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