BOWER v. BUCKEYE VILLAGE MARKET EMPLOYEE BENEFIT PLAN, 1999 U.S. App. LEXIS 12031 (6^th Cir. June 4, 1999) (unpublished)-BEFORE: KENNEDY, DAUGHTREY, and CLAY, Circuit Judges. CLAY, Circuit Judge, concurring. Plaintiff was under-aged, but legally intoxicated, at the time of the one-car accident which caused the underlying injuries. Since the Defendant Plan would not pay the medical costs, the Ohio Department of Human Services paid for the care. Plaintiff and the Ohio Department of Human Services sued for the costs of the treatment. Plaintiff also sued for the costs of treatment that he claimed he would have received if the Defendant Plan had not denied the benefits. The District Court held that the Ohio Department of Human Services had derivative standing to sue. The District Court also held that Plaintiff could raise claims for the medical treatment he did not review. District Court granted summary judgment for defendants on the merits.

Sixth Circuit refused to reach the question whether the Ohio Department of Human Services had derivative standing since it ruled for Defendants on the merits. The Court followed the en banc decision in Perez v. Aetna Life Ins. Co., 150 F.3d 550 (6th Cir. 1998). In that case, the Sixth Circuit held that a "clear grant of discretion to the plan administrator" could be gleaned from language stating that the insurer "shall have the right to require as part of the proof of claim satisfactory evidence . . . that [the claimant] has furnished all required proofs for such benefits . . . ." Id. at 555. The plan document provides that "the administrator has the sole authority and responsibility to review and make final decisions on all claims to benefit hereunder." Sixth Circuit held that this language granted discretion and therefore the district court correctly applied the arbitrary and capricious standard of review. "It would indeed be a twisted interpretation of the quoted language to conclude that the vesting of such broad powers in the administrator did not grant that individual authority to determine eligibility for benefits.

Sixth Circuit agreed that a reasoned explanation could be offered to support the administrator's conclusion that the plan's payment exclusion for charges "incurred in connection with any intentionally self-inflicted injury," or for charges "resulting from or occurring during the commission of a crime" or "while engaged in an illegal act" would apply in this situation. Parties did not dispute that the Plaintiff was legally intoxicated at the time of the accident and that, at age 20, was not of the legal drinking age. Therefore the plan was not arbitrary or capricious in denying benefits.

Concurring opinion stated that the Ohio Department of Human Services had standing despite there being no valid assignment and that the Ohio Department of Human Services was not one of the enumerated parties. Concurrence argued that ERISA did not preempt the Ohio Medicaid laws, OHIO REV. CODE @@ 5101.58 and 5101.59 since a Federal statute required a Medicaid recipient to give subrogation rights to the Ohio Department of Human Services.