Anderson v. Cigna Healthcare
Anderson v. Cigna Healthcare
Opinion
UNITED STATES COURT OF APPEALS For the Fifth Circuit
No. 00-40469 Summary Calendar
JANE SULLIVAN ANDERSON, Individually and as guardian of the person of Rickey Mack Anderson,
Plaintiff-Appellant,
VERSUS
CIGNA HEALTHCARE, Individually and in its capacity as Administrator of the Texas Foundries Medical Plan; CIGNA; THE TEXAS FOUNDRIES MEDICAL PLAN,
Defendants-Appellees.
Appeal from the United States District Court For the Eastern District of Texas (9:98-CV-130) December 13, 2000 Before DAVIS, JONES, and DeMOSS, Circuit Judges: PER CURIAM:*
Jane Sullivan Anderson (“Mrs. Anderson”) and Rickey Mack
Anderson (“Mr. Anderson) are husband and wife who are former
employees of Texas Foundries, Ltd. After retirement from Texas
Foundries, Ltd., both maintained participation in the Texas
* Pursuant to 5TH CIR. R. 47.5, the Court has determined that this opinion should not be published and is not precedent except under the limited circumstances set forth in 5TH CIR. R. 47.5.4. Foundries Medical Plan (“the Plan”) which is a self-funded employee
welfare benefit plan established under the provisions of the
Employment Retirement and Income Security Act of the United States.
Texas Foundries entered into an agreement with CIGNA Healthcare of
Texas, Inc. (“CIGNA”) to serve as the claim administrator under the
Plan and such agreement delegated absolute discretion to CIGNA to
make decisions regarding claims and requests for coverage. In
1997, Mr. Anderson suffered a debilitating stroke which left him
completely incapacitated. After initial treatment in a series of
medical hospitals whose services were paid for by the Plan, Mrs.
Anderson and her medical adviser sought to place Mr. Anderson in a
facility called “The Ranch” for longer term care. After a ten-day
trial at The Ranch, CIGNA determined that the care being provided
was essentially custodial in nature and the Plan contains an
express exception as to such custodial care. Accordingly, CIGNA
declined to pay for any further services at The Ranch under the
Plan. Mrs. Anderson, acting individually and as guardian of her
husband, filed suit against CIGNA and the Texas Foundries Medical
Plan for benefits under the Plan. The suit was tried to the
district court without a jury. The district court entered
comprehensive findings of fact and conclusions of law and entered
a final judgment that the plaintiffs take nothing. Mrs. Anderson
timely appealed.
We have carefully reviewed the briefs, the record excerpts,
and relevant portions of the record itself. For the reasons stated
by the district court in its findings of fact and conclusions of
2 law dated March 31, 2000, we affirm the final judgment entered
contemporaneously therewith.
AFFIRMED.
3
Reference
- Status
- Unpublished