ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, State Bar number, and address):
`
`FOR COURT USE ONLY
`
`CM-010
`
`TELEPHONE NO.:
`
`ATTORNEY FOR (Name):
`
`SUPERIOR COURT OF CALIFORNIA, COUNTY OF
`STREET ADDRESS:
`
`FAX NO.:
`
`MAILING ADDRESS:
`
`CITY AND ZIP CODE:
`
`BRANCH NAME:
`CASE NAME:
`Beverly Hills Regional Center, L.P. v. Premera Blue Cross
`CIVIL CASE COVER SHEET
`Complex Case Designation
`Unlimited
`Limited
`Joinder
`Counter
`(Amount
`(Amount
`demanded is
`demanded
`Filed with first appearance by defendant
`$25,000 or less)
`exceeds $25,000)
`(Cal. Rules of Court, rule 3.402)
`DEPT:
`Items 1–6 below must be completed (see instructions on page 2).
`1. Check one box below for the case type that best describes this case:
`Contract
`Auto Tort
`Breach of contract/warranty (06)
`Auto (22)
`Rule 3.740 collections (09)
`Uninsured motorist (46)
`Other collections (09)
`Other PI/PD/WD (Personal Injury/Property
`Damage/Wrongful Death) Tort
`Insurance coverage (18)
`Asbestos (04)
`Other contract (37)
`Product liability (24)
`Real Property
`Medical malpractice (45)
`Eminent domain/Inverse
`condemnation (14)
`Other PI/PD/WD (23)
`Wrongful eviction (33)
`Non-PI/PD/WD (Other) Tort
`Other real property (26)
`Business tort/unfair business practice (07)
`Unlawful Detainer
`Civil rights (08)
`Commercial (31)
`Defamation (13)
`Residential (32)
`Fraud (16)
`Drugs (38)
`Intellectual property (19)
`Judicial Review
`Professional negligence (25)
`Asset forfeiture (05)
`Other non-PI/PD/WD tort (35)
`Petition re: arbitration award (11)
`Employment
`Wrongful termination (36)
`Writ of mandate (02)
`Other employment (15)
`Other judicial review (39)
`is not complex under rule 3.400 of the California Rules of Court. If the case is complex, mark the
`is
`2. This case
`factors requiring exceptional judicial management:
`a.
`Large number of separately represented parties
`Extensive motion practice raising difficult or novel
`b.
`issues that will be time-consuming to resolve
`Substantial amount of documentary evidence
`
`c.
`
`d.
`e.
`
`f.
`
`Large number of witnesses
`Coordination with related actions pending in one or more courts
`in other counties, states, or countries, or in a federal court
`Substantial postjudgment judicial supervision
`
`a.
`
`monetary
`
`b.
`
`3. Remedies sought (check all that apply):
`2
`4. Number of causes of action (specify):
`5. This case
`is
`is not a class action suit.
`6.
`If there are any known related cases, file and serve a notice of related case. (You may use form CM-015.)
`April 13, 2021
`Date:
`Jonathan Stieglitz
`
`nonmonetary; declaratory or injunctive relief
`
`c.
`
`punitive
`
`(TYPE OR PRINT NAME)
`
`(SIGNATURE OF PARTY OR ATTORNEY FOR PARTY)
`
`NOTICE
`Plaintiff must file this cover sheet with the first paper filed in the action or proceeding (except small claims cases or cases filed
`under the Probate Code, Family Code, or Welfare and Institutions Code). (Cal. Rules of Court, rule 3.220.) Failure to file may result
`in sanctions.
`File this cover sheet in addition to any cover sheet required by local court rule.
`If this case is complex under rule 3.400 et seq. of the California Rules of Court, you must serve a copy of this cover sheet on all
`other parties to the action or proceeding.
`Unless this is a collections case under rule 3.740 or a complex case, this cover sheet will be used for statistical purposes only.
`Page 1 of 2
`Cal. Rules of Court, rules 2.30, 3.220, 3.400–3.403, 3.740;
`Cal. Standards of Judicial Administration, std. 3.10
`www.courtinfo.ca.gov
`
`CIVIL CASE COVER SHEET
`
`Form Adopted for Mandatory Use
`Judicial Council of California
`CM-010 [Rev. July 1, 2007]
`
`• •• •
`
`CASE NUMBER:
`
`JUDGE:
`
`Provisionally Complex Civil Litigation
`(Cal. Rules of Court, rules 3.400–3.403)
`
`Antitrust/Trade regulation (03)
`Construction defect (10)
`Mass tort (40)
`Securities litigation (28)
`Environmental/Toxic tort (30)
`Insurance coverage claims arising from the
`above listed provisionally complex case
`types (41)
`
`Enforcement of Judgment
`Enforcement of judgment (20)
`
`Miscellaneous Civil Complaint
`RICO (27)
`Other complaint (not specified above) (42)
`
`Miscellaneous Civil Petition
`Partnership and corporate governance (21)
`Other petition (not specified above) (43)
`
`Electronically FILED by Superior Court of California, County of Los Angeles on 04/13/2021 01:04 AM Sherri R. Carter, Executive Officer/Clerk of Court, by C. Monroe,Deputy Clerk
`
`21STCV13978
`
`

`

`Case 2:21-cv-09274 Document 1-3 Filed 11/29/21 Page 2 of 41 Page ID #:13
`
`CM-010
`
`INSTRUCTIONS ON HOW TO COMPLETE THE COVER SHEET
`To Plaintiffs and Others Filing First Papers. If you are filing a first paper (for example, a complaint) in a civil case, you must
`complete and file, along with your first paper, the Civil Case Cover Sheet contained on page 1. This information will be used to compile
`statistics about the types and numbers of cases filed. You must complete items 1 through 6 on the sheet. In item 1, you must check
`one box for the case type that best describes the case. If the case fits both a general and a more specific type of case listed in item 1,
`check the more specific one. If the case has multiple causes of action, check the box that best indicates the primary cause of action.
`To assist you in completing the sheet, examples of the cases that belong under each case type in item 1 are provided below. A cover
`sheet must be filed only with your initial paper. Failure to file a cover sheet with the first paper filed in a civil case may subject a party,
`its counsel, or both to sanctions under rules 2.30 and 3.220 of the California Rules of Court.
`To Parties in Rule 3.740 Collections Cases. A "collections case" under rule 3.740 is defined as an action for recovery of money
`owed in a sum stated to be certain that is not more than $25,000, exclusive of interest and attorney's fees, arising from a transaction in
`which property, services, or money was acquired on credit. A collections case does not include an action seeking the following: (1) tort
`damages, (2) punitive damages, (3) recovery of real property, (4) recovery of personal property, or (5) a prejudgment writ of
`attachment. The identification of a case as a rule 3.740 collections case on this form means that it will be exempt from the general
`time-for-service requirements and case management rules, unless a defendant files a responsive pleading. A rule 3.740 collections
`case will be subject to the requirements for service and obtaining a judgment in rule 3.740.
`To Parties in Complex Cases.
`In complex cases only, parties must also use the Civil Case Cover Sheet to designate whether the
`case is complex. If a plaintiff believes the case is complex under rule 3.400 of the California Rules of Court, this must be indicated by
`completing the appropriate boxes in items 1 and 2. If a plaintiff designates a case as complex, the cover sheet must be served with the
`complaint on all parties to the action. A defendant may file and serve no later than the time of its first appearance a joinder in the
`plaintiff's designation, a counter-designation that the case is not complex, or, if the plaintiff has made no designation, a designation that
`the case is complex.
`Auto Tort
`Auto (22)–Personal Injury/Property
`Damage/Wrongful Death
`Uninsured Motorist (46) (if the
`case involves an uninsured
`motorist claim subject to
`arbitration, check this item
`instead of Auto)
`Other PI/PD/WD (Personal Injury/
`Property Damage/Wrongful Death)
`Tort
`
`CASE TYPES AND EXAMPLES
`
`CM-010 [Rev. July 1, 2007]
`
`Page 2 of 2
`
`Contract
`Breach of Contract/Warranty (06)
`Breach of Rental/Lease
`Contract (not unlawful detainer
`or wrongful eviction)
`Contract/Warranty Breach–Seller
`Plaintiff (not fraud or negligence)
`Negligent Breach of Contract/
`Warranty
`Other Breach of Contract/Warranty
`Collections (e.g., money owed, open
`book accounts) (09)
`Collection Case–Seller Plaintiff
`Other Promissory Note/Collections
`Case
`Insurance Coverage (not provisionally
`complex) (18)
`Auto Subrogation
`Other Coverage
`Other Contract (37)
`Contractual Fraud
`Other Contract Dispute
`Real Property
`Eminent Domain/Inverse
`Condemnation (14)
`Wrongful Eviction (33)
`Other Real Property (e.g., quiet title) (26)
`Writ of Possession of Real Property
`Mortgage Foreclosure
`Quiet Title
`Other Real Property (not eminent
`domain, landlord/tenant, or
`foreclosure)
`Unlawful Detainer
`Commercial (31)
`Residential (32)
`Drugs (38) (if the case involves illegal
`drugs, check this item; otherwise,
`report as Commercial or Residential)
`Judicial Review
`Asset Forfeiture (05)
`Petition Re: Arbitration Award (11)
`Writ of Mandate (02)
`Writ–Administrative Mandamus
`Writ–Mandamus on Limited Court
`Case Matter
`Writ–Other Limited Court Case
`Review
`Other Judicial Review (39)
`Review of Health Officer Order
`Notice of Appeal–Labor
` Commissioner Appeals
`CIVIL CASE COVER SHEET
`
`Asbestos (04)
`Asbestos Property Damage
`Asbestos Personal Injury/
`Wrongful Death
`Product Liability (not asbestos or
`toxic/environmental) (24)
`Medical Malpractice (45)
`Medical Malpractice–
`Physicians & Surgeons
`Other Professional Health Care
`Malpractice
`Other PI/PD/WD (23)
`Premises Liability (e.g., slip
`and fall)
`Intentional Bodily Injury/PD/WD
`(e.g., assault, vandalism)
`Intentional Infliction of
`Emotional Distress
`Negligent Infliction of
`Emotional Distress
`Other PI/PD/WD
`Non-PI/PD/WD (Other) Tort
`Business Tort/Unfair Business
` Practice (07)
`Civil Rights (e.g., discrimination,
` false arrest) (not civil
`harassment) (08)
`Defamation (e.g., slander, libel)
`(13)
`Fraud (16)
`Intellectual Property (19)
`Professional Negligence (25)
` Legal Malpractice
` Other Professional Malpractice
` (not medical or legal)
`Other Non-PI/PD/WD Tort (35)
`Employment
`Wrongful Termination (36)
`Other Employment (15)
`
`Provisionally Complex Civil Litigation (Cal.
`Rules of Court Rules 3.400–3.403)
`Antitrust/Trade Regulation (03)
`Construction Defect (10)
`Claims Involving Mass Tort (40)
`Securities Litigation (28)
`Environmental/Toxic Tort (30)
`Insurance Coverage Claims
`(arising from provisionally complex
`case type listed above) (41)
`Enforcement of Judgment
`Enforcement of Judgment (20)
`Abstract of Judgment (Out of
`County)
`Confession of Judgment (non-
`domestic relations)
`Sister State Judgment
`Administrative Agency Award
` (not unpaid taxes)
`Petition/Certification of Entry of
` Judgment on Unpaid Taxes
`Other Enforcement of Judgment
`Case
`Miscellaneous Civil Complaint
`RICO (27)
`Other Complaint (not specified
`above) (42)
`Declaratory Relief Only
`Injunctive Relief Only (non-
`harassment)
`Mechanics Lien
`Other Commercial Complaint
`Case (non-tort/non-complex)
`Other Civil Complaint
`(non-tort/non-complex)
`Miscellaneous Civil Petition
`Partnership and Corporate
`Governance (21)
`Other Petition (not specified
`above) (43)
`Civil Harassment
`Workplace Violence
`Elder/Dependent Adult
`Abuse
`Election Contest
`Petition for Name Change
`Petition for Relief From Late
`Claim
`Other Civil Petition
`
`

`

`SHORT TITLE:
`
`CASE NUMBER
`
`CIVIL CASE COVER SHEET ADDENDUM AND
`STATEMENT OF LOCATION
`(CERTIFICATE OF GROUNDS FOR ASSIGNMENT TO COURTHOUSE LOCATION)
`
`This form is required pursuant to Local Rule 2.0 in all new civil case filings in the Los Angeles Superior Court.
`
`Item I. Check the types of hearing and fill in the estimated length of hearing expected for this case:
`
`JURY TRIAL?
`
`YES CLASS ACTION?
`
`YES LIMITED CASE?
`
`YES TIME ESTIMATED FOR TRIAL
`
`HOURS/
`
`DAYS
`
`Item II. Indicate the correct district and courthouse location (4 steps – If you checked “Limited Case”, skip to Item III, Pg. 4):
`
`Step 1: After first completing the Civil Case Cover Sheet form, find the main Civil Case Cover Sheet heading for your
`case in the left margin below, and, to the right in Column A, the Civil Case Cover Sheet case type you selected.
`
`Step 2: Check one Superior Court type of action in Column B below which best describes the nature of this case.
`
`Step 3: In Column C, circle the reason for the court location choice that applies to the type of action you have
`checked. For any exception to the court location, see Local Rule 2.0.
`
`Applicable Reasons for Choosing Courthouse Location (see Column C below)
`
`1. Class actions must be filed in the Stanley Mosk Courthouse, central district.
`2. May be filed in central (other county, or no bodily injury/property damage).
`3. Location where cause of action arose.
`4. Location where bodily injury, death or damage occurred.
`5. Location where performance required or defendant resides.
`
`6. Location of property or permanently garaged vehicle.
`7. Location where petitioner resides.
`8. Location wherein defendant/respondent functions wholly.
`9. Location where one or more of the parties reside.
`10. Location of Labor Commissioner Office
`
`Step 4: Fill in the information requested on page 4 in Item III; complete Item IV. Sign the declaration.
`
`A
`Civil Case Cover Sheet
`Category No.
`
`B
`Type of Action
`(Check only one)
`
`C
`Applicable Reasons -
`See Step 3 Above
`
`Auto (22)
`
` A7100 Motor Vehicle - Personal Injury/Property Damage/Wrongful Death
`
`1., 2., 4.
`
`Uninsured Motorist (46)
`
` A7110 Personal Injury/Property Damage/Wrongful Death – Uninsured Motorist 1., 2., 4.
`
`Asbestos (04)
`
` A6070 Asbestos Property Damage
`
` A7221 Asbestos - Personal Injury/Wrongful Death
`
`2.
`
`2.
`
`Product Liability (24)
`
` A7260 Product Liability (not asbestos or toxic/environmental)
`
`1., 2., 3., 4., 8.
`
`Medical Malpractice (45)
`
` A7210 Medical Malpractice - Physicians & Surgeons
`
` A7240 Other Professional Health Care Malpractice
`
`Other
`Personal Injury
`Property Damage
`Wrongful Death
`(23)
`
` A7250 Premises Liability (e.g., slip and fall)
`
` A7230 Intentional Bodily Injury/Property Damage/Wrongful Death (e.g.,
`
`
`assault, vandalism, etc.)
`
` A7270 Intentional Infliction of Emotional Distress
`
` A7220 Other Personal Injury/Property Damage/Wrongful Death
`
`1., 4.
`
`1., 4.
`
`1., 4.
`
`1., 4.
`
`1., 3.
`
`1., 4.
`
`Tort
`Auto
`
`Damage/ Wrongful Death Tort
`Other Personal Injury/ Property
`
`LACIV 109 (Rev. 03/11)
`
`LASC Approved 03-04
`
`CIVIL CASE COVER SHEET ADDENDUM
`AND STATEMENT OF LOCATION
`
`Local Rule 2.0
`Page 1 of 4
`
`Electronically FILED by Superior Court of California, County of Los Angeles on 04/13/2021 01:04 AM Sherri R. Carter, Executive Officer/Clerk of Court, by C. Monroe,Deputy Clerk
`
`21STCV13978
`
`

`

`Case 2:21-cv-09274 Document 1-3 Filed 11/29/21 Page 4 of 41 Page ID #:15
`
`SHORT TITLE:
`
`CASE NUMBER
`
`A
`Civil Case Cover Sheet
`Category No.
`
`B
`Type of Action
`(Check only one)
`
`C
`Applicable Reasons -
`See Step 3 Above
`
`Business Tort (07)
`
` A6029 Other Commercial/Business Tort (not fraud/breach of contract)
`
`1., 3.
`
`Civil Rights (08)
`
` A6005 Civil Rights/Discrimination
`
`Defamation (13)
`
` A6010 Defamation (slander/libel)
`
`Fraud (16)
`
` A6013 Fraud (no contract)
`
`Professional Negligence (25)
`
` A6017 Legal Malpractice
`
` A6050 Other Professional Malpractice (not medical or legal)
`
`Other (35)
`
` A6025 Other Non-Personal Injury/Property Damage tort
`
`Wrongful Termination (36)
`
` A6037 Wrongful Termination
`
`Other Employment (15)
`
` A6024 Other Employment Complaint Case
`
` A6109 Labor Commissioner Appeals
`
`Breach of Contract/ Warranty
`(06)
`(not insurance)
`
` A6004 Breach of Rental/Lease Contract (not unlawful detainer or wrongful
`
`
`eviction)
`
`
`
` A6008 Contract/Warranty Breach -Seller Plaintiff (no fraud/negligence)
`
` A6019 Negligent Breach of Contract/Warranty (no fraud)
`
` A6028 Other Breach of Contract/Warranty (not fraud or negligence)
`
`Collections (09)
`
` A6002 Collections Case-Seller Plaintiff
`
` A6012 Other Promissory Note/Collections Case
`
`Insurance Coverage (18)
`
` A6015 Insurance Coverage (not complex)
`
`Other Contract (37)
`
` A6031 Tortious Interference
`
` A6009 Contractual Fraud
`
` A6027 Other Contract Dispute(not breach/insurance/fraud/negligence)
`
`1., 2., 3.
`
`1., 2., 3.
`
`1., 2., 3.
`
`1., 2., 3.
`
`1., 2., 3.
`
`2.,3.
`
`1., 2., 3.
`
`1., 2., 3.
`
`10.
`
`2., 5.
`
`2., 5.
`
`1., 2., 5.
`
`1., 2., 5.
`
`2., 5., 6.
`
`2., 5.
`
`1., 2., 5., 8.
`
`1., 2., 3., 5.
`
`1., 2., 3., 5.
`
`1., 2., 3., 8.
`
`Eminent Domain/Inverse
`Condemnation (14)
`
` A7300 Eminent Domain/Condemnation
`
`
`
`Number of parcels______
`
`2.
`
`Wrongful Eviction (33)
`
` A6023 Wrongful Eviction Case
`
`Other Real Property (26)
`
` A6032 Quiet Title
`
` A6018 Mortgage Foreclosure
`
`2., 6.
`
`2., 6.
`
`2., 6.
`
` A6060 Other Real Property (not eminent domain, landlord/tenant, foreclosure)
`
`2., 6.
`
`Unlawful Detainer-Commercial
`(31)
`
`Unlawful Detainer-Residential
`(32)
`
`Unlawful Detainer-
`Post-Foreclosure (34)
`
` A6021 Unlawful Detainer-Commercial (not drugs or wrongful eviction)
`
` A6020 Unlawful Detainer-Residential (not drugs or wrongful eviction)
`
` A6020F Unlawful Detainer-Post-Foreclosure
`
`Unlawful Detainer-Drugs (38)
`
` A6022 Unlawful Detainer-Drugs
`
`2., 6.
`
`2., 6.
`
`2., 6.
`
`2., 6.
`
`Damage/ Wrongful Death Tort
`Non-Personal Injury/ Property
`
`Employment
`
`Contract
`
`Real Property
`
`Unlawful Detainer
`
`LACIV 109 (Rev. 03/11)
`
`LASC Approved 03-04
`
`CIVIL CASE COVER SHEET ADDENDUM
`AND STATEMENT OF LOCATION
`
`Local Rule 2.0
`Page 2 of 4
`
`

`

`Case 2:21-cv-09274 Document 1-3 Filed 11/29/21 Page 5 of 41 Page ID #:16
`
`SHORT TITLE:
`
`CASE NUMBER
`
`A
`Civil Case Cover Sheet
`Category No.
`
`B
`Type of Action
`(Check only one)
`
`C
`Applicable Reasons -
`See Step 3 Above
`
`Asset Forfeiture (05)
`
` A6108 Asset Forfeiture Case
`
`Petition re Arbitration (11)
`
` A6115 Petition to Compel/Confirm/Vacate Arbitration
`
` A6151 Writ - Administrative Mandamus
`
`Writ of Mandate (02)
`
` A6152 Writ - Mandamus on Limited Court Case Matter
`
` A6153 Writ - Other Limited Court Case Review
`
`Other Judicial Review (39)
`
` A6150 Other Writ /Judicial Review
`
`Antitrust/Trade Regulation (03)
`
` A6003 Antitrust/Trade Regulation
`
`Construction Defect (10)
`
` A6007 Construction Defect
`
`Claims Involving Mass Tort
`(40)
`
` A6006 Claims Involving Mass Tort
`
`Securities Litigation (28)
`
` A6035 Securities Litigation Case
`
`2., 6.
`
`2., 5.
`
`2., 8.
`
`2.
`
`2.
`
`2., 8.
`
`1., 2., 8.
`
`1., 2., 3.
`
`1., 2., 8.
`
`1., 2., 8.
`
`Toxic Tort
`Environmental (30)
`
`Insurance Coverage Claims
`from Complex Case (41)
`
` A6036 Toxic Tort/Environmental
`
`1., 2., 3., 8.
`
` A6014 Insurance Coverage/Subrogation (complex case only)
`
`1., 2., 5., 8.
`
` A6141 Sister State Judgment
`
` A6160 Abstract of Judgment
`
`Enforcement
`of Judgment (20)
`
` A6107 Confession of Judgment (non-domestic relations)
`
` A6140 Administrative Agency Award (not unpaid taxes)
`
` A6114 Petition/Certificate for Entry of Judgment on Unpaid Tax
`
` A6112 Other Enforcement of Judgment Case
`
`RICO (27)
`
` A6033 Racketeering (RICO) Case
`
` A6030 Declaratory Relief Only
`
`Other Complaints
`(Not Specified Above) (42)
`
` A6040 Injunctive Relief Only (not domestic/harassment)
`
` A6011 Other Commercial Complaint Case (non-tort/non-complex)
`
` A6000 Other Civil Complaint (non-tort/non-complex)
`
`Partnership Corporation
`Governance (21)
`
` A6113 Partnership and Corporate Governance Case
`
`Other Petitions
`(Not Specified Above)
`(43)
`
` A6121 Civil Harassment
`
` A6123 Workplace Harassment
`
` A6124 Elder/Dependent Adult Abuse Case
`
` A6190 Election Contest
`
` A6110 Petition for Change of Name
`
` A6170 Petition for Relief from Late Claim Law
`
` A6100 Other Civil Petition
`
`2., 9.
`
`2., 6.
`
`2., 9.
`
`2., 8.
`
`2., 8.
`
`2., 8., 9.
`
`1., 2., 8.
`
`1., 2., 8.
`
`2., 8.
`
`1., 2., 8.
`
`1., 2., 8.
`
`2., 8.
`
`2., 3., 9.
`
`2., 3., 9.
`
`2., 3., 9.
`
`2.
`
`2., 7.
`
`2., 3., 4., 8.
`
`2., 9.
`
`Judicial Review
`
`Provisionally Complex Litigation
`
`of Judgment
`Enforcement
`
`Civil Complaints
`Miscellaneous
`
`Civil Petitions
`Miscellaneous
`
`LACIV 109 (Rev. 03/11)
`
`LASC Approved 03-04
`
`CIVIL CASE COVER SHEET ADDENDUM
`AND STATEMENT OF LOCATION
`
`Local Rule 2.0
`Page 3 of 4
`
`

`

`Case 2:21-cv-09274 Document 1-3 Filed 11/29/21 Page 6 of 41 Page ID #:17
`
`SHORT TITLE:
`
`CASE NUMBER
`
`Item III. Statement of Location: Enter the address of the accident, party’s residence or place of business, performance, or other
`circumstance indicated in Item II., Step 3 on Page 1, as the proper reason for filing in the court location you selected.
`
`REASON: Check the appropriate boxes for the numbers shown
`under Column C for the type of action that you have selected for
`this case.
`
`1.
`
`2.
`
`3.
`
`4.
`
`5.
`
`6.
`
`7.
`
`8.
`
`9.
`
`10.
`
`CITY:
`
`STATE:
`
`ZIP CODE:
`
`ADDRESS:
`
`Item IV. Declaration of Assignment: I declare under penalty of perjury under the laws of the State of California that the foregoing is true
`
`and correct and that the above-entitled matter is properly filed for assignment to the ___________________ courthouse in the
`
`____________________ District of the Superior Court of California, County of Los Angeles [Code Civ. Proc., § 392 et seq., and Local
`
`Rule 2.0, subds. (b), (c) and (d)].
`
`Dated: ___________________
`
`
`
`
`
`
`
`
`
`_______________________________________
`(SIGNATURE OF ATTORNEY/FILING PARTY)
`
`PLEASE HAVE THE FOLLOWING ITEMS COMPLETED AND READY TO BE FILED IN ORDER TO PROPERLY
`COMMENCE YOUR NEW COURT CASE:
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`1. Original Complaint or Petition.
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`2.
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`If filing a Complaint, a completed Summons form for issuance by the Clerk.
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`3. Civil Case Cover Sheet, Judicial Council form CM-010.
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`4. Civil Case Cover Sheet Addendum and Statement of Location form, LACIV 109, LASC Approved 03-04 (Rev.
`03/11).
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`5. Payment in full of the filing fee, unless fees have been waived.
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`6. A signed order appointing the Guardian ad Litem, Judicial Council form CIV-010, if the plaintiff or petitioner is a
`minor under 18 years of age will be required by Court in order to issue a summons.
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`7. Additional copies of documents to be conformed by the Clerk. Copies of the cover sheet and this addendum
`must be served along with the summons and complaint, or other initiating pleading in the case.
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`LACIV 109 (Rev. 03/11)
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`LASC Approved 03-04
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`CIVIL CASE COVER SHEET ADDENDUM
`AND STATEMENT OF LOCATION
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`Local Rule 2.0
`Page 4 of 4
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`JONATHAN A. STIEGLITZ
`(SBN 278028)
`jonathan.a.stieglitz@gmail.com
`THE LAW OFFICES OF
`JONATHAN A. STIEGLITZ
`11845 W. Olympic Blvd., Ste. 800
`Los Angeles, California 90064
`Telephone:
`(323) 979-2063
`Facsimile:
`(323) 488-6748
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`Attorney for Plaintiff
`Beverly Hills Regional Center, L.P.
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`SUPERIOR COURT OF THE STATE OF CALIFORNIA
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`COUNTY OF LOS ANGELES
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`Beverly Hills Regional Center, L.P.
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`Case No.:
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`v.
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`Plaintiff,
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`Complaint For:
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`1. NEGLIGENT MISREPRESENTATION
`2. BREACH OF WRITTEN CONTRACT
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`(Jury Trial Requested)
`Total Damages - $1,000,000.00
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`Complaint
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`Premera Blue Cross and DOES 1-10,
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`Defendant.
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`Electronically FILED by Superior Court of California, County of Los Angeles on 04/13/2021 01:04 AM Sherri R. Carter, Executive Officer/Clerk of Court, by C. Monroe,Deputy Clerk
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`Assigned for all purposes to: Stanley Mosk Courthouse, Judicial Officer: Maurice Leiter
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`21STCV13978
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`Case 2:21-cv-09274 Document 1-3 Filed 11/29/21 Page 8 of 41 Page ID #:19
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`Plaintiff Beverly Hills Regional Center, L.P. (hereinafter referred to as “PLAINTIFF” or
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`“Medical Provider”) complains and alleges:
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`PARTIES
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`1.
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`Plaintiff, Medical Provider, is and at all relevant times was a medical corporation,
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`organized and existing under the laws of the State of California. Medical Provider is and at all
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`relevant times was in good standing under the laws of the State of California.
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`2.
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`DEFENDANT, United Healthcare Services, Inc., is and was licensed to do
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`business in and is and was doing business in the State of California, as insurers. PLAINTIFF is
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`informed and believes that DEFENDANT is licensed by to transact the business of insurance in
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`the State of California. DEFENDANT is, in fact, transacting the business of insurance in the
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`State of California and is thereby subject to the laws and regulations of the State of California.
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`3.
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`The true names and capacities, whether individual, corporate, associate, or
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`otherwise, of defendants DOES 1 through 10, inclusive, are unknown to PLAINTIFF, who
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`therefore sues said defendants by such fictitious names. PLAINTIFF is informed and believes and
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`thereon alleges that each of the defendants designated herein as a DOE is legally responsible in
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`some manner for the events and happenings referred to herein and legally caused injury and
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`damages proximately thereby to PLAINTIFF. PLAINTIFF will seek leave of this Court to amend
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`this Complaint to insert their true names and capacities in place and instead of the fictitious
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`names when they become known to it.
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`4.
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`At all times herein mentioned, unless otherwise indicated, DEFENDANT/s were
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`the agents and/or employees of each of the remaining defendants, and were at all times acting
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`within the purpose and scope of said agency and employment, and each defendant has ratified and
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`approved the acts of his agent. At all times herein mentioned, DEFENDANT/s had actual or
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`ostensible authority to act on each other’s behalf in certifying or authorizing the provision of
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`services; processing and administering the claims and appeals; pricing the claims; approving or
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`denying the claims; directing each other as to whether and/or how to pay claims; issuing
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`- 2 -
`COMPLAINT
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`Case 2:21-cv-09274 Document 1-3 Filed 11/29/21 Page 9 of 41 Page ID #:20
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`remittance advices and explanations of benefits statements; making payments to Medical Provider
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`and its Patients.
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`GENERAL ALLEGATIONS
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`5.
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`All of the claims asserted in this complaint are based upon the individual and
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`proper rights of Medical Provider in its own individual capacity and are not derivative of the
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`contractual or other rights of the Medical Provider’s Patient. A number of the claims asserted in
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`this complaint arise out of the Medical Provider’s interactions with DEFENDANT and DOES 1
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`through 10, inclusive and are derived from the representations and warranties made during those
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`conversations amongst those parties. Medical Provider does not in any way, seek to enforce the
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`contractual rights of the Medical Provider’s Patients, through the Patients’ insurance contract,
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`policies, certificates of coverage or other written insurance agreements.
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`6.
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`This complaint arises out of the failure of DEFENDANT to make proper payments
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`and/or the underpayment to Medical Provider by DEFENDANT and DOES 1 through 10,
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`inclusive, of amounts due and owing now to Medical Provider for surgical care, treatment and
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`procedures provided to Patients, who are insureds, members, policyholders, certificate-holders or
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`were otherwise covered for health, hospitalization and major medical insurance through policies
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`or certificates of insurance issued and underwritten by DEFENDANT and DOES 1 through 10,
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`inclusive.
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`7.
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`Medical Provider is informed and believes based on DEFENDANT’s oral and
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`other representations that the Patient was an insured of DEFENDANT either as a subscriber to
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`coverage or a dependent of a subscriber to coverage under a policy or certificate of insurance
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`issued and underwritten by DEFENDANT and DOES 1 through 10, inclusive, and each of them.
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`Medical Provider is informed and believes that the Patient entered into a valid insurance
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`agreement with DEFENDANT for the specific purpose of ensuring that the Patient would have
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`access to medically necessary treatments, care, procedures and surgeries by medical practitioners
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`like Medical Provider and ensuring that DEFENDANT would pay for the health care expenses
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`incurred by the Patient.
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`- 3 -
`COMPLAINT
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`Case 2:21-cv-09274 Document 1-3 Filed 11/29/21 Page 10 of 41 Page ID #:21
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`8.
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`Medical Provider is informed and believes that DEFENDANT and DOES 1
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`through 10, inclusive, and each of them, received and continue to receive, valuable premium
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`payments from the Patient and/or other consideration from Patient under the subject policies
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`applicable to Patient.
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`9.
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`It is standard practice in the health care industry that when a medical provider
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`enters into a written preferred provider contract with a health plan such as DEFENDANT, that a
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`medical provider agrees to accept reimbursement that is discounted from the medical provider’s
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`total billed charges in exchange for the benefits of being a preferred or contracted provider.
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`10.
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`Those benefits include an increased volume of business, because the health plan
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`provides financial and other incentives to its members to receive their medical care and
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`treatments from the contracted provider, such as advertising that the provider is “in network”, and
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`allowing the members to pay lower co-payments and deductibles to obtain care and treatment
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`from a contracted provider.
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`11.
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`Conversely, when a medical provider, such as Medical Provider, does not have a
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`written contract or preferred provider agreement with a health plan, the medical provider receives
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`no referrals from the health plan.
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`12.
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`The medical provider has no obligation to reduce its charges. The health plan is
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`not entitled to a discount from the medical provider’s total bill charge for the services rendered,
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`because it is not providing the medical provider with in network medical provider benefits, such
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`as increased patient volume and direct payment obligations.
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`13.
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`The reason why medical providers have chosen to forgo the benefits of a contract
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`with a payor is that, in recent years, many insurers including DEFENDANT’s contracted rates for
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`in-network providers have been so meager, one-sided and onerous, that many providers like
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`Medical Provider have determined that they cannot afford to enter into such contracts. As a
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`result, a growing number of medical providers have become non-contracted or out of network
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`providers.
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`14.
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`Payors and insurers still want their patients to be seen and so they commonly
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`promise to pay out of network providers a percentage of the market rate for the procedure, also
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`- 4 -
`COMPLAINT
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`Case 2:21-cv-09274 Document 1-3 Filed 11/29/21 Page 11 of 41 Page ID #:22
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`described as, an average payment for the procedure performed or provided by similarly situated
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`medical providers within similarly situated areas or places of practice. Rather than use the words
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`market rate to simplify terms, payors have long used words or combinations of words such as
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`usual, reasonable, customary and allowed, all to mean an average payment for a procedure
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`provided by similarly situated medical providers within similarly situated areas or places of
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`practice (“UCR”).
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`15.
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`The United States government provides a definition for the term UCR. “The
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`amount paid for a medical service in a geographic area based on what providers in the area
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`usually charge for the same or similar medical service. The UCR amount sometimes is used to
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`determine the allowed amount.”1
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`16.
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`Based upon these criteria, Medical Provider’s charges are usual, reasonable and
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`customary. Medical Provider charged DEFENDANT the same fees that it charges all other
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`payors. Medical Provider’s fees are comparable to the prevailing provider rates for other
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`surgeons in comparable geographic areas to the one in which the services were provided.
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`17.
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`DEFENDANT uses the term UCR in its insurance policies.
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`18. When DEFENDANT uses the term UCR for the price of a medical service,
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`DEFEDANT will utilize a medical bill database from Fair Health Inc. to determine the exact
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`dollar amount to be paid for a medical claim.2
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`1 See Healthcare.gov, UCR (Usual, Customary and Reasonable) (February 19, 2020),
`https://www.healthcare.gov/glossary/UCR-usual-customary-and-reasonable/ (defining UCR)
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`2 United Healthcare, Information on Payment of Out-of-Network Benefits (March 6,
`2018), https://www.uhc.com/legal/information-on-payment-of-out-of-network-benefits (“FH,
`[Fair Health], Benchmarking Database. One of two compilations of information on health care
`professional charges created by Fair Health and used by affiliates of UnitedHealth Group to
`determine payment for out-of-network professional services when reimbursed und