City of Hope National Medical Center v. Superior Court
Opinion
Opinion
Vogel, J.
We issued an alternative writ (order to show cause) to consider an issue of first impression in California—whether an insurer may obtain restitution of money paid by mistake to a hospital standing as a bona fide creditor of its insured patient. Our answer is no.
Facts
City of Hope National Medical Center provided medical care to Dominic Constanti and, having obtained a standard assignment from Constanti authorizing direct payment to the hospital, City of Hope billed and was paid by Constanti’s insurer, Western Life Insurance Company. Western Life later decided Constanti’s treatment was experimental and, as such, not covered by his policy. When City of Hope refused Western Life’s request for a refund, Western Life sued City of Hope for declaratory relief, breach of contract, unjust enrichment and conversion. City of Hope answered and later moved for summary judgment, contending an insurer is not entitled to reimbursement of payments made to a hospital unless the payments were induced by the hospital’s fraudulent conduct. The trial court denied the motion and this petition followed.