Life Insurance and AD&D Benefit Claims

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Santos v. Minn. Life Ins. Co., No. 20-cv-06707-PJH,  2021 WL 5302950 (N.D. Cal. Nov. 15, 2021) (Judge Phyllis J. Hamilton). 

Mother of forensics, Frances Glessner Lee, created the Nutshell Studies of Unexplained Death as a teaching instrument for detectives to help them determine causes of death at crime scenes. Such a tool would have been instrumental in this case in determining whether decedent Samuel Chong’s death was an accident, suicide, or homicide, and consequently whether AD&D benefits ought to be paid to plaintiff Eva Marie Santos, Mr. Chong’s cousin and the administrator of the estate. During a well-being check by the San Francisco police, Mr. Chong was found dead “on the floor in the kitchen, near a table. The gas oven door was found open, but the oven was not in use. Blood (and dried vomit) was noted near his head.” The autopsy report listed the cause of death as blunt force head trauma with subdural hematoma. The manner of death was listed as an accident. The toxicology report found methamphetamine, amphetamine, and Temazepam in the decedent’s blood and urine. 
Continue Reading Long-Term Meth User Could Not Have Foreseen Death

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