Hailey v. California Physicians' Service

In Hailey v. California Physicians' Service (2007) 158 Cal.App.4th 452, the insurer--Blue Shield--claimed that the applicant's omission of information concerning her husband's excessive weight and other health issues when completing the application allowed it to rescind the policy after her husband incurred substantial medical expenses in an automobile accident. (Id. at p. 461.) Pointing to evidence that "Blue Shield does not immediately rescind health care contracts upon learning of potential grounds for rescission, but waits until the claims submitted under that contract exceed the monthly premiums being collected," the court held: "A health care services plan may not adopt a 'wait and see' attitude after learning of facts justifying rescission by continuing to collect premiums while keeping open its rescission option if the subscriber later experiences a serious accident or illness that generates large medical expenses." (Id. at p. 473.) As noted, when Blue Shield elected to cancel appellant's policy, it had collected more in premiums than it had paid. Only after appellant sued Blue Shield did it assert a right to rescind which, if successful, would have obligated the company to return appellant's premiums but spared it the expense of litigating her claims.