Tupufia Faamai v. Metropolitan Life Insurance Co

MEMORANDUM

Plaintiff-Appellant Tufupia Faamai (“Faamai”) appeals the district court’s order dismissing with prejudice his ERISA action to recover accidental death benefits for the death of his wife, Melisa Tuitasi Faamai (“Mrs. Faamai”). Mrs. Faamai died after undergoing gastric bypass surgery. We have jurisdiction pursuant to 28 U.S.C. § 1291 , and we affirm.

We review for abuse of discretion Defendant-Appellee Metropolitan Life Insurance Company’s (“Met Life”) denial of Faamai’s claim for accidental death benefits. Abatie v. Alta Health & Life Ins. Co., 458 F.3d 955, 965 (9th Cir.2006). The district court dismissed Faamai’s claim with prejudice because it found that Met Life did not abuse its discretion in denying accidental death coverage based on two exclusions listed in Mrs. Faamai’s accidental death and dismemberment insurance policy. The exclusions were for deaths caused by: (1) the treatment of an “illness or infirmity,” and (2) “infection, other than [an] infection occurring in an external accidental wound.”

1. Met Life excluded Mrs. Faamai’s death from accidental death coverage because it classified obesity as a “physical or mental illness or infirmity,” and gastric…