Simmons v. Allstate Insurance

112 Cal. Rptr. 2d 397, 92 Cal. App. 4th 1068, 2001 Daily Journal DAR 10965, 2001 Cal. Daily Op. Serv. 8845, 2001 Cal. App. LEXIS 801
CourtCalifornia Court of Appeal
DecidedSeptember 14, 2001
DocketC034619
StatusPublished
Cited by83 cases

This text of 112 Cal. Rptr. 2d 397 (Simmons v. Allstate Insurance) 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
Simmons v. Allstate Insurance, 112 Cal. Rptr. 2d 397, 92 Cal. App. 4th 1068, 2001 Daily Journal DAR 10965, 2001 Cal. Daily Op. Serv. 8845, 2001 Cal. App. LEXIS 801 (Cal. Ct. App. 2001).

Opinion

Opinion

CALLAHAN, J.

California’s anti-SLAPP statute (Code Civ. Proc., § 425.16; all further unspecified statutory references are to this code) allows dismissal, at an early stage, of a lawsuit designed primarily to chill the *1070 exercise of First Amendment rights. 1 It permits a special motion to strike any cause of action designed to deter acts in furtherance of a person’s right of petition or free speech. (§ 425.16, subd. (b).)

In this case, Lester A. Simmons, Ute Simmons, and related business entities appeal from an order striking, as a SLAPP suit, a defamation-based cross-complaint they filed against Allstate Insurance Company (Allstate) in response to an unfair business practice suit by Allstate charging the Simmons defendants with bilking insurance companies and overtreating patients.

Seeking reversal, the Simmons defendants contend that Allstate never carried its burden of showing that the cross-complaint fell within the statutory definition; alternatively, if some of the allegations did fall into the SLAPP category, they claim the trial court erred in refusing to grant leave to amend the pleading to eliminate the offending verbiage.

We conclude the trial court correctly struck the cross-complaint and did not err in refusing leave to amend. We shall affirm and award Allstate attorney fees in connection with defending the appeal.

Procedural Overview

Allstate’s Complaint

In June 1999, Allstate filed a complaint against Lester A. Simmons, individually and doing business as Lester A. Simmons, D.C., various other Simmons-related business entities, and Robert A. McAuley, M.D. 2 The opening paragraph aptly conveys the tenor of the complaint: “This action arises out of an illegal scheme to defraud Allstate, its insureds, as well as other insurers and their insureds, through the creation, submission and prosecution of fraudulent, inflated, and exaggerated medical bills and medical records, the performance of unnecessary medical tests and treatments, illegal ownership of chiropractic and medical corporations, the utilization of unlicensed physical therapists to treat patients, and related claims for insurance benefits.”

Allstate averred that defendants engaged in three main forms of illegal conduct: (1) intentional and consistent abuse of the American Medical *1071 Association physicians’ current procedural terminology codes by fraudulently increasing the amounts billed to Allstate and exaggerating the claims of patients; (2) operating chiropractic and medical clinics without valid licenses; and (3) employing unlicensed physical therapists.

Pursuant to the Unfair Practices Act (Bus. & Prof. Code, § 17200 et seq.), Allstate sought injunctive relief against defendants’ allegedly deceptive and fraudulent practices, disgorgement of unlawful profits obtained by reason of their conduct, and payment of attorney fees and costs pursuant to section 1021.5.

Simmons’s Cross-complaint

Lester A. Simmons, Ute Simmons, and their various business entities, including Owlstone Asset Management, Inc., which operates seven clinics in the Sacramento area (collectively Simmons), responded with a cross-complaint against Allstate and “Roes 1 through 500,” who were alleged to be partners and other joint venturers of Allstate.

Contending that new laws have driven up Allstate’s costs, the cross-complaint charges Allstate and other insurance companies with conspiring to force chiropractors such as Simmons out of business in retaliation for their refusal to accept managed care treatment and billing practices. Allstate has done this through maliciously filing frivolous lawsuits, waging a “media war . . . through the use of slanderous, defamatory and libelous statements,” making defamatory statements outside litigation, and wrongfully refusing to pay for authorized care and legitimate claims.

Based on this allegedly wrongful conduct, the cross-complaint posits nine tort causes of action, cast under a variety of legal theories. Notable among them is the slander cause of action, which alleges Allstate levied false charges that Simmons overtreats patients, uses a sham medical director, engages in tax and mail fraud, and is fleeing the country to avoid prosecution.

The Motion to Strike

Allstate brought a motion to strike the cross-complaint under section 425.16, on the ground that all of Simmons’s causes of action arose out of statements in connection with issues under consideration by a judicial or executive body, as well as issues of public interest.

In support of the motion, Allstate asked the court to take judicial notice of certain documents, two of which reflect formal disciplinary proceedings *1072 before the state Board of Chiropractic Examiners (the Board): a Board order denying Simmons’s motion to dismiss an accusation filed by the state Department of Justice and a “Proposed Decision” which included factual findings, rendered by Administrative Law Judge Jaime Rene Roman.

The Board order denying the motion to dismiss found that Simmons, while holding an inactive license, improperly engaged in business activities requiring an active license, improperly advertised the rendering of physical therapy services, which is expressly prohibited by his license, inappropriately advertised his services and improperly solicited patients under the guise of cost-free participation in a scientific research study about pain. The proposed decision found that Simmons had engaged in numerous violations of the Chiropractic Act, including (1) performing examinations with no regard for medical necessity; (2) referring patients, regardless of their medical condition, to Dr. McAuley, who found justification for chiropractic care that was not medically necessary or justified; (3) “inappropriately and fraudulently” billing for levels of service or services not rendered to patients; (4) routinely and fraudulently billing for unperformed X-rays and submitting X-ray reports that were either medically unjustified or not rendered; and (5) tying the rendering of services to employee bonuses, thereby impairing the application of unfettered, conflict-free chiropractic judgment. Characterizing Simmons as “a businessman, not a professional, focused primarily on profit, statistics, productivity, formal legalities, and the receipt of account receivables,” Judge Roman’s decision orders revocation of Simmons’s license to practice chiropractic and reimbursement to the Board of $88,000 in prosecution and enforcement costs.

Allstate also asked the court to take judicial notice of other actions filed by various insurance companies against Simmons for unfair business practices. Simmons opposed the motion to strike and objected to the request for judicial notice.

At the hearing on the motion Simmons’s counsel, faced with an adverse tentative ruling, asked the court to grant Simmons leave to amend the cross-complaint. The court issued an order striking Simmons’s cross-complaint and denied leave to amend.

Appeal

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Cite This Page — Counsel Stack

Bluebook (online)
112 Cal. Rptr. 2d 397, 92 Cal. App. 4th 1068, 2001 Daily Journal DAR 10965, 2001 Cal. Daily Op. Serv. 8845, 2001 Cal. App. LEXIS 801, Counsel Stack Legal Research, https://law.counselstack.com/opinion/simmons-v-allstate-insurance-calctapp-2001.