Schwartz v. Interfaith Medical Center

715 F. Supp. 1190, 11 Employee Benefits Cas. (BNA) 1338, 1989 U.S. Dist. LEXIS 7131, 1989 WL 72515
CourtDistrict Court, E.D. New York
DecidedJune 27, 1989
Docket89 C 1583
StatusPublished
Cited by3 cases

This text of 715 F. Supp. 1190 (Schwartz v. Interfaith Medical Center) is published on Counsel Stack Legal Research, covering District Court, E.D. New York primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Schwartz v. Interfaith Medical Center, 715 F. Supp. 1190, 11 Employee Benefits Cas. (BNA) 1338, 1989 U.S. Dist. LEXIS 7131, 1989 WL 72515 (E.D.N.Y. 1989).

Opinion

MEMORANDUM AND ORDER

NICKERSON, District Judge.

Plaintiffs, resident doctors at defendant Interfaith Medical Center (the Hospital), brought this action seeking, among other things, equitable relief under the Employee Retirement Income Security Act (ERISA), 29 U.S.C. § 1001 et seq. (1982 & Supp. IV 1986), and the Consolidated Omnibus Budget Reconciliation Act (COBRA), 29 U.S.C. § 1161 et seq. (Supp. IV 1986), against the Hospital and its president, defendant Jami-son.

Plaintiffs have moved for a preliminary injunction restraining the Hospital from refusing to administer its self-insured major medical and dental employee welfare benefit plan in accordance with ERISA.

I.

The affidavits and exhibits submitted on this motion show the following.

The Hospital is a 620-bed non-profit hospital providing acute care and other medical services to Bedford-Stuyvesant and surrounding low-income neighborhoods. Since its establishment in 1983 it has been in financial difficulty. It is dependent on reimbursement from Medicaid and Medicare and on state subsidies to meet its costs.

The Hospital says it receives about $1,300,000 per week from Medicaid, $800,-000 every other week from Medicare, $200,-000 per week from Blue Cross/Blue Shield, and $80,000 per week from commercial insurers. Distribution of $18,000,000 in subsidies for 1989 from New York State is not scheduled to begin until July 1989. As of May 31, 1989 the Hospital had expended about $7,500,000 caring for patients who had neither health insurance nor the means to pay for treatment.

Plaintiff Schwartz is the president of the Committee of Interns and Residents (CIR), the recognized collective bargaining representative of the interns, residents, and fellows of the Hospital. CIR is a party to a collective bargaining agreement (the Agreement) with the Hospital effective between January 1, 1987 and December 31, *1192 1989. The other plaintiffs are resident doctors employed by the Hospital. They bring the action on their own behalf and on behalf of those similarly situated.

The Agreement obligates the Hospital to provide on a non-contributory basis hospital, medical-surgical, major medical, and dental insurance coverage for its doctors. The Major Medical coverage features 80/20 coinsurance for the first $2,000 in claims and 100% for claims over $2,000, a $1,000,-000 maximum, and an annual deductible of $100 per individual and $300 per family. The dental plan covers 50% of reasonable and customary charges with a $25 deductible and a $1,000 maximum. The Hospital must provide (a) copies “of the policies and explanatory booklet, if any, providing such coverage to the CIR” as soon as available to the Hospital and (b) “certificates of insurance” to each staff officer within thirty days of employment.

Despite these provisions, which contemplate that the Hospital would provide the benefits through an insurance carrier, the Hospital on April 13, 1988 advised its employees, including the doctors, that effective March 1, 1988 it had terminated all insurance contracts with Phoenix Mutual Life Insurance Company, its group health insurer, and would now self-insure employees’ medical and dental benefits plan. This memorandum, sent one and a half months after the termination, stated that the Hospital was doing what it could “to correct the poor cash flow which made this happen,” encouraged the employees to use the Hospital’s facilities without charge “until we can restore coverage,” and directed the employees who received care to submit claims for reimbursement to the Hospital’s “Benefit Office.”

The Hospital has not replaced the insurance carrier and admits that a backlog of some $70,000 in unpaid medical claims submitted as long ago as September 1988 has accumulated. It says it is paying the valid outstanding claims at the rate of $7,000 per week and will step up payments to $12,GOO-17,000 per week as soon as its distributions from New York State begin so as to finish paying the backlog within five months. Plaintiffs assert that unpaid claims far exceed the amount admitted and that the Hospital has not paid some claims submitted as early as July 1988.

The Agreement provides for arbitration of “disputes regarding the interpretation or application of the terms of this Agreement.” Pursuant to that clause CIR has demanded arbitration to determine whether the Agreement compels the Hospital to provide medical and dental coverage through an insurance carrier. The demand states that the Hospital “is violating” the Agreement “by not providing insurance coverage as described in” the Agreement and “by failing to pay the claims appropriately or at all.”

The remedy sought in arbitration is a direction that the Hospital “obtain coverage for benefits per” the Agreement “through a reputable insurance carrier,” that “all claims be paid as before the violation and promptly,” and that “housestaff otherwise be made whole.”

In this action plaintiffs seek not third-party insurance coverage but to compel the Hospital to comply with ERISA and COBRA in administering its self-insured plan. They allege that the Hospital has violated ERISA by not creating a trust to hold the plan assets, by not appointing plan trustees, by not complying with ERISA’s reporting provisions, by not providing procedures for claims and appeals, and by not sequestering sufficient assets to pay accumulated and projected claims. They further allege that both the Hospital and Jamison have violated ERISA by failing to act solely in the interest of the beneficiaries of the plan, to exercise the skill and care of a prudent person, and to keep separate the assets of the plan.

The complaint and moving papers also assert claims under COBRA, but at oral argument plaintiffs’ counsel said that plaintiffs preferred to pursue only their ERISA claims on this motion.

Defendants assert that they are exempt from the funding and trust establishment requirements of ERISA and that plaintiffs must await the outcome of the arbitration before seeking relief in this court.

*1193 11.

Under 9 U.S.C. § 3, if a suit is brought in this court “upon any issue referable to arbitration under an agreement in writing for such arbitration,” the court shall, upon application by a party, stay the action until completion of the arbitration. Defendants claim that the court must stay this action under that section because “plaintiffs’ basic claims are effectively the same claims” raised in the arbitration, plaintiffs seek money damages in both fora, and if plaintiffs prevail in the arbitration this action will become moot.

It is true that if CIR wins the arbitration, as it plainly should, and the Hospital reinstates third-party group health insurance, plaintiffs will have no need to pursue this action. Neither the parties nor the claims in the two proceedings, however, are the same. CIR sought the arbitration; it is not a party to this action.

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715 F. Supp. 1190, 11 Employee Benefits Cas. (BNA) 1338, 1989 U.S. Dist. LEXIS 7131, 1989 WL 72515, Counsel Stack Legal Research, https://law.counselstack.com/opinion/schwartz-v-interfaith-medical-center-nyed-1989.