Susan Pellicano, Successor in Interest to Michael Pellicano v. The Office of Personnel Management, Insurance Operations, Health Insurance II

Summary

The United States District Court for the Middle District of Pennsylvania adopted a magistrate judge's report and recommendation and resolved cross-motions for summary judgment in a dispute over Federal Employees Health Benefits Act coverage. The court held that OPM's denial of coverage for a replacement shower commode chair for a quadriplegic federal retiree was arbitrary and capricious, granted the plaintiff's motion for summary judgment, and denied the defendant's motion. The court ordered judgment for the plaintiff in the amount submitted for reimbursement of the chair.

Holdings

1. OPM's decision to characterize the shower commode chair as a mere convenience and not medically necessary was arbitrary and capricious and an abuse of discretion.
2. The plaintiff was entitled to summary judgment, and OPM was not entitled to summary judgment, on the remaining shower-commode-chair claim.

Questions Presented

1. Whether OPM's renewed denial of coverage for a replacement shower commode chair was arbitrary and capricious, an abuse of discretion, or otherwise contrary to law under the APA.
2. Whether the district court should grant summary judgment to the plaintiff and award reimbursement for the replacement shower commode chair.

Disposition

other