Spizman v. BCBSM, Inc., No. 16-1557 (8th Cir. 2017)Annotate this Case
The Eighth Circuit affirmed the dismissal of plaintiff's claims against Blue Cross in a suit filed under the Employee Retirement Income Security Act (ERISA), 29 U.S.C. 1001 et seq., after Blue Cross denied round-the-clock in-home health coverage. The district court properly dismissed Count I and II, because these claims for round-the-clock in-home nursing services were contrary to the plain meaning of the private-duty nursing exclusions in the 2012 and 2013 policies. The district court properly dismissed Count VI because the policy plainly excluded extended hours skilled nursing care, and plaintiffs may not use an estoppel theory to enlarge benefits under a written plan.