Qualls ex rel. Qualls v. Blue Cross of California, Inc.

ORDER

The memorandum disposition filed February 9, 1994, is redesignated as an authored opinion by Judge Harry Pregerson.

OPINION

I. INTRODUCTION

Michael Qualls appeals the district court order of summary judgment in favor of defendant-respondent Blue Cross of California (“Blue Cross”). We have jurisdiction under 28 U.S.C. § 1291 . We AFFIRM.

II. BACKGROUND

Mr. Qualls was electrocuted by a faulty electric fan in June of 1988, causing him to lapse into a coma that lasted several weeks, and to suffer permanent brain damage. This and other injuries kept him hospitalized for six months, and Mr. Qualls continues to require home nursing care.

At the time of his accident, he was covered by a small group health insurance policy (“Policy”) issued by Blue Cross to his employer, Saddleback RV Sales (“Saddleback”). The Policy was fully funded by Saddleback, and was provided automatically without cost to all full-time employees after 90 days of employment.

Blue Cross paid Mr. Qualls’s medical bills until he and Blue Cross jointly reached a settlement agreement with the electric fan manufacturer in December of 1990. Under the settlement agreement, the manufacturer paid a total of $7.5…