Goldie Miller, as of the Estate of Sarah M. Potok v. United Welfare Fund

might eventually the individual defendants be possess against Rodriguez’s

found to damages, immunity justify could not Rodriguez’s equita-

the dismissal of claim for expungement

ble relief the form of the hospital

her record.

CONCLUSION reasons, foregoing

For the we conclude summary judgment dismissing first,

second, and fifth inap- causes of action was

propriate. We also note that the district

court’s Rodriguez’s dismissal of seventh action, sought

cause of a declaratory which

judgment Rodriguez was not liable for during cost of care and treatment her confinement,

involuntary premised was on rejection

the court’s of her claims that that rights.

confinement violated her Since we summary judgment concluded that

improperly claims, granted as to the latter

the dismissal of seventh cause of action inappropriate.

was also first,

The judgment dismissing second,

fifth, vacated, and seventh causes of action is

and the matter is pro- remanded for further

ceedings. plaintiff.

Costs to MILLER,

Goldie as Executrix of the Potok,

Estate of M. Sarah

Plaintiff-Appellee, FUND,

UNITED WELFARE

Defendant-Appellant.

No. Docket 94-7908.

United States Court of Appeals,

Second Circuit.

Argued 18, 1995. Jan.

Decided Dec. 1995. (E.D.N.Y.1994). 74-75

After denying parties’ both motions for sum- mary judgment, the district court held a judgment bench trial that resulted directing Miller pay the Fund to medical expenses private care, duty nursing for plus attorneys’ interest and fees. Miller v. Unit- Fund, ed slip op. No. 93 Civ. at Welfare (E.D.N.Y. 1994). May ap- The Fund peals judgment. We vacate and remand.

BACKGROUND 1, 1989, May On Sarah Potok became participant in the which an employ is 3(1) ee plan by § welfare benefit as defined. ERISA, 1002(1) § 29 U.S.C. In the fall cardiologist, Potok’s Dr. James A. Blake, diagnosed suffering her as from Pulmonary Chronic Obstructive Disease. Al though poor Potok was a candidate for cardi surgery ac because of age her advanced - lung damage, severe Dr. Blake recommended surgery cardiac diagnostic since studies indi cated she would survive no more than three months without such treatment. October, In late Potok multiple underwent Kahn, Stephen H. City New York (Opton coronary bypass surgery performed by Dr. Hirsch), Handler Gottlieb Feiler Landau & (the Lang Samuel Hospital New York for Defendant-Appellant United Welfare “Hospital”). Complications prevented a rou- Fund. bypass tine procedure required an inno- surgical vative alternative. According to Dr. D’Orazio, (Khos- City Bernard New York Blake, surgery successful, Potok’s but D’Orazio), rova & Plaintiff-Appellee for Gol- experienced problems she a number of be- die Miller. cause of the operation unusual nature of the WALKER, as well as her age poor advanced Before: health. JACOBS and CALABRESI, She remained in the cardiothoracic Judges. Circuit intensive week, care unit for an entire compared as

WALKER, Judge: Circuit typical stay with the more of one to one-and- days. a-half Potok was then transferred to (“Miller”) Goldie brought Miller suit step-down the cardiothoracic unit for a brief against (the the United Welfare Fund period, finally to the cardiothoracic te- “Fund”) 502(a)(1)(B) § under Employ- lemetry unit, “regular post- floor” for ee Security Retirement Income Act surgery patients. cardiac (“ERISA”), 1132(a)(1)(B), § 29 U.S.C. on be- sister, half of (“Potok”), her Sarah Potok During post-operative period, Potok recover private medical duty benefits for pneumonia contracted experienced nursing care that Potok following received breathing difficulty arrhythmia. and heart unusually complex multiple coronary bypass stroke, She also had a heightened which her surgery. The district court for the Eastern sense of disorientation and hindered her ex- (John Bartels, District of New York R. pressive Dis- abilities. Faced with these circum- Judge), stances, trict concluded that the Fund had Dr. Blake recommended to Miller arbitrarily acted capriciously in denying private Potok full duty the benefits. Miller v. United telemetry care in the thereupon unit. Miller Welfare appeal and to right had a that she the dura- Miller nursing care for duty private hired relevant documents. review the telemetry unit. stay in the sister’s of her tion admis- after her five weeks Approximately appealed let- February Miller from the finally discharged sion, Potok was (the of the Fund to the Board of Trustees ter Eventual- center. a rehabilitation hospital to “Board”), fiduciaries of the “Trustees” or the and live home able to return she was ly, 3(21) ERISA, § plan as defined Unfortunately, in March of independently. 1002(21). 29,1992, April a four- § On U.S.C. cause. an unrelated died from Potok Board reviewed subcommittee of the member (“Byrne”), Byrne claim. Edward Potok’s Miller claimed December On administrator, prepared a three-sen- Fund’s $14,060.50 from reimbursement that stated that for the Trustees report tence duty nurs- sister’s costs of her duty private the sought payment for Miller claim, Miller submitted the ing care. With care, Miller nursing listed the documentation Dr. Blake following from letter copy submitted, amount in and set forth the had 6,1990: December dated meeting to con- During the brief question. my patient regal'd in writing I am complete Byrne Potok’s appeal, the had sider elderly an is Mrs. Potok Potok. Sarah him, including Dr. Blake’s file before claim coronary recently underwent female who notes, letter, analysis of Aetna’s the nurses’ surgery for severe unstable artery bypass claim, correspondence. Miller’s and the postoperative Her immediate angina. contrast, only provided the subcom- Byrne by pneumonia, ar- complicated was course copy his three- with of members mittee Because of rhythmia and disorientation. nor Neither the Trustees report. sentence medical team severity her illness the the a medical back- any member had Fund staff have full that she to her recommended medical ex- they no and consulted ground, Beginning on duty nursing. private time review of the in with their connection perts continuing to Novem- and 4th November Byrne’s report, discussing brief After claim. 26th, 24 hour received Mrs. Potok ber the claim. subcommittee denied the performed nursing nursing. private This 23, 1992, Trust- the In a dated June letter toilet, continually thorough pulmonary Miller that informed ees status, well as her as her mental monitored duty nursing services private order for [i]n rhythm. necessary, they to be considered recovery meaningful made a Mrs. Potok of the illness that the nature must be such returning to an can look forward and medical require constant injury must or undoubt- life. It is productive provided active and not have been that could care nursing thorough edly. case that the nursing the general The ser- by staff. the large part nurses, is care which she received duty by private provided vices improvement superb responsible for the by the easily performed been could Thank patient which this demonstrated. nursing general staff. any I further again. If be you once can this had cited original). Aetna (emphasis in to ask. hesitate please do not assistance verbatim, reason, nearly in its earlier same letter. denial 1991, Aetna, the April and In March Miller, 15, 1993, as executrix April On requested additional processor, Fund’s estate, against the brought suit nursing information, including copy Potok’s York. City of New the Civil Court claim with After notes. Eastern to the the action hand, Fund removed Aetna’s The one of information in additional gov- it was York of New because pri- District adjudicators concluded claims thereafter, Shortly by ERISA. routine tasks erned duty performed nurses vate summary judgment: cross-moved parties floor performed have been could court should the basis that duty on private and that therefore nurses Miller, decision; on the Board’s necessary.” Mil- defer to “medically were not nurses decision was the Trustees’ Aetna, basis June dated a letter from received ler deprived [Po- capricious, and “arbitrary advising denying the claim rights guaranteed by tok] of good [her] ERISA.” did not act in failing faith in to offer Miller, at 73. testimony physician aof at trial. Id. at 8. interest, judgment With the total awarded to In support summary judgment of its mo- Miller, including costs, $39,- fees and was tion, the Fund submitted affidavit of the 450.13. Id. at appeals 10. The Fund from representative Aetna who denied the claim. judgment. this She stated that she had done so because the medically necessary care was not since the ' private performed nursing nurses routine DISCUSSION excerpts duties. Miller depo- offered from a The Fund raises three claims of error Byrne sition of regis- and an affidavit from a 1) the district appeal: court on finding its nurse, Cho, Daly tered Maria who after re- arbitrarily the Trustees acted capri- viewing nursing notes concluded that the 2) ciously; its conclusion that provided nurses more than patient routine 3) medically necessary; care. abused its awarding attorneys’ discretion in considering affidavits, After conflicting addressing claims, fees. Before these we the district court denied the motions for sum- 1) preliminary must decide two issues: mary judgment. Id. at 74-75. The district 2) appropriate review; standard of concluded, however, court that of the three whether the district court should have con- letter, items in Miller’s file—Dr. Blake’s sidered presented evidence that was not notes, nursing and Aetna’s recommendation the Trustees. only and supported the denial denial — Fund’s decision. Id. at 74. It further found I. Standard Review relying alone, that in on Aetna’s denial employee When an plan benefit deprived Fund had Miller right of her to a grants plan a fiduciary discretionary authori 503, full and fair required by § review as 29 ty to construe plan, the terms of the a dis 1133, § thereby U.S.C. had acted “arbi- trict court deferentially must review a denial trarily capriciously.” Id. at 75. 502(a)(1)(B). challenged § benefits under May 2, 1994, On the district court held a Bruch, Firestone Tire & Rubber v.Co. 489 bench trial. Noting previous its finding that 101, 115, 948, 956-57, U.S. 109 S.Ct. 103 the Trustees’ denial of the claim was “arbi- (1989). L.Ed.2d may 80 The court reverse trary Miller, capricious,” No. 93 Civ. only if fiduciary’s arbitrary decision was 2057, 2, slip op. at the court reviewed de novo “ capricious, reason, that is ‘without un Miller’s assertions services supported by substantial evidence or errone were necessary and therefore cov- ” ous as a Pagan matter of law.’ v. NYNEX by plan, ered id. doing so it consid- Plan, 438, (2d Cir.1995) Pension 52 F.3d 442 ered evidence outside the administrative rec- (quoting Abnathya Roche, v. Hoffman-La ord, testimony Blake, such as from Dr. which Inc., (3d Cir.1993)). 2 F.3d 45 Here the it credited in full since the Fund “offered no found, district court parties and the do not medical evidence at trial in the form of a dispute, that the Fund had such discretion physician’s testimony, and therefore failed to ary authority 16,1990 July under the amend rebut opinion.” Dr. Blake’s Id. at 5. The Agreement ments to the and Declaration of district court concluded that Miller had Thus, F.Supp. Trust. 851 at 74. the district preponderance “demonstrated court was entitled to only reverse if the evidence nursing] [the services arbitrary Trustees’ decision was capri or medically necessary, were and therefore cov- cious. ered Plan.” Benefits Id. at 7. though Even only action was for the We review de novo the district court’s single benefit of plan participant, legal the court conclusion that there was no basis for awarded attorneys’ Miller fees since the the Fund’s decision. See v. Equitable Taft court concluded that such an award was (9th like- Soc’y, Assurance 9 F.3d 1471 Life ly conduct, to deter similar Cir.1993); the Fund could Nighswander, Banker v. Mar cf. satisfy request, Mitchell, modest fee (2d and the Cir.1994) tin & 870 Cir.1992) (allow- (5th 631, 638, F.2d court’s 974 of the lower review (requiring de novo beyond to look the admin- ing district courts conclusions ... facts to draw “application to review the administrator’s however, istrative record law”). must doing, we In so interpretation, not to review “the plan but arbi under the Trustees’ decision review claim”). underlying a historical facts Sweat capricious standard. See trary and Co., 39 F.3d Ins. Union man v. Commercial majority our cir follow the sister We Cir.1994). (5th 594, 599-601 concluding that a district court’s cuits arbitrary capricious under the review Administrative II. Evidence Outside to the administrative rec standard is limited Record required are district courts ord. Because rec limit to the administrative their review criticisms is primary the Fund’s One of that, ord, upon if review district it follows considered evidence lower court that the Trustees’ decision court concludes that was outside Potok’s claim support of capricious, it must remand record, i.e., the evidence be- administrative to consider Trustees with instructions to the points Specifically, Trustees. fore the new evidence evidence unless no additional of Nurse the affidavit reliance on the court’s per produce a reasonable conclusion could Cho, did consid- which the Trustees Daly mitting the claim or remand would denial of er.1 formality.” a “useless See War otherwise be that, in have declared Most circuits States, Southeast & Southwest dle v. Central plan fiduciaries under decisions (7th F.2d Pension Areas standard, dis capricious arbitrary and Lewis, Cir.1980) (citing Ruth v. only may the evidence trict courts consider denied, (D.D.C.1958)), 449 U.S. cert. themselves considered. the fiduciaries (1981). 66 L.Ed.2d 841 101 S.Ct. Shield, F.3d 10 Lee v. Blue See Cross/Blue fact that with the This rule is consistent (11th Cir.1994) courts 1547, (requiring 1550 history suggests nothing legislative “in the the ad facts known to only to the “to look federal district Congress intended that that (fear ministrator”); 1471-72 Taft, 9 F.3d at plan ad function as substitute courts would beyond administra ing that examination “goal of and with the ERISA ministrators” findings easily to too lead tive record would fiduciary.” claims prompt resolution of discretion, defeating goal of abuse of Perry, F.2d at 966. 900 expeditiously); disputes to resolve ERISA rely Inc., did not Roche, the district court 2 While Abnathya v. Hoffmann-La the administrative record (3d Cir.1993); outside 40, v. on evidence Sandoval 48 n. 8 F.3d acted arbi Co., determining that the Board in Casualty 967 F.2d Ins. Aetna & Life in consider (10th trarily capriciously, erred Cir.1992); Oldenburger and 380-81 during bench trial ing extrinsic evidence F.2d Pension 934 States Central duty nurs whether the (8th Cir.1991); Simplicity to determine Perry v. Cir.1990) (not necessary there (6th ing care was Eng’g, 900 F.2d Miller, plan. No. under the arbitrary and fore covered ing both de novo that court op. at 2. The district slip “not man Civ. of review do capricious standards bench why it held a de novo stated of evidence never consideration permit date or administrator”). to suggest that it failed Only It did not trial. presented to the the Fund it was concerned scope because remand allowed a broader the Fifth Circuit has Co., it conclude faith.2 Nor did in bad acted v. ARCO Chem. of review. See Wildbur Fund did not find regard court did later position this 2. The in 1. We note that the Fund's testimony failing good the court for' to offer the since it criticizes faith in is not consistent refusing act in trial, Miller, of Nurs- Associate Professor to admit an 93 Civ. physician No. at it, ing’s testimony, which was favorable actually that the slip op. never found but it Hospital’s refusing admit into evidence the for nursing bad faith. constituted initial denial sup- protocols. also cited in The Fund summary judgment an port its motion part of the Byrne, which was not from affidavit record. administrative the evidence in the administrative record the contents of the administrative record— pointed only in granting letter, favor of notes, nursing Blake’s claim. and Aetna’s Consequently, in the district court erred re- analysis claim and denial.—each either item viewing the claim under the de novo stan- position buttressed Miller’s or was neutral. dard. piece We examine each in evidence turn. agree We with the district court that the First, found, Judge as nursing Bartels capricious. Fund’s decision was notes could not have been evidence favor find, however, upon do not We a more of the Fund’s decision since the Trustees at complete fiduciary record a reasonable would gleaned best no information from them and necessarily grant the claim or that a at worst did not understand them. In re- remand to the Trustees would be a useless claim, viewing the denial of Potok’s the sub- Therefore, formality. we vacate and remand actually committee did not examine the nurs- to the district court with the instruction that notes; rather, ing summary it relied on the the case be returned to the Fund for recon- provided by Byrne. Byrne’s deposition As sideration. indicates, however, he found no evidence in justify the notes to the Fund’s ultimate deni- Arbitrary III. The Decision was and Ca- Byrne al of the claim. While first stated that pricious supported the notes the Fund’s conclusion in the administrator’s part, Byrne later testified he did not deferentially, decision a district court must “really” any any reach conclusions or obtain consider “whether the decision was based on notes, information on the basis of the a consideration of the relevant factors.” Jor which at best he “understood somewhat” or dan v. Retirement Comm. Rensselaer Po could not understand at all. Inst., (2d lytechnic Cir. 1995) omitted). (quotations A denial of a Komoroski, A employee, Pat who 502(a)(1)(B) challenged § under is arbi was physician, neither a nurse nor a also trary capricious if “there has been preparation reviewed the interpreted the notes for the Trustees re- Substantial evidence in turn “is such evi any understanding ceived assistance in them. might dence that a accept reasonable mind as Thus, interpretation, without such the nurs- adequate support to the conclusion reached ing notes were to useless the Trustees. by the requires [decisionmaker ... and] Even if the notes explained had been ade- more than a scintilla but than prepon less a quately Trustees, to they the do not lend Sandoval, derance.” 967 at (quota F.2d support position. to the Trustees’ While the omitted). tions may Fund stating be correct in that the In the Trustees’ deci prove notes do not necessity the medical of sion arbitrary capricious under the and stan private nursing, support the notes do not the dard, as our de novo review of the district nursing conclusion that the care was not requires, court’s decision we find that the necessary. particular, they offer no indi- of supported by denial the claim was not availability cation as to the ability and of the substantial evidence. We have no basis for Hospital’s provide nurses to the same level of concluding that the Trustees’ decision rested care that Potok received from private the anything on other than the three-sentence duty Thus, nurses. we find the notes non- report. on Reliance such limited information determinative. deny to the claim capri was Second, cious since it was not we find that Dr. “based on a Blake’s letter did consider Jordan, support ation of the not relevant factors.” the Board’s See conclusion. While omitted). (quotation 46 F.3d at 1271 the “medically More letter did not use the term over, Byrne even if explained necessary,” had plainly detail it reflects Dr. Blake’s be- necessary for nursing care was private that nursing eare was duty the private lief recovery. the the severe full We find pointed out Potok’s necessary. Blake Dr. care, based sim post-operative ipse pronouncement, dixit Potok’s Fund’s of complications from that of case distinguishing Hospital’s reputation, Potok’s ply on New York thus coronary recovering from patient typical circumstances were insuf the of the Aetna’s view that “[b]e- He noted bypass surgery. artery only piece expert ficient to contradict illness,” the severity her cause v. NYSA-ILA Sever evidence. See Catania nursing care. recommended the team medical No. 91 Civ. ance Benefit that were it Moreover, suggests language his *8-9, 1992 LEXIS at U.S.Dist. WL not nursing, Potok would private not for the 1992) (S.D.N.Y. July *24-27 at recovery meaningful [with “made have they arbitrarily when (finding acted trustees pro- returning to an active prospect of] by treating physi supported denied claim life.” ductive contradictory medical cian’s letter without nothing on more than only conclusion evidence based This letter leads eare was Workers duty nursing speculation); Pritt v. United Mine private (S.D.W.Va.1994) not have Am., care necessary that such could It Hospital nurses. unrea provided (finding denial of benefits been expert an opinion of professional were “unable contains the defendants sonable because condition extreme- medical knew Potok’s any who medical evidence’ point to ‘substantial only not the views expresses ly and it well ... [and] supporting the benefits denial at the team also of the medical Dr. Blake but sup only medical evidence substantial assume reasonable to It is Hospital. conclusion”). ports opposite were well medical team Blake and the Dr. out, Moreover, points Fund itself as the nurs- availability of the nature aware of duty to an affirmative seek trustees they be- Hospital and that ing care required. when Donovan expert advice for Potok’s be sufficient it lieved would (2d Cir.), Bierwirth, 263, 272-73 condition. egregious particularly denied, 103 S.Ct. 459 U.S. cert. Third, evidence only piece of record (1982). they If felt L.Ed.2d 631 was Aet- Trustee’s decision supporting the provided the could have Hospital’s nurses very denial, decision which was the na’s from the type care received Potok that, argues reviewing. The Fund was nurses, upon to seek incumbent them experts, it should be right to consult given its they at evidence that sort of medical reviewing the rely the denial able to on at trial to determine tempted to introduce support offers no evidence appeal. Yet it Thus, speculation their was correct. whether review- claim implied that the Aetna its reasons, that the we find foregoing for the care that type of expert on the er was substantial not based on Fund’s decision was Moreover, while provide. staff nurses could arbitrari therefore it acted and that evidence agreeing from prohibited not the was ly capriciously. sup- Aetna, speculation, without with Aetna’s evidence, to is insufficient porting medical

justify decision. the Fund’s by the Fund Reconsideration IV. decision Finally, Fund defends its the deci- that the Trustees’ Although we find underlying of the evi- contending all that arbitrary capricious, we do sion was that the “common-sense conclusion dence is necessarily Miller’s claim that conclude Hospital not have to York do patients at New we do not granted been because should have to in order private nurses hire their own evi- that, receipt of upon additional find the medically re- they the receive ensure fiduciary only have dence, could a reasonable effect, argues In the Fund quired care.” Therefore, to remand we granted the claim. very deci- sense” and that both “common the instruction with the district court to over- sufficient it was were sion for recon- to the Fund returned the ease be and the he Dr. statement that come Blake’s Catania, 176502, 1992WL See sideration. Hospital believed New York team at medical

1074 *9-10, 1992 Dist. U.S. LEXIS at *28- district granted court fees and costs to Mil- 29. Miller, ler. No. slip op. 93 Civ. at 8. light above, In of our holdings we remand to present The incomplete record is the district reweighing court for a of the and we therefore cannot conclude that there 502(g)(1) § factors under recalculation possible is no support evidence that could amount, any, if attorneys’ fees to be denial of proving benefits. The burden of awarded Miller. to necessity the medical of the care Notwithstanding Potok remains with received Miller. that we decline to See Fuja Co., grant v. to Trust benefits Miller rather Ins. but remand Benefit Life (7th Cir.1994) where, district court’s (holding determination for further consideration, here, as an “medically necessary” attorneys’ award of provision fees to plaintiff precluded. is not is described Section 502(g)(1) in the benefits section of the requirement no contains party insurance contract rather than the “exclu awarded attorneys’ section, fees plaintiff prevailing sions” be bears “the burden party. 1132(g)(2). § U.S.C. establishing The dis her entitlement to the insur Cf. trict benefits”). may court attorneys’ award fees ance to ei hearing, At the pro Miller party ther “in Moreover, its discretion.” vided evidence expert, from reliable Potok’s may district court in fact cardiologist, determine that that the care was nec Miller is the prevailing party to the essary. extent Upon receipt case, of this the Fund that her motion summary judgment given should be opportunity present to claimed that the Fund’s arbitrary denial was conflicting or contradictory evidence to over capricious. See Sansevera v. E.I. Du come this evidence. Miller must then be Co., Pont de Nemours & permitted produce any to additional evidence (S.D.N.Y.1994) (granting attorneys’ fees any to rebut on which evidence the Fund plaintiff to summary whose judgment motion rely could deny to benefits. partially granted as that Plan conclusion, we find that the Fund acted Board arbitrarily acted and capriciously in arbitrarily and capriciously in denying the benefits). denying benefits to Potok. We remand to the district court with instructions to return the case to CONCLUSION the Fund for reconsideration in light For foregoing reasons we vacate and presented by evidence both sides. remand with instructions for further consid- eration in accordance with opinion. this Attorneys’Fees V. Award of The Fund challenges also the dis CALABRESI, Judge, Circuit concurring trict court’s decision to attorneys’ award fees part dissenting part: to Miller. 502(g)(1) ERISA, Section requires give ERISA that courts deference § U.S.C. 1132(g)(1), courts, allows district discretionary trustees’ deny decisions to discretion, within their to award attorneys’ claims for benefits. See Firestone Tire & fees and costs party. to either The factors Bruch, Rubber 101, 115, Co. 489 U.S. govern such awards are 948, 956-57, (1989). S.Ct. 103 L.Ed.2d 80 (1) degree offending of the party’s cul- scope The of this deference is substantial. pability (2) faith, or ability bad Even when a court finds the trustees’ deci- offending party satisfy an award of at- sion to be and capricious, the court (3) torney’s fees, whether award of fees typically will not substitute judgment its own would deter persons other from acting sim- trustees, for that of the but will return the ilarly (4) circumstances, under like the rel- claim to them for Opin- reconsideration. See ative parties’ merits positions, ion at (citing v. Catania NYSA-ILA (5) whether the action conferred a common Fund, Severance 3262, 91No. Civ. Benefit benefit on a group pension of plan partici- *9-10, 1992 WL at 1992 U.S.Dist. pants. (S.D.N.Y. LEXIS 10985 at *28-29 July Masters, Chambless v. Mates & Pilots Pen- 1992)). procedure This is consistent with Plan, (2d Cir.1987). sion 815 F.2d Congress’s apparent intent that district concluding After that the final factor was courts not “‘function plan as substitute ad- ” applicable not because the action involved Opinion ministrators.’ (quoting at 1071 only one beneficiary but that the Perry first four v. Simplicity Eng’g, weighed (6th factors in favor plaintiff, Cir.1990)). the Thus, returning the claim to anything company, which was insurance only in those the inappropriate is the trastees may party. It be that on a disinterested evidentiary record but full the in which cases reconsideration, by conclusion, properly chastised this or possible only one of admits would, opinion, the trustees will exercise by court’s the trustees reconsideration where ” “ authority appropriate manner in a more formality.’ reasons, their be a ‘useless for other all the a decision based on evi- render v. Central (quoting at 1071 Wardle Opinion court, can them. But how this before States, dence Areas Pension & S.W. S.E. Cir.1980) (internal record, fairly possibili- (7th evaluate this citation on F.2d omitted)). ty? greater far familiari- far, agreement with The district court has complete I am Thus majori- parties ty experience the both the agree with with majority. I also of than we Fund’s denial circumstances of this case do. that the ty’s determination matter, capri- example, collateral claim was on one For Ms. Miller’s however, I majority, be- had acted in that the trustees bad Unlike indicated cious. sending not, itself, by preclude significant risk is a This fact does lieve there faith. by would be to the trustees possibility claim back that reconsideration us. formality may in the case before more than useless formali- be useless trustees trial of datum the court ty. But it is the sort may be a by the trustees Reconsideration far better place in and evaluate can context different formality two least useless I that the district court we can. believe than evidentiary fully developed aWhen reasons. than we are to deter- better situated is far conclusion, the dis- only one permits record claim back to the sending the mine whether impose that result may properly trict court and a waste of be both unfair would trustees claim is indis- resolution of the The itself. reason, I would allow For that time. trustees to recon- requiring the putable, and this decision on the court to make district simply be a waste would their decision sider majori- by forth the standard set basis Similarly, when the trustees of time. ty. unwillingness to a manifest demonstrated sup- to evidence consideration give portion fair from that Accordingly, I dissent claimant, should not be the claim ports the majority’s opinion that instructs the dis- cases, it In such to the trustees. returned trustees to reevalu- require to trict court support would the evidence may be that well Miller’s claim. ate Ms. grant or a decision a decision either by the But deny reconsideration benefits. inappropriate be would nevertheless trustees a fair obtain the claimant cannot

because defer requirement that courts

hearing. The cannot mean of trustees Nursing decisions Evelyn BLUE, Paltz New d/b/a who are trustees affirm decisions we must Home, Plaintiff-Appellee, obstinate, they biased, lazy that will or so situations, the claimant. such hear the KOREN, M.D.; Mary K. Michele Du Jane required hearing, which is right to a R.N.; Cooney, lemba; Barbara Patricia wholly illusory. plan, would be benefit Rosenfield; R.N.; Brooks, Barbara E. Fund in this say I for sure that cannot Lawrynenko, Mykola Defendants- unwillingness such ease demonstrated has Appellants. Miller’s claim. the merits Ms. to consider 94-9169. Docket No. matter on the I had to decide the But if Appeals, States us, disagree United Court I would with record before Circuit. Second the trustees majority find and would unwillingness. The just this sort exhibited July 1995. Argued trustees who cold reveals set record 26, 1995. Decided Dec. fiduciary responsibili- their totally abdicated They rendering their initial decision. ties in abundantly that all that mat- clear

made reached the conclusion to them was tered notes for the judgment,” clear (quotation error of id. omit meeting However, with the Trustees. she ted), is, if the decision was ‘“without testify Byrne did not could not recall reason, unsupported substantial evidence whether she understood the notes. He had ” law,’ Pagan, or erroneous as a matter knowledge anyone no as to whether who 45). (quoting F.3d at 442 Abnathya, 2 F.3d at

Case Details

Case Name: Goldie Miller, as of the Estate of Sarah M. Potok v. United Welfare Fund

Court Name: Court of Appeals for the Second Circuit

Date Published: Dec 19, 1995

Citation: 72 F.3d 1066

Docket Number: 1108, Docket 94-7908

Court Abbreviation: 2d Cir.