Justia California Court of Appeals Opinion Summaries

Defendant’s vehicle collided into plaintiff’s vehicle at a busy intersection. Plaintiff sustained spinal injuries in the accident and filed suit against defendant. Eventually, plaintiff had surgery to repair a herniated lumbar disc. The jury found defendant negligent and awarded plaintiff a total of $429,773.71 in damages, including $261,773.71 in past medical expenses, which was the full amount of her medical bills. The trial court then entered judgment on the verdict. Defendant appealed. This case raised an issue regarding the calculation of reasonable medical expenses in economic damages awards. Plaintiff lacked medical insurance and contracted with her medical providers to treat her in exchange for a lien on whatever she might recover from defendant in this lawsuit. A third party assignee, MedFin Managers, LLC (MedFin), purchased the lien from the medical providers for a discounted amount. Plaintiff remained liable on the total bill. Defendant contended that the trial court erred in denying her motion to admit evidence of the amounts MedFin paid to purchase the right to recover the full amounts plaintiff’s medical providers billed plaintiff. Defendant argued that the trial court should have allowed her to introduce evidence of the amounts MedFin paid to the medical providers as evidence of the reasonable cost of treatment provided plaintiff, particularly since the court denied defendant’s motion to exclude evidence of the billed amounts. In the published portion of this opinion, the Court of Appeal concluded that because defendant proffered no evidence to show that the MedFin payments represented the reasonable value of plaintiff’s treatment, the probative value of that evidence was substantially outweighed by the probability that it would create a substantial danger of undue prejudice as well as a danger of confusing and misleading the jury. Consequently, the trial court’s ruling precluding evidence of the MedFin payments was not an abuse of discretion. View "Uspenskaya v. Meline" on Justia Law

Pacific Trades Construction & Development, Inc. was a defendant in a lawsuit that alleged, in part, that Pacific Trades was liable for damages for construction defects caused by Pacific Trades's negligent acts or omissions. Underwriters of Interest Subscribing to Policy Number A15274001 (Underwriters) undertook Pacific Trades's defense in that action under its Commercial General Liability (CGL) policy insuring Pacific Trades. ProBuilders Specialty Insurance Company, which also insured Pacific Trades, declined to participate in funding Pacific Trades's defense, claiming (among other things) that a clause in its policy relieved ProBuilders of any duty to defend Pacific Trades when another insurer was doing so. Underwriters sought equitable contribution from ProBuilders for a portion of the defense costs. The parties filed cross-motions seeking summary adjudication of ProBuilders's liability for a portion of the defense costs. The trial court agreed with ProBuilders that a clause in its policy relieved it of any duty to defend Pacific Trades when (as here) another insurer was defending Pacific Trades, and entered summary judgment in favor of ProBuilders. Underwriters appealed that determination. The Court of Appeal concluded that the trial court erred in enforcing the clause in ProBuilders's policy and, because the other arguments raised by ProBuilders in support of its summary judgment motion on Underwriters's claim for equitable contribution did not support the judgment, the Court reversed the judgment. View "Underwriters of Interest v. ProBuilders Specialty Ins. Co." on Justia Law

Plaintiffs filed suit against Mercury for breach of contract and tortious breach of insurance contract after Mercury denied reimbursement for the cost of repair to the second story of plaintiffs' house. Mercury argued that plaintiffs' claim under their homeowner’s insurance policy was not covered because the damage to their property did not constitute a “collapse” as defined by the policy. The trial court granted summary judgment to Mercury and denied plaintiffs' motion for summary adjudication. The court held that Mercury is not liable for the reimbursement costs because there was not a collapse as defined in the policy, the duty to mitigate arises only after a loss from a collapse, and Mercury had no duty, express or implied, to reimburse plaintiffs for costs to prevent imminent insurable damage. Accordingly, the court affirmed the judgment. View "Grebow v. Mercury Ins." on Justia Law

Defendant Cy Tapia, a teenager living with his aunt and grandmother, was driving a vehicle which crashed, inflicting severe and eventually fatal injuries on his passenger, Cory Driscoll. Before his death Driscoll and his mother filed an action for damages. The parties established that the vehicle driven by Tapia was owned by his grandfather and that Tapia was entitled to $100,000 in liability coverage under an auto policy issued to Melissa McGuire (Tapia’s sister), which listed the vehicle as an insured vehicle and listed Tapia as the driver of the vehicle. The policy was issued by petitioner-defendant 21st Century Insurance Company. 21st Century offered to settle the action for the policy limits of the McGuire policy ($100,000). However, plaintiff1 also believed that Tapia might be covered under policies issued to his aunt and grandmother, each offering $25,000 in coverage and also issued by 21st Century. Plaintiff communicated an offer to settle for $150,000 to Tapia’s counsel; 21st Century contended that it never received this offer (although there was certainly evidence to the contrary). Inferrably having realized the seriousness of its position, 21st Century affirmatively offered the “full” $150,000 to settle the case against Tapia. Plaintiff did not accept this offer, but a month later plaintiff’s counsel served a statutory offer to compromise seeking $3,000,000 for Cory Driscoll and $1,150,000 for his mother Jenny Driscoll. Shortly before the expiration of this offer, 21st Century sent Tapia a letter warning him that it would not agree to be bound if Tapia personally elected to accept the offer. Nonetheless, Tapia agreed to the entry of a stipulated judgment in the amounts demanded by plaintiff. 21st Century paid $150,000 plus interest to the plaintiff. Tapia then assigned any rights he had against 21st Century to plaintiff. This assignment and agreement included plaintiff’s promise not to execute on the judgment against Tapia so long as he complied with his obligations, e.g., to testify to certain facts concerning the original litigation and 21st Century’s actions. This bad faith action followed. Petitioner's unsuccessfully moved for summary judgment, and petitioned the Court of Appeal for a writ of mandate to overturn the trial court's denial. Upon review, the Court of Appeal found that plaintiff’s efforts to pursue essentially a “bad faith” action as assignee of the insured was misguided. Accordingly, petitioner was entitled to summary judgment. View "21st Century Ins. v. Super. Ct." on Justia Law

Pursuant to federal law, California’s Medi-Cal program requires beneficiaries to use other health coverage (OHC) they may have before accessing Medi-Cal benefits. The state Department of Health Care Services (DHCS) maintains a database with codes that indicate whether a Medi-Cal beneficiary has OHC and, to some extent, the scope of that coverage. The codes are available to providers when a beneficiary seeks services. Medi-Cal beneficiaries filed suit. Because DHCS allegedly permits Medi-Cal providers to refuse nonemergency services to beneficiaries with OHC, and because the codes are not always correct and the information is limited, beneficiaries may be improperly denied service and referred to other providers even when there is no OHC available for the requested service; beneficiaries may experience delays in receiving nonemergency care and may be subject to a higher copayment than permitted under Medi-Cal. Plaintiffs argued that the assignment of an OHC code should trigger notice and a hearing. The trial and appeals courts rejected their arguments. Neither Welfare and Institutions Code 10950 nor regulation 50951 nor the California Constitution requires DHCS to provide a hearing or notice when it assigns an OHC code. Plaintiffs did not establish any violation of a ministerial duty subject to enforcement by a writ of mandate. View "Marquez v. Dept. of Health Care Servs." on Justia Law

Sequeira did not work on January 1, 2010, because it was a paid holiday. He was hospitalized the next day with a sudden illness and died on January 6 without returning to work. Sequeira’s widow sought benefits under a supplemental life insurance policy that was issued to Sequeira’s employer on January 1, 2010. The trial court ruled that she was not entitled to benefits because the policy required her husband to be “on the job, at his employer’s place of employment, performing his customary duties” between January 1 and his death. The court of appeal reversed. The policy is ambiguous regarding whether Sequeira needed to perform his work responsibilities on New Year’s Day or anytime after that in order for his wife to receive benefits. The court should, therefore, interpret the policy in favor of Sequeira’s reasonable expectations, which are that he should not have to work on New Year’s Day or when he is sick in order to receive coverage that he has paid for. View "Sequeira v. Lincoln National Life Ins. Co." on Justia Law

In 1994, defendant Felicia Alford, then a minor, settled a personal injury claim against certain insureds of defendant State Farm Fire. Under the settlement, State Farm Life was to deliver an annuity providing for guaranteed payments. In July 2012, Alford entered into a contract with RSL Funding, LLC under which she received $30,000 in exchange for a $50,000 portion of the payment due on August 11, 2016. RSL assigned its payment to Extended Holdings, Ltd. (EHL). The trial court approved the transfer, and State Farm did not contest the transfer. A year later, Alford entered into a second contract with RSL in which Alford agreed to assign to RSL $25,000 of the $100,000 payment due on August 11, 2016, and $25,000 of the payment of $151,558.80 due on August 11, 2021, in exchange for a current payment of $22,500. RSL filed a petition for approval of the transfer. State Farm filed an opposition to the petition, asserting, among other grounds, that: (1) the proposed transfer would violate a California Ins. Code, sec. 10139.5, subd. (e)(3)), which provided that an annuity issuer and settlement obligor may not be required to divide payments; and (2) the proposed transfer would materially increase State Farm’s burdens and risks. The trial court approved the transfer petition, and State Farm appealed. After review, the Court of Appeal concluded that the trial court’s order indeed violated section 10139.5(e), and State Farm did not forfeit its right to oppose that order. The Court reversed the trial court and remanded for further proceedings. View "RSL Funding v. Alford" on Justia Law

Jeffrey Epp suffered severe injuries after diving into a swimming pool at the St. Regis Resort, Monarch Beach. Epp and his wife sued the owner of the St. Regis and the entities involved in the design and construction of the swimming pool. The defendants included Valley Crest Landscape Development, Inc. (the general contractor for exterior improvements at the St. Regis), and Mission Pools of Escondido, Inc. (the subcontractor that built the swimming pool). Summary judgment motions and settlements reduced the litigation to a cross-complaint by Valley Crest and its insurer, National Union Fire Insurance Company of Pittsburgh, PA, against Mission Pools. Valley Crest sought to recover the amount it spent in the litigation based on a claim of express indemnity under the terms of the subcontract with Mission Pools. National Union sought to recover attorney fees and costs it had spent for Valley Crest’s defense and settlement of the Epps’ claims pursuant to the policy of general liability insurance that National Union had issued to Valley Crest. National Union proceeded on a claim it was equitably subrogated to Valley Crest’s claims against Mission Pools. The trial court conducted a two-part bench trial on the cross-complaint, found in favor of both Valley Crest and National Union on their respective claims, and awarded them the full amount of recovery sought. In this appeal, Mission Pools argued: (1) the cross-complaint was time-barred under Code of Civil Procedure, section 337.1, subdivision (a); (2) the trial court erred by finding National Union could recover on its claim for equitable subrogation because, under the element of balancing the equities, National Union should have borne the loss; and (3) the trial court erred by denying Mission Pools a jury trial on Valley Crest’s claim for express indemnity. As to the first contention, the Court of Appeal concluded section 337.1(a) did not apply to claims for express indemnity, and, therefore, the first amended cross-complaint was timely. As to the second contention, the Court concluded the trial court did not abuse its discretion by finding that National Union was entitled to recover based on equitable subrogation. The trial court erred, however, by denying Mission Pools a jury trial on Valley Crest’s claim for express indemnity. The Court therefore reversed on that claim and remanded for further proceedings. The Court affirmed in all other respects. View "Valley Crest Landscape v. Mission Pools" on Justia Law

A fire damaged a 12-apartment Oakland building owned by Lee. The fire started in a ground floor unit. Lee’s insurer, California Capital, claimed that flames did not extend beyond that unit. Lee claims the fire damaged six apartments with fire or smoke. Capital prepared an estimate of damage to unit 3 of $69,255.34. Lee retained a licensed public adjuster, who submitted a claim for $800,000. After Capital completed re-inspection, it issued an additional payment of $109,367.41. The court granted a petition to compel an insurance appraisal (Insurance Code 2071), directing the panel to “value three categories of items” without making causation or coverage determinations, or valuing the loss of income. Capital argued that Lee’s estimate sought an award for items that did not exist at the property, including extra windows. The panel declined an inspection request by Capital and issued an award setting forth replacement cost loss and actual cash value for each claimed item. Exhibit A consisted of items in the insurer’s scope of loss. Exhibit B consisted of items in the insured’s scope of loss. The trial court confirmed the award. The court of appeal reversed. The award neither complies with the statute nor accomplishes the objectives of an appraisal. It was error to compel the appraisal panel to assign loss values to items simply because they were listed in the insured’s scope of loss, regardless of whether inspection revealed they were undamaged or never existed. View "Lee v. Cal. Capital Ins. Co." on Justia Law

Plaintiff filed suit against Mid-Century for breach of the insurance policy and insurance bad faith after Mid-Century denied her tender of the defense of a lawsuit brought by nonparty Henri Baccouche. On appeal, plaintiff challenged the trial court's grant of Mid-Century's motion for summary judgment and denial of her cross-motion for summary adjudication. Baccouche filed a verified complaint alleging causes of action for trespass to real property and trees, abatement of private nuisance, declaratory relief, and for quiet title. The court concluded that Baccouche's claims against plaintiff arose from nonaccidental conduct, which was outside the policy. Accordingly, the court affirmed the judgment. View "Albert v. Mid-Century Ins." on Justia Law