1 2 3 4 UNITED STATES DISTRICT COURT 5 NORTHERN DISTRICT OF CALIFORNIA 6 7 GERMAINE GAUDET, Case No. 25-cv-00694-PCP
8 Plaintiff, ORDER GRANTING MOTION TO 9 v. DISMISS AND MOTION TO STAY
10 METROPOLITAN LIFE INSURANCE Re: Dkt. Nos. 34, 45 COMPANY, 11 Defendant.
12 Plaintiff Germaine Gaudet brings this class action against defendant Metropolitan Life 13 Insurance Company (“MetLife”). Gaudet purchased a MetLife long-term-care insurance policy in 14 2007.1 In 2021, the California Department of Insurance (“CDI”) approved MetLife’s request to 15 raise her premium by 123.8%. After the CDI’s approval of the premium increase, MetLife sent 16 Gaudet a letter informing her about the imminent rate increase and giving her information about 17 her options. 18 Gaudet alleges that MetLife knew of the need to increase premiums as early as 2008. 19 Gaudet brings three California state law claims based on MetLife’s failure to inform her of the rate 20 increase or any of the issues leading to the rate increase until 2021: (1) fraud by omission; (2) 21 violation of California’s Unfair Competition Law (“UCL”), Cal. Bus. & Prof. Code § 17200 et 22 seq., and (3) violation of California Insurance Code § 10234.8. 23 MetLife now moves to dismiss the action pursuant to Federal Rule of Civil Procedure 24 25 1 As Gaudet explains in her opposition, long-term care insurance “covers a variety of services for 26 people who become unable to care for themselves, including assistance in the home, adult daycare, assisted living, and nursing home services.” Sieving v. Cont’l Cas. Co., 535 F. Supp. 3d 762, 767 27 (N.D. Ill. 2021). Because individuals generally purchase long-term care insurance policies in their 1 12(b)(6). For the reasons discussed herein, the Court grants MetLife’s motion with leave to 2 amend. 3 BACKGROUND 4 Gaudet resides in San José, California.2 In November 2006, Gaudet applied for a MetLife 5 long-term care insurance policy.3 Gaudet’s policy became effective on January 19, 2007. Her 6 annual policy premium when purchased was $2,944.45. Gaudet has maintained the policy since 7 that date, and it is still in effect today. Gaudet’s current annual premium is $4,541.48.4 Gaudet’s 8 contract for the policy, which she signed in 2006, includes the following key terms:
9 RENEWABILITY: THIS POLICY IS GUARANTEED 10 RENEWABLE FOR LIFE. PREMIUM RATES ARE SUBJECT TO CHANGE. This means You have the right, subject to the terms 11 of the policy, to continue this policy as long as You pay Your premiums on time. We cannot change any of the terms of this policy 12 without Your consent, except that We may change the premium rates, subject to approval by the California Department of Insurance. Any 13 such change in premium rates will apply to all policies in the same 14 class as Yours in the state where this policy was issued. …
15 The premium is due and payable on the Original Coverage Effective Date of the policy and thereafter in accordance with the Premium 16 Schedule that is in effect for the policy as shown on page 3. The premium must be paid in U.S. currency. 17
18 You may change the premium payment mode with Our approval.
19 The amount of the premium for Your initial coverage is based on Your Original Issue Age, Health Rating and Discounts, as of the 20 Original Coverage Effective Date as shown on page 3.
21 We reserve the right to change premium rates on a class basis. The 22 premium will not increase because You get older or Your health changes. In the event of a premium increase, We will offer You the 23 option to lower Your premium by decreasing Your benefit amounts. 24 2 For the purposes of defendants’ Rule 12(b)(6) motion, the Court assumes the truth of the facts 25 alleged in plaintiffs’ complaint. 26 3 Gaudet purchased a VIP2 policy, which is the subject of this action. The complaint also discusses a VIP1 policy that was phased out in favor of the VIP2 policy in 2004. 27 4 After receiving repeated notices about the premium rate changes, Gaudet elected to reduce her See the Benefit Decreases provision of this policy. Your premiums 1 will change if We change Your benefit amounts as a result of Your 2 request or as a result of an increase as provided under the terms of this policy. 3 … 4 Your premium is not expected to increase as a result of the benefit 5 increases provided by [the 5% Automatic Compound Inflation 6 Protection] Rider. However, We reserve the right adjust premiums on a class basis. 7 8 (emphasis in original). 9 In determining the premiums for its long-term care insurance policies, MetLife relied upon 10 certain assumptions. MetLife learned in 2008 that its actual experience materially and adversely 11 deviated from those assumptions. Rather than seek increases in the premium rates for existing 12 customers like Gaudet, “MetLife decided to replace VIP2 policies’ premium rate schedule with 13 one based on updated/more accurate lapse, morbidity and mortality assumptions.” MetLife 14 introduced its new VIP2 premium rate schedule in all 50 states and the District of Columbia 15 between 2008 and 2010. The schedule only applied to individuals purchasing new VIP2 policies 16 (“VIP2 NEW” policies). Preexisting VIP2 policyholders (“VIP2 OLD” policyholders) like Gaudet 17 were not affected. They were not notified that the rate schedule that their plans were based upon 18 was no longer used for new policies. 19 MetLife thereafter experienced continued pricing issues. In response, it developed an 20 updated rate action plan for existing VIP2 OLD policies like Gaudet’s and sought to implement a 21 58% premium rate increase on all VIP2 OLD policyholders across the country. Between October 22 2012 and July 2014, MetLife filed for the rate increase in each state.5 It filed for a California rate 23 increase with the CDI in 2013, but the CDI denied the requested increase. Between 2012 and 24 2017, MetLife implemented 10% to 88% premium rate increases on VIP2 OLD policyholders in 25 26 5 As the complaint explains, all states except Alaska must approve rate increases to MetLife’s 27 long-term care insurance policies before MetLife can implement them. Upon submission of a rate 1 37 states. Like California, several other states denied MetLife’s premium rate increase request. 2 In 2015, MetLife developed a second revised rate action plan for VIP2 OLD policies 3 pursuant to which it sought to implement an additional 18.98% premium rate increase on all VIP2 4 OLD policyholders across the country (totaling an increase of approximately 88% from the 5 original VIP2 OLD pricing). MetLife again sought approval in nearly all states. In 2019, MetLife 6 requested a 105% premium rate increase for California VIP2 OLD policyholders.6 On or about 7 January 21, 2021, the CDI approved this premium rate increase but increased it to authorize a 8 123.8% increase to be implemented over the next four years. On April 15, 2021, MetLife informed 9 Gaudet that it would be increasing her annual premium by 123.8% over the next four years, with 10 the first increase occurring on January 19, 2022.7 MetLife sent subsequent notices on April 15, 11 2023, April 15, 2024, and April 15, 2025. The notices informed Gaudet of the upcoming 12 implementation of the second, third, and fourth phases of the 123.8% premium rate increase. 13 Those phased increases took effect on January 19, 2023, January 19, 2024, and January 19, 2025. 14 Since 2015, MetLife (which has now imposed premium rate increases on VIP2 OLD 15 policyholders in every state) has created at least three more rate action plans, seeking increases to 16 VIP2 OLD policyholders’ premiums by roughly 16.92% in or around 2019–2020; 31.66% in or 17 around 2021; and 9.88% in or around 2023.
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1 2 3 4 UNITED STATES DISTRICT COURT 5 NORTHERN DISTRICT OF CALIFORNIA 6 7 GERMAINE GAUDET, Case No. 25-cv-00694-PCP
8 Plaintiff, ORDER GRANTING MOTION TO 9 v. DISMISS AND MOTION TO STAY
10 METROPOLITAN LIFE INSURANCE Re: Dkt. Nos. 34, 45 COMPANY, 11 Defendant.
12 Plaintiff Germaine Gaudet brings this class action against defendant Metropolitan Life 13 Insurance Company (“MetLife”). Gaudet purchased a MetLife long-term-care insurance policy in 14 2007.1 In 2021, the California Department of Insurance (“CDI”) approved MetLife’s request to 15 raise her premium by 123.8%. After the CDI’s approval of the premium increase, MetLife sent 16 Gaudet a letter informing her about the imminent rate increase and giving her information about 17 her options. 18 Gaudet alleges that MetLife knew of the need to increase premiums as early as 2008. 19 Gaudet brings three California state law claims based on MetLife’s failure to inform her of the rate 20 increase or any of the issues leading to the rate increase until 2021: (1) fraud by omission; (2) 21 violation of California’s Unfair Competition Law (“UCL”), Cal. Bus. & Prof. Code § 17200 et 22 seq., and (3) violation of California Insurance Code § 10234.8. 23 MetLife now moves to dismiss the action pursuant to Federal Rule of Civil Procedure 24 25 1 As Gaudet explains in her opposition, long-term care insurance “covers a variety of services for 26 people who become unable to care for themselves, including assistance in the home, adult daycare, assisted living, and nursing home services.” Sieving v. Cont’l Cas. Co., 535 F. Supp. 3d 762, 767 27 (N.D. Ill. 2021). Because individuals generally purchase long-term care insurance policies in their 1 12(b)(6). For the reasons discussed herein, the Court grants MetLife’s motion with leave to 2 amend. 3 BACKGROUND 4 Gaudet resides in San José, California.2 In November 2006, Gaudet applied for a MetLife 5 long-term care insurance policy.3 Gaudet’s policy became effective on January 19, 2007. Her 6 annual policy premium when purchased was $2,944.45. Gaudet has maintained the policy since 7 that date, and it is still in effect today. Gaudet’s current annual premium is $4,541.48.4 Gaudet’s 8 contract for the policy, which she signed in 2006, includes the following key terms:
9 RENEWABILITY: THIS POLICY IS GUARANTEED 10 RENEWABLE FOR LIFE. PREMIUM RATES ARE SUBJECT TO CHANGE. This means You have the right, subject to the terms 11 of the policy, to continue this policy as long as You pay Your premiums on time. We cannot change any of the terms of this policy 12 without Your consent, except that We may change the premium rates, subject to approval by the California Department of Insurance. Any 13 such change in premium rates will apply to all policies in the same 14 class as Yours in the state where this policy was issued. …
15 The premium is due and payable on the Original Coverage Effective Date of the policy and thereafter in accordance with the Premium 16 Schedule that is in effect for the policy as shown on page 3. The premium must be paid in U.S. currency. 17
18 You may change the premium payment mode with Our approval.
19 The amount of the premium for Your initial coverage is based on Your Original Issue Age, Health Rating and Discounts, as of the 20 Original Coverage Effective Date as shown on page 3.
21 We reserve the right to change premium rates on a class basis. The 22 premium will not increase because You get older or Your health changes. In the event of a premium increase, We will offer You the 23 option to lower Your premium by decreasing Your benefit amounts. 24 2 For the purposes of defendants’ Rule 12(b)(6) motion, the Court assumes the truth of the facts 25 alleged in plaintiffs’ complaint. 26 3 Gaudet purchased a VIP2 policy, which is the subject of this action. The complaint also discusses a VIP1 policy that was phased out in favor of the VIP2 policy in 2004. 27 4 After receiving repeated notices about the premium rate changes, Gaudet elected to reduce her See the Benefit Decreases provision of this policy. Your premiums 1 will change if We change Your benefit amounts as a result of Your 2 request or as a result of an increase as provided under the terms of this policy. 3 … 4 Your premium is not expected to increase as a result of the benefit 5 increases provided by [the 5% Automatic Compound Inflation 6 Protection] Rider. However, We reserve the right adjust premiums on a class basis. 7 8 (emphasis in original). 9 In determining the premiums for its long-term care insurance policies, MetLife relied upon 10 certain assumptions. MetLife learned in 2008 that its actual experience materially and adversely 11 deviated from those assumptions. Rather than seek increases in the premium rates for existing 12 customers like Gaudet, “MetLife decided to replace VIP2 policies’ premium rate schedule with 13 one based on updated/more accurate lapse, morbidity and mortality assumptions.” MetLife 14 introduced its new VIP2 premium rate schedule in all 50 states and the District of Columbia 15 between 2008 and 2010. The schedule only applied to individuals purchasing new VIP2 policies 16 (“VIP2 NEW” policies). Preexisting VIP2 policyholders (“VIP2 OLD” policyholders) like Gaudet 17 were not affected. They were not notified that the rate schedule that their plans were based upon 18 was no longer used for new policies. 19 MetLife thereafter experienced continued pricing issues. In response, it developed an 20 updated rate action plan for existing VIP2 OLD policies like Gaudet’s and sought to implement a 21 58% premium rate increase on all VIP2 OLD policyholders across the country. Between October 22 2012 and July 2014, MetLife filed for the rate increase in each state.5 It filed for a California rate 23 increase with the CDI in 2013, but the CDI denied the requested increase. Between 2012 and 24 2017, MetLife implemented 10% to 88% premium rate increases on VIP2 OLD policyholders in 25 26 5 As the complaint explains, all states except Alaska must approve rate increases to MetLife’s 27 long-term care insurance policies before MetLife can implement them. Upon submission of a rate 1 37 states. Like California, several other states denied MetLife’s premium rate increase request. 2 In 2015, MetLife developed a second revised rate action plan for VIP2 OLD policies 3 pursuant to which it sought to implement an additional 18.98% premium rate increase on all VIP2 4 OLD policyholders across the country (totaling an increase of approximately 88% from the 5 original VIP2 OLD pricing). MetLife again sought approval in nearly all states. In 2019, MetLife 6 requested a 105% premium rate increase for California VIP2 OLD policyholders.6 On or about 7 January 21, 2021, the CDI approved this premium rate increase but increased it to authorize a 8 123.8% increase to be implemented over the next four years. On April 15, 2021, MetLife informed 9 Gaudet that it would be increasing her annual premium by 123.8% over the next four years, with 10 the first increase occurring on January 19, 2022.7 MetLife sent subsequent notices on April 15, 11 2023, April 15, 2024, and April 15, 2025. The notices informed Gaudet of the upcoming 12 implementation of the second, third, and fourth phases of the 123.8% premium rate increase. 13 Those phased increases took effect on January 19, 2023, January 19, 2024, and January 19, 2025. 14 Since 2015, MetLife (which has now imposed premium rate increases on VIP2 OLD 15 policyholders in every state) has created at least three more rate action plans, seeking increases to 16 VIP2 OLD policyholders’ premiums by roughly 16.92% in or around 2019–2020; 31.66% in or 17 around 2021; and 9.88% in or around 2023. If these increases are requested, authorized, and 18 implemented, MetLife will increase all VIP2 OLD policyholders’ premiums by about 218% over 19 the original premium. 20 Gaudet alleges that MetLife never told affected policyholders: (1) that its actual experience 21 deviated from the assumptions it used to initially price VIP2 OLD policies; (2) that its VIP2 OLD 22 policies were underpriced; (3) that MetLife intended to increase VIP2 OLD policyholders’ 23
24 6 As Gaudet explains, MetLife requested a premium rate increase of more than 88% in order to 25 account for the shortfall caused by CDI’s failure to approve its previous rate increase request. 7 MetLife allowed Plaintiff to mitigate the effects of the rate increase by: (1) eliminating her 26 automatic inflation protection; (2) reducing her annual automatic compound inflation protection rate from 5% to 3%; (3) reducing her daily benefit amount; (4) reducing her benefit duration from 27 lifetime to three years; or (5) canceling her policy. The notice (which is attached to the complaint) 1 premiums; (4) that it replaced the VIP2 OLD policy series’ premium rate schedule with a more 2 accurate one from 2008 through 2010; and/or (5) that it could justify VIP2 OLD premium rate 3 increases actuarily starting in at least 2008. MetLife also never told California policyholders (6) 4 that it sought permission for a 58% premium rate increase on all VIP2 OLD policyholders around 5 the country between 2012 and 2014; and/or (7) that the CDI denied MetLife’s 2013 premium rate 6 increase request. Gaudet also alleges based on information and belief that MetLife has not 7 disclosed the full extent of its post-2015 rate action plans to VIP2 OLD policyholders in states in 8 which they have not yet been implemented. 9 Gaudet alleges that had she “known that her policy was underpriced and/or that MetLife 10 planned to increase her premiums in the future, she either: (1) would not have purchased her long- 11 term care insurance policy and/or annually renewed it between 2008 and 202[5]; and/or (2) would 12 have reduced her premiums by decreasing her coverage some time before 2021.” 13 LEGAL STANDARD 14 Federal Rule of Civil Procedure 8(a)(2) requires a complaint to include a “short and plain 15 statement of the claim showing that the pleader is entitled to relief.” Under Federal Rule of Civil 16 Procedure 12(b)(6), a defendant may move to dismiss a complaint for failure to state a claim upon 17 which relief can be granted. Dismissal is required if the plaintiff fails to allege facts allowing the 18 court to “draw the reasonable inference that the defendant is liable for the misconduct alleged.” 19 Ashcroft v. Iqbal, 556 U.S. 662, 678 (2009). “Dismissal under Rule 12(b)(6) is appropriate only 20 where the complaint lacks a cognizable legal theory or sufficient facts to support a cognizable 21 legal theory.” Mendiondo v. Centinela Hosp. Med. Ctr., 521 F.3d 1097, 1104 (9th Cir. 2008). To 22 survive a Rule 12(b)(6) motion, a plaintiff need only plead “enough facts to state a claim to relief 23 that is plausible on its face.” Bell Atl. Corp. v. Twombly, 550 U.S. 544, 570 (2007). 24 In considering a Rule 12(b)(6) motion, the Court must “accept all factual allegations in the 25 complaint as true and construe the pleadings in the light most favorable” to the nonmoving party. 26 Rowe v. Educ. Credit Mgmt. Corp., 559 F.3d 1028, 1029–30 (9th Cir. 2009). While legal 27 conclusions “can provide the [complaint’s] framework,” the Court will not assume they are correct 1 as true allegations that are merely conclusory, unwarranted deductions of fact, or unreasonable 2 inferences.” In re Gilead Scis. Secs. Litig., 536 F.3d 1049, 1055 (9th Cir. 2008) (quoting Sprewell 3 v. Golden State Warriors, 266 F.3d 979, 988 (9th Cir. 2001)). 4 Materials outside the complaint can be considered on a Rule 12(b)(6) motion if they are 5 incorporated by reference therein or otherwise judicially noticeable. See United States v. Ritchie, 6 342 F.3d 903, 908 (9th Cir. 2003) (“A [district] court may [ ] consider certain materials— 7 documents attached to the complaint, documents incorporated by reference in the complaint, or 8 matters of judicial notice—without converting the motion to dismiss into a motion for summary 9 judgment.”). The Court may consider documents which are “not physically attached to the 10 complaint” “if the [ ] ‘authenticity ... is not contested’ and ‘the plaintiff’s complaint necessarily 11 relies’ on them.” Lee v. City of Los Angeles, 250 F.3d 668, 688 (9th Cir. 2001) (quoting Parrino v. 12 FHP, Inc., 146 F.3d 699, 705–06 (9th Cir. 1998)). Federal Rule of Evidence 201 permits judicial 13 notice of “a fact that is not subject to reasonable dispute” because it is “generally known.” 14 ANALYSIS 15 I. The parties’ requests for judicial notice are granted. 16 MetLife requests that the Court take judicial notice of two documents: (1) a copy of 17 Gaudet’s complete application for long-term care insurance; and (2) the Rate Increase History for 18 MetLife’s long-term care insurance published by the CDI on their website and dated December 19 31, 2013, and October 21, 2014. Gaudet requests that the Court take judicial notice of 20 (1) MetLife’s October 13, 2004 Initial Rate Filing with the CDI; (2) the October 7, 2005 approval 21 notification for MetLife’s October 2004 Initial Rate Filing; and (3) CDI filings related to the 22 123.8% premium rate increase MetLife imposed starting in January 2022. 23 The Court grants these requests for judicial notice because each of the documents are 24 public documents, incorporated by reference into Gaudet’s complaint, or available from a source 25 whose accuracy cannot reasonably be questioned. See Fed. R. Evid. 201(b). While the Court takes 26 judicial notice of the existence and content of the documents at issue, it will not take judicial 27 notice of the underlying truth of any factual assertions therein. 1 II. Gaudet fails to plead a claim for fraudulent omission. 2 To state a claim for fraudulent omission under California common law, a plaintiff must 3 plausibly plead that “(1) [the] defendant concealed or suppressed a material fact; (2) the defendant 4 was under a duty to disclose the fact to the plaintiff; (3) the defendant intentionally concealed or 5 suppressed the fact with intent to defraud the plaintiff; (4) the plaintiff was unaware of the fact and 6 would have acted differently if she had known of the concealed or suppressed fact; and (5) the 7 plaintiff sustained damage as a result of the concealment or suppression.” Quackenbush v. Am. 8 Honda Motor Co., 650 F. Supp. 3d 837, 845 (N.D. Cal. 2023), aff’d, No. 24-33, 2025 WL 9 1009273 (9th Cir. Apr. 4, 2025). 10 MetLife argues that Gaudet has failed to plead her fraudulent omission claim because it 11 had no duty to disclose the rate action plans prior to their approval by the CDI, after which it 12 promptly did so. The only theory under which Gaudet asserts that MetLife owed her a duty to 13 disclose is that the duty was “directly imposed by statute or other prescriptive law.” SCC 14 Acquisitions Inc. v. Cent. Pac. Bank, 207 Cal. App. 4th 859, 864 (2012) (cleaned up). Gaudet 15 primarily relies on Pastoria v. Nationwide Ins., 112 Cal. App. 4th 1490 (Cal. Ct. App. 2003), 16 which held that certain California Insurance Code sections impose a duty to disclose impending 17 policy changes on insurers. Id. at 1499. 18 The facts presented in Pastoria are key to understanding the duty to disclose recognized 19 therein. In that case, the plaintiffs purchased insurance policies between August and November 20 2001. On November 28, 2001, they received a notice about material changes to the policies. Id. at 21 1493. The plaintiffs alleged that the defendant knew about these changes when it sold them the 22 policies but that class members were not told of the “impending policy changes” until after they 23 purchased the insurance. The court found that the plaintiffs’ allegations that the defendant “knew 24 of impending material changes to the insurance policies when the plaintiffs purchased the policies 25 but failed to disclose this information to the plaintiffs until after they purchased their policies” 26 were sufficient to state claims for unfair competition and fraud, explaining: [T]he term “impending” means “about to happen” in the sense of a 27 fait accompli. (Webster’s Encyclopedic Unabridged Dict. of the impending changes amount to more than simply a matter of 1 contemplation or discussion at one level or another of the defendants’ 2 controlling executives, officers, employees, and consultants. Fairly read, an impending change to be actionable must be one that is in fact 3 already established according to the insurer’s operating procedures, but not implemented at the time a policy is purchased. 4 Id. at 1496–97. See also Shaffer v. Cont’l Cas. Co., No. CV 06–2235–RGK (PJWX), 2006 WL 5 8435261, at *3 (C.D. Cal. Aug. 9, 2006). 6 MetLife contends that, unlike in Pastoria, Gaudet does not and cannot allege that MetLife 7 knew that it would need to increase premiums at the time Gaudet purchased her policy in January 8 2007. Instead, the complaint asserts that MetLife learned of that information in 2008. Gaudet 9 responds that insurers have a duty to disclose impending changes to premiums and benefits both at 10 the time of an insurance contract’s original formation and upon its modification. See Cal. Ins. 11 Code § 361. She contends that each annual renewal of her policy constituted an “original 12 formation” or “modification” of the insurance contract. See Wheeler v. Am. Fam. Home Ins. Co., 13 632 F. Supp. 3d 1063, 1074 (N.D. Cal. 2022) (“The California Insurance Code dictates that, for 14 purposes of misrepresentations, policy renewals should be treated the same as policy 15 applications.”); Borders v. Great Falls Yosemite Ins. Co., 140 Cal. Rptr. 33, 37 (Ct. App. 1977).8 16 MetLife argues that unlike the term insurance at issue in Wheeler and Borders, Gaudet’s renewals 17 of her long-term care insurance policy cannot fairly be considered a new policy formation or a 18 modification because MetLife was required to agree to continue the coverage so long as Gaudet 19 continued to make her premium payments. 20 The Court need not resolve this issue because even if each renewal involved the formation 21 of a new contract, the rate action plans were not “impending” until after the CDI’s approval in 22 2021, at which time MetLife timely notified Gaudet of the impending rate change. As Pastoria 23 made clear, an insurer’s duty to disclose applies to changes that are “about to happen” or a “fait 24 accompli.” Here, an intervening state actor (the CDI) had control over whether MetLife’s 25 proposed premium increases would ever be implemented, as demonstrated by the fact that 26
27 8 Gaudet also cites Stephan v. Unum Life Ins. Co. of Am., 697 F.3d 917, 927 (9th Cir. 2012), but 1 MetLife’s initial request for rate changes was denied. Until MetLife received CDI approval, its 2 rate action plans were “simply a matter of contemplation or discussion at one level or another of 3 the defendants’ controlling executives, officers, employees, and consultants.” Under Pastoria, 4 MetLife had no duty to disclose such speculative future possibilities to Gaudet. 5 Gaudet argues that MetLife had a policy of continuing to request state approval of its rate 6 action plans until they were approved, and that MetLife’s rate action plans thus involved 7 something more than a “matter of contemplation or discussion” and should instead be considered 8 “already established according to the insurer’s operating procedures” under Pastoria. In her view, 9 MetLife’s policy meant that the plans were certain to be implemented at some point in the future 10 and thus were sufficiently impending to require disclosure. But the complaint itself acknowledges 11 that any proposed rate increases were not certain without CDI approval. See Compl. ¶¶ 30–31 12 (describing how states can deny requests for rate increases). Until that approval, the proposed rate 13 changes could not be considered “impending” or established. See Toulon v. Continental Casualty 14 Co., 877 F.3d 725, 738 (7th Cir. 2017) (affirming the dismissal of claims based on the alleged 15 nondisclosure of potential future rate increases prior to the purchase of a long-term care policy 16 because “regardless of whether [the insurer] knew it would want to increase rates substantially 17 many years in the future,” the insurer could not know whether “the regulators would approve a 18 rate increase”); Collins v. Metro. Life Ins. Co., 117 F.4th 1010, 1018 (8th Cir. 2024) (holding that 19 MetLife had no duty of disclosure under Missouri and Illinois law with respect to future premium 20 increases). Cf. Epstein v. Wash. Energy Co., 83 F.3d 1136, 1140–41 (9th Cir. 1996) (affirming 21 dismissal of a securities fraud claim challenging a public utility’s alleged failure to disclose 22 information related to its rate increase requests and noting that whether the increases would be 23 imposed involved “sheer speculation” based “on an anticipated and contingent outcome” before 24 the state commission responsible for rate approval). 25 Because Gaudet has not plausibly alleged that MetLife had any duty to disclose its rate 26 action plans prior to the CDI’s 2021 approval of those plans, the Court grants MetLife’s motion to 27 dismiss Gaudet’s fraudulent omission claim. III. Gaudet fails to plead a UCL claim. 1 The UCL prohibits “unfair competition,” which is defined as “any unlawful, unfair or 2 fraudulent business act or practice and unfair, deceptive, untrue or misleading advertising.” Cal. 3 Bus. & Prof. Code § 17200. “The ‘unlawful’ practices prohibited by section 17200 are any 4 practices forbidden by law, be it civil or criminal, federal, state, or municipal, statutory, 5 regulatory, or court-made.” Saunders v. Superior Ct., 27 Cal. App. 4th 832, 838–39 (1994). “It is 6 not necessary that the predicate law provide for private civil enforcement.” Id. 7 Gaudet relies exclusively on the “unlawful” theory of UCL liability and bases her claim of 8 unlawfulness on her allegation that MetLife violated California Insurance Code sections 330, 331, 9 332, 334, and 361 as interpreted in Pastoria. See Pastoria, 112 Cal. App. 4th at 1496 (construing 10 these code sections). As explained above, however, her complaint does not plead any violation of 11 the statutory duty identified in Pastoria. Further, California Insurance Code § 339 provides that 12 “[n]either party to a contract of insurance is bound to communicate, even upon inquiry, 13 information of his own judgment upon the matters in question.” Because MetLife’s internal rate 14 action plans were a matter of its own judgment prior to CDI approval, the complaint does not 15 include plausible allegations that MetLife violated the identified code sections by not disclosing 16 the information. 17 Because Gaudet has not plausibly alleged an unlawful act, the Court grants MetLife’s 18 motion to dismiss Gaudet’s UCL claim. 19 IV. Gaudet fails to plead a claim for a violation of § 10234.8. 20 California Insurance Code § 10234.8 provides that: 21 (a) With regard to long-term care insurance, all insurers, brokers, 22 agents, and others engaged in the business of insurance owe a 23 policyholder or a prospective policyholder a duty of honesty, and a duty of good faith and fair dealing. 24 (b) Conduct of an insurer, broker, or agent during the offer and sale 25 of a policy previous to the purchase is relevant to any action alleging a breach of the duty of honesty, and a duty of good faith and fair 26 dealing. 27 1 As with her other claims, Gaudet fails to plead that MetLife violated this provision.9 2 Defendants argue that Gaudet fails to plead a violation of the duty of good faith and fair 3 dealing because she does not plead a breach of contract. See, e.g., Kunde Enters., Inc. v. Nat'l Sur. 4 Corp., 608 F. Supp. 3d 883, 900 (N.D. Cal. 2022) (noting that under California law a breach of the 5 implied covenant of good faith and fair dealing in the insurance context has two elements: “(1) 6 benefits due under the policy must have been withheld and (2) the reason for withholding benefits 7 must have been unreasonable or without proper cause.”); Tran v. Kansas City Life Ins. Co., 228 F. 8 Supp. 3d 1068, 1079 (C.D. Cal. 2017) (“[W]here there is no breach of contract there can be no 9 breach of the implied covenant of good faith and fair dealing.”). But while the common law duty 10 generally depends on an existing contractual obligation, section 10234.8 extends the duty of good 11 faith and fair dealing to prospective policyholders. 12 There is little caselaw addressing this duty owed to prospective policyholders but it must 13 encompass something more than a breach of contract. See LONG-TERM CARE INSURANCE: 14 IT’S BACK TO THE WILD WILD WEST OF BAD FAITH LITIGATION, Ann.2006 ATLA- 15 CLE 577 (“[T]he statutory duty of honesty and good faith and fair dealing is owed to both insureds 16 and applicants and, unlike the common law duty of good faith and fair dealing implied in every 17 insurance contract, is not dependent on the issuance of a policy. Exactly how these statutory duties 18 will play out remains to be seen.” (emphasis in original)).10 Given the context in which Gaudet’s 19 claim arises, however, the Court cannot conclude that the California Legislature intended for 20 section 10234.8 to create duties of disclosure beyond those already imposed upon MetLife by both 21 the common law and the extensive statutory and regulatory requirements that apply to the highly 22 regulated long-term care insurance industry. Those existing sources of law provide extensive 23 guidance as to the circumstances under which such a duty exists, and nothing in section 10234.8 24
25 9 MetLife contends that there is no private right of action to enforce section 10234.8. See 26 Matthews v. Prudential Ins. Co. of Am., No. 8:24-CV-00497-JVS-JDE, 2024 WL 4406927, at *6 (C.D. Cal. Aug. 16, 2024). Because Gaudet has not plausibly alleged a violation of the statute, the 27 Court need not reach the question. 1 suggests that its purpose was to displace that well-established law with an entirely different set of 2 || duties. 3 Gaudet also cannot pursue a duty of honesty claim. As discussed above, MetLife was 4 || honest with Gaudet. Her insurance policy disclosed that her premiums were subject to change. As 5 soon as the CDI approved MetLife’s proposed rate increase, MetLife timely notified her of the 6 || upcoming increase, and for the reasons noted above MetLife had no duty to disclose non- 7 impending changes. 8 For these reasons, Gaudet does not plausibly allege a violation of California Insurance 9 Code Section § 10234.8, and the Court grants MetLife’s motion to dismiss that claim. 10 CONCLUSION 11 For the reasons discussed herein, the Court grants MetLife’s motion to dismiss Gaudet’s 12 || complaint.'! Dismissal is with leave to amend. Any amended complaint must be filed within 28
13 days of this Order.
v 14 Because there is no longer an operative complaint pending before the Court, the Court
15 || grants MetLife’s motion to stay discovery. See Dkt. No. 45. All discovery shall be stayed in this Q 16 action until such time as MetLife files an answer to any amended complaint. The Court vacates
= 17 any existing deadlines set forth in the Federal Rules of Civil Procedure, this Court’s Local Civil
18 Rules, or any order of this Court except for the deadline for an amended complaint. 19 20 21 IT IS SO ORDERED. 22 Dated: August 25, 2025 23 24 Mabe P. Casey Mftts United States District Judge 26 07 '! Although MetLife identified other purported defects in Gaudet’s complaint in its motion to dismiss, such as the alleged untimeliness of her claims, the Court need not address them given its conclusion that the complaint fails to plead any viable cause of action. Should Gaudet file an 28 . : : : amended complaint, MetLife may assert those arguments in any subsequent motion to dismiss.