Newport Beach, CA asked in Public Benefits for California

Q: Under CCP 1094.5, we seek to petition the superior court to review the validity of an administrative order or decision

Medi-Cal denied this beneficiary benefits but Medi-Cal's findings are not support by substantial eveidence in the light of the whole record.

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James L. Arrasmith
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  • Sacramento, CA
  • Licensed in California

A: In California, a writ of administrative mandamus under Code of Civil Procedure section 1094.5 is the appropriate means to challenge the validity of a final administrative decision, such as a denial of Medi-Cal benefits, when the decision is alleged to be unsupported by substantial evidence in the record. Here's what you need to know:

1. Exhaustion of administrative remedies: Before filing a petition for writ of administrative mandamus, the beneficiary must have exhausted all available administrative remedies, such as appeals within the Medi-Cal system.

2. Statute of limitations: The petition must be filed within the applicable statute of limitations, which is generally 30 days from the date of the final administrative decision.

3. Petition contents: The petition should include the following:

a. The parties involved (petitioner and respondent)

b. The specific decision being challenged

c. The grounds for the challenge (e.g., lack of substantial evidence)

d. The relief sought (e.g., reversal of the denial of benefits)

4. Standard of review: Under CCP 1094.5, the court's review is limited to determining whether the administrative agency:

a. Proceeded without or in excess of its jurisdiction

b. Afforded the petitioner a fair trial

c. Abused its discretion

d. Made findings unsupported by substantial evidence in light of the whole record

5. Briefing and hearing: After the petition is filed, the court will set a briefing schedule and hearing date. The petitioner must file an opening brief, the respondent will file an opposition, and the petitioner may file a reply brief. At the hearing, the court will consider the arguments and evidence presented in the briefs and may hear oral arguments.

6. Judgment: If the court finds that the administrative decision is unsupported by substantial evidence, it may issue a writ ordering the agency to set aside its decision and reconsider the matter in light of the court's ruling.

To proceed with a petition for writ of administrative mandamus, it is highly recommended to consult with an attorney experienced in administrative law and Medi-Cal cases. They can assist in preparing the petition, gathering evidence, and presenting arguments to the court.

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