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BUCHHOLZ v. GE EMPLE. BEN. PLAN

August 22, 1989

BETTY L. BUCHHOLZ, Plaintiff,
v.
THE GENERAL ELECTRIC EMPLOYEE BENEFIT PLAN and THE TRAVELERS INSURANCE COMPANY, Defendants



The opinion of the court was delivered by: ROSZKOWSKI

 STANLEY J. ROSZKOWSKI, UNITED STATES DISTRICT JUDGE.

 This action comes before the court on the defendants' motion for summary judgment. For the reasons set forth below, the court denies the defendants' motion.

 NATURE OF THE CASE

 The instant controversy stems from a denial of insurance benefits to the plaintiff Betty Buchholz. Ms. Buchholz enrolled her husband James Buchholz into an "accidental death and dismemberment insurance" policy designating herself as beneficiary. The policy was provided to Betty Buchholz, a General Electric ("G.E.") employee, as part of a personal accident insurance plan which, in turn, was a part of the "General Electric Employee Benefit Plan." Under the terms of the personal accident insurance plan, the "carrier", in this case the defendant Travelers Insurance Company ("Travelers"), was responsible for the determination of benefits including the denial or payment of claims. As a consequence of James Buchholz's death, the plaintiff submitted a claim for benefits under the terms of this personal accident insurance plan. The claim was initially denied by Travelers and denied once again after the plaintiff's request for reconsideration. As a result of these denials, the plaintiff brings a one count complaint against the defendants General Electric Employee Benefit Plan ("Plan") and Travelers for denial of benefits pursuant to 29 U.S.C. § 1132(a)(1)(B) of the Employee Retirement Income and Security Act ("ERISA"). The defendants presently move for summary judgment in their favor.

 DISCUSSION

 The court will not grant any summary judgment motion unless all of the pleadings and supporting documents, if any, indicate that there is no genuine issue as to any material fact and that the moving party is entitled to judgment as a matter of law. Fed.R.Civ.P. 56(c); Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 250, 106 S. Ct. 2505, 2511, 91 L. Ed. 2d 202 (1986); Fitzsimmons v. Best, 528 F.2d 692, 694 (7th Cir. 1976).

 The initial burden is on the moving party to demonstrate that there is no genuine issue or question of material fact in dispute. Rose v. Bridgeport Brass Company, 487 F.2d 804, 808 (7th Cir. 1973). Once the moving party has stated that a fact is not in question, the burden shifts to the non-moving party to demonstrate that there is some question of fact or to contradict the fact and bring it into question. Celotex Corp. v. Catrett, 477 U.S. 317, 106 S. Ct. 2548, 2553, 91 L. Ed. 2d 265 (1986).

 In their motion, the defendants argue that the decision to deny the plaintiff's claim for benefits was not arbitrary and capricious; therefore, summary judgment for the defendants is appropriate.

 In particular, the defendants assert that based on the evidence amassed before Travelers at the time of the denial, the reasonableness of Travelers' decision is indisputable. The problem for the defendants, however, is that their arguments, though they may be completely accurate, may not be relevant. The Supreme Court's decision, in Firestone Tire and Rubber Company v. Bruch, 489 U.S. 101, 109 S. Ct. 948, 103 L. Ed. 2d 80 (1987), has placed in contention the proper standard in which to evaluate the defendants' denial. In short, whether the denial should be judged under a deferential arbitrary and capricious standard or a de novo standard of review.

 The defendants' argument in favor of an arbitrary and capricious standard relies on an exception to the de novo standard carved out in Bruch.1 In essence, the holding of the Bruch court is as follows:

 
Consistent with established principles of trust law, we hold that a denial of benefits challenged under § 1132(a)(1)(B) is to be reviewed under a de novo standard. . . .

 Bruch, 109 S. Ct. at 956.

 The exception targeted by the defendants is derived from the remainder of the ...


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