UNITED STATES DISTRICT COURT 

NORTHERN DISTRICT OF INDIANA 

HAMMOND DIVISION 

ANCHOR HEALTH SYSTEMS, INC., 

 Plaintiff, 

v. CAUSE NO.: 2:16-CV-65-TLS 

DENNIS RADOWSKI, THE CITY OF 

HAMMOND, PROFESSIONAL CLAIMS 

MANAGEMENT, INC., and UNITED 

FOOD & COMMERCIAL WORKERS 

UNION & EMPLOYERS CALUMET 

REGION INSURANCE FUND, 

 Defendants.

OPINION AND ORDER 

This matter is before the Court on the Defendants’ Motions for Summary Judgment [ECF 

Nos. 91, 94], filed on March 25, 2019. The fundamental issue in this case is whether the 

Plaintiff, Anchor Health Systems, Inc., is entitled to reimbursement under various health 

insurance plans for the medical services it provided to Grace Radowski. The United Food & 

Commercial Workers Union & Employers Calumet Region Insurance Fund (“Calfund”) argues 

that the services were custodial and therefore excluded from coverage. The City of Hammond 

and Professional Claims Management, Inc. (“City Defendants”) argue that the City’s health 

insurance plan is not subject to the Employee Retirement Income Security Act of 1974 (ERISA). 

The Defendants also argue that the Plaintiff failed to comply with Federal Rule of Civil 

Procedure 56(c) and Northern District of Indiana Local Rule 56-1(b). See UFCW Union & 

Employers Calumet Region Insurance Fund’s Motion to Strike Plaintiff’s Response [ECF No. 

111]. The Court agrees with these arguments. As such, Calfund’s Motion for Summary Judgment 

[ECF No. 94] and Motion to Strike [ECF No. 111] are GRANTED. The City Defendants’ 

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Motion for Summary Judgment [ECF No. 91] is GRANTED in part and DENIED in part. 

Finally, the Court declines to exercise supplemental jurisdiction over the City of Hammond, 

Professional Claims Management, and Dennis Radowski. 

FAILURE TO COMPLY WITH FEDERAL RULE 56(c) AND LOCAL RULE 56-1(b) 

The Defendants argue that their facts should be deemed admitted because the Plaintiff 

failed to comply with Federal Rule of Civil Procedure 56(c) and Northern District of Indiana 

Local Rule 56-1(b). Calfund also argues that the Plaintiff’s factual assertions should be stricken 

because the Plaintiff’s Response fails to comply with Northern District of Indiana Local Rule 56-

1(b). The Court agrees. 

 “[D]istrict courts are not obliged in [an] adversary system to scour the record looking for 

factual disputes and may adopt local rules reasonably designed to streamline the resolution of 

summary judgment motions.” Waldridge v. Am. Hoechst Corp., 24 F.3d 918, 922 (7th Cir. 1994) 

(citing Herman v. City of Chicago, 870 F.2d 400, 404 (7th Cir. 1989); Bell, Boyd & Lloyd v. 

Tapy, 896 F.2d 1101, 1103–04 (7th Cir. 1990); L.S. Heath & Son, Inc. v. AT & T Info. Sys., Inc., 

9 F.3d 561, 567 (7th Cir. 1993)). In the Northern District of Indiana, a motion for summary 

judgment “must include a section labeled ‘Statement of Material Facts’ that identifies the facts 

that the moving party contends are not genuinely disputed.” N.D. Ind. L.R. 56-1(a). The 

nonmoving party must then file and serve a response brief and “any materials that the party 

contends raise a genuine dispute.” N.D. Ind. L.R. 56-1(b)(1). Furthermore, the nonmoving 

party’s “response brief or its appendix must include a section labeled ‘Statement of Genuine 

Disputes’ that identifies the material facts that the party contends are genuinely disputed so as to 

make a trial necessary.” N.D. Ind. L.R. 56-1(b)(2). 

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 A Statement of Genuine Disputes “is a critical element of any response to a motion for 

summary judgment, because without it, the movant’s version of the facts are accepted as 

undisputed.” Carragher v. Ind. Toll Road Concession Co., 936 F. Supp. 2d 981, 985 n.1 (N.D. 

Ind. 2013); see also Caldwell v. Klemz, No. 2:14-CV-455, 2017 WL 4620693, at *3 (N.D. Ind. 

Oct. 12, 2017). Furthermore, “[p]leadings that do not conform with the local rules may be 

stricken at the discretion of the court.” Goltz v. Univ. of Notre Dame du Lac, 177 F.R.D. 638, 

640 (N.D. Ind. 1997) (citing Tapy, 896 F.2d at 1103; Pfeil v. Rogers, 757 F.2d 850, 858 (7th Cir. 

1985); Graham v. Sec. Sav. & Loan, 125 F.R.D. 687, 688–89 (N.D. Ind. 1989)); see also Mayes 

v. City of Hammond, Ind., 442 F. Supp. 2d 587, 596 (N.D. Ind. 2006). “Moreover, it is a 

reasonable judgment on the part of the district court that strict, consistent, ‘bright line’ 

enforcement is essential to obtaining compliance with the rule and to ensuring that long-run 

aggregate benefits in efficiency inure to district courts.” Goltz, 177 F.R.D. at 640 (citing Midwest 

Imps., Ltd. v. Coval, 71 F.3d 1311 (7th Cir. 1995)). The interpretation and enforcement of local 

rules is left to the sound discretion of the district court. Dr. Robert L. Meinders, D.C., Ltd. v. 

UnitedHealthcare, Inc., 800 F.3d 853, 858 (7th Cir. 2015) (quoting Cuevas v. United States, 317 

F.3d 751, 752 (7th Cir. 2003)); Curtis v. Costco Wholesale Corp., 807 F.3d 215, 219 (7th Cir. 

2015). To that point, the Seventh Circuit has repeatedly upheld “the entry of summary judgment 

when the non-movant has failed to submit a factual statement in the form called for by the 

pertinent rule and thereby conceded the movant’s version of facts.” Waldridge, 24 F.3d at 922–

23 (collecting cases). 

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 In pertinent part, Federal Rule of Civil Procedure 56(c) requires as follows: 

(1) Supporting Factual Positions. A party asserting that a fact . . . is genuinely disputed 

must support the assertion by: 

(A) citing to particular parts of materials in the record, including 

depositions, documents, electronically stored information, affidavits or 

declarations, stipulations (including those made for purposes of the motion 

only), admissions, interrogatory answers, or other materials; or 

(B) showing that the materials cited do not establish the absence . . . of a 

genuine dispute, or that an adverse party cannot produce admissible 

evidence to support the fact. 

. . . 

(3) Materials Not Cited. The court need consider only the cited materials, but it may 

consider other materials in the record. 

Fed. R. Civ. P. 56(c)(1), (3). 

 If a party fails to properly address another party’s assertion of fact as required by Rule 

56(c), the district court may “consider the fact undisputed for purposes of the motion.” Fed. R. 

Civ. P. 56(e)(2). The Court may also “grant summary judgment if the motion and supporting 

materials—including the facts considered undisputed—show that the movant is entitled to it.” 

Fed. R. Civ. P. 56(e)(3). The enforcement of Federal Rule of Civil Procedure 56(e) is left to the 

sound discretion of the district court. See Archdiocese of Milwaukee v. Doe, 743 F.3d 1101, 

1109–10 (7th Cir. 2014). 

 In this case, the Plaintiff’s Response [ECF No. 105] to the City Defendants’ Motion for 

Summary Judgment does not contain a section or appendix which identifies “the material facts 

that the party contends are genuinely disputed so as to make a trial necessary.” N.D. Ind. L.R. 

56-1(b)(2). This Response is also insufficient under Federal Rule of Civil Procedure 56(c). 

 The Plaintiff’s Response [ECF No. 106] to Calfund’s Motion for Summary Judgment is 

also deficient. Namely, Calfund included a section labeled “Statement of Material Facts” that 

clearly identified the facts that it contended were not genuinely disputed. See N.D. Ind. L.R. 56-

1(a). Each of Calfund’s factual assertions are individually numbered and supported by a citation 

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to the record. The Plaintiff’s brief does not contain a “Statement of Genuine Disputes” as 

required by Northern District of Indiana Local Rule 56-1(b)(2). Instead, the Plaintiff’s Brief 

includes a section entitled “Historical Background- Undisputed Facts.” Pl.’s Resp., pp. 2–3, ECF 

No. 106. This section largely provides a procedural overview of the case and does not identify 

purported disputes of material facts.1 This section is also without citation to the record. See Fed. 

R. Civ. P. 56(c)(3). The Plaintiff’s Response then contains a twelve-page section entitled 

“Statement of Facts Which Show There Is No Right To A Summary Judgment.” Id. However, 

this section is argumentative, conclusory, and without adequate citation to the record. See Fed. R. 

Civ. P. 56(c)(1), (c)(3). Critically, the Plaintiff fails to respond to Calfund’s Statement of 

Material Facts. See N.D. Ind. L.R. 56-1(b)(2). As indicated above, the Plaintiff could have 

responded to Calfund’s Statement of Material Facts because each factual assertion was 

individually numbered and supported by a citation to the record. It was the Plaintiff’s 

responsibility under Northern District of Indiana Local Rule 56-1(b)(2) to clearly identify any 

disputes of material fact. See N.D. Ind. L.R. 56-1(b)(2). The Court specifically finds that the 

Plaintiff’s Response [ECF No. 106] fails to meet the requirements of Northern District of Indiana 

Local Rule 56-1(b)(2). Likewise, the Court finds that the Plaintiff’s Response is deficient under 

Federal Rule of Civil Procedure 56(c). 

 Furthermore, the Plaintiff’s failure to comply with Federal Rule of Civil Procedure 56(c) 

and Northern District of Indiana Local Rule 56-1(b)(2) has prejudiced Calfund. Specifically, as 

noted above, the factual assertions within the Plaintiff’s Response [ECF No. 106] are without 

adequate citation to the record, are conclusory, and are intertwined with legal analysis. This 

1

 However, this section does state that “[t]here is no dispute in the evidence that Grace Radowski was bedridden, 

could not speak, received feedings through a gastrointestinal tube, was receiving medications through intravenous 

injections, had bed sores and infections from the same and could not breathe except through a ventilator.” Pl.’s 

Resp. at 3, ECF No. 106. 

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makes it difficult for Calfund to respond to the Plaintiff’s factual assertions. Further, the Plaintiff 

failed to file a “Statement of Genuine Disputes” and did not directly respond to Calfund’s 

Statement of Material Facts. See N.D. Ind. L.R. 56-1(b)(2). The Plaintiff’s failure to comply with 

Northern District of Indiana Local Rule 56-1(b)(2) makes it difficult for Calfund to understand 

which of its factual assertions are in dispute. See N.D. Ind. L.R. 56(b)(2). Likewise, the City 

Defendants are prejudiced because the Plaintiff did not file a “Statement of Genuine Disputes.” 

See id. 

 The Court is also burdened by the Plaintiff’s failure to comply with Federal Rule of Civil 

Procedure 56(c) and Northern District of Indiana Local Rule 56-1(b)(2). “A district court is not 

required to ‘wade through improper denials and legal argument in search of a genuinely disputed 

fact.’” Smith v. Lamz, 321 F.3d 680, 683 (7th Cir. 2003) (quoting Bordelon v. Chi. Sch. Reform. 

Bd. of Trs., 233 F.3d 524, 529 (7th Cir. 2000)). Furthermore, “a mere disagreement with the 

movant’s asserted facts is inadequate if made without reference to specific supporting material.” 

Id. (citing Edward E. Gillen Co. v. City of Lake Forest, 3 F.3d 192, 196 (7th Cir. 1993)). It was 

the Plaintiff’s duty, rather than the Court’s, to properly support its opposition to the Defendants’ 

Motions for Summary Judgment. See Ammons v. Aramark Unif. Servs., Inc., 368 F.3d 809, 818 

(7th Cir. 2004); see also Waldridge, 24 F.3d at 923–24. Further, because the record in this case is 

complex and voluminous, failure to strictly enforce the above-mentioned rules would result in an 

inefficient use of judicial resources. See Waldridge, 24 F.3d at 922; Goltz, 177 F.R.D. at 640. 

The Court also emphasizes that the Plaintiff is a sophisticated company that is represented by 

local counsel. 

 Therefore, based upon the record as a whole, the Court finds that the Plaintiff’s failure to 

comply with Federal Rule of Civil Procedure 56(c) and Northern District of Indiana Local Rule 

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56-1(b)(2) has prejudiced the Defendants and the Court. In an exercise of discretion, the 

Defendants’ statements of material facts as supported by the evidence of record are deemed 

admitted. Further, the Plaintiff’s factual assertions are stricken. 

STATEMENT OF MATERIAL FACTS

 In January 2012, Grace Radowski was an employee of a grocery store and a member of 

the United Food & Commercial Workers Union (the “Union”). See Ex. A, Dennis Radowski 

Dep., p. 4, ECF No. 96-1.2 As a member of the Union, Grace received health insurance through 

the Calumet Region Insurance Fund (“Calfund”). Id. The Calfund insurance plan is subject to the 

Employment Retirement Income Security Act of 1974. See Ex. U, Union’s Answer to Second 

Am. Compl., p. 2, ECF No. 96-21. Following the termination of her employment, Grace elected 

to continue her insurance coverage. Id. However, custodial care was excluded from coverage 

under the Calfund insurance plan. See Ex. D, Calfund Insurance Plan, pp. 3–4, ECF No. 96-4. 

Specifically, Article 18(s) of the Calfund insurance plan stated that “Notwithstanding any other 

provision of the Plan to the contrary, Covered Expenses shall not include, and no payment shall 

2

 Throughout this Opinion and Order, the Court will cite to the CM/ECF electronic page header rather than the page 

number listed on the actual document. 

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be made under the Plan, for . . . Custodial Care, except when provided by a Hospice.” Id. The 

insurance policy defined custodial care as follows: 

Section 2.14. Custodial Care. 

 Services or supplies; regardless of where or by whom they are provided, that: 

(a) a person without medical skills or background could provide or be trained to 

provide; or 

(b) are provided mainly to help the patient with daily living activities, including but 

not limited to, walking, getting in or out of bed, exercising or moving, bathing, 

using the toilet, administering enemas, dressing and assisting with hygiene 

needs, assistance with tube or gastrostomy feedings and stoma and ostomy 

maintenance, cleaning or preparation of meals, acting as a companion or sitter, 

or administering or supervising the administration of medication including but 

not limited to the administration of insulin and other injectable medications, 

changing of dressings, or as part of a maintenance treatment plan not reasonably 

expected to improve the patient’s condition, sickness, injury or functional 

ability. 

Id. at 18. 

 The Calfund insurance plan was administered by a board of trustees. See id. at 19. As 

seen below, the board of trustees had broad discretionary powers when administering the policy: 

Section 5.2 Administration 

The Trustees or their designee shall have all rights, duties and powers necessary or 

appropriate for the administration of the Plan. In particular, the Trustees or their designee 

shall have and shall exercise complete discretionary authority to construe, interpret and 

apply all of the terms of the Plan, including all matters relating to eligibility for benefits, 

amount, time or form of payment, and any disputed or allegedly doubtful terms. . . . 

Id. 

 On January 20, 2012, Grace suffered a debilitating stroke. See Radowski Dep. at 9–10, 

ECF No. 96-1. Thereafter, Grace was in a comatose state until her death on September 5, 2014. 

Id. at 3, 9–10; Ex. L, Comprehensive Adult Assessment, pp. 10–11, ECF No. 96-12. Grace was 

dependent upon a ventilator for breathing. See Comprehensive Adult Assessment at 4, ECF No. 

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96-12. She was incontinent and required a catheter. Id. at 9. Grace was unable to dress herself or 

care for her personal hygiene. Id. at 11. She was unable to feed herself and was “fed nutrients 

through nasogastric tube or gastrostomy.” Id. at 12. She was “[u]nable to take medication unless 

administered by another person.” Id. at 13. 

 On the date of her stroke, Grace was rushed to Community Hospital in Munster, Indiana. 

See Radowski Dep. at 4–5, ECF No. 96-1. Grace received medical treatment at Community 

Hospital for several hours before being air-lifted to Rush Hospital in Chicago, Illinois. Id. at 5. 

Grace received treatment at Rush Hospital for several weeks before being transferred to Regency 

Hospital in East Chicago, Indiana. Id. On March 23, 2012, Grace was transferred to the ventilator 

unit of Whispering Pines Health Care Center, which is a nursing home. Id. at 6. In the spring of 

2013, Whispering Pines notified Grace’s husband, Dennis Radowski, that it would be 

discontinuing its ventilator care unit. Id. at 7–8. Dennis was unable to find another facility, so he 

decided to transfer Grace back to their home. Id. at 8. 

 Following the closure of the ventilator unit, Dennis Radowski selected the Plaintiff, 

Anchor Health Systems, to provide medical services to Grace. Id. at 8–9. The Plaintiff received 

authorization from Medicaid to perform the services. See Ex. F, Various Anchor Health Care 

Documents, p. 16, ECF No. 96-6. However, on May 17, 2013, the Plaintiff received notice that 

Calfund would not authorize the services because Calfund concluded that the proposed care was 

custodial. Id. at 14. 

 In June 2013, the Plaintiff contracted with Dennis Radowski to provide medical services 

to Grace. See Radowski Dep. at 8–9, ECF No. 96-1; Ex. K, Agreement to Establish Home Health 

Care Services, p. 4, ECF No. 96-11. Pursuant to their agreement, the Plaintiff would provide 

medical services for 8–12 hours per day. See Agreement to Establish Home Health Care Services 

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at 5, ECF No. 96-11; Comprehensive Adult Assessment at 3, ECF No. 96-12. The Plaintiff’s care 

included repositioning, administering nebulizer treatments, providing gastrointestinal feedings 

(“g-tube”), emptying a catheter bag, administrating injections, ventilation care, general grooming 

care, and stoma (“bed-sore”) maintenance. See Comprehensive Adult Assessment at 4–15, ECF 

No. 96-12. 

 In September 2013, Medicaid withdrew authorization for the Plaintiff’s medical services. 

See Anchor Health Care Documents at 25, ECF No. 96-6. On April 9, 2014, the Plaintiff sent a 

demand letter to Calfund which demanded payment for the services that it provided to Grace. See 

Ex. L, Demand Letter, p. 2, ECF No. 96-14. On April 15, 2014, Calfund denied the Plaintiff’s 

request for payment. See Ex. O, Denial Letter, pp. 2–3, ECF No. 96-15. In relevant part, a claims 

administrator explained that the Plaintiff’s request for payment was denied because the services 

it provided were custodial in nature and therefore excluded from coverage. Id. at 2. The denial 

letter informed the Plaintiff how to appeal to the board of trustees. Id. at 2–3. Following this, the 

parties continued to negotiate. See Ex. P, Email Communication Between CalFund and Plaintiff, 

ECF No. 96-16. 

 On July 25, 2014, Calfund sent another denial letter to the Plaintiff. See Ex. Q, Second 

Denial Letter, p. 2, ECF No. 96-17. In relevant part, Calfund stated that it was denying coverage 

because it determined that the care was custodial and therefore excluded from coverage. Id. As 

seen below, Calfund provided notice regarding the Plaintiff’s right to appeal the denial of 

coverage: 

. . . Custodial Care is a non-covered expense. As a result, your appeal will be referred to 

the Board of Trustees. The Board of Trustees will review the appeal without deference to 

this review. 

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Right to Provide Additional Information. You may submit documents or information to 

the Appeal Committee of the Board of Trustees, in addition to the material you previously 

submitted. I encourage you to do so because the action taken at the Appeal Committee 

meeting will be final. Any additional information or clarification that you want the Trustees 

to consider should be submitted for review. The information or supporting documents 

should set forth your reasons for disagreement with the denial of the claim, and should 

address the specifics of the claim rejection . . . . 

 The information should be submitted to the Board of Trustees . . . . If you wish to do so, 

the information must be in writing and must be received by August 25, 2014. 

Note that you have the right to bring a civil action under Section 502(a) of the Employee 

Retirement Income Security Act of 1974 (ERISA) following the denial of a claim on appeal. 

In addition, the Diagnosis code and Treatment code and their interpretation are available 

on request for any denied claim. 

Id. at 3 (emphasis in original). 

 On August 22, 2014, the Plaintiff appealed to the board of trustees and argued that it was 

entitled to payment because the services it provided were medically necessary rather than 

custodial. See Ex. R, Appeal of Health Claims, pp. 2–3, ECF No. 96-18. On September 12, 2014, 

the board of trustees determined that the services were custodial and denied the appeal. See Ex. 

S, Minutes of the Board of Trustees Meeting, p. 4, ECF No. 96-19. On September 15, 2014, 

Calfund sent an explanatory letter to the Plaintiff which stated that “the Trustees determined that, 

based on review by the Fund Medical Consultant, the care provided by Anchor Health Systems 

during the period in question was custodial in nature and consequently excluded under the Plan. 

For these reasons, the claim determination was upheld.” Ex. T, Explanatory Letter, p. 2, ECF No. 

96-20. The explanatory letter informed the Plaintiff of its right to bring a civil action under 

ERISA. Id. 

Dennis Radowski was employed by the City of Hammond and was insured under the City 

of Hammond health plan (city insurance plan). See Ex. A, Radowski Dep., p. 4, ECF No. 93-1. 

At all relevant times, Grace was listed as a dependent on the city insurance plan. Id. The city 

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insurance plan was administered by Professional Claims Management, Inc. See Ex. C, City 

Defendants’ Responses to Plaintiff’s First Request for Production, p. 20, ECF No. 93-3. David J. 

Baker, the Chief Executive Officer for Professional Claims Management, stated that “the only 

employer included in the City’s health insurance plan is the City of Hammond and the agencies 

and departments that are a part of the City, such as the Hammond Sanitary District. There are no 

non-governmental entity employers that participate in the City’s plan.” Ex. D, Aff. of David J. 

Baker ¶ 4, ECF No. 93-4. Based upon this, Baker concluded that the city insurance plan “is not a 

multi-employer plan.” Id. The Plaintiff also submitted claims to the city insurance plan, but these 

claims were denied. See City Defendants’ Responses to Plaintiff’s First Request for Production 

at 60, ECF No. 93-3. 

LEGAL STANDARD 

 “The court shall grant summary judgment if the movant shows that there is no genuine 

dispute as to any material fact and the movant is entitled to judgment as a matter of law.” Fed. R. 

Civ. P. 56(a). The Supreme Court has explained that “the burden on the moving party may be 

discharged by ‘showing’—that is, pointing out to the district court—that there is an absence of 

evidence to support the nonmoving party’s case.” Celotex Corp. v. Catrett, 477 U.S. 317, 323 

(1986). “If the moving party has properly supported his motion, the burden shifts to the nonmoving party to come forward with specific facts showing that there is a genuine issue for trial.” 

Spierer v. Rossman, 798 F.3d 502, 507 (7th Cir. 2015). “To survive summary judgment, the 

nonmoving party must establish some genuine issue for trial such that a reasonable jury could 

return a verdict in [his] favor.” Gordon v. FedEx Freight, Inc., 674 F.3d 769, 772–73 (7th Cir. 

2012). Within this context, the Court must construe all facts and reasonable inferences from 

those facts in the light most favorable to the nonmoving party. Frakes v. Peoria Sch. Dist. No. 

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150, 872 F.3d 545, 550 (7th Cir. 2017). However, the nonmoving party “is only entitled to the 

benefit of inferences supported by admissible evidence, not those ‘supported by only speculation 

or conjecture.’” Grant v. Trs. of Ind. Univ., 870 F.3d 562, 568 (7th Cir. 2017) (citing Nichols v. 

Michigan City Plant Planning Dep’t, 755 F.3d 594, 599 (7th Cir. 2014)). Likewise, irrelevant or 

unnecessary factual disputes do not preclude the entry of summary judgment. Carroll v. Lynch, 

698 F.3d 561, 564 (7th Cir. 2012) (citing Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 248 

(1986)). 

ANALYSIS 

The Court will only address the arguments which are necessary for the resolution of this 

case. Calfund argues it is entitled to summary judgment because the denial of coverage was 

reasonable and proper notice was given. The Court agrees with this argument and grants 

Calfund’s request for summary judgment. In pertinent part, the City Defendants argue that the 

city insurance plan is not subject to ERISA. The Court agrees with this argument. Because 

Calfund has been dismissed and the city insurance plan is not subject to ERISA, the Court 

declines to exercise supplemental jurisdiction over the state law claims brought against the City 

of Hammond, Professional Claims Management, and Dennis Radowski. 

A. The Calfund Insurance Plan 

In essence, Calfund argues that the Plaintiff’s services were custodial and therefore 

excluded from coverage. As such, Calfund argues that it is entitled to summary judgment 

because (1) the denial of coverage was reasonable and (2) proper notice was given. The Court 

agrees. 

 The Employee Retirement Income Security Act of 1974 (ERISA) regulates private 

employee benefit plans. See District of Columbia v. Greater Washington Bd. of Trade, 506 U.S. 

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125, 127 (1992); 29 U.S.C. § 1003(a). “A denial of benefits is normally reviewed de novo 

‘unless the benefit plan gives the administrator or fiduciary discretionary authority to determine 

eligibility for benefits or to construe the terms of the plan.’” Speciale v. Blue Cross and Blue 

Shield Ass’n, 538 F.3d 615, 620 n.2 (7th Cir. 2008) (quoting Firestone Tire & Rubber Co. v. 

Bruch, 489 U.S. 101, 115 (1989)). In this case, as seen below, Calfund’s insurance policy gave 

the board of trustees the discretionary authority to determine eligibility for benefits and to 

construe the terms of the plan: 

 The Trustees or their designee shall have all rights, duties and powers necessary 

or appropriate for the administration of the Plan. In particular, the Trustees or their 

designee shall have and shall exercise complete discretionary authority to construe, 

interpret and apply all of the terms of the Plan, including all matters relating to eligibility 

for benefits, amount, time or form of payment, and any disputed or allegedly doubtful 

terms. 

Calfund Insurance Plan at 18, ECF No. 96-4. 

 When, as here, an ERISA plan grants the administrator discretionary authority to 

determine benefits, courts review the administrator’s decision under the arbitrary and capricious 

standard. Hennen v. Metro. Life Ins. Co., 904 F.3d 532, 539 (7th Cir. 2018) (citing Tompkins v. 

Cent. Laborers’ Pension Fund, 712 F.3d 995, 999 (7th Cir. 2013)). Under the arbitrary and 

capricious standard, the court will overturn the administrator’s decision only if there is an 

absence of reasoning to support it. Jackman Fin. Corp. v. Humana Ins. Co., 641 F.3d 860, 864 

(7th Cir. 2011). Specifically, the court will affirm an administrator’s decision “as long as (1) it is 

possible to offer a reasoned explanation, based on the evidence, for a particular outcome, (2) the 

decision is based on a reasonable explanation of relevant plan documents, or (3) the 

administrator has based its decision on a consideration of the relevant factors that encompass the 

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important aspects of the problem.” Speciale, 538 F.3d at 621 (quoting Sisto v. Ameritech 

Sickness & Accident Disability Benefit Plan, 429 F.3d 698, 700 (7th Cir. 2005)). 

 In this case, custodial care was excluded from coverage under the Calfund insurance 

plan. See Calfund Insurance Plan at 3–4, ECF No. 96-4. Specifically, the plan stated that 

“Notwithstanding any other provision of the Plan to the contrary, Covered Expenses shall not 

include, and no payment shall be made under the Plan, for . . . Custodial Care, except when 

provided by a Hospice.” Id. In relevant part, the insurance plan defined custodial care as follows: 

 Services or supplies; regardless of where or by whom they are provided, that . . . 

are provided mainly to help the patient with daily living activities, including but not limited 

to, walking, getting in or out of bed, exercising or moving, bathing, using the toilet, 

administering enemas, dressing and assisting with hygiene needs, assistance with tube or 

gastrostomy feedings and stoma and ostomy maintenance, cleaning or preparation of 

meals, acting as a companion or sitter, or administering or supervising the administration 

of medication including but not limited to the administration of insulin and other injectable 

medications, changing of dressings, or as part of a maintenance treatment plan not 

reasonably expected to improve the patient’s condition, sickness, injury or functional 

ability. 

Id. at 18 (emphasis added). 

 The Plaintiff provided services to Grace for 8–12 hours per day. See Agreement to 

Establish Home Health Care Services at 4, ECF No. 96-11; Comprehensive Adult Assessment at 

3, ECF No. 96-12. It is undisputed that the Plaintiff’s care included repositioning, administering 

nebulizer treatments, providing gastrointestinal feedings (“g-tube”), emptying a catheter bag, 

administrating injections, ventilation care, general grooming care, and stoma (“bed-sore”) 

maintenance. See Comprehensive Adult Assessment at 4, ECF No. 96-11; see also Pl.’s Resp. to 

Mot. for Summ. J., p. 3, ECF No. 106 (“There is no dispute in the evidence that Grace Radowski 

was bedridden, could not speak, received feedings through a gastrointestinal tube, was receiving 

medications through intravenous injections, had bed sores and infections from the same and 

could not breathe except through a ventilator.”). Following her stroke, Grace was in a comatose 

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state until her death. See Comprehensive Adult Assessment at 10–11, ECF No. 96-12. Grace was 

dependent upon a ventilator for breathing. Id. at 4. She was incontinent and required a catheter. 

Id. at 9. Grace was unable to dress herself or care for her personal hygiene. Id. at 11. Grace was 

unable to feed herself and was “fed nutrients through nasogastric tube or gastrostomy.” Id. at 12. 

She was “[u]nable to take medication unless administered by another person.” Id. at 13. 

 Based upon Grace’s medical condition, the board of trustees could have reasonably 

concluded that the Plaintiff’s medical services were “part of a maintenance treatment plan not 

reasonably expected to improve the patient’s condition, sickness, injury or functional ability.” 

Calfund Insurance Plan at 18, ECF No. 96-4. As such, the board of trustees could have 

reasonably concluded that the Plaintiff’s medical services were custodial and therefore excluded 

from coverage. See id. at 3–4. Accordingly, the denial of coverage was reasonable rather than 

arbitrary and capricious. See Becker v. Chrysler LLC Health Care Benefits Plan, 691 F.3d 879, 

892–93 (7th Cir. 2012) (concluding that the administrator’s denial of coverage was not arbitrary 

and capricious because the administrator could have reasonably concluded that the care provided 

at the nursing home was custodial, even if the patient received some skilled nursing care). 

 Likewise, Calfund provided the Plaintiff proper notice of the denial. On May 17, 2013, 

the Plaintiff received notice that Calfund would not reimburse the Plaintiff for the services it 

intended to provide to Grace. See Various Anchor Health Care Documents at 14, ECF No. 96-6. 

The Plaintiff began providing the services in June 2013. See Radowski Dep. at 8–9, ECF No. 96-

1. The Plaintiff sent Calfund a demand letter in April 2014 for some of the services it provided to 

Grace. See Demand Letter, ECF No. 96-14. Calfund denied the Plaintiff’s request for payment 

and informed the Plaintiff how to appeal to the board of trustees. See Denial Letter at 2–3, ECF 

No. 96-15; Second Denial Letter at 2, ECF No. 96-17. Calfund explained in pertinent part that it 

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was denying coverage because it concluded that the care was custodial. See id. The Plaintiff 

appealed to the board of trustees, but the request was denied. See Minutes of the Board of 

Trustees Meeting at 4, ECF No. 96-19. An explanatory letter informed the Plaintiff that the claim 

was denied because the board of trustees determined that the Plaintiff’s services were custodial. 

See Explanatory Letter at 2, ECF No. 96-20. The explanatory letter informed the Plaintiff of its 

right to bring an ERISA action. Id. Based upon the record in this case, the Court concludes that 

Calfund provided proper notice. See Dade v. Sherwin-Williams Co., 128 F.3d 1135, 1140–41 

(7th Cir. 1997) (“The notice must be written in a manner calculated to be understood by the 

participant and the plan must provide the participant with a reasonable opportunity for a full and 

fair review of the denial by a fiduciary of the decision denying the claim.” (citing 29 U.S.C. 

§ 1133; Halpin v. W.W. Grainger, Inc., 962 F.2d 685, 688–89 (7th Cir. 1992)). Therefore, for the 

reasons stated above, Calfund’s Motion for Summary Judgment [ECF No. 94] is granted. 

B. The City Insurance Plan 

 In relevant part, the City Defendants argue that the city insurance plan is not subject to 

ERISA. Based upon the record in this case, the Court agrees. 

 The provisions of ERISA “shall not apply” to an employee benefit plan that is a 

governmental plan. 29 U.S.C. § 1003(b)(1); see also Graham v. Bd. of Educ. of the City of Chi., 

No. 18 C 4761, 2019 WL 215098, at *2 (N.D. Ill. Jan. 16, 2019). “The term ‘governmental plan’ 

means a plan established or maintained for its employees by the Government of the United 

States, by the government of any State or political subdivision thereof, or by any agency or 

instrumentality of any of the foregoing.” 29 U.S.C. § 1002(32); see also Simac v. Health All. 

Med. Plans, Inc., 961 F. Supp. 216, 218 n.6 (C.D. Ill. 1997). An “entity is a political subdivision 

if it is ‘either (1) created directly by the state, so as to constitute departments or administrative 

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arms of the government, or (2) administered by individuals who are responsible to public 

officials or to the general electorate.’” Shannon v. Shannon, 965 F.2d 542, 548 (7th Cir. 1992) 

(quoting NLRB v. Nat. Gas Util. Dist. of Hawkins Cty., Tenn., 402 U.S. 600, 604–05 (1971) 

(emphasis omitted)). 

It is undisputed that the City of Hammond is administered by individuals who are 

responsible to the general electorate. See Ind. Code § 36-4-1-1 et seq. Further, it is undisputed 

that “the only employer included in the City’s health insurance plan is the City of Hammond and 

the agencies and departments that are a part of the City, such as the Hammond Sanitary District. 

There are no non-governmental entity employers that participate in the City’s plan.” Decl. of 

David J. Baker ¶ 4, ECF No. 93-4. Further, the Plaintiff has previously conceded that the city 

insurance plan is a governmental plan that is not subject to ERISA. See Report of Rule 26(f) 

Report Meeting, ECF No. 49; see also Keller v. United States, 58 F.3d 1194, 1198 n.8 (7th Cir. 

1995) (“Judicial admissions are formal concessions in the pleadings, or stipulations by a party or 

its counsel, that are binding upon the party making them. They may not be controverted at trial 

or on appeal.”). Therefore, based upon the record presented in this case, the Court concludes that 

city insurance plan is not subject to ERISA. Accordingly, the Court grants summary judgment in 

favor of the City of Hammond and Professional Claims Management, Inc. to the extent Plaintiff 

has brought an ERISA claim against them. 

C. The Court’s Supplemental Jurisdiction 

The Court’s federal question jurisdiction was premised upon the Plaintiff’s ERISA claim. 

See 28 U.S.C. § 1331; see also Report of Rule 26(f) Report Meeting, ECF No. 49. However, as 

seen above, the Court has concluded that (1) Calfund is entitled to summary judgment and (2) 

the city insurance plan is not subject to ERISA. Because the Court has dismissed all claims over 

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which it had original jurisdiction, it declines to exercise supplemental jurisdiction over the 

remaining state law claims brought against the Defendants City of Hammond, Professional 

Claims Management, Inc., and Dennis Radowski. 

“Federal courts are courts of limited jurisdiction.” Kokkonen v. Guardian Life Ins. Co. of 

Am., 511 U.S. 375, 377 (1994). “When all federal claims have been dismissed prior to trial, the 

principle of comity encourages federal courts to relinquish supplemental jurisdiction pursuant to 

§ 1367(c)(3).” Hansen v. Bd. of Trs. of Hamilton Se. Sch. Corp., 551 F.3d 599, 607 (7th Cir. 

2008). Although the decision to exercise supplemental jurisdiction is discretionary, “there is a 

general presumption that the court will relinquish supplemental jurisdiction and dismiss the statelaw claims without prejudice.” Rivera v. Allstate Ins. Co., 913 F.3d 603, 618 (7th Cir. 2018) 

(citing RWJ Mgmt. Co., Inc. v. BP Prods. N. Am., Inc., 672 F.3d 476, 479–80 (7th Cir. 2012)). 

“The presumption is rebuttable, but it should not be lightly abandoned, as it is based on a 

legitimate and substantial concern with minimizing federal intrusion into areas of purely state 

law.” RWJ Mgmt. Co., Inc., 672 F.3d at 479 (internal quotation marks omitted). The presumption 

favoring dismissal may be rebutted if: 

(1) the statute of limitations has run on the pendent claim, precluding the filing of a 

separate suit in state court; (2) substantial judicial resources have already been 

committed, so that sending the case to another court will cause a substantial duplication 

of effort; or (3) when it is absolutely clear how the pendent claims can be decided. 

Sharp Elecs. Corp. v. Metro Life Ins. Co., 578 F.3d 505, 514–15 (7th Cir. 2009) (internal 

quotation marks omitted). 

 First, the statute of limitations has not run on the Plaintiff’s state law claims. See Ind. 

Code § 34-11-2-11 (10-year statute of limitations for claims arising out of a written contract); 

Ind. Code § 34-11-8-1 (Indiana savings statute); see also 28 U.S.C. § 1367(d)(tolling period of 

limitations on claims under the court’s supplemental jurisdiction during pendency of action and 

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for at least thirty days after dismissal of the claim). Second, after a careful review of the record, 

the Court finds that it has not expended substantial resources in this case. Rather, the Court’s 

efforts have largely been focused on resolving the Plaintiff’s ERISA claim at the summary 

judgment stage. See Davis v. Cook County, 534 F.3d 650, 654 (7th Cir. 2008) (“[T]he district 

court disposed of the federal claims on summary judgment, and so ‘substantial judicial 

resources’ have not yet been committed to the case.”). Further, because the Court has not spent 

great effort on the Plaintiff’s state law claims, there will not be a substantial duplication of effort 

if this matter is refiled in state court. Cf. Tyler v. Trs. of Purdue Univ., 834 F. Supp. 2d 830, 846 

(N.D. Ind. 2011) (“Here, both parties have briefed Tyler’s state law claims, and this Court is 

intimately familiar with the details of the case. Requiring the state court to address these claims 

would cause a substantial duplication of effort.”). 

 Finally, although the Court has determined that Calfund is entitled to summary judgment 

because the board of trustees could have reasonably concluded that the Plaintiff’s services were 

custodial, it is not “absolutely clear” that this rationale should apply to the City Defendants. 

Namely, within their twenty-three-page brief, the City Defendants devote once sentence of 

analysis to whether coverage was properly denied due to a custodial care exclusion. See City 

Defs.’ Br. in Supp. of Mot. for Summ. J., p. 18, ECF No. 92. “It is not the obligation of this court 

to research and construct the legal arguments open to parties, especially when they are 

represented by counsel.” United States v. Wantuch, 525 F.3d 505, 516 n.5 (7th Cir. 2008). As 

such, for the purposes of this federal lawsuit , the issue of whether the City Defendants properly 

denied coverage due to a custodial exclusion is waived. See United States v. Holm, 326 F.3d 872, 

877 (7th Cir. 2003). Rather than focusing their analysis on the issue of a custodial exclusion, the 

City Defendants devote the vast majority of their brief to issues of Indiana contract law and 

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whether the city insurance plan is governed by ERISA. The Court has reviewed the City 

Defendants’ state law arguments, and it is not “absolutely clear” that the Plaintiff could not 

prevail under a state law breach of contract theory. At the very least, it is not “absolutely clear” 

how the Plaintiff’s claim against Dennis Radowski should be decided. 

 Thus, principles of federalism and judicial efficiency strongly indicate that this Court 

should not exercise supplemental jurisdiction over the remaining Defendants. See Huffman v. 

Hains, 865 F.2d 920, 923 (7th Cir. 1989) (“[R]espect for the state’s interest in applying its own 

law, along with the state court’s greater expertise in applying state law, [are] paramount 

concerns.”). As such, the Court declines to exercise supplemental jurisdiction over the Plaintiff’s 

state law claims against the City of Hammond, Professional Claims Management, and Dennis 

Radowski. The Plaintiff’s state law claims against these Defendants are dismissed without 

prejudice. 

CONCLUSION

For the reasons stated above, the United Food and Commercial Workers Union & 

Employers Calumet Region Insurance Fund’s Motion for Summary Judgment [ECF No. 94] and 

Motion to Strike [ECF No. 111] are GRANTED. The Clerk of Court is DIRECTED to enter 

judgment in favor of the Defendant United Food and Commercial Workers Union & Employers 

Calumet Region Insurance Fund and against Plaintiff Anchor Health Care Systems, Inc. 

The City Defendants’ Motion for Summary Judgment [ECF No. 91] is GRANTED in 

part and DENIED in part. The Court GRANTS summary judgment in favor of the Defendants 

City of Hammond and Professional Claims Management, Inc. to the extent Plaintiff has brought 

any federal claims against them. As to any federal claims, the Clerk of Court is DIRECTED to 

enter judgment in favor of Defendants the City of Hammond and Professional Claims 

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Management, Inc. and against Plaintiff Anchor Health Care Systems, Inc. The Court DECLINES 

to exercise supplemental jurisdiction over the Plaintiff’s state law claims against the City of 

Hammond, Professional Claims Management, Inc., and Dennis Radowski. The Plaintiff’s 

remaining state law claims against the City of Hammond, Professional Claims Management, 

Inc., and Dennis Radowski are DISMISSED without prejudice. The Court’s April 1, 2020 Order 

[ECF No. 112] is VACATED. 

SO ORDERED on April 22, 2020. 

 s/ Theresa L. Springmann 

 CHIEF JUDGE THERESA L. SPRINGMANN 

 UNITED STATES DISTRICT COURT 

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