- Counsel
- Interpleader Law
- Result for
- The insured's wife, the named beneficiary, our client
- Case
- Gambino v. Metropolitan Life Insurance Co.
- Court
- U.S. District Court, Central District of California
- Docket
- No. 2:18-cv-07389-VBF-JPR
- Decided
- November 1, 2019
- Issue
- Whether ERISA preempts California Insurance Code §§ 10369.1 and 10369.12, and whether they reach an employer group policy issued to an employer in Massachusetts
The insured had accidental death coverage under his employer’s group plan, insured by MetLife. He died of an accidental overdose of medications his doctor had prescribed for him. MetLife denied the claim under an exclusion for drugs not “taken or used as prescribed by a physician,” saying the level in his system showed he had taken more than the prescribed dose. The group policy said it was governed by Massachusetts law.
We represented his wife, the named beneficiary, in federal court under ERISA. California Insurance Code § 10369.12 lets a policy exclude losses from intoxicants or controlled substances only “unless administered on the advice of a physician,” and § 10369.1 requires covered policies to be at least that favorable to the insured. We argued that the statute asks whether the medication was taken on a doctor’s advice, not whether every dose matched the label, so MetLife’s stricter exclusion could not be enforced as written. MetLife moved to dismiss, arguing that ERISA preempted the California statutes and that they could not reach a policy issued to an employer in Massachusetts.
The court denied the motion (ECF No. 27, Sept. 30, 2019) and explained its reasons in a written order (ECF No. 31, Nov. 1, 2019). It held that ERISA does not preempt §§ 10369.1 and 10369.12, because they regulate insurance. It also held that the statutes apply to this coverage. The certificate of insurance was part of the policy, and delivering it to the insured in California, where MetLife knew he lived and worked, counted as delivering the policy there. The policy was also issued for delivery in California, because it required MetLife to issue a certificate for delivery to each covered employee.
What it shows. A plan’s choice of another state’s law does not automatically shut out California’s insurance protections for an employee who lives and works in California. When state law limits a drug or intoxication exclusion, an insurer may not be able to rely on stricter wording in its policy.
Read the court's order
- Order denying motion to dismiss (Nov. 1, 2019) (PDF)
- Docket entry for the order (ECF No. 31, Nov. 1, 2019), CourtListener
Past results do not guarantee a similar outcome. This summary describes the court's ruling; it is not legal advice about any other case.
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