Tackitt v. Prudential Ins. Co. of America, No. 84-8887
| Court | United States Courts of Appeals. United States Court of Appeals (11th Circuit) |
| Writing for the Court | EUGENE A. WRIGHT |
| Citation | 758 F.2d 1572 |
| Parties | Donald F. TACKITT, Plaintiff-Appellant, v. PRUDENTIAL INSURANCE COMPANY OF AMERICA, United States of America, and Special Agents Mutual Benefit Association, Inc., Defendants-Appellees. |
| Docket Number | No. 84-8887 |
| Decision Date | 30 April 1985 |
Page 1572
v.
PRUDENTIAL INSURANCE COMPANY OF AMERICA, United States of
America, and Special Agents Mutual Benefit
Association, Inc., Defendants-Appellees.
Eleventh Circuit.
Page 1574
Thomas W. Thrash, Atlanta, Ga., for plaintiff-appellant.
Ben Kingree, Anthony J. McGinley, Atlanta, Ga., for Prudential Ins. Co. of America.
Myles E. Eastwood, Asst. U.S. Atty., Atlanta, Ga., for U.S.
James R. Barnett, Denis F. Gordon, Washington, D.C., Edward Katze, Atlanta, Ga., for Special Agents Mut. Ben. Ass'n, Inc.
Appeal from the United States District Court for the Northern District of Georgia.
Before KRAVITCH, HATCHETT, and WRIGHT, * Circuit Judges.
EUGENE A. WRIGHT, Circuit Judge:
Tackitt's suit against the defendants claimed (1) a vested right to reimbursement for home nursing expenses at 1977 benefit levels, and (2) arbitrary and capricious action in the approval of reductions in the benefit levels by the government. The district court granted defendants' motion for summary judgment. Tackitt v. Prudential Insurance Co. of America, 595 F.Supp. 887 (N.D.Ga.1984). Tackitt timely appeals.
Tackitt retired in 1972 after 30 years of service as an FBI agent. He continued his medical insurance by participating in the Special Agents Mutual Benefit Association (SAMBA) Health Benefit Plan. The SAMBA plan is underwritten in part by Prudential.
In December 1972, Tackitt suffered spinal trauma in an automobile accident. Complications of the injury have left him a double leg amputee. He has received home nursing care since 1977 when the first amputation took place. SAMBA fully reimbursed him for those nursing costs until 1982. His home nursing expenses in 1982 approximated $80,000.
The Office of Personnel Management (OPM) asked SAMBA and other health benefit providers to keep all benefit levels constant from 1982 to 1983. Prudential advised SAMBA that a 30% increase in premiums would result if the benefits remained constant. SAMBA developed a package of eight benefit changes to prevent the premium increase. One change was a ceiling on home nursing payments of $2,500 per year. OPM approved the changes for the 1983 benefit plan.
1. Vested Right to Reimbursement
We review summary judgment decisions de novo. Clemons v. Dougherty County, 684 F.2d 1365, 1368 (11th Cir.1982). We resolve all reasonable doubts about the facts in favor of the non-movant. Warrior Tombigbee Transportation Co. v. M/V Nan Fung, 695 F.2d 1294, 1296 (11th Cir.1983).
Tackitt contends that SAMBA and Prudential have breached their contract with him by not reimbursing him for home nursing expenses at the 1977 level, the year in which he first required the services. Health benefit plans are limited to one year and are subject to annual modification. 5 U.S.C. Sec. 8902. No cases have held that government insurers must continue benefits at a constant level. See Allen v. United States, 732 F.2d 107, 108 (8th Cir.1984).
Tackitt contends that the clause limiting the effect of contract modifications is ambiguous. It reads:
The contract may be modified or terminated. However, no such modification or termination will affect adversely any benefit for a covered service received prior to such modification or termination.
Tackitt claims that "benefit" is an ambiguous term....
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...law to resolve FEHBA coverage or benefits disputes that the point merited little discussion. See also Tackitt v. Prudential Ins. Co., 758 F.2d 1572 (11th Cir.1985) (citing FEHBA's former preemption provision for proposition that federal law controls interpretation of FEHBA contracts). Cf. G......
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...711-712 n. 1 (7th Cir.1993); Nesseim v. Mail Handlers Benefit Plan, 995 F.2d 804, 806 (8th Cir.1993); and Tackitt v. Prudential Ins. Co., 758 F.2d 1572, 1575 (11th Cir.1985). Administrative regulations cannot confer federal question jurisdiction. See e.g., Article III, U.S. Constitution. On......
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Georgia Power Co. v. Georgia Public Service Com'n, Nos. A90A0494
...superior court defined arbitrary and capricious decisions as those having no rational basis, relying on Tackitt v. Prudential Ins. Co., 758 F.2d 1572, 1575(6) (11th Cir.1985). That is appropriate. Greyhound Lines v. Ga. Public Svc. Comm., 236 Ga. 76, 77, 222 S.E.2d 347, supra. The opinions ......
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Ctr. for Sci. in the Pub. Interest v. Perdue, Case No.: GJH-19-1004
...appropriate degree of consistency between school meal standards and the Dietary Guidelines, see Tackitt v. Prudential Ins. Co. of Am. , 758 F.2d 1572, 1575 (11th Cir. 1985) (characterizing the requirement that the Office of Personnel Management "act in a manner consistent with the goal......
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Empire Healthchoice Assur., Inc. v. McVeigh, No. 03-9098.
...law to resolve FEHBA coverage or benefits disputes that the point merited little discussion. See also Tackitt v. Prudential Ins. Co., 758 F.2d 1572 (11th Cir.1985) (citing FEHBA's former preemption provision for proposition that federal law controls interpretation of FEHBA contracts). Cf. G......
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Roux v. Lovelace Health System, Inc., Civ. No. 96-991 LCS/WWD.
...711-712 n. 1 (7th Cir.1993); Nesseim v. Mail Handlers Benefit Plan, 995 F.2d 804, 806 (8th Cir.1993); and Tackitt v. Prudential Ins. Co., 758 F.2d 1572, 1575 (11th Cir.1985). Administrative regulations cannot confer federal question jurisdiction. See e.g., Article III, U.S. Constitution. On......
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Georgia Power Co. v. Georgia Public Service Com'n, Nos. A90A0494
...superior court defined arbitrary and capricious decisions as those having no rational basis, relying on Tackitt v. Prudential Ins. Co., 758 F.2d 1572, 1575(6) (11th Cir.1985). That is appropriate. Greyhound Lines v. Ga. Public Svc. Comm., 236 Ga. 76, 77, 222 S.E.2d 347, supra. The opinions ......
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Ctr. for Sci. in the Pub. Interest v. Perdue, Case No.: GJH-19-1004
...appropriate degree of consistency between school meal standards and the Dietary Guidelines, see Tackitt v. Prudential Ins. Co. of Am. , 758 F.2d 1572, 1575 (11th Cir. 1985) (characterizing the requirement that the Office of Personnel Management "act in a manner consistent with the goals and......