Health Net of California, Inc. v. Department of Health Services

6 Cal. Rptr. 3d 235, 113 Cal. App. 4th 224, 2003 Cal. Daily Op. Serv. 9773, 2003 Daily Journal DAR 12288, 2003 Cal. App. LEXIS 1685
CourtCalifornia Court of Appeal
DecidedNovember 12, 2003
DocketC041197
StatusPublished
Cited by32 cases

This text of 6 Cal. Rptr. 3d 235 (Health Net of California, Inc. v. Department of Health Services) 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
Health Net of California, Inc. v. Department of Health Services, 6 Cal. Rptr. 3d 235, 113 Cal. App. 4th 224, 2003 Cal. Daily Op. Serv. 9773, 2003 Daily Journal DAR 12288, 2003 Cal. App. LEXIS 1685 (Cal. Ct. App. 2003).

Opinion

Opinion

KOLKEY, J.

Civil Code section 1668 provides: “All contracts which have for their object, directly or indirectly, to exempt anyone from responsibility for his own fraud ... or violation of law, whether willful or negligent, are against the policy of the law.” 1

In this case, we are called upon to resolve whether section 1668 invalidates a contractual clause that prohibits any recovery of damages (but not equitable *227 relief) for any violation of statutory or regulatory law not made part of the parties’ contractual obligations. Based on the clear intent of section 1668, as expressed in its plain language, and consistent with the case law, we find that section 1668 prevents a party from imposing such a contractual prohibition against the recovery of damages for any future violations of statutory or regulatory law.

Plaintiff Health Net of California, Inc. (Health Net) contracted with the California Department of Health Services (DHS) to be one of two health plans providing managed care services to Medi-Cal patients in Tulare County. But in violation of Welfare and Institutions Code section 14087.305, subdivision (j), and its implementing regulations, DHS assigned all “default enrollees”—that is, those who failed to select a plan—to the competing health plan, Blue Cross of California (Blue Cross) over a two-month period. Although the trial court issued a writ of mandate directing DHS to redistribute future default enrollees, it denied damages for the violation based on a provision in Health Net’s contract (added at DHS’s insistence) which prohibited the recovery of damages as a remedy for any violation of law not expressly incorporated into the contract. Health Net appeals.

While courts have often observed that the application of section 1668 is not as broad as its language suggests, they have nonetheless held that under the statute, “a party [cannot] contract away liability for his fraudulent or intentional acts or for his negligent violations of statutory law.” (Gardner v. Downtown Porsche Audi (1986) 180 Cal.App.3d 713, 716 [225 Cal.Rptr. 757].) We see no reason why this settled interpretation of section 1668 should not be extended to cover regulatory violations in light of the fact that regulations, by definition, merely “implement, interpret, or make specific” statutory law (Gov. Code, § 11342.600) and given that the language of section 1668 is not limited to statutory violations but more broadly refers to any “violation of law.” It also makes no difference that the contractual clause here bars only the recovery of damages, and not equitable relief, because section 1668 can apply to a limitation on liability (Klein v. Asgrow Seed Co. (1966) 246 Cal.App.2d 87, 99-101 [54 CaLRptr. 609] (Klein)), at least where the limitation rises to the level of an “exemption] . . . from responsibility for [a] . . . violation of law” in the words of section 1668. An unqualified prohibition against the recovery of damages in the context of a commercial transaction certainly qualifies as such an exemption.

Since the exculpatory provision imposed by DHS on Health Net is unenforceable as against public policy under section 1668, we shall reverse and remand for further proceedings.

*228 FACTUAL AND PROCEDURAL BACKGROUND

I. The Two-Plan Model

The Medi-Cal program, which is California’s version of the federal Medicaid program, offers managed care, using, among other things, what is known as the “Two-Plan Model.” Under the Two-Plan Model, in regions designated by DHS, health services are provided to Medi-Cal beneficiaries through no more than two prepaid health plans: a commercial plan and a local initiative. (Cal. Code Regs., tit. 22, §§ 53800, subd. (a), 53810, subd. (//).)

The commercial plan is a prepaid health plan, which DHS awards through a competitive bidding process. (Cal. Code Regs., tit. 22, §§ 53800, subd. (b)(1), 53810, subd. (g).) The local initiative is likewise a prepaid health plan, but it is organized or designated by a county government, to which DHS awards a contract. (Id., §§ 53800, subd. (b)(2), 53810, subd. (v).)

DHS designated Tulare County as one of the regions subject to the Two-Plan Model. Health Net operates the commercial plan in Tulare County pursuant to an agreement with DHS called the “Standard Agreement.” 2 Blue Cross was designated to operate the local initiative.

II. The Contractual Provision At Issue

In 1997, DHS began proposing amendments to the Standard Agreement. The parties eventually agreed to seven amendments. Although Health Net strenuously objected to the last amendment—Amendment A07—it ultimately and reluctantly signed the amendment in 1998 because DHS insisted that Health Net sign as a condition of receiving a legally required retroactive rate increase.

Amendment A07 revised Section 3.1 of the Standard Agreement (hereinafter Section 3.1)—the contractual clause at issue here.

Section 3.1, headed “Interpretation of Contract,” provides in its revised form as follows: “If it is necessary to interpret this Contract, all applicable laws may be used as aids in interpreting the Contract. However, the parties agree that any such applicable laws shall not be interpreted to create *229 contractual obligations upon DHS or Contractor [(Health Net)], unless such applicable laws are expressly incorporated into this Contract in some section other than this Section 3.1, Interpretation of Contract. Except for Section 3.19, Sanctions and Section 3.20, Liquidated Damages Provision, the parties agree that any remedies for DHS’[s] or Contractor’s non-compliance with laws not expressly incorporated into this Contract, or any covenants implied to be part of this Contract, shall not include money damages, but may include equitable remedies such as injunctive relief or specific performance. In the event any provision of this Contract is held invalid by a court, the remainder of this Contract shall not be affected. This Contract is the product of mutual negotiation, and if any ambiguities should arise in the interpretation of this Contract, both parties shall be deemed authors of this Contract.” (Italics added.)

Amendment A07 also deleted former Section 3.2 of the Standard Agreement. 3 The pertinent effect of this deletion was to eliminate any reference in the agreement to the sections of the Welfare and Institutions Code regarding the Two-Plan Model (Welf. & Inst. Code, § 14087.305) and the related regulations promulgated by DHS (Cal. Code Regs., tit. 22, §§ 50185.5, 53800 et seq.), which the trial court found DHS had violated here. And as a result, Section 3.1 operated to prohibit the recovery of damages for DBS’s violation of these statutory and regulatory provisions because that section bars the recovery of damages for the failure to comply with any laws not expressly incorporated into the contract.

III. Background Underlying Health Net’s Suit

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6 Cal. Rptr. 3d 235, 113 Cal. App. 4th 224, 2003 Cal. Daily Op. Serv. 9773, 2003 Daily Journal DAR 12288, 2003 Cal. App. LEXIS 1685, Counsel Stack Legal Research, https://law.counselstack.com/opinion/health-net-of-california-inc-v-department-of-health-services-calctapp-2003.