Hunter v. Baylor Health Care System

Court: ND Tx  08/14/2019  District Court Finds that a Hospital was not an "Insurer" for Purposes of Determining whether a Discretionary Clause in an Occupational Injury Benefit Plan was Banned

A Court of the Northern District of Texas granted a hospital's motion for summary judgment that it, as an administrator of a ERISA plan, did not qualify as an insurer under Texas Insurance Code Sec. 1701.062 (banning discretionary clauses in certain insurance policies), where the claimant failed to meet her burden to show the hospital qualified as insurer; thus, an abuse of discretion standard apllied to review of the hospital's claim denial rather than statutory de novo review.

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ERISA plandenial of claimpreexisting conditionTexas Insurance Code Section 1701.062discretionary clauseoccupational injury benefit planabuse of discretionde novo reviewsubstantial evidence

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