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Insurance
Coverage Denied
Traumatic Servicemembers' Group Life Insurance

Carlos Mendez v. United States of America

Published: Sep. 29, 2017 | Result Date: Aug. 25, 2017 |

Case number: 16-cv-2486-AJB-JLB Summary Judgment –  Defense

Court

USDC Southern District of California


Attorneys

Plaintiff

Peter S. Cameron
(Law Offices of Peter S. Cameron APC)


Defendant

Daniel E. Butcher


Facts

Carlos Mendez sued the United States, in connection with the denial of his claim for benefits.

Contentions

PLAINTIFF'S CONTENTIONS: On Jan. 30, 2006, while plaintiff was stationed in the Philippines, the equipment he was utilizing broke, causing heavy weights to fall onto his chest. The impact caused his pectoralis tendon to rupture, resulting in great pain. Plaintiff was medically evacuated to Balboa Naval Medical Center where he underwent surgery. He was ultimately discharged on Feb. 8.

He applied for benefits under the Traumatic Servicemembers' Group Life Insurance Program, but was denied. He resubmitted an application for benefits in 2015, but was again denied. He appealed, but was unsuccessful in doing so.

Plaintiff then filed this complaint for judicial review of the denial. Plaintiff then moved for summary judgment.

DEFENDANT'S CONTENTIONS: Defendant contended that plaintiff had received Traumatic Servicemembers' Group Life Insurance benefits for a similar injury sustained in 2007. Finding insufficient evidence to support plaintiff's claim, the Board for Correction of Naval records denied his appeal. Defendant filed a cross-motion for summary judgment.

Result

The court denied Mendez's motion for summary judgment and granted the federal government's cross-motion. The denial of Mendez's Traumatic Servicemembers' Group Life Insurance benefits was upheld.


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