54. Burks v. Kaiser Foundation Health Plan (2008) 160 Cal.4th 1021
H&S §1363.1 requires a binding arbitration provision in a health care svc plan to be “prominently displayed” immediately above the signature line of the enrollment form. Kaiser’s placement of the provision in standard text in a box right above the signature line was not sufficiently prominent to enforce.
55. Prospect Med. Grp., Inc. v Northridge Emergency Med. Grp (2009) 45 Cal.4th 497. Emergency room physicians may not balance bill insured out of network patients for emergency services covered the patients’ health plans. Rather, med grps must resolve their differences with the health plans rather than involving the insured patients.
56. Newton v. Clemons (2003) 110 Cal.App.4th 1
A county providing medical services through a county hospital may submit a lien under CC §3045.1 and/or Govt Code §23004.1.
57. Boston Mut. Ins. Co. v Murphree, 242 F.3d 899 (9th Cir. 2001)
An insured (AZ) ERISA plan cannot reach its insured’s UIM coverage through a COB provision that allows plan to coord benefits with any “auto policy.” The court applied the reasonable expectations doctrine and interpreting ambiguities v. drafter to rule in the insured’s favor. If the ins co wanted to reach UIM coverage w/ its COB provision, it should have so specified in the policy. Ct also awarded attys fees to the insured under the “special circumstances” doctrine.
58. Fairbanks v. Superior Ct (2009) CA Supreme Ct, 4/20/09, 2009 WL 1035264
The CA CLRA (CC §1750, et seq.) does not apply to life insurance because life insurance is not a “good” or “service” subject to the act. The Court relied heavily upon the fact that the CLRA was derived primarily from a model consumer act, which defined services to include insurance. Since that definition was not included in the CLRA, the Court presumed that the CA legislature intended that insurance be excluded. The Court limited the holding to life insurance (in FN. 1) but the rationale of the decision would appear to apply to other types of insurance as well.
59. Allen v. U.S., 668 F.Supp.1242 (W.D. WI 1987)
Under 42 USC §2652(c) of the Medical Care Recovery Act (Champus, military, TriCare, VA, etc.) provides that no action taken by the U.S. in connection with its subrogation rights shall operate to deny to the injured person the recovery for that portion of his damages not covered under the statute (non-medical). The court interpreted this section of the statute as a make whole rule: “...persuaded that §2652(c) requires that the injured party be made whole before the government may be reimbursed under the Act.” Ct further held that even a prorata division to the government wd constitute a “denial of recovery.” Id at 1257-1258. Note: This case is not in the Lexis anno. under §2652 but is in WestLaw. But see Commercial Union Ins. Co. v. U.S. 999 F.2d 581 (1993 DC Cir.) holding that U.S. does not have priority but that pro-rata distribution among claimants was appropriate under general equitable principles. See also Cockerham v. Garvin, 768 F.2d 784 (6th Cir. 1985) with great language re equitable apportionment and common fund reductions where U.S. does not participate in case.
Mark C. Blane is a San Diego Auto Accident Attorney, and the managing lawyer of the Law Offices of Mark C. Blane, a San Diego, California Personal Injury Law Firm devoted to representing families of injured persons of automobile accidents. If you or someone you love, has been injured or killed in San Diego County, or Southern California, due to the negligence of another, please order your FREE copy of Mr. Blane's book, The 10 Secrets You Need To Know About Your Injury Case, BEFORE You Call A Lawyer. It is full of helpful information, insights, and secrets that will help you protect your legal rights. It normally sells for $16.95; however, it is free to all California residents, or those injured in a Californi a accident.