Weis

Weis v. Accidental Death & Dismemberment Benefit Plan of Kaiser Foundation Health Plan Inc.

Good Law

442 F. Supp. 2d 850·2006 WL 2355075·39 Employee Benefits Cas. (BNA) 1070·2006 U.S. Dist. LEXIS 59792

United States District Court, Northern District of CaliforniaAugust 14, 2006C 05-05159 EDLCalifornia3,411 words

Opinion

Laporte, J.

FINDINGS OF FACT AND CONCLUSIONS OF LAW AFTER COURT TRIAL ON THE ADMINISTRATIVE RECORD

I. INTRODUCTION

The parties filed cross-motions for summary judgment regarding whether Defendant Accidental Death & Dismemberment Benefit Plan of Kaiser Foundation Health Plan, Inc. (“Defendant”) erroneously denied Plaintiff Robert L. Weis’ dismemberment claim. The parties stipulated that this Court reviews the denial de novo. See Joint Case Management Statement (“JCMS”) at 3:19-20. During the hearing, the parties did not object to the Court conducting the proceedings by way of trial on the administrative record. See Kearney v. Standard Ins. Co., 175 F.3d 1084, 1094-95 (9th Cir.1999) (absent circumstances requiring admission of additional evidence, courts conducting de novo review of an ERISA plan decision should conduct trial on administrative record). For the reasons set forth below, the Court denies the cross motions for summary judgment, and finds in favor of Plaintiff after trial on the administrative record.

II. UNDISPUTED FACTS

A. The Accident.

Plaintiff Robert L. Weis II was born with congenital cataracts. Administrative Record (“AR”) 42, 269. "When he was approximately five years…

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