Hoffmann v. Life Insurance Co. of North America

MEMORANDUM

1. The district court did not err in placing the burden on' Appellant David Hoff-mann to show that he has Bipolar II. Hoffmann argues that LINA should be the one proving that his condition is subject to the mental illness limitation because the provision is more akin to an exclusion than to a condition for coverage. But even if we accept this contention as true, LINA has met that burden by demonstrating that Hoffmann is disabled due to a mental illness. The real issue is whether Hoffmann has a kind of mental illness—Bipolar II— that is exempted from the policy’s limitation provision. Because that exemption is not a condition on the mental illness limitation, we conclude that Hoffmann bears the burden of proving that he suffers from Bipolar II, just as he would have the burden to prove his eligibility for coverage. See Sabatino v. Liberty Life Assurance Co., 286 F.Supp.2d 1222, 1232 (N.D. Cal. 2003).

2. The district court’s finding that Hoff-mann has not met his burden is not clearly erroneous. After examining Hoffmann’s medical records, LINA’s claim reviewers found no evidence that Hoffmann had experienced a hypomanic episode as required for a diagnosis of Bipolar II…