Society of New York Hospital v. Malsky

86 Misc. 221
CourtCivil Court of the City of New York
DecidedApril 12, 1976
StatusPublished

This text of 86 Misc. 221 (Society of New York Hospital v. Malsky) is published on Counsel Stack Legal Research, covering Civil Court of the City of New York primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Society of New York Hospital v. Malsky, 86 Misc. 221 (N.Y. Super. Ct. 1976).

Opinion

Felice K. Shea, J.

This is an action by New York Hospital for services in the amount of $3,045.10 rendered to defendant Edward Maisky, Jr. ("Maisky”). Defendants Maisky and his father have impleaded the Health and Welfare Fund of the Provision Salesmen and Distributors Union, Local 627 ("the Union”), alleging that Maisky is a covered dependent under the terms of the Union’s group health insurance plan. The plaintiff hospital is conceded by all parties to have a meritorious claim against defendants. The issue, submitted to the court on an agreed statement of facts, is whether third-party defendant is liable to third-party plaintiffs.

The court must decide first a threshhold question of jurisdiction. Although none of the parties herein challenged the court’s jurisdiction to adjudicate this dispute, it is well settled [223]*223that subject matter jurisdiction "cannot be conferred upon the court by any consent or stipulation of the parties.” (Robinson v Oceanic Steam Nav. Co., 112 NY 315, 324.)

In a recent case which raised the question whether a dependent child was covered by her father’s union health insurance plan, the Civil Court of the City of New York, Bronx County, held that "the determination as to whether or not the daughter is a covered dependent under the plan is not within the jurisdiction of the Civil Court. The nature of this action has been held to be an action to declare and enforce rights in a trust fund, as a purported beneficiary [citations omitted]. Therefore, the case must be transferred to the Supreme Court, Article 6, section 19 f of the New York State Constitution.” (Sommers v Horsford, NYLJ, Feb. 13, 1976, p 10, col 3.)

This court must respectfully disagree that the nature of the third-party action is equitable. While it is true that the trustees of a union welfare trust fund manage the assets of the fund and may exercise fiduciary functions with regard to over-all policy and planning, they exercise no fiduciary discretion in carrying out contractual provisions such as those upon which this action is based. The Union has contracted with Associated Hospital Service of New York (Blue Cross Plan) for hospital benefits and it is this contract, inserted verbatim into the welfare plan trust agreement, which the court must construe.

The court in Sommers v Horsford (supra) relied on two cases in support of its conclusion that a claim for health insurance benefits against a union welfare fund must be transferred to a court of equity. Matter of Heilman v Ploss (46 AD2d 658) dealt with an action for supplemental unemployment insurance benefits; in Kaminsky v Connolly (73 Misc 2d 789) the claim was for pension benefits. In these two cases, and in the older pension cases (e.g., Milberg v Nagler, 17 Misc 2d 893; Hoffman v Nagler, 206 Mise 623), it would appear that the union welfare plans were privately funded. To the extent that it was necessary to review fiduciary discretion under the facts of those cases, they may be sound law. No reason exists, however, to extend the doctrine to claims against a union welfare fund for benefits which are funded by insurance.

Where a union welfare fund purchases insurance for the benefit of union employees, questions of construction of the contract of insurance are cognizable in a court of law. In [224]*224Smith v Boer (45 Misc 2d 338) the Civil Court of the City of New York determined which of two provisions in a union trust agreement governed the claim of the beneficiary of a deceased union member to recover the proceeds of a group life insurance policy. In Pasko v Cuba (33 Misc 2d 350) plaintiff’s intestate brought suit in the former Municipal Court to enforce the terms of a life insurance policy against union welfare fund trustees who had sole power to approve the application. The court held (p 352): "The union’s claim that the court has no jurisdiction is without merit. Plaintiff’s intestate, as a third-party beneficiary, may institute suit under the collective bargaining contract and need not resort to a court of equity.” (See, also, Soto v International Organization of Masters Mates & Pilots of Amer., 74 Misc 2d 355; Krohn v Steinlauf, 22 Misc 2d 365.)

In essence, third-party plaintiffs are bringing suit upon a collective bargaining agreement which provides hospital insurance benefits. The union member and his covered dependents are also third-party beneficiaries of the group insurance contract and are entitled, if they choose, to sue Blue Cross directly. (Blue Cross of Northeastern N.Y. v Ayotte, 35 AD2d 258; 1 Appleman, Insurance Law and Practice, § 41, p 52.) The fact that the union welfare fund is administered by trustees does not change the true nature of the proceeding.

The traditional rationale for the doctrine that an action for breach of contract may not be maintained against a trustee in a court of law is that a jury might be called upon to decide complicated questions involving the conduct of a trustee in the administration of a trust. (3 Scott, Trusts [3d ed], § 197.2.) This reasoning has no application to the case at bar where the issue is insurance coverage, not fiduciary discretion. Furthermore, since no issues of fact remain to be tried, and no jury was requested in any case, transfer of this matter to a court of equitable jurisdiction could serve no useful purpose. Unless compelling reasons are present, principles of sound judicial administration proscribe transfers which use the time of nonjudicial personnel, cost money and cause delay.

The court, then, holds that it has subject matter jurisdiction and turns to a consideration of the undisputed facts.

Maisky’s father is a union member who is eligible for union welfare benefits. Maisky was born on April 30, 1953 and suffered from congenital heart disease, causing him to be absent from school for extended periods of time and to fall [225]*225behind his schoolmates. Between June 4 and June 9, 1973, he was hospitalized for heart surgery and the implanting of a pacemaker. At the time hospital services were rendered, Mai-sky was 20 years old, a full-time student in his last year of high school, unmarried, dependent on his father and living at home with his family.

The Union denied liability for Maisky’s hospital expenses, claiming that he was not a covered dependent under the terms of the Union’s welfare plan. The health and welfare fund booklet describing health, dental and life insurance benefits available under the union welfare plan defines eligible dependent child as follows:

"(b) each unmarried child of an Eligible Member through the end of the calendar year in which his 19th birthday occurs; except, however, the child will continue to be eligible until he reaches his 23rd birthday if he
"(1) is dependent upon the Eligible Member for support and maintenance; and
"(2) has the same permanent residence as the Eligible Member; and
"(3) is an unmarried, registered, full-time student working toward a degree at an accredited college or university.”

In addition to the booklet containing the definition above, Maisky’s father received a health and welfare fund booklet with the legend "Supplemental Benefits” on the cover, which described health insurance available under Group Health Incorporated ("GHI”).

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Bluebook (online)
86 Misc. 221, Counsel Stack Legal Research, https://law.counselstack.com/opinion/society-of-new-york-hospital-v-malsky-nycivct-1976.