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Click here for the full text of this decision FACTS:Brenda Crosson was an employee of Sales Support Services Inc. and a participant in its employee health care plan, a self-insured employee welfare benefit plan governed by the Employee Retirement Income Security Act. The plan was part of the ProAmerica PPO managed care network and allowed its participants to receive discounted care from designated PPO providers. Sales Support, as the plan sponsor, administrator and named fiduciary, reserved the right to determine eligibility for benefits and to construe the plan’s terms. Berkley Risk Managers (Berkley) served as Sales Support’s third-party plan administrator. Crosson, who was pregnant, was admitted to Harris Methodist Fort Worth (Harris), a preferred provider organization (PPO) for the plan, where she gave birth to extremely premature twins. Their subsequent hospitalization cost $666,931. Although the plan paid the charges incurred by Crosson at the hospital, and it concedes the twins were covered through Crosson’s plan participation, it paid nothing for Harris’ services to the twins. Harris filed suit under ERISA against Sales Support and the plan for their failure to reimburse it for services provided to the twins. Sales Support filed third-party claims against both Berkley and its excess loss insurers, Standard Security Life Insurance Company of New York (SSLIC) and Transamerica (collectively, excess-loss insurers), and the excess-loss insurers filed counterclaims against Sales Support. Numerous cross-motions for summary judgment were filed. The district court resolved the competing claims by granting summary judgment against Harris, in favor of Sales Support and the plan. The district court held that Crosson did not sufficiently assign her benefits claim on behalf of her twins to Harris, and was thus denied recovery for the twins’ lengthy hospital stay. The district court accordingly dismissed as moot the claims between Sales Support and the excess-loss insurers. Harris appealed the court’s dismissal of its claims; Sales Support and the excess-loss insurers appealed the dismissal of their competing claims. HOLDING:Reversed and remanded for further proceedings. The district court held that Harris never obtained a valid assignment for the twins’ services based on its narrow interpretation of both the hospital’s “General Conditions of Treatment” form executed by Crosson and the language of the company’s summary plan description (SPD). The court notes that ERISA requires that the SPD be “written in a manner calculated to be understood by the average plan participant, and . . . be sufficiently accurate and comprehensive to reasonably apprise such participants and beneficiaries of their rights and obligations under the plan.” Also, the court states that any ambiguities in the SPD must be resolved in the employee’s favor, and the SPD must be read as a whole. The court finds from its examination of Harris’ form that, taken in its entirety, it signaled Crosson’s intent to assign the twins’ claims. The court also finds that the SPD furnishes an additional basis for Harris’ claim. The court holds that the plan document covers all participants in the plan, and the fact that Harris also had a standard written assignment form for incoming patients does not diminish the plan’s coverage one way or the other. The court reasons that Harris was merely attempting to ensure that it received a valid assignment from any patient admitted for treatment and states that Sales Support and the excess-loss insurers cannot use Harris’ admission form as a means to circumvent the plan’s obligations under the plain language of its governing documents. Because the court finds that Harris was properly assigned the benefits for the Crosson twins, it states that it must also address whether Harris’ derivative claims are barred by the three-year limitations period included in the plan. The plan requires that any action to recover benefits be commenced within “three (3) years from the time written proof of loss is required to be given.” Additionally, “[w]ritten proof of loss covering the details of the loss” must be given “within ninety days after the date of such loss.” The dispute is over how to determine what constitutes a “loss” under the plan, which contains no explicit definition of “loss.” The court concludes that the term “loss” must be practically construed and varies depending on the circumstances of medical care covered by the plan; the hospitalization in this case constituted one event of “loss” for purposes of applying the plan’s three-year deadline for filing suit; and that “loss” accrued on the date of the twins’ discharge. The court therefore holds that Harris timely filed suit. OPINION:Jones, J.; Jolly, Higginbotham, and Jones, JJ.

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