Riverside S.D. v. Riverside Ed. Assoc. REA-PSEA-NEA

CourtCommonwealth Court of Pennsylvania
DecidedAugust 1, 2022
Docket159 C.D. 2021
StatusUnpublished

This text of Riverside S.D. v. Riverside Ed. Assoc. REA-PSEA-NEA (Riverside S.D. v. Riverside Ed. Assoc. REA-PSEA-NEA) is published on Counsel Stack Legal Research, covering Commonwealth Court of Pennsylvania primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Riverside S.D. v. Riverside Ed. Assoc. REA-PSEA-NEA, (Pa. Ct. App. 2022).

Opinion

IN THE COMMONWEALTH COURT OF PENNSYLVANIA

Riverside School District : : v. : : No. 159 C.D. 2021 Riverside Educational Association : REA-PSEA-NEA, : Submitted: June 23, 2022 Appellant :

BEFORE: HONORABLE PATRICIA A. McCULLOUGH, Judge HONORABLE ANNE E. COVEY, Judge HONORABLE LORI A. DUMAS, Judge

OPINION NOT REPORTED

MEMORANDUM OPINION BY JUDGE McCULLOUGH FILED: August 1, 2022

Riverside Educational Association, PSEA-NEA (Association) appeals the February 3, 2021 order of the Lackawanna County Common Pleas Court (trial court), granting Riverside School District’s (District) motion to vacate an arbitration award (Award) on the basis the claim is not arbitrable pursuant to the collective bargaining agreement (CBA). For the reasons that follow, we reverse and remand to the trial court. Factual and Procedural History The relevant facts as found by the arbitrator are as follows.1 On May 17, 2016, the District and Association entered into a CBA effective September 1, 2013, through August 31, 2020. (Award at 3.) On July 1, 2016,

1 “Under the essence test, the arbitrator’s findings of fact are binding on the courts, and the reviewing court may not undertake any independent factual analysis.” Pennsylvania State System of Higher Education, Lock Haven University v. Association of Pennsylvania State College & University Faculties, 193 A.3d 486, 495 (Pa. Cmwlth. 2018). two months after the CBA was signed, Highmark purchased Blue Cross and became the healthcare insurance provider for the District and Association. (Award at 3, 8-9.) The District did not provide notice to the Association of the change in providers. (Award at 8-9.) At the time of the dispute Susan Ludwikowski (Ludwikowski) was employed as a science teacher at Riverside School District. For twenty years, Ms. Ludwikowski had been receiving weekly psychiatric therapy sessions with the same out-of-network therapist. Prior to July 2016, Ms. Ludwikowski’s out-of-pocket expense each week was $51.80 with Blue Cross; however, after Highmark became her insurance provider her out-of-pocket expense was $100.48 for the same service. This was a result of a decrease in the Allowable Charge for Ms. Ludwikowski’s weekly therapy from $154.00 with Blue Cross to $93.15 with Highmark. (Award at 8.) On April 5, 2017, the Association, on behalf of Ms. Ludwikowski, filed a grievance challenging the new health insurance. The District denied the grievance and the parties proceeded to arbitration on November 5, 2019. Arbitrator’s Award At the outset, the arbitrator considered the arbitrability of the grievance. (Reproduced Record (R.R.) at 172a.) To decide whether the grievance was arbitrable, the arbitrator considered the text of the CBA and the underlying grievance. Pertinent sections of the CBA include: Article II, (B)(1): Insurance Program – The District agrees to pay the premium, for each member of the bargaining unit on the active payroll and their dependents, for a group Hospital and Medical Service Plan in the form of a Blue Cross/Blue Shield of Northeastern Pennsylvania PPO (Professional Provider Organization) Plan which will have unlimited coverage for In- Network (Preferred) and a maximum coverage of One Million ($1,000,000) Dollars for Out of Network (Non-Preferred). The plan summary for such services is attached hereto and made a part hereof.

2 ....

Article II, (B)(5): Carrier – The District shall have the right to select and change the insurance carrier or carriers provided there are no decreases in benefits. The District will notify the Association of any known tentative or actual alteration or modification of any insurance program under consideration or effected by the carrier.

....

Article II, (B)(10): Grievance of Insurance Benefits – A grievance arising out of a claim for insurance benefits shall not be arbitrable if the dispute involves a claim that the carrier is not providing contracted benefits; recourse in such an event will be with the carrier and through the courts, if necessary.

(R.R at 19a-20a.) The arbitrator specifically relied upon Article II, Section (B)(10) and stated, “the District’s unilateral change from Blue Cross to Highmark violates specific, clear, and unambiguous language in the CBA which governs how and under what conditions a change in providers can be made.” Id. According to the arbitrator, “it would be a stretch to hide behind that language to bar certain insurance benefit grievances from being adjudicated through the grievance procedure, especially if the allegation is that the District violated the [CBA] causing a dispute in the delivery of benefits.” Id. Thus, the arbitrator concluded the alleged violations in the instant grievance are arbitrable and not barred under Article II, Section (B)(10), and subsequently, addressed the merits of the case. (R.R. at 173a.) The arbitrator framed the issue before him as follows: Did the Riverside School District violate the [CBA] by accepting a change in healthcare providers? If so, what shall be the remedy?

(Award at 3.)

3 The arbitrator noted the CBA explicitly lists Blue Cross as the healthcare insurance provider, which the parties negotiated and agreed to during bargaining, Blue Cross’s Plan Summary is made a part of and incorporated into the CBA in Article II, Section (B)(1), and the District then accepted a change in health insurance carriers after the CBA was negotiated. (Award at 6-7.) The arbitrator observed that Article II, Section (B)(5) clearly states two criteria that must be met in the event of a change in insurance carriers. (Award at 7.) First, the District “must ensure that such a change in insurance carriers will not reduce any benefit levels that the negotiated plan provided for[,] and second, the District is obligated to notify the Association of any perceived or actual change in carriers, as evidenced by the word ‘will’ in the second sentence.” Id. The arbitrator then reviewed the evidence to determine if the change in health insurance carriers had decreased healthcare benefits. The arbitrator noted that Highmark’s Allowable Charge for out-of-network mental health services is significantly lower than Blue Cross’s Allowable Charge. (Award at 8.) Mr. William Butler of Mergo Benefits Company testified on behalf of the District and conceded that the plan allowance cover charge for out-of-network mental health services is lower under Highmark’s Plan Summary, which caused an increase in out-of-pocket expenses for employees using the medical service. (Award at 7-8.) Thus, the arbitrator concluded this was a decrease in employee benefits and a breach of the CBA. Id. Moreover, the arbitrator examined Article II, Section (B)(5) of the CBA, which required that the District notify the Association of “any known tentative or actual alteration or modification of any insurance program under consideration or effected by the carrier.” (Award at 8.) The arbitrator found that this language required the District to notify the Association of any changes in the negotiated healthcare plan, whether the District sought to make these changes from Blue Cross to Highmark or not. Id. Further, the arbitrator noted that “a total change in health[]care provider” qualified as a “major modification of the insurance program,” which required the District to give

4 notice to the Association. Id. The arbitrator found no notice was provided to the Association. Id. On April 15, 2020, the arbitrator sustained in part the grievance and made the grievant, Ms. Ludwikowski, “whole” for the out-of-pocket expenses from April 5, 2017, to April 15, 2020, that she suffered due to the change in insurance plans. (Award at 9-10.) Trial Court’s Decision On May 13, 2020, the District filed a petition to vacate the Award with the trial court.

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Bluebook (online)
Riverside S.D. v. Riverside Ed. Assoc. REA-PSEA-NEA, Counsel Stack Legal Research, https://law.counselstack.com/opinion/riverside-sd-v-riverside-ed-assoc-rea-psea-nea-pacommwct-2022.