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. On August 30, 2019, the Court issued Findings of Fact and Conclusions of Law regarding Plaintiff’s claims that were completely unpaid by Defendants. In this third phase, the parties ask the Court to decide whether Plaintiff is entitled to additional benefits for certain claims that he contends were underpaid according to the terms of the applicable Plan. 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. The parties agree that each patient at issue 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. The parties agree that the Plan is governed by the Employee Retirement and Income Security Act of 1974 (ERISA). FAC ¶¶ 40-41;…