Martinez

FINDINGS OF FACT AND CONCLUSIONS OF LAW; ENTRY OF FINAL JUDGMENT

I. INTRODUCTION

The Court held a two-day trial on December 9, 2009 and February 3, 2010. The Court heard evidence regarding the proper standard of review to apply to Defendant’s benefits determination. Having made the following factual findings and thoroughly examined the administrative record, the Court finds that Defendant abused its discretion by unreasonably interpreting and applying the plan when denying Plaintiffs claim for benefits. The Court vacates the Plan’s prior determinations and remands the matter to the Plan to make a proper decision on Plaintiffs claim in the first instance.

II. FACTUAL BACKGROUND

Plaintiff Ana Martinez (“Plaintiff’) filed this action under the Employee Retirement Income Security Act of 1974 (“ERISA”), 29 U.S.C. § 1132 (a),(e), and (g), for the purpose of obtaining benefits under an employer-provided health insurance plan administered by defendant The Beverly Hills Hotel and Bungalows Employee Benefit Trust Employee Welfare Plan (“Defendant” or “the Plan”).

A. Steve Martinez’s Condition

Plaintiffs 15-year-old son Steve Martinez had a severe epileptic seizure at the school…