Davis v. Blue Cross of Northern California

In Davis v. Blue Cross of Northern California (1979), 25 Cal.3d 418, the court emphasized the importance of apprising a beneficiary of the availability of arbitration and the means of initiating it. The trial court determined that Blue Cross waived its right to compel arbitration by breaching its covenant of good faith and fair dealing in failing to inform claimants of the right to arbitration when rejecting their claims. In affirming the order denying Blue Cross' petition to compel arbitration, the Supreme Court observed that the trial court's finding "that the average insured would not know of a right to arbitration buried in an obscure provision of a hospitalization policy" unless informed "squares with common experience" and added: "Without advice on the subject, the average insured is not likely to be aware of a potential arbitration remedy or of the means of initiating such a procedure." ( Id., at p. 429.) In stressing the importance in the health care service contract context of a beneficiary's awareness of the existence of an arbitration remedy, the court in Blue Cross noted that in enacting recent legislation governing health care service plans, "the Legislature included a number of specific provisions requiring such health service plans (1) to explicitly disclose the existence of any arbitration procedures in their informational brochures (Health & Saf. Code, 1363, subd. (a)(10)) and (2) to include in the subscriber's contract a provision which sets forth, inter alia, 'the type of disputes subject to arbitration, the process to be utilized, and how it is to be initiated.' (Health & Saf. Code, 1373, subd. (i).)" ( Davis v. Blue Cross of Northern California, supra, 25 Cal.3d 418, 430.) The court commented that the statutes recognize the importance of giving insureds "timely and meaningful notice of the procedure so that they can realistically resort to arbitration if they decide to do so. (Cf. Health & Saf. Code, 1368, subds. (b) and (c).)" ( Id., at p. 430.) Health and Safety Code section 1363, subdivision (a)(10), provides: "(a) The commissioner shall require for use by each plan disclosure forms or materials containing such information regarding the benefits, services, and terms of the plan contract as the commissioner may require, so as to afford the public, subscribers, and enrollees with a full and fair disclosure of the provisions of the plan in readily understood language and in a clearly organized manner. The commissioner may require that such materials be presented in a reasonably uniform manner so as to facilitate comparisons between plan contracts of the same or other types of plans. Nothing contained in this chapter shall preclude the commissioner from permitting such disclosure form to be included with the evidence of coverage or plan contract. "The disclosure form shall provide for at least the following information, in concise and specific terms, relative to the plan, together with such additional information as may be required by the commissioner, in connection with the plan or plan contract: ". . . ."(10) If the plan utilizes arbitration to settle disputes, a statement of that fact."