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Access over workers' compensation decisions, including En Banc, Significant Panel Decisions, and writ-denied cases.

Case No. MISSING
Regular Panel Decision

Pig Newton, Inc. v. Boards of Directors of the Motion Picture Industry Pension Plan

Plaintiff Pig Newton, Inc. commenced an action against the Boards of Directors of the Motion Picture Industry Pension Plan, Health Plan, and Individual Account Plan, seeking a declaration that certain provisions of the Plans’ Trust Agreements were invalid and unenforceable. The Defendants counterclaimed for delinquent contributions under ERISA. The core dispute revolved around "Controlling Employee Provisions" in the Trust Agreements, which obligated employers to contribute for Controlling Employees for a specified number of hours and weeks regardless of actual hours worked. Pig Newton argued these provisions were invalid, not properly incorporated, or conflicted with collective bargaining agreements (CBAs). The Court, applying federal common law and an arbitrary and capricious standard of review for the Directors' interpretation, found the provisions valid, properly incorporated, and not in conflict with the CBAs, concluding that Szekely (Pig Newton's sole owner) qualified as a Controlling Employee. Consequently, the Court denied Plaintiff's motion for summary judgment and granted Defendants' cross-motion for summary judgment, dismissing Plaintiff's complaint and awarding Defendants the sought-after contributions, interest, auditors’ fees, and liquidated damages.

ERISAMultiemployer PlanPension PlanHealth PlanDeclaratory JudgmentSummary JudgmentTrust AgreementsCollective Bargaining AgreementsControlling Employee ProvisionsDelinquent Contributions
References
44
Case No. MISSING
Regular Panel Decision

Ames v. Group Health Inc.

Plaintiffs, including trustees John Ames and Michael Pantony of the United Welfare Fund-Welfare Division (UWF) and participant Fred Tremarcke, sued Group Health Incorporated (GHI) under ERISA and HIPAA. They alleged GHI illegally discriminated against Tremarcke by denying his health coverage after he went on disability leave, arguing it violated HIPAA's anti-discrimination provisions and breached the insurance policy. Tremarcke's employer, Classic Chevrolet, continued making health contributions on his behalf, and a 'Side Letter of Understanding' with his union attempted to maintain his 'active employee' status. The court ultimately ruled in favor of GHI, finding that Tremarcke did not meet the eligibility requirements of the UWF-GHI plan, which required working over 20 hours per week, and that the 'Side Letter' could not unilaterally alter GHI's contractual obligations. Consequently, the plaintiffs' motion for partial summary judgment was denied, and the defendant's motion for partial summary judgment was granted, dismissing the second and third causes of action.

ERISAHIPAACOBRAHealth InsuranceDisability BenefitsSummary JudgmentFiduciary DutyBreach of ContractMulti-employer FundCollective Bargaining Agreement
References
6
Case No. MISSING
Regular Panel Decision
Jun 20, 1996

Trustees of the Health & Welfare & the Pension Funds of the Four Joint Boards v. Schlesinger Bros.

Plaintiffs, Trustees of the Health and Welfare and Pension Funds of the Four Joint Boards and Esther Maiese, filed an action against Schlesinger Brothers, Inc. and the International Leather Goods, Plastics, Novelty and Service Workers Union, alleging violations of ERISA and LMRA. Specifically, plaintiffs claimed that defendants breached ERISA's 'sole benefit rule' by diverting contributions from the FJBC Funds to the International's Funds. They also alleged that Schlesinger violated the collective bargaining agreement under LMRA. The court determined that Schlesinger did not act as a fiduciary under ERISA and that the plaintiffs lacked standing to bring the LMRA claim against the employer. Similarly, the court found that the International union was not subject to fiduciary duties under ERISA when engaged in collective bargaining. Consequently, the court granted Schlesinger's motion to dismiss the entire complaint and the International's motion to dismiss the ERISA claim, leaving only the LMRA claim against the International viable.

ERISALMRAFiduciary DutyCollective Bargaining AgreementMotion to DismissPension FundsHealth and Welfare FundsUnionEmployer LiabilityStanding
References
31
Case No. No. 95 Civ. 0119 (HB)
Regular Panel Decision
Jun 20, 1996

TRUSTEES OF HEALTH & WELFARE v. Schlesinger Bros.

Plaintiffs, Trustees of the Health and Welfare and Pension Funds of the Four Joint Boards and Esther Maiese, filed an action against Schlesinger Brothers, Inc. and The International Leather Goods, Plastics, Novelty and Service Workers Union, alleging violations of ERISA and LMRA concerning the diversion of pension contributions. Schlesinger moved to dismiss the entire complaint, and the International moved to dismiss the ERISA claim. The United States District Court for the Southern District of New York granted both motions, finding that neither defendant acted as a fiduciary under ERISA when negotiating the collective bargaining agreement, nor did plaintiffs have standing under LMRA § 301 as non-parties to the agreement. As a result, the complaint against Schlesinger was dismissed entirely, and the ERISA claim against the International was dismissed.

ERISA Fiduciary DutyLMRA ClaimsPension Fund ContributionsCollective Bargaining AgreementMotion to DismissLack of StandingEmployer LiabilityUnion Fiduciary DutiesBenefit Plan AdministrationSole Benefit Rule
References
15
Case No. 99 Civ. 11886 WCC
Regular Panel Decision
Jul 11, 2000

Leonard v. DUTCHESS CTY. DEPT. OF HEALTH

Plaintiffs, including restaurant and bowling center owners and the National Smokers Alliance, challenged smoking regulations promulgated by the Dutchess County Department of Health and Board of Health. They alleged violations of equal protection, free speech, 42 U.S.C. § 1983, the New York State Constitution, and Article 78. The defendants moved to dismiss, arguing lack of subject matter jurisdiction, while plaintiffs moved for summary judgment and injunctive relief. The court, treating both as motions for summary judgment, found that the Board of Health exceeded its authority under the New York State separation of powers doctrine by enacting regulations that balanced economic, social, and privacy interests, rather than solely health concerns. Specifically, the court noted the Board's consideration of non-health factors, the non-interstitial nature of the regulations compared to state law, and the County Legislature's prior failure to pass similar legislation. Consequently, the court granted plaintiffs' motion for summary judgment and permanently enjoined the defendants from enforcing the challenged smoking regulations.

Smoking RegulationsPublic Health LawSeparation of PowersAdministrative Agency OverreachSummary JudgmentInjunctive ReliefDutchess CountyClean Indoor Air ActConstitutional LawArticle 78
References
12
Case No. MISSING
Regular Panel Decision

Washington Heights-West Harlem-Inwood Mental Health Council, Inc. v. District 1199, National Union of Hospital & Health Care Employees, RWDSU

This case involves a dispute between District 1199, National Union of Hospital and Health Care Employees, and Washington Heights-West Harlem-Inwood Mental Health Council, Inc. The union sought to enforce an arbitration award requiring the Council to rehire and provide back pay to an employee, Edward Lane. The Council cross-moved to vacate the award, arguing that no valid collective bargaining agreement with an arbitration clause existed between the parties. Although the parties had acted under the terms of a proposed agreement for a period, including processing some grievances and wage increases, no formal, signed contract had ever been executed. Citing recent appellate court decisions emphasizing contract formalism over implied intent, the District Court granted the Council's motion to vacate the arbitration award and denied the union's motion to enforce it, concluding that without a signed agreement, there was no contractual duty to arbitrate.

Arbitration AwardSummary JudgmentContract FormationCollective BargainingLabor DisputeContract FormalismVacation of AwardEnforcement of AwardMeeting of the MindsFederal Court
References
23
Case No. MISSING
Regular Panel Decision
Dec 27, 2001

MacRo v. Independent Health Ass'n, Inc.

Plaintiffs Cheryl Macro and Kim Zastrow, insured under a group health contract with Independent Health through the Tonawanda City School District, initiated a class action in state court to challenge Independent Health's modification of infertility treatment coverage. Defendant Independent Health removed the case to federal court, asserting ERISA preemption. Plaintiffs moved to remand, arguing that their claims fell under New York Insurance Law, which is exempt from ERISA preemption by the saving clause, and that their health plan qualified as a 'governmental plan' also exempt from ERISA. The District Court granted the plaintiffs' motion, concluding that the claims were indeed saved from ERISA preemption and that the plan was exempt, thus rendering federal subject matter jurisdiction absent. The court accordingly remanded the case back to New York State Supreme Court.

Infertility CoverageHealth Insurance DisputesERISA PreemptionSaving ClauseGovernmental PlansRemoval to Federal CourtSubject Matter JurisdictionNew York Insurance LawClass Action LitigationEmployee Benefits Plan
References
31
Case No. 2022 NY Slip Op 07383 [211 AD3d 1616]
Regular Panel Decision
Dec 23, 2022

Williams v. Kaleida Health

Dr. Aston B. Williams, a physician with medical staff privileges at Kaleida Health, sought a medical exemption from a COVID-19 vaccine mandate, which was subsequently denied. As a result of noncompliance, his privileges at Buffalo General Medical Center were suspended. Williams initiated legal action, requesting injunctive relief to prevent the revocation of his privileges. Kaleida Health moved to dismiss the complaint. The Supreme Court denied Williams's motion for an injunction and partially granted Kaleida Health's motion, dismissing the complaint without prejudice. The Appellate Division, Fourth Department, affirmed this decision, determining that Public Health Law § 2801-c provides the exclusive remedy for alleged violations of § 2801-b (1), necessitating Williams to first pursue his claim before the Public Health and Health Planning Counsel.

COVID-19 vaccine mandatemedical staff privilegesinjunctionPublic Health Lawexclusive remedyPHHPCadministrative remediesdismissal without prejudicehealth care workersemployer-employee dispute
References
4
Case No. MISSING
Regular Panel Decision

Jacobson v. Weinberger

Harry Jacobson sought judicial review of a final administrative decision by the Secretary of Health, Education and Welfare concerning the calculation of his retirement insurance benefits. Jacobson contended his benefits were incorrectly determined, specifically challenging the Secretary's recomputation method and the reduction applied due to his election of early benefits. The court, after reviewing the administrative record and applicable law, concluded that the Secretary's computation was correct, explaining the statutory basis for benefit calculation, recomputation, and early benefit reductions. Consequently, the defendant's motion for summary judgment was granted, and the plaintiff's cross-motion was denied.

Social Security ActRetirement Insurance BenefitsBenefit RecomputationEarly Benefit ReductionSummary JudgmentAdministrative Decision ReviewAverage Monthly WagePrimary Insurance AmountExcess Earnings
References
2
Case No. MISSING
Regular Panel Decision

Franzese v. United Health Care/Oxford

Plaintiffs Robert and Elizabeth Franzese, parents and legal guardians of disabled adult Robert Franzese Jr. ("Bobby"), sued United Health Care/Oxford under ERISA to recover medical benefits. Bobby, suffering from chronic lung disease, requires 24/7 in-home nursing care. Oxford denied preauthorization for private duty nursing, citing it as an exclusion, and denied home health care services. The court granted Oxford's summary judgment motion regarding private duty nursing and Xopenex preauthorization, finding private duty nursing not covered. However, the court denied Oxford's motion regarding home health care services, deeming Oxford's denial arbitrary and capricious due to lack of substantial evidence. The case is remanded to Oxford for reconsideration of home health care benefits.

Employee Retirement Income Security Act (ERISA)Medical BenefitsHealth Insurance DenialSummary JudgmentArbitrary and Capricious StandardHome Health CarePrivate Duty NursingPreauthorizationMedical NecessityChronic Lung Disease
References
37
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