Zuckerbrod v. Phoenix Mutual Life Ins., 78 F.3d 46 (1^st Cir. 1996)- This is a claim for benefits under 29 U.S.C. § 1132(a)(1)(B). Mr. Zuckerbrod was hospitalized for open heart surgery and a fasciotomy to his left leg. His doctor recommended private duty nursing (to prevent infection and possible loss of the left leg) for the period March 2, 1990 through April 13, 1990. On July 13, 1990, a nurse consultant for the Defendant determined that the chargers for April 1, 1990 through April 13, 1990 were custodial in nature and not essential treatment. Defendant's nurse consultant determined that one shift per day was medically necessary for the period March 3 through March 8, March 12 through March 28 and April 1 through April 4. Shortly after July 13, 1990 another physician for the plaintiff stated that private duty nursing was necessity to save the patient's leg, his sanity and perhaps his life. The Defendant's claim analyst testified that she did not now whether the defendant ever submitted this letter to the nurse consultant. On August 3, 1990 the defendant had a surgical consultant review the file. This doctor did not change the recommendation to pay one shift per day. Defendant's doctor stated "I believe that the care provided by an adequately staffed med[ical] sur[gical] nursing floor would be able to cover this gentlemen's treatment. The need for [private duty nurses] is the physician's choice based on his assessment of staffing adequacy." This action followed. After a three day bench trial the district court determined that Defendant did not act arbitrary and capricious. The first circuit vacated the district court. The First Circuit found it to be an arbitrary and capricious decision of defendant not to pay for the nursing services. The Defendant claims that its consultants relied in part upon the letters of the plaintiff's doctors. The First Circuit noted that nothing in those letters suggest that private duty nursing was only available part of the day. The First Circuit also found it arbitrary and capricious for defendant to rely upon the surgical consultant to deny the claims since the consultant stated it was up to the treating physician to determine staffing adequacy. The First Circuit also found it significant that the Defendant authorized one shift of nursing per day with no adequate explanation. The First Circuit also noted that the defendant's' claim manual states claims determinations should be resolved in favor of the claimant.