Brehm v. 21st Century Ins. Co. (2008) 166 Cal.App.4th 1225, 83 Cal.Rptr.3d 410

Summary (1) Trial court erred in dismissing insured’s claim on demurrer based on the genuine-dispute doctrine. Application of the doctrine was a factual issue that could not be determined on the pleadings. (2) The insurer’s contractual right to arbitrate uninsured-motorist (“UM”) claims did not relieve it from its obligation to make reasonable efforts to assess and settle the claim, and its failure to make those efforts would support a claim against it for bad faith.

Kotler v. PacifiCare of California (2005) 126 Cal.App.4th 950

Summary – On a motion for summary judgment, it was concluded there was a question of fact whether a delay of six weeks in arranging for a specialist was reasonable, in Kotler the health care services plan denied two appeals by the patient that sought reimbursement for a specialist the patient saw on his own because of the delay. (Id. at pp. 956-957.)

This was the first case in California to hold that an HMO could be sued for bad-faith for making its subscribers wait an unreasonable amount of time for medical treatment.

Smith v. Pacificare Behavioral Health (2001) 93 Cal.App.4th 139

Held that health insurers and HMOs in California were required to comply with California statutes that regulated the use of arbitration clauses in health-insurance contracts. Mr. Ehrlich later convinced other appellate courts to adopt the reasoning of Smith, in Imbler v. PacifiCare of California (2002) 103 Cal.App.4th 567, and Zolezzi v. PacifiCare of California (2003) 105 Cal.App.4th 573.

UNUM Life Ins. Co. of America v. Ward, 526 U.S. 358 (1999)

Mr. Ehrlich briefed and argued this case in the U.S. Supreme Court. In a unanimous decision the Supreme Court adopted the position advocated by Mr. Ehrlich, and limited ERISA’s preemptive scope by making ERISA plans subject to state common-law rules of insurance regulation, which generally benefit consumers. The Ward decision benefited more than 80 million people who obtained their health insurance, life insurance, or disability insurance through their employer.