Kuntz v. Kaiser Found. Hosp.
| Decision Date | 12 April 2021 |
| Docket Number | C087967 |
| Court | California Court of Appeals Court of Appeals |
| Parties | Edward William KUNTZ et al., Plaintiffs and Appellants, v. KAISER FOUNDATION HOSPITAL et al., Defendants and Respondents. |
62 Cal.App.5th 1135
277 Cal.Rptr.3d 271
Edward William KUNTZ et al., Plaintiffs and Appellants,
v.
KAISER FOUNDATION HOSPITAL et al., Defendants and Respondents.
C087967
Court of Appeal, Third District, California.
Filed April 12, 2021
Certified for Partial Publication.*
The Law Office, Edward P. Dudensing, Sacramento, Jay P. Renneisen, Walnut Creek, and Andrew J. Collins for Plaintiffs and Appellants.
Muro & Lampe, Inc., Mark A. Muro, Folsom, Marion's Inn LLP, Mark Palley, Yvonne M. Pierrou, Oakland, and Denise Ngo for Defendants and Respondents.
MURRAY, J.
Plaintiffs, consisting of the estate of decedent Edward William Kuntz (decedent), his wife, and his three children, sued, among others, the Kaiser Foundation Hospital and the Permanente Medical Group, Inc. (collectively Kaiser), asserting against Kaiser causes of action sounding in elder abuse, negligent infliction of emotional distress, and wrongful death. Kaiser filed a petition to stay the action and compel arbitration. The trial court granted the petition as to the elder abuse cause of action, staying the other causes of action. Ultimately, the trial court entered judgment in favor of Kaiser.
On appeal, plaintiffs assert that (1) Kaiser failed to satisfy its burden of producing a valid agreement to arbitrate, and (2) Kaiser failed to comply with the mandatory requirements of Health and Safety Code section 1363.1 concerning the disclosure of arbitration requirements.1
We affirm.
FACTUAL AND PROCEDURAL BACKGROUND
Plaintiffs commenced this action against Kaiser, among others, by filing a complaint alleging causes of action to recover damages, inter alia, for elder abuse ( Welf. & Inst. Code, § 15600 et seq. ), negligent infliction of emotional distress,2 and wrongful death. Decedent's estate asserted the elder abuse cause of action, while decedent's wife and children asserted the negligent infliction of emotional distress and wrongful death causes of action. We dispense with the underlying factual allegations because they are not relevant to any issue presented on appeal.
Petition to Stay Action and Compel Arbitration
Kaiser filed a petition to stay the action and compel arbitration. Kaiser asserted that decedent was enrolled as a member of the Kaiser Foundation Health Plan, Inc. (Health Plan), pursuant to his wife's employment under an "Agreement for Group Coverage" (CalPERS Agreement) between Health Plan and the Board of Administration of the California Public Employees’ Retirement System (CalPERS). Decedent and his wife enrolled under the CalPERS Agreement by an enrollment process administered exclusively by CalPERS.
According to Kaiser, an arbitration provision required binding arbitration of all of plaintiffs’ claims. The arbitration provision was contained in the versions of the CalPERS Combined Evidence of Coverage and Disclosure Form for the Basic Plan operative in 2012 and 2013, the time period relevant to plaintiffs’ claims. This document is incorporated into the CalPERS Agreement.
Kaiser included a copy of the Combined Evidence of Coverage and Disclosure Form for the Basic Plan, effective January 1, 2013, as an exhibit in support of its petition. The arbitration provision in that document, under the heading, "Binding Arbitration," stated, in part, "For all claims subject to this ‘Binding Arbitration’
section, both Claimants and Respondents give up the right to a jury or court trial and accept the use of binding arbitration."3 The 2012 version of the Combined Evidence of Coverage and Disclosure Form for the Basic Plan contained essentially the same arbitration provisions.
Kaiser further asserted that section 1363.1, which requires that the enrollment form signed by the subscriber contain a prominently displayed arbitration notice, did not apply to CalPERS enrollments.4 Kaiser relied on Government Code section 22869, which states that information disseminated by the CalPERS Board pursuant to section 22863 "shall be deemed to satisfy the requirements of Chapter 2.2 (commencing with Section 1340 ) of Division 2 of the Health and Safety Code." Chapter 2.2, known as the Knox-Keene Health Care Service Plan Act of 1975 (Knox-Keene Act) ( § 1340 ), includes section 1363.1. Kaiser asserted that CalPERS administers its own enrollment process with its own enrollment forms, and that Health Plan is not allowed to substitute its own enrollment form or modify CalPERS's enrollment forms. Thus, because the enrollment materials at issue are disseminated pursuant to Government Code section 22869 by the CalPERS Board and not by Kaiser, those materials are deemed to satisfy the requirements of the Knox-Keene Act, and specifically section 1363.1.
In a declaration submitted with Kaiser's petition, Angela Kohls, Area Vice President, Strategic Accounts, described CalPERS's practice of providing enrollment publications to CalPERS members prior to the open enrollment period each year. Kohls also stated that these publications were available through the CalPERS website. The Health Benefit Summary advised CalPERS members that the Kaiser plan required binding arbitration of claims, and indicated that the applicable arbitration provision was set forth in the Kaiser Evidence of Coverage, which was posted on the CalPERS website. Kohls also stated that, each year, prior to open enrollment, CalPERS mailed to its members an open enrollment packet that included a newsletter, a Health Benefit Statement, and a business reply card for requesting a written copy of the Health Benefit Summary and other information. Further, CalPERS's agreement with Health Plan required Health Plan to mail subscribers an Evidence of Coverage after confirmation of enrollment, which Health Plan routinely did. Additionally, beginning in 2009, each year, Health Plan sent subscribers a card that could be submitted to request a copy of the new Evidence of Coverage. The card also instructed subscribers how to view and download the Evidence of Coverage online. Kohls stated that Health Plan could not unilaterally amend the Evidence of Coverage, and that any change Health
Plan proposed had to be approved by CalPERS.
In another declaration, Alice E. Davis, Operations Manager of Special Accounts at Kaiser Permanente California Service Center, stated that her responsibilities included verifying eligibility of past and present members of the Health Plan. Davis stated that she accessed Health Plan's membership records for decedent. Those records indicated that decedent "was continuously enrolled as a Health Plan member, as either a subscriber or a spousal dependent, on various accounts, since 1983." Davis stated that Health Plan's records showed that, as of October 1, 2008, decedent was enrolled as a member "by way of his spouse's employment, under an agreement between Health Plan and" CalPERS. Decedent "remained continuously enrolled on that account, though with a change in subgroup, until his death." Davis stated that Health Plan had no involvement in the CalPERS enrollment process, and that CalPERS administered its own enrollment process with its own enrollment forms. She further stated that Health Plan had never been permitted to substitute its enrollment forms, or to modify CalPERS enrollment forms.
Plaintiffs’ Opposition
Plaintiffs opposed Kaiser's petition to stay the action and compel arbitration. Plaintiffs asserted that Kaiser failed to meet its burden of producing a valid agreement to arbitrate because Kaiser had not "produced an enrollment form demonstrating that [decedent] was a Kaiser member, let alone that he or anyone else connected with him agreed to arbitration." According to plaintiffs, Kaiser presented no evidence to establish that decedent or a family member was a CalPERS employee or received health care benefits through CalPERS. Plaintiffs repeatedly referred to Kaiser's failure to produce an enrollment form.
Plaintiffs further asserted that Kaiser had not complied with the mandatory requirements of section 1363.1. Again, plaintiffs emphasized that Kaiser produced no enrollment form, and therefore asserted that Kaiser failed to establish that any such enrollment form complied with the requirement of section 1363.1 that an arbitration agreement be prominently displayed on the enrollment form. Plaintiffs disputed Kaiser's contention that it was not required to satisfy the requirements of section 1363.1. Plaintiffs maintained that Kaiser failed to prove that the CalPERS board satisfied the requirements of Government Code section 22863 such that it could invoke Government Code section 22869. Additionally, plaintiffs asserted that " section 22869 does not exempt Kaiser from complying with ... section 1363.1" (Italics added.) Plaintiffs further asserted that there was no evidence that CalPERS prohibited Kaiser from complying with section 1363.1, and therefore there was no evidence that compliance was impossible.
Kaiser's Reply
Kaiser filed a reply, asserting that it had shown the existence of a valid arbitration agreement through the authenticating declarations, the agreements between Health Plan and CalPERS, the Evidence of Coverage documents, the arbitration provision in the 2012 Evidence of Coverage, and Davis's declaration stating that decedent's membership records indicated that he had been enrolled as a Health Plan member since 1983 and had been enrolled through his wife's employment since October 1, 2008. With the reply papers, Kaiser included a supplementary declaration by Davis and a printout of decedent's membership records. In her supplemental declaration, Davis explained certain data from the
printout: "Attached as Exhibit A is a true and correct copy of a screen print of Health Plan's computerized membership history records screen for [decedent], with [decedent's] birth date, medical record number, Social Security number, and home address redacted for privacy. The purchaser ID number ‘3’ indicates that [decedent] was a CalPERS...
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