Wilkinson v. Norcal Mutual Insurance

98 Cal. App. 3d 307, 159 Cal. Rptr. 416, 1979 Cal. App. LEXIS 2274
CourtCalifornia Court of Appeal
DecidedOctober 31, 1979
DocketCiv. 3719
StatusPublished
Cited by26 cases

This text of 98 Cal. App. 3d 307 (Wilkinson v. Norcal Mutual 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
Wilkinson v. Norcal Mutual Insurance, 98 Cal. App. 3d 307, 159 Cal. Rptr. 416, 1979 Cal. App. LEXIS 2274 (Cal. Ct. App. 1979).

Opinion

Opinion

BROWN (G. A.), P. J.

This appeal is pursued by Jack E. Wilkinson, M.D., from a summary judgment and judgment of dismissal granted in favor of the defendant, Norcal Mutual Insurance Company, a medical malpractice insurance carrier. The sole issue is whether Wilkinson exhausted his administrative remedies pursuant to Insurance Code section 1858 et seq. and section 11587 1 before filing his second amended complaint.

Wilkinson is a licensed physician and surgeon who has practiced his profession in Fresno for approximately 25 years, and prior to the events herein he enjoyed staff privileges at the major hospitals in the Fresno area.

*311 Appellant had been insured by Travelers Insurance Company; that company canceled his policy. After a period of time appellant’s staff privileges were terminated at various Fresno hospitals because he was not covered by professional liability insurance. Thereafter he applied to Norcal for insurance which, after first denying the application, on April 30, 1976, issued a policy of medical malpractice insurance subject to the following conditions: (1) the policy would contain a deductible of $10,000 per claim, (2) a 100 percent premium surcharge would be required, (3) coverage for neurosurgery and orthopedic surgery would be excluded. Appellant objected to the conditions, and under protest paid the premium. From all that appears the policy or renewals thereof is still in effect. Appellant’s staff privileges with the limitation that he would not perform neurosurgery or orthopedic surgery were reinstated at the several hospitals.

On May 13, 1976, appellant filed his complaint for an unspecified amount of damages against Norcal by reason of the conditions imposed in the policy. 2

On March 21, 1977, appellant filed his second amended complaint in which he alleged for the first time that he had exhausted all administrative remedies against Norcal.

Norcal moved for a summary judgment on two grounds: (1) that appellant had not exhausted the intracompany remedies by way of appeal provided by Norcal’s underwriting guidelines, and (2) that appellant had not exhausted his governmental administrative remedies under sections 1858 et seq. and 11587. The trial court granted the summary judgment solely on ground (2), holding as to ground (1) that an issue of fact existed with respect to whether appellant did in fact exhaust Nor-cal’s internal remedies. Since we will affirm the judgment on ground (2) we shall confine our discussion to that ground.

It is established by the declarations that on March 10, 1977, 11 days before filing the second amended complaint, appellant’s counsel wrote to the Department of Insurance requesting a hearing before the Insurance Commissioner pursuant to section 1858 on the “following grounds”:

*312 “1. Dr. Wilkinson is a person aggrieved by the rate charged;
“2. Dr. Wilkinson is a person aggrieved by the rating plan;
“3. Dr. Wilkinson is a person aggrieved by the rating system;
“4. Dr. Wilkinson is a person aggrieved by the underwriting rule
followed by Norcal;
“5. Dr. Wilkinson is a person aggrieved by the underwriting rule adopted by Norcal.
“And, in particular that the insurance premium charged is excessive, inadequate, and/or unfairly discriminatory.”

This request was never answered in writing nor did the Insurance Commissioner take formal action in response thereto. However, in a declaration filed by Paul A. Eisler, counsel for appellant, in opposition to the motion for summary judgment, he states: “Since the writing of my letter of March 10, 1977 (Exhibit ‘K’) to the Department of Insurance I have had several telephone conversations with Mr. Loeb, and I was advised by him that any further action by the Department of Insurance either under Insurance Code § 1858 or § 11587 would not benefit the Plaintiff, Dr. Wilkinson, in this matter and that, therefore, the Department of Insurance feels that no further action should be taken by it as the administrative remedy, if any there is, would not aid Plaintiff but possibly cause Plaintiff further detriment as Norcal had the choice of cancelling Plaintiff’s insurance.”

In sum, appellant contends on this appeal that the trial court erred in granting Norcal’s motion for summary judgment because:

(1) Appellant exhausted all available governmental remedies; in any event it would have been futile to pursue the administrative remedies further because
(a) The Department of Insurance told appellant’s counsel in a telephone conversation that it did not intend to pursue the matter further and that the department could do nothing further for him.
(2) Were appellant to have pursued an administrative remedy under section 11587 any further he would have suffered irreparable injury and was therefore not required to continue with it.
*313 (3) Section 1858 does not provide an adequate or effective administrative remedy to an aggrieved individual, and appellant was therefore not required to pursue one under it.
(4) In any event summary judgment is improper because there was a triable issue of fact as to whether the administrative remedies were exhausted.
(5) Assuming summary judgment was proper, the action should have been abated and not dismissed.

It is well settled that a jurisdictional prerequisite to review by the courts is the exhaustion of all administrative remedies. (Abelleira v. District Court of Appeal (1941) 17 Cal.2d 280 [109 P.2d 942, 132 A.L.R. 715].) As the Abelleira court stated: “The rule itself is settled with scarcely any conflict. It is not a matter of judicial discretion, but is a fundamental rule of procedure laid down by courts of last resort, followed under the doctrine of stare decisis, and binding upon all courts. We are here asked to sanction its violation, either on the ground that a valid exception to the rule is applicable, or that despite the uniformity with which the rule has been applied, it may be disregarded by lower tribunals without fear of prevention by the higher courts. This last point cannot be too strongly emphasized, for the rule will disappear unless this court is prepared to enforce it. To review such action of a lower court only on appeal or petition for hearing would permit interference with the administrative proceeding pending the appeal or hearing, with the effect of completely destroying the effectiveness of the administrative body. The writ of prohibition can alone operate surely and swiftly enough to prevent this unfortunate result; and only if we recognize that the rule is jurisdictional will it be uniformly enforced.

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Cite This Page — Counsel Stack

Bluebook (online)
98 Cal. App. 3d 307, 159 Cal. Rptr. 416, 1979 Cal. App. LEXIS 2274, Counsel Stack Legal Research, https://law.counselstack.com/opinion/wilkinson-v-norcal-mutual-insurance-calctapp-1979.