Christianson v. Poly-America, Inc. Medical Benefit Plan

288 F. Supp. 2d 991, 31 Employee Benefits Cas. (BNA) 2123, 2003 U.S. Dist. LEXIS 19274
CourtDistrict Court, D. Minnesota
DecidedOctober 21, 2003
DocketCiv.02-1384(RHK/AJB)
StatusPublished

This text of 288 F. Supp. 2d 991 (Christianson v. Poly-America, Inc. Medical Benefit Plan) is published on Counsel Stack Legal Research, covering District Court, D. Minnesota primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Christianson v. Poly-America, Inc. Medical Benefit Plan, 288 F. Supp. 2d 991, 31 Employee Benefits Cas. (BNA) 2123, 2003 U.S. Dist. LEXIS 19274 (mnd 2003).

Opinion

MEMORANDUM OPINION AND ORDER

KYLE, District Judge.

Introduction

This matter comes before the Court on cross-motions for summary judgment. *992 Plaintiff Richard Christianson has sued Defendant Poly-America, Inc. Medical Benefits Plan (“Poly-America”) alleging that Poly-America violated its fiduciary duty under the Employee Retirement Income Security Act of 1974 (“ERISA”), 29 U.S.C. § 1001, et seq., by denying his claim for medical expenses incurred during a hospitalization for deep vein thrombosis. Both sides agree that there are no disputes of material fact and that judgment is appropriate as a matter of law. For the reasons set forth below, the Court will grant Christianson’s motion and deny Poly-America’s motion.

Background

On January 18, 2001, Christianson visited his doctor, Dr. Robyn Oliver, after experiencing painful swelling in his left leg. (Nolan Aff. Ex. 6 (Letter of Dr. Oliver), Ex. 2 (United Hospital Intake Form) at 1.) Dr. Oliver sent Christianson to Regina Hospital, where an ultrasound revealed deep vein thrombosis of the lower leg. (Nolan Aff. Ex. 2 (Intake Form) at 1.) Deep vein thrombosis is a blood clot in a vein that generally occurs where the blood stops or slows down, such as the calves, of the legs. (See WebMD Health, “Deep Vein Thrombosis,” available at http:// my.webmd.com/ content/healthwise /139/34730); see also Fed.R.Evid. 201(b). The major risk associated with deep vein thrombosis is that the blood clot will break lose and travel though the bloodstream to the lungs. (Id.) Treatment varies from anticoagulant medication to the insertion of a vena cava filter to prevent blood clots from traveling through the bloodstream. (Id.) Smoking is a risk factor for deep vein thrombosis. (Grell Aff. Ex. 6 (Christian-son Letter).)

Christianson was promptly admitted to United Hospital. (Nolan Aff. Ex. 2 at 1.) Dr. Georgia Taggart, the admitting physician, noted on the intake form that Chris-tianson’s work “involves standing on a hard concrete floor for 50 plus hours a week. He has to stand for long periods of time, with very little walking.... Other than that, he has no real risk factors for deep venous thrombosis.” (Id.) Dr. Tag-gart noted that Christianson’s habits included smoking and developed a two-part “Assessment and Plan”: '

1. Deep venous thrombosis. This is a healthy, 46-year-old man with a new deep venous thrombosis. He has minimal risk factors for deep venous thrombosis, other than prolonged standing and tobacco abuse. I think he needs investigation for the factor V Leiden mutation.... 1
2. Tobacco abuse. Smoking cessation counseling offered.

(Id.)

Christianson was admitted to a hospital bed, where he underwent a left leg-thrombolysis and six days of lytic therapy designed to break-up the blood clot- and restore normal blood flow. (Id. Ex. 3 (Discharge Report) at 1.) Dr. Charles Terzian noted that Christianson “had no risk factors for deep venous thrombosis.” (Id.) Upon discharge, he instructed Chris-tianson to “refrain from smoking” and reiterated a primary diagnosis of “[d]eep venous thrombosis of [the] lower left extremity” and a “[sjecondary diagnosis [of] tobacco dependency.” (Id.)

Christianson submitted medical bills totaling approximately fifty thousand dollars to his insurer, the Poly-America Medical Benefit Plan. Under the plan, “[c]harges *993 related in any way, shape or form to, or complicated by, the use of tobacco products or for treatment of an ailment or condition associated with the use of tobacco” are excluded from coverage. (Grell Aff. Ex. 1 (Poly-America Medical Plan) at 18.) On June 1, 2001, the plan administrator sent Christianson a letter stating that Poly-America had determined that his medical expenses were related to smoking and denied his claim under the plan. (Nolan Aff. Ex. 1 (First Denial Letter).) On June 30, 2001, Christianson requested a review of that decision. (Id. Ex. 4 (Second Denial Letter).) Upon consultation with Dr. Jerry Gurkoff, an osteopath and orthopedic surgeon, the plan administrator confirmed his original decision. (Id.)

On September 20, 2001, Dr. Oliver sent a letter to Poly-America stating her belief that Christianson’s deep vein thrombosis was “idiopathic,” or of an unknown cause or origin. (Id. Ex. 6 (Oliver Letter).) Likewise, Dr. Terzian submitted a letter stating that there was “nothing in Dr. Taggart’s and my dictation to support [the] claim” that Christianson’s “deep venous thrombosis was related to tobacco abuse.” (Id. Ex. 7 (Terzian Letter).) This suit followed. 2

Standard of Decision

Summary judgment is appropriate if there is no genuine issue of material fact and the moving party is entitled to judgment as a matter of law. See Fed.R.Civ.P. 56(c). It is to be granted only where the evidence is such that no reasonable jury could return a verdict for the nonmoving party. See Anderson v. Liberty Lobby, 477 U.S. 242, 250, 106 S.Ct. 2505, 91 L.Ed.2d 202 (1986). The Court views the evidence, as well as all reasonable inferences, in a light most favorable to the nonmoving party. See Enterprise Bank v. Magna Bank, 92 F.3d 743, 747 (8th Cir.1996); see Adkison v. G.D. Searle & Co., 971 F.2d 132, 134 (8th Cir.1992). The moving party carries the burden of showing that there is no genuine issue of material fact. See Celotex Corp. v. Catrett, 477 U.S. 317, 322, 106 S.Ct. 2548, 91 L.Ed.2d 265 (1986); Mems v. City of St. Paul, Dep’t of Fire & Safety Servs., 224 F.3d 735, 738 (8th Cir.2000). The nonmoving party may not rest upon the allegations or denials of its pleadings. Rather, the non-movant must establish the existence of specific facts that create a genuine issue for trial. Neither mere allegations nor denials are sufficient. See Liberty Lobby, 477 U.S. at 256, 106 S.Ct. 2505.

On summary judgment, the court does not weigh facts or determine the credibility of affidavits and other evidence. See id. at 249, 106 S.Ct. 2505. The nonmovant cannot, however, avoid summary judgment by highlighting some alleged factual dispute between the parties.

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Bluebook (online)
288 F. Supp. 2d 991, 31 Employee Benefits Cas. (BNA) 2123, 2003 U.S. Dist. LEXIS 19274, Counsel Stack Legal Research, https://law.counselstack.com/opinion/christianson-v-poly-america-inc-medical-benefit-plan-mnd-2003.