Eugene S. v. Horizon Blue Cross Blue Shield of New Jersey

Eugene S. v. Horizon Blue Cross Blue Shield of New Jersey

No. 10-4225. United States Court of Appeals, Tenth Circuit.
November 15, 2011.
Ramifications of Court Decision:

SPD With Discretionary Language Must Be Incorporated Into Plan Document To Be Effective. When an anti-assignment clause in SPD is not found in the final or master copy of the plan, word by word, we shall be able defeat all anti-assignment in SPD’s under Amara.
“Mr. S. argues that he does not have access to the governing plan documents and cannot determine if such governing documents conflict with any grant of authority present in the SPD, Aplee. Br. 37-38, he did not request a copy of any such documents during the administrative appeal process or in discovery. Nor did he ask the district court to delay ruling on cross-motions for summary judgment so that he could seek out any such documents. Meanwhile, at oral argument, Horizon’s counsel maintained that the only plan document not in evidence has no bearing on the discretion afforded to Horizon and is irrelevant to the present case. Thus, the SPD—which contains the language of the Plan—is sufficient for our review.”



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