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ÐÌò òà ` à1.€€à ¸ àPetitioner€Remains€Eligible€for€Benefits€Ð Ì# Ðà ` àà ¸ àas€a€Member€of€the€ERISA€Plan.€ó ó€.€.€.€.€.€.€.€.€.€.€.€.à x à11Ð Ê$  ÐÌò òà ` à2.€€à ¸ àRespondents€Agreed€to€Contract/Statutory€Ð Î&"" Ðà ` àà ¸ àDuties€to€Protect€Members.ó ó€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.à x à11Ð Ì'## ÐÌò òà ` à3.à ¸ àThe€COS€Imposed€in€the€ER€Ð Ð) %% Ðà ` àà ¸ àDenies€Limits€on€Member€Liability.€ó ó.€.€.€.€.€.€.€.€.€.à x à12Ð Î*&& ÐÐ Ò+"'' Ðñ‘Tññ’Tññ‘TñÑ?XÑÑ7€eXXd숈dþ7ÑØØÑ  Ññ‘Tññ’Tññ‘TñòòTABLE€OF€CONTENTS,€CONTððDóóà  àà p àà È àà  àà x àòòPAGEóóÐ ° Ðò òà ` à4.à ¸ àThe€Action€Presents€Clean,€Ð ° Ѐà ` àà ¸ àCovered€Claims.ó ó€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.à x à13Ð ®þ ÐÌò òà ` à5.€€à ¸ àRespondents€Breached€their€Duties€byÐ ² Ðà ` àà ¸ àLeaving€Petitioner€to€be€Dunned.ó ó€.€.€.€.€.€.€.€.€.€.€.€.€.à x à13Ð °  ÐÌÔ‡ ŠÁŠŠŠÁÔò òD.€à ` àSTATEMENT€OF€THE€CASEó ó€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.à x à15Ð ´  ÐÌÔ#†ŠÁŠŠ ŠÁq#Ôò òà ` à1.€€à ¸ àAt€the€Pleading€Stage,€the€Lower€CourtÐ ¸   Ðà ` àà ¸ àDismissed€the€ER€Doctors€Who€hadÌà ` àà ¸ àMerely€Followed€Their€Contract.ó ó€.€.€.€.€.€.€.€.€.€.€.€.à x à15Ð ´  ÐÔ‡ ŠÁŠŠŠÁÔÌÔ#†ŠÁŠŠ ŠÁ1#Ôò òà ` à2.à ¸ àThe€Lower€Court€ð ðSeverelyÐ ¸  Ðà ` àà ¸ àLimitedðð€UCL€Discovery.ó ó€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.à x à17Ð ¶ ÐÌò òà ` à3.à ¸ àRulings€on€Cross„Motions€BelowÐ º  Ðà ` àà ¸ àand€the€DCA€Ignored€DutiesÌà ` àà ¸ àto€Protect€Members.ó ó€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.à x à17Ð ¶ ÐÌò òE.€à ` àDISCUSSIONó ó€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.à x à18Ð º  ÐÌò òà ` à1.€€à ¸ àThe€Widespread€Practice€Imposing€FullÐ ¾ Ðà ` àà ¸ àLiability€for€Basic€ER€Care€Breaches€Ìà ` àà ¸ àRespondentsðð€Duties€to€Membersó ó€.€.€.€.€.€.€.€.€.€.€.€.€.à x à18Ð º  ÐÌà ` àà ¸ àò òa.€€à  àThe€Inclusion€of€InvalidÐ ¾ Ðà ` àà ¸ àà  àTerms€Deceives€Members.€ó ó.€.€.€.€.€.€.€.€.€.€.€.à x à20Ð ¼  ÐÌà ` àà ¸ àò òb.€€à  àBy€Declining€to€Contract€with€ER€Doctors,€Ð À! 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Ðà ` àà ¸ àà  àViolate€ERISA€and€State€Laws.ó ó€.€.€.€.€.€.€.€.à x à21Ð ¾&"" ÐÌò òà ` à2.€€à ¸ àContinued€Standing€is€Present€Ð Â($$ Ðà ` àà ¸ àUnder€the€New€UCL.€ó ó.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.à x à24Ð À)%% ÐÌ/€/€/Ð Ä+'' ÐòòTABLE€OF€CONTENTS,€CONTððDóóà  àà p àà È àà  àà x àòòPAGEóóÐ ° Ðò òà ` àà ¸ àa.€€à  àUCL€Standing€Should€be€Ð ° Ðà ` àà ¸ àà  àBroadly€Interpreted.ó ó€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.à x à24Ð ®þ ÐÌà ` àò òà ¸ àb.€€à  àThe€DCA€Cavalierly€RejectedÐ ² Ðà ` àà ¸ àà  àPetitionerððs€Factual€Injuries.ó ó€.€.€.€.€.€.€.€.€.€.à x à25Ð °  ÐÌà ` àò òà ¸ àc.€€à  àTaking€of€Policy€Rights€andÐ ´  Ðà ` àà ¸ àà  àDiminution€in€Value€Produce€Standing.ó ó€.à x à26Ð ²  ÐÌà ` àò òà ¸ àd.€€à  àIn€this€Public€Interest€Action,€Ð ¶  Ðà ` àà ¸ àà  àPetitioner€Retains€Capacity€to€Ìà ` àà ¸ àà  àMaintain€the€Action€Because€HeÌà ` àà ¸ àà  àShares€a€Common€Wrong.ó ó€.€.€.€.€.€.€.€.€.€.€.€.à x à26Ð °  ÐÌò òà ` à3.€€à ¸ àThe€Claims€do€not€Hinder€anyÐ ´ Ðà ` àà ¸ àJurisdiction€of€the€Department€ó ó.€.€.€.€.€.€.€.€.€.€.€.€.€.à x à29Ð ² ÐÌò òà ` à4.€€à ¸ àPetitioner€and€the€General€Public/Class€Ð ¶ Ðà ` àà ¸ àare€Entitled€to€Relief.ó ó€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.à x à30Ð ´ ÐÌà ` àà ¸ àò òa.€€à  àThe€UCL€Violation€Justifies€Relief€Ð ¸ Ðà ` àà ¸ àà  àfor€the€General€Public.ó ó€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.à x à31Ð ¶ ÐÌà ` àà ¸ àò òb.€€à  àERISA€Presents€a€Parallel€Basis€Ð º  Ðà ` àà ¸ àà  àfor€Relief€for€Members.ó ó€.€.€.€.€.€.€.€.€.€.€.€.€.€.à x à31Ð ¸ ÐÌò òà ` à5.€€à ¸ àClass€Procedures€Should€be€Ð ¼  Ðà ` àà ¸ àDeemed€Satisfied€and€Excused.ó ó€.€.€.€.€.€.€.€.€.€.€.€.€.€.à x à33Ð º  ÐÌà ` àò òa.€€à ¸ àFormalistic€Pleading€is€Not€Required.ó ó€.€.€.€.€.€.€.€.à x à33Ð ¾" ÐÌà ` àò òb.€€à ¸ àDelay€in€Certification€is€ExcusableÐ Â$  Ðà ` àà ¸ àand€Does€Not€Expand€Liability.ó ó€.€.€.€.€.€.€.€.€.€.€.€.€.à x à34Ð À%!! ÐÌò òF.€à ` àCONCLUSIONó ó€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.à x à37Ð Ä'## ÐÌò òCERTIFICATE€OF€APPELLATE€COUNSELó ó€.€.€.€.€.€.€.€.€.€.€.€.à x à37Ð È)%% ÐÌ/€/€/Ð Ì+'' Ðà@ää#àò òTABLE€OF€AUTHORITIESó óˆÐ ° ÐòòCASESà ¸ àà  àà h àà À àà  àà p àà È àà  àà x àPAGEóóÐ ®þ ÐòòAetna€Health€Inc,€v€Ô_ÔDavilaóó€(2004)€542€US€200€.€.€.€.€.€.€.€.€.€.€.€.€.€.à x à31Ð ®þ ÐÌòòAlch€v.€Superior€Courtóó€(2004)€122€Cal.App.4th€339€.€.€.€.€.€.€.€.€.€.à x à27,€34Ð ®þ ÐÌòòAlliance€for€a€Better€Downtown€Millbrae€v.€Wadeóó€€Ð ® þ Ðà ` à(2003)€108€Cal.App.4th€123€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€à x à2Ð ® þ ÐÌòòAmerican€Drug€Stores€v.€Harvard€Pilgrim€Health€Careóó€Ð ® þ  Ðà ` à(D.€Mass.€1997)€973€F.€Supp.€60€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.à x à31Ð ®þ  ÐÌòòAnderson€v.€Continental€Casualty€Companyóó€Ð ®þ  Ðà ` à(E.D.€Cal.€2003)€258€F.€Supp.€2d€1127€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€à x à21Ð ®þ  ÐÌòòBarquis€v.€Merchants€Collection€Assn.€of€Oaklandóó€Ð ®þ Ðà ` à(1972)€7€Cal.3d€94€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.à x à24Ð ®þ ÐÌòòBarela€v.€Superior€Courtóó€(1981)€30€Cal.3d€244€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.à x à27Ð ®þ ÐÌòòBartold€v.€Glendale€Federal€Bankóó€(2000)€81€Cal.App.4th€816€.€.€.à x à34Ð ®þ ÐÌòòBell€v.€Farmers€Insurance€Exchangeóó€Ð ®þ Ðà ` à(2004)€115€Cal.App.4th€715€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.à x à36Ð ®þ ÐÌòòBenton€v.€Vanderbiltóó€(2000€M.D.€Tenn.)€118€F.Supp.2d€877€.€.€.€.à x à19Ð ®þ ÐÌòòBode€v.€St€Josephððs€Health€Systemsóó€Ð ®þ Ðà ` à(C.D.€Cal.€2003)€€298€F.€Supp.2d€918€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.à x à23Ð ® þ ÐÌòòBrandt€v.€Superior€Courtóó€(1985)€37€Cal.3d€813€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.à x à9Ð ®"þ ÐÌòòBrochtrup€v.€Intepóó€(1987)€190€Cal.App.3d€323€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.à x à34Ð ®$þ  ÐÌòòBunker€v.€County€of€Orangeóó€(2002)€103€Cal.App.4th€542€.€.€.€.€.€.à x à27Ð ®&þ!" ÐÌòòCalifornia€Medical€Association€v.€Aetna€U.S.€Healthcare€Ð ®(þ#$ Ðà ` àof€California,€Incóó.€(2001)€94€Ô_ÔCal.AppÔ_Ô.4th€151€.€.€.€.€.€.€.€.€.€.à x à5Ð ®)þ$% ÐÌÐ ®+þ&' Ðà@àò òTABLE€OF€AUTHORITIES,€CONTððDó óˆÐ ° ÐòòCASES€CONTððDà  àà h àà À àà  àà p àà È àà  àà x àPAGEóóÐ ®þ ÐòòCalifornia€Water€&€Tel.€Co.€v.€Los€Angelesóó€Ð ®þ Ðà ` à(1967)€253€Cal.App.2d€16€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.à x à26Ð ®þ ÐÌòòChateau€Chamberay€Homeowners€Assn.€v.€Associated€Ð ® þ Ðà ` àIntððl.€Ins.€Co.óó€(2001)€90€Cal.App.4th€335€.€.€.€.€.€.€.€.€.€.€.€.€.à x à2,€24Ð ® þ ÐÌòòCisneros€v.€UD€Registryóó€(1995)€39€Cal.App.4th€548€.€.€.€.€.€.€.€.€.€.à x à26Ð ® þ ÐÌòòCity€of€Ontario€v.€Superior€Courtóó€(1970)€2€Cal.3d€335€.€.€.€.€.€.€.€.€.à x à34Ð ®þ  ÐÌòòCivil€Service€Employees€Ins.€Co.€v.€Superior€Courtóó€Ð ®þ  Ðà ` à(1978)€22€Cal.3d€362€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€à x à35Ð ®þ  ÐÌòòCoast€&€Southern€Fed.€S.€&€L.€Assn.€v.€Trans-Coast€Ð ®þ Ðà ` àS.€&€L.€Assn.óó€(1971)€16€Cal.App.3d€205€.€.€.€.€.€.€.€.€.€.€.€.€.€.à x à29Ð ®þ ÐÌòòCoast€Plaza€Doctors€Hospital€v.€Ô_ÔUHPÔ_Ô€Healthcareóó€Ð ®þ Ðà ` à(2002)€105€Cal.€App€4th€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.à x à5Ð ®þ ÐÌòòCollege€Hospital€Inc.€v.€Superior€Courtóó€(1994)€8€Cal.4th€704€.€.€.à x à20Ð ®þ ÐÌòòCommercial€Life€Ins.€Co.€v.€Superior€Court€of€San€Diego€Co.óó€Ð ®þ Ðà ` à(1988)€47€Cal.€3d€473€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.à x à32Ð ®þ ÐÌòòCorbett€v.€Superior€Courtóó€(2002)€101€Cal.App.4th€649€.€.€.€.€.€.€.€.à x à36Ð ®þ ÐÌòòCorsiniÔ_Ô€v.€United€Health€Plans€of€New€Englandóó€Ð ® þ Ðà ` à(D.R.I.€2001)€145€F.€Supp.€2d€184€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.à x à31Ð ®!þ ÐÌòòCortez€v.€Ô_ÔPurolatorÔ_Ô€Air€Filtration€Products€Co.óó€Ð ®#þ Ðà ` à(2000)€23€Cal.4th€163€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.à x à26,€31,€36Ð ®$þ  ÐÌòòCrisci€v.€Security€Ins.€Co.óó€(1967)€66€Cal.2d€425€.€.€.€.€.€.€.€.€.€.€.€.€.à x à26Ð ®&þ!" ÐÌòòDesert€Healthcare€Dist.€v.€Ô_ÔPacifiCareÔ_Ô,€FHP,€Inc.óó€Ð ®(þ#$ Ðà ` à(2001)€94€Ô_ÔCal.AppÔ_Ô.4th€781€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.à x à5Ð ®)þ$% ÐÌòòDonabedian€v.€Mercury€Ins.€Co.óó€(2004)€116€Cal.App.4th€968€.€.€.à x à29Ð ®+þ&' Їà@àò òTABLE€OF€AUTHORITIES,€CONTððDó óˆÐ ° ÐòòCASES€CONTððDà  àà h àà À àà  àà p àà È àà  àà x àPAGEóóÐ ®þ ÐòòEmployment€Devl.€Dept.€v.€Superior€Courtóó€Ð ®þ Ðà ` à(1981)€30€Cal.3d€256€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.à x à35Ð ®þ ÐÌòòEstate€of€Mendenhallóó€(1960)€182€Cal.App.2d€441€.€.€.€.€.€.€.€.€.€.€.à x à26Ð ® þ ÐÌòòEvangelatos€v.€Superior€Courtóó€(1988)€44€Cal.3d€1188€.€.€.€.€.€.€.€.à x à2Ð ® þ ÐÌòòEye€Dog€Foundation€v.€St.€Bd.€of€Guide€Dogs€for€the€Blindóó€Ð ® þ  Ðà ` à(1967)€67€Cal.2d€536€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.à x à32Ð ®þ  ÐÌòòFarmers€Ins.€Exchange€v.€Superior€Courtóó€Ð ®þ  Ðà ` à(1992)€2€Cal.4th€377€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.à x à30Ð ®þ  ÐÌòòFidelity€Federal€Savings€&€Loan€Assn.€v.€Longóó€Ð ®þ Ðà ` à(1959)€175€Cal.App.2d€149€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.à x à34Ð ®þ ÐÌòòFrieman€v.€San€Rafael€Rock€Quarryóó€Ð ®þ Ðà ` à(2004)€116€Cal.App.4th€29€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.à x à34Ð ®þ ÐÌòòGaines€v.€The€Sargent€Fletcher,€Inc.€Group€Life€Ins.€Planóó€Ð ®þ Ðà ` à(E.D.€Cal.€2004)€329€F.€Supp.2d€1198€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.à x à23Ð ®þ ÐÌòòGrauberger€v.€St.€Francis€Hosp.óó€Ð ®þ Ðà ` à(N.D.€Cal.€2001)€149€F.€Supp.2d€1186€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.à x à19Ð ®þ ÐÌòòHamwi€v.€Citinational„Buckeye,€Inc.óó€Ð ®þ Ðà ` à(1977)€72€Cal.App.3d€462€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€à x à33Ð ® þ ÐÌòòHartwell€Corp.€v.€Superior€Courtóó€(2002)€27€Cal.4th€256€.€.€.€.€.€.à x à30Ð ®"þ ÐÌòòHome€Sav.€&€Loan€Assn.€v.€Superior€Courtóó€Ð ®$þ  Ðà ` à(1974)€42€Cal.App.3d€1006€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.à x à35Ð ®%þ ! ÐÌòòHome€Sav.€&€Loan€Assn.€v.€Superior€Courtóó€Ð ®'þ"# Ðà ` à(1976)€54€Cal.App.3d€208€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.à x à35Ð ®(þ#$ ÐÌòòIzzi€v.€Mesquite€Country€Clubóó€(1986)€186€Cal.App.3d€1309€.€.€.€.à x à9Ð ®*þ%& ÐÐ ®+þ&' Ðà@àò òTABLE€OF€AUTHORITIES,€CONTððDó óˆÐ ° ÐòòCASES€CONTððDà  àà h àà À àà  àà p àà È àà  àà x àPAGEóóÐ ®þ ÐòòKentucky€Assn€of€Health€Plans€v.€Milleróó€Ô‡ ŠÁŠŠŠÁÔ(2003)€538€U.S.€329Ô#†ŠÁŠŠ ŠÁZJ#Ôñ‘Tññ’Tññ‘TñÔ‡Ša€ŠÐòòEmploÔñ‘Tññ’Tññ‘Tñ.€.€.à x à21Ð ®þ ÐÌòòKinlaw€v.€State€of€Californiaóó€(1991)€54€Cal.3d€326€.€.€.€.€.€.€.€.€.€.€.à x à4Ð ®þ ÐÌòòKraus€v.€Trinity€Management€Services,€Inc.óó€Ð ® þ Ðà ` à(2000)€23€Cal.€4th€116€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.à x àpassimÐ ® þ ÐÌòòLa€Sala€v.€American€Savings€and€Loanóó€(1971)€5€Cal.3d€864€.€.€.€.à x à27Ð ® þ  ÐÌòòMassey€v.€Bank€of€Americaóó€(1976)€56€Cal.App.3d€29€.€.€.€.€.€.€.€.€.à x à33Ð ®þ  ÐÌòòMcCall€v.€PacifiCare€of€Cal.,€Inc.óó€(2001)€25€Cal.4th€412€.€.€.€.€.€.€.à x à29Ð ®þ  ÐÌòòMcCormick€v.€Board€of€Supervisorsóó€Ð ®þ Ðà ` à(1988)€198€Cal.App.3d€352€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.à x à34Ð ®þ ÐÌÔ_ÔÔ_ÔòòMoore€v.€State€of€Californiaóó€(1984)€157€Cal.App.3d€715€.€.€.€.€.€.€.à x à34Ð ®þ ÐÌòòMoss€v.€Superior€Courtóó€(1998)€17€Cal.4th€396€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.à x à35Ð ®þ ÐÌòòNader€v.€€Allegheny€Airlinesóó€(1976)€426€U.S.€290€.€.€.€.€.€.€.€.€.€.€.€.à x à30Ð ®þ ÐÌòòNealy€v.€U.S.€Health€Careóó€(1999)€93€N.Y.2d€209€.€.€.€.€.€.€.€.€.€.€.€.€.à x à31Ð ®þ ÐÌòòOceanside€Union€School€District€v.€Superior€Courtóó€Ð ®þ Ðà ` à(1962)€58€Cal.2d€180€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.à x à10Ð ®þ ÐÌòòOchsÔ_Ô€v.€Ô_ÔPacificCareÔ_Ô€of€Californiaóó€Ð ®!þ Ðà ` à(2004)€115€Cal.€App.4th€782€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.à x à5,€30Ð ®"þ ÐÌòòOlszewski€v.€Scripps€Healthóó€(2003)€30€Cal.4th€798€.€.€.€.€.€.€.€.€.€.€.€.à x à35Ð ®$þ  ÐÌòòParnell€v.€Adventist€Health€System/Westóó€Ð ®&þ!" Ðà ` à(2005)€35€Cal.4th€595€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.à x à19Ð ®'þ"# ÐÌòòPastoria€v.€Nationwide€Insuranceóó€Ð ®)þ$% Ðà ` à(2003)€112€Cal.App.4th€1490€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.à x à20Ð ®*þ%& ÐÐ ®+þ&' Ðà@àò òTABLE€OF€AUTHORITIES,€CONTððDó óˆÐ ° ÐòòCASES€CONTððDà  àà h àà À àà  àà p àà È àà  àà x àPAGEóóÐ ®þ ÐòòPeople€v.€Freemont€Life€Insurance€Co.óó€Ð ®þ Ðà ` à(2002)€104€Cal.App.4th€508€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.à x à21,€25,€31Ð ®þ ÐÌòòPeople€v.€McKaleóó€(1979)€25€Cal.3d€626€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€à x à20Ð ® þ ÐÌòòPeople€v.€Toomeyóó€(1984)€157€Cal.App.3d€1€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.à x à25Ð ® þ ÐÌòòPodolsky›€v.€First€Healthcare€Corp.óó€œÐ ® þ  Ðà ` à(1996)›€50€Cal.App.4th€œ632€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.à x à9,€19Ð ®þ  ÐÌòòPrata€v.€Superior€Courtóó€(2001)€91€Cal.App.4th€1128€.€.€.€.€.€.€.€.€.à x à27Ð ®þ  ÐÌòòRiskin€v.€Towersóó€(1944)€24€Cal.2d€274€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€à x à34Ð ®þ  ÐÌòòRodas€v.€Spiegelóó€(2001)€87€Cal.App.4th€513€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.à x à7Ð ®þ ÐÌòòRodoloffÔ_Ô€v.€Provident€Life€and€Accident€Companyóó€Ð ®þ Ðà ` à(S.D.€Cal.€2003)€256€F.€Supp.€2d€1137€.€.€.€.€.€.€.€.€.€.€.€.€.€.à x à32Ð ®þ ÐÌòòSamuraÔ_Ô€v.€Kaiser€Foundation€Health€Plan,€Inc.óó€Ð ®þ Ðà ` à(1993)€17€Ô_ÔCal.AppÔ_Ô.4th€1284€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.à x àpassimÐ ®þ ÐÌòòSatten€v.€Webbóó€(2002)€99€Cal.App.4th€365€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.à x à30Ð ®þ ÐÌòòSerafini€v.€Blakeóó€(1985)€167€Cal.€App.€3d€Supp.€11€.€.€.€.€.€.€.€.€.€.à x à19Ð ®þ ÐÌòòSolorzano€v.€Superior€Courtóó€(1992)€10€Cal.€App.€4th€1135€.€.€.€.à x à8,€28,€29,€32Ð ® þ ÐÌòòSouza›€v.€Capital€Co.óó€(1963)€220€Cal.App.2d€œ744€.€.€.€.€.€.€.€.€.€.€.€.à x à34Ð ®"þ ÐÌòòState›€Farm€Fire€&€Casualty€Co.€v.€Pietakóó€œÐ ®$þ  Ðà ` à(2001)›€90€Cal.App.4th€œ600€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.à x à34Ð ®%þ ! ÐÌòòState€Farm€Fire€&€Casualty€Co.€v.€Superior€Courtóó€Ð ®'þ"# Ðà ` à(1996)€45€Cal.App.4th€1093€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.à x à30Ð ®(þ#$ ÐÌòòStocks€v.€City€of€Irvineóó€(1981)€114€Cal.App.3d€520€.€.€.€.€.€.€.€.€.€.à x à28Ð ®*þ%& ÐÐ ®+þ&' Ðà@àò òTABLE€OF€AUTHORITIES,€CONTððDó óˆÐ ° ÐòòCASES€CONTððDà  àà h àà À àà  àà p àà È àà  àà x àPAGEóóÐ ®þ ÐòòUniversity€of€Southern€California€v.€Superior€Courtóó€Ð ®þ Ðà ` à(1990)€222€Cal.App.3d€1028€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.à x à22Ð ®þ ÐÌòòValley€Bank€v.€Superior€Courtóó€(1975)€15€Cal.3d€652€.€.€.€.€.€.€.€.€.€.à x à9Ð ® þ ÐÌòòVasquez€v.€Superior€Courtóó€(1971)€4€Cal.3d€800€.€.€.€.€.€.€.€.€.€.€.€.€.à x à10,€25Ð ® þ ÐÌòòViles€v.€State€of€Californiaóó€(1967)€66€Cal.2d€24€.€.€.€.€.€.€.€.€.€.€.€.€.à x à34Ð ® þ  ÐÌòòWershba€v.€Apple€Computer,€Inc.óó€(2001)€91€Cal.App.4th€224€.€.€.à x à28Ð ®þ  ÐÌòòWertheim€v.€Hartford€Life€Insurance€Co.óó€Ð ®þ  Ðà ` à(E.D.€Va€2003)€268€F.€Supp.€2d€643€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.à x à24Ð ®þ  ÐÌòòWhiteside€v.€Tenet€Healthcare€Corp.óó€Ð ®þ Ðà ` à(2002)€101€Cal.App.4th€693€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.à x à7,€27Ð ®þ ÐÌòòWilens€v.€T.D.€Waterhouse€Group,€Inc.óó€Ð ®þ Ðà ` à(2003)€120€Cal.App.4th€746€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€à x à27Ð ®þ ÐÌòòWilner€v.€Sunset€Life€Ins.€Companyóó€Ð ®þ Ðà ` à(2000)€78€Cal.App.4th€952€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.à x à33Ð ®þ ÐÌSTATE€STATUTESÌBusiness€and€Professions€Code€Section€17200€et€seq.€.€.€.€.€.€.€.€.€à x à2Ð ®þ ÐÌBusiness€and€Professions€Code€Section€17204€.€.€.€.€.€.€.€.€.€.€.€.€.€.à x à24Ð ® þ ÐÌCode€of€Civil€Procedure€Section€382€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€à x à33Ð ®"þ ÐÌCode€of€Civil€Procedure€Section€473€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.à x à10,€33Ð ®$þ  ÐÌÔ‡ ŠÁŠŠŠÁÔEvidence€Code€Section€452(c)€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€à x à7Ð ®&þ!" ÐÌÔ#†ŠÁŠŠ ŠÁ(f#Ôñ‘Tññ’Tññ‘TñÔ‡Ša€Š ÐÌòÔñ‘Tññ’Tññ‘TñÔ‡ ŠÁŠŠŠÁÔEvidence€Code€Section€459€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€à x à7Ð ®(þ#$ ÐÌÔ#†ŠÁŠŠ ŠÁg#Ôñ‘Tññ’Tññ‘TñÔ‡Ša€Š ÐÌòÔñ‘Tññ’Tññ‘TñÔ‡ ŠÁŠŠŠÁÔHealth€and€Safety€Code€Section€1317€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.à x à6Ô#†ŠÁŠŠ ŠÁh#Ôñ‘Tññ’Tññ‘TñÔ‡Ša€Š ÐÌòÔñ‘Tññ’Tññ‘TñÐ ®*þ%& ÐÐ ®+þ&' Ðà@àò òTABLE€OF€AUTHORITIES,€CONTððDó óˆÐ ° ÐSTATE€STATUTES€CONTððDà À àà  àà p àà È àà  àà x àPAGEÐ ®þ ÐHealth€and€Safety€Code€Section€1340€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.à x à2Ð ®þ ÐÌHealth€and€Safety€Code€Section€1360€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.à x à8,€19,€20,€22Ð ®þ ÐÌHealth€and€Safety€Code€Section€1371€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.à x à8,€22,€24Ð ® þ ÐÌHealth€and€Safety€Code€Section€1371(c)€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.à x à24Ð ® þ ÐÌHealth€and€Safety€Code€Section€1371.4€.€.€.€.€€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.à x à8,€22,€29Ð ®þ  ÐÌHealth€and€Safety€Code€Section€1371.35(f)€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.à x à8,€22Ð ®þ  ÐÌHealth€and€Safety€Code€Section€1371.37(e)„(f)€.€.€.€.€.€.€.€.€.€.€.€.€.€.à x à29Ð ®þ  ÐÔ‡ ŠÁŠŠŠÁÔÌÔ#†ŠÁŠŠ ŠÁm#Ôñ‘Tññ’Tññ‘TñÔ‡Ša€Š ÐÌòÔñ‘Tññ’Tññ‘TñÔ‡ ŠÁŠŠŠÁÔHealth€and€Safety€Code€Section€1379€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€à x à7,€12,€21,€29Ð ®þ ÐÌÔ#†ŠÁŠŠ ŠÁ…m#Ôñ‘Tññ’Tññ‘TñÔ‡Ša€Š ÐÌòÔñ‘Tññ’Tññ‘TñHealth€and€Safety€Code€Section€127630(a)(5)€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.à x à4Ð ®þ ÐÌRevenue€and€Taxation€Code€Section€5140€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.à x à26Ð ®þ ÐFEDERAL€STATUTESÌ29€U.S.C.€ðð1001€et€seq.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.à x à2Ð ®þ ÐÌ29€U.S.C.€ðð1132€(a)(1)(B)€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.à x à32Ð ®þ ÐÌÔ‡ ŠÁŠŠŠÁÔ42€U.S.C.€1395dd€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.à x à6Ð ®þ ÐÔ#†ŠÁŠŠ ŠÁdp#Ôñ‘Tññ’Tññ‘TñÔ‡Ša€Š ÐÌòÔñ‘Tññ’Tññ‘TñOTHER€CALIFORNIA€AUTHORITIESÐ ®þ Ð28€Cal.€Code€of€Regs.€1300.63.1(c)(9)€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.à x à19Ð ® þ ÐÌ28€Cal.€Code€of€Regs.€1300.67(g)(1)€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.à x à21Ð ®"þ ÐÌ28€Cal.€Code€of€Regs.€1300.67.8€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.à x à7,€21,€29Ð ®$þ  ÐÌ28€Cal.€Code€of€Regs.€1300.70€(b)(2)(H)1€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.à x à8Ð ®&þ!" ÐÌ28€Cal.€Code€of€Regs.€1300.71€(b)(2)€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.à x à8,€22Ð ®(þ#$ ÐÌ28€Cal.€Code€of€Regs.€1300.71(e)€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.à x à24Ð ®*þ%& ÐÐ ®+þ&' Ðà@àò òTABLE€OF€AUTHORITIES,€CONTððDó óˆÐ ° ÐOTHER€CALIF.€AUTHORITIES€CONTððDòòà p àà È àà  àà x àPAGEóóÐ ®þ Ð28€Cal.€Code€of€Regs.€1300.71(e)(6)€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.à x à7Ð ®þ ÐÌ28€Cal.€Code€of€Regs.€1300.71(e)(8)€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.à x à8,€22Ð ®þ ÐÌ28€Cal.€Code€of€Regs.€1300.71€(h)€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€à x à24Ð ® þ ÐÌAB€1455€(ch.€827€stats€2000)€Section€1(c)„(d)€.€.€.€.€.€.€.€.€.€.€.€.€.€.à x à4,€29Ð ® þ ÐÌCalifornia€Rules€of€Court,€Rule€28(b)(1)€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.à x à10Ð ®þ  ÐÌCalifornia€Rules€of€Court,€Rule€28.1(e)(1)€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€à x à7Ð ®þ  ÐÌCalifornia€Rules€of€Court,€Rule€28.1(e)(2)€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€à x à10Ð ®þ  ÐÌCalifornia€Rules€of€Court,€Rule€1850(b)€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.à x à33Ð ®þ ÐÌProposition€64€(2004)€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.à x àpassimÐ ®þ ÐÌProposition€99€(1988)€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.à x à4Ð ®þ ÐOTHER€FEDERAL€AUTHORITIESÌ29€Ô_ÔC.F.R.Ô_Ô€2560.503„1(b)(1)€(2000)€€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.à x à23Ð ®þ ÐÌ29€C.F.R.€2560.503„1€(b)(1)(iii)€(2000)€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.à x à23Ð ®þ ÐÌ29€C.F.R.€2560.503„1€(d)(3)€(2000)€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.à x à23,€24Ð ®þ ÐÌ29€Ô_ÔC.F.R.Ô_Ô€2560.503„1€(e)€(2000)€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.à x à32Ð ® þ ÐÌ29€Ô_ÔC.F.R.Ô_Ô€2560.503„1€(f)(3)„(4)€(2000)€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.à x à24Ð ®"þ ÐÌ29€C.F.R.€2560.503„1€(o)€(2002)€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.à x à23Ð ®$þ  ÐÌFederal€Rules€of€Civil€Procedure,€Rule€23(b)(2)€.€.€.€.€.€.€.€.€.€.€.€.€.€.à x à28Ð ®&þ!" ÐOTHER€STATE€AUTHORITIESÌ20€N.Y.L.€Sch.€J,€Intððl€&€Comp.€L.€249€(2000)€.€.€.€.€.€.€.€.€.€.€.€.€.€.à x à31Ð ®(þ#$ ÐÌ83€Boston€U.€Law€Review€553,€(June€2003)€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.€.à x à6,€14ñ‘Tññ’Tññ‘TñÔ†ÿÿÔÔ†ÿÿÔÔ  ÔÔ  Ôñ‘TñÑ?XÑÑ7€eXXdìXXdì7ÑØØÑ  Ññ’Tññ“TñÐ ®*þ%& ÐÐ ®+þ&' ÐÑO‹¼ ÑÑ€PÑÙÙØ ØÑ  Ññ“Tññ”Tññ“TñÑO¿ ÑÙÙØ ØÑ  ÑÑO÷* ÑØ ØÑ  Ññ“Tññ”Tñà@,,$àò òPETITION€FOR€REVIEWˆÐ ° Ðó óÌÓÓTO€THE€HONORABLE€RONALD€M.€GEORGE,€CHIEF€JUSTICE,€ANDÏHONORABLE€ASSOCIATE€JUSTICES€OF€THE€SUPREME€COURT€OFÏCALIFORNIA:Ìà ` àROBERT€J.€COHEN€(ð ðpetitionerðð)€petitions€for€review€of€the€decision€ofÏthe€Fourth€District€Court€of€Appeals,€Division€Three€(per€Richard€Fybel,€J.)€Ï(ð ðDCAðð),€affirming€the€Superior€Court€of€Orange€Countyððs€(ð ðlower€courtðð)Ïjudgment€in€favor€of€HEALTH€NET€OF€CALIFORNIA,€INC.€(ð ðHealth€Netðð)€andÏLOS€ALAMITOS€MEDICAL€CENTER,€INC.€(ð ðLos€Alamitosðð)€(collectivelyÏð ðrespondentsðð).€€That€decision€is€Ex.€1a›.€€The€order€of€the€DCA€of€May€25,€2005,Ïœmodifying€its€decision,›€denying€rehearing,€and€ordering€partial€publication€is€œEx.›Ï1b.€€Some€of€the€issues€œherein›€are€related€to€cases€pending€or€granted€review:ÓÓÌÌò òRELATED€CASES/SUPREME€COURT€NO.ó óÐ ®þ ÐòòKids€Against€Pollution€v.€California€Dental€Assn.óó€œS117156›Ð ¬ü ÐòòCalifornia€for€Disability€Rights€v.€Mervynððsóó€œS131798›Ð ¬ü ÐòòBranick€v.€Downey€Savings€&€Loan€Assnóó€œS132433›Ð ¬ü ÐòòBenson€v.€Kwikset€Corp.óó€œS142443›Ð ¬ ü ÐòòBivens€v.€Corel€Corp.óó€œS132695›Ð ¬!ü ÐòòLytwyn€v.€Fryððs€Electronics,€Inc.óó€œS133075›Ð ¬"ü ÐòòFrey€v.€Trans€Union€Corp.óó€œS133272›Ð ¬#ü ÐòòThornton€v.€Career€Training€Centeróó€œS133275›Ð ¬$ü  ÐòòFoundation€Aiding€the€Elderly€v.€Superior€Courtóó€œS133293›Ð ¬%ü ! М̛ÌÓ=ƒÓà ` àœNumerous€related›€cases€œare›€also€pending€in€the€œlower€courts.Ì/€/€/Ð ¬*ü%& Ðò òA.€€à ` àISSUES€PRESENTEDó óÐ ° Ðà ` à1.€€Petitioner,€like€millions,€purchased€HMO€coverage€from€Health€NetÏwhose€advertising€and€Evidence€of€Coverage€(ð ðEOCðð)€state€that›€member€liabilityÏis€limited€to€a€co„payment.€œThat€limitation€is€contradicted›€by€form€Conditions€ofÏService€(ð ðCOSðð)€imposed€œby€in„network›€Emergency€œRooms›€(ð ðERðð),€œa€time€ofÏconspicuous›€consumer€œvulnerability.€€Have›€respondents€violated€Health€and€SafetyÏCode€ðð€œ1340›€et€seq.,œ×ƒ ×Ý ƒ%#ÃÝòòÚ  Ú1Ú  ÚóóÝ  Ý×  ×›€œ29€U.S.C.€ðð1001€et€seq.€(ð ðERISAðð),€or€Business€andÐ ¬ü  ÐProfessions€Code€ðð€17200€et€seq.€(ð ðUCLðð),€when›€they€promise€members€will€œò òonly›ó óÐ ¬ü  Ðbe€responsible€for€co„payments,€fail€to€pay,€and€impose€full€member€liability€forÏroutine€ER€care?Ìà ` à2.€€œWhat›€relief€is€available€to€œmembers€who€paid€ER€bills,€or€premiums€forÏER€care€where€pre„paid€care€was€not€established€at€assigned€network€hospitals?Ìà ` à3.€€The€DCA€did€not€apply€the€presumption€in€òòEvangelatos€v.€SuperiorÐ ´ ÐCourtóó€(1988)€44€Cal.3d€1188,€1207„1208.€€Does€Proposition€64€applyÐ ´ Ðretroactively?Ìà ` à4.€€When€bills€were€not€paid,€care€was€disrupted,€petitioner€was€dunned,Ïcalled€at€home€at€night,€and€threatened€with€credit€ruination€and€litigation.€€HasÏpetitioner€suffered€ð ðinjury€in€fact€and€.€.€.€lost€money€or€propertyðð,€even€though€heÏrefused€to€pay€the€bills?Ð ´($$ Ðà ` à5.€€Under€what€circumstances€will€compliance€be€met€where€cross„motionsÏfor€summary€judgment€were€determined€without€class€certification€as€authorizedÏunder€former€law?Ìà ` à6.€€Should€this€action€be€granted€review€and€consolidated/held€with€relatedÏactions?€€Because€of€alternative€stated€grounds,€limited€review€may€not€alter€theÏresults€below.Ìò òB.€€WHY€THIS€ACTION€DESERVES€REVIEW€AS€TO€ALL€ISSUES.ó óÐ °  Ðà ` àThis€case€challenges€HMO€practices€that€shift€downstream€risk€to€largeÏnumbers€of€members€for€bills€not€paid€by€often€bankrupt,€intermediary€physiciansððÏassociation/medical€groups€(ð ðIPAðð).€€The€issues€divide€into:€ð ðbalance€billingðð€ofÏmembers€for€unpaid€provider€claims€(issues€1€and€2),€and€Proposition€64€(issues€3„¼6).€€However,€injury€for€standing€under€Proposition€64€(issue€4)€flows€from€theÏinjury€caused€by€balance€billing.€€The€facts€were€ripened€in€cross„motions€forÏjudgment.€€òòChateau€Chamberay€Homeowners€Assn.€v.€Asso.€Intððl.€Ins.€Co.óó€(2001)Ð ¬ü Ð90€Cal.App.4th€335€(issues€of€law€remain);€òòAlliance€for€a€Better€DowntownÐ ¬ ü ÐMillbrae€v.€Wadeóó€€(2003)€108€Cal.App.4th€123,€1299€(reviewed€òòde€novoóó).€€PublicÐ ¬"ü Ðinterest€is€present€in:€a)€stability€for€a€teetering€emergency€care€system,€b)€rights€ofÏmembers€to€be€held€harmless€for€ER€care;€and€c)€application€of€Proposition€64.Ìà ` àThe€DCA€prejudiced€the€public€interest€in€two€ways.€›€œFirst,€it€permits€anÏongoing€failure€of€Health€Net€to€timely€pay€ER€bills€which€has€been€determined€toÐ ¬*ü%& Ðð ðjeopardize€the€health€care€delivery€system.ðð€€Joint€Appendix€(ð ðJAðð)€p.€1876.׃@×Ý ƒ%#ÃÝòòÚ  Ú2Ú  ÚóóÝ  Ý×  ׀Р° ÐSecond,€it€allows€members€to€continue€being€duped›€into€paying€œtheir€HMOððs€bills›Ïby€œð ðresponsibilityð𛀜terms€imposed€in€form€COS.›€€œThe€DCA€contradicts€lawÏdisapproving€of€balance€billing€and€provides€precedent€that€unpaid€ER€doctorsÏfreely€bill€members,€who€in€turn€have€no€judicial€remedy€against€the€HMO.€€IfÏreview€is€not€granted€at€this€time,€or€the€opinion€is€depublished,€restitution€will€beÏprecluded€for€periods€of€high€IPA€defaults.Ìò ò1.€€The€ER€Funding€Crisis€Invokes€Important€Public€Concern.ó óÐ ° Ðà ` àThe€legislature€has€declared€that€ð ðthere€is€a€looming€health€care€crisis€inÏAmerica.ðð€€€ðð€127630(a)(5).€€Voters€agreed€by€adopting€Proposition€99€in€1988Ïwhich€taxed€cigarette€sales€to€fund€ò òuninsuredó ó€ER€care.€€Ballot€materials€explainedÐ ¬ü Ðthat,€ð ðThe€truth€is€it€takes€money€to€deliver€medical€care.ðð€€However,€ñTñTñTññŽTñtñŽTñhat€initiativeÏdid€not€abate€the€dilemma€in€ERs.€€òòSeeóó€òòKinlaw€v.€State€of€Californiaóó€(1991)€54Ð ´ ÐCal.3d€326.€€Indeed,€the€funding€crisis€has€expanded€to€HMOs,€where€theÏlegislature€has€found€that,€€ð ð[T]here€is€an€urgent€need€to€resolve€.€.€.€[payment€ofÏER€claims].ðð€€AB€1455€(ch.€827€stats.€2000)€ðð€1(c)„(d).Ì/€/€/Ì/€/€/Ð ´&"" Ðò òa.€€Absent€a€Contract€with€Health€Net,€ER€Doctors€Have€No€Recourse€AgainstÐ ° ÐHMOs.Ìó óà ` àHowever,€in€2001€instead€of€urgent€resolution,€HMOs€added€a€profit„Ð ¨ø Ðmotivated€shell€game€that€further€reduces€ER€doctorsðð€ð ðmoney€to€deliver€medicalÏcareðð€ò òeven€though€the€member€is€insuredó ó.€€Emerging€cases€held€that€providersÐ ¨ ø Ðdo€not€have€a€recourse€against€HMOs€for€unpaid€claims€assigned€to€IPAs.€ÏUnrecognized€below,€those€cases€also€held€that€HMOs€owe€duties€to€members.€ÏòòCalifornia€Medical€Asso.€v.€Aetna€U.S.€Healthcare€of€Cal.,€Incóó.€(2001)€94Ð ° ÐÔ_ÔCal.AppÔ_Ô.4th€151,€166€(HMO€duty€is€owed€ð ðto€the€enrollees€.€.€.€not€to€Physiciansðð);ÏòòDesert€Healthcare€Dist.€v.€Ô_ÔPacifiCareÔ_Ô,€FHP,€Inc.óó€(2001)€94€Ô_ÔCal.AppÔ_Ô.4th€781;€€òòCoastÐ ° ÐPlaza€Doctors€Hospital€v.€Ô_ÔUHPÔ_Ô€Healthcareóó€(2002)€105€Cal.App€4th€693,€703„704;Ð ° ÐòòÔ_ÔOchsÔ_Ô€v.€Ô_ÔPacificCareÔ_Ô€of€Californiaóó€(2004)€115€Cal.€App.4th€782,€791€(ER€physicianÐ ° Ðhas€C/A€against€member€who€has€C/A€against€HMO).€€Without€a€directÏrelationship,€there€is€nothing€for€ER€doctors€under€the€HMO€shell.Ìò òb.€€Health€Netððs€Underfunded€Intermediaries€Routinely€Fail€to€Pay.ó óÐ °  Ðà ` àHealth€Net€requires€that€ER€claims€be€submitted€pursuant€to€unspecifiedÏð ðindustry€standardsðð.€€JA€p.€1786.€€Uncontradicted€evidence€showed€that,€takingÏadvantage€of€cases€insulating€HMOs,€the€industry€standards€changed€in€2001€whenÏER€physicianððs€claims€were€delegated€to€IPAs.€€JA€p.€3308.Ì/€/€/Ð ¬*ü%& Ðà ` àIPAs€assume€the€risk€of€loss€if€costs€of€care€exceed€the€ð ðcapitatedðð€(perÏmember)€monthly€payment€set€by€the€HMO.€€JA€p.€3143.€€Providers€trying€toÏcollect€from€IPAs€experience€a€wide€shortfall€because€of€ubiquitous€IPAÏinsolvency.€€Between€1997€and€1999,€ò ò115€California€IPAs€declared€bankruptcyó ó,Ð °  Ðdisrupting€care€for€2.5€million€HMO€members.€€83€Boston€University€Law€ReviewÏ553,€557€and€564€(June€2003).€€The€years€1999€though€2003€experienced€similarÏdefault€rates€when€ò òanother€140€of€Health€Netððs€IPAs€closedó ó€for€financial€reasons.€Ð ¸  ÐJA€p.€3144.€€The€only€evidence€is€that€IPA€insolvency€is€caused€by€actuariallyÏunsound€payments€to€IPAs,€especially€in€unpredictable€and€often€uncontrollableÏareas€like€oncology€and€radiology.€€JA€p.€3144.€€California€IPAs€are€in€aÏð ðDarwinian€struggle€for€survival,ðð€where€success€depends€on€ð ðavoiding€the€high„¼cost€patients€who€need€us€most.ðð€€€€83€Boston€U.€Law€Review€553,€564€(JuneÏ2003).€€Health€Net€never€contested€that€it€ð ðknew€or€should€have€known€about€thisÏnotorious€problem€that€was€the€subject€of€industry„wide€debate,€study,€and€publicÏhearings€well€before€the€treatment€of€plaintiffððs€son€in€2001.ðð€€JA€p.€3144„45.Ìò òc.€€Unpaid€ER€Doctors€Must€Either€Donate€to€HMO€Profits€or€DunnÐ À" ÐMembers.ó óÐ ¼$  Ðà ` àHealth€Net€converts€ER€doctors€into€involuntary€contributors€to€its€massiveÏâ âsubsidy.€€€ðð€1317;€42€U.S.C.€1395dd€(ER€ò òmustó ó€stabilize€without€regard€to€ability€toÐ ¸($$ Ðpay);€Ex.€2€p.€4€(ð ðnumber€[of€claims]€.€.€.€may€be€largeðð).׃ ×Ý ƒ%#ÃÝòòÚ  Ú3Ú  ÚóóÝ  Ý×  ×€€The€member€is€not€atÐ ° Ðâ ârisk€where€the€provider,€seeking€referrals,€implements€non„recourse€arrangements.€ÏJA€p.€1616€(Jeremyððs€ò ònonó ó„emergency,€ò òcontractedó ó€COS€at€Long€Beach€MemorialÐ ° ÐHospital,€Para.€12:€ð ðThe€patientððs€plan€will€be€financially€responsible,€subject€toÏco„payments.€.€.ðð€for€covered€services);€òòseeóó€òòWhiteside€v.€Tenet€Healthcare€Corp.óóÐ ¸  Ð(2002)€101€Cal.App.4th€693,€703.€€However,€Health€Net€explained€that€itsÏgatekeeper€power€is€ineffective€with€ER€doctors€who€are€ð ðhistorically€unwillingððÏto€contract€with€its€rag„tag€IPAs,€because€ð ðthey€donððt€need€.€.€.€patient€referralsðð.€ÏReporterððs€Transcript€(ð ðRTðð)€p.Ô‡ ŠÁŠŠŠÁÔ€94Ô#†ŠÁŠŠ ŠÁ¾©#Ô.€€With€ER€doctors€unwilling€to€bear€IPA€risk,Ð ¸ ÐHealth€Net€forgets€ðð1379€protection,€violating€28€Cal.€Code€of€Regs.€1300.67.8.Ìà ` à€€Health€Net€still€fails€to€pay€ER€physicians.€€The€2005€Department€actionÏrequired€some€reimbursement€for€providers/members,€but€made€findings€only€as€toÏclaims€underpaid€by€an€80%€reimbursement€scheme€over€a€ò ò10€month€period€inÐ ¸ Ð2004ó ó,€and€omitted€ò òcompletelyó ó€unpaid€claims€during€years€of€IPA€failures.€€Ex.€2Ð À Ðpp.€1,€5.€€Additional€shrinkage€is€assured€because€members€are€reimbursed€only€ifÏthey€initiate€a€claim€to€be€mixed€in€with€other€mail,€rather€than€using€availableÏprovider€collection€reports.€€Ex.€2€pp.€3,€5;€òòseeóó€JA€pp.€1772,€1825.€€After€only€ò ò10Ð È$  Ðmonthsó ó€ò òofó ó€ò òlimited€reliefó ó,€the€Department€then€ò ògives€up€four€òòyearsóó€of€furtherÐ ° Ðenforcement€ó óð ðfor€the€balance€billing€.€.€.€between€January€1,€ò ò2000ó ó€and€October€12,Ð ¸ Ðò ò2004ó ó".€€Ex.€2€at€6.€€This€court€is€membersðð€last€resort,€having€been€rejected€by€theÐ À ÐDCA€and€deserted€by€the€industry„dominated€Department€for€times€of€high€IPAÏdefault.€€The€exclusive€jurisdiction€found€by€the€DCA€is€just€another€empty€shell.ÌÔ‡ ŠÁŠŠŠÁÔò ò2.€€Members€Deserve€to€be€Held€Harmless€from€Widespread€HMO€RiskÐ È  ÐShifting.ó óÐ Ä  ÐÔ#†ŠÁŠŠ ŠÁ ¯#Ôà ` àHealth€Net€owes€it€members€duties€regardless€of€delegation.€€òòSolorzano€v.Ð À ÐSuperior€Courtóó€(1992)€10€Cal.App.4th€1135,€1144„45€(deception).€€€Health€NetÐ À Ðmust€supervise€the€financial€and€administrative€capacity€of€its€IPAs€(JA€p.€2740Ï[admits€duty],€28€Cal.€Code€of€Regs.€€ðð1300.70€(b)(2)(H)1),€and€must€assumeÏclaims€if€the€IPA€fails.€28€Cal.€Code€of€Regs.€ðð1300.71(e)(6);€ðððð€1360;€1371.4Ï(must€pay€for€ER€care);€1371;€and€1371.35€(f)€(HMOððs€duty€ð ðshall€€not€€be.€.€.Ïwaived€when€the€plan€requires€its€[IPA].€.€.€to€pay€claims.€.€.ðð);€28€Cal.€Code€ofÏRegs.€ðð1300.71€(b)(2)€(cure€misdirection€of€claims)€and€ðð1300.71(e)(8).€ÌÔ‡ ŠÁŠŠŠÁÔà ` àÔ#†ŠÁŠŠ ŠÁž²#ÔWithout€payment,€the€ER€doctors,€ð ðcanððt€be€sure€who€is€responsible€otherÐ À" Ðthan€the€member.ðð€€JA€p.€3309.€€Downstream€risk€for€basic€ER,€like€the€$713Ïbilled€to€petitioner,€is€shifted€to€the€member.€€The€pre„paid€plan€member€is€leftÏholding,€and€being€beaten€with,€the€ER€stick.€€Ô‡ ŠÁŠŠŠÁÔUncontradicted€evidence€shows€thatÐ À($$ Ðbalance€billing€of€members€for€unpaid€costs€of€care€ð ðis€a€large€and€serious€problemÐ À*&& Ðin€the€HMO€industry.€.€.€.€Members€are€often€billed€by€providers€for€supposedlyÏcovered€claims.ðð€€JA€p.€3145;€òòseeóó€1711€(Amount€unpaid€to€one€ER€by€one€IPA€isÐ ° Ð$5121.69).Ô#†ŠÁŠŠ ŠÁ´#Ô€€During€the€litigation,€tÔ‡ ŠÁŠŠŠÁÔhe€ER€doctors€declared€that€members€ð ðonÐ ° Ðoccasionðð€pay€the€bills.€€JA€p.€3309.€€However,€before€litigation,€when€petitionerÏcalled€and€complained€that€HMO€liability€was€being€foisted€on€him,€the€ER€groupÏresponded,€ð ðIt€happens€a€lot.ðð€€JA€p.€3035;€òòseeóó€Ex.€2,€p.€3€(there€ð ðmay€be€.€.€.Ð °  Ðmembers€who€.€.€.€have€paid€sums€.€.€.€in€excess€of€their€financial€responsibilitiesÏ[in€the€EOC]ðð).Ô#†ŠÁŠŠ ŠÁâµ#ÔÔ‡ ŠÁŠŠŠÁÔÐ ° Ðà ` àBillings€are€coercive€because€of€the€need€for€continuing€treatment,€creditÏreporting€can€affect€loan€costs,€patients€can€be€unwilling€to€disappoint€their€trustedÏdoctors,€and€consumers€would€rather€pay€than€litigate.€€JA€pp.€1928,€3145.€ÏSimilarly,€the€COS€is€adhesive.€€Ô#†ŠÁŠŠ ŠÁä·#ÔÔ‡ ŠÁŠŠŠÁÔòòPodolsky€v.€First€Healthcare€Corp.óó€(1996)€50Ð ° ÐCal.App.4th€632,€Ô#†ŠÁŠŠ ŠÁV¹#ÔÔ‡ ŠÁŠŠŠÁÔ652Ô#†ŠÁŠŠ ŠÁð¹#ÔÔ‡ ŠÁŠŠŠÁÔ„54Ô#†ŠÁŠŠ ŠÁ5º#Ô;€òòIzzi€v.€Mesquite€Country€Clubóó€(1986)€186€Cal.App.3dÐ ° Ð1309,€1318.›€œÔ‡ ŠÁŠŠŠÁÔ€Ô#†ŠÁŠŠ ŠÁغ#ÔRespondentsðð€COS€contradicts€the€promises€by€requiring€members›€toÐ ° Мguaranty€payment€for€basic€ER€care.€€òòPodolskyóó,€supra€pp.€645„46€(TermsÐ °  Ðð ðguarantorðð›€and€œð ðresponsible›€œpartyðð›€are€œequivalent).›€€The€œDCA€held›€œthis›€œpractice›Ïœlawful,€refusing€enforcement€of€HMO€duties,€€ERISA,€and€UCL.€€It›€presentsÏœwidespread›€œinterest›€œof€first€impression€warranting€review.›€€òòBrandt€v.€SuperiorÐ °&"" ÐCourtóó€(1985)€37€Cal.3d€813,€816;€òòValley€Bank€v.€Superior€Courtóó€(1975)€15€Cal.3dÐ °($$ Ð652,€œ655.›€€œMillions›€of€œmembers›€deserve€to€be€œheld›€harmless€from€œbalance€billing.€Ð °*&& ÐThe€consumerððs€central€purpose€in€buying€coverage,€to€shift€the€risk€of€costs€to€aÏpool€of€insureds,€is€damaged€by€respondentsðð€shedding€risk€back€to€members.€€JAÏpp.€3143„44.Ô‡ ŠÁŠŠŠÁÔ€€Ô#†ŠÁŠŠ ŠÁо#ÔIn€òòVasquez€v.€Superior€Courtóó€(1971)€4€Cal.3d€800,€808,€this€courtÐ ° Ðheld€that,€ð ð[p]rotection€of€unwary€consumers€from€being€duped€.€.€.€is€an€exigencyÏof€the€utmost€priority€in€contemporary€society.ððÌò ò3.€€Proposition€64€is€Leading€to€Inconsistency.ó óÐ °  Ðà ` àProposition€64€has€divided€the€courts€and€ð ðgeneral€guidelines€can€be€laidÏdown€for€future€cases,ðð€resolving€conflicts,€and€providing€uniformity.€€òòOceansideÐ ¬ü  ÐUnion€School€District€v.€Superior€Courtóó€(1962)€58€Cal.2d€180,€185„86;€CaliforniaÐ ¬ü ÐRules€of€Court,€Rule€28(b)(1).€€Additionally,€petitioner€is€one€of€few€affectedÏplaintiffs€in€pending€petitions.€€The€DCA€took€a€view€of€continued€standing€thatÏcontradicts€the€remedial€UCL.€€It€is€of€first€impression€and€review€can€provideÏguidance€on€standing€as€well€as€Code€of€Civil€Procedure€ðð€473€relief.Ìà ` àPetitionerððs€arguments€on€Proposition€64€generally€duplicate€those€ofÏsimilar€parties€in€the€related€petitions€at€p.€1.€€He€incorporates€arguments€that€theÏinitiative€operates€prospectively€only€pursuant€to€Cal.€Rules€of€Court,€RuleÏ28.1(e)(2).€€Discussion€of€Proposition€64€below€is€limited€to€the€issues€of€standingÏand€class€procedures,€assuming€retroactivity€òòarguendoóó.Ð ¬&ü!" Ð/€/€/Ì/€/€/Ð ¬*ü%& Ðò òC.€€STATEMENT€OF€FACTS.ó óÐ ° Ðò ò1.€€Petitioner€Remains€Eligible€for€Benefits€as€a€Member€of€the€ERISA€Plan.ó óÐ ¬ü Ðà ` àPetitioner›€and€his€then€16€year€old€son€Jeremy,€œremain›€participants€œin›€œhisÏemployerððs€ERISA›€plan€(JA€œp.€3037),›€and€formerly€were€members€of€œan€HealthÏNet›€œHMO›€offered€œto€the€public€and€as€a€service€within€that€ERISA€plan.€€JA€pp.Ï1163€(membership),›€1201€(Jeremy€œeligible),›€œ1569,›€œ1716.€€After€enrollment,€HealthÏNet€unilaterally€changed€petitionerððs€selected€group,€a€still„solvent€Allied,€to€LongÏBeach€IPA€without€disclosure€of€any€financial€problems.€€JA€p.€€3031.Ìò ò2.€€Respondents€Agreed€to€Contract/Statutory€Duties€to€Protect€Members.ó óÐ ¨ø Ðà ` àUnlike€a€Kaiser„type€plan,€Health€Net€does€not€provide€care,€but€ð ðarrangesÏmedical€service€.€.€.€through›€contracts€with€œIPAs€and€hospitals.ðð€€JA€pp.€123,€19Ï(2.1€million€members),€3143€(one€of€the€largest€California€HMOs);€1148,›€1740Ïœ(ð ðrequired›€by€law€to€œarrangeð𛀜prepaid€care).€€Ô‡ ŠÁŠŠŠÁÔHospital€services€for€members›Ð ¤ô Ðinvolve€œ440›€in„network€hospitals€in€California.€€JA€œpp.€1695,€1945.€€Los›€AlamitosÏis€one€of€œ41€Tenet›€Hospitals€œcontracting€member€ER€services.€€JA›€œpp.€1162„63›Ïœ(admits›€œTenet›€œHealthcare€hospital);›€œ1576,›€1883€œ(admits›€œð ða›€contracted€hospitalÏwhere€œmembers.›€.€.€could€receive€medical€œservicesðð).ÌÔ#†ŠÁŠŠ ŠÁMÈ#ÔÔ‡ ŠÁŠŠŠÁÔà ` àHealth›€Netððs€marketing€œmatrix€(JA›€œpp.€1589„90),€and€its›€œEOC›€(JA€œpp.›€œ1595„Ð ¤&ô!" Ð96)›€mailed€to€œmembers›€œafter€enrollment€(JA›€p.€œ126)›€state€that€members€will€òòonlyóóÐ ¤(ô#$ Ðbe€responsible€for€œa€$50.00›€co„payment€œfor€non„admitted›€emergency€œcare,›Ð ¤*ô%& Ðincluding€òòbothóó€facilities€and€professional€services.€€JA€œp.€311€(form€ð ðbasis€ofÐ ° Ðcoverageðð);€1595„96€(ER€$50€co„payment);›€œ1805›€and€œ1816,›€œand›€œ1892„93›€œ(co„¼payment);›€1589„90€œ(advertising€matrix);›€1579€œ(plain›€language€œexpert€for€ðð€1360Ïstandard);›€Ô_Ô1732€and€1882€œ(matrix›€œauthorized›€by€Health€œNet)Ô_Ô.ÌÔ#†ŠÁŠŠ ŠÁÊ#Ôà ` àThe€agreement›€between€Los€Alamitos€and€Health€Net€œappears›€consistentÐ °  Ðwith€the€œadvertising€and›€EOC€when€at€JA€p.€1744€it€œprovides:ÌÓÓà8 ` àà ¸ àIn€no€event,€.€.€.€shall€any€member€be€liable€for€sums€owed€byÏHEALTH€NET,€and€neither€HOSPITAL€ò ònor€any€health€careÐ °  Ðprovider€rendering€services€to€Members€pursuant€to€thisÏagreement€shall€bill,ó ó€charge,€collect€a€deposit€or€other€sum€or€seekÐ ² Ðcompensation,€remuneration€or€reimbursement€from,€or€maintain€anyÏaction€or€have€any€other€recourse€against€a€Member.€.€.Ð ` Ð ` Ð  ÐÌÓµÍÓà ` àòòSee€alsoóó€€ðð1379;€JA€pp.€1770€(cannot€bill€ER€costs€to€ð ðmembers›€for€anyÐ ¶ Ðsuch€serviceðð);€1744€œ(surcharge›€œprohibited).Ìò ò3.€€The€COS€Imposed€in€the€ER€Denies€Limits€on€Member€Liability.ó óÐ ¶ Ðà ` àTenet›€œform€COS›€œstill€in›€use€œ(JA€pp.€2533„34)›€œspawns€downstream€memberÏrisk€by€contradicting€limited€liability:ÌÓÓà8 ` àI›€further€understand€that€œI›€am€responsible€to€the€hospital€andÏphysician(s)€for€all€reasonable€œcharges›€incurred€by€me€and€not€paidÏby€third€party€œbenefits.€[JA€pp.€1605„09]›Ð ` Ð ` Ð  ÐÌÓÓà ` àœSimilarly,€Los€Alamitos€did€not€pass€on€any€prohibition€against€billingÏmembers€to€its€ER€physicians.€€JA€pp.€1804,€1815.€›€œThere€was€no€ð ðbilling€error.ðð€ÏER€doctors€merely€followed€their€contract€with€Los€Alamitos€which€states:Ì/€/€/Ð ²+'' ÐÓÓà8 ` à[ER€Doctorsðð]€Group€shall€separately€bill€patients€for€professionalÏservices€rendered€pursuant€to€this€agreement€.€.€.€.€€JA€p.€1827.Ó8ÓÓÐ ` Ð ` Ð  Ðò ò4.€€The€Action€Presents€Clean,€Covered€Claims.ó óÐ ° Ðà ` àJeremy›€received€œER€services›€from€Los€Alamitos€on€March€15,€2001,€andÏœsuffered›€two€episodes€of€œseizures›€œin€June›€œand›€œNovember›€œof€2001.›€€JA€pp.€œ1571„72.›€ÏœCoverage€is€clear.€€JA›€pp.€1740€œ(ð ðemergencyðð›€defined);€œ1801›€and€1813€œ(medically›Ïœnecessary);›€1884€œ(transported€by€ambulance);€2856€(ð ðThere€are€no€non„coveredÏservicesðð).€€The€evidence€uniformly€shows€that€all€co„payments€were€paid.€€JA€ppÏ1571„2;€1717;€1885.Ìò ò5.€€Respondents€Breached€their€Duties€by€Leaving€Petitioner€to€be€Dunned.ó óÐ ¬ü Ðà ` àDisruptions€to€Jeremyððs€care€occurred€after€his€November€2001€seizure,Ïwhen€he€urgently€required€a€referral€to€a€neurologist.€€At€that€time,€petitioner€wasÏdenied€access€to€a€referral€by€his€ð ðprimary€careðð€physician€until€he€changed€IPAsÏbecause€Long€Beach€IPA€had€not€been€paying€its€bills.€€JA€p.€1573„74.€€PetitionerÏpromptly€called€Health€Net€who€refused.€€He€called€the€Department€Ô‡ ŠÁŠŠŠÁÔandÐ ¨ø Ðcomplained€about€the€referral€denial.€€It€intervenedÔ#†ŠÁŠŠ ŠÁØ#Ô.€€JA€pp.€1574„75,€1626€(phoneÐ ¨!ø Ðbills).€€During€the€calls,€Health€Net€asked€if€petitionerððs€complaint€to€the€DMHCÏwould€be€resolved€if€it€changed€his€IPA.€€The€DCA€infers€some€waiver€whenÏpetitioner€stated€ð ðthat€it€would,€but€mentioned€all€of€the€bills€that€[he]€had€beenÏreceiving.ðð€€JA€p.€€1574.€€Without€any€time€to€investigate,€Health€Net€immediatelyÏresponded€that€the€bills€were€in€error€and€should€be€ignored.€€JA€pp.€1574,€3034.Ð ¨+ø&' Ðà ` àÔ‡ ŠÁŠŠŠÁÔThe€IPA€plays€a€central€role€in€authorizing€and€paying€for€care.€€JA€pp.Ð ° Ð1595€(ð ðAlways€present€your€.€.€.€[ID]€card.ðð);€1710€(ID€states:€ð ðTO€DOCTORðð,Ïcontact€Long€Beach€IPA).€€ER€providers€are€required€to€consult€and€getÏauthorization€from€the€IPA.€€JA€p.€1747,€1770,€1785.Ô#†ŠÁŠŠ ŠÁ›Ú#Ô€€The€president€of€LongÐ °  ÐBeach€IPA€stated€that€payment€of€claims€was€its€obligation,€ð ðincluding€non„¼admitted€emergency€room€professional€services.ðð€JA€p.€3206.€€Long€Beach€IPAððsÏcontract€with€Health€Net€shows€ER€professional€services€as€part€of€a€ð ðshared€riskÏpoolðð€of€the€IPA,€but€Health€Net€expunged€particulars.€€JA€pp.€2928€and€2933.€Ïð ðShared€risk€poolsðð€are€items€budgeted€to€the€IPA€which€can€be€adjusted€based€onÏdeviation€from€the€initial€amount€set€by€the€HMO.€€83€Boston€U.€Law€R.€553,€560Ïfn€34,€580€(June€2003).Ìà ` àThe€ER€providers€first€billed€Long€Beach€IPA€as€follows:€a)€04/04/01€forÏservices€provided€03/15/01;€b)€08/14/01€for€services€provided€06/07/01;€and€c)Ï12/05/01€for€services€provided€11/13/01.€€JA€pp.€2727„31.€€However,€due›€to€anÏœunder€funded›€œdelegation€by›€œHealth€Net€of›€œoncology›€œcosts€in€2001,›€Long€BeachÏIPA€œbecame€insolvent.€€It€eventually€joined€the€hundreds€of€other€Health€Net€IPAsÏin€disruptive€bankruptcy€proceedings€in€January€2002.€€JA€pp.€3207.€€The€ERÏdoctors,€CA€EM„1€MED€SERVICES,›€œare€listed›€œas€creditors›€œin€that€filing.›€€JA€p.Ï1711€($5121.69€œunpaid).€€Ô‡ ŠÁŠŠŠÁÔWhen€petitioner€inspected€that€file,€he€found€publiclyÐ °($$ Ðfiled€claim€forms€containing€his,€and€thousands€of€other€membersðð€personalÐ °*&& Ðidentification€and€medical€information,€including€the€diagnosis€and€treatment€ofÏJeremy.€€JA€pp.€3031,€3039„54.Ô#†ŠÁŠŠ ŠÁšà#Ô€The€IPA€ð ðshellðð€had€nothing€under€it€but€insult€toÐ ° Ðmembersðð€privacy.Ìà ` àÔ‡ ŠÁŠŠŠÁÔThe€ER€doctors€also€submitted€an€ð ðon€demandðð€statement€on€12/01/01€toÐ °  ÐHealth€Net.€€JA€p.€2448.€Ô#†ŠÁŠŠ ŠÁgâ#ÔÔ‡ ŠÁŠŠŠÁÔ€Following€its€own€advice,€Health€NetÔ#†ŠÁŠŠ ŠÁ"ã#ÔÔ‡ ŠÁŠŠŠÁÔ€ignored€the€bills,Ð °  Ðpaid€nothing,€and€requested€no€information.€€JA€pp.€Ô#†ŠÁŠŠ ŠÁ‰ã#Ô1575,€2727„31Ô‡ ŠÁŠŠŠÁÔ.€€The€ERÐ °  Ðdoctors€remained€unpaid€for€a€year.€€Petitioner€was€billed€numerous€times,€sent€toÏcollections,Ô#†ŠÁŠŠ ŠÁ4ä#ÔÔ‡ ŠÁŠŠŠÁÔ€called€at€home€at€night,€and€threatened€with€credit€ruination€and€suit.€Ð ° ÐJA€pp.€1573„75.€€Like€millions€of€members€assigned€to€insolvent€IPAs,€he€becameÏthe€only€payment€ð ðpeaðð€left€under€any€Health€Net€shell.ÌÔ#†ŠÁŠŠ ŠÁóä#Ôò òD.›€STATEMENT€OF€THE€CASEó óÐ ° Мò ò1.€€At€the€Pleading€Stage,€the€Lower€Court€Dismissed€the€ER€Doctors€WhoÐ ¬ü Ðhad€Merely€Followed€Their€Contract.ó óÐ ¨ø Лà ` àœPetitioner›€filed€the€complaint€œAugust›€12,€œ2002.€€JA€pp.€1,€3.€€ImmediateÏservice€on€Health€Net€followed.€€JA€p.€1850€(August€14,€2002).€€SubstitutedÏcounsel€promptly€moved€to€amend.€€JA€pp.€47,€49,€340€(granted).€€RespondentsÏdemurred.€€RT›€pp.€2„3;€JA€pp.€œ355,›€œ371,›€œ384.›€€œPetitioner€opposed.›€€JA€p.€œ421.›€€œLos›ÏAlamitos€œargued€it›€œhas›€a€œright›€œas€a€matter€of€law€to›€œcollect€from€petitioner€pursuant›Ïto€the€œCOS,€even€though€petitioner€never€signed.›€€JA€œpp.›€œ614,€1571„72.›€€DemurrersÏwere€sustained€with€œleave.›€€JA€p.€œ629.Ð ¤*ô%& Ðà ` àThe€operative›€Second€Amended€Complaint€(ð ðSACðð)€œalleged€petitionerððs›Ïmembership€in€Health€Netððs€HMO€œindividually,€and›€that€œhe€brings›€the€action€ð ðonÏbehalf€of€the€general€publicðð.€€œJA›€p.€636.€œ€The›€SAC€alleges€breach€œof€duty€in›€notÏconfiguring€œER›€œcare€to›€comply€with€the€œEOC›€œand›€law,€and€permitting€thatÏœconfiguration›€to€continue€after€notice,€with€the€specific€intent€to€avoid€costs€ofÏdoing€business.€€JA€p.€636.€€The€SAC€alleges€a€conflict€between€the€œEOC›€and€theÏœadhesive€COS›€œimposed›€by€Tenet€hospitals€like€Los€œAlamitos.›€€JA€pp.€œ636„38.›€ÏHealth€Net€is€alleged€to€œnot›€œpay€numerous›€œclaims€through€systematic€practices,›Ïwhich€œare€then€billed€to€and€paid€by€the›€œmembers.€€Respondents€are€alleged€to€beÏunjustly›€œenriched.›€€JA€p.€œ639.€›€Restitution€œfor:›€œthe›€value€of€œER€bills€paid€byÏmembers,€and€unearned€premiums€paid€for›€œER€care,›€œand€declaratory›€and€injunctiveÏrelief€œare€sought.›€€JA€p.€œ647.Ìà ` àRespondents€demurrered.€€JA›€pp.€834,€œ846,›€1002.€€œPetitioner€opposed.›€€JAÏp.€971,€œ981„2.›€€The€lower€courtððs€ruling€on€demurrers€œdismissed›€the€ER€œphysicians.€ÏJA›€pp.€œ1011„12.›€€Los€Alamitosðð€demurrers€were€overruled€to€C/A€2€through€4,Ïsustained€as€to€remainder€without€œleave.›€€JA€p.€1010.€€Health€Netððs€demurrers€wereÏoverruled€as€to€C/A€1€through€5,€sustained€as€to€œremainder›€without€œleave.›€€òòIdóó.€Ð °$  МRespondents›€answered.€€JA€pp.€€1148€(Health€Net),€1162€(Los€œAlamitos).Ì/€/€/Ì/€/€/Ð °*&& Ðò ò2.€€The€Lower€Court€Precluded€UCL€Discovery.ó óÐ ° Ðà ` àPetitioner€attempted€UCL€discovery,€described€by€Health€Net€as€ð ðseverelyÏlimitedðð€by€lower€court€rulings.€€RT€p.€46:13.€€Interrogatories€seeking€IDs€ofÏmembers€whose€claims€were€paid€late€or€communicating€about€ER€bills€[JA€p.Ï450,€456,€484„488]€were€denied€as›€œburdensome.›€€JA€pp.€œ907„08;›€RT€p.€œ25.›€ÏœSubpoenas€seeking€blank›€œER€COS›€œfrom›€œ44›€of€the€440€Health€Netððs€in„networkÏœhospitals€[RT€pp.€73„4;€JA›€pp.€œ2750„54]€were€quashed€on€motion€of€respondentsÏ[JA›€pp.€1509,€œ1931,€2705]€as€irrelevant.›€€JA€p.€œ2769.Ìà ` àPetitionerððs€Requests€for€Admissions›€œseeking€to€establish€widespreadÏinsolvency€by€IPAs€supervised€by€Health€Net€[JA›€pp.€1392,€œ1400„17]€wereÏobjected€to€by€motion€for€protective€order.€€JA›€pp.€1308,€1387,€œ2742.›€€€œPetitioner›Ïœopposed.›€€JA€pp.€œ2720„37.›€€The€lower€court€granted€œprotection€and›€œsanctionedÏcounsel›€ò òandó ó€petitioner€œ$2050.›€€JA€pp.€2755„56;€RT€pp.€œ60›€œ(only€ò òthisó ó›€IPA€and€ò òyouró óÐ ¬ü Мclient€relevant);›€œ64.€€Petitioner€reasonably€ceased€discovery€after€sanctions€wereÏimposed€on€him€personally€for€relevant€information€sought€by€counsel.Ìò ò3.€€Rulings€on€Cross„Motions€Below€and€the€DCA€Ignored€Duties€to€ProtectÐ ´" ÐMembers.ó óÐ °$  Лà ` àPetitioner€moved€for€summary€adjudication€œof€the›€UCL.€€JA€pp.€1548„1930.€ÏœRespondents›€œseparately€moved›€for€summary€judgment€œof€the›€SAC.€€JA€œpp.›€1953€etÏœseq.,›€œ1975€et€seq.›€œ€Petitionerððs€motion›€was€denied,€œrespondentsðð€motions€wereÐ ¬*ü%& Ðgranted,›€and€judgments€œentered.›€€JA€pp.€€œ3381„82,›€3422€et€seq.,€œ3445„55.€ÏRespondents€filed€cost€bills€totaling€$10,000.€€JA›€œpp.›€œ3413,€3456.›€€œPetitionerððsÏmotion›€to€Tax/Strike/Fix€œhis€fees›€œwas›€œdenied,›€except€as€to€œHealth€Netððs€$164€inÏð ðtrialðð€exhibits.€€JA›€pp.€3466„67€œ(Payment€Ô‡ ŠÁŠŠŠÁÔinsufficientÔ#†ŠÁŠŠ ŠÁîö#Ô€correction).Ð °  Ðà ` àNotice›€of€Appeal€œwas›€timely€œfiled.›€€JA€p.€œ3463.€€The€decision€of€the€DCAÏaffirming€the€judgment€was€entered€April€27,€2005.€€Ex.€1a.€€Petitioner€requestedÏrehearing€May€3,€2005.€€On€May€25,€2005,€the€DCA€denied€rehearing,€certifiedÏpublication€except€parts€IV„VI,€and€modified€its€opinion€to€reverse€discoveryÏsanctions€resulting€in€Ô‡ ŠÁŠŠŠÁÔa€change€in€the€judgmentÔ#†ŠÁŠŠ ŠÁ½ø#ÔÔ‡ ŠÁŠŠŠÁÔ.€€Ex.€1b.Ð ° ÐÔ#†ŠÁŠŠ ŠÁù#Ôò òE.€DISCUSSIONó óÐ ° Ðà ` àThe€argument€is€divided€into€three€groups:€Section€1„„the€merits€of€the€UCLÏclaims;€followed€by€the€related€Section€2„„standing€under€Proposition€64;€and,ÏSections€3€through€5„„theories€in€avoidance€of€the€merits€and€remedy.Ìò ò1.›€€The€Widespread€Practice€œImposing›€Full€Liability€for€œBasic€ER€CareÐ ¬ü ÐBreaches€Respondentsðð€Duties€to€Members.›€œó óÐ ¨ ø Ðà ` àLos›€Alamitos€œauthorized›€Health€Net€to€represent€that€œit€provides›€ER€care€onÏa€œpre„paid›€œbasis.€›€œJA›€pp.€1593,€œ1760,€1812.€€It€also€contracts›€with€Health€Net€toÏprovide€œER€services›€œconsistent›€with€the€œEOC.€€JA›€pp.€1805,€1816,€1744.€€œIt€thenÏignores›€the€agreed€limitations€œas€to€ER›€care€(JA€pp.€614,€1607),€and€œimposes›€ò òfulló óÐ ¤(ô#$ Ðliability€on€members€œfor€100%€of›€ò òbothó ó€ER€doctors€ò òandó ó€facilities€charges€as€if€aÐ ¬*ü%& Мpre„paid›€policy€did€not€exist.€€€JA€pp.€364,€œ1606,›€œÔ‡ ŠÁŠŠŠÁÔòòcontraóó€JA€pp.€1780€(Health€NetÐ ° Ðrate€is€75%€of€facilities€charges),Ô#†ŠÁŠŠ ŠÁ]ý#Ô€2730„31€(Health€Net€paid€less€than€amountsÐ ° Ðdunned),€3068„69€(EOB€for€facilities€charges).€€While€the€DCA€cited€the€ERÏdoctorsðð€agreement€to€accept€reductions€ò òif€paid€by€the€HMOó ó€[Ô‡ ŠÁŠŠŠÁÔJA€p.€1828Ô#†ŠÁŠŠ ŠÁËþ#Ô],€theÐ °  Ðmember€has€no€way€to€ascertain€any€reduction€that€is€not€reflected€in€the€bills.Ìà ` àThe›€respondents€cannot€œconvert›€a€œð ðco„paymentðð›€into€a€ð ðdown€œpaymentðð›Ïœconsistent€with›€œreasonable€expectations€of€consumers€of€basic€ER€services€orÏðð1360.›€œ€28€Cal.€Code€of€Regs.€1300.63.1(c)(9)€(EOC€must€identify€exclusions).›ÏThe€COS€œnullifies€a›€memberððs€œproperty›€œinterest€in€limited€liability.€€Petitioner€ð ðgotÏwhat€he€paid€forðð€only€if€he€waived€those€property€rights,€stood€as€guarantor€ofÏperformance€by€Health€Net€and€its€intermediaries,€and€only€after€seven€months€ofÏlitigation.Ìà ` àFull€liability€cannot€be€a€condition€of€care€already€required€by€the€EOC.€ÏòòSeeóó€Ô‡ ŠÁŠŠŠÁÔòòPodolsky€v.€First€Healthcare€Corp.óó€(1996)€50€Cal.App.4th€632,€at€Ô#†ŠÁŠŠ ŠÁý#ÔÔ‡ ŠÁŠŠŠÁÔ652Ô#†ŠÁŠŠ ŠÁ†#ÔÔ‡ ŠÁŠŠŠÁÔ„54Ð ¸ Ð(guaranties€for€services€already€required€by€law€Ô#†ŠÁŠŠ ŠÁË#ÔÔ‡ ŠÁŠŠŠÁÔð ðlack€considerationðð);Ô#†ŠÁŠŠ ŠÁV#Ô€òòParnell€v.Ð ¸  ÐAdventist€Health€System/Westóó€(2005)€35€Cal.4th€595,€601€(hospital€lien€limited€toÐ ¸" Ðagreement„„ð ðwe€simply€give€effect€to€its€contractsðð);€òòSerafini€v.€Blakeóó€(1985)€167Ð ¸$  ÐCal.€App.€3d€Supp.€11,€12;€òòBenton€v.€Vanderbiltóó€(2000€M.D.€Tenn.)€118€F.€Supp.Ð ¸&"" Ð2d€877€(collection€limited€to€agreement);€òòseeóó€òòGrauberger€v.€St.€Francis€Hosp.óóÐ ¸($$ Ð(N.D.€Cal.€2001)€149€F.€Supp.2d€1186€(balance€billing€prohibited).€€The€DCA€is€atÐ ¸*&& Ðodds€with€standard€contract€law€by€exempting€HMOs€from€promises€to€millions€ofÏmembers€for€basic€ER€services.Ìò òa.€€The€Inclusion€of€Invalid€Terms€Deceives€Members.Ð ° Ðó óà ` àThe€mere€inclusion€of€invalid€liability€terms€is›€an€unlawful€œpractice›€becauseÐ ¬ ü Ðof€the€likelihood€that€œmembers€will›€be€deceived.€€òòPeople€v.€McKaleóó€(1979)€25Ð ¬ ü ÐCal.3d€œ626;›€œòòaccordóó›€Ô_ÔòòSamuraÔ_Ô€v.€Kaiser€Foundation€Health€Plan,€Inc.óó€(1993)€17Ð ¬ü  ÐÔ_ÔCal.AppÔ_Ô.4th€1284,€1297€œ(Ô‡ ŠÁŠŠŠÁÔð ðIt›€is€an€unfair€or€fraudulent€business€practice€to€assert€aÐ ¬ü  Ðcontractual€right€that€one€does€not€haveððÔ#†ŠÁŠŠ ŠÁO#Ô);€œòòseeóó€òòPastoria›€v.€Nationwide€InsuranceóóÐ ¬ü  Ð(2003)€112€Cal.App.4th€1490,€1497€œ(nondisclosure›€of€imminent€reductions€inÏœcoverage).€€Thus,€the€COS€violates€ðð1360€and€the€UCL€even€had€no€member€everÏbeen€billed.Ìò òb.€€By€Declining€to€Contract€with€ER€Doctors,€Health€Net€has€Failed€to€EarnÐ ¬ü ÐPremiums€Paid€for€ER€Care.ó óÐ ¨ø Ðà ` àThere€is€no€provider€of€routine€ER›€care€ò òon€the€stated€termsó ó,€and€HealthÐ ¤ô ÐNet€has€failed€to€make€œpre„paid€arrangements›€for€ER€services.€œ€JA›€p.€1740€(HealthÏNet€is€ð ðrequired€by€law€to€arrange€œfor€[services]€.€.€.›€œon›€a€prepaid€œbasisðð);€RT€p.€91Ï(tie€a€Health€Net€ð ðribbonðð€around€an€ER€care€ð ðstrawðð).›€€Health€Netððs€knowledgeÏthat€œER›€doctors€œare€historically€non„contracted›€œimplies€ratification.€€òòSee›€œóóJA›€œp.€›Ð ¬&ü!" М1780€(Health›€Net€œreviews€contracts);€òòCollege€Hospital€Inc.€v.€Superior€CourtóóÐ ¬(ü#$ Ð(1994)€8€Cal.4th€704,€726.€€Respondents€have€no€defense€ð ðeven€when€theirÐ ¬*ü%& Ðconduct€is€consistent€with€industry€standards.ðð€€€òòPeople€v.€Freemont€Life€Ins.€Co.óóÐ ° Ð(2002)€104€Cal.App.4th€508,€526.Ìà ` àThe€most€certain€way€to€prevent€balance€billing€is€for€Health€Net€to€payÏclaims€when€services€are€provided.€€Health€Net€need€only€arrange€a€directÏrelationship,€similar€to€that€with€Los€Alamitos.€€JA€pp.€1746,€3308„09€(like€otherÏHMOs);€28€Cal.€Code€of€Regs.€1300.67.8€(ð ðWritten€contracts€must€be€executedÏ[for]€.€.€.€each€provider€.€.€.€which€regularly€furnishes€services.€.€.ðð).€€Routine€ERÏservices€are€ð ðregularly€furnishedðð€since€they€must€be€included€in€basic€HMOÏcoverage.€€28€Cal.€Code€of€Regs.€1300.67(g)(1);€òòsee€óóJA€p.€1711€($5121.69€unpaidÐ ° Ðto€one€ER€by€one€IPA).€€€Form€COS€can€then€easily€be€aligned€with€the€EOC€toÏprevent€continuing€member€deception.€€ðð1379;€JA€p.€1616.€€The€DCA€wronglyÏdecided€this€issue€of€first€impression€when€it€left€pre„paid€members€at€risk.Ìò òc.€€The€Respondents€Simultaneously€Violate€ERISA€and€State€Laws.ó óÐ ° Ðà ` àThe€DCA€acknowledged€Ô_ÔERISAÔ_Ô€jurisdiction€by€recasting€the€SAC,€butÏfound€no€material€deception€or€violation€using€dates€of€claims€presentation€toÏHealth€Net€after€the€litigation€commenced.€€Such€holding€conflicts€with€publishedÏauthorities€and€deserves€review.€€Memberððs€rights€under€state€laws€affectingÏinsurance€and€the€risk€pooling€arrangement€are€saved€under€ERISA.€€òòAnderson€v.Ð ¬&ü!" ÐContinental€Casualty€Companyóó€(E.D.€Cal.€2003)€258€F.€Supp.€2d€1127,€1132,Ð ¬(ü#$ Ðòòcitingóó€òòKentucky€Assn€of€Health€Plans€v.€Milleróó€(2003)€538€U.S.€329).€€€The€DCAÐ ¬*ü%& Ðcreates€a€conflict€since€ðð€1360€et€seq.€has€been€found€enforceable€under€ERISA,Ïdespite€any€Department€jurisdiction.€€òòSamura€v.€Kaiser€Foundation€Health€Plan,Ð ° ÐInc.óó€(1993)€17€Ô_ÔCal.AppÔ_Ô.4th€1284,€1299.Ð ° Ðà ` àHealth€Net€violated€surviving€statutory€duties.€ðð1371.4€(must€pay€for€ERÏcare);€€ðððð1371€and€1371.35(f)€(an€HMOððs€duty€to€promptly€pay€ð ðshall€not€be€.€.€.Ïwaived€when€the€plan€requires€its€[IPA].€.€.€to€pay€claims.€.€.ðð);€28€Cal.€Code€ofÏRegs.€ðð€1300.71€(b)(2)€(cure€misdirection€within€10€days);€ðð€1300.71€(e)(8).€€TheÏDCAððs€finding€that€the€ER€bills€were€not€delegated€is€based€on€a€statement€thatÏdoes€not€actually€deny€delegation,€but€merely€concludes€that€the€IPA€was€ð ðnotÏresponsibleðð.€€JA€p.€2876.€€Petitioner€timely€objected.€€JA€p.€3341.€€InadmissibleÏevidence€is€not€substantial.€€òòUniversity€of€Southern€California€v.€Superior€CourtóóÐ ° Ð(1990)€222€Cal.App.3d€1028,€1035.€€The€contract€speaks€for€itself.€€The€courtsÏbelow€forgot€the€proper€scope€of€inquiry€on€summary€judgment.Ìà ` àAs€to€the€timing€of€payments,€the€DCA€relied€on€a€staged€ceremony€whichÏHealth€Net€used€during€the€litigation€to€cover€up€its€prior€failures.€€JA€pp.€2730,Ï2732€(ð ð02/27/03€Susan€from€Ô_ÔHlthÔ_Ô€net€Ô_ÔcldÔ_Ô€„€they€would€like€the€claim€Ô_ÔfaxððdÔ_Ô€818„¼676„7200").€€The€DCAððs€finding€of€no€adequate€presentation€of€claims€ð ðuntil€afterÏthe€lawsuit€was€filedðð€(Ex.€1a€p.€16)€is€incorrect.€€The€payments€reflect€simple„¼minded€theater,€not€timely€compliance.Ì/€/€/Ð °*&& Ðà ` àIn€billing€the€IPA,€the€ER€doctors€did€exactly€what€was€requested€of€themÏby€Health€Net.€€Ô‡ ŠÁŠŠŠÁÔJA€p.€3309€(no€directions€to€directly€bill€Health€Net);€òòsee€óóÔ#†ŠÁŠŠ ŠÁ@#ÔJA€p.Ð ° Ð1710€(ID€instructs€doctors€to€contact€the€IPA).€€The€ER€doctors€billed€the€IPA€onÏ04/04/01€for€the€first€visit,€on€08/14/01€for€the€second€visit,€and€on€12/05/01€forÏthe€third€visit.€€JA€pp.€2727„31.€€Claims€were€filed€with€Health€Net€on€those€dates.Ì€€€à ` àERISA€regulations,€operative€when€the€services€were€provided€must€apply.€Ð °  ÐòòBode€v.€St€Josephððs€Health€Systemsóó€(C.D.€Cal.€2003)€298€F.€Supp.€2d€918,€920;€29Ð °  ÐC.F.R.€2560.503„1€(o)€(2002).€€Those€regulations€required€that€a€reasonable€claimÏprocedure€be€established€[29€Ô_ÔC.F.R.Ô_Ô€2560.503„1(b)(1)€(2000)]€and€administered€inÏa€way€that€does€not€unduly€hamper€initiation€or€processing€of€a€claim.€€òòGaines€v.Ð ° ÐThe€Sargent€Fletcher,€Inc.€Group€Life€Insurance€Planóó€(C.D.€Cal.€2004)€329€F.Ð ° ÐSupp.2d€1198,€1220,€29€Ô_ÔC.F.R.Ô_Ô€2560.503„1€(b)(1)(iii)€(2000).€€When€Health€NetÏfailed€to€oversee€its€IPA,€the€disruption€of€claims€handling€was€unduly€hampered.Ìà ` àA€claim€is€filed€by€either€the€member€ò òoró ó€representative€when€requirementsÐ ° Ðof€a€reasonable€claim€procedure€have€been€met.€€29€C.F.R.€2560.503„1€(d)€(2000).€ÏWhile€doctors€are€directed€to€contact€the€IPA,€the€EOC€contains€no€procedure€forÏpetitioner€whose€ð ðclaim€is€deemed€filed€when€a€written€or€oral€communication€isÏmade€.€.€.€to€the€person€or€organizational€unit€which€handles€claims€for€benefitsÏunder€the€plan.ðð€€29€Ô_ÔC.F.R.Ô_Ô€2560.503„1(d)(3)€(2000).€€Petitionerððs€phone€calls€inÏNovember€2001,€brushed€off€by€Health€Net,€presented€a€claim.€€òòChateauÐ ¸*&& ÐChamberay€Homeowners€Assn.€v.€Associated€Intððl.€Ins.€Co.óó€(2001)€90€Cal.App.4thÐ ° Ð335,€347„48€(no€investigation€breaches€contract€and€bad€faith€without€dispute).Ìà ` àFurther,€personal€service€of€the€ER€bills€(JA€pp.€1850€(Aug.€14,€2002),€43„6Ï[exhibits])€raises€duties€to€process€and€pay.€€29€C.F.R.€2560.503„1€(d)(3)€(2000).€ÏDuties€include€promptly€providing€notice€of€any€additional€materials€needed€toÏperfect€the€claim.€€€ðð€1371.35€(c),€29€Ô_ÔC.F.R.Ô_Ô€2560.503„1€(f)(3)„(4)€(2000);€28€Cal.ÏCode€of€Regs.€1300.71€(e)€(must€acknowledge€receipt€of€claim)€and€1300.71€(h)Ï(45€days€ð ðof€receipt€.€.€.€by€plan€or€capitated€providerðð€to€contest).€Ìà ` àInaction€by€the€plan€causes€claims€to€be€ð ðdeemed€deniedðð.€€òòWertheim€v.Ð ° ÐHartford€Life€Insurance€Co.,óó€(E.D.€Va€2003)€268€F.€Supp.€2d€643,€659„660.€Ð ° ÐHealth€Net€violated€ERISA€by€obdurate€inaction;€it€failed€to€pay€or€requestÏinformation€within€45€days.€€JA€pp.€1574„75,€2727„31;€ðð€1371.€€Contrary€toÏestablished€authority,€the€DCA€eviscerated€ERISA€and€state€law.Ìò ò2.›€€œContinued€Standing€is€Present€Under€the€New€UCL.ó óÐ ° Ðà ` àPresenting€an€issue€related€to€the€merits€above,€Business€and€ProfessionsÏCode€ðð17204€requires€ð ðinjury€in€fact€and.€.€.€lost€money€or€property.ððÌò òa.€€UCL€Standing€Should€be€Broadly€Interpreted.ó óÐ ¬$ü  Ðà ` àThe€DCAððs€myopic€view€of€standing›€œoffends€the›€remedial€œpurposes€of€theÏUCL.›€€òòBarquis€v.€Merchants€Collection€Assn.€of€Oaklandóó€(1972)€7€Cal.3d€94,€99„Ð ¨(ø#$ Ð101,€œ11„112›€œ(ð ðgiven›€the€creative€nature€of€the€scheming€mindðð).€€This€remedialÐ ¨*ø%& Ðcharacter€was€reaffirmed€by€Proposition€64€at€SEC.€1€œ(1).€€This€court›€œhas€held:ÌÓÓà8 ` àModern€society€seems€increasingly€to€expose€men€to€.€.€.€injuries€forÏwhich€individually€they€are€in€a€poor€condition€to€seek€legal€redress,Ïeither€because€they€do€not€know€enough€or€because€such€redress€isÏdisproportionately€expensive.€€If€each€is€left€to€assert€his€rights€aloneÏif€and€when€he€can,€there€will€at€best€be€a€random€and€fragmentaryÏenforcement,€if€there€is€any€at€all.€€This€result€.€.€.€will€operateÏseriously€to€impair€the€deterrent€effect€of€the€sanctions€whichÏunderlie€much€contemporary€law.€€òòVasquez€v.€Superior€Courtóó€(1971)Ð °  Ð4€Cal.3d€800,€807.Ð ` Ð ` Ð  ÐÌÓÊ)Óà ` àIdentical€policies€attach€to€the€UCL€where€the€purposes€include€ð ðthe€rightÏof€the€public€to€protections€from€fraud€and€deceit€[citations].ðð€€òòPeople€v.€FreemontÐ ° ÐLife€Insurance€Co.óó€(2002)€104€Cal.App.4th€508,€514.€€"Restitution€is€.€.€.€designedÐ ° Ðto€penalize€a€defendant€for€past€unlawful€conduct€and€thereby€deter€futureÏviolations."€€òòPeople€v.€Toomeyóó€(1984)€157€Cal.App.3d€1,€25„26.€€BroadÐ ° Ðconstruction€implements€important€public€policies€as€identified€by€this€court€inÏòòKraus€v.€Trinity€Management€Services,€Inc.óó€(2000)€23€Cal.4th€116,€126:Ð ° ÐÓÓà8 ` àRepresentative€UCL€actions€make€it€economically€feasible€to€sueÏwhen€individual€claims€are€too€small€.€.€.€and€thereby€encourageÏattorneys€to€undertake€private€enforcement€actions.Ð ` Ð ` Ð  ÐÌÓö.Óò òb.€€The€DCA€Cavalierly€Rejected€Petitionerððs€Factual€Injuries.ó óÐ °" Ðà ` àActual€injury€flowed€to€petitioner:€disruption€of€Jeremyððs€care,€dunning,Ïcalls,€and€threats€to€credit€and€litigation.€€JA€pp.€1626€(phone€bills€after€disruptionÏof€critically€needed€care)€1628„30,€2450„51(mom€and€petitioner€called€upset),Ï3034„36€(distress).€€Such€injuries€have€been€found€sufficient.€€òòSeeóó€òòCisneros€v.€UDÐ ¬*ü%& ÐRegistryóó€(1995)€39€Cal.App.4th€548,€580„81€(credit€reporting);€òòCrisci€v.€SecurityÐ ° ÐIns.€Co.óó€(1967)€66€Cal.2d€425,€433-434€(payment€delay;€ð ða€plaintiff€who€.€.€.€losesÐ ° Ðhis€property€and€suffers€mental€distress€may€recoverðð).€€The€DCAððs€narrow€viewÏignores€recognized€impacts€from€respondentsðð€conduct.Ìò òc.€€Taking€of€Policy€Rights€and€Diminution€in€Value€Produce€Standing.ó óÐ °  Ðà ` àImposition€of€personal€guaranties€for€routine€care€erodes€the€memberððsÏð ðbenefit€of€the€bargainðð.€€Uncontradicted€evidence€showed€that€the€value€of€HealthÏNetððs€plan€is€substantially€reduced€by€its€risk€shifting.€€JA€pp.€1928€(3%€ofÏpremiums€for€ER€services),€3234„35€(Difference€in€value€of€$1,764.56€comparedÏto€a€Kaiser€plan€which€canððt€compete€with€Health€Netððs€risk€shedding€schemes).€Ïð ðPropertyðð€includes€the€pilfered€policy€term€limiting€liability.€€òòEstate€ofÐ ¬ü ÐMendenhallóó€(1960)€182€Cal.App.2d€441,€444€(policy€is€property).€€ð ðMoneyððÐ ¬ü Ðincludes€restitution€as€allowed€by€this€court€in€òòCortez€v.€Purolator€Air€FiltrationÐ ¬ü ÐProducts€Co.óó€(2000)€23€Cal.4th€163,€174.€€Health€Netððs€eventual€payment€of€theÐ ¬ü Ðclaims€does€not€affect€this€already€spilt€milk.€€Petitionerððs€loss€of€contractualÏlimited€liability,€and€the€loss€of€premium€value,€independently€confirm€standing.Ìò òd.€€In€this€Public€Interest€Action,€Petitioner€Retains€Capacity€to€Maintain€theÐ ¬$ü  ÐAction€Because€He€Shares€a€Common€Wrong.ó óÐ ¨&ø!" Ðà ` àCommon€law€standing/capacity€doctrines€for€public€interest€cases€retainÏvitality€despite€partial€codification.€€òòCalifornia€Water€&€Tel.€Co.€v.€Los€AngelesóóÐ ¤*ô%& Ð(1967)€253€Cal.App.2d€16,€26;€òòseeóó€òòBarela€v.€Superior€Courtóó€(1981)€30€Cal.3d€244,Ð ° Ð256.€€Thus,€traditional€common€law€concepts€apply€to€this€action€once€the€statutoryÏterms€are€satisfied.€€The€DCA€would€require€a€member€to€pay€the€bills€beforeÏenforcing€duties€against€Health€Net,€similar€to€a€taxpayer€who€may€only€seek€aÏrefund.€€Revenue€and€Taxation€Code€ðð5140.€€However,€refusal€to€pay€the€billsÏdoes€not€affect€public€interest€capacity.€€òòPrata€v.€Superior€Courtóó€(2001)€91Ð °  ÐCal.App.4th€1128,€1146.€€Further,€petitioner€properly€asserts€only€an€ð ðon€behalf€ofÏthe€general€publicðð€claim,€and€need€not€join€an€individual€UCL€claim.€€òòAlch€v.Ð ° ÐSuperior€Courtóó€(2004)€122€Cal.App.4th€339,€378,€387„89;€òòBunker€v.€County€ofÐ ° ÐOrangeóó€(2002)€103€Cal.App.4th€542,€546.Ð ° Ðà ` àEventual€payment€by€Health€Net€also€does€not€avoid€the€merits.€€In€òòLa€SalaÐ ° Ðv.€American€Savings€and€Loanóó€(1971)€5€Cal.3d€864,€the€trial€court€concluded€thatÐ ° Ðð ðthere€is€no€individual€plaintiff€remaining.€.€.ðð€having€recovered€what€was€dueÏthem€personally.€€òòIdóó.€at€p.€870.€€This€court€reversed€stating€that€the€personalÐ ° Ðrecovery€did€not€ð ðrender€those€plaintiffs€unfitðð€in€their€representative€capacity.€€òòIdóó.,Ð °  Ðòòaccordóó,€€òòWilens€v.€T.D.€Waterhouse€Group,€Inc.óó€(2003)€120€Cal.App.4th€746,€755Ð °" Ð(ð ðpicking€offðð€plaintiffs€disapproved).€€Indeed,€payments€to€providers€are€notÏò òpetitionerððsó ó€property.€€òòWhiteside€v.€Tenet€Healthcare€Corp.óó€(2002)€101€Cal.App.Ð °&"" Ð4th€693,€703.Ì/€/€/Ð ¸*&& Ðà ` àRepresentative€standing€is€recognized€where€consumers€have€suffered€aÏcommon€wrong,€although€not€necessarily€the€same€amounts€or€types€of€damages.€ÏIn€òòWershba€v.€Apple€Computer,€Inc.óó€(2001)€91€Cal.App.4th€224,€the€companyÐ ° Ðadvertised€free€24„hour€technical€phone€support€with€purchase,€similar€to€pre„paidÏHMO€promises.€€òòId.óó€at€230.€€To€save€money,€Apple€canceled€free€support€butÐ °  Ðoffered€a€paid€support€option€to€purchasers,€like€the€fee„for„service€COS.€€òòIdóó.€€TheÐ °  Ðplaintiffs€had€called€and€been€refused€service,€but€had€not€paid€for€service.€€òòIdóó.€at€Ð °  Ð232.€€The€court€approved€the€representative€plaintiffs€stating:ÌÓÓà8 ` àThe€fact€that€the€class€representatives€had€not€personally€incurred€allÏof€the€damages€suffered€by€each€different€class€member€does€notÏnecessarily€preclude€their€providing€adequate€representation€to€theÏclass.€€(citation)€€.€.€.€[A]ll€of€the€class€members€here€allege€aÏcommon€wrong:€They€were€deprived€of€the€promised€free€technicalÏsupport.€€òòIdóó.€at€238„39.а` Ð ` Ð  ÐÌÓ¦BÓà ` àòòAccordóó,€Fed.€Rules€of€Civil€Procedure,€Rule€23(b)(2).€€Petitioner€andÐ ° Ðmembers€suffer€the€common€wrong€of€respondentsðð€risk€shifting.Ìà ` àFinally,€an€affected€plaintiff€who€gains€personal€knowledge€of€the€falsity€ofÏthe€HMOððs€promises,€reasonably€changes€HMOs.€€òòSolorzano€v.€Superior€CourtóóÐ °! Ð(1992)€10€Cal.App.4th€1135,€1138,€1149.€€A€rule€avoiding€the€merits€unless€theÏplaintiff€maintains€enrollment€in€the€HMO,€would€tend€to€insulate€the€mostÏegregious€conduct€from€review.€€òòSeeóó€òòStocks€v.€City€of€Irvineóó€(1981)€114Ð °'## ÐCal.App.3d€520,€531„33.€€The€omissions€are€repetitive€yet€avoid€review.€€TheyÏdeserve€a€forum.Ð °+'' Ðò ò3.€€Petitionersðð€Claims€do€not€Hinder€any€Jurisdiction€of€the€Department.Ð ° Ðó óà ` àPetitioner€does€not€seek€to€rewrite€Health€Netððs€contracts€approved€by€theÐ ¬ü ÐDepartment,€but€rather,€to€challenge€the€failure€of€Health€Net€to:€1)€contract€ò òat€alló óÐ ¬ü Ðfor€basic€ER€services€in€violation€of€28€Cal.€Code€of€Regs.€1300.67.8,€2)€pay€ERÏproviders€under€ððñTñ€ñTñ1371.4,€and€3)€protect€members€from€risk€in€contracts€per€ðð1379Ïand€the€EOC;€òòseeóó€Ex.€2,€p.2€(Department:€duty€to€pay€and€to€prohibit€billingÐ ´  Ðapplied€before€2004).€These€claims€fall€within€the€holding€of€òòSamuraÔ_Ô€v.€KaiserÐ ´  ÐFoundation€Health€Plan,€Inc.óó€(1993)€Ô_ÔÔ_Ô17€Ô_ÔCal.AppÔ_Ô.4th€1284,€1299„1300€("despite€theÐ ´ Ðexistence€of€a€statutory€enforcement€scheme,€.€.€.€may€still€sue.€.€.").Ìà ` àThe€òòSamuraóó€court€did€not€have€benefit€of€the€2000€amendments.€Ð ´ Ððð1371.37(e)„(f)€(non„exclusive€remedies€which€do€not€affect€any€other€duty€underÏstatute€or€contract);€AB€1455€(ch.€827€stats€2000)€ððñTñ€ñTñ1(d)€(Department€to€ð ðassistðð€inÏimplementing€law);€òòcfóó€òòMcCall€v.€PacifiCare€of€Cal.,€Inc.óó€(2001)€25€Cal.4th€412,Ð ´ Ð422€(intent€must€affirmatively€appear).€€Exclusive€intent€was€not€shown€for€UCLÏclaims€involving€insurance€in€òòDonabedian€v.€Mercury€Ins.€Co.óó€(2004)€116Ð ´  ÐCal.App.4th€968,€983,€nor€savings€and€loans.€€òòCoast€&€Southern€Fed.€S.€&€L.Ð ´" ÐAssn.€v.€Trans-Coast€S.€&€L.€Assn.óó€(1971)€16€Cal.App.3d€205,€210.€€ð ðCongressÐ ´$  Ðclearly€.€.€.€intended€a€call€to€the€states€(and€private€parties)€.€.€.€for€all€the€help€itÏcould€get€.€.€.€in€regulating€the€marketing€of€HMOððs.ðð€€òòSolorzano€v.€Superior€CourtóóÐ ´($$ Ð(1992)€10€Cal.App.4th€1135,€1149.€€Claims€are€precluded€only€if€they€areÐ ´*&& Ð"inconsistent€with€and€subvert€the€exclusive€jurisdiction.€.€.ðð.€€òòSatten€v.€WebbóóÐ ° Ð(2002)€99€Cal.App.4th€365,€384;€òòaccordóó€òòHartwell€Corp.€v.€Superior€Courtóó€(2002)Ð ° Ð27€Cal.4th€256,€266€(ð ðhinder€or€interfereðð).Ìà ` àAny€jurisdiction€in€the€Department€does€not€extend€to€hospital€COS€formsÏor€any€ERISA€claims.€€Even€had€the€Department€approved€the€COS,€it€would€notÏbe€entitled€to€deference.€€òòSamura€v.€Kaiser€Foundation€Health€Plan,€Inc.óó€(1993)€Ô_ÔÔ_Ô17Ð °  ÐÔ_ÔCal.AppÔ_Ô.4th€1284,€1294.€€The€remedies€sought€do€not€rely€on€any€expertise€of€theÏDepartment.€€òòSeeóó€òòNader€v.€€Allegheny€Airlinesóó€(1976)€426€U.S.€290,€304„06.€€TheÐ ° ÐUCL€must€be€consistent€with€the€law€that€it€ð ðborrowsðð.€€òòState€Farm€Fire€&Ð ° ÐCasualty€Co.€v.€Superior€Courtóó€(1996)€45€Cal.App.4th€1093,€1103.€€Courts€retainÐ ° Ðð ðconsiderable€flexibility€.€.€.€as€required€by€the€interests€of€justice,ðð€in€decidingÏadministrative€jurisdiction.€€òòFarmers€Ins.€Exchange€v.€Superior€Courtóó€(1992)€2Ð ° ÐCal.4th€377,€392.€€The€DCA€conflicts€with€legislative€intent€and€sound€policy.Ìò ò4.€€Petitioner€and€the€General€Public/Class€are€Entitled€to€Relief.ó óÐ ° ÐÑ€;êZÑà ` àPetitionerððs€action€to€reimburse€members€who€paid€bills€beyond€the€co„¼payment€was€discussed€by€the€court€in€òòÔ_ÔOchsÔ_Ô€v.€Ô_ÔPacificCareÔ_Ô€of€Californiaóó€(2004)Ð ¬"ü Ð115€Cal.App.4th€782,€791€(ð ðÔ_ÔOchsÔ_Ô€[ER€physician]€may€have€a€remedy€againstÏindividual€patients,€and€those€patients€a€remedy€against€PacificCareðð).€€The€DCAÏcontradicts€the€general€public/class€remedy€opined€in€òòOchsóó.€€It€also€conflicts€withÐ ¬(ü#$ Ðsound€policy€by€precluding€representative€actions€to€avoid€the€individual,€daisy„Ð ¬*ü%& ÐÑ;êZ+ÑÑ7€µ"Xd숈dþ7ÑÑ  Ññ”TñÑ;êZ ÑÑ7€Õ XdìXXdì7ÑÑ  Ññ”TññTñÑ;êZ ÑÑ7€Õ XdìXXdì7ÑÑ  ÑñTññTñÑ;êZ ÑÑ7€Õ XdìXXdì7ÑÑ  ÑñTññŽTñÑ;êZ ÑÑ7€Õ XdìXXdì7ÑÑ  ÑñŽTñchain€of€litigation€envisioned€by€òòOchsóó.Ð ° Ðò òa.€€The€UCL€Violation€Justifies€Relief€for€the€General€Public.ó óÐ ° Ðà ` àUCL€actions€include€an€injunction€to€prevent€future€harm€(Ô_ÔòòPeopleÔ_Ô€v.Ð ¬ü ÐFremont€Life€Insurance€Co.óó€(2002)€104€Cal.App.4th€508),€and€restitution€ofÐ ¬ ü Ðunlawfully€collected€amounts.€€òòCortez€v.€Purolator€Air€Filtration€Products€Co.óóÐ ¬ ü Ð(2000)€23€Cal.4th€163,€174;€òòCorsini€v.€United€Health€Plans€of€New€EnglandóóÐ ¬ü  Ð(D.R.I.€2001)€145€F.€Supp.€2d€184.€€This€court€has€approved€remedial€hearingsÏwhich€ð ðidentify,€locate,€and€repay€.€.€.€the€full€amount€of€funds€improperlyÏacquired.€.€.ðð.€€òòKraus€v.€Trinity€Mgt.€Services,€Inc.óó€(2000)€23€Cal.4th€116,€138;€Ô‡ ŠÁŠŠŠÁÔRTÐ ¬ü Ðpp.€77„8Ô#†ŠÁŠŠ ŠÁ[\#Ô€(lower€court€defers€ID€of€members€until€remedy).Ð ¬ü Ðò òb.€€ERISA€Presents€a€Parallel€Basis€for€Relief€for€Members.ó óÐ ¬ü Ðà ` àHealth€Net€confuses€its€HMO€service€plan€with€the€underlying€ERISA€planÏto€which€petitioner€still€belongs.€€òòSeeóó€JA€p.€3354€(no€longer€a€member€of€ð ðtheÐ ¨ø Ðplanðð).€€The€Secretary€of€Labor€has€succinctly€observed€that€an€ð ðHMO€.€.€.€is€notÏan€ERISA€plan€at€all,€but€rather€a€service€provider€to€the€ERISA€plan€establishedÏby€the€[employer].ðð€€20€N.Y.L.›€œSch›.€J,€Intððl€&€Comp.€L.€249,€276€(2000),€quotingÏòòNealy€v.€U.S.€Health€Careóó€(1999)€93€N.Y.2d€209;€òòseeóó€òòAmerican€Drug€Stores€v.Ð ¨$ø  ÐHarvard€Pilgrim€Health€Careóó€œ(D.€Mass.›€1997)€973€F.€œSupp.€60,›€œ67„68.Ð ¨&ø!" Ðà ` àIn€addition€to€his€surviving€rights€under€state€law,€the›€court€œin›€òòAetna€HealthÐ ¨(ø#$ ÐInc,€v€œDavilaó󛀜(2004)›€542€US€œ200,€124€S.Ct.€2488,€2496€ñ—Tñheld€that€ERISA€does€notÐ ¨*ø%& Ðapply€to€non„plan€entities€like€Los€Alamitos,€and€ñ—Tñdescribed€€parallel€relief€toÐ ¨*ø%& Ðthe€UCL€as›€follows:ÌÓÓà0 ` àœA›€civil€action€may€be€brought€œ.€.€.›€(B)€to€recover€benefits€due€him€under€theÏterms€of€his€plan,€to€enforce€his€œrights€.€.€.€or€to€clarify€his€rights€to€futureÏbenefits€under€the€terms€of€the€plan.€29€U.S.C.€ðð1132(a)(1)(B)Ð ` (#` (# ÐÌÓNaÓà ` àòòSee›€alsoóó€òòCommercial€Life€Ins.€Co.€v.€Superior€Court€of€San€Diego€CountyóóÐ °  Ð(1988)€47€œCal.3d›€473,€œ477;€òòSolorzano€v.€Superior€Courtóó€(1992)€10€Cal.€App.€4thÐ °  Ð1135,€1138€(injunction€not€preempted€by€Medicare€laws).›€€Thus,€as€a€member€ofÏthe€ERISA€plan,€petitioner€has€rights€to€declaratory€relief€as€to€œfuture€benefits›€œdueÏunder€the€HMO€service€offered€within€that€plan.€€He›€is€still€being€lied€to€œbyÏrespondents€at›€every€open€œenrollment.›€€œ€€This€court€in€òòEye€Dog€Foundation€v.€St.Ð ° ÐBd.€of€Guide€Dogs€for€the€Blindóó€(1967)€67€Cal.2d€536,€541€discussed€the€properÐ ° Ðscope€of€declaratory€relief€as€follows:ÌÓÓà8 ` àà ¸ à[T]he€"present€right"€contemplated€is€the€right€to€haveÏimmediate€judicial€assurance€that€advantages€will€be€enjoyed€orÏliabilities€escaped€in€the€future.Ð ` Ð ` Ð  ÐÌÓSeÓà ` àRetrospective€declaratory€relief€was€also€ignored.€€Petitioner€was€neverÏinformed€by€an€Explanation€of€Benefits€(ð ðEOBðð),€and€Health€Net€did€not€pay€theÏfull€amount€nor€applicable€interest.€€òòRodoloff€v.€Provident€Life€and€Accident€Co.óóÐ °" Ð(S.D.€Cal.€2003)€256€F.€Supp.€2d€1137,€1142€(removes€cloud);€òòcfóó€JA€pp.€3068„69Ð °$  Ð(EOB€for€facilities€charges);€29€C.F.R.€ðð€2560.503„1(e).€€The€DCAððs€finding€thatÏrelief€is€not€justified€leaves€California€residents€uniquely€precluded€fromÏexercising€ERISA€rights.Ð °*&& Ðò ò5.›€€Class€Procedures€Should€be€Deemed€Satisfied€œand€Excused.ó óÐ ° Ðà ` àThe€need€for€relief€under€Code€of€Civil€Procedure€ðð€473€involves›€twoÏœaspects:€a)›€leave€to€œallege€affected€plaintiff/class€issues;›€and€œb)›€relief€from€anyÏfailure€to€move€to€certify€the€putative€class€prior€to€a€hearing€on€the€œmerits.€€òòSeeóóÐ ¬ ü ÐCal.€Rules€of€Court,€Rule€1850(b)€(may€ð ðgrant€relief€from€complianceðð).€ÏDirections€for€relief€are€required€to€prevent€merit€avoidance.€€òòSeeóó€òòMassey€v.€BankÐ ¬ü  Ðof€Americaóó€(1976)€56€Cal.App.3d€29,€32.Ð ¬ü  Ðò òa.€€Formalistic€Pleading€is€Not€Required.ó óÐ ¬ü  Ðà ` àIf€retroactive,›€formal€pleading€of€class€œcertification›€issues€is€not€œnecessary.›€ÏIn€òòWilner€v.€Sunset€Life€œIns.€Companyóó›€(2000)€œ78€Cal.App.4th›€952,€œ964›€the€courtÐ ¨ø Ðnoted€that€œa€prior€class€complaint€was€superseded€by€the€filing€of€an€amendedÏcomplaint,€but€that,€ð ð[a]s€a€matter€of€practicality,€we€shall€direct€the€trial€court€toÏdeem€the€class€action€allegations€to€be€incorporated€into€the€second€amendedÏcomplaint,€which,€of€course,€contains€no€such€allegations.ðð€€FormalisticÏð ðmechanical€allegationsðð€of€class€procedures€are€undoubtedly€well€known€toÏrespondents.›€€òòSeeóó€òòHamwi€v.€Citinational„Buckeye,€Inc.óó€(1977)€72€Cal.App.3d€462,Ð ¨"ø М467.€›€œThere€is€a€close€identity€between€the€widespread€business€practices€allegedÏand€compliance€with€the€substance€of€Code€of€Civil€Procedure€ðð€382.€€The›€œclass›Ïmay€be€œdefined›€in€a€motion€to€certify,€notice€given,€and€due€œprocess›€œsatisfied.ñ˜TñÌ/€/€/ñ˜TñÐ ¨*ø%& Ðò òb.€€Delay€in€Certification€is€Excusable€and€Does€Not€Expand€Liability.ó óÐ ° Ðà ` àThe€twin€events€of€the€passage€of€Proposition€64,€and€any€judicial€findingÏof€retroactivity€impose€unanticipated€requirements.€€Further,€erroneous€ordersÏprecluding€discovery,€require€time€to€cure.€€Any€omission€was€not€caused€by€aÏfailure€to€research,€laxness,€or€incompetence€justifying€denial.€€òòFidelity€FederalÐ ¬ ü ÐSavings€&€Loan€Assn.€v.€Longóó€(1959)€175€Cal.App.2d€149,€154.€€Indeed,€classÐ ¬ü  Ðtreatment€had€been€found€unnecessary€under€former€law.€€òòAlch€v.€Superior€CourtóóÐ ¬ü  Ð(2004)€122€Cal.App.€4th€339,€408;€òòFrieman€v.€San€Rafael€Rock€Quarryóó€(2004)€116Ð ¬ü  ÐCal.App.4th€29,€37.€€After€discovery€sanctions€were€personally€imposed€onÏpetitioner,€further€attempts€would€be€futile€pumping€of€oil€from€a€dry€well.Ìà ` àRelief€for€a€mistake€in€law€based€on€mere€confusion€was€affirmed€by€thisÏcourt€in€òòCity€of€Ontario€v.€Superior€Courtóó€(1970)€2€Cal.3d€335,€343€(counsel€notÐ ¬ü Ðomniscient);€òòsee€alsoóó€òòViles€v.€Californiaóó€(1967)€66€Cal.2d€24,€29;€òòRiskin€v.€TowersóóÐ ¬ü Ð(1944)€24€Cal.2d€274€(court€ruling);€òòState€Farm€Fire€&€Casualty€Co.€v.€PietakóóÐ ¬ü Ð(2001)€90€Cal.App.4th€600,€607€(split€of€authority);€òòMcCormick€v.€Board€ofÐ ¬ ü ÐSupervisorsóó€(1988)€198€Cal.App.3d€352,€360,€363€(court€decision);€òòBrochtrup€v.Ð ¬"ü ÐIntepóó€(1987)€190€Cal.App.3d€323,€329„30€(ambiguity€in€statute);€€€òòMoore€v.€StateÐ ¬$ü  Ðof€Californiaóó€(1984)€157€Cal.App.3d€715,€722„23€(court€ruling);€òòSouza€v.€CapitalÐ ¬&ü!" ÐCo.óó€(1963)€220€Cal.App.2d€744,€758€(ambiguity€as€to€stay).Ð ¬(ü#$ Ð/€/€/Ð ¬*ü%& Ðà ` àA€claimed€failure›€œto›€œcertify›€prior€to€a€determination€of€the€merits€œraisesÏconstitutional›€œimplications€for›€œboth€sides.›€€For€petitioner,€the€"retroactiveÏapplication€of€a€decision€disapproving€prior€authority€on€which€a€person€mayÏreasonably€rely€œ.€.€.€denies€due€process."€€òòMoss€v.€Superior€Courtóó€(1998)€17€Cal.4thÐ °  Ð396,€429;€òòOlszewski€v.€Scripps€Healthóó€(2003)€30€Cal.4th€798,€829.€€Many€of€theÐ °  Ðrelated€pending€petitions€have€inconsistently€struggled€with€due›€œprocess€issues.€ÏòòBranick€v.€Downey€Savings€and€Loanóó€(2005)€126€Cal.App.4th€828,€844„45Ð °  Ð(substitution€of€plaintiffs);›€òòLytwyn€v.€Fryððs€Electronicsóó€(2005)€126€Cal.App.4thÐ ° Ð1455€œ(class›€allegations);€òòBivens€v.€Corel€Corp.óó€(2005)€126€Cal.App.4th€1392,Ð ° М1405„06€fns›€5€and€6,€œ(substitution›€of€œplaintiff);›€òòBenson€v.€Quickset€Corp.óó€(2005)Ð ° Ð126€Cal.App.4th€œ887,€Slip›€œOp.€p.›€17€œ(ð ðdue›€process€œrequire[s].€.€.›€œan›€œopportunityðð).Ìà ` àOn€the€other€hand,€respondents›€œmay€object€to€ð ðone„way€interventionðð€inÏclass›€œactions.›€€òòHome€Sav.€&€Loan€Assn.€v.€Superior€Courtóó€(1976)€54€Cal.App.3dÐ ° Ð208,€œ213-14;›€òòHome€Sav.€&€Loan€Assn.€v.€Superior€Courtóó€(1974)€42€Cal.App.3dÐ ° Ð1006,€œ1013-14.›€€œPetitioner€moved€for€summary€adjudication€of€the€UCL€before€theÏexistence€of€Proposition€64.€€However,€respondents›€œalso€made€cross„motionsÏbefore›€class€notice€had€been€given€and€did€not€object€to€petitionerððs€œmotion.›€ÏœRespondents›€œhave€waived€any€prematurity€objection.€€òòBartold€v.€Glendale€FederalÐ °&"" ÐBankóó€(2000)€81€Cal.App.4th€816,€831€fn€8;€òòEmployment€Devl.€Dept.€v.€SuperiorÐ °($$ ÐCourtóó€(1981)€30€Cal.3d€256,€263;€òòCivil€Service€Employees€Ins.€Co.€v.€SuperiorÐ °*&& ÐCourtóó€(1978)€22€Cal.3d€362,€371-373.€€Respondents›€œstand€in€the›€same€œcircle€they›Ð ° Мtry€to›€œdraw€around€petitioner.Ìà ` àRespondents€cannot€prove€the€residual€issue€of€prejudice€from€any€delay,Ïbecause€class€relief€is€identical€to€that€previously€available€by€way€of€formerÏð ðrepresentativeðð€UCL€action.€€òòCortez€v.€Purolator€Air€Filtration€Products€Co.óóÐ °  Ð(2000)€23€Cal.4th€163.€€The€only€speculative€deviation€is€in€the€òòcy€presóó€doctrineÐ °  Ðfor€members€who€cannot€be€located.€€òòKraus€v.€Trinity€Mgt.€Services,€Inc.óó€(2000)Ð °  Ð23€Cal.4th€116,€137;€òòCorbett€v.€Superior€Courtóó€(2002)€101€Cal.App.4th€649,€668.€Ð ° ÐRespondents€cannot€claim€some€vested€right€to€their€plunder€based€on€failing€toÏfind€their€own€members.€€Otherwise,€a€party€could€create€a€defense€through€delayÏand€expungement€of€membership€records.€€Further,€the€availability€of€òòcy€presóóÐ ° Ðfunds€is€not€expansive€since€it€commonly€avoids€a€separate€award€of€attorneysððÏfees€against€respondents.€€òòe.g.óó€òòBell€v.€Farmers€Ins.€Exchangeóó€(2004)€115Ð ° ÐCal.App.4th€715,€726.€€Thus,€the€pleadings€should€be€liberally€construed€and€reliefÏdirected€so€that€remedy€may€be€had€by€this€petitioner€or€by€substituted€member.Ì/€/€/Ì/€/€/Ì/€/€/Ð  °&"" Ðò òF.€CONCLUSIONó óÐ ° Ðà ` àHMO€members€and€their€ER€doctors€should€treated€lawfully€and€asÏpromised€by€granting€of€review.ÌDated:€June€27,€2005à h àà À àà  àRespectfully€submitted,Ð ¬ ü ÐÓÓÌà ` àà ¸ àà  àà h àà À àà  à___________________________Ìà ` àà ¸ àà  àà h àà À àà  àRichard€L.€SpixÌà ` àà ¸ àà  àà h àà À àà  àAttorney€for€PetitionerÓd„ÓÌÌà@± ± àò òCERTIFICATE€OF€APPELLATE€COUNSELó óˆÐ ¬ü ÐÓ€Óà ` àI,€RICHARD€L.€SPIX,€certify€that€this€brief€contains€839ñ•Tñ3ñ•Tññ–Tñ0ñ–Tñ€words,€notÏincluding€tables€or€this€certificate,€as€reported€by€the€word€processing€programÏused€in€its€generation.ÌÓ€ÓDated:€June€27,€2005à h àà À àà  à___________________________Ð (x Ðà ` àà ¸ àà  àà h àà À àà  àRichard€L.€SpixÌà ` àà ¸ àà  àà h àà À àà  àAttorney€for€PetitionerÐ  (x ÐØ&Øà@¼ ¼ àPROOF€OF€SERVICE€BY€MAIL--CCP€1013A€AND€2015.5ˆÌÌà@ àSTATE€OF€CALIFORNIA,€COUNTY€OF€ORANGEˆÌÌÓ€ÓI€declare€as€follows:Ìà ` àI€am€over€eighteen€years€of€age€and€not€a€party€to€the€within€action;€myÏbusiness€address€is€1505€E.€17th€St.,€Ste.€229€Santa€Ana,€CA€92705.Ìà ` àOn€June€27,€2005,€I€served€a€copy€of€the€foregoing€PETITION€FORÏREVIEW€on€the€interested€parties€in€the€within€action€by€depositing€a€true€copyÏthereof,€enclosed€in€a€sealed€envelope€with€postage€thereon€fully€prepaid,€in€theÏUnited€States€mail€at€Santa€Ana,€California,€addressed€as€follows:ÌÓ€­ˆÓLaw€Office€of€Norman€Filer€(Los€Alamitos)€à p àò òPER€B&P€Code€ðð€17209:ó óÐ 0€ Ð500€No.€State€College€Blvd.,€Ste.€1270à  àà p àOrange€County€District€Atty.Ð 4„ ÐOrange,€CA€92868à  àà h àà À àà  àà p à700€Civic€Center€Drive€WestÐ 4„ Ðà ` àà ¸ àà  àà h àà À àà  àà p àSuite€200ÌMusik,€Peeler€&€Garret€(Health€Net)à  àà p àSanta€Ana,€CA€92702Ð 4„ ÐMichael€F.€Klien,€Esq.Ì225€Broadway,€Ste.€1900à h àà À àà  àà p àRonald€A.€Reiter,€Esq.Ð 4„ ÐSan€Diego,€CA€92101„5028à À àà  àà p àSupervising€Deputy€Atty.€GeneralÐ 4„ Ðà ` àà ¸ àà  àà h àà À àà  àà p àOffice€of€the€Attorney€GeneralÌHonorable€Clay€Smith€Dept.€C„17(Lower€Ct)à p àConsumer€Law€SectionÐ 4„ ÐOrange€County€Superior€Courtà À àà  àà p à455€Golden€Gate€Ave.,€Ste.€11000Ð 4„ Ð700€Civic€Center€Drive€Westà À àà  àà p àSan€Francisco,€CA€94102Ð 4„ ÐSanta€Ana,€California€92702„1994ÌÌClerk€of€the€4th€DCA€(Appellate€Court)Ì925€N.€SpurgeonÌSanta€Ana,€California€92701ÌÌÓ€Óà ` àI€declare€under€penalty€of€perjury€under€the€laws€of€the€State€of€California,Ïthat€the€foregoing€is€true€and€correct€and€that€this€declaration€was€executed€onÏJune€27,€2005,€at€Santa€Ana,€California.ÌÓ€Óà ` àà ¸ àà  àà h àà À àà  à______________________________Ìà ` àà ¸ àà  àà h àà À àà  àRichard€L.€Spix