Cooper v. Kizer

230 Cal. App. 3d 1291, 282 Cal. Rptr. 492, 91 Cal. Daily Op. Serv. 3860, 91 Daily Journal DAR 6090, 1991 Cal. App. LEXIS 509
CourtCalifornia Court of Appeal
DecidedMay 23, 1991
DocketB049842
StatusPublished
Cited by12 cases

This text of 230 Cal. App. 3d 1291 (Cooper v. Kizer) is published on Counsel Stack Legal Research, covering California Court of Appeal primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Cooper v. Kizer, 230 Cal. App. 3d 1291, 282 Cal. Rptr. 492, 91 Cal. Daily Op. Serv. 3860, 91 Daily Journal DAR 6090, 1991 Cal. App. LEXIS 509 (Cal. Ct. App. 1991).

Opinion

Opinion

EPSTEIN, J.

In this case we are asked to determine the appropriate standard of review of an administrative decision denying an application for Medi-Cal benefits for the disabled. Appellant challenges the adequacy of the administrative finding that he was not disabled. He also contends that he should have been found disabled within the applicable statutory guidelines. Respondent contends that the trial court properly exercised independent judgment in reviewing the administrative record pursuant to Code of Civil Procedure section 1094.5 and hence that the findings of the administrative law judge are not properly before us. We agree with respondent that the trial court properly exercised its independent judgment and decline to review the findings of the administrative law judge. In the unpublished portion of this opinion, we conclude that the trial court’s finding that appellant is not disabled is supported by substantial evidence. We therefore affirm the judgment.

Factual and Procedural History

We provide only a general summary of the factual and procedural history, reserving a detailed review of the facts regarding the asserted errors for our discussion of those issues.

Appellant applied for Medi-Cal benefits to the disabled on March 7, 1986. He claims that he has been disabled and unable to work since 1985. He argues that the administrative record supports a finding that he is disabled because of a seizure disorder, shoulder and hip pain. His application for benefits was denied in January 1987, and appellant filed a request for a fair hearing.

The administrative law judge held a hearing, receiving testimony from appellant. The record was left open to include an orthopedic evaluation ordered by the administrative law judge. In January 1988, after receipt of the orthopedic evaluation, the administrative law judge determined that appellant was not disabled. Respondent adopted the decision of the administrative law judge. Appellant filed a timely petition for a writ of mandamus pursuant to Code of Civil Procedure section 1094.5.

*1295 Following a hearing which did not include the presentation of testimony or new evidence, the trial court filed its statement of decision finding that while appellant did have physical limitations, he was able to perform sedentary work. The trial court also found that the evidence of mental limitations was not, alone, sufficient to support a finding of disability to perform sedentary work. In particular, the trial court determined that the evidence in the record did not establish that appellant suffered from uncontrollable seizures. The trial court concluded: “Thus whether the ‘substantial evidence’ or ‘independent judgment’ test is applied, the ALJ’s decision must be upheld. The court notes, however, that some years have passed since this application and review process began. If those years have generated evidence which would establish that petitioner indeed suffers from uncontrollable seizures causing loss of conciousness [szc ] as claimed, this would seem to establish a substantial impairment establishing a disability.” Appellant filed a timely notice of appeal.

Discussion

I

Standard of Review

At the heart of this appeal is appellant’s argument that respondent Department of Health Services failed to make specific findings regarding his claims of seizures and pain. Appellant contends that such findings are crucial to the trial court’s review of the administrative record in order to determine whether respondent abused its discretion in denying him eligibility. Respondent asserts that the administrative findings are not material to our review because the trial court properly exercised its independent judgment in determining that appellant is not disabled and therefore is not entitled to Medi-Cal benefits. We agree with respondent for the reasons discussed below. 1

The regulations governing eligibility for Medi-Cal benefits are set out at title 22, California Code of Regulations, section 50000 et seq. 2 Section 50951 provides that an unsuccessful applicant may seek judicial review of the administrative decision of the department through an administrative writ of mandate and subsequent review by this court pursuant to Welfare and Institutions Code sections 10950-10965. Welfare and Institutions Code *1296 section 10962 provides for judicial review through the administrative mandate process, pursuant to Code of Civil Procedure section 1094.5.

Both Code of Civil Procedure section 1094.5 and Welfare and Institutions Code section 10962 have been construed as leaving to the courts the establishment of standards for deciding which cases require independent judgment review and which substantial evidence review. (Frink v. Prod (1982) 31 Cal.3d 166, 173-174 [181 Cal.Rptr. 893, 643 P.2d 476].) We must balance a number of factors in determining which standard applies. In the seminal case of Bixby v. Pierno (1971) 4 Cal.3d 130 [93 Cal.Rptr. 234, 481 P.2d 242], the Supreme Court distinguished between administrative cases in which an applicant seeks to qualify for program benefits from cases in which the benefits of an individual, who previously had been found to be eligible, are terminated. “The courts must decide on a case-by-case basis whether an administrative decision or class of decisions substantially affects fundamental vested rights and thus requires independent judgment review. [Citations.] As we shall explain, the courts in this case-by-case analysis consider the nature of the right of the individual: whether it is a fundamental and basic one, which will suffer substantial interference by the action of the administrative agency, and, if it is such a fundamental right, whether it is possessed by, and vested in, the individual or merely sought by him. In the latter case, since the administrative agency must engage in the delicate task of determining whether the individual qualifies for the sought right, the courts have deferred to the administrative expertise of the agency. If, however, the right has been acquired by the individual, and if the right is fundamental, the courts have held the loss of it is sufficiently vital to the individual to compel a full and independent review. The abrogation of the right is too important to the individual to relegate it to exclusive administrative extinction, [f] In determining whether the right is fundamental the courts do not alone weigh the economic aspect of it, but the effect of it in human terms and the importance of it to the individual in the life situation.” (Bixby v. Pierno, supra, 4 Cal.3d at p. 144.) As this passage indicates, the Bixby court looked to the degree to which a “right is ‘vested,’ that is, already possessed by the individual,” in deciding whether the right involved was sufficiently fundamental to justify independent judgment review. (4 Cal.3d at p. 146.)

The Supreme Court again explained the fundamental vested right test for independent judgment review in Interstate Brands v. Unemployment Ins.

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230 Cal. App. 3d 1291, 282 Cal. Rptr. 492, 91 Cal. Daily Op. Serv. 3860, 91 Daily Journal DAR 6090, 1991 Cal. App. LEXIS 509, Counsel Stack Legal Research, https://law.counselstack.com/opinion/cooper-v-kizer-calctapp-1991.