Torres v. Unitedhealthcare Insurance Company

• Court: Court of Appeals for the Ninth Circuit
• Decided: November 4, 2025
• Docket: 24-4502
• Status: Unpublished

Opinion

NOT FOR PUBLICATION FILED UNITED STATES COURT OF APPEALS NOV 4 2025 MOLLY C. DWYER, CLERK U.S. COURT OF APPEALS FOR THE NINTH CIRCUIT

DANIEL TORRES, No. 24-4502 D.C. No. Plaintiff - Appellant, 2:23-cv-01533-KK-SK and MEMORANDUM* EMSURGCARE, EMERGENCY SURGICAL ASSISTANT,

Plaintiffs,

v.

UNITEDHEALTHCARE INSURANCE COMPANY,

Defendant - Appellee,

and

KARL STORZ ENDOSCOPY-AMERICA, INC.,

Defendant.

* This disposition is not appropriate for publication and is not precedent except as provided by Ninth Circuit Rule 36-3. Appeal from the United States District Court for the Central District of California Kenly Kiya Kato, District Judge, Presiding

Argued and Submitted October 20, 2025 Pasadena, California

Before: IKUTA, R. NELSON, and VANDYKE, Circuit Judges.

Plaintiff-Appellant Daniel Torres (“Torres”) appeals the district court’s order

granting judgment to Defendant-Appellee UnitedHealthcare Insurance Company

(“United”) in a lawsuit Torres filed to challenge United’s denial of benefits. Torres

alleges two points of error on appeal. First, Torres argues that the district court erred

by reviewing Torres’s claim for abuse of discretion rather than de novo after

concluding that Section 10110.6 of the California Insurance Code did not apply to

health insurance policies. Second, Torres argues that the district court abused its

discretion by denying Torres’s untimely motion to amend his complaint.

We have jurisdiction to review the district court’s final decision under

28 U.S.C. § 1291. We review a district court’s choice of the standard of review de

novo and its denial of leave to amend pleadings for abuse of discretion. Abatie v.

Alta Health & Life Ins. Co., 458 F.3d 955, 962 (9th Cir. 2006); Kamal v. Eden

Creamery, LLC, 88 F.4th 1268, 1275 (9th Cir. 2023). We affirm in part and vacate

and remand in part.

1. The district court erred by adopting an interpretation of Section 10110.6

inconsistent with the interpretation of California’s intermediate appellate courts.

2 24-4502 Section 10110.6 of the California Insurance Code voids any discretionary-review

clause in a policy for “life insurance or disability insurance” and requires that claims

related to such policies be reviewed de novo. Cal. Ins. Code § 10110.6(a); see

Firestone Tire & Rubber Co. v. Bruch, 489 U.S. 101, 115 (1989). California’s

intermediate appellate courts have repeatedly observed that health insurance is a

form of disability insurance for purposes of the California Insurance Code. See, e.g.,

Ticconi v. Blue Shield of Cal. Life & Health Ins. Co., 160 Cal. App. 4th 528, 539 n.7

(2008), petition for review denied, 2008 Cal. LEXIS 7013 (June 11, 2008) (“[H]ealth

insurance … is a type of disability insurance.”); Nieto v. Blue Shield of California

Life & Health Ins. Co., 181 Cal. App. 4th 60, 79 n.4 (2010) (“[H]ealth insurance is

a type of disability insurance.”); Blue Shield of California Life & Health Ins. Co. v.

Superior Ct., 192 Cal. App. 4th 727, 733 (2011) (“Health insurance policies are

considered a form of disability insurance.”).

When a state’s highest court has not interpreted a provision of state law, “a

federal court is obligated to follow the decisions of the state’s intermediate appellate

courts” absent “convincing evidence that the state supreme court would decide

differently.” Vestar Dev. II, LLC v. Gen. Dynamics Corp., 249 F.3d 958, 960 (9th

Cir. 2001) (quoting Lewis v. Tel. Emps. Credit Union, 87 F.3d 1537, 1545 (9th Cir.

1996)). Because the district court did not follow California’s intermediate appellate

courts’ interpretation of state law, the district court failed to treat the

3 24-4502 discretionary-review clause in the health insurance policy at issue as void and

improperly reviewed Torres’s claim for abuse of discretion when it should have

reviewed his claim de novo.

The district court’s analysis of the “the plain language of the statute” does not

present convincing evidence that the California Supreme Court would disagree with

the state’s intermediate appellate courts’ interpretation of Section 10110.6. Torres

v. United Healthcare Ins. Co., No. CV 23-1533-KK-SKX, 2024 WL 3498861, at *9

(C.D. Cal. June 28, 2024). The district court’s textual analysis failed to give proper

weight to the statutory definition of “health insurance” found in California Insurance

Code Section 106, which defines health insurance as “an individual or group

disability insurance policy that provides coverage for hospital, medical, or surgical

benefits.” Cal. Ins. Code § 106 (emphasis added). Additional references to health

insurance throughout the Code demonstrate that under California’s applicable law,

health insurance is included within the umbrella category of “disability insurance.”

E.g., Cal. Ins. Code § 10111.2(a) (distinguishing a “policy of disability insurance

other than health insurance, as defined in Section 106” (emphasis added)); Cal. Ins.

Code §§ 10176.61(a), 10123.196(a), 10123.83(a), 10123.9, 10126.6(a) (referring to

health insurance by its statutory definition of “disability insurance polic[ies] ... that

cover[] hospital, medical, or surgical expenses.” (emphasis added)).

California law establishes that health insurance is a form of disability

4 24-4502 insurance for purposes of the California Insurance Code. We vacate the district

court’s grant of judgment to United and remand to the district court to review

Torres’s claim de novo in the first instance.

2. The district court did not abuse its discretion when it denied Torres’s

untimely motion to amend his complaint to add a claim for breach of fiduciary duty.

If a party has not demonstrated diligence establishing good cause to amend on an

untimely motion, we must deny it. And when a motion to amend is based on

information a party possessed “long before the deadline to amend had passed,” the

party lacks such diligence. Branch Banking & Tr. Co. v. D.M.S.I., LLC, 871 F.3d

751, 765 (9th Cir. 2017); Fed. R. Civ. P. 16(b).

Four months before the deadline to amend expired, Torres specifically alleged

in his first amended complaint that “[a]ccording to [Torres’s] health plan, [United]

is obligated to attempt a negotiation with Medical Providers” and that “[United] did

not attempt a good faith negotiation.” And by his own account, more than nine

months before the deadline to amend pleadings, Torres had personally received all

the letters and notices from United that generated the alleged duty to negotiate and

that notified him of United’s refusal to pay an increased share of his medical bills.

We affirm the district court’s denial of Torres’s motion for leave to amend.

AFFIRMED in part, VACATED and REMANDED in part.

5 24-4502