Adel F. Samaan v. Aetna Life Insurance Company

I. INTRODUCTION

The parties agreed to trifurcate this matter. On January 14, 2019, the Court issued an Order re Standing, Exhaustion of Administrative Remedies, and Contractual Limitations. Dkt. 43. In this second phase, the parties ask the Court to decide whether Plaintiff is entitled to benefits for certain unpaid claims. The Court deemed this matter appropriate for decision without oral argument and took the matter under submission on August 1, 2019. Having reviewed and considered the parties’ briefs and the administrative record, the Court makes the following Findings of Fact and Conclusions of Law.

II. BACKGROUND

Plaintiff is a medical doctor. Dkt. 53-1 (Samaan Dec.) ¶ 1. This phase involves healthcare services Plaintiff provided to ten different patients. Dkt. 53-3. The parties agree that each patient was a beneficiary of the Bank of America Plan (Plan), as described in the 2013 and 2016 Summary Plan Descriptions, and that Defendants were the claims administrators of the Plan. Dkt. 25 (“FAC”) ¶ 5; Dkt. 53 at 2; Dkt. 60 at 5-6. Plaintiff seeks recovery of unpaid benefits for 43 claim events2 involving the patients pursuant to the Plan. See FAC ¶¶ 40-41; Dkt.…