Miscellaneous: xxxxxxx xxxxx VS KAISER FOUNDATION HEALTH PLAN, INC.

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                                Electronically FILED by Superior Court of California, County of Los Angeles on 04/03/2049
                                                                                    QG-C\ PIM Sterri R. Carter, Executive Officer/Clerk of Court, by N. Alvarez, Deputy Clerk

                                                                                                                                                                                     CM-01
                      ATTORNEY OR PARTY WIT! UT ATTORNEY wane ‘State Bar number, and address):                                                      FOR COURT USE ONLY
                        Michael T. Carr (CSB)        308:
                        LAW OFFICES OF MICHAEL T. CARR, APC
                       2670 Myrtle Avenue, Suite 106
                       Monrovia, California 91016
                            ‘TELEPHONE NO. 626) 254-8901                         raxno. (626) 254-8921
                      ATTORNEY FOR (Name): oberta xxxxx
                 SUPERIOR COURT OF CALIFORNIA, COUNTY OF                Los Angeles
                         STREET ADDRESS: 111 North Hill Street
                         MAILING ADDRESS:
                         CITY AND ZIP CODE: Los Angeles, California 90012
                             BRANCH NAME: Stanley      osk Courthouse
                      CASE NAME:
                      xxxxxxx xxxxx v Kaiser Foundation Health Plan, Inc.
                         CIVIL CASE COVER SHEET                                       Complex Case Designation
                                                                                                                                  CASE NUMBER:
                           Unlimited                    Limited                                                                      19STC¥11518
                           (Amount                      (Amount                 [7]     counter          [1      soinder
                           demanded         demanded is                                                    JUDGE:
                                                                  Filed with first appearance by defendant
                           exceeds $25,000) $25,000 or less)           (Cal. Rules of Court, rule 3.402)     DEPT:
                                                Items 1-6 below must be completed (see instructions on page 2).
                 1. Check one box below for the case type that best describes this case:
                        Auto Tort                                            Contract                                      Provisionally Complex Civil Litigation
                              Auto (22)                                             Breach of contracthwarranty (06)       (Cal. Rules of Court, rules 3.400-3.403)
                              Uninsured motorist (46)                        CI     Rule 3.740 collections (09)            [J AntitrustrTrade regulation (03)
                       Other P/PDWD (Personal Injury/Property                Ct Other collections (09)                           Construction defect (10)
                       Damage/Wrongful Death) Tort                           LI Insurance coverage (18)                    CE)   Mass tort (40)
                               Asbestos (04)
                                                                             Oo Other contract (37)                        C) Securities litigation (28)
                               Product liability (24)
                               Medical malpractice (48)
                                                                             Real Property                                 CL] Environmental/Toxic tort          (30)

                               Other P/PDIWD (23)
                                                                                      Eminent domain/inverse
                                                                                      condemnation (14)
                                                                                                                           0     Insurance coverage claims arising from the
                                                                                                                                 above listed provisionally complex case
                        Non-Pi/PD/WD (Other) Tort                            [1       wrongful eviction (33)                       pes (41
                               Business tort/unfair business practice (07)            Other real property (26)             Enforcement of Judgment
                               Civil rights (08)                             Unlawful Detainer                                   Enforcement of judgment (20)
                               Defamation (13)                                        Commercial (31)                      Miscellaneous Civil Complaint
                               Fraud (16)                                             Residential (32)                     Oo    RICO (27)
                               Intellectual property (19)                             Drugs (38)                                 Other complaint (not specified above) (42)
                               Professional negligence (25)                  Judicial Review
                                                                                                                           Miscellaneous Civil Petition
                                                                                    Asset forfeiture (05)
                               Other non-PI/PD/WD tort (35)                                                                      Partnership and corporate governance (21)
                        Employment                                                   Petition re: arbitration award (11)
                                                                                                                           [1    other petition (not specified above) (43)
                               Wrongful termination (36)                     (1 writ of mandate (02)
                               Other employment (15)                         [1] other judicial review (39)
             2.         Thiscase [_Jis          Lv    Tis not   complex under rule 3.400 of the California Rules of Court. If the case is complex, mark the
                        factors requiring exceptional judicial management:
                        a. CO      Large number of separately represented parties                 d. [] Large number of witnesses
                       b. oO       Extensive motion practice raising difficult or novel           e. [_] Coordination with related actions pending in one or more courts
                                   issues that will be time-consuming to resolve                         in other counties, states, or countries, or in a federal court
                        c.[]       Substantial amount of documentary evidence                     f. Co Substantial postjudgment judicial supervision
             3.         Remedies sought (check all that apply): a.[[/] monetary                 _b.[__] nonmonetary; declaratory or injunctive relief                   c.        punitive
             4          Number of causes of acti      specify): 4
             5.         This case         is          is not   a class action suit.
             6.         If there are any known related cases, file and serve a notice of related case. (You may use form CM-015.)
             Date: April 2,2019
             Michael T. Carr
                                                 (TYPE OR PRINT NAME)
                                                                                                           »               Lew          OE, "ATTORNEY FOR PARTY)
                                                                                                NOTICE
                  «     Plaintiff must file this cover sheet with the first paper filed in the action or proceeding (except small claims cases or cases filed
                        under the Probate Code, Family Code, or Welfare and Institutions Code). (Cal. Rules of Court, rule 3.220.) Failure to file may result
                        in sanctions.
                      * File this cover sheet in addition to any cover sheet required by local court rule.
                      ¢ If this case is complex under rule 3.400 et seq. of the California Rules of Court, you must serve a copy of this cover sheet on alll
                        other parties to the action or proceeding.
                      * Unless this is a collections case under rule 3.740 or a complex case, this cover sheet will be used for statistical purposes only                              a ord
             Form Adopted for Mandatory Use                                  CIVIL CASE COVER SHEET                                  Cal. Ruesof Cour, rules 2.30, 3.220, 3.400-3.403, 3.740,
               ‘Judicial Council of California                                                                                                3. Standards of Judicial Administration, std. 3.10
                (CM-010 [Rev. July 1, 2007}                                                                                                                               www.courtinfo.ca.gov