Dragu
Dragu v. Motion Picture Industry Health Plan for Active Participants
Opinion
Lead Opinion
Seeborg, J.
ORDER GRANTING PLAINTIFF’S AND DENYING DEFENDANT’S MOTIONS FOR SUMMARY JUDGMENT
I. INTRODUCTION
Plaintiff Elise Dragu mangled her jaw, mouth, teeth, and gums when she tumbled down a rocky creek while hiking in Northern California. She sought medical treatment for her various injuries from oral surgeon, Dr. Robert A. Shuken, D.D.S., who recommended extracting the damaged teeth, inserting bone grafts where possible, implanting fixtures for implantation of abutments and crowns, and — lastly — installing abutments and crowns as replacements for the missing teeth. Dragu requested coverage for the medical procedures from her medical benefit plan, Defendant Motion Picture Industry Health Plan for Active Participants (“the Plan”), which is subject to the requirements of the Employee Retirement Income and Security Act (“ERISA”), 29 U.S;C.§ 1001 et seq.
The Plan initially denied coverage for dental implants, including the implantation of fixtures and placement of abutments and crowns, on the basis that “Dental services are not covered under the Plan.” Keenley Decl. Ex. 4 at 532. 1 Dragu appealed the adverse determination to the Plan’s Benefits/Appeals Committee. After reviewing the…