Blue Shield of
v. Super. Ct.
Filed 5/30/13
Blue Shield of Cal. Life & Health Ins. v. Super. Ct. CA1/1
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opinion has not been certified for publication or ordered published for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
FIRST
APPELLATE DISTRICT
DIVISION
ONE
BLUE SHIELD
OF CALIFORNIA LIFE & HEALTH INSURANCE COMPANY,
Petitioner,
v.
THE
SUPERIOR COURT OF THE CITY AND COUNTY
OF SAN FRANCISCO,
Respondent;
ELVIS BOKAN
et al.,
Real Parties in Interest.
A138356
(San
Francisco City
& County
Super. Ct.
No. CGC-11-510839)
Blue
Shield of California Life & Health Insurance Company (Blue Shield) filed a
timely petition for writ of mandate pursuant to Code of Civil Procedure,
section 437c, subdivision (m)(1), seeking reversal of the trial court’s order
denying its motion for summary judgment on the grounds it is entitled to
summary judgment as a matter of law. We shall grant the petition.
Background
Real
parties in interest Elvis Bokan, by and through his guardian ad litem Rebekah
Bokan (his mother) and Rebekah Bokan, individually, filed a complaint against
Blue Shield in May 2011, alleging causes of action for
good faith and fair dealing, and relief from asserted forfeiture. The complaint alleged these facts: Rebekah purchased a contract of family health
insurance (Policy) from Blue Shield, effective March 1, 2009, which provided
benefits to her, her spouse and children for a range of medically necessary
services; Rebekah’s son Elvis was born on January 25, 2010; on or about March
1, 2010, Elvis was admitted to Sutter Hospital for medical care and was
discharged on or about March 13, 2010; Sutter Hospital issued a bill of charges
for over $182,000 in medical services and other contractors at the hospital
issued separate invoices; the type of services provided to Elvis at Sutter Hospital
were covered under the Policy, but Blue Shield refused to pay for the care
Elvis received at Sutter Hospital.
The
Policy contains a “Conditions of Coverage†section with a subsection entitled
“Limitation [of] Enrollment.†Paragraph
3 under “Conditions of Coverage, Enrollment,†states: “The Effective Date of the benefits of a
newborn child will be the date of birth subject to the section entitled
LIMITATION OF ENROLLMENT.†The section
entitled “Limitation Of Enrollment†provides that coverage of a newborn child
whose effective date of coverage is established as his or her date of birth
under paragraph 3 “shall terminate on the
32nd day following that Dependent’s Effective Date unless a Subscriber Change
Request for the Dependent is submitted to Blue Shield Life prior to such 32nd
day.â€
Blue
Shield filed its motion for summary judgment in May 2012. Blue Shield asserted it was entitled to
summary judgment because the undisputed facts showed Rebekah failed to send
Blue Shield a subscriber change request adding baby Elvis to the Policy within
31 days, therefore, Elvis was not an insured under the Policy and, thus, all
causes of action failed as a matter of law.
On
March 18, 2013, the trial
court filed its order denying defendant’s motion for summary judgment and
summary adjudication. In pertinent part,
the trial court ruled: “Plaintiffs have
met their burden of showing there is a triable issue of material fact whether
Plaintiff provided timely notice to Blue Shield prior to March 10, 2010 sufficient for Elvis to be
included as a dependent to the policy.
[Citation.] [Fn. omitted.] Defendant knew Ms. Bokan was expecting a
child and communicated with her about her delivery date. Defendant received claims for Elvis’s
coverage several days after his birth with the Bokans’ subscriber information
number, and Elvis’s home address. This
was the nature of the information that Defendant needed to add a newborn
dependent to a policy. This issue of
notice is sufficient to deny summary adjudication on each of the causes of
action in the Complaint for which summary adjudication is sought, and punitive
damages.â€
Discussion
“We
review an order denying a motion for summary judgment de novo. [Citation.]
Summary judgment is properly granted when the papers show there is no
triable issue of material fact, and the moving party is entitled to judgment as
a matter of law. [Citation.] Issues of law, including statutory
construction and the application of that construction to a set of undisputed
facts, are subject to this court’s independent review. [Citation.]â€
(Hill Brothers Chemical Co. v.
Superior Court (2004) 123 Cal.App.4th 1001, 1005 (Hill Brothers).)
“An
order denying a motion for summary judgment may be reviewed by a petition for
writ of mandate. (Code Civ. Proc.,
§ 437c, subd. (m)(1).) Where the
trial court’s denial of a motion for summary judgment will result in a trial on
nonactionable claims, a writ of mandate will issue. [Citation.]â€
(Hill Brothers, supra,123
Cal.App.4th at p. 1005.)
In
its mandamus petition, Blue Shield asserts that even if it was aware Rebekah
was pregnant and accepted claims incurred by Elvis within the initial period of
31-day coverage after his birth, this does not raise a triable issue of
material fact, as the trial court determined.
Rather, Blue Shield contends the issue remains one of law—whether Blue
Shield can be held liable for nonpayment when the Policy specifically provides
that coverage for a newborn child does not extend beyond 31 days unless a
subscriber change request form is submitted to Blue Shield.
Blue
Shield’s contention has merit. As noted
above, the Policy contained specific limitations on the enrollment of a newborn
child, providing that a newborn child is covered for a period of 31 days after
the date of birth, and that such coverage terminates on the 32nd day “
Dependent is submitted to Blue Shield Life prior to such 32nd day.†Whereas, real parties in interest acknowledge
they did not submit a subscriber change request adding baby Elvis to the Policy
within the 31-day period, they assert notice should be imputed to Blue Shield
on the grounds Blue Shield received all the information necessary to include
baby Elvis in the Policy within the 31-day period—Blue Shield knew Rebekah was
expecting a child, communicated with her about her delivery date and received
claims for baby Elvis’s birth-related medical care several days after his
delivery that included the Bokans’ subscriber number, Elvis’s name and the
Bokans’ home address.
Real
parties in interest’s contention misses the mark and ignores the fact that the
Policy requires the subscriber to notify Blue Shield by a written subscriber
change request that the subscriber wishes to continue coverage for the newborn
child beyond the 31-day period following birth.
Such notification is an affirmative requirement and a condition
precedent to continued coverage for a newborn child under the Policy. (See Redlands
Community Hospital v. New England Mutual Life Ins. Co. (1994) 23 Cal.App.4th
898, 908 [affirming summary judgment in favor of defendant insurance company in
coverage dispute over newborn twins who were hospitalized for more than two
months after birth, where policy “requir[ed] evidence of insurability in any
application made after the 31-day periodâ€]; see also Prudential Ins. Co. of America, Inc. v. Superior Court (2002) 98
Cal.App.4th 585, 600–601 (Prudential)
[issuing writ of mandate directing trial court to enter summary judgment in
favor of defendants insurance companies on the grounds claimant was not insured
under her father’s employee health plan as a qualified dependent because
undisputed facts showed she was not enrolled as a full-time student at the time
of her accident].)
In
sum, the “Limitation [Of] Enrollment†provision in the Policy is clear and
unambiguous. (See Prudential, supra, 98 Cal.App.4th at pp. 598–599 [policy
interpretation is subject to independent review and “plain meaning of a policy
provision governsâ€].) That provision
required Rebekah to submit a subscriber change request to Blue Shield within 31
days in order to continue coverage for her newborn child, and the undisputed
facts show she failed to do so. Thus,
the trial court should have entered summary judgment in favor of Blue Shield.
Disposition
We
have previously notified the parties we might issue a peremptory writ in the
first instance. (Palma v. U.S. Industrial Fasteners, Inc. (1984) 36 Cal.3d 171,
177–180.) No useful purpose would be
served by further briefing and oral argument.
Accordingly,
let a peremptory writ of mandate issue commanding the Superior Court of the
City and County of San Francisco, in its case No. CGC-11-510839, to vacate its
order denying the motion for summary judgment of Blue Shield, and to enter a
new order granting the motion. Each
party is to bear its own costs in this original proceeding.
______________________
Sepulveda, J.*
We concur:
______________________
Dondero, Acting P.J.
______________________
Banke, J.
* Retired Associate Justice of
the Court of Appeal, First Appellate District, Division Four, assigned by the
Chief Justice pursuant to article VI, section 6 of the California Constitution.
