In 1989, plaintiff contracted spinal meningitis, resulting in the amputation of both hands at the wrists and both legs below the knees and was fitted for prostheses which were covered under her father’s insurance plan. Able to live independently with the prostheses, she was later covered under her employer’s medical insurance plan. In 2009, her prostheses began to fail, but found that the prostheses, although indisputably medically necessary, were not covered under the plan. The federal district court concluded the insurance company’s exclusion does not violate California law. Agreeing with the trial court that the policy expressly excluded coverage, the Ninth Circuit affirmed the grant of summary judgment in favor of the insurance company. (Garcia v. Pacificare of California, Inc. (Ninth Cir.; May 8, 2014) 750 F.3d 1113.)
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