Premier Medical Management Systems, Inc. v. California Insurance Guarantee Ass'n

39 Cal. Rptr. 3d 43, 136 Cal. App. 4th 464, 71 Cal. Comp. Cases 210, 2006 Cal. Daily Op. Serv. 1103, 2006 Cal. App. LEXIS 145
CourtCalifornia Court of Appeal
DecidedFebruary 6, 2006
DocketB179325
StatusPublished
Cited by50 cases

This text of 39 Cal. Rptr. 3d 43 (Premier Medical Management Systems, Inc. v. California Insurance Guarantee Ass'n) 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.

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Premier Medical Management Systems, Inc. v. California Insurance Guarantee Ass'n, 39 Cal. Rptr. 3d 43, 136 Cal. App. 4th 464, 71 Cal. Comp. Cases 210, 2006 Cal. Daily Op. Serv. 1103, 2006 Cal. App. LEXIS 145 (Cal. Ct. App. 2006).

Opinion

Opinion

EPSTEIN, P. J.

The principal issue on this appeal is whether the trial court erred in denying a special motion to strike a complaint under the anti-SLAPP law, Code of Civil Procedure section 425.16 (strategic lawsuit against public participation, hereafter section 425.16). The dispute originated in efforts by insurers and employers to obtain a determination from the Workers’ Compensation Appeals Board (WCAB) as to whether the plaintiff Premier Medical Management Systems, Inc. was improperly representing treating physicians in WCAB proceedings. Premier and five affiliated treating physicians sued the insurers and employers, alleging various tort and statutory causes of action based on claims that tire defendants were in fact engaged in anticompetitive activity. The trial court denied the defendants’ special motion to strike.

We conclude the complaint falls within the ambit of section 425.16. We also conclude that plaintiffs cannot establish a probability of prevailing on the merits because the conduct of defendants which forms the basis for the complaint is petitioning activity protected by the First Amendment. Plaintiffs fail to present any exception to that doctrine that would enable them to prevail on the merits. The trial court erred in denying defendants’ special motion to strike.

FACTUAL AND PROCEDURAL SUMMARY

The Workers’ Compensation Act (WCA) is “a comprehensive statutory scheme governing compensation given to California employees for injuries incurred in the course and scope of their employment.” (Charles J. Vacanti, M.D., Inc. v. State Comp. Ins. Fund (2001) 24 Cal.4th 800, 810 [102 Cal.Rptr.2d 562, 14 P.3d 234] (Vacanti), citing Lab. Code, § 3201.) Under this scheme, an insurer ordinarily must pay all medical or medical-legal bills of an injured employee within 60 days of receipt. (Lab. Code, §§ 4603.2, subd. (b), 4622, subd. (a).) If the insurer contests the bill, payment is due only if ordered by the WCAB. (Lab. Code, §§ 4603.2, subd. (b), 4622, subd. (a).)

As the Supreme Court explained in Vacanti, medical providers who treat employee injuries covered by the WCA may file lien claims for the cost of their services directly with the WCAB. (Vacanti, supra, 24 Cal.4th at p. 811, citing Lab. Code, §§ 4903, 5300.) Such a provider is a “party in interest” to the WCAB proceeding, with full due process rights, including the right to be heard. (Vacanti, at p. 811.)

In this case, California Insurance Guarantee Association (CIGA) became responsible for some covered claims because of the insolvency and liquidation of the insurer on those claims. It disputed charges for services rendered *469 through Premier. In July 2002, CIGA asked the WCAB to consolidate 13 pending cases involving claims filed by Premier plaintiffs in litigated cases covered by CIGA. An amended petition for removal and consolidation was filed in October 2002.

In September 2002, defendant The Explorer Insurance Company (Explorer) and defendant Insurance Company of the West (ICW) filed separate petitions to consolidate several pending proceedings before the WCAB involving Premier-related bills and liens. In late 2003, other defendants 1 also filed petitions to consolidate Premier-related WCAB liens.

Defendants argued that these proceedings should be consolidated, based on allegations that Premier and its affiliates were unlawfully practicing medicine, chiropractic treatment, and physical therapy as a result of illegal fee-sharing in violation of Business and Professions Code section 650. They also alleged that Premier and its affiliates were illegally referring business and making improper and excessive charges.

Premier opposed the consolidation petitions, arguing that they were brought for the improper purpose of delay. The WCAB ordered consolidation in May 2004. It reasoned that the business practices of Premier and its affiliates were common issues in each of the cases for which consolidation was sought, and that to litigate these issues separately in hundreds of workers’ compensation cases would clog the workers’ compensation tribunals. The workers’ compensation judge noted that if the defendants prevailed in their arguments, all lien claims could be denied. The WCAB granted consolidation and stayed all liens. Its order was later amended to add claims involving the other defendants in this action. The workers’ compensation judge clarified that the scope of the stay extended to all Premier bills and liens against the defendants in the consolidated actions. During the appearance at which this ruling was announced, counsel for Premier stated that he planned to sue defendants under the Racketeer Influenced and Corrupt Organizations Act, title 18 United States Code section 1961 et seq. (RICO).

The complaint was filed in July 2004. Plaintiffs are Premier Medical and five individual physicians affiliated with it (Francis G. D’Ambrosio, Robert Schatz, Frank J. Coufal, Afshin Mashoof, Manuel Anell). We refer to them collectively as Premier or Plaintiffs. The named defendants are CIGA, several *470 insurance companies, and other entities. 2 All are defendants in the consolidated workers’ compensation cases in which lien claims have been filed by Plaintiffs. We refer to them collectively as defendants.

The gravamen of the complaint is that after Premier submitted plaintiff physicians’ bills to defendants for payment, and filed liens in numerous workers’ compensation cases before the WCAB, defendants collectively conspired to contest, delay, and avoid payment of these bills and liens.

The first cause of action alleges violation of the Cartwright Act (Bus. & Prof. Code, § 16720), the state antitrust statute. The complaint alleges that the defendants conspired to delay or avoid payment of the bills and liens; reduce the amount paid on the claims; prevent lawful competition by the plaintiff physicians; fix the amount Plaintiffs could bill or lien for treatment of medical services to the employers’ applicants; agree to pay a certain price (unilaterally agreed upon by defendants) on Plaintiffs’ claims; and “pool, combine and directly or indirectly unite other interests connected with the payment to Plaintiffs for medical treatment and services provided Employers’ Applicants so that the price of such treatment and medical services would be affected to Defendants’ benefit.” It also alleges the price fixing directly or indirectly affected free and unrestricted competition between Plaintiffs and defendants’ preferred medical providers. Plaintiffs allege that these activities produced multiple anticompetitive results, such as restriction on competition and on applicants’ ability to choose service providers.

The second cause of action claims violations of the RICO statute, title 18 United States Code sections 1961, 1962(c). It alleges that the insurers were “enterprises” through which defendants conspired to perpetrate a scheme of unlawfully delaying or refusing to pay claims. The complaint also alleges that defendants engaged in racketeering activities including mailing and electronically wiring multiple wrongful and unlawful objections to billings and liens so that defendants could strong-arm Plaintiffs to accept less on the claims.

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39 Cal. Rptr. 3d 43, 136 Cal. App. 4th 464, 71 Cal. Comp. Cases 210, 2006 Cal. Daily Op. Serv. 1103, 2006 Cal. App. LEXIS 145, Counsel Stack Legal Research, https://law.counselstack.com/opinion/premier-medical-management-systems-inc-v-california-insurance-guarantee-calctapp-2006.