Searching over 5,500,000 cases.


searching
Buy This Entire Record For $7.95

Download the entire decision to receive the complete text, official citation,
docket number, dissents and concurrences, and footnotes for this case.

Learn more about what you receive with purchase of this case.

Ravannack v. United Healthcare Insurance Co.

United States District Court, E.D. Louisiana

May 15, 2015

JOCEL RAVANNACK,
v.
UNITED HEALTHCARE INSURANCE COMPANY, SECTION:

ORDER AND REASONS

JANE TRICHE MILAZZO, District Judge.

Before the Court is Defendant's Motion for Partial Summary Judgment (Doc. 17). For the following reasons, the Motion is DENIED. The Court also gives notice to the parties that it is considering granting partial summary judgment to Plaintiff pursuant to Rule 56(f). In light of this notice, the parties may file additional briefing as outlined in this order.

BACKGROUND

Plaintiff Jocel Ravannack filed this action in Louisiana state court seeking judicial review of Defendant United Healthcase's denial of health insurance benefits. Defendant removed the action to this Court, contending that the health insurance plan at issue was governed by the Employee Retiree Income Security Ace of 1974 ("ERISA"). In response to this Court's case management order, the parties stipulated that ERISA governed the plan at issue (Doc. 15). The parties do not agree, however, on the appropriate standard of review in this case. Accordingly, Defendant filed the instant Motion asking this Court to determine the appropriate standard.

LAW AND ANALYSIS

Summary judgment is appropriate "if the pleadings, depositions, answers to interrogatories, and admissions on file, together with affidavits, if any, show that there is no genuine issue as to any material fact and that the moving party is entitled to a judgment as a matter of law."[1] A genuine issue of fact exists only "if the evidence is such that a reasonable jury could return a verdict for the nonmoving party."[2] Because the standard of review applicable to an ERISA case is a pure question of law, [3] summary judgment is an appropriate vehicle for raising the issue.

It is well settled that ERISA benefit denials are "reviewed under a de novo standard unless the benefit plan gives the administrator or fiduciary discretionary authority to determine eligibility for benefits or to construe the terms of the plan."[4] "Discretionary authority cannot be implied; an administrator has no discretion to determine eligibility or interpret the plan unless the plan language expressly confers such authority on the administrator."[5] The plan need not contain any specific "magic words" granting discretion to the administrator.[6] Rather, the Court must consider the plan language as a whole, focusing on the breadth of the administrator's power.[7]

The crux of this dispute turns on the effect of an amendment to the plan. The amendment, labeled "Discretionary Clause Amendment, " removed almost every reference to discretion in the plan documents. For example, prior to the amendment, Section 8 of the plan, entitled "General Legal Provisions, " read, in pertinent part:

Interpretation of Benefits
We have the discretion in accordance with state and federal law, to do all of the following:
• Interpret Benefits under the Policy.
• Interpret the other terms, conditions, limitations and exclusions set out in the Policy, including this Certificate, the Schedule of Benefits, and any Riders and/or Amendments.
• Make factual determinations related to the Policy and its Benefits.
We may delegate this discretionary authority to other persons or entities that provide services in regard to the ...

Buy This Entire Record For $7.95

Download the entire decision to receive the complete text, official citation,
docket number, dissents and concurrences, and footnotes for this case.

Learn more about what you receive with purchase of this case.