Personal Injury Lawyer Blog
(Please note: the names and locations of all parties have been changed to protect the confidentiality of the participants in this automobile accident/insurance coverage case and its proceedings.)
STATEMENT OF FACTS
1. Plaintiffs submitted their application for a family health care services contract to Blue Shield in 2000 through insurance agent Kenny Shulman.
2. Blue Shield extended coverage to Sally Lawrence and her family commencing December 15, 2000.
3. Blue Shield conducted no investigation and made no inquiry beyond the application answers into whether the information Sally Lawrence provided on the application was accurate and complete before issuing coverage, and instead performed its risk assessment on the assumption the application contained no errors by assigning values to the risks disclosed.
4. Blue Shield did not make inquiry into the accuracy and completeness of Sally Lawrence’s application answers and did not make any inquiry or investigation into the accuracy and completeness of her responses until February 8, 2001, when it referred plaintiffs’ contract to its Underwriting Investigation Unit. .
5. The Blue Shield application’s agent’s certification required Kenny Shulman to ask Sally Lawrence, Bob Lawrence and Sammy Lawrence each question contained in the Blue Shield application, exactly as stated, to ensure that each oral answer was accurately set forth in the written application.
6. Kenny Shulman did not ask Sally Lawrence, Bob Lawrence and Sammy Lawrence each question contained in the Blue Shield application, exactly as stated, to ensure that each oral answer was accurately set forth in the written application.
7. Plaintiffs’ Second Amended Complaint contains causes of action for Breach of Contract, Breach of the Covenant of Good Faith and Fair Dealing and Intentional Infliction of Emotional Distress.
8. The California Court of Appeal, Fourth District, Division Three, determined that the three causes of action set forth in Plaintiffs’ Second Amended Complaint are viable.
9. Plaintiffs’ Second Amended Complaint pleads plaintiffs’ entitlement to punitive damages and its prayer requests an award of punitive damages.
10. Plaintiffs’ Second Amended Complaint pleads plaintiffs’ entitlement to punitive damages and its prayer requests an award of punitive damages.
11. The 13th affirmative defense in Blue Shield’s Answer to Plaintiff’s Second Amended Complaint alleges plaintiffs waived their right to recovery by unspecified acts and conduct.
12. Blue Shield issued a health care services plan to plaintiffs effective December 15, 2000.
13. On February 8, 2001, Blue Shield’s medical management department referred plaintiffs’ contract to Judith Crarey of Blue Shield’s Underwriting Investigation Unit. (See Part 4 of 11.)
For more information you are welcome to contact Sacramento personal injury lawyer, Moseley Collins.