Life Insurance and AD&D Benefit Claims

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Wolf v Life Ins. Co. of N. America, No. 3:20-cv-05684-BHS, __ F. Supp. __ (W.D. Wash. May 25, 2021) (Judge Benjamin Settle).

This week’s notable decision is a victory for the plaintiff, represented by Kantor & Kantor, in the Western District of Washington. The plaintiff was the father and life insurance beneficiary of 26-year-old Scott Wolf, who had recently died in a car accident. While speeding the wrong way on a one-way access road along a highway, he hit a speed bump, which flipped his car into an adjacent bay, where he drowned. Mr. Wolf had alcohol in his system at the time of his death. He was wearing a seatbelt and had his hazard lights on at the time of the accident.
Continue Reading Court Awards Accidental Death Benefits in Auto Accident Case, Finding Death Was Not “Substantially Certain” to Occur

This week’s first notable decision, Meyers v. Kaiser Found. Health Plan, Inc., No. 19-15051, __F.App’x__, 2020 WL 1673078 (9th Cir. Apr. 6, 2020), is a cautionary tale for claimants seeking out-of-network treatment under a Kaiser health plan. Meyers brought the action on behalf of her teenage daughter, A.M., a covered dependent under the Kaiser medical plan. Meyers sought reimbursement of medical expense for A.M.’s treatment at Elevations residential treatment center for approximately four months in 2016. 

District Court Judge Lucy Koh granted judgment for Kaiser following a bench trial. Meyers appealed.

While the parties disputed the standard of review, the Ninth Circuit agreed with the district court— even under de novo review, Kaiser’s denial was proper. 
Continue Reading Ninth Circuit Holds Kaiser Not Liable for Out-of-Network Mental Health Treatment Benefits

This week’s notable decision is a district court order in Auwae v. Metro. Life Ins. Co., No. 19-CV-02504-RBJ, 2020 WL 996874 (D. Colo. Mar. 2, 2020), a matter challenging the applicability of an ERISA life insurance policy’s two-year suicide exclusion. 

On a motion to dismiss, the court was asked to decide if the following exclusion in a group life policy applied as written: 

“If a Dependent commits suicide within 2 years from the date Life Insurance for such Dependent takes effect, We will not pay such insurance….” 

While the date of enrollment was disputed, it was not after January 1, 2018. The dependent committed suicide on February 4, 2019—more than one year, but less than two years after the latest effective date. MetLife denied the claim applying the language as written. Plaintiff appealed, noting that MetLife violated Colorado law by not recognizing the applicability of Colorado Revised Statute § 10-7-109. MetLife upheld the denial of benefits. 
Continue Reading District Court Rules Colorado Law Turns Life Insurance Policy’s Two-Year Suicide Exclusion into a One-Year Exclusion