Smith v. Shewry

173 Cal. App. 4th 1133
CourtCalifornia Court of Appeal
DecidedApril 21, 2009
DocketNo. B207305
StatusPublished

This text of 173 Cal. App. 4th 1133 (Smith v. Shewry) 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
Smith v. Shewry, 173 Cal. App. 4th 1133 (Cal. Ct. App. 2009).

Opinion

Opinion

WILLHITE, Acting P. J.—

INTRODUCTION

After being admitted to Stanford Medical Center (Stanford) for treatment of a terminal illness, Robert Darrough (Darrough) applied for Medi-Cal benefits and appointed a law firm, Health Advocates, LLP (Health Advocates), to represent him in all matters relating to that application. Following Darrough’s death, his Medi-Cal application was denied. Health Advocates requested an administrative hearing under Welfare and Institutions Code section 10950 to contest that denial. The administrative law judge dismissed the request because Health Advocates had failed to comply with the requirement that it obtain authorization to pursue the matter from either Darrough’s estate or his heirs. Health Advocates then obtained from the probate court the appointment of one of its attorneys as special administrator of Darrough’s estate to pursue the Medi-Cal claim. Following that appointment, Health Advocates sought a rehearing of the decision dismissing its earlier request for an administrative hearing. The request for a rehearing was denied. Health Advocates responded by filing a petition for a writ of mandate in the superior court. The superior court issued the writ, ordering a rehearing on Darrough’s application for Medi-Cal benefits.

[1136]*1136We reverse. Darrough’s authorization of Health Advocates to act as his agent was revoked by his death. Health Advocates was required to obtain new authorization from either Darrough’s estate or his heirs to contest the denial of Darrough’s Medi-Cal application. Health Advocates failed to obtain that authorization in a timely manner. Therefore, the trial court erred in issuing the writ of mandate.

FACTUAL AND PROCEDURAL BACKGROUND

1. Application for Medi- Cal

On October 31, 2005, Darrough, suffering from a terminal illness, was admitted to Stanford. Darrough completed an application for Medi-Cal benefits on November 4, 2005, and on the same day signed a form appointing Health Advocates as his authorized representative regarding his Medi-Cal application. In its writ petition, Health Advocates describes itself as “a law firm that represents Stanford with regard to Medi-Cal collections.”1 The form recites that Darrough “retains, authorizes and empowers” Health Advocates “to represent [him] and act on [his] behalf as [his] authorized representative regarding [his] application for Medi-Cal. . . eligibility and benefits, including completing and signing all application forms and related documents, and prosecution of all fair hearing and other administrative and judicial proceedings required for the enforcement of [his] rights.” (Capitalization omitted.) The form further provides that Darrough “consents], authorize^] and empowers] Health Advocates to obtain and release all information from and to all private and public sources related to any benefits to which [he] may be entitled” and that Darrough agrees that the relevant public agencies would “direct all telephone calls, notices, forms, documents, correspondence, medical records and reports to Health Advocates.” (Capitalization omitted.)

On November 8, 2005, the El Dorado County Department of Social Services (County) received Darrough’s Medi-Cal application. Darrough died the next day, November 9. On December 6, 2005, County denied Darrough’s application for Medi-Cal benefits because he had failed to provide some required information.

2. Administrative Proceedings

On March 3, 2006, Health Advocates filed a request for an administrative hearing. (See Welf. & Inst. Code, § 10950.) Its letter states, in pertinent part: [1137]*1137“The above-referenced claimant [Darrough] has authorized us to request a Fair Hearing on his/her behalf. We disagree with the action taken by the County in denying our client’s claim and respectfully request that a Fair Hearing be scheduled forthwith.” Health Advocates attached a copy of the November 4, 2005 form signed by Darrough appointing it as his authorized representative.

However, shortly thereafter, Health Advocates, apparently recognizing that it could not rely upon Darrough’s authorization to request the hearing, tendered another “Authorized Representative Form.” This one, dated March 16, 2006, recited the applicant as “David B. Reil for Robert B. Darrough (Deceased).” (Capitalization omitted.) Reil had been a friend of Darrough’s who had provided him with room and board for the previous five years. In addition, Reil had a durable power of attorney for the exclusive purpose of making health care decisions on Darrough’s behalf.

On June 5, 2006, a hearing was conducted by an administrative law judge (ALJ). County urged that Health Advocates lacked standing to request the hearing. County cited several regulations found in the Manual of Policies and Procedures (MPP) promulgated by the State Department of Social Services.

Section 22-003.1 of the MPP provides: “A state hearing shall be available to a claimant who is dissatisfied with a county action and requests a hearing in the manner set forth below.” Claimant is defined as the “person who has requested a state hearing and is or has been any of the following: [][]... [f] A representative of the estate of a deceased applicant or recipient.” (§ 22-001(c)(2)(C).) Section 22-004.5 goes on to state: “If the prospective claimant dies before filing a request for a state hearing, a request may only be filed by those individuals specified in Section 22-004.41.” (Italics added.) Section 22-004.41 identifies those individuals as the executor or administrator of the estate if there is a probate proceeding or as an heir if there is no probate. (§ 22-004.41.)

Because Darrough died before a request was made for a hearing to contest County’s denial of his Medi-Cal application and because Health Advocates was not a proper representative of Darrough’s interests as defined by Section 22-004.41 of the MPP, County urged that Health Advocates lacked standing to request a hearing. (§ 22-054.3 [“A request for [a] hearing . . . shall be dismissed by a written hearing decision when: [f] . . . [f] .35 The person who requests the hearing does not have standing to request the hearing.”].)

[1138]*1138At the administrative hearing, Health Advocates acknowledged that “in order ... to proceed [with the request for a hearing, it] would have to have a new AR [authorized representative] form dated on or after the date of the notice of action signed by somebody who has standing to appoint us as AR.” Health Advocates explained that first it had unsuccessfully tried to contact Darrough’s mother; that next it had located one of Darrough’s cousins but the individual was uncooperative; and that finally it had obtained the authorization from Reil.2 Health Advocates stated that Reil had informed it that Darrough had left no estate.

The ALJ concluded that Health Advocates lacked standing, and, in an order filed on June 7, 2006, dismissed its request for a hearing.

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Bluebook (online)
173 Cal. App. 4th 1133, Counsel Stack Legal Research, https://law.counselstack.com/opinion/smith-v-shewry-calctapp-2009.