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SCARINCI v. CICCIA

March 1, 1995

NANCY M. SCARINCI
v.
VINCE J. CICCIA, SECRETARY AT&T BENEFIT CLAIM AND APPEAL COMMITTEE



The opinion of the court was delivered by: JAMES MCGIRR KELLY

 J. M. KELLY, J.

 MARCH 1, 1995

 The court has now considered the testimony that has been presented in this case and is prepared to make its Findings of Fact and Conclusions of Law and decision.

 FINDINGS OF FACT

 1. Plaintiff Nancy M. Scarinci ("Scarinci") is a citizen of the Commonwealth of Pennsylvania and was an employee of the American Telephone and Telegraph Company ("AT&T") at its Allendale Road, King of Prussia, Pennsylvania facility until February 20, 1991.

 2. Defendant Vince J. Ciccia is Secretary of the AT&T Benefit Claim & Appeal Committee. He has been Secretary of the AT&T Benefit Claim & Appeal Committee since May 1, 1991.

 3. The AT&T Sickness & Accident Disability Benefit Plan ("SADB Plan") provides that AT&T shall be Plan Administrator and shall appoint an "Employees' Benefit Committee" with administrative responsibilities.

 4. The Employees' Benefit Committee has the powers "necessary in order to enable it to administer the Plan" and adopts such by-laws and rules as it may find appropriate.

 5. The Employees' Benefit Committee "shall grant or deny claims for benefits under the Plan and authorize disbursements according to the [SADB] Plan."

 6. The Employees' Benefit Committee may delegate its authority to grant or deny claims for benefits.

 7. Where the Employees' Benefit Committee has delegated its authority to grant or deny claims, the Employees' Benefit Committee hears appeals from the denial of claims for benefits.

 8. When the Employees' Benefit committee reviews the denial of a claim, it "shall determine conclusively for all parties all questions arising in the administration of the Plan, and any decision of such Committee shall not be subject to further review."

 9. The AT&T Sickness & Accident Disability Benefit Plan Summary Plan Description ("SADB Plan Summary") specifically gives the Employees' Benefit Committee the final and discretionary authority to determine eligibility for benefits under the AT&T SADB Plan.

 10. The AT&T Benefit Claim & Appeal Committee, of which Ciccia is Secretary, is the successor to the Employees' Benefit Committee.

 11. The AT&T Benefit Claim & Appeal committee has delegated to Authorized Benefit Managers in the AT&T Benefit Office the authority to initially grant and deny claims for benefits.

 12. The AT&T Health Affairs Organization ("Health Affairs") has the initial responsibility of collecting and evaluating the medical evidence of an employee's disability. When an employee files a claim for benefits, Health Affairs sends information to the Benefit Office sufficient to allow the Authorized Benefit Manager to decide the claim.

 13. The AT&T Benefit Claim & Appeal Committee decides appeals from an Authorized Benefits Manager's denial of a claim for benefits.

 14. The AT&T SADB Plan appeal procedures mandate written claims and written statements of the petitioner's contentions:

 
If the claimant or a person duly authorized by the claimant sends a written request for review of a denied claim, the person sending the request has the right:
 
* * * *
 
To send to the Secretary, AT&T Benefit Claim & Appeal Committee, a written statement of the issues and any other documents in support of the claim for benefits.

 16. The AT&T Benefit Claim & Appeal Committee can only award benefits to AT&T employees bases on a condition existing while they were employed by AT&T:

 
Rights to Benefits. Neither the action of the Board of Directors in establishing this Plan, nor any action hereafter taken by the Board or the Committee shall be construed as giving to any officer, agent or employee a right to be retained in the service of the company or right or claim to any benefit or allowance after discharge from the service of the Company, unless the right to such benefits has occurred prior to such discharge.

 17. The purpose of the AT&T SADB Plan is to provide for "the payment of definite amounts to employees when they are disabled by accident or sickness."

 18. To qualify for benefits, the employee must "furnish certification satisfactory to the Company of disability and treatment from the physician who is caring for you . . . [and] provide relevant information to the Benefit Office when requested."

 19. Prior to August 22, 1990, plaintiff Scarinci worked in a clerical job for either AT&T or, prior to the divestiture of AT&T, for an affiliate company of AT&T.

 20. Prior to August 22, 1990 and prior to any disability, Scarinci elected to accept the Facility Closing Plan offer for her facility which, pursuant to her acceptance, would have resulted in her voluntary termination of employment effective November 9, 1990. Plaintiff accepted a payment of approximately $ 10,000 as a benefit for accepting the Facility Closing Plan.

 21. Commencing on August 22, 1990, Scarinci was absent from work due to knee surgery which was not related to her employment.

 22. On August 11, 1990, Scarinci's doctor, John R. Donahue ("Dr. Donahue") performed a "medical plica ...


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