Source: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-almd-1_04-cv-00849/USCOURTS-almd-1_04-cv-00849-2/pdf.json

Nature of Suit Code: 791
Nature of Suit: Employee Retirement Income Security Act (ERISA)
Cause of Action: 29:1132 E.R.I.S.A.-Employee Benefits

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IN THE DISTRICT COURT OF THE UNITED STATES FOR THE

MIDDLE DISTRICT OF ALABAMA, SOUTHERN DIVISION

JERRY WILLOUGHBY, )

)

Plaintiff, )

)

v. ) CIVIL ACTION NO.

) 1:04cv849-T

WAL-MART, ASSOCIATES, INC., ) (WO)

a foreign corporation, )

et al. )

)

Defendants. )

ORDER

Based on the oral representations made at the

pretrial hearing held on October 5, 2005, and by

agreement of the parties, it is ORDERED as follows:

(1) Defendant Wal-Mart, Associates, Inc.’s

motion for summary judgment (Doc. No. 30) is denied,

with leave to renew.

(2) The issue of whether defendant Walmart

improperly refused to pay the medical expenses

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incurred by plaintiff Jerry Willoughby for penile

implant surgery is remanded to the Administrative

Committee of Walmart’s Health and Welfare Plan, so

that it may reconsider plaintiff Willoughby’s

appeal. According to the Administrative Committee’s

own procedures and based on any new evidence the

parties may submit, the Administrative Committee may

reach a different, or the same, decision, as it

deems appropriate.

(3) Within 60 days of the entry of this order,

the parties are to report back to this court on the

Administrative Committee’s decision and file with

the court a copy of the administrative record,

including the reasons the Administrative Committee

gives in support of its decision and whatever

evidence the Administrative Committee considered in

reaching its decision.

After reviewing the administrative record of

plaintiff Willoughby’s February 2004 appeal to the

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Administrative Committee and considering the

parties’ representations at the pretrial hearing,

the court offers these comments:

(1) As the administrative record now stands, the

court is unable to discern the basis for the

Administrative Committee’s conclusion that

Willoughby’s penile implant was treatment related to

sexual dysfunction. 

(2) The record contains no evidence explaining

what Peyronie’s disease is, what its symptoms are,

and what the standard treatments for it are.

(3) The record contains no evidence on the

severity of plaintiff Willoughby’s case of

Peyronie’s disease.

(4) The record contains no evidence on the

purpose of penile implants and the role they

generally play in treating diseases. 

(5) The record contains no clear evidence

indicating why plaintiff Willoughby’s treating

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physician elected to conduct penile implant surgery

in plaintiff Willoughby’s particular case.

(6) The record contains no evidence as to

whether the penile implant surgery in plaintiff

Willoughby’s case was primarily to treat a sexual

dysfunction or for another purpose. 

(7) The record contains no explanation for

defendant Walmart’s decision to cover some of the

costs related to plaintiff Willoughby’s treatment

for Peyronie’s disease, but not the penile implant.

(8) In conclusion, although the court recognizes

that it will review the Administrative Committee’s

decision only to determine if the decision was

arbitrary and capricious, the court cannot make that

determination unless the evidence upon which the

Administrative Committee based its decision is

contained in the administrative record.

The trial of this case is cancelled. 

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The clerk of the court is DIRECTED to close this

case administratively pending the remand to the

Administrative Committee of Walmart’s Health and

Welfare Plan.

DONE, this the 6th day of October, 2005.

_____________________________ /s/ Myron H. Thompson

UNITED STATES DISTRICT JUDGE 

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