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ORDER GRANTING IN PART AND DENYING IN PART PLAINTIFFSâ MOTION FOR PARTIAL SUMMARY JUDGMENT AND DENYING DEFENDANTS MOTION FOR PARTIAL SUMMARY JUDGMENT JOSEPH C. SPERO, United States Magistrate Judge. I. INTRODUCTION Plaintiffs Terri Smith and Michelle Smith Fregoso (âPlaintiffsâ) brought this action against Stonebridge Life Insurance Company (âStonebridgeâ) for breach of contract and tortious bad faith. Plaintiffsâ claims arise from Stonebridgeâs denial of their claim for benefits under an accidental death insurance policy following their motherâs death from an overdose of prescription pain medication. Stonebridge filed a Motion for Partial Summary Judgment (âDefendants Motionâ) on the breach of contract claim on August 13, 2008. Plaintiffs filed their own Motion for Partial Summary Judgement (âPlaintiffsâ Motionâ) on the breach of contract claim on August 15, 2008. The Court held a hearing on the cross-motions on September 26, 2008 at 9:30 a.m. For the reasons stated below, Defendantsâ Motion is DENIED, and Plaintiffsâ Motion is GRANTED in part and DENIED in part. II. BACKGROUND *1213 A. Facts 1 Diane Geraldine Hall-Hussain (âHall-Hussainâ) was insured under an accidental death/dismemberment policy (the âPolicyâ) issued to her by Stonebridge. Joint Statement of Undisputed Facts (âJSUFâ) ¶ 1. The policy became effective on November 7, 2005, and provided accidental death benefits in the amount of $50,000 in the event of Hall-Hussainâs accidental death. Id. Plaintiffs Terri Smith and Michelle Smith Fregoso, Hall-Hussainâs daughters, are beneficiaries of the Policy in equal shares. JSUF ¶ 18. Beginning in April 2005, Hall-Hussainâs primary physician, Dr. Chia Chen, began prescribing her oxycodone, 2 a narcotic pain killer, to treat Hall-Hussainâs intractable pain. JSUF ¶ 14. Chen advised Hall-Hussain of the risks of taking oxycodone, including the risk of overdose, and instructed Hall-Hussain not to take more than prescribed. Laska Deck iso Defs Mot., Ex. 1 at 33:3-22; 36:4-7. Dr. Chen believed that Hall-Hussain understood those risk. Id. at 35:24-35:3. Dr. Chen last saw Ms. Hall-Hussain on April 3, 2007, at which time she increased Hall-Hussainâs oxycodone dosage from two 40 mg pills three times a day to three 40 mg pills three times a day. JSUF ¶ 16. When Hall-Hussain last saw Dr. Chen on April 3rd, 2007, she told Dr. Chen that she âfeels depressed because of pain.â Laska Decl. iso Defs Opp., Ex. 1 at 57:18-24. Dr. Chen testified that Hall-Hussain had a history of depression and that âit would be very strange to have someone who has chronic pain and her medical problems not to be depressed.â Id. at 58:1-19. Hall-Hussainâs daughter, Michelle Smith Fregoso, submitted a declaration in which she stated that at the time of her death her mother âwas very close with her entire family,â financially supported her brother and fixed him meals every day. Fregoso Deck iso Piâs Mot. at ¶¶ 4,5. She testified that her mother loved her family and had a zest for life. Id. at ¶ 12. Unfortunately, Ms. Hall-Hussain was found dead in her home on April 9, 2007. JSUF ¶ 5. The Deputy Coroner who investigated the scene found a bottle of Oxy-Contin containing only one tablet lying on the bed. SAE, Ex. B. Another OxyContin tablet that had spilled out of the open bottle was found on the bed. Id. The label on the bottle stated that it had been filled on March 27, 2007 and had contained 180 tablets of 40mg each. Id. Hall-Hussainâs daughter stated that after her motherâs death she discovered in her motherâs handbag a pill organizer containing a weekâs worth of her pills, and that her mother would also keep some of her medications in a medicine chest in her bedroom. Fregoso Deck iso Piâs Mot. at ¶ 15. There is no evidence that oxycodone was found in either of these containers. Id. Smith-Fre-goso did not speak to the Coronerâs investigator about her motherâs custom or habit of keeping her medicines. Id. at ¶ 14. The Death Investigation Report prepared by the Deputy Coroner stated that the manner of death was âaccidental.â JSUF ¶ 9. The deputy coroner testified that he determined Hall-Hussainâs death was an accident based on the toxicology report, the lack of a suicide note, and from talking to Hall-Hussainâs family, who told the deputy coroner she was âa happy, nor *1214 mal person that didnât-well, never threatened suicide to them.â Stennet Decl. iso Plâs Mot, Ex. 2 at 45:5-12. The toxicology-report stated that the effective range for oxycodone was .005 to .05 mg/L, while the potentially toxic range begins at .2 mg/L. SAE, Ex. B, p. 11. The oxycodone level in Ms. Hall-Hussainâs blood was measured to have been .25 mg/L. 3 Id. The Deputy Coroner testified that this level of oxycodone in Hall-Hussainâs blood was on the âlow-end of potentially toxic,â and that he would expect the level of oxycodone for a suicide attempt to be in the range of 1.2 to 3.2 milligrams per liter. Stennet Decl. iso Plâs Mot, Ex. 2 at 45:10-22. A final death certificate was issued on April 26, 2007 and listed the immediate cause of Hall-Hus-sainâs death as â[o]xycodone intoxication.â JSUF ¶ 8. The Death Certificate states that the manner of death was âaccidental.â JSUF ¶ 9. On April 27, 2007, Hall-Hussainâs daughters made a demand to Stonebridge to collect the accidental death benefit. JSUF ¶ 17. On June 12, 2007, Stone-bridge sent a letter to Plaintiffs denying their claim on the basis that Hall-Hus-sainâs death fell within two exclusions in the Policy. SAE, Ex. E. The exclusions cited by Stonebridge state: No benefit shall be paid for Injury that 3. Is caused by or results from the Covered Personâs taking or using any narcotic, barbituate or any other drug, unless taken or used as prescribed by a Physician-, or ... 7. ' Is due to disease, bodily or mental infirmity, or medical or surgical treatment of these. SAE, Ex. A at p. 5 (emphasis added). Plaintiffs filed the complaint in this action in the Southern District of California on September 5, 2007, asserting claims for breach of contract and tortious bad faith. The action was transferred to this Court on March 17, 2008. The parties now bring cross-motions for partial summary judgment on the breach of contract claim. B. The Motions In its Motion, Plaintiffs ask the Court to determine that Plaintiffs are entitled to coverage under the Policy because Hall-Hussainâs death was an accident and no exclusions in the Policy apply. In support of its position that the death was an accident, Plaintiffs cite to evidence from the Coronerâs Report determining the death to be an accident. On the other hand, Stonebridge asserts that because there is evidence that Hall-Hussain knew the risks of taking more Oxycodone than prescribed, and had a history of depression, there is a genuine issue of material fact as to whether her death was accidental or intentional. Both motions ask the Court to determine whether the Policy exclusions cited by Stonebridge apply to Hall-Hussainâs death. To the extent that Stonebridge denied coverage based on the drug exclusion, Plaintiffs assert that: 1) California Insurance Code section 10369.12 applies to Hall-Hussainâs Policy; 2) Hall-Hussainâs death would not be excluded under the statutory exclusionary language of section 10369.12; and therefore 3) because the Policyâs language is less favorable than section 10369.12, section 10369.1 requires that the Policyâs drug exclusion be readout and replaced with the statutory language. *1215 On the other hand, Stonebridge asserts that: 1) section 10369.12 applies only to group policies, not individual policies such as Hall-Hussairis; 2) even if section 10369.12 applies, the statutory exclusion still excludes Hall-Hussairis death; and 3) if the statutory language is interpreted to not exclude coverage, it is inconsistent with the type of coverage provided by the Policy and therefore inoperative under section 10323. To the extent that Stonebridge denied coverage based on the medical exclusion, Plaintiffs assert that this exclusion does not apply because Hall-Hussain âdid not die as a result of treatment but rather died as a result of an accidental overdose of oxycodone.â Piâs Mot at p. 10. In addition, Plaintiffsâ assert that interpreting the Policyâs medical treatment exclusion to apply to deaths caused by prescription drug overdoses is inconsistent with section 10369.12. III. ANALYSIS A. Summary Judgment Standard Rule 56 of the Federal Rules of Civil Procedure provides that summary judgment âshall be rendered forthwith if the pleadings, depositions, answers to interrogatories, and admissions on file, together with affidavits, if any, show that there are no genuine issues as to any material fact and that the moving party is entitled to judgment as a matter of law.â Fed.R.Civ.P. 56(c). A âgenuineâ issue of material fact exists if there is sufficient evidence for a reasonable jury to return a verdict for the non-moving party. Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 248 , 106 S.Ct. 2505 , 91 L.Ed.2d 202 (1986). In order to prevail, a party moving for summary judgment must show the absence of a genuine issue of material fact with respect to an essential element of the non-moving partyâs claim, or to a defense on which the nonmoving party will bear the burden of persuasion at trial. Celotex Corp. v. Catrett, 477 U.S. 317, 323 , 106 S.Ct. 2548 , 91 L.Ed.2d 265 (1986); see also Nissan Fire & Marine Ins. Co. v. Fritz Cos. Inc., 210 F.3d 1099 (9th Cir.2000). Once the movant has made this showing, the burden shifts to the party opposing summary judgment to âdesignate specific facts showing there is a genuine issue for trial.â Celotex, 477 U.S. at 323 , 106 S.Ct. 2548 . To establish a âgenuineâ issue of fact when opposing summary judgment, a plaintiff must âproduce at least some significant probative evidence tending to supportâ the allegations in the complaint. Smolen v. Deloitte, Haskins & Sells, 921 F.2d 959, 963 (9th Cir.1990). The Court need not âscour the record in search of a genuine issue of material fact.â Keenan v. Allan, 91 F.3d 1275, 1279 (9th Cir.1996). In an insurance coverage dispute, the interpretation of the terms of the insurance policy is a question of law for the court. Heighley v. J.C. Penney Life Insurance Co., 257 F.Supp.2d 1241, 1250 (C.D.Cal.2003). Because this Courtâs jurisdiction is based on diversity, California substantive law applies. Id. at 1251 . B. Was the Death Accidental In order to prevail on their Motion, Plaintiffs must show that there is no genuine issue of material fact that Hall-Hus-sairis death was accidental. In opposition to Plaintiffsâ Motion, Stonebridge cites evidence that Ms. Hall-Hussain (1) was an experienced user of oxycodone, (2) knew the risks of taking too many pills, (3) with knowledge of those risks took more pills than prescribed and (4) had a history of *1216 depression and told her doctor shortly before her death, âI feel depressed because of pain.â SAE, Ex. D at p. 16, Laska Deck iso Defs Opp., Ex. 1 at 57:4-25. Based on these facts, Stonebridge argues that a reasonable trier of fact could determine that Ms. Hall-Hussain took the overdose intentionally, or was at least indifferent to whether she lived or died. Defs Opp. p. 8. The Court agrees with Stonebridge that a genuine issue of material exists as to whether Hall-Hussainâs death was accidental. âIn California, the burden is on the person claiming the accidental death benefits to establish that the insuredâs death resulted from an accident.â Heighley, 257 F.Supp.2d at 1251 . In most accidental death and dismemberment policies, as in Hall-Hussainâs Policy, the term âaccidentâ is undefined. Courts in California have defined an accidental death as one where âthe death of the insured was objectively unexpected, unintended, and happened out of the usual course of events.â Heighley, 257 F.Supp.2d at 1252 (citing Bornstein v. J.C. Penney Life Ins. Co., 946 F.Supp. 814 (C.D.Cal.1996)). A policy that insures against âaccidental death,â requires only âthat the insuredâs death was not designed or anticipated by the insured, i.e., accidental death is an unintended and undesigned result even if caused by the insuredâs voluntary act.â Heighley, 257 F.Supp.2d at 1253 (citing Weil, 7 Cal.4th at 134-135, 27 Cal.Rptr.2d 316 , 866 P.2d 774 ). âPolicies requiring only that there be proof of accidental death are construed broadly, such that the injury or death is likely to be covered unless the insured virtually intended his injury or death.â Weil, 7 Cal.4th at 140 , 27 Cal.Rptr.2d 316 , 866 P.2d 774 (emphasis added; internal quotes omitted). See e.g. Pilcher v. New York Life Ins. Co., 25 Cal.App.3d 717 , 102 Cal.Rptr. 82 (1972) (holding that death by self-administered heroin overdose was accidental in policy covering âaccidental deathâ). A jury could reasonably conclude that Hall-Hussain took more oxycodone than prescribed. Her body was found next to a near empty bottle of oxycodone. SAE, Ex. B. The number of pills missing from the bottle was greater than the number of pills she should have taken pursuant to her prescription, and the toxicology report showed a potentially toxic amount of oxycodone in Hall-Hussainâs blood. Id. Plaintiffsâ have submitted evidence that Hall-Hussain also kept medicine in a pill organizer and a medicine chest. In the absence of evidence that oxycodone tablets were found in either of these locations, a jury could reasonably conclude that, of entire bottle of oxycodone, only two tablets remained. 4 Thus, the relevant question is not whether Hall-Hussain took more pills than prescribed, but rather when taking more pills than prescribed she âdesigned, anticipatedâ or âvirtually intendedâ her death. Heighley, 257 F.Supp.2d at 1253 . Plaintiffs cite to evidence which could support a finding that Hall-Hussainâs death was not intentional. First, the Death Investigation Report detailed the findings of Deputy Coroner Horton that Hall-Hussainâs death was an accident. JSUF ¶ 9. The Deputy Coroner testified that the bases for his conclusion were that: 1) the amount of Oxycodone in Hall-Hus-sainâs system, .25 mg/L, was low for an attempted suicide, which usually involve levels in the range of 1.2 to 3.2 mg/L; 2) *1217 no suicide note was found; and 3) discussions with Hall-Hussainâs family members indicated that Hall-Hussain had not been despondent or suicidal prior to her death. Stennet Decl. iso Piâs Mot., Ex. 2 at 45:10-22. However, Stonebridge notes that the Deputy Coroner conceded that suicide notes are present in only half the cases ultimately ruled to be suicides. Laska Decl. iso Defs Opp., Ex. 2 at 65:7-13. Furthermore, with respect to the Deputy Coronerâs opinion regarding the expected level of oxycodone for suicide, Stonebridge noted that Deputy Horton is not a toxicologist. Id. at 65:25-67:5. On the other hand, Stonebridge asserts that evidence in the record supports a finding that Hall-Hussainâs death was intentional, not accidental. Hall-Hussain was an experienced user who understood the risks of taking oxycodone and had been instructed not to take more than the prescribed dose. Laska Decl. iso Defs Mot., Ex. 1 at 33:3-22; 35:24-36:3; 36:4-7. Furthermore, Hall-Hussain had a history of depression and had told Dr. Chen on April 3rd that she âfelt depressed because of pain.â Id. at 58:18-24. Five days after her dosage was increased, Hall-Hussain took more Oxycodone pills than she had been prescribed and died from oxycodone intoxication. The evidence cited by Stonebridge is sufficient to create a genuine issue of material fact as to whether Hall-Hussainâs was an accident. Accordingly, the Court DENIES Plaintiffsâ motion for partial summary judgment to the extent it seeks to adjudicate whether Hall-Hussainâs death was accidental under the policy. C. The Policy Exclusions While Plaintiffs have the burden of proving coverage under the Policy, Stone-bridge has the burden of proving that an exclusion in the Policy applies. See Searle v. Allstate Life Ins. Co., 38 Cal.3d 425, 436 , 212 Cal.Rptr. 466 , 696 P.2d 1308 (1985). Therefore, the question presented by both motions is whether there is a genuine issue of material fact as to the applicability of either the Policyâs drug exclusion or medical exclusion to Hall-Hussainâs death. 1. Whether California Insurance Code Section 10369.12 Applies to Hall-Hussainâs Policy. The first question to be resolved is whether section 10369.12 applies to an individual accidental death policy such as Hall-Hussainâs Policy. Stonebridge asserts that California Insurance Code section 10369.12 and the other provisions cited by Plaintiffs apply only to group disability policies, and not individual policies. As support for this assertion, Stonebridge argues that â[sjection 10270 (titled âScope of Chapterâ) specifies the types of insurance subject to the provisions of Chapter 4.â Defs Mot. at p. 11. Because section 10270 mentions â âselected group disability insuranceâ as well as certain enumerated categories of insurance covering more than one person (such as, for example, âblanket insuranceâ and âtuition refund insurance.â),â but does not explicitly mention individual insurance, Sto-nebridge reads this provision as excluding individual disability insurance from the provisions of Chapter Four. Id. Stone-bridgeâs reading of section 10270 is unsupported by the plain reading of that section, the structure and organization of the Code as a whole, and regulations and court decisions interpreting the Code. The construction of a statute is a question of law to be decided by the Court. *1218 See Dean W. Knight & Sons, Inc. v. State of California ex rel. Dept. of Transportation, 155 Cal.App.3d 300, 305 , 202 Cal.Rptr. 44 (Cal.Ct.App.1984). âIt is a fundamental principle of statutory interpretation that statutes are not construed in isolation, but rather, with reference to the entire scheme of law of which they are part so that the whole may be harmonized and retain effectiveness.â Intâl Longshoremenâs and Warehousemenâs Union v. Los Angeles Export Terminal, Inc., 69 Cal.App.4th 287, 301 , 81 Cal.Rptr.2d 456 (Cal.Ct.App.1999). First, the plain language of section 10270 does not support Stonebridgeâs statutory construction. Section 10270(a) reads â[Excluded insurance.] This chapter shall not apply to workmenâs compensation insurance nor any policy of liability insurance with or without supplementary coverage therein, nor any policy or contract of reinsurance.â § 10270(a). Notably, âindividual disability insuranceâ is not included as type of insurance excluded from coverage by the chapter. § 10270(a). Under the maxim of statutory construction, âexpres-sio unius est exclusio alterius,â where âexemptions are specified in a statuteâ the court âmay not imply additional exemptions unless there is a clear legislative intent to the contrary.â Rojas v. Superior Court, 33 Cal.4th 407, 424 , 15 Cal.Rptr.3d 643 , 93 P.3d 260 (2004). Here, there is no evidence that the Legislature specifically intended to exclude individual disability insurance from coverage. In addition, Stonebridgeâs interpretation of sections 10270 and 10369.12 is inconsistent with the structure and organization of the- Code as a whole. The title of the relevant division (âLife and Disability Insuranceâ), and relevant chapter, (âStandard Provisions in Disability Policiesâ) both refer to âdisabilityâ policies, not âgroup disabilityâ policies. Even the relevant statute refers to âdisability policies,â and not âgroup disability policies.â § 10369.12. Section 106 of the Insurance Code defines the term âdisabilityâ as including accidental death and dismemberment insurance policies, but makes no reference to the term applying only to âgroupâ policies. 5 § 106. In other locations within the chapter, where a statute speaks to âgroupâ policies only, it says so. See, e.g., § 10270.9 (titled âGroup disability policy; prerequisites to issuanceâ); § 10270.98 (titled âGroup Policies; reduction of benefits in case of other coverage; payment of benefitsâ). See also, California Practice Guide: Insurance Litigation, § 6:479 (Rutter 2008) (stating that âspecial doctrines apply to accidental death benefits payable under group insurance policies.â). Similarly, where the Code speaks to âindividualâ disability insurance only, it says so explicitly. See, e.g., § 10270.98 (exempting âindividual policies or contractsâ from reduction of benefits provision); § 10270.99 (defining âindividual policies or contractsâ as used in § 10270.98 as not including âselected group disability policiesâ); § 10273.6 (titled âRenewal of individual health benefit plansâ; exceptions); § 10293 (allowing commissioner to âwithdraw approval of an individual or mass-marketed policy of disability insuranceâ if benefits are unreasonable in relation to the premium charged). *1219 Finally, no court has held that section 10369.12 or the other provisions of Chapter Four are inapplicable to individual disability policies. If anything, the legal decisions interpreting provisions within Chapter Four support the position that the chapter does apply to individual disability policies. For example, in John Hancock Mut. Life Ins. Co. v. Greer, the California Court of Appeal held that an incontestability clause in plaintiffs individual disability policy was mandated by section 10350.2, a provision within Chapter Four. 60 Cal.App.4th 877, 880 , 71 Cal.Rptr.2d 48 (1st Dist.1998). Other courts in California have held that other provisions in the chapter do not apply to group policies, and therefore only apply to individual policies. See e.g. Peterson v. American Life & Health Ins. Co., 48 F.3d 404, 410 (9th Cir.1995) (noting that the âCommissionerâs regulations implementing section 10291.5(b)(7) apply only to âindividual disability policies.â â) (emphasis added); Twohey v. Lincoln Nat. Life Ins. Co., 2000 WL 1006529 , 3 (N.D.Cal.2000), aff'd 273 F.3d 817 (9th Cir.2001) (holding that âthe Provisions set forth in [section 10369.6] of the insurance code for use in individual policies ... are not applicable to group disability insuranceâ) (emphasis added). Regulations interpreting the relevant Code provisions also apply them to individual policies. See, Ins. Regulation 10 CA ADC § 2232.30 (finding in reference to section 10369.1 that â[t]he instructions under the heading for each optional uniform provision state whether or not, or to what extent the subject matter of each such uniform provision as set forth in the Insurance Code for use in individual policies may be used in group disability policiesâ) (emphasis added). Accordingly, the Court finds that section 10369.12 and the other Insurance Code provisions cited by Plaintiffs apply to Hall-Hussainâs individual accidental death insurance policy. 2. Whether the Policy Exclusion is Less Favorable than the Statutory Exclusion Because section 10369.12 applies to Hall-Hussainâs Policy, the Court must next consider whether the Policy exclusion, âunless taken or used as prescribed by a physicianâ is less favorable to Plaintiffsâ than the statutory exclusion, âunless administered on the advice of a physician.â Cal. Ins.Code § 10369.12. If the policy provision is less favorable than the statutory provision, then the statutory provision controls. See e.g., Holloway v. J.C. Penney Life Ins. Co., 190 F.3d 838 (7th Cir.1999); Olson v. American Bankers Ins. Co. of Florida, 30 Cal.App.4th 816 , 35 Cal.Rptr.2d 897 (substituting statutory language of 10369.12 for less favorable policy language). In support of its Motion, Stonebridge asks the Court to interpret âadministered on the advice of a physicianâ to require an insured to take prescription drugs âas prescribed by a physicianâ, i.e. to require that the dosage prescribed by the physician have been taken, and no more or less. Under this interpretation, the language of the Policy exclusion would be no less favorable to Plaintiffs than the statutory exclusion because coverage for Hall-Hussainâs death would be precluded under either provision. On the other hand, Plaintiffsâ Motion asks the Court to interpret the statutory exclusion âon the advice of a physicianâ more broadly. In Plaintiffsâ view, this statutory provision allows coverage as long as the drug causing death was prescribed to the insured, regardless of whether the prescribed dosage was taken. Under this interpretation, section 10369.12 would not *1220 exclude coverage here, even where an overdose was taken. Plaintiffs argue that the policy provision, allowing coverage for accidents involving prescription drugs only when the drugs were taken âas prescribed,â is less favorable and would exclude coverage. For the reasons stated below, the Court agrees with Plaintiffsâ interpretation of the two provisions. As a result, the statutory exclusion applies and does not exclude coverage for Hall-Hussairis death. Policy language should be interpreted in its âordinary and popularâ sense. Cal. Civil. Code § 1644 . Where the language of a policy is ambiguous, however, the policy is interpreted in favor of coverage. See AIU Insurance Co. v. Superior Court, 51 Cal.3d 807, 821-822 , 274 Cal.Rptr. 820 , 799 P.2d 1253 (1990). However, when interpreting insurance policy language required by statute, the statute âmust be construed to effect not the intent of the parties, but the intent of the legislature; therefore the rules of statutory construction apply.â Galanty v. Paul Revere Life Ins. Co., 23 Cal.4th 368, 374 , 97 Cal.Rptr.2d 67 , 1 P.3d 658 (2000). âA policy provision will be considered ambiguous when it is capable of two or more constructions, both of which are reasonable.â Powerine Oil, Inc. v. Superior Court, 37 Cal.4th 377 , 33 Cal.Rptr.3d 562 , 118 P.3d 589 (2005). The statutory provision at issue reads: A disability policy may contain a provision in the form set forth herein. Intoxicants and controlled substances: The insurer shall not be liable for any loss sustained or contracted in consequence of the insuredâs being intoxicated or under the influence of any controlled substance unless administered on the advice of a physician. § 10369.12 (emphasis added). Under section 10369.1, no insurance policy may include an exclusion ârespecting a matterâ set forth in, inter alia, section 10369.12, unless the insurer uses language identical to the language in the statute. § 10369.1. However, the insurer may use different wording if such wording is submitted to and approved by the commissioner and the wording is not âless favorable in any respect to the insured or the beneficiary.â Id. (emphasis added). Here, both Stonebridgeâs drug exclusion and the statutory exclusion set forth in 10369.12 ârespectâ the same matter â losses caused by use of controlled substances. Although Stonebridge has submitted evidence that their language was approved by the commissioner, under 10369.1 the statutory language controls if the Policyâs language is âless favorableâ to insureds. See Olson v. American Bankers Ins. Co. of Florida, 30 Cal.App.4th 816 , 35 Cal.Rptr.2d 897 (Cal.Ct.App.1994) (substituting statutory language of 10369.12 for less favorable policy language). Therefore, in order to determine whether âas prescribed by a physicianâ is less favorable to an insured than âon the advice of a physician,â the Court must determine whether âon the advice of a physicianâ excludes coverage for deaths caused by taking more prescription drugs than were prescribed. Plaintiffs do not dispute the plain meaning of âas prescribed by a physician.â If operative, this language would exclude coverage if the insured exceeded the prescribed dose and was injured as a result. For example in Ortega v. Aetna Life Ins. Co., the district court considered a claim for benefits where the insuredâs policy excluded âloss caused or contributed to by ... [u]se of alcohol, intoxicants, or drugs, *1221 except as prescribed, by a physician.â 2007 WL 1125782 at *1 (S.D.Tex. Apr.16, 2007). In granting summary judgment for the insurer, the court cited evidence that the decedent âtook more methadone than was prescribed by her doctor.â âAccordingly, the administrator reasonably found that [decedentâs] death was âcaused or contributed toâ by the use of drugs not taken as prescribed by her physician.â Id. at *3. As noted above, the evidence here shows that at the very least Hall-Hussain took more oxycodone than was prescribed to her by Dr. Chen. Therefore, if the Policy language âas prescribed by a physicianâ controls, coverage for Hall-Hussainâs death will be excluded. On the other hand, the rules of statutory interpretation and the cases cited by Plaintiff suggest that the statutory exclusion reading âon the advice of a physicianâ does not apply to Hall-Hussainâs death. Only one court in California has interpreted the language in section 10369.12. See Legare v. Canada Life Assurance Co., No. 02-0798 (S.D.Cal. Feb. 18, 2004) (unpublished âFindings of Facts and Conclusions of Lawâ) 6 . Legare involved an insured who died in a car accident while under the influence of prescription pain medication. The insurance company denied coverage based on an exclusion in the policy for deaths caused while the insured was âunder the influence of an intoxicant.â Applying California law, the Court found that defendantâs exclusion was more restrictive than the âon the advice of a physicianâ language mandated by section 10369.12. Accordingly, the Court rewrote the policy exclusion to conform with the statutory language. The insurer argued that coverage was still precluded because the statutory language âon the advice of a physicianâ required a showing âthat decedent was taking the medication exactly as prescribed,â and the insuredâs toxicology report showed he took more than prescribed. Id. at ¶ 17. In rejecting Defendantsâ argument, the court found that âthe focus of the statutory limitation is to exclude the losses resulting from the illegal use of drugs as opposed to the legitimate use of a controlled substance pursuant to a physicianâs advice.â Based on this rationale, the court found that âDefendants ... failed to prove the substances found in Mr. Le-gareâs system were not administered on the advice of a physicianâ and entered judgment for the insured. Id. In finding that âon the advice of a physicianâ did not require a showing that the medication was taken exactly as prescribed, the court in Legare relied on a decision from the District of Nevada interpreting an almost identical Nevada statute. See Hummel v. Continental Casualty Ins. Co., 254 F.Supp.2d 1183, 1189 (D.Nev. 2003). Hummel involved an insured who died from an overdose of prescription oxy-codone and whose policy excluded coverage unless the drug was taken âas prescribed by a physician.â Id. at 1186. Like section 10369.12, the Nevada statute mandated that policies with drug exclusions apply language identical in words or effect to âon the advice of a physician.â Id. First, applying the rules of statutory construction, the court in Hummel found âon the advice of a physicianâ to be ambiguous. The plain language of âadministered on the advice of â... can and does in fact *1222 lead to differing results. The word administered for example has a number of definitions, one of which is âto give remedially.â Websterâs New International Dictionary 27 (3rd ed. 1986). Under this definition, administered could mean given on the advice of a physician and would not necessarily include the dosage advised by the physician. Id. at 1189 . In Hummel the insuredâs prescription called for her to take one tablet of oxyco-done twice a day to relive her migraine headaches. When she filled her prescription the bottle contained 60 tablets. The insured had been prescribed sixty pills of oxycodone to be taken twice daily to relieve her migraine headaches. Based on this prescription, the pill bottle should have contained 48 pills at the time of her death but was instead found empty. Despite the fact that the insured took many more oxycodone than she had been prescribed, the court held âthe reasonable and appropriate construction of the term âadministered on the advice ofâ included âEricaâs situation where her physician gave her a prescription of Oxycodone to relieve her migraines.â â Id. at 1190 . The court held that because â âtaken as prescribed byâ would require âexact adherence to the instructed dosagesâ while âon the advice ofâ would not, the policy exclusion applies a more strict standard and must yield to the statutory exclusion. Id. Applying the statutory exclusion, there was âno dispute that Ericaâs physician prescribed her oxyco-doneâ and therefore âContinental breached the insurance contract by denying coverage.â Id. On the other hand, applying Ohio law, the Sixth Circuit in an unpublished deeision held that an âon the advice of a physicianâ drug exclusion did preclude coverage where an insured took more prescription medicine than was prescribed. Dice v. General Electric Capital Assurance, 93 Fed.Appx. 68, 70 (6th Cir.2004) (unpublished disposition). 7 Unlike Legare and Hummel , the âon the advice of a physicianâ language in Dice was not statutorily required by Ohio law, but rather was the language of the policy itself. The coroner had âdetermined that [the insuredâs] death was caused by acute multiple drug intoxication and that oxycodone, cocaine, al-prazolam, and diazapam were the contributing drugs.â Id. at 69 . The court cited to evidence that showed the insured had 300 mg of OxyContin in her blood stream, while she should have had only 240 mg based on her prescription. The Sixth Circuit held that because the insured âingested more OxyContin than her physician had prescribed or advised that she ingestâ âOxyContin was not administered on the advice of [the insuredâs] physicianâ and therefore the policy exclusion is applicable. Id. Although Dice suggests that some states may disagree with the courts in Legare, and Hummel , it contains no analysis to explain its holding, and the Court finds it unpersuasive. The Court concludes that the exception âon the advice of a physicianâ to the statutory exclusion involving controlled substances does not require that the Hall-Hussain have taken her prescription oxycodone in the exact dosages prescribed by her doctor. First, as noted by the court in Hummel , this statutory language is reasonably susceptible to two constructions: 1) requiring compliance with the physicians dosage instructions, or 2) merely requiring that the substance at issue have *1223 been prescribed. Therefore, under California law, we must âinterpret the statute in light of the Legislatureâs intent.â Galanty v. Paul Revere Life Ins. Co., 23 Cal.4th 368, 374 , 97 Cal.Rptr.2d 67 , 1 P.3d 658 (Cal.2000). As noted by the district court in Legare, âthe focus of the statutory limitation is to exclude losses resulting from the illegal use of drugs as opposed to the legitimate use of controlled substance pursuant to a physicianâs advice.â Legare, 02-0798, at p. 3 (citing Hummel, 254 F.Supp.2d at 1183 ) (emphasis added). There is no evidence that the Legislature intended this exclusion to limit or regulate the accidental overdoses of prescription drugs by this exclusion. Stonebridge asserts that interpreting âon the advice of a physicianâ to include situations where an insured takes more medicine than prescribed would render the statutory provision meaningless. Plâs Motion, p. 14. Although Stonebridge does not say how the provision is meaningless, the plain language of the provision shows that it is not. Nothing in the interpretation followed by Legare and Hummel prevents an insurer from denying coverage caused by an insuredâs overdose of illegal drugs. In that sense, the provision has significant meaning. Stonebridge additionally contends that such an interpretation would result in insurers being unable to protect themselves from the risk of an intentional overdose by an insured. Def's Opp., p. 18-19. For the reasons stated below, this contention is incorrect. As Plaintiffs point out, even if the statutory exclusion applies, beneficiaries still have the burden of proving that the insuredâs death was âaccidental.â This burden is not necessarily easily met, as evidenced by the Courtâs denial of summary judgment for Plaintiffs on that same issue. 8 Accordingly, the statutory exclusion applies and does not exclude coverage for Hall-Hussainâs death. 3. California Insurance Code section 10323 Stonebridge asserts that if the Court interprets âon the advice of a physicianâ to allow coverage where an insured takes more drugs than prescribed, then the statutory exclusion would be inconsistent with the âtype of coverageâ provided by the Policy. âTo the extent that the âon the advice of a physicianâ language ... may be construed ... to cover a death caused by an overdose of prescription narcotics intentionally taken ... it is inconsistent with the accidental death coverage provided under the Policy.â Defs Opp., p. 15. Therefore, Stonebridge asserts that under § 10323 of the Insurance Code it can apply the more stringent, âas prescribed by a physicianâ language. The Court disagrees with Stonebridge that section 10323 applies in this instance. Section 10323 provides: If any provision set forth in Article 4a or 5a of this chapter is in whole or in part inapplicable to or inconsistent with the coverage provided by a particular form of policy the insurer, with the approval of the commissioner, shall omit from such policy any inapplicable provision or However, Stonebridge has not submitted any evidence that the Legislatureâs intent in drafting section 10369.12 was to discourage prescription drug abuse. *1224 part of a provision, and shall modify any inconsistent provision or part of the provision in such a manner as to make the provision as contained the policy consistent with the coverage provided by the policy. Cal.Ins.Code § 10323 (emphasis added). First, Stonebridgeâs focus on narcotics intentionally taken is misplaced. This language being interpreted is an exclusion from and accidental death policy. Under that policy, regardless of the wording of the exclusion, the insured has the burden of proving that the death was accidental. âAccidental death is an unintended and undesigned result even if caused by the insuredâs voluntary act.â Heighley, 257 F.Supp.2d at 1253 (citing Weil v. Fed. Kemper Life Assurance, 7 Cal.4th 125, 27 Cal.Rptr.2d 316 , 866 P.2d 774 (Cal.1994)). As already noted above, the issue for coverage is not whether Hall-Hussain intentionally took more oxycodone than prescribed, but rather whether she did so intending to die. In other words, the coverage provisions of an accidental death policy provide coverage for the accidental consequences of an intentional overdose. Stonebridge has failed to explain how the interpretation of âon the advice of a physicianâ supported by Hummel and Le-gare, is inconsistent with this coverage provided by the policy for âaccidental deaths.â It cannot be sufficient, under section 10323, for an insurer to claim that the statutory exclusion is narrower than the exclusion they wanted to include in the policy. The statutory exclusion must be shown to be inconsistent with the type of coverage sought to be provided. No such showing has been made here. Therefore, the Court concludes that the Policyâs drug does not apply to exclude coverage in this case. 4. The Medical treatment exclusion Lastly, Stonebridge asserts that even if the Policyâs drug exclusion doesnât apply to Hall-Hussainâs death, Plaintiffsâ claim was nonetheless properly denied because Hall-Hussainâs death was due to âdisease, bodily or mental infirmity, or medical treatment of these.â Because Sto-nebridgeâs interpretation is inconsistent with other provisions of the Policy and with the statutory requirements of section 10369.1, et. seq., the Court finds that Hall-Hussainâs death does not fall within this exclusion. Exclusion 7 in the policy excludes coverage for any injury that, â[i]s due to disease, bodily or mental infirmity, or medical or surgical treatment of these.â SAE, Ex. A at p. 5 (emphasis added). Although the medical exclusion could possibly be read to apply to deaths caused by taking prescription drugs if read in isolation, this exclusion must be read in the context of the entire contract. See, e.g., Employers Reinsurance Co. v. Superior Court, 161 Cal.App.4th 906, 919 , 74 Cal.Rptr.3d 733 (Cal.Ct.App.2008) (â[w]e consider the contract as a whole and interpret the language in context, rather than interpret a provision in isolation.â). The medical treatment exclusion must be read in light of the exception to the drug exclusion for deaths caused by drugs âprescribed by a Physician.â If one were to read the medical exclusion as excluding coverage of deaths caused by prescription drugs, it would be inconsistent with the drug provision which purports to allow coverage for deaths caused by prescription drugs. Defendantsâ interpretation of the medical exclusion would therefore render the exception to the exclusion providing coverage for deaths caused by prescription drugs meaningless. See Mirpad, LLC v. Califor *1225 nia Ins. Guarantee Assoc., 132 Cal.App.4th 1058, 1073 , 34 Cal.Rptr.3d 136 (2005). (â[A]n interpretation that gives effect to every clause is preferred over one that would render other policy terms meaningless.â). The Court cannot agree with such a construction. At oral argument, counsel for Stone-bridge argued that the medical exclusion nonetheless applies because it is broader than the drug exclusion. However, it is precisely because the medical exclusion is broader that it cannot exclude coverage for deaths by prescription drugs. See Thompson v. Toll Dublin, LLC, 165 Cal.App.4th 1360, 1370 , 81 Cal.Rptr.3d 736 (2008) (âwhere general and particular contract provisions are inconsistent, particular controls general.â). This interpretation is also supported by the special rules for interpretation of insurance contracts. See Great Western Drywall, Inc. v. Interstate Fire & Casualty Co., 161 Cal.App.4th 1033, 1040 , 74 Cal.Rptr.3d 657 (Cal.Ct.App.2008) (exceptions to exclusions are âtreated in the same manner as a coverage provision and therefore ... interpreted broadly consistent with the insuredâs reasonable expectations,â while âexclusionary clauses are interpreted narrowly against the insurer.â). Here, no reasonable insured would expect that a policy which specifically allows coverage for deaths caused by prescription drugs would expect the same coverage to be excluded under a more general exclusion. Finally, Stonebridgeâs interpretation of the medical exclusion fails in light of Insurance Code sections 10369.1 and 10369.12. Just as the subject matter of the statutory exclusion in section 10369.12 is âcontrolled substancesâ in general, the subject matter of the exception to that exclusion is âprescription drugsâ in particular. Thus, to the extent the medical exclusion is read as pertaining to âprescription drugs,â it cannot be less favorable to an insured than the statutory exception in section 10369.12. § 10369.1. As noted above, the statutory exception specifically allows coverage for deaths caused by drugs taken âon the advice of a physician.â § 10369.12. Therefore, to the extent the medical treatment exclusion excludes deaths caused by drugs taken âon the advice of a physicianâ i.e., prescription drugs, it is âless favorableâ to insureds and invalid. Accordingly, the Policyâs medical exclusion does not apply to exclude coverage in this case. IV. CONCLUSION As set forth above, Plaintiffsâ Motion is GRANTED IN PART and DENIED IN PART. Defendantsâ Motion is DENIED. IT IS SO ORDERED. 1 . The Court relies on facts that it finds to be undisputed and, where the facts are in dispute, draws all inferences in favor of the party opposing summary judgment. 2 . Oxycodone is the generic version of Oxy-Contin. JSUF ¶ 13; SAE Ex. J at 25:1-5. 3 . Dr. Chen testified that it is possible for a person to âoverdoseâ even while taking a prescribed dose, if for example, âthere was some change in your medical status that you couldnât metabolize the medication.â Casino Decl. iso Piâs Opp. at 55:1-16. 4 . The Court overrules Stonebridge's objections to this testimony to the extent it relates to Hall-Hussainâs custom of keeping pills in a pill organizer and medicine chest. 5 . As one California practice guide notes, "[although not specifically defined, the concept of individual disability coverage is implicit in the Insurance Code. For example. .. .the Commissioner has issued extensive regulations regarding minimum benefit standards for individual policies and several bulletins regarding standards for approval of forms for individual policies.â California Insurance Law & Practice, § 25.03[2] (Lexis Nexis 2008). 6 . Stonebridge objects to Plaintiffs' citation of Legare on the grounds that Plaintiffs failed to properly request judicial notice of the decision. Legare is not binding authority, and it is not necessary for the Court to take judicial notice. Nonetheless, the Court overrules Sto-nebridgeâs objection to the extent Plaintiffs cite Legare as persuasive authority. 7 . The Sixth Circuit rules permit citation to unpublished decisions. 6th Cir. R. 28(e). 8 . Stonebridge also argues that interpreting âon the advice of a physicianâ to include accidental overdoses of prescription drugs is contrary to public policy and encourages prescription drug abuse. Def's Mot., p. 14.
Case Information
- Court
- N.D. Cal.
- Decision Date
- October 7, 2008
- Status
- Precedential