Freedman v. Cal. Health Benefit Exchange CA3

CourtCalifornia Court of Appeal
DecidedDecember 17, 2021
DocketC087968
StatusUnpublished

This text of Freedman v. Cal. Health Benefit Exchange CA3 (Freedman v. Cal. Health Benefit Exchange CA3) 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
Freedman v. Cal. Health Benefit Exchange CA3, (Cal. Ct. App. 2021).

Opinion

Filed 12/17/21 Freedman v. Cal. Health Benefit Exchange CA3 NOT TO BE PUBLISHED California Rules of Court, rule 8.1115(a), prohibits courts and parties from citing or relying on opinions not certified for publication or ordered published,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 This opinion has not been certified for publication or ordered published for purposes of rule 8.1115.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 THIRD APPELLATE DISTRICT (Sacramento) ----

MICHAEL FREEDMAN, C087968

Plaintiff and Appellant, (Super. Ct. No. 34-2016-00191819-CU-CO- v. GDS)

CALIFORNIA HEALTH BENEFIT EXCHANGE,

Defendant and Respondent.

This appeal from a grant of summary judgment arises out of a contract dispute between plaintiff Michael Freedman (Freedman) and defendant California Health Benefit Exchange (Covered California). The contract was to secure Freedman’s services as a Covered California certified insurance agent. Covered California subsequently terminated the contract because of Freedman’s harassing and abusive treatment of Covered California employees. Freedman sued Covered California for damages, alleging five separate causes of action for breach of contract, based primarily on Covered California’s purported failure to comply with the contract’s dispute resolution procedures. Covered California moved

1 for summary judgment on the grounds that there was no triable issue of material fact with respect to whether Covered California breached the contract and/or whether any alleged breach was the legal cause of Freedman’s asserted harm. The trial court granted the motion. On appeal, Freedman, appearing in propria persona,1 contends the trial court erred by (1) misidentifying the issues framed by the pleadings; (2) concluding there were no triable issues of material fact; and (3) allowing Covered California to rely on a procedurally deficient separate statement. We affirm the grant of summary judgment in favor of Covered California. BACKGROUND FACTS AND PROCEDURE Covered California is an independent public entity that administers the state health insurance exchange established to comply with the federal Patient Protection and Affordable Care Act. (Gov. Code, § 100500 et seq.; King v. Burwell (2015) 576 U.S. 473, 478-479 [192 L.Ed.2d 483, 489-490].) The health insurance exchange enables eligible individuals and small businesses to compare and purchase private health insurance coverage. (Stats. 2010, ch. 655.) Many of those purchasing coverage through the exchange are eligible for tax credits or cost-sharing subsidies to help offset the cost of health insurance premiums (also known as “premium assistance”). (Stats. 2010, ch. 655, § 2; 26 U.S.C. § 36B(b); Cal. Code Regs., tit. 10, § 6474, subd. (c).) In 2014, Freedman entered into a standard agreement with Covered California. The purpose of the contract was to secure Freedman’s services as an insurance agent to assist consumers with subsidized health care eligibility and enrollment services.

1 Self-represented litigants are held to the same legal standards as parties represented by attorneys. (Kobayashi v. Superior Court (2009) 175 Cal.App.4th 536, 543.) “[M]ere self-representation is not a ground for exceptionally lenient treatment. Except when a particular rule provides otherwise, the rules of civil procedure must apply equally to parties represented by counsel and those who forgo attorney representation.” (Rappleyea v. Campbell (1994) 8 Cal.4th 975, 984-985.)

2 The terms and conditions of the contract were set forth in a series of exhibits attached to a one-page form bearing the parties’ signatures. Exhibit C to the contract, entitled “General Terms and Conditions,” contains a section, “E.1.,” addressing “Termination For Cause.” That section provides, in relevant part: “The Exchange may terminate this Agreement for cause and be relieved of any payments at any time. Upon notice from the Exchange terminating this Agreement for Cause, Contractor shall immediately discontinue all activities affected, unless the notice directs otherwise, and the Exchange may proceed with the work in any manner deemed appropriate by the Exchange. In such event, the Exchange shall not be liable to pay Contractor any compensation from the date of termination, and all costs to the Exchange shall be remitted to the Exchange within 30 days. The Exchange may, at its sole discretion, offer an opportunity to cure any breach prior to terminating for default. A failure to terminate this Agreement for cause shall not be a waiver of the right to do so with respect to any past, current or future default. Such right of termination shall be without prejudice to any other remedies available to the Exchange. The Exchange may terminate this Agreement for cause without prior written notice to Agent at any time for any of the following occurrences: [¶] . . . [¶] g. Threatening, harassing, or acting in an abusive manner toward the Exchange or any of its employees, agents, representatives, or Consumers. [¶] Although termination is effective immediately, Agent may dispute the Termination for Cause decision pursuant to Section C of this Exhibit, Dispute Provisions.” Section C of the same exhibit, entitled “Dispute Provisions,” establishes a four- step dispute resolution process. The first step is for the parties to deal in good faith and informally attempt to resolve the dispute. If the dispute persists, the contractor can move the dispute to the next step by submitting a “written dispute notice” within 15 calendar days after the date of the action causing the dispute. Within 15 calendar days after receipt of the written dispute notice, Covered California must issue a written decision regarding the dispute. If the contractor remains unsatisfied, the contractor may proceed

3 to the third step by submitting a written appeal to Covered California’s executive director. The appeal must be submitted within 15 calendar days of the written decision. If an appeal is submitted, the executive director has 30 days to issue a final decision, or the appeal will be deemed denied. The executive director’s decision is conclusive and binding unless within 30 days the contractor commences an action in court to contest it.2

2 Section C of the contract specifically provides: “1. The parties shall deal in good faith and attempt to resolve disputes informally. If the dispute persists, Contractor shall submit a written dispute notice to the Agent Services within 15 calendar days after the date of the action causing the dispute. The written dispute notice shall contain the following information: [¶] a. The decision or issue under dispute; [¶] b. The reason(s) Contractor believes the decision or position taken by the Exchange is in error (if applicable, reference pertinent Contract provisions); [¶] c. Identification of all documents and substance of all oral communication which support Contractor’s position; and [¶] d. The dollar amount in dispute, if applicable.

“2. Within 15 calendar days after receipt of the dispute notice, Agent Services shall issue a written decision regarding the dispute. The written decision shall include the following information: [¶] a. A description of the dispute; [¶] b. A reference to pertinent Contract provisions, if applicable; [¶] c. A statement of the factual areas of agreement or disagreement; and [¶] d. A statement of the State’s decision with supporting rationale[.]

“3. If the Contractor is not satisfied with the decision of the Exchange, the Contractor may, within 15 calendar days of the Exchange’s decision, submit a written appeal to the Exchange Executive Director. The Executive Director shall then issue a final decision on the dispute within 30 days after receiving Contractor’s written appeal.

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Bluebook (online)
Freedman v. Cal. Health Benefit Exchange CA3, Counsel Stack Legal Research, https://law.counselstack.com/opinion/freedman-v-cal-health-benefit-exchange-ca3-calctapp-2021.