Kenseth v. Dean Health Plan, Inc.

Dist. Ct. erred in granting defendant-plan administrator's motion for summary judgment in ERISA action, where record contained sufficient facts to support allegations that defendant breached its fiduciary duty to plaintiff-HMO member by providing her with summary of benefits that was less than clear as to whether her surgery was covered under plan by inviting her to call its customer service representative with questions about coverage but failing to inform her that representations made by representative that plaintiff's surgery was covered was not binding on defendant and by failing to advise plaintiff as to alternative means to obtain definitive determination about coverage question in advance of plaintiff's surgery. Ct also found, though, that plaintiff's requested relief of compensatory damages for costs of surgery may not be viable under section 1132(a)(3) of ERISA, which provides for only equitable relief, and that Dist. Ct. properly entered summary judgment in favor of defendant on plaintiff's collateral estoppel count where record showed that plaintiff failed to give representative all material facts before obtaining opinion that surgery was covered.