Pacificare Life & Health Ins. Co. v. Jones

238 Cal. Rptr. 3d 150, 27 Cal. App. 5th 391
CourtCalifornia Court of Appeal, 5th District
DecidedSeptember 20, 2018
DocketG053914
StatusPublished
Cited by8 cases

This text of 238 Cal. Rptr. 3d 150 (Pacificare Life & Health Ins. Co. v. Jones) is published on Counsel Stack Legal Research, covering California Court of Appeal, 5th District primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Pacificare Life & Health Ins. Co. v. Jones, 238 Cal. Rptr. 3d 150, 27 Cal. App. 5th 391 (Cal. Ct. App. 2018).

Opinion

GOETHALS, J.

*397INTRODUCTION

Dave Jones, in his capacity as Insurance Commissioner of the State of California (the Commissioner), appeals from an order enjoining him from enforcing three regulations, adopted in 1992, to implement the unfair claims settlement practices provision of the Unfair Insurance Practices Act (UIPA) ( Ins. Code, § 790, et seq. )1 The injunction was issued at the conclusion of the first phase of a trial in which PacifiCare *154Life and Health Insurance Company is challenging the Commissioner's finding that it had committed over 900,000 acts and practices in violation of the Insurance Code.

The first of the three enjoined regulations states that, for purposes of the statute defining unfair claims settlement practices (§ 790.03, subd. (h) 790.03(h) ), a violation occurs when the prohibited settlement practice is either "knowingly committed on a single occasion," or "performed with such frequency as to indicate a general business practice." ( Cal. Code Regs., tit. 10, § 2695.1(a).)2 The second regulation defines the word " '[k]nowingly' " to include implied and constructive knowledge (Reg. 2695.2(l) ). The third regulation defines the word " '[w]illful' " without requiring any specific intent to cause harm or violate the law. (Reg. 2695.2(y).)

We reverse the order imposing the injunction in its entirety. The trial court determined the first regulation was inconsistent with the language of section 790.03(h), which it concluded had been interpreted by our Supreme Court in Moradi-Shalal v. Fireman's Fund Ins. Companies (1988) 46 Cal.3d 287, 303, 250 Cal.Rptr. 116, 758 P.2d 58 ( Moradi-Shalal ), and in *398Zhang v. Superior Court (2013) 57 Cal.4th 364, 379-380, fn. 8, 159 Cal.Rptr.3d 672, 304 P.3d 163 ( Zhang ), to apply only to insurers engaged in a pattern of misconduct. We disagree. As we will discuss further below, our Supreme Court's only binding interpretation of that statutory language is found in Royal Globe Ins. Co. v. Superior Court (1979) 23 Cal.3d. 880, 891, 153 Cal.Rptr. 842, 592 P.2d 329 ( Royal Globe ), which held that section 790.03(h) can be violated by an insurer's single knowing act. Consequently, we must apply that precedent.

After considering the Supreme Court's comments on the "single act liability" issue in Moradi-Shalal and Zhang in their proper contexts, we conclude that to the extent they suggest disagreement with the court's holding in Royal Globe on that specific issue, those comments are dicta. We also believe PacifiCare's contrary interpretation would be inconsistent with the unambiguous direction provided on this issue by the Legislature over the past 80 years.

The trial court also erred in declaring the Commissioner's regulations defining " '[k]nowingly committed' " and " '[w]illfull' or '[w]illfully' " to be invalid. The Commissioner has been given broad authority to promulgate regulations relating to the UIPA, including regulations defining the terms used therein. We must accord substantial deference to those regulations and conclude neither of these is inconsistent with the statutes to which they relate.3

FACTS

In 2008, following a lengthy investigation, the California Department of Insurance filed an administrative enforcement action against PacifiCare, alleging it engaged in multiple unfair claims settlement practices described in section 790.03(h), as *155well as other violations of the Insurance Code. Following an evidentiary hearing, the Commissioner issued a lengthy decision and order, finding PacifiCare engaged in over 900,000 acts and practices in violation of the Insurance Code. As a result, the Commissioner imposed penalties in excess of $173 million.

In July 2014, PacifiCare filed a petition for writ of mandate and complaint for declaratory and injunctive relief in the trial court, challenging the *399Commissioner's decision and order. Among other things, PacifiCare challenged the validity of three regulations previously promulgated by the Commissioner, and relied upon by him in the prosecution of this action. Those regulations related to a number of specifically defined unfair claims settlement practices. (Reg. 2695.1(a).)

The first challenged regulation is Reg. 2695.1(a), which is part of the preamble to the regulatory article entitled "Fair Claims Settlement Practices Regulations." (Regs. 2695.1-2695.14.) PacifiCare objected to the clause in that regulation describing section 790.03(h) as "enumerat[ing] sixteen claims settlement practices that, when either knowingly committed on a single occasion, or performed with such frequency as to indicate a general business practice, are considered to be unfair claims settlement practices. ..." PacifiCare claims the regulation's language is inconsistent with section 790.03(h), which it contends does not include the single knowing commission of an enumerated act in its definition of an unfair claims settlement practice. As a result, PacifiCare argues that this regulation is invalid.

The second challenged regulation is Reg. 2695.2(l), which defines " '[k]nowingly committed' " for purposes of the fair claims settlement practices regulations as "performed with actual, implied or constructive knowledge, including but not limited to, that which is implied by operation of law." PacifiCare argues this definition is inconsistent with section 790.03(h) because "knowingly," in ordinary parlance, must mean deliberately-a meaning PacifiCare claims is inconsistent with implied or constructive knowledge.

The third challenged regulation is Reg. 2695.2(y), which defines " '[w]illful' or '[w]illfully' when applied to the intent with which an act is done or omitted [as] simply a purpose or willingness to commit the act, or make the omission ....

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Cite This Page — Counsel Stack

Bluebook (online)
238 Cal. Rptr. 3d 150, 27 Cal. App. 5th 391, Counsel Stack Legal Research, https://law.counselstack.com/opinion/pacificare-life-health-ins-co-v-jones-calctapp5d-2018.