Opinion ID: 710225
Heading Depth: 2
Heading Rank: 4

Heading: Reconsideration by the Fund

Text: 38 Although we find that the Trustees' decision was arbitrary and capricious, we do not conclude that Miller's claim necessarily should have been granted because we do not find that, upon the receipt of additional evidence, a reasonable fiduciary could only have granted the claim. Therefore, we remand to the district court with the instruction that the case be returned to the Fund for reconsideration. See Catania, 1992 WL 176502, at  9-10, 1992 U.S. Dist. LEXIS 10985, at  28-29. 39 The present record is incomplete and we therefore cannot conclude that there is no possible evidence that could support a denial of benefits. The burden of proving the medical necessity of the nursing care Potok received remains with Miller. See Fuja v. Benefit Trust Life Ins. Co., 18 F.3d 1405, 1408 (7th Cir.1994) (holding that where, as here, the medically necessary provision is described in the benefits section of the insurance contract rather than the exclusions section, the plaintiff bears the burden of establishing her entitlement to the insurance benefits). At the hearing, Miller provided evidence from a reliable expert, Potok's cardiologist, that the care was medically necessary. Upon receipt of this case, the Fund should be given the opportunity to present conflicting or contradictory evidence to overcome this evidence. Miller must then be permitted to produce any additional evidence to rebut any evidence on which the Fund could rely to deny benefits. 40 In conclusion, we find that the Fund acted arbitrarily and capriciously in denying the benefits to Potok. We remand to the district court with instructions to return the case to the Fund for reconsideration in the light of evidence presented by both sides.