Judge: Daniel S. Murphy, Case: 23STCV18404, Date: 2024-03-27 Tentative Ruling

Case Number: 23STCV18404    Hearing Date: March 27, 2024    Dept: 32

BACKGROUND

            On August 3, 2023, Plaintiff Heather Toomes filed this action against Defendant UHC of California, asserting causes of action for breach of contract and breach of the implied covenant of good faith and fair dealing. The complaint alleges that Defendant wrongfully refused to authorize a needed surgery for Plaintiff based on surgery guidelines that were biased and financially-driven.

            On March 1, 2024, Plaintiff filed the instant motion to compel further responses to her requests for production. Defendant filed a late opposition on March 15, 2024. Plaintiff filed her reply on March 20, 2024. The Court does not find Defendant’s late opposition to be prejudicial and proceeds on the merits.

LEGAL STANDARD

Upon receiving responses to its discovery requests, the propounding party may move for an order compelling further responses if the responses are incomplete or evasive, or objections are without merit or too general. (Code Civ. Proc., §§ 2030.300(a), 2031.310(a), 2033.290(a).)

The party seeking production of documents bears the initial burden of showing good cause through a fact-specific showing of relevance. (Kirkland v. Superior Court (2002) 95 Cal.App.4th 92, 98.) Once this showing is made, the burden shifts to the responding party to justify any objections. (Ibid.)

MEET AND CONFER

A motion to compel further must be accompanied by a meet and confer declaration demonstrating an attempt to resolve the matter informally. (Code Civ. Proc., §§ 2030.300(b)(1), 2031.310(b), 2033.290(b).) The Court finds that Plaintiff has satisfied the meet and confer requirement. (See Davis Decl.)

DISCUSSION

            Plaintiff moves to compel responses to RFP Nos. 1-3, 6, and 8-16. In opposition, Defendant argues that only five of the requests are really at issue because it has provided supplemental responses to the remaining requests. The Court addresses these five requests below. The adequacy of the supplemental responses is not the subject of this motion. 

            a. RFP Nos. 8 and 9

            RFP No. 8 seeks all documents setting forth the procedures Defendant followed in researching, developing, adopting, or updating the Medical Policies for various medical conditions, including for the specific surgery Plaintiff required, from January 1, 2018 to present. RFP No. 9 seeks all documents from January 1, 2018 to present evidencing any activity of the Medical Technology Assessment Committee relating to the research, development, adoption, or updating of the Medical Policy for the specific surgery Plaintiff required.

            Plaintiff has established good cause for information relating to the Medical Policy tied her specific surgery because she alleges that Defendant wrongfully adopted a biased policy that favored profits over medical necessity. Plaintiff alleges that Defendant’s process for adopting its medical policy did not comply with California law. Therefore, the history of the policy leading up to Plaintiff’s rejection is relevant, not just the policy itself. Plaintiff may inquire into records from January 1, 2019 to May 15, 2023, the date Plaintiff was rejected. However, Plaintiff has not established good cause for records pertaining to other Medical Policies or for documents from a time period after she was rejected.

            The motion is granted as to RFP Nos. 8 and 9, limited to records pertaining to the specific type of surgery that Plaintiff was rejected for, and limited to the time period from January 1, 2019 to May 15, 2023. To the extent Defendant has produced or will produce all such documents, it must provide a code-compliant response to that effect. (See Code Civ. Proc., § 2031.220.) To the extent Defendant cannot produce such documents, it must provide a code-compliant response to that effect. (See Code Civ. Proc., § 2031.230.)

            b. RFP Nos. 10 and 11

            RFP No. 10 seeks all documents from January 1, 2018 to present evidencing any activity of persons outside the Medical Technology Assessment Committee relating to the research, development, adoption, or updating of the Medical Policy for the specific surgery Plaintiff required. RFP No. 11 seeks all documents from January 1, 2018 to present evidencing any research, investigation, or analysis Defendant performed regarding the type of surgery Plaintiff requested.

            These requests mirror the ones discussed above and are subject to the same analysis. Therefore, the motion is granted as to RFP Nos. 10 and 11, subject to the same limits and requirements set forth above.

            c. RFP No. 15

            RFP No. 15 seeks all agreements in effect in 2023 between Defendant and the medical group to which Plaintiff was assigned. Plaintiff argues that there is good cause because she is entitled to discover whether and to what extent Defendant delegated the rejection decision to Plaintiff’s medical group.

However, Plaintiff alleges that Defendant, not her medical group, was responsible for the rejection. Plaintiff does not allege that Defendant delegated the decision or that any other entity participated in the decision. The complaint alleges that Defendant rejected Plaintiff’s surgery based on Defendant’s medical policy. Therefore, the motion is denied as to RFP No. 15.    

            d. Remaining Requests

            The motion is granted as to the remaining requests because Defendant’s responses failed to abide by the Code requirements for statements of compliance or inability to comply. (See Code Civ. Proc., §§ 2031.220, 2031.230.) Defendant must also “[i]dentify with particularity any document . . . falling within any category of item in the demand to which an objection is being made” and “[s]et forth clearly the extent of, and the specific ground for, the objection.” (Id., § 2031.240(a).) To the extent Defendant has supplemented its responses, those supplemental responses are not the subject of this motion.

CONCLUSION

            Plaintiff’s motion to compel further responses is GRANTED in part as set forth above.