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Insurance Law
 

INSURANCE  LAW
Insurance Law Case Summaries

■ Smith v. Shewry , No. B207305
 

INTRODUCTION

          After being admitted to Stanford Medical Center (Stanford) for treatment of a terminal illness, Robert Darrough (Darrough) applied for Medi-Cal benefits and appointed a law firm, Health Advocates, LLP (Health Advocates), to represent him in all matters relating to that application.  Following Darrough’s death, his Medi-Cal application was denied.  Health Advocates requested an administrative hearing under Welfare and Institutions Code section 10950 to contest that denial.  The administrative law judge dismissed the request because Health Advocates had failed to comply with the requirement that it obtain authorization to pursue the matter from either Darrough’s estate or his heirs.  Health Advocates then obtained from the probate court the appointment of one of its attorneys as special administrator of Darrough’s estate to pursue the Medi-Cal claim.  Following that appointment, Health Advocates sought a rehearing of the decision dismissing its earlier request for an administrative hearing.  The request for a rehearing was denied.  Health Advocates responded by filing a petition for a writ of mandate in the superior court.  The superior court issued the writ, ordering a rehearing on Darrough’s application for Medi-Cal benefits.

          We reverse.  Darrough’s authorization of Health Advocates to act as his agent was revoked by his death.  Health Advocates was required to obtain new authorization from either Darrough’s estate or his heirs to contest the denial of Darrough’s Medi-Cal application.  Health Advocates failed to obtain that authorization in a timely manner.  Therefore, the trial court erred in issuing the writ of mandate.


■ HELD:

Trial court's writ of mandate ordering a rehearing on an application for Medi-Cal benefits is reversed where: 1) the authorized representative form between the deceased and plaintiff created an agency relationship, and death ended the agency relationship and any authority plaintiff had to act on his behalf; 2) plaintiff was required to obtain new authorization from either the deceased's estate or heirs to contest the denial of the Medi-Cal application, which plaintiff failed to do in a timely manner; and 3) plaintiff did not produce new evidence requiring the grant of a rehearing.
Smith v. Shewry -B207305-4/21/09 CA2/4
Smith v. Shewry -B207305-4/21/09 CA2/4-pdf  

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