Sharkh v. Continentale Krankenversicherung A.G. CA2/7

CourtCalifornia Court of Appeal
DecidedMay 17, 2021
DocketB303219
StatusUnpublished

This text of Sharkh v. Continentale Krankenversicherung A.G. CA2/7 (Sharkh v. Continentale Krankenversicherung A.G. CA2/7) 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
Sharkh v. Continentale Krankenversicherung A.G. CA2/7, (Cal. Ct. App. 2021).

Opinion

Filed 5/17/21 Sharkh v. Continentale Krankenversicherung A.G. CA2/7 NOT TO BE PUBLISHED IN THE OFFICIAL REPORTS

California Rules of Court, rule 8.1115(a), prohibits courts and parties from citing or relying on opinions not certified for publication or ordered published, except as specified by rule 8.1115(b). This opinion has not been certified for publication or ordered published for purposes of rule 8.1115.

IN THE COURT OF APPEAL OF THE STATE OF CALIFORNIA

SECOND APPELLATE DISTRICT

DIVISION SEVEN

MIRIAM ABU SHARKH et al., B303219

Plaintiffs and Appellants, (Los Angeles County Super. Ct. No. SC127208) v.

CONTINENTALE KRANKENVERSICHERUNG A.G. et al.,

Defendants and Respondents.

APPEAL from a judgment of the Superior Court of Los Angeles County, Gerald Rosenberg and Marc D. Gross, Judges. Reversed and remanded. McKennon Law Group, Robert J. McKennon and Andrea Soliz for Plaintiffs and Appellants. Wilson Elser Moskowitz Edelman & Dicker, Gary S. Pancer and Adam Le Berthon for Defendant and Respondent Continentale Krankenversicherung a.G. Daniels, Fine, Israel, Schonbuch & Lebovitz and Mark R. Israel for Defendant and Respondent Global Medical Management, Inc. _______________________________

Miriam Abu Sharkh, both in her individual capacity and as guardian ad litem for her minor sons, LM Abu Sharkh Holfeld and LV Abu Sharkh Holfeld, appeals from the judgment of dismissal entered after the trial court granted the motion to dismiss under the doctrine of forum non conveniens filed by defendant Continentale Krankenversicherung a.G. and joined by Global Medical Management, Inc. (GMMI). We reverse and remand for the trial court to reconsider the motion. FACTUAL AND PROCEDURAL BACKGROUND 1. The Parties and the Insurance Policy Continentale is a German insurance company with its principal place of business in Dortmund, Germany. Continentale sells comprehensive health and long term care insurance directly to individuals in Germany and through group policies in partnership with organizations in Germany. In 1992 Continentale contracted with the German Academic Exchange Service (Deutscher Akademischer Austauschdienst e.V. or DAAD) to provide health insurance to individual members of DAAD. The contract has been renewed annually since 1992. DAAD, headquartered in Bonn, Germany, is a consortium of German higher education institutions and their student bodies. DAAD provides scholarships and grants to students, researchers and lecturers to study and work in Germany and internationally. Pursuant to the contract between Continentale and DAAD,

2 Continentale agreed to provide health insurance to DAAD funding recipients and their immediate families while those recipients travelled, worked and studied outside Germany. DAAD collects premium payments from its individual members and pays the policy premium to Continentale in a lump sum each month. In order to be covered under the policy an individual must be registered by DAAD with Continentale. The policy states its “area of application is countries outside of Germany, unless otherwise agreed” and the “scope of the insurance cover[age] is based on the [policy] as well as the statutory regulations of the Federal Republic of Germany.”1 GMMI is a Texas corporation with its principal place of business in Pembroke Pines, Florida. In 2012 Continentale and GMMI entered into a contract pursuant to which GMMI would “provide medical cost containment services” for Continentale in the United States, including “medical case management,” providing evidence of coverage to insureds’ medical providers, processing submitted claims and paying approved medical claims.2 According to Continentale, although GMMI issued payments for approved claims in the United States, all coverage decisions were made by Continentale employees in Germany.

1 The policy was issued in German. The record contains an English language translation of the policy prepared by a translator in Cologne, Germany in 2017 and submitted by Continentale in support of its motion to dismiss. 2 In exchange for services provided Continentale agreed to pay GMMI “twenty-two percent (22%) of the amount saved or recovered on [Continentale’s] behalf from medical providers, insurance companies and all third parties.”

3 The contract between GMMI and Continentale was executed in both German and English. Sharkh is a citizen of both Germany and the United States. In 2007 she took a position at Stanford University, initially as a visiting scholar with the Center of Democracy, Development and Rule of Law and later as a consulting associate professor with the Center for International Development. Because of her position at Stanford, Sharkh was eligible for health insurance through DAAD’s group policy with Continentale. DAAD registered Sharkh as an insured under the group policy in October 2006 with an address in Mainz, Germany. In January 2007 Continentale was provided with an updated address for Sharkh in Palo Alto, California. It is undisputed that Sharkh was a resident of California continuously from 2007 to mid-2016. LM was born in California in 2011. LV was born in California in 2013. Upon his birth each child was registered with Continentale as an insured under the DAAD group policy. 2. LM’s Illness and Cancellation of the Policy When he was five months old, LM contracted measles. As a result he developed a rare, progressive and usually terminal brain disorder that includes inflammation and irritation in the brain. By the time he was four years old, LM’s condition had deteriorated significantly, requiring him to be hospitalized for almost six months during late 2014 and early 2015. LM did not have control over his extremities; he suffered from frequent seizures, was fed through a tube in his stomach and often required supplemental oxygen. In March 2015 LM’s doctors informed Sharkh that LM likely had only three months to live. LM’s doctors recommended he be discharged to the family home with 24-hour nursing and

4 hospice care. Continentale agreed to the treatment plan. According to the first amended complaint, in July 2015, as LM lived beyond his three-month life expectancy, Continentale and GMMI began to deny or delay payment of claims for reasons that had never previously been raised and in some cases denied coverage for preapproved claims or claims substantially similar to those that had been previously paid. In January 2016 Sharkh received an email from GMMI inquiring about LM’s current life expectancy. When the family’s physician replied that LM had already outlived his anticipated life expectancy, GMMI responded the answer was not sufficient. In February 2016 Continentale and GMMI began refusing to pay for LM’s nursing care. Sharkh contacted Continentale in an attempt to resolve the claim denials but was told GMMI handled claims in the United States and Continentale did not have access to information necessary to explain the claims decisions. Sharkh then reached out to GMMI and was told she would be contacted by the GMMI employee who handled her claims. Sharkh never received a response. On April 29, 2016 Sharkh received an email from Continentale stating it was terminating the family’s coverage under the policy. The email stated Continentale had signed an agreement with DAAD to terminate coverage without prior notice and cited as a legal basis a provision of the German Civil Code.3 The email also stated, “In particular, the duration and

3 According to the first amended complaint the cited section of the German Civil Code provides that a contract may be terminated for “a compelling reason” but in certain circumstances termination may require notice and opportunity to cure.

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Bluebook (online)
Sharkh v. Continentale Krankenversicherung A.G. CA2/7, Counsel Stack Legal Research, https://law.counselstack.com/opinion/sharkh-v-continentale-krankenversicherung-ag-ca27-calctapp-2021.