California Postclaims Disability Insurance Underwriting Class Action Revisited.

    On December 4, 2007 California's Second District Court of Appeal certified this 20-page opinion for publication "following rehearing":  Ticconi_v. Blue Shield of California (Cal. 2d DCA Dec. 4, 2007).pdf.  On January 3, 2008 according to the Court's docket available online, the Court granted a petition for rehearing.  Rehearing is pending at this time.

    On December 4, 2007 the Second District issued a ruling in the Ticconi case in which the California Appellate Court reversed a Trial Court's Order that denied a motion to certify a Class Action.  The Plaintiff-Policyholder in that case, Mr. Augusto Ticconi, alleged that he applied for and received "a policy of short-term health and accidental insurance from Blue Shield Life.  Blue Shield Life markets such policies as temporary, 12-month coverage to individuals, such as college students or those changing jobs, who need insurance while they are waiting for permanent coverage."  The attached official opinion does not have page numbers.  This quote is taken from the bottom of the second page ("page 2") of the linked pdf of the California Appellate Court's official opinion.

    Allegedly after Mr. Ticconi presented more than $100,000.00 of medical bills to Blue Shield Life for payment under the Policy, Blue Shield Life rescinded the Policy on the ground of misrepresentations in the application.  Id. at "page 3".   However, Blue Shield Life did not attach the application to the Policy or endorse the application on the Policy as a California Statute required it to do.  For that reason, arguably it could not rely on the application as the source of any representations.   In essence, Mr. Ticconi alleged that Blue Shield Life did this sort of thing frequently enough to justify a Class Action concerning what amounted to "postclaims underwriting" of Disability or Health Insurance subject to California Statutes.

    "Postclaims underwriting of disability, i.e., health insurance ... is flatly prohibited" by the California Insurance Code, wrote California's Second District Court of Appeal in its original opinion in this case.  Id. at "page 8".

    As was noted at the beginning, the original opinion in this case is the subject of a rehearing which is pending at this time.

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