Santos v. Minnesota Life Insurance Company

CourtDistrict Court, N.D. California
DecidedNovember 15, 2021
Docket4:20-cv-06707
StatusUnknown

This text of Santos v. Minnesota Life Insurance Company (Santos v. Minnesota Life Insurance Company) is published on Counsel Stack Legal Research, covering District Court, N.D. California primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Santos v. Minnesota Life Insurance Company, (N.D. Cal. 2021).

Opinion

1 2 3 4 UNITED STATES DISTRICT COURT 5 NORTHERN DISTRICT OF CALIFORNIA

7 EVA MARIE SANTOS, Case No. 20-cv-06707-PJH 8 Plaintiff,

9 v. ORDER GRANTING PLAINTIFF’S MOTION FOR JUDGMENT AND 10 MINNESOTA LIFE INSURANCE DENYING DEFENDANT’S MOTION COMPANY, FOR JUDGMENT 11 Defendant. Re: Dkt. Nos. 49, 50 12

13 14 Plaintiff and defendants’ cross-motions for judgment under Federal Rule of Civil 15 Procedure 52 came on for hearing before this court on October 7, 2021. Plaintiff 16 appeared through her counsel, Lee Harris and Adrian Hern. Defendant appeared 17 through its counsel, Charan Higbee. Having read the papers filed by the parties and 18 carefully considered their arguments and the relevant legal authority, and good cause 19 appearing, the court hereby rules as follows. 20 I. FINDINGS OF FACT 21 This is an ERISA case. Samuel Chong (“decedent” or “insured”) was a fifty-five- 22 year-old engineer and employee of Apple, Inc. Plaintiff Eva Marie Santos, Chong’s 23 cousin, brings this action in her capacity as the administrator of his estate. Defendant 24 Minnesota Life Insurance Company (also known as Securian Financial Group, Inc.) 25 issued a group insurance policy for accidental death of Apple employees, including 26 Chong. 27 A. The Insured’s Death 1 check by the San Francisco Police, after he was a “no show” at work and missed a 2 psychotherapy appointment a few days prior. ML 114 (Dkt. 49-1 at 117).1 He was found 3 on the floor in the kitchen, near a table. ML 115 (Dkt. 49-1 at 118). The gas oven door 4 was found open, but the oven was not in use at the time Chong was discovered. ML 115 5 (Dkt. 49-1 at 118). Blood was noted near his head and flowed a short distance from the 6 body. ML 115 (Dkt. 49-1 at 118). There also was dried vomit near his head. ML 115 7 (Dkt. 49-1 at 118). 8 The autopsy report lists the cause of death as blunt force head trauma with 9 subdural hematoma consistent with a fall to the back of the head. ML 126 (Dkt. 49-1 at 10 129). Under the category “contributing,” “methamphetamine present” is listed. ML 126 11 (Dkt. 49-1 at 129). The manner of death is listed as “accident.” ML 126 (Dkt. 49-1 at 12 129). The comment section of the report states:

13 The autopsy findings are most consistent with a mechanism of injury from a fall to the back of the head in an individual under 14 the influence of methamphetamine. There are no additional injuries that would suggest the involvement of a second party. 15 16 ML 126 (Dkt. 49-1 at 129). The toxicology report found methamphetamine, amphetamine, 17 and Temazepam present in the decedent’s blood and urine. ML 128 (Dkt. 49-1 at 131). 18 The level of methamphetamine in the blood sample was 2258 ng/mL, and the level of 19 amphetamine was 307 ng/mL. ML 128 (Dkt. 49-1 at 131). 20 The corrected death certificate lists the immediate cause of death as blunt force 21 head trauma with subdural hematoma. ML 209-10 (Dkt. 49-1 at 212-13). The section for 22 “other significant conditions contributing to the death but not resulting in the underlying 23 cause” notes “methamphetamine present.” ML 209-10 (Dkt. 49-1 at 212-13). In the 24 section describing how injury occurred (events which resulted in injury), the death 25 certificate lists “drug related.” ML 209-10 (Dkt. 49-1 at 212-13). The death certificate 26

27 1 The citation designation “ML” denotes the Minnesota Life Bates number of the 1 provides a series of check boxes regarding the available options for manner of death, 2 including “natural,” “accident,” “homicide,” “suicide,” “pending investigation,” and “could 3 not be determined.” ML 209 (Dkt. 49-1 at 212). From these options, the manner of 4 Chong’s death is “accident.” ML 209-10 (Dkt. 49-1 at 212-13). 5 Chong had a history of manic-depressive psychosis, a long history of 6 methamphetamine abuse with past rehabilitation, and many years of psychotherapy. ML 7 114-15 (Dkt. 49-1 at 117). His psychotherapist reported Chong had a long-standing 8 methamphetamine addiction, chronic suicidal ideations, and depression. ML 115, 117 9 (Dkt. 49-1 at 118, 120). No notes were found in the residence. ML 115 (Dkt. 49-1 at 10 118). Chong’s physician would later certify that he “did not ever prescribe 11 methamphetamine or its FDA approved brand-name medication Desoxyn” to the 12 decedent. ML 218 (Dkt. 49-1 at 221). 13 B. The Life Insurance Policy 14 At the time of his death, Chong was covered under two group insurance policies 15 issued by Minnesota Life to Apple. Group Term Life Insurance Policy No. 34017-G 16 provided a basic life insurance death benefit of $311,000 for the insured. ML 15, 28, and 17 335-408 (Dkt. 49-1 at 18, 31, and 338-411). Group Accidental Death and 18 Dismemberment Policy No. 33957-G issued by Minnesota Life to Apple (“the Policy”) 19 provided an accidental death benefit in the amount of $311,000 for the insured (i.e. twice 20 his annual salary). ML 26, 28 (Dkt. 49-1 at 29, 31). The basic life insurance death 21 benefit was already paid by defendant to plaintiff—only the accidental death benefit is the 22 subject of plaintiff’s complaint in this action. 23 The Policy’s accidental death benefit is to be paid “upon receipt at our home office 24 of written proof satisfactory to us that you died . . . as a result of a covered accidental 25 injury.” ML 73 (Dkt. 49-1 at 76). The Policy contains the following definition:

26 Accidental death or dismemberment by accidental injury means that an insured’s death or dismemberment results, directly and 27 independently of all other causes, from an accidental injury 1 ML 72 (Dkt. 49-1 at 75). 2 The Policy contains specific exclusions. Relevant to this case and Chong’s death, 3 the Policy states:

4 In no event will we pay the accidental death or dismemberment benefit where the insured’s death or dismemberment results 5 from or is caused directly or indirectly by any of the following: . . . 6 (7) being under the influence of any prescription drug, narcotic, or hallucinogen, unless such prescription drug, narcotic, or 7 hallucinogen was prescribed by a physician and taken in accordance with the prescribed dosage. 8 9 ML 74 (Dkt. 49-1 at 77). This exclusion hereinafter is referred to as the “drug exclusion.” 10 C. Defendant’s Denial of Claim for Accidental Death Benefits 11 Plaintiff, as the administrator of the estate, submitted an initial beneficiary 12 statement to Minnesota Life in March 2018. ML 33-34, 143 (Dkt. 49-1 at 36-37, 146). By 13 letter dated November 16, 2018, Minnesota Life informed plaintiff that the claim for the 14 basic life insurance benefit in the amount of $311,000 had been approved. ML 90-91 15 (Dkt. 49-1 at 93-94). 16 Minnesota Life continued to process the claim for the accidental death benefit. An 17 Associate Medical Director for Minnesota Life, Dr. Shapland, issued a medical opinion on 18 December 17, 2018, wherein she reported that the usual and customary dose for 19 methamphetamine is 15 mg per day and Chong’s methamphetamine level was 70.6 20 times higher and within the “fatal” range. ML 24, 25 and 313 (Dkt. 49-1 at 27, 28, and 21 316). Based on the probability that the methamphetamine in Chong’s system led to toxic 22 effects, she opined that the methamphetamine ingestion was a contributory cause of his 23 death. 24 Thereafter, Minnesota Life denied plaintiff’s claim for accidental death benefit, 25 stating in a letter that Chong’s methamphetamine level of 2258 ng/mL was “in the fatal 26 range,” and suggesting that the death was the result of an overdose. ML 137-139 (Dkt. 27 49-1 at 140-142). 1 appeal letter dated May 16, 2019. ML 142-144, 175-181 (Dkt. 49-1 at 145-47, 178-184). 2 In reviewing plaintiff’s administrative appeal, Minnesota Life obtained a medical opinion 3 from another of its Associate Medical Directors, Dr. Motlhatlhedi. ML 313 (Dkt. 49-1 at 4 316). Dr.

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Santos v. Minnesota Life Insurance Company, Counsel Stack Legal Research, https://law.counselstack.com/opinion/santos-v-minnesota-life-insurance-company-cand-2021.