When will an arbitration panel award damages for misrepresentation on a medical malpractice claim?

California, United States of America


The following excerpt is from Blue Cross of California v. Jones, 19 Cal.App.4th 220, 23 Cal.Rptr.2d 359 (Cal. App. 1993):

Respondents rejoin that they had a tort claim on which they prevailed, and the arbitrators were therefore free to fashion a remedy on [19 Cal.App.4th 228] "principles of equity and good conscience...." (Moncharsh v. Heily & Blase, supra, 3 Cal.4th at p. 11, 10 Cal.Rptr.2d 183, 832 P.2d 899.) We reject this argument for the reason that in rendering their award, the arbitrators specifically segregated the tort damages from the benefits due under the policies. However, as respondents correctly emphasize, their primary contention was that appellant misrepresented the nursing benefits available to them under the second policies, and thereby induced them to purchase that coverage and forego the opportunity to obtain other health insurance. Consequently, the scope of the nursing benefits under the policies and all questions of law and fact connected therewith were issues clearly within the purview of the arbitration panel, and our review thereof is foreclosed. (Id., at p. 28, 10 Cal.Rptr.2d 183, 832 P.2d 899.)

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