Pagarigan v. Aetna

Filed 11/28/05 Pagarigan v. Aetna U.S. Healthcare CA2/7

NOT TO BE PUBLISHED IN THE OFFICIAL REPORTS

California Rules of Court, rule 977(a), prohibits courts and parties from citing or relying on opinions not certified for publication or ordered published, except as specified by rule 977(b). This opinion has not been certified for publication or ordered published for purposes of rule 977.

IN THE COURT OF APPEAL OF THE STATE OF CALIFORNIA

SECOND APPELLATE DISTRICT

DIVISION SEVEN

TERI PAGARIGAN et al., Plaintiffs and Appellants, v. AETNA U.S. HEALTHCARE OF CALIFORNIA, INC., et al., Defendants and Respondents.

B167722 (Los Angeles County Super. Ct. No. PC027083) ORDER MODIFYING OPINION AND DENYING REHEARING [no change in the judgment]

IT IS ORDERED the opinion filed herein October 25, 2005, is modified as follows:

1. On page 3, third full paragraph, line 6, replace the word “Aetna” with the word “it.”

2. On page 6, second full paragraph, lines 4 – 9, delete the two sentences beginning with the clause “But unlike” and ending with the clause “which it contracts.”

3. On page 8, between paragraphs two and three, insert the following paragraph:

“We find the above duties inherent in the common law and to require no statutory basis. But we also note the Legislature enacted Section 3428(a) which became effective shortly after Mrs. Pagarigan’s treatment at Magnolia Gardens and confirmed the existence of such duties.”

4. On page 8, paragraph three, line 1 replace the first two words, “Section 3428” with the following clause. “In other provisions, 3428”

5. On page 9, first full paragraph, line 1, replace the clause “That same code section, however, also imposes a general duty on Aetna and like plans – ” with the clause, “But 3428 (a) imposes a statutory duty on Aetna and like plans comparable to the common law duty this court finds to have existed before the Legislature acted – ”

6. On page 10, line 1, replace everything after the word “provider” with the following: “attributable at least in part to the plan’s serious underpayment to the provider for the services it is expected to supply.”

7. On page 12, first full paragraph, line 7, add the following new sentence after the sentence ending “for Aetna insured patients.”:

“Nor is it alleged Aetna knew or should have known Magnolia Gardens had become inadequately funded and staffed to properly care for Aetna insured patients after entering into the contract to provide services to those patients.”

These modifications effect no change in the judgment.

Appellants’ petition for rehearing is denied.

PERLUSS, P.J. JOHNSON, J. WOODS, J.

Courtesy of California Legal Resource Directory, a source for providers and consumers of legal resources. Because we know legal.

El Cajon Lawyers are available and standing by to help you.