Blue Shield of Cal. Life & Health Ins. v. Super. Ct. CA1/1

Filed 5/30/13 Blue Shield of Cal. Life & Health Ins. v. Super. Ct. CA1/1

NOT TO BE PUBLISHED IN OFFICIAL REPORTS

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 This opinion has not been certified for publication or ordered published for purposes of rule 8.1115.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, A138356 Petitioner, v. (San Francisco City & County Super. Ct. No. CGC-11-510839) THE SUPERIOR COURT OF THE CITY AND COUNTY OF SAN FRANCISCO, Respondent; ELVIS BOKAN et al., Real Parties in Interest.

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 breach of contract, breach of covenant of good faith and fair dealing, and relief from asserted forfeiture. The complaint alleged

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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.” 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