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BEVANS v. IRON WORKERS' TRI-STATE WELFARE PLAN

January 27, 1997

ROBERT L. BEVANS AND ROGER J. BEVANS, PLAINTIFFS,
v.
IRON WORKERS' TRI-STATE WELFARE PLAN AND MID-AMERICA PENSION PLAN, DEFENDANTS.



The opinion of the court was delivered by: Mihm, Chief Judge.

ORDER

This matter is now before the Court on the parties' cross-motions for summary judgment. For the reasons set forth below, Plaintiffs' Motion for Summary Judgment [#12] is DENIED, and Defendant's*fn1 Motion for Summary Judgment [#15] is GRANTED.

Factual Background

Defendant, Iron Workers' Tri—State Welfare Plan (the "Plan"), is a self-funded employee welfare benefit plan as defined by the Employee Retirement Income Security Act ("ERISA"), 29 U.S.C. § 1002(1). (Defendant's Statement of Undisputed Facts ("Defendant's Statement") at 1.) As such, the purpose of the Plan is to provide health and welfare benefits to eligible participants and beneficiaries. (Plaintiffs' Response to Statement of Undisputed Facts ("Plaintiffs' Response") at 1.) It is undisputed that Plaintiff Robert Bevans ("Mr. Bevans") was an eligible participant in the Plan at all relevant times and that his son, Plaintiff Roger Bevans ("Roger"), was eligible to receive benefits as a dependent. (Defendant's Statement at 3.)

The facts underlying this litigation follow. On May 16, 1995, Roger, then a minor, consumed some quantity of gin mixed with soda pop while watching a basketball game at a friend's house. (Plaintiffs' Statement of Undisputed Facts ("Plaintiffs' Statement") at 1; Defendant's Statement at 4.)*fn2 After leaving his friend's house, Roger stopped at the church where his mother and father were helping with a banquet. Roger's mother detected the odor of alcohol on Roger's breath and asked Mr. Bevans to take Roger home. (Plaintiffs' Statement at 1.) The parties disagree about whether Roger was intoxicated and whether he had been grounded or other. wise punished by his mother before being taken home. (Plaintiffs' Statement at 1; Defendant's Response to Plaintiffs' Statement of Undisputed Facts ("Defendant's Response") at 2.)

Once home, Roger exercised on a treadmill and took 3-4 500 mg Tylenol tablets. (Defendant's Response at 2; Plaintiffs' Statement at 1.) After already having taken the 3-4 Tylenol tablets, Roger then consumed an unknown large quantity of 500 mg Tylenol tablets.*fn3 (Plaintiffs' Statement at 2.) Plaintiffs contend that Roger took the Tylenol in an attempt to cure a headache, while the Plan cites medical reports indicating that Roger took the Tylenol out of anger and frustration with his parents. (Plaintiffs' Statement at 2; Defendant's Statement at 3-5.) After becoming ill at school the following day, Roger went home and was later admitted to Trinity Medical Center in Moline, Illinois. (Defendant's Statement at 3-4.) On May 19, 1995, Roger was transferred to the University of Iowa Hospital in Iowa City, Iowa, where he received treatment for the Tylenol overdose and corresponding liver necrosis. (Defendant's Statement at 3.)

Mr. Bevans submitted claims from Roger's treating physicians and hospitals for payment by the Plan. (Defendant's Statement at 5.) The Plan denied all of these claims under the exclusion for charges incurred as a result of self-inflicted injuries. Id. This provision provides that no benefits are payable under the Plan for:

  Services and supplies which are for the treatment of
  any condition caused by war, or any act of war,
  declared or undeclared, or by participating in a riot
  or as the result of the commission of a felony or of
  an intentionally self-inflicted injury.

(Affidavit of Trisha Bevans, Exhibit 5 at 44.) Mr. Bevans appealed the Plan's denials on September 1, 1995. Id. On October 19, 1995, the Plan's Appeals Committee upheld the denial of benefits, and this decision was ratified by the Plan's Board of Trustees on October 20, 1995. Id. at 6-7. On February 14, 1996, Plaintiffs filed their Complaint in the Circuit Court of the Fourteenth Judicial Circuit, Rock Island County, Illinois, alleging that the Plan's denial violated ERISA by wrongly invoking the exclusion for an intentionally self-inflicted injury in the benefit plan. (Complaint at 4.) The case was removed to this Court on March 27, 1996. (Notice of Removal at 1.)

Discussion

A motion for summary judgment will be granted where there are no genuine issues of material fact and the moving party is entitled to judgment as a matter of law. Fed. R.Civ.P. 56(c). The moving party has the responsibility of informing the court of portions of the record or affidavits that demonstrate the absence of a triable issue. Celotex Corp. V. Catrett, 477 U.S. 317, 323, 106 S.Ct. 2548, 2552, 91 L.Ed.2d 265 (1986). The moving party may meet its burden of showing an absence of material facts by demonstrating "that there is an absence of evidence to support the non-moving party's case." Id. at 325, 106 S.Ct. at 2553. Any doubt as to the existence of a genuine issue for trial is resolved against the moving party. Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 255, 106 S.Ct. 2505, 2513, 91 L.Ed.2d 202 (1986); Cain v. Lane, 857 F.2d 1139, 1142 (7th Cir. 1988).

If the moving party meets its burden, the non-moving party then has the burden of presenting specific facts to show that there is a genuine issue of material fact. Matsushita Elec. Indus. Co., Ltd. v. Zenith Radio Corp., 475 U.S. 574, 586-87, 106 S.Ct. 1348, 1355-56, 89 L.Ed.2d 538 (1986). Federal Rule of Civil Procedure 56(e) requires the non-moving party to go beyond the pleadings and produce evidence of a genuine issue for trial. Celotex Corp., 477 U.S. at 324, 106 S.Ct. at 2553. This Court must then determine whether there is a need for trial—whether, in other words, there are any genuine factual issues that properly can be resolved only by a finder of fact because they may be reasonably resolved in favor of either party. Anderson, 477 U.S. at 250, 106 S.Ct. at 2511.

I. Standard of Review

Plaintiffs bring suit pursuant to 29 U.S.C. § 1132(a)(1)(B) of ERISA, which authorizes a participant or beneficiary of an employee welfare benefit plan to bring a civil action "to recover benefits due to him under the terms of his plan. . . ." 29 U.S.C. § 1132(a)(1)(B). A challenge to a denial of benefits brought under § 1132(a)(1)(B) is to be reviewed de novo "unless the benefit plan gives the administrator or fiduciary discretionary authority to determine eligibility for benefits or to construe the terms of the plan." Phillips v. Lincoln National Life Ins. Co., 978 F.2d 302, 307 (7th Cir. 1992), citing Firestone Tire & Rubber Co. v. Bruck, 489 U.S. 101, 115, 109 S.Ct. 948, 956, 103 L.Ed.2d 80 (1989); Hickey v. A.E. Staley Mfg., 995 F.2d 1385, 1389 (7th Cir. 1993). In this case, "Trustees administer the Plan according to its written terms." (Affidavit of Joseph J. Burke at 2.) Defendant further admits that "[t]he Plan does not contain language giving the Trustees discretion to interpret ambiguous Plan provisions." (Defendant's Response to Plaintiffs' Motion for Summary Judgment at 3.) Accordingly, because the Plan is governed by ERISA and does not ...


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