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Burkitt v. NECA-IBEW Welfare Trust Fund

October 29, 2009

NORMA J. BURKITT, PLAINTIFF
v.
NECA-IBEW WELFARE TRUST FUND, DEFENDANT



The opinion of the court was delivered by: John A. Gorman United States Magistrate Judge

ORDER

The parties have consented to have this case heard to judgment by a United States Magistrate Judge pursuant to 28 U.S.C. § 636(c), and the District Judge has referred the case to me. Now before the court are the parties' cross motions for summary judgment (Docs. 5 and 8). As explained more fully herein, the Plaintiff's motion is denied and the Defendant's motion is granted.

The Plaintiff's motion for summary judgment states that her argument that she is entitled to summary judgment in her favor is fully contained within her response to the Defendant's motion for summary judgment; no new arguments are presented in her motion. Hence, the ruling on Defendant's motion will resolve both motions.

SUMMARY JUDGMENT GENERALLY

The purpose of summary judgment is to "pierce the pleadings and to assess the proof in order to see whether there is a genuine need for trial." Matsushita Elec. Indus. Co., Ltd. v. Zenith Radio Corp., 475 U.S. 574, 587 (1986). Under Rule 56(c) of the Federal Rules of Civil Procedure, summary judgment should be entered if and only if there is no genuine issue as to any material fact, and the moving party is entitled to judgment as a matter of law. See Jay v. Intermet Wagner Inc., 233 F.3d 1014, 1016 (7th Cir.2000); Cox v. Acme Health Serv., 55 F.3d 1304, 1308 (7th Cir. 1995). If the undisputed facts indicate that no reasonable jury could find for the party opposing the motion, then summary judgment must be granted. Hedberg v. Indiana Bell Tel. Co., 47 F.3d 928, 931 (7th Cir. 1995), citing Anderson, 477 U.S. 242, 248 (1986).

The Local Rules of this court specify the form and content for all motions for summary judgment and responses and replies thereto. See, Local Rule CDIL 7.1(D). As the Seventh Circuit has explained, "[D]istrict courts are not obliged in our adversary system to scour the record looking for factual disputes and may adopt local rules reasonably designed to streamline the resolution of summary judgment motions." Herman v. City of Chicago, 870 F.2d 400, 404 (7th Cir.1989). See also, Bell, Boyd & Lloyd v. Tapy, 896 F.2d 1101, 1103- 04 (7th Cir.1990); L.S. Heath & Son, Inc. v. AT & T Info. Sys., Inc., 9 F.3d 561, 567 (7th Cir.1993). The Seventh Circuit has repeatedly put their imprimatur on strict enforcement of local rules, sustaining entry of summary judgment when the non-movant has failed to submit a factual statement in the form called for by the pertinent rule and thereby conceded the movant's version of the facts. See, Waldridge v. American Hoechst Corp., 24 F.3d 918, 922 (7th Cir.1994) (collecting cases).

UNDISPUTED FACTS

In neither Plaintiff's opposition to Defendant's motion nor in her own motion does she set out a statement of facts, nor does she provide the court with a statement-by-statement response to Defendant's statement of undisputed facts, despite the fact that both are required by this Court's Local Rule 7.1. Rather, Plaintiff states in her motion for summary judgment that "[t]here are no factual disputes with respect to the issue before the Court." (Doc. #8 ¶2). Accordingly, the Court finds that the facts set forth in Defendant's motion are undisputed.

Moreover, to the extent that there are fact-based arguments in Plaintiff's response that rely on facts that are not included in the Defendant's Statement of Fact, those additional facts are ignored as unsupported by the record. See, Waldridge, 24 F.3d 918, 922.

The facts as set forth by Defendant are as follows. Plaintiff, Norma J. Burkitt, is a participant in the health and welfare plan of the defendant, NECA-IBEW Welfare Trust Fund ("Fund"). The Fund is a not-for-profit fringe benefit fund established and administered pursuant to the Employee Retirement Income Security Act ("ERISA"), 29 U.S.C. § 1001 et seq. The Fund is administered by and through its Board of Trustees, and the benefits paid by the Fund are governed by a Summary Plan Description ("SPD") and Plan Document.

The SPD and the Plan document both provide in several places that the Trustees have discretionary authority to interpret the plan. For example, on page 57 of the SPD, it provides that "[t]he Trustees have discretionary authority to determine all benefit claim appeals and to interpret the Plan." The Plan document, on page 95, states: "The Trustees have discretionary authority to determine all benefit claim appeals and to interpret the Plan. The Trustees' decision in the appeal will be given judicial deference in any later court action."

Page 49 of the SPD excludes from coverage "any charge for services is subject to the exercise of the Trustees' discretion to reasonably interpret the terms of the Trust, Plan, or Summary Plan Description and that is deemed a non-Covered Expense or service." A similar provision is found in the Plan document at page 80.

The Plan document at p.48-49 cautions: "The fact that a physician may provide, order, recommend, or approve a service or supply does not mean that the service or supply will be considered Medically Necessary for the medical coverage provided by the Plan." The SPD, on page 9, states that the Trustees: determine if a particular service, supply or procedure is Medically Necessary. The Trustees may rely on the advice of medical professionals retained by the Fund to make this determination. The fact that a physician may provide, order, recommend, or approve a service or supply does not mean that the service or supply will be considered Medically Necessary for the medical coverage provided by the Plan.... The Trustees are the final determiners of Medical Necessity for benefits payable under this Plan.

The SPD explicitly excludes from coverage any "expense or charge for services or supplies...not Medically Necessary in treating the Injury or Sickness." The terms "Medically Necessary" and "Medical Necessity" ...


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