Becker v. Chrysler LLC Health Care Benefits Plan

Federal 7th Circuit Court
Civil Court
Case Number: 
No. 11-2624
Decision Date: 
August 20, 2012
Federal District: 
E.D. Wisc.
Dist. Ct. did not err in granting defendant-plan's motion for summary judgment in ERISA action alleging that defendant improperly denied coverage under health-care benefits plan for plaintiff's stay in nursing home. Terms of plan precluded coverage for treatment that did not require skilled nursing services and was otherwise designed to assist patient with simple activities of daily living. Moreover, defendant's decision to deny plaintiff's claim was not arbitrary or capricious where three different independent physicians determined that plaintiff had received only custodial, as opposed to skilled care, for her heart failure, diabetes and renal insufficiency conditions. Fact that plaintiff received assistance with her medications and with her diabetes testing and monitoring did not require finding that plaintiff had received skilled nursing services.