121 F.3d 198 (5th Cir. 1997), 96-20782, Barhan v. Ry-Ron Inc.

Docket Nº:96-20782.
Citation:121 F.3d 198
Party Name:Constance J. BARHAN, Plaintiff-Appellant, v. RY-RON INC., et al., Defendants, Charlie Thomas Chevrolet, Inc. & Affiliates Employee Benefit Plan and Allianz Life Insurance Company of North America, Defendants-Appellees.
Case Date:September 05, 1997
Court:United States Courts of Appeals, Court of Appeals for the Fifth Circuit
 
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Page 198

121 F.3d 198 (5th Cir. 1997)

Constance J. BARHAN, Plaintiff-Appellant,

v.

RY-RON INC., et al., Defendants,

Charlie Thomas Chevrolet, Inc. & Affiliates Employee Benefit

Plan and Allianz Life Insurance Company of North

America, Defendants-Appellees.

No. 96-20782.

United States Court of Appeals, Fifth Circuit

September 5, 1997

Page 199

[Copyrighted Material Omitted]

Page 200

Michael F. Rafferty, Memphis, TN, for Plaintiff-Appellant.

William Fulton Broemer, Broemer & Associates, Houston, TX, Marta Kaye Hill, Broemer & Weisblatt, Houston, TX, for Charlie Thomas Chevrolet Inc. & Affiliates Employee Benefit Plan, Defendant-Appellee.

Don W. Davis, Dallas, TX, for Allianz Life Ins. Co., of North America, Defendant-Appellee.

Appeal from the United States District Court for the Southern District of Texas.

Before KING, DAVIS and DeMOSS, Circuit Judges.

W. EUGENE DAVIS, Circuit Judge:

Constance Barhan appeals from a district court's summary judgment order denying her insurance benefits under her employer's insurance plan. We affirmed in part, reversed in part and remand.

I.

In late 1992, Barhan was diagnosed with adjuvant breast cancer. Her doctor recommended that she receive high-dose chemotherapy with peripheral stem-cell support (HDCT/PSCS). Her medical provider requested approval of the treatment from Barhan's insurer, the Charlie Thomas Chevrolet, Inc. & Affiliates Employee Benefit Plan ("the Plan"). The plan administrator, citing exclusions in the plan for treatments not recognized by the American Medical Association and experimental or investigational procedures, denied coverage. 1

Barhan filed suit against the Plan and Allianz Life Insurance Company of North America ("Allianz") seeking a declaratory judgment that the treatment ordered by her doctor was covered by the Plan and that she was deprived of the "full and fair review" of her claim required by ERISA, 29 U.S.C. § 1133(2). 2 She also asked the court to order the Plan to pay for her treatment and enter a judgment for $30,124.44, the amount of unpaid medical expenses. The Plan and Allianz filed motions for summary judgment, which the district court granted.

II.

A.

On appeal, Barhan challenges the plan administrator's denial of coverage under

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§ 502(a)(1)(B) of the Employee Retirement Income Security Act of 1974 (ERISA), 29 U.S.C. § 1132(a)(1)(B), and contends that the district court erred in granting summary judgment upholding the denial of benefits.

We review the district court's holding on the question of whether the plan administrator abused its discretion de novo. Sweatman v. Commercial Union Ins. Co., 39 F.3d 594, 601 (5th Cir.1994). Summary judgment is appropriate if "the pleadings, depositions, answers to interrogatories, and admissions on file, together with the 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." Fed.R.Civ.P. 56(c); Celotex Corp. v. Catrett, 477 U.S. 317, 322, 106 S.Ct. 2548, 2552, 91 L.Ed.2d 265 (1986). The moving party must identify evidence that establishes the absence of any genuine issue of material fact, Celotex Corp., 477 U.S. at 323, 106 S.Ct. at 2553, and the court reviewing a grant of summary judgment must evaluate the facts in the...

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