DISCLAIMER: The following unofficial case summaries are prepared by the clerk's office
as a courtesy to the reader. They are not part of the opinion of the court.
182784P.pdf 03/20/2020 Ivan Mitchell v. Blue Cross Blue Shield of ND
U.S. Court of Appeals Case No: 18-2784
and No: 18-2890
U.S. District Court for the District of North Dakota - Fargo
[PUBLISHED] [Kelly, Author, with Colloton and Beam, Circuit Judges]
Civil case - ERISA. The wrongful denial of plan benefits breaches the
parties' contract and deprives the participant of the benefit of their
bargain; this constitutes an injury to the participant even if the
benefits have been assigned to a third party, such as the service
provider; as a result, plaintiffs satisfy the injury-in-fact component of
standing; they also have statutory standing to bring an action to recover
benefits due under the terms of the plan; the plan gives Blue Cross broad
discretion to determine the "Allowed Charge" for air-ambulance services
and Blue Cross has adopted a consistent interpretation, tied to an
external benchmark, which is compatible with both the plan's language and
its purpose, and the court cannot say Blue Cross has abused its
discretion; Blue Cross's interpretation of the "medical-supply fee"
language was not an abuse of its discretion, and the district court erred
in granting plaintiff's motion for summary judgment on this claim.