Atlanticare Management, LLC, d/b/a Putnam Ridge v. Scottsdale Insurance Company

District Court, S.D. New York·Decided June 9, 2026·No. 7:24-cv-03956·Unknown

Opinion

DOCUMENT ELECTRONICALLY FILED UNITED STATES DISTRICT COURT DOC #: SOUTHERN DISTRICT OF NEW YORK DATE FILED: 6/9/2026 ATLANTICARE MANAGEMENT, LLC, d/b/a PUTNAM RIDGE, Plaintiff, 24-cv-3956 (NSR) ~against- OPINION & ORDER SCOTTSDALE INSURANCE COMPANY, Defendant.

NELSON S. ROMAN, United States District Judge: Plaintiff Atlanticare Management, LLC d/b/a Putnam Ridge (“Putnam Ridge” or “Plaintiff’) commenced this action on May 22, 2024, asserting claims for breach of contract and declaratory judgment against Defendant Scottsdale Insurance Company (‘‘Scottsdale” or ‘“Defendant”). (ECF No. 1.) Plaintiff filed the operative First Amended Complaint on June 20, 2025. (“FAC,” ECF No. 26.) Presently before the Court is Defendant’s motion to dismiss the FAC pursuant to Federal Rule of Civil Procedure 12(b)(6). (Mot., ECF No. 32.) For the following reasons, Defendant’s motion is GRANTED with prejudice. BACKGROUND A. Factual Background The following facts are derived from the First Amended Complaint and are taken as true and construed in the light most favorable to the Plaintiff at this stage. Plaintiff Putnam Ridge is a limited liability company incorporated in New York. (FAC 4 1.) Defendant Scottsdale Insurance Company is an insurance company incorporated in Ohio, with its principal place of business in Arizona. (/d. J 3.) Putnam Ridge operates a nursing and

rehabilitation facility in Brewster, New York. (Id. ¶ 8.) As part of its employee benefits program, Putnam Ridge offers its employees self-insured health care benefits (the "Plan"). (Id. ¶ 9.) In order to remain covered in the Plan, employees are required to contribute premiums or work a certain number of hours to be eligible for benefits under the Plan. (Id. ¶ 10.) Putnam Ridge entered into a

Network Service Agreement ("NSA") with Cigna Health and Life Insurance Company ("Cigna"), allowing for Putnam Ridge employees in the Plan to receive care from providers within Cigna's network. (Id. ¶ 11.) Westchester County Health Care Corporation (the "Hospital") is a participating provider in Cigna's network, meaning Putnam Ridge's employees in the Plan can receive treatment and care from the Hospital. (Id. ¶ 12.) Putnam Ridge was insured under a Senior Care Liability Insurance package policy issued by Scottsdale Insurance Company (the "Policy"). (Id. ¶ 29.) The Policy provides Putnam Ridge Employee Benefits Liability ("EBL") coverage with limits of $1,000,000 per claim and $3,000,000 in the aggregate. (Id. ¶ 30.) The EBL coverage states that: “[Scottsdale] will pay those sums that [Putnam Ridge] becomes legally obligated to pay as damages because of any act, error or omission, of [Putnam Ridge] or of any other person for whose acts [Putnam Ridge] is legally liable, to which this insurance applies. [Scottsdale] will have the right and duty to defend [Putnam Ridge] against any “suit” seeking those damages . . . This insurance applies to damages only if: (1) [t]he act, error or omission is negligently committed in the ‘administration’ of your ‘employee benefit program.’” (Id. ¶ 31.)

The Policy offers the following pertinent definitions:

Administration is defined as: “[p]roviding information to ‘employees,’ including their . . . beneficiaries, with respect to eligibility for or scope of ‘employee benefit programs.’” (Id. ¶ 32.) Administration also includes “[e]ffecting, continuing or terminating any ‘employee’s’ participation in any benefit included in the ‘employee benefit program.’” (Id.)

The Policy further provides that a “claim” seeking damages is deemed made when notice of the “claim” is received and recorded by either the insured or Scottsdale, whichever comes first. (Id. ¶ 33.) A claim is defined as “any demand, or ‘suit,’ made by an ‘employee’ or an ‘employee’s’ . . . beneficiaries, for damages as the result of an act, error or omission.” (Id. ¶ 34.)

An employee is defined as a “person . . . formerly employed” by Putnam Ridge.” (Id. ¶ 35.)

The Policy does not define “beneficiaries.” (Id. ¶¶ 38–39.)

On or about March 24, 2021, an employee of Putnam Ridge stopped consistently appearing for work (the "Patient"). (Id. ¶ 14.) Consequently, on or about March 31, 2021, the Patient was no longer eligible for Plan benefits. (Id. ¶ 15.) On or about June 22, 2021, the Patient went to the Hospital to receive medical treatment and care. (Id. ¶ 16.) On June 23, 2021, the Patient signed a General Consent for Treatment Agreement with the Hospital, which included a clause (the "Assignment") providing that the Patient "assign[ed] to [the Hospital] any and all rights, title, and interest that I have in any insurance proceeds or benefits payable to me or on my behalf for services rendered to me by [the Hospital]." (FAC ¶ 17.) Putnam Ridge alleges that the Hospital was erroneously informed that the Patient was actively enrolled in the Plan and, in accordance with that status, provided the Patient with medical care in the amount of approximately $1.6 million. (Id. ¶¶ 18–19.) After the Patient was discharged, the Hospital submitted a claim for reimbursement to Cigna, but Cigna refused to pay the claim, alleging that Putnam Ridge was responsible for payment of the Hospital's claim because the Patient was enrolled in the Plan sponsored by Putnam Ridge. (Id. ¶ 20.) In or about February 2022, the Patient attempted to have Putnam Ridge pay the claim, but Putnam Ridge advised the Patient that she was not enrolled in the Plan at the time of her medical service with the Hospital due to her failure to work the required number of hours and/or pay premiums. (Id. ¶ 21.) The Patient objected to Putnam Ridge's response and complained to Putnam Ridge concerning its alleged errors and omissions in failing to inform her or the Hospital that she was no longer covered under the Plan. (Id. ¶ 22.) On February 25, 2022, Putnam Ridge reported to Scottsdale the Patient's objection and complaints concerning Putnam Ridge's alleged errors in administering the Plan. (Id. ¶ 23.)

Scottsdale acknowledged the claim on March 8, 2022, opened a file concerning the Patient's complaints, and stated that it understood the notice to concern "errors arising in the administration of the facilities employee benefit program that may give rise to a future claim." (Id. ¶ 24.) Pursuant to the General Consent for Treatment Agreement, the Patient assigned to the Hospital "any insurance proceeds or benefits payable" to her or on her behalf for services the Hospital rendered. (Id. ¶ 17.) Putnam Ridge alleges that this assignment reaches damages recoverable against Putnam Ridge for errors in administering the Plan, and that the Hospital, having stepped into the Patient's “shoes,” sued on the assigned rights. (Id. ¶¶ 25–26.) On October 2, 2023, the Hospital commenced that action against Cigna and Putnam Ridge in the Supreme Court of New York, County of Westchester, Index No. 64114/2023 (the "Underlying Action"),

alleging that Putnam Ridge was financially responsible for the Hospital's damages for the cost of the Patient's care. (Id. ¶¶ 26–27.) On November 6, 2023, Cigna filed crossclaims against Putnam Ridge, alleging that Putnam Ridge "failed to provide Cigna with timely and/or accurate information regarding the Patient's eligibility." (Id. ¶ 28.) Putnam Ridge alleges that the Hospital qualifies as the Patient's beneficiary for purposes of the EBL coverage and that the Underlying Action therefore triggers Scottsdale's duty to defend and indemnify under the Policy. (Id. ¶¶ 41–42, 45–46.) Putnam Ridge provided Scottsdale timely notice of the claim (Id. ¶ 47), which Scottsdale acknowledged as "concerning errors arising in the administration of the facilities employee benefit program that may give rise to a future claim" (Id. ¶ 48).

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Atlanticare Management, LLC, d/b/a Putnam Ridge v. Scottsdale Insurance Company, (S.D.N.Y. 2026).

Atlanticare Management, LLC, d/b/a Putnam Ridge v. Scottsdale Insurance Company (Atlanticare Management, LLC, d/b/a Putnam Ridge v. Scottsdale Insurance Company) — published by Counsel Stack Legal Research, free access to 12M+ legal documents.

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