Diagnostic Medical Associates MD, P.C. v. New York City District Council of Carpenters Welfare Fund
Diagnostic Medical Associates MD, P.C. v. New York City District Council of Carpenters Welfare Fund
Opinion of the Court
SUMMARY ORDER
Geoffrey Richstone and Diagnostic Medical Associates (“DMA”) (collectively, “Appellants”) appeal from the judgment of the United States District Court for the Southern District of New York (Maas, M.J.), granting summary judgment in favor of New York City District Council of Carpenters Welfare Fund (“Fund”) and dismissing Appellants’ claims under the Employee Retirement Income Security Act of 1974 (“ERISA”), 29 U.S.C. § 1001 et seq. The Fund operates the Major Medical and Dental Benefits Plan (“Plan”), an employee welfare benefit fund under ERISA. The Plan vests primary authority over administration of the Plan to the Trustees of the Fund; day-to-day administration of the Plan was delegated to Blue Cross/Blue Shield (“BC/BS”).
During the relevant period (from January 1, 1998 to November 9, 1999) Appellants provided medical care to William Marcucci, a participant in the Plan. Appellants submitted claims to the Plan seeking payment for the treatment, but the Plan denied the claims on the ground that the treatment was not medically necessary. Marcucci assigned his claims under the Plan to Appellants, and Appellants subsequently filed suit.
When an ERISA benefit plan vests “the administrator with broad discretionary authority to determine eligibility,” we review its decisions “under the arbitrary and capricious standard.” Celardo v. GNY Auto. Dealers Health & Welfare Trust, 318 F.3d 142, 145 (2d Cir. 2003). “Under the arbitrary and capricious standard, the scope of judicial review is narrow.” Id. at 146. “A court may overturn a plan administrator’s decision to deny benefits only if the decision was “without reason, unsupported by substantial evidence or erroneous as a matter of law.’” Id. (quoting Pagan v. NYNEX Pension Plan, 52 F.3d 438, 442 (2d Cir. 1995)).
Appellants’ claims were initially rejected by BC/BS, and were then rejected on appeal by the Trustees. Appellants argue that the Plan does not vest the Trustees with discretionary authority in their appellate function, and that therefore we should review the Trustees’ denial of Appellants’ claims de novo. The terms of the Plan say otherwise. The Trustees have authority to “construe the Plan,” to “decide all questions arising in the interpretation of the Plan,” and to “[pjrovide a full, fair and final review of any claim.” The Trustees “shall be deemed to have properly exercised such authority unless [they have] abused [their] discretion ... by acting arbitrarily and capriciously.”
Appellants argue that the Fund’s denial was based on impermissible “blacklisting,”
For the reasons set forth above, the judgment of the district court is hereby AFFIRMED.
. We need not decide whether Marcucci properly assigned to DMA his claims against the Fund. Assuming the assignment was proper, DMA’s and Richstone’s claims suffer the same defects.
Reference
- Full Case Name
- DIAGNOSTIC MEDICAL ASSOCIATES MD, P.C., and Geoffrey Richstone v. NEW YORK CITY DISTRICT COUNCIL OF CARPENTERS WELFARE FUND
- Status
- Published