PUBLISHED
APPELLATE DECISIONS
Insurance Law |
Health Care Law | Tort Litigation
Insurance Law
Simon v. Value Behavioral
Health, Inc. (9th Cir. 2000) 208 F.3d 1073
In Simon, appellant argued that he could sue health
plans to recover benefits under ERISA because he had been assigned the
right to those benefits by the patients’ mental health providers, that
the plans’ industry-wide use of preferred providers networks and the
sharing of pricing information was an antitrust violation, and that their
profits from claim denials from non-preferred providers to create
preferred provider networks was unlawful under RICO.
The Ninth Circuit held that appellant lacked standing to sue as an
assignee under ERISA and antitrust laws, and appellant failed to allege
under RICO that he was directly injured and that the plans were a
racketeering enterprise separate from their health care service
contractual obligations.
- Delbert C. Gee
Williams
v. California Physicians’ Service
(1999)
72 Cal.App.4th 722.
The Williams case affirmed that a health plan may modify the level of
benefits being offered if its right to modify is unambiguously stated in
the plan language. The Court refused to establish a common law right to
vested health benefits. The right to modify benefits to control costs is
not unconscionable.
-Delbert C. Gee
Hartenstine v. Superior Court (1987)
196 Cal.App.3d 206, 241 Cal.Rptr. 756.
The Hartenstine opinion was the first case in California to hold that bad faith
lawsuits brought by federal employees for denial of health benefits are preempted by the
FEHBA.
-Delbert C. Gee
Health Care Law
Ochoa v. Superior Court (1985)
39 Cal.3d 159, 216 Cal.Rptr. 661.
This wrongful
death medical malpractice claim involved a pre-trial appeal of the issue of what degree of
alleged inadequate care is necessary to state a federal civil rights claim for cruel and
unusual punishment of a prisoner. Accepting the facts as pleaded, the California Supreme
Court (Rose Bird) reversed two lower courts in finding civil rights violations in the care
alleged.
- Brock D. Phillips
Heda v. Superior Court (1990)
225 Cal.App.3d 525, 275 Cal.Rptr. 136.
This writ
action involved a plaintiff who wished to obtain copies of the defendant's own, personal
medical records to assert a claim for trial priority based upon plaintiff's claim that the
defendant was terminally ill. The Court of Appeal reversed the ruling of the Superior
Court, holding that plaintiffs have no right to invade the medical privacy of defendants
to buttress a claim for trial priority.
-Brock D. Phillips
Tort Litigation
Anaya v. Superior Court (1984)
160 Cal.App.3d 228, 206 Cal.Rptr. 520.
Anaya defined the requirements for joinder of multiple plaintiffs in a single mass
toxic tort exposure case.
- Delbert C. Gee
Francois v. Raybestos-Manhattan, Inc. (N.D. Cal. 1983)
577 F.Supp. 434.
Francois examined the question of the applicability of admiralty jurisdiction in an
asbestos shipyard exposure case.
- Delbert C. Gee
