Perris Valley Community Hospital, LLC v. Southern California Pipe Trades Administrative Corp.

MEMORANDUM

Perris Valley Community Hospital LLC (the “Hospital”) appeals a summary judg-' ment in favor of the Southern California Pipe Trades Administrative Corporation and the Southern California Pipe Trades Health and Welfare Fund (the “Administrators”). We have jurisdiction under 28 U.S.C. § 1291 and affirm.

1. The Administrators oversee an employee benefit plan (the “Plan”) subject to the Federal Employee Retirement Income Security Act (“ERISA”), 29 U.S.C. § 1001 et seq. Months after a covered patient reached the Plan’s $500,000 lifetime benefits cap in December 2008, the Administrators issued a Supplement to the Plan supplying additional coverage for “claims incurred since January 1, 2009.” The Administrators then paid the Hospital’s claims for services rendered to the patient in January 2009, but refused to pay for charges incurred in December 2008 after the lifetime limit had been reached. The patient assigned her rights under the Plan to the Hospital, and this suit ensued.

2. Because the Plan is subject to ERISA, confers discretionary authority on the Administrators to determine eligibility for benefits, and the Administrators both evaluate and fund the Plan, we review…