Sign In
Events
Newsletters
Search

Close

Close Search

Cancel

SEARCH
MY LAW.COMNEW

Walsh v. Empire Blue Cross/Blue Shield Inc.

Union's Benefits Plan Did Not Cover Experimental, Investigational Botox Injections

X

Thank you for sharing!

Your article was successfully shared with the contacts you provided.

MEMORANDUM & ORDER  Plaintiff Mary Ellen Walsh (“Plaintiff” or “Walsh”) commenced this action against defendant Empire Healthchoice Assurance, Inc. (“EHA”), Empire Health Choice HMO (“HMO”) and Empire Blue Cross/ Blue Shield (“BC/BS”) (collectively “Defendants”) under section 502(a)(1)(B) of the Employee Retirement Income Security Act of 1974 (“ERISA”) to recover benefits she contends are due her under the terms of an employee welfare benefit plan. Presently before the Court is Plaintiff’s motion and Defendants’ cross-motion for summary judgment. For the reasons set forth below, Plaintiff’s motion is denied and Defendant’s motion is granted.BACKGROUNDThe following facts are undisputed unless otherwise noted.1I. The PartiesPlaintiff is a beneficiary of the Plumbers Local Union No. 1 Welfare Fund (the “Welfare Fund”) an employee welfare benefit plan within the meaning of section 3(1) of ERISA. On February 24, 2016 when the services at issue were provided, she was eligible for benefits in accordance with the terms of the self-insured plan of benefits (the “Plan”) sponsored by the Welfare Fund. EHA performs claims adjudication services and makes its network of hospitals, doctors and other medical providers available to the Welfare Fund’s participants and beneficiaries in accordance with an administrative services agreement with the Welfare Fund. EHA does not act as an insurer with respect to the Welfare Fund or its Plan. When EHA approves a claim for payment, the Welfare Fund pays the claim and thus EHA has no financial stake in how claims are adjudicated. (Defs.’ 56.1 Statement

3-6.) HMO has no relationship to Plaintiff or with the Welfare Fund and that BC/BS is not a legal entity but rather a name under which EHA and HMO conduct business. (Langhorne Aff. (DE 27-4)

Trending Stories

 
Reprints & Licensing
Mentioned in a Law.com story?

License our industry-leading legal content to extend your thought leadership and build your brand.

LEARN MORE

More From ALM

Premium Subscription
With this subscription you will receive unlimited access to high quality, online, on-demand premium content from well-respected faculty in the legal industry. This is perfect for attorneys licensed in multiple jurisdictions or for attorneys that have fulfilled their CLE requirement but need to access resourceful information for their practice areas.
View Now
Team Accounts
Our Team Account subscription service is for legal teams of four or more attorneys. Each attorney is granted unlimited access to high quality, on-demand premium content from well-respected faculty in the legal industry along with administrative access to easily manage CLE for the entire team.
View Now
Bundle Subscriptions
Gain access to some of the most knowledgeable and experienced attorneys with our 2 bundle options! Our Compliance bundles are curated by CLE Counselors and include current legal topics and challenges within the industry. Our second option allows you to build your bundle and strategically select the content that pertains to your needs. Both options are priced the same.
View Now
Go to CLE Center
New York Legal Awards 2024
September 05, 2024
New York, NY

The New York Law Journal honors attorneys and judges who have made a remarkable difference in the legal profession in New York.


Learn More
African Legal Awards 2024
September 06, 2024
Johannesburg

The African Legal Awards recognise exceptional achievement within Africa s legal community during a period of rapid change.


Learn More
Consulting Best Firms to Work For 2024
September 12, 2024
New York, NY

Consulting Magazine identifies the best firms to work for in the consulting profession.


Learn More
Go to Events Go to Webcasts
(NEW) COMMERCIAL LITIGATION ASSOCIATE WANTED FOR ELITE LITIGATION BOUTIQUE FIRM (Atlanta, GA OR Miami, FL)

Our client, a boutique litigation firm established by former BigLaw partners, is seeking to hire a commercial litigation associate to join e...


Apply Now ›
Real Estate Attorney

COLE SCHOTZ P.C.Prominent mid Atlantic law firm with multiple regional office locations seeks a senior attorney with commercial real estate ...


Apply Now ›
Attorney

ATTORNEYS WANTED ROCKLAND/BERGEN COUNTYKantrowitz, Goldhamer & Graifman, P.C. Expanding and established multi-practice, mul...


Apply Now ›
Go to Lawjobs
Lawyers of Distinction
06/27/2024
The American Lawyer

Professional Announcement


View Announcement ›
SMGQ Law
06/21/2024
Daily Business Review

Full Page Announcement


View Announcement ›
Blume Forte Fried Zerres & Molinari
06/14/2024
New Jersey Law Journal

Professional Announcement


View Announcement ›
Go to Professional Announcements