Perez v. Kaiser Foundation Health Plan

CourtCalifornia Court of Appeal
DecidedMay 16, 2023
DocketA165140
StatusPublished

This text of Perez v. Kaiser Foundation Health Plan (Perez v. Kaiser Foundation Health Plan) 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
Perez v. Kaiser Foundation Health Plan, (Cal. Ct. App. 2023).

Opinion

Filed 5/16/23 CERTIFIED FOR PARTIAL PUBLICATION*

IN THE COURT OF APPEAL OF THE STATE OF CALIFORNIA

FIRST APPELLATE DISTRICT

DIVISION THREE

MARIA PEREZ et al., Plaintiffs and Appellants, A165140 v. KAISER FOUNDATION HEALTH (Sonoma County Super. Ct. No. PLAN, INC., et al., SCV-261649) Defendants and Respondents.

Vicente and Maria Perez1 appeal from a judgment confirming an arbitration award for Kaiser Foundation Health Plan, Inc. (KFHP), Kaiser Foundation Hospitals, and The Permanente Medical Group, Inc. (collectively Kaiser). The Perezes contend there was no valid arbitration agreement, and therefore the trial court erred by granting Kaiser’s motion to compel arbitration. They also argue the award must be vacated because the arbitrator failed to comply with his continuing duty to disclose the results of other cases involving Kaiser — cases initially disclosed as pending when the

*Pursuant to California Rules of Court, rules 8.1105(b) and 8.1110, this opinion is certified for publication with the exception of Discussion, sections I, II, and IV. 1For clarity, and intending no disrespect, we use first names when referring to the Perezes individually. Andrea Perez — the Perezes’ 22-year- old daughter — initially filed suit, but she tragically passed away in June 2018, and her parents continued the underlying proceedings as a wrongful death and survival action. 1 arbitrator was appointed but that resolved during the Perezes’ arbitration. Unpersuaded by the arguments adequately raised and supported in plaintiffs’ briefs (Reyes v. Kosha (1998) 65 Cal.App.4th 451, 466, fn. 6), we affirm. BACKGROUND Kaiser is a licensed health care service plan that provides or arranges hospital and professional health care services for plan members. Employers who offer Kaiser’s health care services must distribute a document titled “Evidence of Coverage” each year to Kaiser subscribers. The document provides enrollees or subscribers with information regarding their benefits, rights, and obligations as Kaiser members. The Evidence of Coverage includes an arbitration clause, stating “Any dispute shall be submitted to binding arbitration if,” as relevant here, the claim “arises from or is related to an alleged violation of any duty incident to or arising out of or relating to this Evidence of Coverage or a Member Party’s relationship to [Kaiser], including any claim for medical or hospital malpractice.” The clause further explains members — including a member’s relative — enrolled in Kaiser’s Evidence of Coverage “thus give up their right to a court or jury trial” unless the claim falls within certain exceptions not relevant here. Francis Coppola Winery, LLC (Coppola) employees may select Kaiser health care coverage through Coppola’s online benefits enrollment process. Employees selecting the Kaiser plan are instructed, “you must agree to the authorization agreement by clicking on the ‘Save’ button.” The agreement allows Coppola to enroll employees in the Kaiser plan and to deduct premiums from their paychecks. It also confirms the length of health care coverage and circumstances for paying for coverage if employees terminate coverage.

2 In a separate section of the authorization agreement — titled “Kaiser Foundation Health Plan, Inc., and Kaiser Permanente Insurance Company Arbitration Agreement” — Kaiser notifies enrollees of a mandatory arbitration requirement. (Fn. omitted.) The disclosure states, in relevant part: “I understand . . . any dispute between myself, my heirs, relatives . . . on the one hand and [KFHP], Kaiser Permanente Insurance Company (KPIC), any contracted health care providers . . . on the other hand, for alleged violation of any duty arising out of or related to . . . any claim for medical or hospital malpractice” — such as a claim medical services “were improperly, negligently, or incompetently rendered” — “must be decided by binding arbitration under California law and not by lawsuit or resort to court process.” (Fn. omitted.) It continues, “I agree to give up our right to a jury trial and accept the use of binding arbitration. I understand that the full arbitration provision is contained in the Evidence of Coverage and in the Certificate of Insurance.” The clause also identifies certain disputes that are not subject to binding arbitration, such as ones involving dental plans. Under the disclosure is a notice advising employees that “By clicking the SAVE button below, I understand that this action will serve as my electronic signature of agreement to the conditions provided in the [KFHP] and [KPIC] Arbitration Agreement (above).” Immediately below this notice, the web page includes a note stating, “If you do not wish to accept the arbitration agreement above you must click on the CANCEL button below.” Doing so returns the employee to the plan selection screen to select a different health plan. At the bottom of the web page are three buttons, “BACK,” “SAVE,” and “CANCEL.”

3 I. Coppola purchased a winery in March 2014 and hired some of the winery’s employees, including Maria. Coppola wanted to quickly enroll the employees in its benefits program to prevent any lapse in benefits. New Coppola employees had an orientation where they learned about available benefit programs. Eligible employees received a welcome letter containing a summary of benefits and identifying their first-time usernames and log in information required for using the online enrollment system. During the orientation, employees chose and signed up for benefits using Coppola laptops. Two to four employees shared one to two laptops per table. When employees logged into the online site, they could view their own basic information, select benefits, and add any dependents they wanted to cover. Three members of Coppola’s human resources team were present and available to answer questions as people went through the process. Pursuant to the company’s best practice, human resources employees weren’t to sit at a computer and act on behalf of an employee. Records reflect Maria and Andrea were enrolled as Kaiser members as of April 1, 2014. II. In 2017, Andrea filed a complaint against Kaiser alleging negligence and fraud arising out of its failure to timely diagnose and treat her aggressive cancer. Kaiser, citing Maria’s membership agreement, petitioned to compel arbitration and stay the lawsuit. In her opposition, Andrea argued Kaiser failed to comply with Health and Safety Code section 1363.1, which sets forth specific requirements for disclosing arbitration agreements with health care service plans like Kaiser’s. She also disputed Maria agreed to arbitrate. Maria declared she was unaware of ever signing an agreement waiving rights to a jury trial and being bound to arbitration. No one

4 explained the arbitration agreement to her. She further did not understand that clicking a “SAVE” button constituted an agreement to arbitrate claims. Although Maria admitted she had a fairly good understanding of English, she was not a native speaker and declared she could not read English well enough to understand she was agreeing to arbitration. Maria also stated she did not operate the computer; it was solely operated by a Coppola human resources employee. During a hearing on the motion to compel arbitration, Coppola’s director of people operations testified regarding the online enrollment system and benefits orientation. To start the process, employees were given a temporary password by the human resources department. To continue beyond the home page, employees needed to immediately change the temporary password to a password of their own choosing. The director assumed Maria logged into the benefit system — a screenshot of Maria’s benefits page has a date and time stamp with Maria’s name, the criteria for logging into the system.

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Bluebook (online)
Perez v. Kaiser Foundation Health Plan, Counsel Stack Legal Research, https://law.counselstack.com/opinion/perez-v-kaiser-foundation-health-plan-calctapp-2023.