Baptist Memorial Hospital v. Marsaw, 2000 U.S. App. LEXIS 2472 (6th Cir. Feb. 16, 2000)(unpublished)

Baptist Memorial Hospital v. Marsaw, 2000 U.S. App. LEXIS 2472 (6th Cir. Feb. 16, 2000)(unpublished)-Baptist Memorial Hospital ("BMH") appealed the order of the district court granting Bakery & Confectionary Union & Industry International Health Benefits Fund's ("the Fund") motion for summary judgment and denying BMH's motion for summary judgment. BMH claimed that the Fund owed it $ 355,216.33 for hospital services provided to David Marsaw, the dependent of a Fund beneficiary. The Fund denied payment of BMH's claim on the basis that BMH submitted the claim to the Fund long after the Fund's limitation period for showing proof of loss had run and because BMH admitted Marsaw without obtaining the certification as the Fund's plan required.

This court affirmed the district court's decision and reasoning in total. The court did, however, point out that the doctrine of equitable tolling principles used in Branch v. G. Bernd Co., 955 F.2d 1574 (11th Cir. 1992), did not apply to this case. The court found that "because the Fund's SPD expressly stated the limitations period for benefits claims, any application of federal common law tolling principles such as those applied by the Branch court would vitiate the primacy and integrity of the Fund's written plan." Citing Health Cost Controls v. Isbell, 139 F.3d 1070, 1072 (6th Cir. 1997); 1998 FED App. 0090P (6th Cir.),  federal courts may not apply common law theories to alter the express terms of written benefit plans."

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