The opinion of the court was delivered by: Siragusa, District Judge.
The Plaintiff filed a complaint with the Court on June 21,
2000, alleging that the Defendants improperly denied benefits to
him under an accidental dismemberment policy. Both parties agree
that the plan involved here falls under the provisions of the
Employee Retirement Income Security Act of 1974 ("ERISA"). This
case is before the Court on the Defendants' motion for summary
judgment and the Plaintiff's cross-motion for summary judgment.
Because the Court finds that the Plan Administrator's decision
was not arbitrary and capricious, the Court denies the
Plaintiff's motion for summary judgment and grants the
Defendants' motion for summary judgment, dismissing the case.
The plan at issue here is the January 1, 1997, Kodak
Accidental Death Insurance Plan ("Plan"). A copy of that plan is
attached to the affirmation of Pamela R. Cromp as Exhibit A.
Under Article nine of the Plan, a beneficiary who loses his
thumb is entitled to dismemberment benefits of twenty-five
percent of the employee's choice of coverage. Since the
Plaintiff chose coverage of $500,000, he would be entitled to
$125,000 if he met the Plan's requirements for loss of thumb.
On November 20, 1997, the Plaintiff was severely injured in a
hunting accident when a shotgun slug or bullet hit his right
thumb. According to his doctor, Jeffrey A. Jones, M.D., the
Plaintiff lost "3/4 of his thumb metacarpal, loss of the bone
attaching the thumb to the rest of the hand (trapezium), as well
as skin and muscle damage and complete transaction of the median
nerve all from a single bullet wound." Letter from Jeffrey A.
Jones, M.D. to Ian Mackler, Esq. (Nov. 23, 1998) at 1 (contained
in Cromp affirmation, Exhibit F).
The Plan defines Loss of Thumb at section 2.17, which states,
in pertinent part: "`Loss of Thumb' means that a Participant's
thumb is severed at or above knuckle joint nearest the hand."
Section 13.4, Governing Law, states that, "[t]his document shall
be construed and governed in accordance with the laws of New
York State, except as such laws are preempted by applicable
Article 11 of the Plan gives the Plan Administrator "the
exclusive right: to interpret the Plan; to determine eligibility
for Coverage; to determine eligibility for Benefits; to construe
any ambiguous provision of the Plan; to correct any default; to
supply any omission; to reconcile any inconsistency; and to
decide any and all questions arising in the administration;
interpretation; and application of the Plan." Plan section
11.1(b). This article further provides:
The Plan Administrator shall have full discretionary
authority in all matters related to the discharge of
his responsibilities and exercise of his authority
under the Plan including, without limitation, his
construction of the terms of the plan and his
determination of eligibility for Coverage and
Benefits. It is the intent of the Plan that the
decisions of the Plan Administrator and his action
with respect to the Plan shall be conclusive and
binding upon all persons having or claiming to have
any right or interest in or under the Plan and that
no such decision or action shall be modified upon
judicial review unless such decision or action is
proven to be arbitrary or capricious.
On or about May 13, 1998, the Plaintiff applied for accidental
dismemberment benefits in the amount of $125,000. The
application was made to the Metropolitan Life Insurance Company.
See Cromp affirmation Exhibit B. Metropolitan was the Claims
Administrator under the Plan. See Plan section 13.1. On
November 11, 1998, Metropolitan denied the Plaintiffs claim
finding that while the Plaintiff had lost, "approximately 75% of
[his] thumb metacarpal (the bone between the thumb and the
hand), [his] thumb was not severed."
Pursuant to section 11.4 of the Plan, the Plaintiff appealed
this decision to the Plan Administrator, the Director,
Compensation, Benefits and Staffing, U.S. & G., Human Resources,
Eastman Kodak Co. See Ian Mackler, Esq. letter to Susan Izzo
(Nov. 18, 1998), Cromp affirmation Exhibit D. On June 16, 1999,
the Plan Administrator, Pamela R. Cromp, affirmed the decision
of the Claims Administrator. See Pamela R. Cromp letter to Ian
Mackler, Esq. (June 16, 1999), Cromp affirmation Exhibit E. Ms.
The facts demonstrate that Mr. Van Wuyckhuyse's
injury did not involve a severing of the thumb at or
above the knuckle joint and, therefore, did not
constitute a "Loss of Thumb" within the meaning of
the plan. Although Dr. Jones noted that Mr. Van
Wuyckhuyse's injury was "similar to" a thumb
severance and replantation, he also acknowledges in
his 11/23/98 correspondence that "the thumb blood