Aquino v. New England Securities, et al.
United States District Court, Eastern District of New York
United States Court of Appeals, Second Circuit
- Issue: The plaintiff brought an action alleging breach of the ADA in connection with several 401k Plans and Life Insurance Policies.
- Resolution: Upon Summary Judgment, the Court dismissed all causes of action and Plaintiff’s subsequent Appeal and Motion for Reconsideration of Appellate Decision were denied.
Fontana v. Champion Mortgage Co., Inc.
Supreme Court of the State of New York, Suffolk County
- Issue: The plaintiff brought a putative class action alleging that improper charges were assessed by a national bank in connection with providing a mortgage payoff statement. After class certification was successfully opposed, Plaintiff subsequently moved to amend the putative class action complaint to include claims relating to the alleged over-charging of interest.
- Resolution: The Court denied class certification and Plaintiff’s subsequent motion to amend the class action complaint. The Second Department affirmed the decision denying plaintiff’s Motion to Amend the Complaint. See 819 N.Y.S.2d 472, 2006 N.Y. App. Div. LEXIS 998 (2d Dep’t 2006).
Regan v. Metropolitan Life Insurance Company
Supreme Court of the State of New York, Monroe County
United States District Court, Western District of New York
- Issue: The plaintiff brought a putative class action challenging secondary payor status in connection with the Empire Plan when the member was eligible for Medicare coverage.
- Resolution: The Supreme Court (Monroe County) granted Summary Judgment dismissing the complaint. This decision was affirmed by the New York State Appellate Division, Fourth Department. Regan v. N.Y.S. Dept. of Civil Service. et al. 284 A.D.2d 950, 725 N.Y.S.2d 917 (4th Dept. June 8, 2001). Motions for Leave to Appeal to the New York State Court of Appeals and the United States Supreme Court were denied. When the same class plaintiff subsequently commenced a similar putative class action in Federal Court, members of DLO successfully moved for summary judgment and opposed class certification. The Second Circuit affirmed the decision. See Fed Appx. 718, 2003 U.S. App. LEXIS 23409, 32 Employee Benefits Cas. (BNA) 1396 (2d Cir, 2003), cert. denied, 2004 U.S. Lexis 6643 (2004).
Long Island Pulmonary Associates, P.C. v. Metropolitan Life Insurance Company
Supreme Court of the State of New York, Nassau County
- Issue: Health care provider brought action against health insurer, alleging libel, tortious interference with contractual relations and anti-trust violations, based on the insurer’s audit of plan enrollees. The insurer brought a counterclaim to recover overpayments made to the provider as a result of the provider’s waiver of co-payments.
- Resolution: The Trial Court granted Defendant’s Motion for Summary Judgment on all claims and dismissed the complaint. This decision was affirmed by the New York State Appellate Division, Second Department. The counterclaim seeking reimbursement of the co-payment waivers was settled with the provider. See 303 A.D.2d 645, 756 N.Y.S.2d 788, 2003 N.Y. App. Div. LEXIS 3135 2d Dep’t 2003).
Recovery Home Services v. Metropolitan Life Insurance Company
Supreme Court of the State of New York, New York County (Gammerman, J.)
284 A.D.2d 178, 726 N.Y.S.2d 253 (2d Dep’t 2001)
- Issue: The plaintiff brought the action seeking benefits for skilled nursing services under the New York State Health Insurance Plan (the Empire Plan). After trial, the Court ruled for UnitedHealth, and the plaintiff appealed the decision.
- Resolution: The Appellate Division affirmed the trial court’s decision. See Order and Decision dated June 12, 2001, 284 A.D.2d 178, 726 N.Y.S.2d 253 (1st. Dep’t 2001). The First Department held that there is no ambiguity in the coverage language of the Empire Plan concerning skilled nursing benefits. The First Department affirmed the Trial Court’s determination that “there was no coverage if the insured’s condition was chronic.” Id. The trial court in Recovery Home Services rejected the plaintiff’s argument that several chronic conditions translate into an acute condition, holding that “nor can it be said that the overall picture of her chronic problems must be considered collectively as acute.”
Basri v. Metropolitan Life Insurance Company
Supreme Court of the State of New York, Orange County
306 A.D.2d 302, 760 N.Y.S.2d 654 (2d Dep’t 2003)
- Issue: The plaintiff, a physician, brought the action to recover benefits under the New York Health Insurance Plan (Empire Plan) for services he provided to participants in the Plan. The trial court dismissed the action finding that the majority of claims were time-barred. Plaintiff lacked standing to sue as a nonparticipating provider, and as a result of his bankruptcy filing.
- Resolution: The Appellate Division affirmed the decisions of the trial court. See Order and Decision dated June 9, 2003, 306 A.D.2d 302, 760 N.Y.S.2d 654 (2d Dep’t 2003).
Kerrigan v. Metropolitan Life Ins. Co.
2013 N.Y. Misc. LEXIS 6489
Appeals Court of New York held that insurer must have actual, not constructive, knowledge of misrepresentation during underwriting and rejected claimed that insurer should have ascertained from records available. New York Court of Appeals denied a motion for leave to appeal to the Court of Appeals based on alleged post claim underwriting.
Park v. Metropolitan Life Insurance Company
421 F. App’x 197 (3d Cir.), cert. denied, 132 S. Ct. 243, 181 L .Ed. 2d 138 (U.S. 2011)
Third Circuit Court of Appeals upholds rescission of a million-dollar policy based upon material misrepresentations where the plaintiff’s primary argument was that the insured did not understand the English language.
Williams v. Prudential Financial, Inc.
138 A.D.3d 643, 644 (N.Y. App. Div. 2016)
New York Appellate Division decision affirming trial court dismissal of a complaint seeking benefits under a lapsed policy, rejecting the beneficiary’s claim that the grace period to pay premiums was extended by the agent, who did not have the authority to extend the grace period.
Ferguson v. Brighthouse Life Insurance Company
(D. Ct. Michigan 2025)
Court rejected plaintiff’s claim that court must balance the “equities” as it does with mandatory car insurance matters even where material misrepresentation is undisputed.