2009AP1558 Steffens v. BlueCross BlueShield of Illinois

Insurance
ERISA

Where a benefits plan gave the plan the right to recover expenses incurred as a result of accidents for which a third party may be liable, it was not arbitrary for the plan administrator to conclude that it was entitled to reimbursement.
“In sum, given Steffens’ consistent averments prior to settlement that the surgery-necessitating injuries arose out of the accident, we cannot say that the Plan administrator’s determination that the surgery-necessitating injuries arose out of the accident was arbitrary and capricious. Stated another way, because Steffens himself averred both before and after BlueCross’s counterclaim for reimbursement under the Plan that the surgery-necessitating injuries arose out of the accident, it is reasonable for the Plan administrator to have reached the same conclusion. See Ruiz, 400 F.3d at 991.”

Reversed.

2009AP1558 Steffens v. BlueCross BlueShield of Illinois

Roggensack, J.

Attorneys: For Appellant: Peterson, John C., Appleton; Risseeuw, Amy Marie, Appleton; For Respondent: Sullivan, Sheila M., Madison; Germonprez, Sarah, Madison

Full Text