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Date: 11-29-2005
Case Style: Palm Medical Group v. State Compensation Insurance Fund
Case Number: Unknown
Judge: Unknown
Court: Superior Court, San Francisco County, California
Plaintiff's Attorney:
Drew Pomerance of Roxborough, Pomerance & Nye, LLP, Los Angeles, California
Defendant's Attorney: Unknown
Description:
Palm Medical Group, Inc. sued the California State Fund, the state's largest workers' compensation insurer, requiring State Fund to institute fair procedures when considering medical clinics for admission into its preferred provider network.
Since 1998, State Fund had consistently refused to admit Fresno-based Palm Medical Group, Inc. into its network without providing fair procedures, Pomerance explained. State Fund had falsely accused Palm Medical of mishandling claims and poor patient care without an investigation. Pomerance argued that SCIF's action was in direct violation of the common law doctrine of "Fair Procedure." This doctrine, which has been in existence for over a hundred years, requires that -- when a private business has substantial economic power and the use of that power can affect one's ability to earn a living -- the decision-making "must be both substantively rational and procedurally fair."
Outcome: Plaintiff's verdict for $1.13 million. The jury agreed, stating that (1) State Fund dominated the workers' compensation market in Fresno and throughout the state, (2) the reasons for excluding Palm Medical were arbitrary and unreasonable, and (3) had State Fund considered Palm Medical fairly, it would have admitted the clinic into its network. Due to loss of business, the jury awarded Palm Medical $1.13 million in damages.
Plaintiff's Experts: Unknown
Defendant's Experts: Unknown
Comments: None