Aetna Life Insurance v. Superior Court

Aetna Life Insurance Company (Aetna) seeks mandate review as authorized by Code of Civil Procedure section 437c of a referee’s decision granting partial summary adjudication in favor of the insured, Mary Ellen Hammer, on questions of coverage under a group health insurance policy. The superior court adopted the referee’s findings of fact and conclusions of law without a hearing and ordered the findings and conclusions deemed established as a matter of law. We have concluded the reference was not authorized by statute and therefore the writ must issue ordering the partial summary adjudication be vacated.

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Mrs. Hammer, both individually and as the executrix of the estate of her husband John E. Hammer, is the plaintiff in an action against Aetna for tortious breach of insurance contract. While Hammer and her husband were insured under Aetna’s group health policy made available to employees of the County of San Diego, Mr. Hammer received treatment at a facility in the Bahamas known as the Immunology Researching Centre for his disease of spindle cell malignant melanoma. The treatment was known as “immunoaugmentative therapy” (IAT). Mr. Hammer has since died. Aetna refused…