# U ni te d S ta te s Co ur t of A pp ea ls

For the Eig hth Circu it

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No. 1 6- 15 57

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Ral ei gh Sp iz m an ; Ro be rt S pi zm an

ll ll ll ll ll ll ll ll ll ll l Pla in ti

ff s - Ap pe ll an ts

v.

BCB SM, In c., do in g b us in es s as Blu e Cro ss Blu e Sh ie ld of M in ne so ta

ll ll ll ll ll ll ll ll ll ll l Defe nd

an t - Ap pe ll ee

__ __ __ __ __ __
App eal fro m

Uni te d S ta te s Di st ric t Co ur t fo r th e Dis tri ct of M in ne so ta - Mi nn eap ol is

__ __ __ __ __ __

Su bm it te d: Decem

be r 13 , 20 16
Fil ed : M ay

4, 2 01 7

__ __ __ __ __ __

Befo re LOKEN, MURPHY, and KELLY , Cir cu it Ju dg es

.

__ __ __ __ __ __

LOKEN, Ci rcu it Ju dg e.

Ral ei gh Sp iz m an was ho sp it al iz e d i n N o v em be r 20 12 an d ret ur ne d ho m e in

Feb ru ary 20 13

, whe re a ho m e he al th care pr ov id er an d pe rs on al care as si st an ts be ga n

pr ov id in g 24 -h ou r care

. Bl ue Cro ss Bl ue Sh ie ld o f Mi nn es ot a pr ov id ed Ral ei gh ’s

he al th care in su ran ce co ve rag e un de r a gr ou p po li cy sp on so red by he r hu sb an d

Ro be rt’s em

pl oyer. W he n Bl ue Cro ss de ni ed th e Sp iz m an s “ ro un d- th e-cl oc k” in

ho m e he al th care co ve rag e, th ey br ou gh t th is fed eral act io n, as se rti ng cl ai m s fo r rel ie fin si x co un ts

. The di st ric t co ur t gr an te d Bl ue Cro ss ’s m ot io n to di sm is s fo ur co un ts

, 1

th e p a r ti es st ip ul at ed to di sm is s th e rem ai ni ng two co un ts wit h pr ejud ic e, an d th e

co ur t en te red fin al jud gm en t in fav o r o f B l u e Cro ss

. The Sp iz m an s ap pe al th e
di sm is sa l of Co un ts I, II, an d VI, cl ai m s go ve rn ed b y t h e Emp l oyee Ret ire m en t

In co m e Secu rit y Act (ERISA), 29 U.S.C. §§ 10 01 et seq . W e ta ke th e fact s all eg ed

in th ei r Fi rs t Am en de d Co m pl ai nt as tru e an d al so co ns id er in su ra n c e po li cy
do cu m en ts pl aced in th e di st ric t co ur t reco rd

. See Ene rv at io ns , In c. v. Mi nn

. Mi n. &
Mfg

. Co

., 38 0 F.3d 10 66

, 10 69 (8 th Ci r. 20 04 ). Rev ie win g th e gr an t of a m ot io n to

di sm i s s d e no vo , we affi rm

. Harri s v. The Epo ch Grp ., L.C., 35 7 F.3 d 82 2, 82 4- 25
(8 th Cir . 20 04 ) (s ta nd ard of r ev ie w).

I. Ba ck gr ou nd.

On Nov em

be r 18

, 20 12

, Ral ei gh Sp iz man was ho sp it al iz ed an d pl aced on a

ve nt il at or aft er d ev el op in g a cu te asp ira ti on pn eu m on ia . Befo re s he ret ur ne d h om e,

th e Sp i z man s de ci de d to hi re a ho m e he al th ag en cy to m an ag e he r pu lm on ary
reh ab il it at io n an d wean in g of f th e ve nt il at or

. Th e B lu e Cro ss gr ou p he al th care

po li cy is su ed to Ro be rt’s em pl oyer was ren ewed each cal en da r y ear. The Co m pl ai nt

al le ge d th at a Bl ue Cro ss ag en t as su red Ro be rt th at th e 20 13 po li cy wou ld pr ov id e th e

sa m e co ve rag e as th e 20 12 po li cy an d wou ld co ve r Ral ei gh ’s ho m e he al th care ne ed s.

In earl y 20 13

, a Bl ue Cro ss cl ai m s rep res en ta ti ve to ld Ro be rt th ere wou ld be co ve rag e

an d be ne fit s fo r Ral ei gh ’s care

. Des pi te th es e as s u r a nc es , Bl ue Cro ss de ni ed

co ve rag e o f th e Sp iz m an s’ cla im for 24 -h ou r in -h om e h eal th care

.

Afte r Bl ue Cr o s s de ni ed th ei r in te rn al ap pe al s, th e Sp iz m an s br ou gh t th is

fed eral co ur t act io n. Bl ue Cro ss m ov ed to di sm is s fiv e of th e si x co un ts

. Mag is tra te

The Hon or ab le Mi ch ael J. Dav is

, Uni te d St at es Dis tri ct Ju dg e fo r th e Dis tri ct 1

of Mi nn es ot a, ad op ti ng th e Rep or t and Rec om m en da ti on of th e Hon or ab le Ton y N.
Leu ng , Uni te d S ta te s M ag is tra te Ju dg e fo r th e Dis tri ct of M in ne so ta

.

-2

-Ju dg e Leu ng is su ed a Rep or t an d Rec om m en da ti on reco m m en di ng di sm is sa l of fo ur

co un ts

, whi ch th e di st ric t co ur t ad op te d afte r de no vo rev ie w. Sp iz m an v. BCB SM,

In c., 20 15 W L 45 69 24 9, at *1 1 (D. Mi nn

. Ju ly 27

, 20 15 ). Not di sm is se d were Co un t
III, a cl ai m un de r 29 U.S.C. § 11 32 (a)( 1) (b ) to reco ve r be ne fit s du e un de r th e ERISA
pl an , an d Co un t IV, a cl ai m un de r 29 U.S.C. § 11 32 (a)( 3) fo r “ ot he r ap pr op ria te

eq ui ta bl e rel ie f” fro m Bl ue Cro ss ’s al le ge d br each of fid uc ia ry du ty in refu si ng to pa y pl an be ne fit s. Th e d i s t ric t co ur t su bs eq ue nt ly di sm is se d Co un ts III an d IV wit h

pr ejud ic e pu rs ua nt to th e pa rti es ’ st ip ul at io n. The is su es be fo re us are th e Sp iz m an s’

ap pe al of t he di sm is sa l o f Co un ts I, II, an d VI.

II . Count I a nd Co unt I I.

In Co un ts I an d II, t h e Sp iz m an s so ug ht a de cl arat or y jud gm en t th at th ey are

en ti tl ed to he al th care co ve rag e fo r “ Ral ei gh Sp iz m an ’s ho m e he al th care ne ed s an d

req ui rem en ts ,” whi ch

, th e Co m pl ai nt al le ge d, in cl ud ed “ in te rm it te nt sk il le d nu rs in g

c a r e b e yo n d on e vi si t pe r da y .” The Bl ue Cro ss 20 12 Cert ifi cat e of Co ve rag e

pr ov id ed ho m e he al th care co ve rag e fo r “ [s ]kil le d care or de red in wri t i n g by a ph y si ci an an d pr ov id ed by [ap pr ov ed ] ho m e he al th ag en cy em pl o y ees ,” in cl ud in g

“ [s ]ervi ces th at are m ed ic al ly ne ces sa ry an d p ro vi de d b y a li cen se d nu rs e.” Bu t th e

po li cy ex cl ud ed “ se rv ic es fo r or rel at ed to pr iv at e-d ut y nu rs in g.” The po li cy di d no t

de fin e “ pr iv at e-d ut y nu rs in g.” Th e 20 13 Cert ifi cat e of Co ve rag e li ke wis e co ve red

sk il le d ho m e he al th care se rv ic es in cl ud in g “ in te rm it te nt sk il le d nu rs in g care in y ou r
ho m e.” Bu t th e po li cy ex cl ud ed “ ex te nd ed ho ur s s ki ll ed nu rs in g care, als o referr ed

to as pr iv at e-d u t y nu rs in g care .” The po li cy de fin ed “ in te rm it te nt sk il le d nu rs in g

care ” as “ a vi si t by a reg is te red nu rs e or li cen se d pr act ic a l nu rs e of up to fo ur (4 )

co ns ecu ti ve ho ur s i n d ur at io n.”

A

. In Co un t I, th e Sp iz m an s al le ge d th at th e 20 13 po li cy Cert ifi c a t e

su bs ta nt ia ll y red uc e d t h e co ve rag e pr ov id ed by th e 20 12 po li cy by li m it in g th e

-3

-co ve rag e of “ in te rm it te nt sk il le d nu rs in g care ” to on e fo ur -h ou r vi si t; th at Bl ue Cro ss

vi ol at ed it s affi rm at iv e du ty to no ti fy th e Sp iz m an s of th is red uc ti on i n c ov erag e,

ren de rin g th e ex cl us io n in th e 2 0 1 3 po li cy vo id un de r Mi nn es ot a la w; an d th at th e

20 12 po li cy co ve red Ral ei gh ’s “ ro un d- th e-cl oc k 24 -h ou r care ” be cau se it s “ pr iv at edu ty nu rs in g care ” ex cl us io n was am bi gu ou s an d th eref

or e m us t be co ns tru ed ag ai ns t

th e in su rer u nd er Mi nn es ot a la w.

In di sm is si ng Co un t I, Ma g i st rat e Ju dg e Leu ng co nc lu de d th at in te rp ret in g

“ pr iv at e-d ut y nu rs in g” as ex cl ud in g Ral ei gh ’s ro un d- th e-cl oc k in -h om e nu rs in g care

“ is co ns on an t wit h th e te rm ’s co m m on ly un d e r s t oo d m ean in g an d di ct io na ry
de fin it io n.” Sp iz m an , 20 15 W L 45 69 24 9, at *5

. W e ag ree. W E B S T E R ’ S T H IR D N E W

I N T E R N A T I O N A L D IC T IO N A R Y de fin es “ pr iv at e-d ut y ,” whe n us ed as an ad jecti ve
de sc rib in g a nu rs e, as “ cari ng fo r a si ng le pa ti en t ei th er in th e ho m e or in a ho sp it al .”
(u na br id ge d ed

. 19 86 ). Si m il arl y , Med ic ai d reg ul at io ns pr ov id e th at “ [p ]riva te du ty

nu rs in g se rv ic es m ean s nu rs in g se rv ic es fo r be ne fi ci ar ie s w ho re qui re m or e indiv id ua l

an d co nt in uo us care t h a n i s a v a i l ab le fro m a vi si ti ng nu rs e.” 42 C.F.R. § 44 0.8 0.

Pro vi di ng Ral ei gh r o un d- th e-cl oc k in -h om e nu rs in g care is nu rs in g “ fo r a si ng le

pa ti en t

. . . in th e ho m e,” an d i s “m o r e i n di vi du al an d co nt in uo us care th an is

av ai la bl e fro m a vi si ti ng nu rs e.” Thu s, the Sp iz m an s’ cl ai m fo r ro un d- th e-cl oc k in

ho m e nu rs in g care fel l wit hi n th e pl ai n m ean in g an d co m mo n un de rs ta nd in g of th e

“ pr iv at e-d ut y

nu rs in g” ex cl us io n i n t he 20 12 po li cy

.

On ap pe al

, th e Sp iz m an s arg ue th at

, un de r Mi nn es ot a la w, “ pr iv at e-d ut y

nu rs in g” is an am

bi gu ou s te rm th at m

us t be co ns tru ed in th ei r fav or

. Thi s co nt en ti on
is co nt rary to well -s et tl ed fed eral la w. In co ns tru in g am bi gu it ie s in an ERISA pl an ,

we ap pl y fed eral la w, no t Mi nn es ot a la w, co ns tr ui ng di sp ut ed la ng ua ge “ wit ho ut

de ferr in g to ei th er pa rty’ s in te rp ret at io n.” Brewe r v. Lin co ln Nat’l Life In s. Co

., 92 1

F.2 d 15 0, 15 4 (8 th Ci r. 19 90 ) (q uo ta ti on om it te d)

, cert

. de ni ed

, 50 1 U.S. 12 38 (1 99 1)

. W e do no t ap pl y “ t h e co nt ra in su rer or reas on ab le ex pe ct at io n do ct rin es , bo th of

-4

-whi ch are ge ne ral ru le s of co nt ract co ns tru ct io n no t sp eci fic t o th e in su ran ce

in du st ry .” Mee st er v. IASD Heal th Serv s. Co rp ., 96 3 F.2 d 19 4, 19 7 (8 th Ci r. 19 92 ).

Bec au se an ERISA pl an m us t be “ writ te n in a m an ne r cal cu la te d to be un de rs to od by

th e av erag e pl an pa rti ci pa nt ,” 29 U.S.C. § 10 22 (a), we acco rd p o l i c y t erm s th ei r

or di na ry , pl ai n m ean in g. See Kno wlt on v. Anh eu se r-Bu sc h Co s. Pen si on Pl an , 84 9

F.3 d 42 2, 42 9 (8 th Ci r. 20 17 ); Kit te rm an v. Co ve nt ry Heal th Care of Io wa, In c., 63 2

F.3 d 44 5, 44 8 ( 8 t h Ci r. 20 11 ). “ Rec ou rs e to th e or di na ry , di ct io na ry de fin it io n of

w o rd s is no t on ly reas on ab le

, bu t m ay be ne ces sa ry .” Kho ur y v. Grp

. Heal th P l a n , In c., 61 5 F .3d 94 6, 9 55 (8t h C ir. 2 01 0) (qu ot at io n o m it te d)

.

W e rev ie w a pl an ad m in is tra to r’s de ci si on un de r th e sa m e st an da rd of rev ie w

as th e di st ric t co ur t. See Je ss up v. Alco a, In c., 48 1 F.3 d 10 04

, 10 06 (8 th Ci r. 20 07 ).

As s u m in g wit ho ut de ci di ng th at th e ap pr op ria te st an da rd is de no vo rev ie w of th e

20 12 po li cy ’s “ pr iv at e-d ut y nu rs in g” ex cl us io n, we ag ree wit h th e di st ric t co ur t th at

th e Sp iz m an s’ cl ai m fo r ro un d- th e-cl oc k in -h om e nu rs in g c a r e , th e on ly cl ai m

as se rte d in Co un t I, fel l wit hi n th e pl ai n la ng ua ge of th e “ pr iv at e- d u t y n u r s in g”

ex cl us io n. Acco rd Krau ss v. Oxf or d Heal th Pl a n s , I n c

. , 41 8 F. Su pp

. 2d 41 6, 43 3
(S.D.N.Y. 20 05 ) (“ pr iv at e or sp eci al du ty” nu rs in g ex cl us io n ba rred rei m bu rs em en t

fo r “ co ns ta nt care so le ly” to in su red ), aff’d, 51 7 F.3 d 61 4, 62 9 (2 d Ci r. 20 08 ). Thu s,

t h e d i s t r i c t co ur t pr op erl y di sm is se d Co un t I fo r fai lu re to st at e a cl ai m , wh et he r or

no t t he 20 13 po li cy

red uc ed th is co ve rag e. 2

B. In C ou nt II, th e Sp iz m an s al le ge d t ha t t he 20 13 po li cy , if ap pl ic ab le , als o

co ve red th ei r cl ai m fo r ro un d- th e-cl oc k in -h om e nu rs in g se rv ic es

. Bl ue Cro ss ru le d

The Sp iz m an s’ alt ern at iv e arg um en t th at th ey are en ti tl ed to co ve rag e u nd er 2

th e 20 12 po li cy ’s be ne fit su bs ti tu ti on pr ov is io n is wit ho ut m eri t. The po li cy pr ov id es th at “ be ne fit su bs ti tu ti on can no t be us ed to al lo w co ve ra g e fo r se rv ic es or su pp li es

ex cl ud ed by th e Pl an .” The po li cy ex cl ud ed th ei r cl ai m fo r ro un d- th e-cl oc k in -h om e

nu rs in g c are, s o b en efi t s ub st it ut io n d id no t ap pl y

.

-5

-th at th is cl ai m was b arre d b y

th e ex cl us io n o f “ ex te nd ed ho ur s sk il le d nu rs in g care,

al so refe rred to as pr iv at e-d ut y nu rs in g c are.” The Sp iz m an s as se rt t he ir cl ai m was
wit hi n th e co ve rag e fo r “ in te rm i t te nt sk il le d nu rs in g care .” The y arg ue th at th e
d e f in it io n of th at te rm -- a vi si t by a reg is te red or li cen se d pr act ic al nu rs e of u p t o

fo ur ho ur s du rat io n -- di d no t in cl ud e th e wor ds “ pe r da y ,” an d th eref or e th ey were

al lo wed to st ack m

ul ti pl e fo ur -h ou r vi si ts in a si ng le da y to m eet Ral ei gh ’s ro un d- th ecl oc k in -h om e nu rs in g ne ed s. The di st ric t co ur t reject ed th is co nt en ti on , co nc lu di ng

th at Bl ue Cro ss di d no t ab us e it s di sc ret io n in in te rp ret in g th e 20 13 po li cy pr ov is io ns

co ve rin g “ in te rm it te nt sk il le d nu rs in g care ” an d ex cl u d i n g “ex te nd ed ho ur s sk il le d

nu rs in g c are.”

W he n a n ER I S A pl an gr an ts di sc ret io na ry au th or it y to m ak e be ne fit

de te rm in at io ns , th e ad m in is tra to r’s in te rp ret at io n o f th e p la n i s s ub ject t o a bu se -o fdi sc ret io n rev ie w. In gr am v. Term in al R.R. Ass ’n of St

. Lo ui s Pen si on Pl an fo r

Non sc he du le Em

ps ., 81 2 F.3 d 62 8, 63 0- 31 (8 th Ci r. 20 16 ). The Sp iz m an s co nc ed e

th at th e 20 13 po li cy ex pr es sl y gr an te d Bl ue Cro ss di sc ret io na ry au th or it y

. Bu t th ey

arg ue th e di st ric t co ur t erre d in rev ie win g Bl ue Cro ss ’s ad ve rs e de ci si on fo r ab us e of

di sc ret io n be cau se “ a pa lp ab le co nf li ct of in te res t or a se rio us pr oc ed ur al irr eg ul ari ty

ex is te d, whi ch

. . . cau se d a se rio us br each of th e [ c l a im ] ad m in is tra to r’s fid uc ia ry
du ty.” Id

. at 63 1 (q uo ta ti on om it te d)

. W hi le Bl ue Cro ss di d ha ve a fin an ci al co nf li ct

of in te res t as bo th pa y or an d pl an ad m in is tra to r, th e Su pr em e Co ur t cl ari fie d in

Met ro po li ta n Life In s. Co

. v. Glen n, 55 4 U.S. 10 5 (2 00 8)

, th at th is co nf li ct do es no t

ch an ge th e ab us e-o f-d is cret io n st an da rd of rev ie w. Rat he r, “ rev ie win g judg e[s ]

. . .
ta ke acco un t of th e co nf

li ct whe n de te rm in in g whe th er th e [ c l a i ms ad m in is tra to r],

su bs ta nt iv el y or pr o c e d u r a l l y , ha s ab us ed [it s] di sc ret io n.” Id

. at 11 5. The di st ric t

co ur t pr op erl y ga ve “ so m e weig ht ” to th is co nf li ct of in te res t in r ev ie win g Bl ue

Cro ss ’s de ci si on

. Sp iz m an , 20 15 W L 45 69 24 9, at *6

. As in Jo hn so n v

. Uni te d of

Om ah a Life In s

. C o

. , th e pr oc ed ur al irr eg ul ari ti es al le ge d by th e Sp iz m an s do no t

-6

-“ tri gg er [ de no vo rev ie w ba se d on ] a to ta l la ck of fai th in th e in te gr it y of th e de ci si on

m ak in g p ro ces s.” 7 75 F.3d 98 3, 9 88 (8t h C ir. 2 01 4) (qu ot at io n o m it te d)

.

W he n a pl an ad m in is tra to r’s de ci si on is rev ie wed fo r ab us e of di sc ret io n, “ th e
ad m in is tra to r’s in te rp ret at io n of un cert ai n te rm s in a pl an wi ll no t be di st ur be d if

reas o n a b l e

. ” Kin g v. Hart fo rd Life & Acc. In s. Co

., 41 4 F.3 d 99 4, 99 9 (8 th Ci r.

20 05 ) (en ba nc ) (q uo ta ti on om it te d)

. “ Wh e r e a p l an fid uc ia ry of fere d a reas on ab le

in te rp ret at i o n of a di sp ut ed pl an pr ov is io n, co ur ts m ay no t rep la ce it wit h an

in te rp ret at io n of th ei r own -- an d th eref or e can no t di st ur b as an ‘abu se of di sc ret io n’

th e ch al le ng ed be ne fit s de te rm in at io n.” In gr am , 81 2 F.3 d at 63 4 (q uo ta ti on om it te d)

.

The Sp iz m an s as se rt th at th e 20 13 po li cy sh ou ld be co ns tru ed as co ve rin g

m u l ti pl e nu rs in g care vi si ts each da y be cau se th e po li cy di d no t de fin e in te rm it te nt

care as li m it ed to on e fo ur -h ou r vi si t. Bu t th is in te rp ret at io n wou ld be un reas on ab le

be cau se , as th e di st ric t co ur t no te d, st ack in g m ul ti pl e fo ur -h ou r nu rs in g vi si ts wou ld

nu ll ify th e po li cy ex cl us io n of “ ex t e nd ed ho ur s sk il le d nu rs in g care ,” whi ch th e

po li cy de fin ed as care th at is “ co nt in uo us .” Sp iz m an , 20 15 W L 45 69 24 9, at *7 ; se e

Kin g, 41 4 F.3 d at 10 04 -0 5. Thu s, ev en if Bl ue Cro ss ’s de ci si on is rev ie wed de no vo ,
rat he r th an fo r ab us e of di sc ret io n, we ag ree wit h th e di st ric t co ur t th at de ni al of th e

Co un t II cla im

for rou nd -th e-cl oc k i n- ho m e n ur si ng care m us t b e u ph el d.

Fo r th es e reas on s, we affi rm th e di sm is sa l of Co un t I an d Co un t II of th e Fi rs t

Am en de d Co m

pl ai nt . Th e Sp iz m an s ar gu e th at th e d is tri ct co ur t ac te d p rem at ur el y

in di sm is si ng th es e cl ai m s w ith ou t fact ua l de ve lo pm en t of th ei r al le ga ti on s th at a Bl ue

Cro ss cl ai m s rep res en ta ti ve to ld t h e Sp iz m an s th at th e 20 13 po li cy wou ld co ve r

Ral ei gh ’s ho m e he al th care ; th at Bl ue C r o s s g ran te d so m e cl ai m s, de ni ed so m e
cl ai m s, an d he ld ot he rs in pr oc es s as pa rt of a pl oy to frau du le nt ly ba r ex te rn al rev ie w
of it s c la im s de ci si on s; an d th at Bl ue Cro ss un reas on ab ly de la y ed de ci di ng th ei r

in te rn al ap pe al s. The se al le ga ti on s m i g h t h av e be en rel ev an t to th e cl ai m in Co un t

-7

-III to reco ve r be ne fit s du e un de r th e ERISA pl an , or th e cl ai m in Co un t IV fo r br each

of fid uc ia ry du ty. Bu t th e Sp iz m an s elec te d to di sm is s t ho se cla im s with pr ejud ic e.

As th e cl ai m s in Co un t I an d Co un t II fo r ro un d- th e-cl oc k in -h om e nu rs in g serv ic es

were co nt rary to th e pl ai n m ean in g of th e pr iv at e-d ut y nu rs in g ex cl us io ns in th e 20 12

an d 2 01 3 p ol ic ie s, t ho se Co un ts were p ro pe rly dis m is se d.

II I. Co unt VI

.

In Co un t VI, a cl ai m fo r eq ui ta bl e es to pp el

, th e Sp iz man s a l l e g e d th at th ey

were en ti tl ed to eq ui ta bl e r el ie f un de r 29 U.S.C. § 11 32 (a)( 3) th at gr an ts th e ho m e
he al th care be ne fit s Bl ue Cro ss ’s ag en ts pr om is ed wou ld be pa id un de r am bi gu ou s

po li cy te rm s. The di st ric t co ur t d i s m is se d Co un t VI be cau se th e po li cy pl ai nl y

ex cl ud ed “ ex te nd ed ho ur s sk il le d nu rs in g care ,” an d th e Sp iz m an s “ m ay no t us e an

es to pp el th eo ry to en la rg e be ne fit s un d e r a writ te n pl an .” Sp iz m an , 20 15 W L

45 69 24 9, at *1 1. The pr in ci pl e is so un d. See Neu m an n v. AT&T Co m m nc ’ns, In c.,

37 6 F.3 d 77 3, 78 4 (8 th C i r

. 20 04 ); Fi nk v. Uni on Cen t. Life In s. Co

., 94 F.3 d 48 9,

49 2 (8 th Cir . 19 96 ). W e co nc lu de it was c or rect ly app li ed

.

As pl ead ed in Co un t I an d Co un t II, th e Sp iz m an s cl ai m ed co ve rag e fo r ro un dth e-cl oc k in -h om e sk il le d nu rs in g care th at th e po l ic y ex cl ud ed

. Not hi ng in Co un t

VI su gg es te d th at an y ot he r le ve l o f be ne fit s was be in g cl ai m ed in th ei r es to pp el

th eo ry

. Thu s, th e di st ric t cou rt so un dl y reas on ed th at Co un t VI so ug ht an im pr op er

en la rg em en t of pl an be ne fit s. The co ur t de cl in ed to di sm is s Co un t IV, a br oa d cl ai m

fo r eq ui ta bl e rel ie f un de r § 11 32 (a)( 3) fo r Bl ue Cro ss ’s al le ge d br each es of fid uc ia ry
du ty, b ecau se “ th e in st an t di sp ut e is st il l at th e m ot io n t o di sm is s st ag e.” Sp iz m an , 20 15 W L 45 69 24 9, at *1 0. Thu s, th e on ly § 11 32 (a)( 3) cl ai m th e co ur t di sm is se d on

th e pl ead in gs was on e fo r be ne fit s ex cl ud ed by th e pl ai n m ean in g of th e te rm s of th e pl an . To th e ex te nt th e Sp iz m an s in te nd ed to ass ert an eq ui ta bl e es to pp el cla im for

-8

-so m e le ss er le ve l of be ne fit s, th ey vo lu nt ari ly rel in qu is he d th at cl ai m by di sm is si ng

Co un t IV wi th pre

jud ic e.

Fo r th es e rea so ns , th e jud gm en t o f th e d is tri ct co ur t i s af fir m ed

.

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