Hailey v. California Physicians' Services

Full title: CINDY HAILEY et al., Plaintiffs and Appellants, v. CALIFORNIA PHYSICIANS…

Court: California Court of Appeals, Fourth District, Third Division

Date published: Jan 22, 2008

No. G035579 (Cal. Ct. App. Jan. 22, 2008)

Opinion

Page 1241b

158 Cal.App.4th 1241b __ Cal.Rptr.3d__ CINDY HAILEY et al., Plaintiffs and Appellants, v. CALIFORNIA PHYSICIANS’ SERVICE, Defendant and Respondent. No. G035579. California Court of Appeal, Fourth District, Third Division January 22, 2008

THE COURT.

It is ordered that the opinion filed herein on December 24, 2007, 158 Cal.App.4th 452;___Cal.Rptr.3d___, be modified as follows:

1. On page 1 [158 Cal.App.4th 458, advance report, counsel listing], the counsel listing for California Department of Managed Health Care is modified to read:

2. On page 4 [158 Cal.App.4th 460, advance report, 3d full par., 1st sentence], first sentence of the first full paragraph, beginning “Before issuing a contract” is deleted and the following sentences are inserted in its place:

3. On page 4 [158 Cal.App.4th 460, advance report, 4th full par., line 5], third sentence of the second full paragraph, delete the words “a Blue Shield” and insert the word “an” in its place so that the sentence reads:

4. On page 5 [158 Cal.App.4th 461, advance report, 2d full par., line 2], second sentence of the second paragraph, beginning with “Based on this claim,” is deleted and the following sentence is inserted in its place:

Page 1241c

Because of this development, on February 8, 2001, Blue Shield’s medical management department referred the Haileys’ contract to Judith Crary of its “Underwriting Investigation Unit” which, as Crary describes in her declaration, “investigates potential fraud by Blue Shield subscribers.”

5. On page 5 [158 Cal.App.4th 461, advance report, 2d full par., line 7], following the end of the last sentence of the second paragraph, which concludes, “gastro esophageal reflux disease,” add the following new sentence:

6. On page 5 [158 Cal.App.4th 461, advance report, 3d full par., line 1], first sentence of the third paragraph, the word “permanently” is changed to “completely” so the sentence reads:

7. On page 6 [158 Cal.App.4th 461, advance report, 5th par.], the first full paragraph is deleted, beginning with “After Blue Shield cancelled the policy,” and ending with “resulted in further surgery and medication,” and the following paragraph is inserted in its place:

8. On page 9 [158 Cal.App.4th 464,advance report, 1st full par., line 3], first sentence of the first full paragraph, the phrase “health care provider’s ability” is changed to “health care service plan’s ability.”

9. On page 10 [158 Cal.App.4th 464, advance report, 2d full par., line 10], second line of the first partial paragraph, after the sentence ending in “omission of Steve’s health information,” add the following sentences:

Page 1241d

weight on the application was willful. Similarly, Steve's misplaced reliance on Cindy to accurately complete the application also negates an inference of willfulness.

10. On page 11 [158 Cal.App.4th 466, advance report, 1st full par., line 2], first sentence of the second full paragraph, the phrase “receiving a claim stemming from” is deleted and replace it with “learning of” so the sentence now reads:

11. On page 12 [158 Cal.App.4th 466, advance report, 3d full par., line 4], third sentence of the first full paragraph, the word “provider” is changed to “plan” so that the sentence reads:

12. On page 13 [158 Cal.App.4th 467, advance report, 1st full par., line 1], first sentence of the first full paragraph, replace the phrase “health plan providers” with “health care service plans.”

13. On page 13 [158 Cal.Ap..4th 467, advance report, 3d full par., line 2], first sentence of the second paragraph, the word “a” is to be inserted between the words “had” and “Blue” and also delete the “’s” on “Shield’s” so the sentence now reads:

14. On page 13 [158 Cal.App. 4th 467, advance report, 4th full par., line 4], second sentence of the third paragraph, the word “provider’s” is changed to “insurer’s” so the sentence reads:

Page 1241e

15. On page 14 [158 Cal.App.4th 467, advance report, 4th full par., line 8], last sentence of the first partial paragraph, the word “provider” is changed to “insurer” so the sentence reads:

16. At the end of the first partial paragraph on page 15 [158 Cal.App.4th 469, advance report, 1st par., line 2], after the sentence ending “under any definition of the term,” add as footnote 6 the following footnote, which will require renumbering of all subsequent

These modifications do not change the judgment.