a patient and his physician” (Stafford, supra, 42 Cal.2d
    at p. 779) and the parties’ stipulation that Silvester and Niparko
    were in a fiduciary relationship, a relationship imposing a
    fiduciary duty was established as a matter of law. As Silvester
    concedes, the fiduciary duty owed in either a traditional
    fiduciary relationship or confidential relationship is the same:
    the party in the more powerful position must “act with the
    utmost good faith for the benefit of the other.” (Brown, supra,
    168 Cal.App.4th at pp. 959-960.) No legally distinct duty arises
    from one versus the other, and Silvester cites no authority that
    suggests otherwise. Therefore, we agree with the trial court that
    3      Certain cases set forth the elements of constructive fraud
    as “(1) a fiduciary or confidential relationship; (2) nondisclosure
    (breach of fiduciary duty); (3) intent to deceive, and (4) reliance
    and resulting injury (causation).” (See, e.g., Prakashpalan,
    supra, 223 Cal.App.4th at p. 1131, quoting Younan v. Equifax
    Inc. (1980) 
    111 Cal.App.3d 498
    , 516, fn. 14.) However, as noted
    in the use notes to CACI No. 4111 for constructive fraud claims
    under Civil Code section 1573, “these elements conflict with the
    statute in at least two ways. First, the statute clearly states that
    no fraudulent intent (or intent to deceive) is required. Second,
    the statute is not limited to nondisclosure; it extends to
    information that is disclosed, but misleading.” (Judicial Council
    of Cal., Civ. Jury Instns. (2020 ed.) Directions For Use to CACI
    No. 4111.)
    20
    the jury was not required to find a confidential relationship
    creating a fiduciary duty to establish such a duty existed for
    purposes of a constructive fraud claim.
    Because it was undisputed that Niparko owed a fiduciary
    duty to Silvester, Silvester’s proposed instruction “would be
    redundant and confusing.” (Ford v. Polaris Industries, Inc. (2006)
    
    139 Cal.App.4th 755
    , 775.) Where an element of a cause of action
    is already established as a matter of law or its finding is
    subsumed by another test, it is not necessary for the jury to
    independently determine that element. (See 
    ibid.
     [where finding
    of a jet ski design defect established increased risk of harm as a
    matter of law, there was “no need” for special instruction also
    requiring plaintiffs to prove the defect increased risk]; Mayes v.
    Bryan (2006) 
    139 Cal.App.4th 1075
    , 1080 [in wrongful death
    action, “trial court did not err in refusing to instruct the jury on
    ‘but for’ causation because the jury was instructed on ‘substantial
    factor’ and ‘but for’ is subsumed under the substantial factor
    test”; “instruction would have been redundant, with the result
    that the omission did not prejudice defendants”]; Johnson v.
    Matson Nav. Co. (1958) 
    163 Cal.App.2d 336
    , 339 [where
    “instructions requested by appellant were redundant, . . . their
    refusal was not error”].) There was no need for Silvester’s
    proposed instruction, and the trial court did not err in refusing to
    give it.
    f. The jury instruction did not improperly limit the scope of
    Silvester’s constructive fraud claim
    Silvester also argues the court’s instruction improperly
    limited the scope of his constructive fraud claim solely to
    misrepresentation and omission about Silvester’s medical care
    rather than for conduct relating to his solicitation of donations.
    21
    We disagree. The constructive fraud instruction required the
    jury to find Niparko “knew or should have known that Dominic
    Silvester did not need the medical treatment he was receiving; or
    that Dominic Silvester did not have the disease for which he was
    being treated; or that Dominic Silvester’s medical treatment was
    harming and not helping him; or that Dr. Niparko’s treatment
    had caused Dominic Silvester harm; or that Dr. Niparko was not
    acting in Dominic Silvester’s best interests,” that Niparko “misled
    Dominic Silvester by providing him with inaccurate or incomplete
    information; or by failing to disclose some or all of the above
    information”; and that Silvester reasonably would have behaved
    differently “if accurate and complete information had been
    provided, or omitted information had been disclosed”; Silvester
    was harmed, and Niparko’s conduct was a substantial factor in
    that harm. (Italics added.)
    The trial court also gave a reliance instruction (CACI No.
    1907) instructing that “Dominic Silvester relied on any one of
    Dr. Niparko’s misrepresentations or omissions if: 1. The
    misrepresentation or omission substantially influenced Dominic
    Silvester to make financial pledges and payments to Johns
    Hopkins and to benefit Dr. Niparko; and 2. He would probably
    not have made the financial pledges and payments, or continued
    his relationship with Dr. Niparko, if Dr. Niparko had not made
    the misrepresentation or omitted the information. It is not
    necessary for a misrepresentation or omission to be the only
    reason for Dominic Silvester’s actions.”
    Silvester contends that as instructed the jury could
    “consider only whether Mr. Silvester had been lied to by Dr.
    Niparko about his medical care.” However, the constructive
    fraud instruction permitted the jury to find that Niparko was
    22
    liable because he was not acting in Silvester’s best interests and
    caused Silvester harm. This instruction is in line with Civil Code
    section 1573, subdivision (1), which states constructive fraud
    consists of “any breach of duty which, without an actually
    fraudulent intent, gains an advantage to the person in fault, or
    anyone claiming under him, by misleading another to his
    prejudice, or to the prejudice of any one claiming under him[.]”
    (Italics added.) The constructive fraud instruction, particularly
    when read in tandem with the reliance instruction, confirms the
    jury was properly informed that it could find (if the facts
    supported such a finding) that Niparko’s conduct in soliciting
    donations was a breach of his duty to Silvester.
    2. The Trial Court’s Evidentiary Rulings
    a. Standard of review
    “Trial court rulings on the admissibility of evidence,
    whether in limine or during trial, are generally reviewed for
    abuse of discretion.” (Pannu v. Land Rover North America, Inc.
    (2011) 
    191 Cal.App.4th 1298
    , 1317, accord, Zhou v. Unisource
    Worldwide, Inc. (2007) 
    157 Cal.App.4th 1471
    , 1476.) “The trial
    court’s error in excluding evidence is grounds for reversing a
    judgment only if the party appealing demonstrates a ‘miscarriage
    of justice’—that is, that a different result would have been
    probable if the error had not occurred.” (Zhou, at p. 1480; see
    Evid. Code, § 354; Code Civ. Proc., § 475.) Under Evidence Code
    section 353, a verdict also “shall not be reversed due to the
    erroneous admission of evidence unless: ‘(a) There appears of
    record an objection to or a motion to exclude or to strike the
    evidence that was timely made and so stated as to make clear the
    specific ground of the objection or motion . . . .’” (Atkins v.
    Strayhorn (1990) 
    223 Cal.App.3d 1380
    , 1390; see Evid. Code,
    23
    § 353, subd. (a).) If a trial court’s decision to admit or exclude
    evidence involves a question of law, we review that decision de
    novo. (Zhou, at p. 1476.)
    b. The trial court prejudicially abused its discretion when it
    excluded evidence regarding Silvester’s vulnerability and
    emotional distress, and medical ethics evidence
    i.    Silvester’s vulnerability and emotional distress
    Silvester contends the trial court erroneously excluded
    evidence of his vulnerability and emotional distress, including
    when it granted Respondent’s Motion in Limine No. 1 to exclude
    evidence of Silvester’s emotional distress during his relationship
    with Niparko, and when it sustained relevance objections4 to his
    medical expert’s testimony regarding his observations of Silvester
    and the expert’s opinion that medication caused Silvester to be
    vulnerable and impaired, both behaviorally and emotionally.
    Silvester asserts the trial court’s error was exacerbated by
    allowing Respondent to introduce testimony that Silvester was
    not vulnerable or behaviorally impaired during their
    relationship, while not allowing Silvester to introduce contrary
    evidence.5
    The court also precluded Silvester’s expert from showing
    the jury a slide containing the word “vulnerability,” stating:
    4     “Relevant evidence” is that which has “any tendency in
    reason to prove or disprove any disputed fact that is of
    consequence to the determination of the action.”
    5     The court did permit Silvester to present some evidence on
    this point, including the testimony of both Silvester and his wife
    who described his deteriorated physical and emotional state.
    24
    “Vulnerability is not going to be at issue in this case because of
    the fact that we have an automatic fiduciary duty due to the
    physician patient relationship, so I would suggest you perhaps
    delete that, okay.” Silvester argued that his vulnerability was
    relevant to reliance as well as to the existence and breach of
    Niparko’s fiduciary duty. The trial court stated that
    vulnerability “relates to the issue of whether or not you create the
    relationship that gives rise to this cause of action. And in this
    case you have an automatic one which is not necessarily [sic] to
    be separately proven and has already been established. . . . [The]
    ruling has not changed. . . . You already have a breach of
    fiduciary duty aspect of this, which is again already established
    and so therefore you—it doesn’t enhance. It doesn’t make it
    different. It didn’t make it better. . . .”
    On appeal, Silvester argues evidence of his vulnerability
    and emotional distress was relevant to proving the existence and
    breach of a confidential relationship for purposes of constructive
    fraud and relevant to justifiable reliance for actual fraud, on
    which the jury was also instructed.6 Specifically, Silvester
    6        The trial court gave the following instructions on actual
    fraud:
    “[CACI] 1900. Intentional Misrepresentation
    In addition to his constructive fraud claim on which I just
    instructed you, Dominic Silvester claims that Dr. Niparko made a
    false representation that harmed him. To establish this claim,
    Dominic Silvester must prove the following:
    1. That Dr. Niparko represented to Dominic Silvester that a fact
    was true;
    2. That Dr. Niparko’s representation was false;
    25
    asserts evidence of his vulnerability was “relevant to foreclosing
    any attempt by Respondent to rebut Mr. Silvester’s justifiable
    reliance required for actual fraud, . . . .” He argues the trial
    court’s rulings “were particularly prejudicial because they skewed
    the evidence by receiving Respondent’s evidence to rebut Mr.
    3. That Dr. Niparko knew that the representation was false
    when he made it, or that he made the representation recklessly
    and without regard for its truth;
    4. That Dr. Niparko intended that Dominic Silvester rely on the
    representation;
    5. That Dominic Silvester reasonably relied on Dr. Niparko’s
    representation;
    6. That Dominic Silvester was harmed; and
    7. That Dominic Silvester’s reliance on Dr. Niparko’s
    representation was a substantial factor in causing Dominic
    Silvester’s harm.”
    “[CACI] 1901. Concealment
    As a third and separate claim, Dominic Silvester also claims that
    he was harmed because Dr. Niparko concealed certain
    information. To establish this claim, Dominic Silvester must
    prove the following:
    1. That Dr. Niparko intentionally failed to disclose certain facts
    to Dominic Silvester;
    2. That Dominic Silvester did not know of the concealed facts;
    3. That Dr. Niparko intended to deceive Dominic Silvester by
    concealing the facts;
    4. That had the omitted information been disclosed, Dominic
    Silvester reasonably would have behaved differently;
    5. That Dominic Silvester was harmed; and
    6. That Dr. Niparko’s concealment was a substantial factor in
    causing Dominic Silvester’s harm.”
    26
    Silvester’s vulnerability, yet excluding evidence Mr. Silvester’s
    evidence of his vulnerability.” (Italics in original.)
    For the reasons articulated above, we find the court did not
    abuse its discretion when it excluded the vulnerability and
    emotional distress evidence that Silvester attempted to introduce
    for the purpose of establishing that he had a confidential
    relationship with Niparko that created a fiduciary duty.
    However, we agree with Silvester that evidence of his
    vulnerability and emotional distress is relevant to his justifiable
    reliance, which is an element of both actual and constructive
    fraud.
    When a fraud claim is based on a misrepresentation or
    nondisclosure by a fiduciary in a superior position of knowledge
    or power, reasonable reliance is presumed: A representation by
    the party in the superior position in the fiduciary relationship
    “creates a rebuttable presumption of reasonable reliance subject
    to being overcome by substantial evidence to the contrary.”
    (Edmunds, supra, 16 Cal.App.4th at p. 1302.) Here, the jury was
    instructed that there was a fiduciary relationship between
    Niparko and Silvester, and was instructed to presume that
    Silvester reasonably relied on Niparko’s representations, unless
    Niparko rebutted the presumption with substantial evidence.
    Respondent sought to rebut that presumption by successfully
    introducing testimony that Silvester was not vulnerable or
    behaviorally impaired, including:
    •Kelley’s testimony that Silvester seemed “lucid” with “his
    wits about him,” and never appeared “vulnerable” or “brow
    beaten” by Niparko;
    •Testimony of Johns Hopkins Medicine Dean Edward
    Millier that Silvester did not have diminished capacity;
    27
    •Testimony of Johns Hopkins infectious disease doctor
    Paul Auwaerter about his “impression” of Silvester as physically
    fit;
    •Testimony of defense expert Dr. Robert Jackler that
    Silvester was intelligent and able to absorb information given to
    him;
    •Seo’s testimony that Silvester suffered little or no side
    effects from his chemotherapy drugs; and
    •Hoffman’s testimony on cross-examination that he had
    not observed Silvester display mental incapacity.
    The trial court erred when it foreclosed Silvester from
    presenting evidence regarding his vulnerability and emotional
    distress, which was offered to disprove the evidence respondent
    presented to rebut the presumption of Silvester’s reasonable
    reliance on Niparko. This included Silvester’s medical expert’s
    observations of Silvester and his opinion that steroids and
    chomotherapy drugs made Silvester vulnerable and impaired him
    behaviorally and emotionally. The evidence of Silvester’s
    vulnerability was relevant to the jury’s determination regarding
    whether Respondent succeeded in overcoming the presumption
    that Silvester reasonably relied on Niparko.
    ii.   Medical ethics evidence
    The trial court denied Respondent’s Motion in Limine No. 5
    to exclude the testimony of Silvester’s medical ethics expert, Dr.
    Erin Egan, regarding codes of ethics and professional guidelines
    applicable to physicians’ fundraising from patients and HIPAA
    privacy requirements. However, the court ruled Egan could not
    testify about whether Niparko violated applicable medical ethics
    standards while simultaneously treating and fundraising from
    Silvester. The trial court explained Egan would not be allowed to
    28
    reach conclusions that were properly in the purview of the trier of
    fact but “certainly can testify about what these standards are,
    but can’t say: I’ve decided this is what happened and that’s a
    violation of, okay? Other than that, I think that it’s an
    appropriate use of expert testimony . . . .” The court confirmed it
    was “fair game to ask Dr. Egan: How should this situation [have]
    been handled, if consistent with the norms?” if it was a “complete
    hypothetical.”
    At trial, the court reiterated Egan could not testify
    regarding whether Niparko had acted unethically when he
    simultaneously treated and solicited money from Silvester,
    commenting, “[T]his is not a case for breach of medical ethics.
    This is a fraud and concealment case.” The court stated: “Our
    claims are fraud, fraud based on concealment, and constructive
    fraud. That requires misrepresentation or concealment of
    material facts, not violations of HIPAA, not violations of ethical
    issues.” The trial court also stated that HIPAA violations were
    “irrelevant.”
    Silvester argues the court erroneously prevented Egan from
    expressing her opinions that Niparko’s solicitation of Silvester for
    donations (when Niparko was Silvester’s treating physician)
    violated applicable medical ethics standards. Silvester also
    asserts that when Niparko shared information about Silvester’s
    medical condition and shared private communications between
    Silvester and Niparko with third parties, Niparko violated
    Silvester’s privacy and HIPAA rights. Silvester contends
    evidence that Niparko violated medical ethical guidelines “is
    relevant to establish Niparko’s breach of the ‘special,’
    ‘confidential’ and ‘trust’ aspects of their relationship” and
    29
    relevant to proving Niparko took advantage of Silvester’s
    “vulnerability” while soliciting money from him.
    A breach of medical ethics may be a breach of fiduciary
    duty (see Scripps Clinic v. Superior Court (2003) 
    108 Cal.App.4th 917
    , 930-931 [triable issue of fact whether medical clinic
    breached its fiduciary duty by violating medical ethics code]), if
    that breach of fiduciary duty results in “misleading another to his
    prejudice” (Civ. Code, § 1573). Accordingly, evidence that
    Niparko’s solicitation activities violated medical ethics standards
    is relevant, and the trial court abused its discretion by
    prohibiting Egan from opining whether Niparko had violated
    ethical guidelines.
    As previously discussed, Silvester may have been able to
    establish Niparko was liable for constructive fraud under Civil
    Code section 1573 if the jury found that Niparko was not acting
    in Silvester’s utmost best interests and misled Silvester to his
    harm. If the jury found that Niparko violated medical ethics
    standards in his solicitation of Silvester, there is a reasonable
    chance the jury would have reached a verdict in Silvester’s favor.
    It is probable that the jury would have reached a different
    conclusion if the court had not erred, and instead had permitted
    Silvester to present evidence regarding his vulnerability and
    emotional distress, as well as medical ethics evidence. The trial
    court’s exclusion of that evidence was a prejudicial abuse of
    discretion requiring a new trial.
    iii.  The trial court did not err in excluding evidence
    of insurance
    Silvester contends the trial court abused its discretion by
    denying Silvester’s motion in limine to permit reference to
    Niparko’s insurance and granting Respondent’s motion in limine
    30
    to exclude references to indemnity or insurance protecting the
    estate. Silvester argues he was prejudiced because he was
    prevented from introducing evidence that MCIC was the insurer
    of the estate and any recovery would first come from insurance or
    other indemnity obligations protecting the estate, leaving the
    jury with the impression he was pursuing the assets of a grieving
    widow.
    Evidence Code section 1155 makes evidence of a
    defendant’s liability insurance inadmissible to prove negligence
    or other wrongdoing. “The purpose of this statute is to prevent
    the prejudicial use of evidence of liability insurance[.]”
    (Industrial Indemnity Co. v. Mazon (1984) 
    158 Cal.App.3d 862
    ,
    865.) Evidence of a defendant’s insurance coverage generally “‘“is
    regarded as both irrelevant and prejudicial to the defendant.”’”
    (Blake v. E. Thompson Petroleum Repair Co. (1985) 
    170 Cal.App.3d 823
    , 830.) There is a substantial risk of prejudice to a
    defendant from the introduction of evidence the defendant is
    insured for the harm he or she allegedly caused—“[a]ny such
    evidence would have an obvious potential to prejudice the jury’s
    determination of the insured’s liability.” (Moradi–Shalal v.
    Fireman’s Fund Ins. Companies (1988) 
    46 Cal.3d 287
    , 311.)
    Here, although the parties agreed Silvester would not seek
    to execute on any estate assets other than insurance and
    indemnity protections, that agreement was not material to
    whether the trial court abused its discretion in its in limine
    rulings because the parties did not reach that agreement until
    the last day of trial.7 During the motions in limine, it was
    7     Although the trial court, during the hearing on the in
    limine motions, told counsel they could raise the issue again if
    “the world has changed,” Silvester did not renew his in limine
    31
    possible that Silvester could recover damages from estate
    property (over policy limits) because Silvester named Niparko’s
    widow (the personal representative of the estate) as a defendant.
    (Prob. Code, § 553 [stating “[u]nless the personal representative
    is joined as a party, a judgment in the action . . . does not
    adjudicate rights by or against the estate”].)
    Silvester also argues the trial court prejudicially erred
    when it prevented him from using the fact of Niparko’s
    indemnification by Johns Hopkins’ insurer to impeach the
    impartiality of Johns Hopkins-related witnesses. “Trial courts,
    for obvious reasons, have generally kept evidence from the jury
    that a defendant had insurance coverage on the involved liability.
    However, every rule has its exceptions, and ‘(f)acts tending to
    show interest, bias or motive on the part of a witness may always
    be brought out on cross-examination even though it may thereby
    be disclosed that the defendant was protected by insurance.’”
    (Brainard v. Cotner (1976) 
    59 Cal.App.3d 790
    , 795, quoting Hart
    v. Wielt (1970) 
    4 Cal.App.3d 224
    , 231 (1970).) Silvester provides
    no explanation how Niparko’s indemnification by Johns Hopkins’
    insurer would tend to show interest, bias, or motive on the part of
    Johns Hopkins-affiliated witnesses.
    We conclude the trial court did not abuse its discretion
    when it excluded evidence of insurance under Evidence Code
    section 1155.
    request to permit reference to Niparko’s insurance after he
    entered into the agreement not to execute on estate assets.
    32
    iv.     Silvester forfeited the argument that the trial
    court erred in excluding evidence of Niparko’s
    character
    Silvester contends that four witnesses (Angela Niparko,
    Nancy Mellon, Dean Miller and Dr. Warren Ross) were
    improperly allowed to testify to Niparko’s good character.
    Evidence of a person’s character “generally is inadmissible when
    offered to prove his or her conduct on a specified occasion.” (Evid.
    Code, § 1101.) At trial Silvester did not object to the testimony of
    any of these witnesses as inappropriate character evidence. He
    argues he preserved his objections by filing his Motion in Limine
    No. 1 (Exclude Evidence of Decedent’s Reputation or Character,)
    noting “[a] motion in limine to exclude evidence is normally
    sufficient to preserve an issue for review without the necessity for
    defendant to renew an objection at the time the evidence was
    offered.” (Summers v. A.L. Gilbert Co. (1999) 
    69 Cal.App.4th 1155
    , 1184 [objections preserved on appeal where applicable
    motion in limine was denied and party also renewed its specific
    objections at trial]).
    We disagree that Silvester sufficiently preserved his
    objections. In ruling on Silvester’s Motion in Limine no. 1, the
    trial court stated: “I’m not expressly granting or denying it, but
    I’m telling you the limitation is going to be based on a case-by-
    case or question-by-question analysis, all right?” Although “‘“[a]n
    attorney who submits to the authority of an erroneous, adverse
    ruling after making appropriate objections or motions, does not
    waive the error in the ruling by proceeding in accordance
    therewith and endeavoring to make the best of a bad situation for
    which he was not responsible”’ [Citations.]” (Mary M. v. City of
    Los Angeles (1991) 
    54 Cal.3d 202
    , 212–213), here the trial court
    33
    reserved its ruling on this issue, asserting it would determine the
    admissibility of character evidence on a case-by-case basis during
    questioning at trial. It was incumbent on Silvester to specifically
    object to inadmissible character evidence during the trial. (Evid.
    Code, § 353 [objection to evidence must be “timely made and so
    stated as to make clear the specific ground of the objection or
    motion”].)
    Silvester argues the trial court overruled his relevance
    objection to Ross’s testimony about Niparko’s candidacy for a
    chair position with USC, and the court denied his motion to
    strike Ross’ testimony based on hearsay and relevance. He also
    notes that he objected to Angela Niparko’s testimony based on
    relevance, under section 352 and as calling for testimony to the
    ultimate fact whether Niparko would not have acted
    fraudulently; he then moved to strike, and his motion was
    denied.
    However, Silvester’s objections below were not the same
    ones he now makes on appeal. To satisfy Evidence Code section
    353, subdivision (a), the objection or motion to strike must be
    both timely and specific as to its basis. An objection to evidence
    must generally be preserved by specific objection at the time the
    evidence is introduced; the opponent cannot make a ‘placeholder’
    objection stating general or incorrect grounds (e.g., ‘relevance’)
    and revise the objection later . . . .” (People v. Demetrulias (2006)
    
    39 Cal.4th 1
    , 21-22 [objection based on relevance, foundation,
    speculation, or nonresponsiveness “does not, in itself, alert the
    trial court to the claim that the testimony objected to is
    inadmissible character evidence”].) “What is important is that
    the objection fairly inform the trial court, as well as the party
    offering the evidence, of the specific reason or reasons the
    34
    objecting party believes the evidence should be excluded, so the
    party offering the evidence can respond appropriately and the
    court can make a fully informed ruling. If the court overrules the
    objection, the objecting party may argue on appeal that the
    evidence should have been excluded for the reason asserted at
    trial, but it may not argue on appeal that the court should have
    excluded the evidence for a reason different from the one stated
    at trial.” (People v. Partida (2005) 
    37 Cal.4th 428
    , 435.)
    Silvester’s objections “neither mentioned Evidence Code
    section 1101 nor asserted that the evidence constituted
    inadmissible character evidence.” (People v. Valdez (2012) 
    55 Cal.4th 82
    , 130 [objections that evidence was “irrelevant,
    cumulative, lacking in foundation, or prejudicial . . . were
    insufficient to preserve for appeal the claim that the evidence
    was inadmissible under Evidence Code section 1101, subdivision
    (a)”].) Silvester did not accurately and timely object to what he
    characterizes as the trial court’s improper admission of character
    evidence.
    3. The Trial Court Did Not Err In Its Order Granting
    Summary Adjudication on Silvester’s Punitive Damages
    Claim
    In granting summary adjudication on Silvester’s punitive
    damages claim, the trial court held that “no punitive damages
    may be awarded against the decedent’s Estate, even if MCIC is to
    pay the judgment.” Silvester maintains this ruling erroneously
    conflates the estate (as insured by MCIC) and the personal
    representative of the estate. Relying on Probate Code sections
    550 through 554 (governing claims against decedents covered by
    insurance), Silvester contends Code of Civil Procedure section
    377.42 only prohibits recovery of punitive or exemplary damages
    35
    against a deceased defendant’s personal representative and not
    against an insurance company covering the deceased defendant’s
    estate. We conclude the plain language of Probate Code section
    552 mandates that claims against decedents covered by
    insurance must proceed “in the same manner as if the claim had
    been brought against the personal representative,” and nothing
    in the law suggests that liability for punitive or exemplary
    damages should be determined differently than it would be
    against the personal representative.
    a. Standard of review
    We review de novo the trial court’s ruling on a motion for
    summary adjudication. (Jacks v. City of Santa Barbara (2017) 
    3 Cal.5th 248
    , 273; Doe v. Lawndale Elementary School Dist. (2021)
    
    72 Cal.App.5th 113
    , 124.) We also “review questions of statutory
    construction de novo. Our primary task ‘in interpreting a statute
    is to determine the Legislature’s intent, giving effect to the law’s
    purpose.’” (Akopyan v. Superior Court of Los Angeles County
    (2020) 
    53 Cal.App.5th 1094
    , 1098, quoting California Building
    Industry Assn. v. State Water Resources Control Bd. (2018) 
    4 Cal.5th 1032
    , 1041.) “We give the words of the statute ‘a plain
    and commonsense meaning’ unless the statute specifically defines
    the words to give them a special meaning.” (MacIsaac v. Waste
    Management Collection & Recycling, Inc. (2005) 
    134 Cal.App.4th 1076
    , 1083, quoting Flannery v. Prentice (2001) 
    26 Cal.4th 572
    ,
    577.) In so doing, “‘“we do not construe statutes in isolation, but
    rather read every statute ‘with reference to the entire scheme of
    law of which it is part so that the whole may be harmonized and
    retain effectiveness.’”’” (Smith v. Superior Court (2006) 
    39 Cal.4th 77
    , 83; accord, People v. Gonzalez (2017) 
    2 Cal.5th 1138
    ,
    1141 [“‘[W]e consider the language of the entire scheme and
    36
    related statutes, harmonizing the terms when possible.’
    [Citations.]”)
    b. Code of Civil Procedure section 377.42’s ban on recovery
    of punitive or exemplary damages applies equally to
    actions against a personal representative and actions
    against the estate under Probate Code 550
    Code of Civil Procedure section 377.42 provides, “In an
    action or proceeding against a decedent’s personal representative
    or, to the extent provided by statute, against the decedent’s
    successor in interest, on a cause of action against the decedent,
    all damages are recoverable that might have been recovered
    against the decedent had the decedent lived except damages
    recoverable under Section 3294 of the Civil Code or other
    punitive or exemplary damages.”8 Code of Civil Procedure
    section 377.42 is generally understood to extinguish all punitive
    or exemplary damages claims against an individual upon that
    individual’s death. (See Whelan v. Rallo (1997) 
    52 Cal.App.4th 989
    , 992 [“case law has consistently held the right to punitive
    damages is extinguished . . . if the defendant dies before
    judgment is entered”]; Bancroft-Whitney Co. v. Glen (1966) 
    64 Cal.2d 327
    , 357 (1966) [“The cause of action for punitive damages
    8     “Decedent’s successor in interest” is defined as “the
    beneficiary of the decedent’s estate or other successor in interest
    who succeeds to a cause of action or to a particular item of the
    property that is the subject of a cause of action.” (Code Civ. Proc.,
    § 377.11.) Given our conclusion that the plain language of
    Probate Code section 552 mandates that a claim against the
    estate under section 550 be treated identically to a claim brought
    against the personal representative, we need not address
    Respondent’s argument that MCIC is Niparko’s “successor in
    interest.”
    37
    does not survive [decedent’s] death,” citing Prob. Code, § 573,
    predecessor to Code Civ. Proc, § 377.42].) The longstanding
    rationale for this rule is that “since the purpose of punitive
    damages is to punish the wrongdoer for his acts, accompanied by
    evil motive, and to deter him from the commission of like wrongs
    in the future, the reason for such damages ceases to exist with
    his death,” and “punitive damages by way of example to others
    should be imposed only on actual wrongdoers.” (Evans v. Gibson
    (1934) 
    220 Cal. 476
    , 490; accord, Roddenberry v. Roddenberry
    (1996) 
    44 Cal.App.4th 634
    , 666; cf. Piscitelli v. Friedenberg (2001)
    
    87 Cal.App.4th 953
    , 982 [holding in legal malpractice case “[i]t is
    inconsistent with the goal of punishment to transfer the
    punishment to an actor innocent of the conduct necessary to
    justify an award of punitive damages”], citing Evans, 220 Cal. at
    pp. 489-490.)
    If a decedent was insured, “an action to establish the
    decedent’s liability for which the decedent was protected by
    insurance may be commenced or continued against the decedent’s
    estate without the need to join as a party the decedent’s personal
    representative or successor in interest” (Prob. Code, § 550), with
    the estate named as defendant but only the insurer served in the
    action (id., § 552, subd. (a)).9 Thereafter, “[t]he proceedings are
    9      Probate Code section 550 provides: “(a) Subject to the
    provisions of this chapter, an action to establish the decedent’s
    liability for which the decedent was protected by insurance may
    be commenced or continued against the decedent’s estate without
    the need to join as a party the decedent’s personal representative
    or successor in interest. [¶] (b) The remedy provided in this
    chapter is cumulative and may be pursued concurrently with
    other remedies.”
    38
    conducted as if the action were against the personal
    representative of the estate[.]” (Meleski v. Estate of Albert Hotlen
    (2018) 
    29 Cal.App.5th 616
    , 624 (Meleski); see Prob. Code, § 552,
    subd. (a).) However, unless the personal representative is joined
    as a party and the plaintiff files a creditor claim against the
    estate, a judgment in an action under Probate Code section 550
    “does not adjudicate rights by or against the estate”—damages
    are “enforceable only from the insurance coverage and not
    against property in the estate.” (Prob. Code, §§ 553-554; see
    Meleski, 29 Cal.App.5th at p. 624; Estate of Prindle (2009) 
    173 Cal.App.4th 119
    , 129 (Prindle).)10 A plaintiff may concurrently
    Probate Code section 552 provides: “(a) An action under
    this chapter shall name as the defendant, ‘Estate of (name of
    decedent), Deceased.’ Summons shall be served on a person
    designated in writing by the insurer or, if none, on the insurer.
    Further proceedings shall be in the name of the estate, but
    otherwise shall be conducted in the same manner as if the action
    were against the personal representative. [¶] (b) On motion of an
    interested person, or on its own motion, the court in which the
    action is pending may, for good cause, order the appointment and
    substitution of a personal representative as the defendant. [¶] (c)
    An action against the estate of the decedent under this chapter
    may be consolidated with an action against the personal
    representative.”
    10     Probate Code section 553 provides: “The insurer may deny
    or otherwise contest its liability in an action under this chapter
    or by an independent action. Unless the personal representative
    is joined as a party, a judgment in the action under this chapter
    or in the independent action does not adjudicate rights by or
    against the estate.”
    39
    pursue an action against the personal representative, which
    allows damages above the policy limits to be enforced against the
    estate. (Prob. Code, §§ 550, subd. (b); 553, subd. (b).)
    Section 550 et seq. of the Probate Code provides a
    streamlined way to name the decedent’s estate as the defendant
    to recover insurance proceeds without the need to join the
    decedent’s personal representative as a party. Proceeding
    against an insured estate under section 550 “merely simplifies—
    and in many cases accelerates—recovery against a deceased
    tortfeasor: Probate is avoided, the decedent’s liability is litigated
    without placing his or her estate at risk, and recovery is limited
    to the decedent’s available insurance proceeds.” (Smith v.
    Interinsurance Exchange (1985) 
    167 Cal.App.3d 301
    , 303-304.)
    The crux of Silvester’s argument is that because an insured
    estate may proceed as a nominal defendant in an action against
    the estate independently of the personal representative of the
    estate, liability for punitive damages should operate differently
    against the insurer than against the personal representative.
    Silvester attempts to fashion a legal distinction and alternate
    path to liability where none exists.
    Probate Code section 554 provides: “(a) Except as provided
    in subdivision (b), either the damages sought in an action under
    this chapter shall be within the limits and coverage of the
    insurance, or recovery of damages outside the limits or coverage
    of the insurance shall be waived. A judgment in favor of the
    plaintiff in the action is enforceable only from the insurance
    coverage and not against property in the estate. [¶] (b) Where the
    amount of damages sought in the action exceeds the coverage of
    the insurance, subdivision (a) does not apply if both of the
    following conditions are satisfied: (1) The personal representative
    is joined as a party to the action. (2) The plaintiff files a claim in
    compliance with Section 9390.”
    40
    Silvester does not dispute that Code of Civil Procedure
    section 377.42 expressly prohibits punitive or exemplary damages
    in an action against the decedent’s personal representative.
    Rather, he contends, “Substantively, this case has two
    defendants: (1) the Estate, and (2) the [personal representative],”
    and suggests that because there is no express statutory bar in the
    Probate Code to recovery for punitive or exemplary damages from
    an estate’s insurance he should be able to pursue punitive and
    exemplary damages to the extent of the estate’s insurance.11
    Silvester is incorrect. First, in an action under Probate
    Code section 550, “[i]t is a legal fiction that the estate is the
    party”—the estate itself “is not a legal entity” but “‘merely a
    name to indicate the sum total of the assets and liabilities of a
    decedent.’” (Meleski, supra, 29 Cal.App.5th at p. 624.) Where, as
    here, a personal representative has been appointed and an action
    filed “against both that representative and the ‘estate’ of the
    decedent, the two defendants are really one and the same.”
    Neuland v. Russell (1975) 
    50 Cal.App.3d 1
    , 6 (Neuland)
    [construing former Probate Code section 721].) An action against
    the estate of the decedent under Probate Code section 550 may be
    consolidated with an action against the personal representative
    (Prob. Code, § 552, subd. (b)) specifically because the liability
    issues are identical. (See com. to Prob. Code, § 552
    [“Consolidation may be appropriate since the issues relating to
    liability are the same.”], italics added.) Thus, there is no
    11    Although “California law prohibits indemnification of
    punitive damages by insurers” (Piscitelli v. Friedenberg, supra,
    87 Cal.App.4th at p. 982; see Ins. Code, § 533), Silvester asserts
    Maryland law applies to the question of insurability and would
    permit insurance coverage of punitive damages. We need not and
    do not address this issue in reaching our conclusion here.
    41
    substantive distinction between the nominal defendants for
    purposes of liability. Including an action against the personal
    representative merely provides the possibility of recovery from
    the estate for damages over insurance policy limits. (Prob. Code,
    § 553, subd. (b).)
    Second, we find dispositive the plain language of Probate
    Code section 552, subdivision (a), which instructs that actions
    against an insured decedent under section 550 “shall be in the
    name of the estate, but otherwise shall be conducted in the same
    manner as if the action were against the personal representative.”
    (Italics added, see Meleski, supra, 29 Cal.App.5th at p. 624
    [same]; Prindle, supra, (2009) 
    173 Cal.App.4th 119
    , 129 [same,
    noting former Probate Code section 721 had same effect as
    current section 550 et seq.]; Neuland, supra, 50 Cal.App.3d at
    p. 6 [same, under former Probate Code section 721].)
    The commonsense interpretation of the statutory directive
    to conduct proceedings “in the same manner as if the action were
    against the personal representative” is that an action against the
    estate under Probate Code section 550 must be treated
    identically to an action against the personal representative—
    including for purposes of liability for punitive damages. Here,
    Code of Civil Procedure section 377.42 specifies that no punitive
    or exemplary damages are available in an action against the
    personal representative: “In an action or proceeding against a
    decedent’s personal representative . . . , all damages are
    recoverable that might have been recovered against the decedent
    had the decedent lived except damages recoverable under Section
    3294 of the Civil Code or other punitive or exemplary damages.”
    Treating an action against the estate under Probate Code section
    550 “in the same manner” as an action against the personal
    42
    representative means the punitive damages limitation in Code of
    Civil Procedure section 377.42 must apply to both. (Cf.
    Sakaguchi v. Sakaguchi (2009) 
    173 Cal.App.4th 852
    , 860 [where
    one statute stated a statement of damages “shall be served in the
    same manner as a summons” and another provided for service of
    a summons by mail, it follows that a statement of damages could
    be served by mail].) Silvester’s assertion that recovery of
    punitive or exemplary damages is permitted against insurance
    covering a decedent’s estate but not against a decedent’s personal
    representative is directly contradicted by the plain language and
    unambiguous requirement of Probate Code section 552,
    subdivision (a), that actions under section 500 “shall be
    conducted in the same manner as if the action were against the
    personal representative.”
    We also reject Silvester’s contention that the trial court in
    its order granting summary adjudication erred by referring to
    MCIC at all given Respondent’s notice of motion for summary
    judgment, which posed as the sole issue that Silvester “cannot
    assert a claim for punitive damages against the personal
    representative in this action.” “A motion for summary
    adjudication tenders only those issues or causes of action
    specified in the notice of motion, and may only be granted as to
    the matters thus specified.” (Schmidlin v. City of Palo Alto
    (2007) 
    157 Cal.App.4th 728
    , 743-744.) However, the notice does
    not have to “precisely identif[y]” “the ‘matters’ at issue”⎯even
    just “a listing of the disputed causes of action . . . is sufficient.”
    (Sequoia Ins. Co. v. Superior Court (1993) 
    13 Cal.App.4th 1472
    ,
    1478.) Here, particularly because the personal representative
    and estate defendants are substantively indistinguishable for
    liability purposes, it is sufficient that the personal
    43
    representative’s notice of motion raised the issue of punitive
    damages. Her memorandum also argued that “MCIC is not a
    tortfeasor or wrongdoer in this case,” and Silvester “cannot
    recover damages against MCIC that do not survive Dr. Niparko’s
    death.” The issue was thus squarely before the trial court, which
    correctly concluded that “the Representative has standing to
    dispute punitive damages generally as any punitive damage
    award would necessarily be against the Estate, whether or not
    MCIC pays such damages.”
    DISPOSITION
    The judgment is reversed. The matter is remanded for a
    new trial. Appellant is to recover costs on appeal.
    WISE, J.
    We concur:
    SEGAL, Acting P. J.            FEUER, J.
         Judge of the Alameda County Superior Court, assigned by
    the Chief Justice pursuant to article VI, section 6 of the
    California Constitution.
    44