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Lee v. Metropolitan Life Ins. Co.

United States District Court, N.D. California

February 11, 2015

CORLISS LEE, Plaintiff,
v.
METROPOLITAN LIFE INSURANCE COMPANY, Defendant

Decided February 10, 2015.

Page 1068

For Corliss Lee, Plaintiff: Nicholas Garrett Emanuel, LEAD ATTORNEY, Gates Eisenhart Dawson, San Jose, CA.

For Metropolitan Life Insurance Company, a New York Corporation, Defendant: James Christopher Castle, Barger Wolen LLP, Los Angeles, CA; Michael A.S. Newman, Barger & Wolen LLP, Los Angeles, CA; Royal Forest Oakes, Barger & Wolen LLP, Los Angeles, CA.

Page 1069

ORDER DENYING PLAINTIFF'S MOTION FOR SUMMARY JUDGMENT; GRANTING IN PART AND DENYING IN PART DEFENDANT'S MOTION FOR SUMMARY JUDGMENT

Re: Dkt. Nos. 35, 40

VINCE CHHABRIA, United States District Judge.

Introduction

Corliss Lee has brought this suit against Metropolitan Life Insurance Company (" Metlife" ), alleging breach of contract, breach of the implied duty of good faith and fair dealing, and violations of California's Unfair Competition Law, California Business and Professions Code § 17200 et seq., arising from Metlife's repeated denials of Lee's claims for benefits under a long-term care policy. The parties have filed cross-motions for summary judgment. Lee's motion is denied in full. Metlife's motion is granted in part and denied in part.

Background

Lee's policy provided coverage for the cost of a caregiver in the event that a physical or mental disability prevented her from caring for herself. As is relevant to this case, Lee would be eligible for benefits upon giving Metlife satisfactory proof that she was " Chronically Ill."

" Chronically Ill" means You are unable to perform, without Substantial Assistance from another individual, at least two (2) Activities of Daily Living (" ADL" ) for an expected period of at least ninety (90) days due to a loss of functional capacity; or You require Substantial Supervision to protect You from threats to health and safety due to Severe Cognitive Impairment.

White Decl., Ex. B at MET-LEE 000026.

Between April 2008 and November 2011, Lee filed four claims for benefits under the policy. Metlife denied each claim. Twice, Lee appealed the denials though Metlife's internal appeals process. In both appeals, Metlife upheld its decision. Although each of Lee's claims for benefits included some evidence suggesting she experienced difficulty performing certain " Activities of Daily ...


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