Case 3:21-cv-06060-JCS Document 1-1 Filed 08/05/21 Page 1 of 13
`
`SUMMONS
`(CITACION JUDICIAL)
`
`
`SUM-100
`
`footagzterraem
`
`NOTICE TO DEFENDANT:
`
`(A me At. DEMANDADO):
`ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE
`COMPANY; THE RETA TUST PLAN; and DOES 1~IO
`
`YOU ARE‘ BEING SUED BY PLAINTIFF:
`(LO ESTA DEMANDANDO EL DEMANDANTE):
`BEA S,
`
`
`
`NOTiCEi You have been sued". The court may decide against you without your being heard unless you respon within 80 days. Read the information
`below,
`You have 30 CALENDAR DAYS after, this summons and legal papers are served on you to file a written response at this court and have a copy
`served on the plaintiff. A letter or phone cell will not protect you. Your written response must be in proper legal form it you want the court to hear your
`case. There may be a court form that you can use for your response You can Iind these court forms and more information at the California Courts
`Online Se|i~Help Center (wwoourtlnl’ouagov/selflielp), your county law library, or the courthouse nearest ypu. if you cannot pay the filing fee, ask the
`court clerk for a fee waiver form. if you do not file your response on time. you may lose the case by default‘ and your wages‘ money. and property may
`be taken without further warning from the court.
`There are other legal requirements. You may want to call an attorney right away. it you do not know an attomey, you may want to call an attorney
`reierral service. ti you cannot afford an attorney, you may be eligible lorfree legal services from a nonprofit legal services program. You can locate
`these nonprofit groups at the Caiitornia Legal ServicesWeb site (wwwjawhelpcallfomiaorg). the California Courts Online Selthelp Center
`(Mt/w.courtinfocagov/sellhelp), or by contacting your local court or county bar association. NOTE: The court has a statutory lien for waived tees and
`costs on any settlement or arbitration award oi $10,000 or more in a civil case. The court‘s lien must be paid before the court will dismiss the case
`[AV/SO! Lo hem demandado. Si no responde denim de 30 dies, la aorta puede decidlr en su contra sin escuchar su version. Lea la lnlormacldn a
`commit/acted
`Tlene 30 Dl'AS DE CALENDARIO después rate que la enlreguan esta cilaclén ypape/es [age/as para presenter una respuesta por escn'to en esta
`curls yhacer que se entregue una copra al demandanle. Una can‘a o una llamada' telefdnlca no lo protegen; Su respuesla por esprito tiene que ester
`en fomzato legal coneclo sr‘ desea qua pmcesen su case en la cone Es poslble que- haya un formulan‘o que ustect pueda user para su respuesta.
`Puede encontrar estos fonnularios de la cone y mas infbnnaClén en at Centre de Ayuda de las Cortes de California (WWW. sucorte.oa.gov}, en la
`biblioleca de leyes de su condado 0 en la corte que le quede mas cema. Si no puede pager/a were do pmsentaclén older at! secretano de la come que
`)6 do an formulan‘o do exencr‘on de page de ouolas. Sr’ no presenta su respuesta a tiempo puade perder el (2550 por incumplimlento y la cone le padre
`qultar su sueldo dine/o y bienes sin masadvertencia
`Hay atlas requisites legales Es recomendable qua llama a an abogado lnmediatamente. Si no GonOce a un abogado, puede llamar a an serviclo de
`romlsr’én a abogados. Si no puede pagar a un abogado, es posib/e que cumpla con los requisites para obtener serviciostlegales gretur’tos de un
`pmgrama de serviclcs legales sin fines de lucro, Puede encontrar estas grapes sin fines de Iucro enrel'sitio. Web de California Legal Services,
`(wwwtIawhelpcalifomr‘aorg), en el‘Centro de Ayuda de las Cortes de California. {wweucortecagoir} o porliéndose'en contacto con la corte 0 el
`colegio de abogados locales. AVISO: Parley, Ia cone tlene derecho a reclamarrlas cuotas y 103 castes exenlos porlmponer an gravamen some
`cualqur'er reouperacion (to $10,000 6 mas de valor recibr’da mediante un acuendo a una concesrbn do arbltraje en rm case do derecho civil. Tlene que
`pager e! gran/amen de la cone antes de que la aorta pueda deseohar el case,
`The name end address of the court is:
`.
`,
`(El hombre y direccién de la Cone es): San Franmsco COW”! SUBSTIOY Court
`400 McAllisler Street
`CGC-21-591 598
`San Francisco. CA 94102
`The name, address, and telephone number of piaintifl’s attorney, or plaintiff without an attorney‘ is: (El hombre, la direccion y el nomero
`do teléfono del abogado do! demandenle, o (tel demandante qua no tiene abogado, as):
`David M. Lillenstein, DL Law Group. 345 Franklin $treet‘ San Francisco; CA 94102; (415)678-5050
`
`CASE NUMBERthmero del Case):
`
`
`Clerk by
`DATE:
`
`(F9058)
`(Searetan’o)
`(FormfifilZWflrBQdf this summons use Proof oi Semioe of Summons (form POS010)) EDWARD SANTOS
`(Para prueba do antrega de esta citation use el formulano Proof of Service of Summons {POS010))
`NOTICE TO THE PERSON SERVED: You are'served
`
`. Deputy
`(Ad/unto)
`
`t.
`
`2.
`
`[
`
`as an individual defendant,
`
`as the person sued under the fictitious name of (specify):
`
`3. CZ on behalf of (specify)
`
`THE RETA TRUST PLAN
`
`
`
` Page 1 0t 1
`
`I
`under: [: CC? 418.10tcorporation)
`1 CC? 416,20 tdelunctcdrporatlon)
`CCP 416.40 (association or partnership)
`XX other (spawn/)2 Trust
`[:3 by personaldelivery on (date)
`SUMMONS
`
`4
`
`CCP41660 (minor)
`[:j CCP 418,70 (oonservatee)
`[:1 GOP 416.90 (authorized person)
`
`Form Adopted tor Mandatory Use
`Juolaai Councli of Calitomia
`
`Code at ClYlI F’rocedure §§ 4t2r20. 455
`Wucourts cagov
`
`

`

`Case 3:21-cv-06060-JCS Document 1-1 Filed 08/05/21 Page 2 of 13
`
`David M. Lilienstein, SBN 218923
`david@dllawgroup.com
`Katie 1. Spielman, SBN 252209
`katie@dllawgroup.com
`DL LAW GROUP
`345 Franklin St.
`San Francisco, CA 94102
`Telephone: (415) 678-5050
`Facsimile: (415) 358-8484
`
`Attorneys for Plaintiff,
`BEA S.
`
`IN THE SUPERIOR COURT OF CALIFORNIA
`
`COUNTY OF SAN FRANCISCO
`
`ELECTRON lCALLY
`
`F I L E D
`Superior Court of California,
`County of San Francisco
`
`05/06/2021
`Clerk of the Court
`BY: KALENE APOLONIO
`Deputy Clerk
`
`CGC-21-591598
`
`BEA 8.,
`
`v.
`
`Plaintiff,
`
`ANTHEM BLUE CROSS LIFE AND
`HEALTH INSURANCE COMPANY dba
`
`ANTHEM BLUE CROSS; THE RETA
`
`TRUST PLAN; and DOES 1 through 1.0,
`
`Defendants.
`
`I.
`
`Case No.
`
`COMPLAINT FOR BREACH OF
`
`CONTRACT; BREACH OF THE
`COVENANT OF GOOD FAITH AND
`
`FAIR DEALING; JURY TRIAL
`DEMANDED
`
`INTRODUCTION
`
`
`
`
`
`Plaintiff Bea S. hereby requests a jury trial on all
`
`issues in this action against Defendant
`
`ANTHEM BLUE CROSS LLFE AND HEALTH INSURANCE COMPANY dba ANTHEM BLUE
`
`CROSS; THE RETA TRUST PLAN; and DOES 1 through 10.
`
`Plaintiff Bea S. alleges as follows:
`
`//
`
`//
`
`

`

`Case 3:21-cv-06060-JCS Document 1-1 Filed 08/05/21 Page 3 of 13
`
`II.
`
`PARTIES
`
`Plaintiffis, and all. relevant times, was a resident of California.
`
`Plaintift‘Bea S. was at all relevant times, J.S.’s parent and legal guardian, and had legal.
`
`l.
`
`2.
`
`responsibility for his care, health, and welfare. J .S. was, at all relevant times, a minor child.
`
`3.
`
`Bea S. was the individual responsible for his and .l.S.’s health coverage, as that term
`
`(“responsible individual”) is defined by the Department of the Treasury. Internal Revenue Service.
`
`4.
`
`Bea S. was a member of the subject health insurance benefits plan. 1.8. was a member of
`
`the subject health insurance benefits plan. The plan, or policy, is referred to as the Reta Trust Plan (“the
`
`Plan”), established by the Roman Catholic dioceses.
`
`5.
`
`Defendant ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY
`
`dba ANTHEM BLUE CROSS (“ANTHEM”) is a health insurance company authorized to transact and
`
`currently transacting the business of insurance in the State of Califomia, including the County of San
`
`Francisco.
`
`6.
`
`Defendant THE RETA TRUST PLAN (“the Plan”) is a group health care plan established
`
`by the Roman Catholic dioceses and religious orders to provide healthcare plans for clergy, religious
`
`members, and employees and eligible family members of Catholic employers.
`
`7.
`
`The true names or capacities, whether individual, corporate, associate, or otherwise, of
`
`defendants DOES 1 through 10, inclusive, are unknown to Plaintiff who therefore sue said defendants
`
`by such fictitious names. Plaintiff is informed and believes and on such information and belief alleges
`
`that each of the defendants sued herein as a DOE is legally responsible in some manner for the events
`
`and happenings referred to herein, and will ask leave of this court to amend this Complaint to insert their
`
`true names and capacities in place and instead of the fictitious names when the same become known to
`
`Plaintiff.
`
`8.
`
`At all times relevant, the DOE defendants, and each of them, were, subject to the discovery
`
`of new facts, the agents and employees of the remaining defendants, and were at all times acting within
`
`the purpose and scope of said agency and employment, and each defendant has ratified and approved the
`
`acts of its agent.
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`Case 3:21-cv-06060-JCS Document 1-1 Filed 08/05/21 Page 4 of 13
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`III.
`
`FIRST CAUSE OF ACTION
`
`(Breach of Contract against ANTHEM. BLUE CROSS LIFE AND HEALTH. INSURANCE
`COMPANY dba ANTHEM BLUE CROSS; THE RETA TRUST PLAN; and DOES 1-10)
`
`As for the FIRST CAUSE OF ACTION, Plaintiff complains against Defendants ANTHEM
`
`BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY dba ANTHEM BLUE CROSS; THE
`
`RETA TRUST PLAN; and DOES 1 through 10 and allege:
`
`9.
`
`Plaintiff incorporates by refence each and every paragraph of this Complaint as though
`
`set forth in full in this cause of action.
`
`10.
`
`1].
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`At all relevant times, Plaintiff performed all terms, conditions and obligations required of
`
`them under the Plan.
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`12.
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`13.
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`At all times herein mentioned, the Plan was in full force and effect.
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`At all relevant times, J .S. was insured under the Reta Trust Plan (“the Plan”) administered
`
`by Defendant ANTHEM. At all times relevant; the Plan provided behavioral and mental health benefits
`
`that were administered by Defendant ANTHEM.
`
`l4.
`
`Under the terms and conditions of the Plan, to qualify for residential treatment relating to
`
`psychiatric disorder treatment, the covered individual’s symptoms or condition must meet the criteria for
`
`~ Medical Necessity.
`
`15.
`
`Medically necessary services as defined under the Plan are “those that the Claims
`
`Administrator determines to be:
`
`a. Appropriate and necessary for the diagnosis and treatment of the medical condition;
`
`b. Provided for the diagnosis or direct care and treatment of the medical condition;
`
`c. Within standards of good medical practice within the organized medical community;
`
`(1. Not primarily for your convenience, or for the convenience of your Physician or
`
`another provider; and
`
`e. The most appropriate procedure. supply, equipment or service which can safely be
`
`provided. The most appropriate procedure, supply, equipment or service must satisfy
`
`the following requirements:
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`Case 3:21-cv-06060-JCS Document 1-1 Filed 08/05/21 Page 5 of 13
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`i. There must be valid scientific evidence demonstrating that the expected health
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`benefits from the procedure, supply, equipment or service are clinically
`
`significant
`
`and produce
`
`a
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`greater
`
`likelihood of benefit, without
`
`a
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`disproportionately greater risk of harm or complications, for you with the
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`particular medical condition being treated than other possible alternatives; and ~
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`ii. Generally accepted forms of treatment that are less invasive have been tried and
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`found to be ineffective or are otherwise unsuitable; and
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`iii. For hospital stays, acute care as an inpatient as necessary due to the kind of
`services you are receiving or the severity ofyo-ur condition and safe and adequate
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`care cannot be received by you as an outpatient or in a less intensified medical
`
`setting.”
`
`16.
`
`The Plan guarantees coverage for inpatient and outpatient treatment for mental health
`
`conditions.
`
`17.
`
`California’s Mental Health Parity Act, Health & Safety Code §1374.72 specifically
`
`requires that health care plans provide medically necessary diagnosis, care and treatment for the treatment
`
`of Specified mental illnesses at a level equal. to the provision of benefits for physical illnesses
`
`18.
`
`IS. has a long history of mental illness and serious emotional disturbances, which at all
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`times relevant only worsened and became more severe, to the point where, as set. forth below, he was a
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`threat to his life and others.
`
`19.
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`At all times relevant, J .S. suffered from, inter alia, major depressive disorder, parent-child
`
`relational problem, generalized anxiety disorder and cannabis use disorder.
`
`20.
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`At age 12, J .S. began treatment with a psychiatrist and was diagnosed with A'D’HD. He
`
`required weekly therapy and medication to combat his pervasive mental health issues.
`
`21.
`
`Despite medication and therapy, J.S. demonstrated signs of depression and suicidal
`
`ideation. He frequently expressed desires to harm himself to his parents.
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`22.
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`In high school J.S. became disruptive, violent, and sold drugs, resulting in his expulsion.
`
`KDOOQC‘t
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`Case 3:21-cv-06060-JCS Document 1-1 Filed 08/05/21 Pagex6 of 13
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`23.
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`Upon transfer to a new school, J.S.’s behavior and mental health conditions exacerbated
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`further. He frequently stole, continued to sell drugs, and self-harmed regularly.
`
`J.S. cut his face and
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`branded his hand.
`
`24.
`
`J .8. continued mental health treatment and regularly took mediation. Despite this, J S
`
`deteriorated further. He set tires inside and outside of the home. He destroyed his parent’s prOperty and
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`threatened to harm. them.
`
`25.
`
`Due to J.S.’s violent outbursts, and threats of bodily hann to himself and others, J.S.°s
`
`treating providers determined, as medically necessary, that he required a higher level of care.
`
`26.
`
`At the recommendation of his treating providers, J.S. was admitted to Second Nature-
`
`
`
`Uintas (“Second Nature”).
`
`27.
`
`At all relevant times, J.S.’s treatment at Second Nature was medically necessary, based
`
`upon the reasoned medical opinions of J.S.’s numerous mental health providers.
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`28.
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`While at Second Nature J .S.’s treaters recommended that J.S. be placed in a higher level
`
`of care at a residential treatment center. Following completion of his treatment at Second Nature, J ,S.
`
`was transferred to Catalyst Residential Treatment Center (“Catalyst”).
`
`29.
`
`At all relevant times, J .S. ’3 treatment at Catalyst was medically necessary, based upon the
`
`reasoned medical opinions of. J .S.’s numerous mental health providers.
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`30.
`
`Plaintiff filed a claim with ANTHEM to cover the cost of J.S.’s mental health treatment
`
`and care at Second Nature, as was required under the terms and conditions of the Policy.
`
`31.
`
`32.
`
`33.
`
`34.
`
`ANTHEM denied coverage for treatment at Second Nature.
`
`Plaintiff appealed ANTHEM’s denial and provided supporting medical records.
`
`ANTHEM denied Plaintiff’ s appeal for J.S.‘s treatmentat Second Nature.
`
`Plaintiff submitted a second level appeal of ANTI-IBM’s appeal denial for J.S.’s treatment
`
`at Second Nature.
`
`35.
`
`ANTHEM upheld the denial of Plaintiff’s claim for treatment at Second Nature on the
`
`second level appeal.
`
`36.
`
`Plaintiff filed a claim with ANTHEM to cover the cost of J .S.’s mental health treatment
`
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`Case 3:21-cv-06060-JCS Document 1-1 Filed 08/05/21 Page 7 of 13
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`ANTHEM denied coverage for treatment at Catalyst.
`
`Plaintiff appealed ANTHEM ’s denial and provided supporting medical records.
`
`Plaintiff submitted a second level appeal ot‘ANTHEM’s appeal denial for J.S.‘s treatment
`
`37.
`
`38.
`
`39,
`
`at Catalyst.
`
`40.
`
`ANTHEM upheld the denial of Plaintiff‘s claim for treatment at Catalyst on the second
`
`level appeal.
`
`41.
`
`THE PLAN adopted and ratified ANTHEM’S denials of Plaintiff’ 5 claims and appeals for
`
`J.S.’s treatment at Second Nature and Catalyst, and refused to pay for J .S.’s treatment.
`
`42.
`
`Not only was DEFENDANTS’ denial unreasonable in light of the obvious medical
`
`necessity for IS. ’s ongoing care at a residential treatment center, but the denial also violated the
`
`California Mental Health Parity Act, as well as the Mental Health Parity and Addictions Equity Act of
`2008 (“MI‘lPAEA”), which alone provided a basis for approving all-of the care for Ryan that is at issue
`
`herein.
`
`43.
`
`As a direct and proximate result of DEFENDANTS’ claim denial, Plaintiff was forced to
`
`pay substantial sums of money, out—of-pocket, in excess of this court’s jurisdiction, for J.S.’s treatment
`
`at Second Nature and Catalyst.
`
`44.
`
`As a direct and proximate result, of. DEFENDANTS’ claim denial, Plaintiff has been.
`
`damaged in an amount equal to the mental. health benefits owing, plus interest, that amount increasing
`
`monthly, as a result of the conduct alleged herein.
`
`45.
`
`In denying the mental health claims set forth above, Defendants ANTHEM BLUE CROSS
`
`LIFE AND HEALTH INSURANCE COMPANY dba ANTHEM BLUE CROSS, THE RETA TRUST
`
`PLAN, and DOES 1 through 10, and each of them, have breached and continue to breach the mental
`
`health insurance contract that is the subject of this litigation.
`
`//
`
`//
`
`//
`
`//
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`Case 3:21-cv-06060-JCS Document 1-1 Filed 08/05/21 Page 8 of 13
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`IV.
`
`SECOND CAUSE OF ACTION
`
`(Breach of the Covenant of Good Faith and Fair Dealing (Insurance Bad Faith)
`' Against ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY dba BLUE
`ANTHEM. BLUE CROSS, and DOES 1. through 10)
`
`46.
`
`Plaintiff incorporates by reference each. and every paragraph of this Complaint as though
`
`set forth in this cause of action.
`
`47.
`
`At all times herein relevant, ANTHEM agreed to act in good faith and deal fairly with
`
`Plaintiff Bea S. ANTHEM thereby assumed a special relationship with and fiduciary-like obligations to
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`Plaintiff and agreed to abide by said duties. Nevertheless, ANTHEM refused and failed to act in good
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`faith and deal fairly with Plaintiff, and breached said obligations, as is set forth more particularly in this
`
`Complaint.
`
`48.
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`ln the absence of a reasonable basis for doing so, and with full knowledge and/or
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`conscious disregard of the consequences, ANTHEM failed and refused to provide Plaintiff the benefits
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`promised under the Policy, under the laws of California.
`
`49.
`
`ANTHEM engaged and continues to engage in conduct to further its own economic
`
`interest and in violation of its contractual and fiduciary obligations to Plaintiff, including but not limited
`
`to:
`
`
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`a. Unreasonably denying the benefits of the Policy;
`
`b. Misrepresenting pertinent policy provisions and coverages at issue;
`
`0. Misrepresenting medical. evidence;
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`(1. Misrepresenting and or disregarding the opinions of treating physicians and therapists;
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`e. Denying benefits based on insufficient, inadequate, and biased medical analyses:
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`f. Repeated denials and requirements for appeals;
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`g. Failing to place the financial interests of its insureds on an equal par with Defendant’s
`
`own financial interests;
`
`h. Failing to objectively evaluate Plaintiff’s claim and attempting to find reasons not to pay
`
`their claim;
`
`\
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`i. Failing to conduct a full and fair investigation. This included a one—sided claims handling
`
`procedure that was biased against approving medically necessary claims for care at
`
`OO\]O\
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`Case 3:21-cv-06060-JCS Document 1-1 Filed 08/05/21 Page 9 of 13
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`guidelines, that are impermissibly strict and fall below reasonable standards in the medical
`
`community; and the failure to either consult with or consider the opinions of treating
`
`medical professionals;
`
`j. Conducting a medical analysis of the claim by medical personnel who sought to provide
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`a pretext for denying Plaintiff's claim, instead of looking for reasons to pay the claim and
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`instead of crediting the wealth of medical information establishing Medical necessity, as
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`defined under the terms and conditions of the Policy;
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`k. Failing to consider the requirements of the California Mental Health Parity Act, as well
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`as the Mental Health Parity and Addictions Equity Act of 2008 (“MHPAEA”), which
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`alone provided a basis for overturning ANTHEM’S claim denial(s) at issue herein; and
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`l. Shifting the burden of investigation onto its insureds.
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`m. Engaging in an unlawful pattern of practice for denying medically necessary residential
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`treatment in order to save money and increase profits.
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`50.
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`In doing the acts listed above, ANTHEM breached the covenant of good faith and fair
`
`dealing, and engaged in unfair claim settlement practices.
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`51.
`
`ANTHEM continues to engage in the aforementionedacts and said conduct and bad faith
`
`constitutes a continuing tort and continuing bad faith to Plaintiff, causing continued damage as described
`
`herein beyond the date of the filing of this action.
`
`52.
`
`As a direct and proximate result of the aforementioned conduct of ANTHEM, Plaintiff
`
`has been. damaged in an amount in excess of the jurisdiction of this Court, to be determined at trial.
`
`53.
`
`As a further direct and proximate result of the aforementioned conduct of ANTHEM,
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`Plaintiff suffered financial, mental and emotional distress, including, but not limited to, fear, aggravation,
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`depression, humiliation and anxiety, and have thereby incurred general damages in a sum in excess of
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`the jurisdiction of this court to be determined according to proof at trial.
`
`54.
`
`As a further, direct and proximate result of the aforementioned conduct of ANTHEM,
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`Plaintiffhas been obliged to expend or incur liability for costs of suit, attorneys’ fees and related expenses
`
`in an amount not yet fully ascertained, but which will be submitted at the time of trial.
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`Case 3:21-cv-06060-JCS Document 1-1 Filed 08/05/21 Page 10 of 13
`
`55.
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`As a further, direct and proximate result of the aforementioned conduct of ANTHEM,
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`Plaintiff has suffered other special damages in. amounts according to proof at the time of trial. which
`
`include, but are not limited to, Plaintiffs inability to replace the Policy under the terms and conditions
`
`represented to them. In doing the acts set forth above, ANTHEM acted fraudulently, maliciously,
`
`oppressively, and in conscious disregard of Plaintiff‘s rights in a despicable fashion. Plaintiff is therefore
`
`entitled to punitive damages in. a sum sufficient to punish. and deter Defendants so that such conduct will
`
`not take place again.
`
`V.
`
`PRAYER FOR RELIEF
`
`AS TO ALL CAUSES OF ACTION
`
`WHEREFORE, Plaintiff prays that the Court grant the following relief as against ANTHEM
`
`BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY dba ANTHEM BLUE CROSS, THE
`
`RETA TRUST PLAN; and DOES 1 through 10:
`
`
`
`56.
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`General damages for the failure to provide the promised benefits under the subject contract
`
`of insurance in a sum to be determined at the time of trial, and a return of the payments which Plaintiff
`
`paid to Second Nature and Catalyst;
`
`57.
`
`General damages for mental and emotional distress and other incidental damages in a sum
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`to be determined at trail;
`
`58.
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`59.
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`60.
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`61.
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`62.
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`63.
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`Punitive and exemplary damages;
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`Treble damages as allowed under Cal. Civil Code §3345
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`Special. damages in an amount according to proof;
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`For costs of suit herein incurred;
`
`For reasonable attorneys’ fees; and
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`For such other and further relief as the Court deems just and proper.
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`JURY TRIAL IS HEREBY DEMANDED
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`Case 3:21-cv-06060-JCS Document 1-1 Filed 08/05/21
`
`Page 11 of 13
`
`'DL LAW GROUP
`
`)
`
`/ 7
`,
`X / {iii/,fl/K v;
`By: /
`David M. Lilienstein
`
`Katie J. Spiolman
`Attomeys for Plainliff, Bea S.
`
`OOQON
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`10
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`Case 3:21-cv-06060-JCS Document 1-1 Filed 08/05/21 Page 12 of 13
`
`immerse Merv war HOUT mtonnsv (Nam, State Bar number, and address}:
`David M. Lilienstein (SBN 218923); Katie J. Spielman (sen 252209)
`DL Law Group
`345 Franklin Street. San Francisco, CA 94102
`
`F“ COURTUSEO’V”
`
`
`
`
`" reactions no:
`(415) 678—5050
`‘
`m: no, leptons»:
`(415) 388-8484
`
`Arronnsv FOP. (Name): Plaintiff Bea S.
`
`SUPERIOR COURT OF CALIFORNIA. COUNTY OF SAN FRANCiSCO
`
`STREET Agnfigss; 400 MCAllister Street
`
`MAlLlNG ADDRESS:
`
`
`
`..
`
`ELECTRON [CALI-Y
`F I L E D '
`Superior Court of California.
`County of San Francisco
`
`05/06/2021
`Clerk of the Court
`BY: KALENEAPOLONIO
`Deputy Clerk
`
`
`
`on? AND ZiPCOQE: San Francisco, CA 94102
`
`BRANCH NAME:
`.
`,,
`.
`CASE NAME:
`
`
`Bea S, v, Anthem Blue Cross Live and Health insurance Company, et al.
`
`CIVIL CASE COVER SHEET
`
`
`Complex Case Designation
`CASE NUMBER:
`CGC-Z1-591598
`
`:3 Counter
`[:l Joinder
`
`
`demanded
`demanded is
`Filed With first appearance by defendant
`
`
`
`DE PT..
`
`exceeds $25,000)
`$25,000)
`(Cal. Rules of Court. rule 3.402)
`
` W
`
`Items 1~6 below must be completed (see lnstrUctions on page '2).
`1. Check one DB} been? for the case type that best describes this case:
`Auto Tort
`Contract
`
`*
`
`Provisionally Complex Civil Litigation
`
`
`
`.
`
`ve
`
`
`
`21
`
`)
`
`(Cal. Rules “CW“! rules 3'400‘3-403)
`[:3 Breach oicontract/warrantyiOS)
`C: Auto (22)
`C: AntitrusUTrade regulation (03)
`:3 Rule 3740 collections (09)
`C: Uninsured motorlsl(46)
`[:1 Construction defect (10)
`[:3 Other collections (09)
`Other PilPD/WDtPersonal Injury/Property
`[:3 Mass iorti40)
`[35:] insurance coverage (18)
`Damage/Wrongful Death) Tort
`g :ecluntieslfiijxniih (30
`[:1 Otherconlracrran
`% ifsjjgj’igggiiflm)
`[:3 ingurrgsgecoveragecclaims a)rising from the
`Real P:ooertytd
`.
`ll
`C: Medical malpractice (45)
`.
`.
`.
`em:
`1
`fybpifgitfd provrstonally complex case
`C! conggsinac’go‘:("14: we
`fl: OtherPl/PDIWDiZS)
`Enforcement of Judgmen‘
`[:3 Wrongful eviction (33)
`Non‘PlIPD/WD (Other) “ion
`[:3 Enl‘Orcement oijudgmentl20)
`C: Business tort/unfair business practice (07) [:3 Other real WODGFW (25)
`Miscellaneous Civil Complaint
`C] CW“ rights (03)
`Unlawful Detainer
`[:1 RtCO(27)
`[:3 Defamation (13)
`[:1 Commemia‘ (313'
`[:j Other complaint (not specifiedabove) (42)
`[:3 Frauditb)
`[:3 Residential (32)
`Miscellaneous Civil Petition
`[:1 lntellectuaiproperty(19)
`E: Drugs(38)
`t
`I P '
`h’
`d
`[:3 Professional negligence (25)
`Judicial Review
`[:3 amérs .1? an cargoféegwemncfi
`[:3 Othernon--Pi/Po/wotorl(35)
`C1 Asse‘fmffi’mm‘os)
`Employment
`[:3 Petition re: arbitration award (11) E Other petition ("0“ spearlied above) (43)
`[: Wrongful termination (36)
`[:3 Will“ mandate (02)
` WW w.» W W
`[:3 Other employmentris)
`m Otherjudiciaireview(39)
`
`2. This case [:1 is E] is not
`complex under rule 0.400 of the. Calliornia Rules of Court. if the case is complex, mark the
`factors requiring exceptional judicial management;
`a.
`l
`i Large number of separately represented parties
`b. [:3 Extensive motion practice raising difficult or novel
`issues that will be time-consuming to resolve
`c. [:3 Substantial amount of documentary evidence
`
`d. [:1 Large-number of witnesses
`e. [:] 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
`f.
`3. Remedies sought (check all that apply).‘a. [Z] monetary b. [j nonmonetary; declaratory orinjunctive relief c. l:] punitive
`4. Number of causes of action (specify): 2; Breach of Contract, Breach of Covenant of Good Faith and Fair Dealing
`5. This case [:3 is
`[35:] is not
`a class action suit.
`6.
`if there are any known related caees, file and serve a notice of related case, (You may use form CM~015J
`
`
`Date: May 3, 2021
`r-—;
`" aims
`David‘M. Lilienstein if” }
`
`recon eniilr NAME V
`,
`y
`,
`,
`,
`,
`,
`,
`_'
`'(sicnnruns or new on Arrosu'svron PARTY
`
`
`
`- Plaintiff must tile this cover sheet with the first paper tiled 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.
`
`
`
`

`

`Case 3:21-cv-06060-JCS Document 1-1 Filed 08/05/21 Page 13 of 13
`
`CASE NUMBER: CGC—21-591598 BEA 8. VS. ANTHEM BLUE CROSS LIFE AND HEALTH INSI
`
`NOTICE TO PLAINTIFF
`
`A Case Management ConferenCe is set for:
`
`DATE:
`
`OCT-06-2021
`
`TIME;
`
`10:30AM
`
`PLACE: Department 610
`400 McAllister Street
`
`San Francisco, CA 94102-3680
`
`All parties must appear and comply with Local Rule 3.
`
`CRC 3.725 requires the filing and service of a case management statement form CM-110
`
`no later than 15 days before the case management conference. However, it would facilitate
`
`days before the case management conference.
`
`the issuance of a case management order without an appearance at the case
`
`management conference if the case management statement is filed and served twenty—five
`
`Plaintiff must serve a copy of this notice upon each party to this action with the summons and
`complaint. Proof of service subsequently filed with this c0urt shall so state. This case is
`eligible for electronic filing and service per Local Rule 2.11. For more information,
`
`please visit the Court's website at www.5fsuperiorcourt.org under Online Services.
`
`[DEFENDANTS: Attending the Case Management Conference does not take the place
`of filing a written response to the complaint. You must file a written response with the
`court within the time limit required by law. See Summons]
`
`ALTERNATIVE DISPUTE RESOLUTION REQUIREMENTS
`
`IT IS THE POLICY OF THE SUPERIOR COURT THAT EVERY CIVIL CASE SHOULD PARTICIPATE IN
`MEDIATION, ARBITRATION, NEUTRAL EVALUATION, AN EARLY SETTLEMENT CONFERENCE, OR
`OTHER APPROPRIATE FORM OF ALTERNATIVE DISPUTE RESOLUTION PRIOR TO A TRIALt
`
`(SEE LOCAL RULE 4)
`
`Plaintiff m serve a copy of the Alternative Dispute Resolution (ADR) Information Package
`on each defendant along with the complaint.
`(CRC 3.221.) The ADR package may be
`accessed at www.5fsuperiorCourt.org/divisions/civilldispute~resolution or you may request a
`paper copy from the filing clerk. All counsel must discuss ADR with clients and opposing
`counsel and provide clients with a copy of the ADR Information Package prior to filing
`the Case Management Statement.
`
`Superior Court Alternative Dispute Resolution Administrator
`400 McAlIister Street, Room 103-A
`San Francisco, CA 94102
`(415) 551-3869
`
`