Opinion
TOBRINER, J.
Defendants appeal from an order denying enforcement of an arbitration provision in a medical services contract entered into between the Board of Administration of the State Employees Retirement System (hereafter board) and defendant Kaiser Foundation Health Plan.1 Plaintiff, a state employee who enrolled under the Kaiser plan, contends that she is not bound by the provision for arbitration. The instant appeal presents the issue whether an agent or representative, contracting for medical services on behalf of a group of employees, has implied authority to agree to arbitration of malpractice claims of enrolled employees arising under the contract.
We shall explain that although the courts in the past regarded arbitration as an unusual and suspect procedure, they now recognize it as an accepted method of settlement of disputes. Since Civil Code section [703]*7032319 grants an agent the authority to do whatever is “proper and usual” to carry out his agency, the board enjoyed an implied authority to agree to arbitration of malpractice claims of enrolled employees.
We shall point out that although plaintiff relies upon principles pertaining to adhesion contracts to bar enforcement of the arbitration provision, such precepts only affect contractual provisions imposed by the stronger party upon the weaker which unfairly limit the duties or liability of the stronger. They do not apply to the arbitration provision in this case, a product of negotiations between parties possessing parity of bargaining strength, providing merely for a forum for enforcement of the rights of enrolled employees rather than a substantive limitation of them.
We shall reject, finally, plaintiff’s contention that the arbitration provision violates constitutional and statutoiy provisions protecting the right to trial by juiy. Persons entering into arbitration agreements know and intend that disputes arising under such agreements will be resolved by arbitration, not by juries; neither decision nor policy calls for an explicit waiver of the parties’ right to jury trial or for express conformance with Code of Civil Procedure section 631, the applicable procedural statute.
Accordingly, we reverse the order of the trial court and direct that court to grant Kaiser’s motion to compel arbitration.
1. Summary of proceedings.
In 1945 the Legislature enacted the State Employees’ Retirement Act (Gov. Code, § 20000 et seq.) and delegated the administration of the act to a board selected pursuant to Government Code section 20100. Although this section has been amended frequently, it has at all times provided that at least one-third of the board members must be persons elected to that office by the public employees enrolled under the State Employees Retirement System.
In 1961, when California enacted the Meyers-Geddes Employee’s Medical and Hospital Care Act (Gov. Code, § 22751 et seq.), the Legislature entrusted the administration of this new enactment to the existing retirement board. To make group medical plans available to state employees, the act authorized the board to enter into renewable one-year contracts with carriers offering basic health plans. (Gov. Code, [704]*704§§ 22774, 22790, 22793.) The act provides that state employees may enroll under any medical plan embodied in a contract negotiated between the board and the carriers (Gov. Code, § 22810); the state and the employees each contribute a portion of the cost of the plan. (Gov. Code, §§ 22825-22829.) The act requires that contracts must include a grievance procedure to protect the rights of the employees (Gov. Code, § 22793), but neither expressly grants nor withholds authority for the board to agree to arbitration of employees’ malpractice claims.
Pursuant to the provisions of the act, the board negotiated an agreement with Kaiser Foundation Health Plan, a corporation, to provide medical, hospital, and related health care benefits to state employees and their families. The agreement states that it is “subject to amendment... by mutual agreement between [Kaiser] and . . . Board without the consent or concurrence of the Members. By electing medical and hospital coverage pursuant to this Agreement, or accepting benefits hereunder, all Members . . . agree to all terms, conditions and provisions hereof.”
When plaintiff first enrolled under the Kaiser plan in 1965, it did not contain an arbitration provision. On April 1, 1971, however, the Kaiser Foundation Health Plan, anticipating the inclusion of an arbitration provision, mailed to all subscribers a brochure which, in describing the terms and benefits of the plan, stated that claims involving professional liability and personal injury must be submitted to arbitration. Shortly thereafter, on May 28, 1971, the Kaiser Foundation Health Plan and the board amended their contract in several respects and included a provision for binding arbitration of “any claim arising from the violation of a legal duty incident to this Agreement.”2
On August 1, 1971, plaintiff underwent a hysterectomy at the Kaiser Hospital in Los Angeles. During the surgery, her bladder was perforated; blood transfusions were required; plaintiff thereafter contracted serum hepatitis.3
[705]*705Plaintiff filed a malpractice complaint against Kaiser and the blood banks. Kaiser moved to stay the action and compel arbitration. Opposing this motion, plaintiff filed a declaration stating that because of absence from work by reason of illness she had not received the April 1971 brochure, that she was not aware of the execution of the arbitration agreement in May of 1971, and thus had no knowledge that the Kaiser plan, at the time of her operation, required arbitration of malpractice claims.
By order of April 22, 1974, the trial court denied the motion to stay the action and compel arbitration. Kaiser appeals from that order.4
2. The board, as agent for the employees, had implied authority to provide for arbitration of malpractice claims.
Government Code sections 22774, 22790 and 22793 authorize the board to negotiate contracts for group medical plans for state employees. In negotiating such agreements and amendments the board acts as the agent or representative of the employees. (Bios v. Bankers Life Co. (1955) 133 Cal.App.2d 147, 150 [283 P.2d 744]; see Boseman v. Insurance Co. (1937) 301 U.S. 196, 204-205 [81 L.Ed. 1036, 1040-1041, 57 S.Ct. 686, 110 A.L.R. 732]; Elfstrom v. New York Life Ins. Co. (1967) 67 Cal.2d 503, 512, fn. 5 [63 Cal.Rptr. 35, 432 P.2d 731].)5 The acts of an agent within [706]*706the scope of his authority bind the principal (see Civ. Code, § 2330); application of this rule in the present context yields the conclusion that contract provisions, as well as amendments to the contract,6 negotiated by the board within the scope of its authority as an agent, bind those employees who enroll under the contract.
This preliminary doctrinal recitation sets the stage for the principal issue of this appeal: whether the board, as agent of the employees, had implied authority to agree to a contract which provided for arbitration of all disputes, including malpractice claims, arising under that contract. That issue turns on the application of Civil Code section 2319, which authorizes a general agent “To do everything necessary or proper and usual . . . for effecting the purpose of his agency.” For the reasons explained below, we conclude that arbitration is a “proper and usual” means of resolving malpractice disputes, and thus that an agent empowered to negotiate a group medical contract has the implied authority to agree to the inclusion of an arbitration provision.
In Crofoot v. Blair Holdings Corp. (1953) 119 Cal.App.2d 156, 183-184 [260 P.2d 156],7 Justice Peters summarized the evolution of legal attitudes toward arbitration. “Arbitration has had a long and troubled history. The early common law courts did not favor arbitration, and greatly limited the powers of arbitrators. But in recent times a great change in attitude and policy has taken place. Arbitrations are now usually covered by statutory law, as they are in California. Such statutes evidence a strong public policy in favor of arbitrations, which policy has frequently been approved and enforced by the courts.” Subsequent decisions confirm the self-evident fact that arbitration has become an accepted and favored method of resolving disputes (Ware v. Merrill Lynch, Pierce, Fenner & Smith, Inc. (1972) 24 Cal.App.3d 35, 43 [100 Cal.Rptr. 791]; Federico v. Frick (1970) 3 Cal.App.3d 872, 875 [84 Cal.Rptr. 74]; Roberts v. Fortune Homes, Inc. (1966) 240 Cal.App.2d 238, 244 [49 Cal.Rptr. 429]), praised by the courts as an expeditious and [707]*707economical method of relieving overburdened civil calendars (Player v. Geo. M. Brewster & Son, Inc. (1971) 18 Cal.App.3d 526, 534 [96 Cal.Rptr. 149]).
The transformation of legislative and judicial attitudes toward arbitration has encouraged a dramatic development in the use of this procedure. A 1952 study estimated that “aside from personal injuiy cases and cases in which the government is a party, more than 70 percent of the total civil litigation is decided through arbitration rather than by the courts” (Mentschikoff, The Significance of Arbitration—A Preliminary Inquiry (1952) 17 Law & Con temp. Prob. 698). In the following decades arbitration further expanded its role to encompass in certain circumstances disputes requiring evaluation of personal injury claims: California and many other states now require arbitration of uninsured motorist claims (see Ins. Code, § 11580.2), and proposals for no-fault automobile insurance frequently provide for arbitration (see Judicial Council of Cal., Study of the Role of Arbitration in the Judicial Process (1973) pp. 71-73).
Plaintiff nevertheless recites judicial authority holding that a provision for arbitration frames an extraordinary method of resolving disputes and that consequently the authority of an agent to agree to arbitration must be specially conferred. The only decisions which support that proposition, however, are cases from other states which date from an era of judicial hostility to arbitration. (Pope v. Wheatley (Tex.Civ.App. 1932) 54 S.W.2d 846; Dunn v. Moore (1938) 22 Tenn.App. 412 [123 S.W.2d 1095]; Manufacturers’ & Builders’ Fire Ins. Co. v. Mullen (1896) 48 Neb. 620 [67 N.W. 445].)8 That judicial era has long since receded into a remote past. (See Gear v. Webster, supra, 258 Cal.App.2d 57, 61; Henderson, Contractual Problems in the Enforcement of Agreements to Arbitrate Medical Malpractice (1972) 58 Va.L.Rev. 947, 956.) The agent today who consents to arbitration follows a “proper and usual” practice “for effecting the purpose” of the agency; he merely agrees that disputes arising under the contract be resolved by a common, expeditious, and judicially favored method.
[708]*708The matter becomes even clearer if we narrow our focus to arbitration of disputes arising under group contracts. In collective bargaining agreements, which, like the present contract, are negotiated by elected representatives on behalf of a group of employees, arbitration has become a customary means of resolving disputes. (See, e.g., Fire Fighters Union v. City of Vallejo (1974) 12 Cal.3d 608, 622 [116 Cal.Rptr. 507, 526 P.2d 971]; Charles J. Rounds Co. v. Joint Council of Teamsters No. 42 (1971) 4 Cal.3d 888 [95 Cal.Rptr. 53, 484 P.2d 1397]; Posner v. Grunwald-Marx, Inc., supra, 56 Cal.2d 169, 180.) Negotiators have invariably accepted without question the authority of the union representative to agree to such arbitration provisions. (See Code Civ. Proc., § 1280.) A New York decision confirms the equivalent right of a trade association representative to agree to an arbitration clause on behalf of the employers. (Mencher v. B. & S. Abeles & Kahn (1948) 274 App.Div. 585 [84 N.Y.S.2d 718, 733].) The viability of these thousands of agreements for arbitration should certainly not be sacrificed on the altar of an exotic and arid legalism that in all these years has not even occurred to the parties.
Finally, we observe the growing interest in and use of arbitration to cope with the increasing volume of medical malpractice claims. (See Judicial Council Study, op. cit., supra, pp. 70-71 and references there cited; Butler, Arbitration: An Answer to the Medical Malpractice Crisis (Sept. -Oct. 1975) 9 Beverly Hills Bar J. 41; Henderson, op. cit., supra, 58 Va.L.Rev. 947; Note, Rx for New York’s Medical Malpractice Crisis (1975) 11 Colum.J.L. & Soc. Prob. 467, 500-503.)9 The authority of an agent to agree to the arbitration of such claims finds an illustration in our decision in Doyle v. Giuliucci (1965) 62 Cal.2d 606 [43 Cal.Rptr. 697, 401 P.2d 1]. In Doyle, the father of an injured minor entered into a contract with the Ross-Loos Medical Group which provided for arbitration of tort and contract claims arising under the contract. In an unanimous opinion authored by Chief Justice Traynor, we held that the minor was bound by [709]*709the provision of the agreement to submit her malpractice claim to arbitration. “[T]he power to enter into a contract for medical care that binds the child to arbitrate any dispute arising thereunder,” we stated, “is implicit in a parent’s right and duty to provide for the care of his child.” (P. 610.) Rejecting the contention that the arbitration clause unreasonably limited the minor’s rights, we replied, “The arbitration provision in such contracts is a reasonable restriction, for it does no more than specify a forum for the settlement of disputes.” (Ibid.)
We do not believe Doyle can be distinguished from the instant case because it involves a parent contracting on behalf of a child instead of an agent contracting on behalf of its principal. Both parent and agent serve as fiduciaries with limited powers, and if, as Doyle holds, the implied authority of a parent includes the power to agree to arbitration of the child’s malpractice claims, we perceive no reason why the implied authority of an agent should not similarly include the power to agree to arbitration of the principal’s malpractice claims.
We therefore conclude that an agent or other fiduciary who contracts for medical treatment on behalf of his beneficiaiy retains the authority to enter into an agreement providing for arbitration of claims for medical malpractice.11
[710]*7103. The principles that govern contracts of adhesion do not bar enforcement of the arbitration amendment.
Plaintiff asserts that she was unaware of the arbitration amendment and should not be bound by its terms. Although she must acknowledge the general rule that one who assents to a contract is bound by its provisions and cannot complain of unfamiliarity with the language of the instrument (see Federico v. Frick, supra, 3 Cal.App.3d 872, 875; 1 Witkin, Summary of Cal. Law (8th ed. 1973) p. 93 and cases there cited), she points to an exception to that rule in the instance of a contract of adhesion. As we have frequently explained, courts will not enforce provisions in adhesion contracts which limit the duties or liability of the stronger party unless such provisions are “conspicuous, plain and clear” (Steven v. Fidelity & Casualty Co. (1962) 58 Cal.2d 862, 878 [27 Cal.Rptr. 172, 377 P.2d 284]) and will not operate to defeat the reasonable expectations of the parties (see Atlantic Nat. Ins. Co. v. Armstrong (1966) 65 Cal.2d 100, 112 [52 Cal.Rptr. 569, 416 P.2d 801]).
Contending that the Kaiser contract is one of adhesion, plaintiff argues that the courts should refuse to enforce its arbitration clause on the ground that the clause is inconspicuous, unexpected, and disrupts the members’ reasonable expectation that a malpractice claim will be adjudicated by trial by juiy. We explain our reason for concluding that the principles governing adhesion contracts do not cover the present case.
The concept that a contract of adhesion should be interpreted and enforced differently from an ordinary contract has evolved from cases which have involved contractual provisions drafted and imposed by a party enjoying superior bargaining strength—provisions which unexpectedly and often unconscionably limit the obligations and liability of the party drafting the contract. (See Neal v. State Farm Ins. Cos. (1961) 188 Cal.App.2d 690 [10 Cal.Rptr. 781]; Steven v. Fidelity & Casualty Co., supra, 58 Cal.2d 862; Tunkl v. Regents of University of California (1963) 60 Cal.2d 92 [32 Cal.Rptr. 33, 383 P.2d 441, 6 A.L.R.3d 693]; Gray v. Zurich Insurance Co. (1966) 65 Cal.2d 263 [54 Cal.Rptr. 104, 419 P.2d 168]; Schmidt v. Pacific Mut. Life Ins. Co. (1969) 268 Cal.App.2d 735 [74 Cal.Rptr. 367].) The present case resembles those precedents only in that the members were offered the Kaiser plan on a “take it or leave it” basis without opportunity for individual bargaining. The Kaiser contract, however, lacks those oppressive features which have characterized the contracts adjudicated in the prior decisions.
[711]*711In the characteristic adhesion contract case, the stronger party drafts the contract, and the weaker has no opportunity, either personally or through an agent, to negotiate concerning its terms. (See Steven v. Fidelity & Casualty Co., supra, 58 Cal.2d 862, 882; Kessler, Contracts of Adhesion—Some Thoughts About Freedom of Contract (1943) 43 Colum.L.Rev. 629, 632.) The Kaiser plan, on the other hand, represents the product of negotiation between two parties, Kaiser and the board, possessing parity of bargaining strength. Although, plaintiff did not engage in the personal negotiation of the contract’s terms, she and other public employees benefitted from representation by a board, composed in part of persons elected by the affected employees, which exerted its bargaining strength to secure medical protection for employees on more favorable terms than any employee could individually obtain.
In many cases of adhesion contracts, the weaker party lacks not only the opportunity to bargain but also any realistic opportunity to look elsewhere for a more favorable contract; he must either adhere to the standardized agreement or forego the needed service. (See, e.g., Tunkl v. Regents of University of California, supra, 60 Cal.2d 92.) Plaintiff, on the other hand, enjoyed the opportunity to select from among several medical plans negotiated and offered by the board, some of which did not include arbitration provisions, or to contract individually for medical care.
Finally, in all prior contract of adhesion cases, the courts have concerned themselves with weighted contractual provisions which served to limit the obligations or liability of the stronger party. The arbitration amendment, by way of contrast, bears equally on Kaiser and the members. It does not detract from Kaiser’s duty to use reasonable care in treating patients, nor limit its liability for breach of this duty, but merely substitutes one forum for another. (See Doyle v. Giuliucci, supra, 62 Cal.2d 606, 610.)
Although plaintiff asserts that the arbitration amendment promotes Kaiser’s interest to the disadvantage of the members enrolled under the Kaiser plan, she overlooks the benefits of the arbitral forum. The speed and economy of arbitration, in contrast to the expense and delay of juiy trial, could prove helpful to all parties; the simplified procedures and relaxed rules of evidence in arbitration may aid an injured plaintiff in presenting his case. Plaintiffs with less serious injuries, who cannot afford the high litigation expenses of court or jury trial, disproportionate to the [712]*712amount of their claim, will benefit especially from the simplicity and economy of arbitration; that procedure could facilitate the adjudication of minor malpractice claims which cannot economically be resolved in a judicial forum. Thus plaintiff’s charge that the board surrendered the members’ rights to juiy trial without receiving an adequate quid pro quo must fail. Moreover, to the extent that arbitration reduces Kaiser’s litigation expense, it may enable Kaiser to offer medical care to members at rates lower than otherwise would be the case.
To support her contract of adhesion argument, plaintiff points to Tunkl v. Regents of University of California, supra, 60 Cal.2d 92; that decision, however, serves instead to illuminate by contrast the nonoppressive character of the contract in the present case. In Tunkl, defendant hospital presented to all incoming patients a document entitled “Conditions of Admission,” which provided that the patient release the hospital from liability for negligent or wrongful acts. We observed that the “would-be patient is in no position to reject the proffered agreement, to bargain with the hospital, or in lieu of agreement to find another hospital.” (60 Cal.2d at p. 102.) Thus, the patient had no realistic choice but to assent to a standardized agreement under which he waived his right to recover for negligently inflicted injuries.
As we have explained, plaintiff, in contrast to Tunkl, benefited from the board’s assertion of equal power on her behalf, enjoyed the opportunity to choose from among alternative medical plans, and waived no substantive right. We conclude that Tunkl is not controlling in the instant setting; the principles of adhesion contracts, as" elucidated and applied in Tunkl and the other cases we have cited, do not bar enforcement of terms of a negotiated contract which neither limit the liability of the stronger party nor bear oppressively upon the weaker. Accordingly, such principles do not bar enforcement of the arbitration amendment against plaintiff Madden.
4. Enforcement of the arbitration provision does not violate constitutional or statutory protections of the right to trial by jury.
Article I, section 16, of the California Constitution permits the waiver of a jury trial in a civil action “by the consent of the parties, expressed as prescribed by statute.” As an implementation of this constitutional mandate, Code of Civil Procedure section 631 specifies several means by which a party can waive a juiy trial: “written consent [713]*713filed with the clerk or judge,” “oral consent, in open court, entered in the minutes or docket,” failure to request a jury in timely fashion, failure to deposit jury fees, or failure to appear at trial. Plaintiff maintains that section 631 constitutes an exclusive listing of the means by which a party can waive his right to trial by jury in a civil action (see 4 Witkin, Cal. Procedure (2d ed. 1971) p. 2918 and cases there cited), and that the arbitration amendment is ineffective because it does not conform to the provisions of this section.
Section 631, however, presupposes a pending action, and relates only to the manner in which a party to such action can waive his right to demand a jury trial instead of a court trial. It does not purport to prevent parties from avoiding jury trial by not submitting their controversy to a court of law in the first instance. Indeed it has always been understood without question that parties could eschew jury trial either by settling the underlying controversy, or by agreeing to a method of resolving that controversy, such as arbitration, which does not invoke a judicial forum. Consequently when the Legislature enacted the specific language of the California Arbitration Act (Code Civ. Proc., § 1280 et seq.) to govern the enforcement of arbitration agreements, it did not require that such agreements conform to section 631. Any requirement that the courts, contrary to legislative intent, engraft the terms of section 631 onto the Arbitration Act would be wholly impractical and onerous; we see no reason why the courts should become the repository of thousands of arbitration agreements, nor can we discern any policy to be served by striking down such agreements when not filed with a court or entered in its minutes.
Plaintiff further contends that the arbitration provision in the Kaiser contract fails because it does not expressly waive the parties’ constitutional right to jury trial.12 But to predicate the legality of a consensual arbitration agreement upon the parties’ express waiver of jury trial would be as artificial as it would be disastrous.
[714]*714When parties agree to submit their disputes to arbitration they select a forum that is alternative to, and independent of, the judicial—a forum in which, as they well know, disputes are not resolved by juries. Hence there are literally thousands of commercial and labor contracts that provide for arbitration but do not contain express waivers of jury trial. Courts have regularly enforced such agreements; in Charles J. Rounds Co. v. Joint Council of Teamsters No. 42, supra, 4 Cal.3d 888, for example, we unanimously affirmed an order compelling an employer to submit a contract dispute to arbitration, although the arbitration provision did not expressly waive the employer’s right to trial by jury. Relying on this consistent pattern of judicial decision, contracting parties, such as Kaiser and the board in the case at bar, continue to draft arbitration provisions without express mention of any right to jury trial. Before today no one has so much as imagined that such agreements are consequently invalid; to destroy their viability upon an extreme hypothesis that they fail expressly to negative jury trials would be to frustrate the parties’ interests and destroy the sanctity of their mutual promises.
5. Plaintiff cannot avoid arbitration with Kaiser by joining other parties as defendants in her malpractice suit.
Plaintiff contends that a stay of her action with respect to Kaiser will lead to piecemeal and protracted litigation because she has also named as defendants the two blood banks. We agree that plaintiff may properly join the blood banks as parties defendant (Landau v. Salam (1971) 4 Cal.3d 901 [95 Cal.Rptr. 46, 484 P.2d 1390]), but that right does not empower her to avoid her duty to arbitrate any dispute with Kaiser. We point out that under these circumstances, the trial court is not required to stay all proceedings against the defendants who are not entitled to arbitration; the court may, in its discretion, sever the action as to the blood banks or limit any stay to those issues subject to arbitration. (See Code Civ. Proc., § 1281.4; Cook v. Superior Court (1966) 240 Cal.App.2d 880, 885 [50 Cal.Rptr. 81].)
6. Conclusion.
Under the aegis of permissive legislation and favorable judicial decisions, arbitration has become a proper and usual means of resolving civil disputes, including disputes relating to medical malpractice. We should not now turn the judicial clock backwards to an era of hostility toward arbitration. We should not fetter that institution with artificial [715]*715requirements that a contracting agent must secure express authorization to enter into an arbitration provision or that the provision itself must explicitly waive rights to jury trial. We should not impose debilitating obstructions, such as those urged by plaintiffs, which could very well jeopardize the legality of the huge number of presently functioning and efficacious arbitration agreements.
We conclude that the trial court erred in denying Kaiser’s motion to compel arbitration and in refusing to stay the action against Kaiser. The trial court’s refusal to stay the action as to the blood bank defendants is not challenged on appeal, but the trial court may wish to reconsider its order with respect to those defendants in light of our disposition of Kaiser’s appeal.
The order of April 22, 1974, denying Kaiser’s motion to stay further proceedings and compel arbitration is reversed, and the cause remanded for further proceedings consistent with the views expressed herein. The appeal from the order of May 22, 1974, denying Kaiser’s petition for reconsideration, is dismissed.
Wright, C. J., McComb, J., Sullivan, J., Clark, J., and Files, J.,* concurred.
Assigned by the Chairman of the Judicial Council.