performed. If defendant's argument is accepted, this second group of cases must be excluded from the program since such plaintiffs can be described as merely seeking specific performance. Neither Congress nor the judges of the Eastern District who promulgated the Local Arbitration Rule would have intended such disparate and arbitrary treatment of similar civil cases.
Moreover, the legislative history provides no reason to accept defendant's construction of the statute. See the House Report; Hearing on Court-Annexed Arbitration and Experimentation Before the Subcomm. on Courts, Civil Liberties and the Administration of Justice of the House Comm. on the Judiciary, 99th Cong., 2d Sess. (1987) (cited by and relied upon by the 100th Congress in its House Report).
Nevertheless defendant urges the court to be guided by the Supreme Court's construction of "money damages" in Bowen v. Massachusetts, 487 U.S. 879, 101 L. Ed. 2d 749, 108 S. Ct. 2722 (1988). But Bowen provides no help. There, the Supreme Court merely sought to determine whether Congress intended federal courts to have jurisdiction in a dispute between the Secretary of Health and Human Services and a State when the Secretary refused to reimburse the State for certain classes of Medicaid expenses. The Court held that section 702 of the Social Security Act, denying district court jurisdiction over claims for "money damages" from federal agencies, did not bar a district court from ordering the Secretary to reimburse the State. The Court there interpreted the term "money damages" in light of Congress's purpose in enacting section 702.
Even if this court accepts defendant's view that it should construe the statute and rule solely based on their "plain meaning," and the Bowen Court did not place great weight on that basis, this court cannot agree that the Local Arbitration Rule's limitation to cases solely seeking money damages "plainly" excludes Ritzer request to be compensated for the medical expenses he incurred. Indeed if Ritzer personally paid the hospital because the Fund refused, the reimbursement he now seeks is not, as defendant contends, "the exact thing to which he deems himself entitled" (emphasis in defendant's brief). The exact thing Ritzer wanted was for the Fund to pay the hospital directly.
The court rejects the Fund's interpretation of Local Arbitration Rule 3A.
The court nevertheless grants the Fund's request to remove the case from the court-annexed arbitration program.
As noted above the program was intended to expedite the resolution of relatively simple, fact-based controversies. An arbitrator can decide as well as a court, for example, whether a defendant struck a plaintiff or whether a plaintiff performed a contractual obligation.
But a dispute, as here, over whether an ERISA plan's trustees acted in an arbitrary and capricious manner will rarely be so simple. Such disputes, in which a defendant previously acted as a tribunal vested with quasi-agency decision-making authority, blend issues of fact with issues of law and are thus unsuited for arbitration.
While the Local Arbitration Rule does not explicitly authorize the court to remove an individual case from the arbitration program, the court finds such authority inhering in its discretionary power sensibly to manage its own caseload. In any event, plaintiff has not objected to defendant's request to remove the case.
Plaintiff exhausted his administrative appeal and the court has jurisdiction to hear this dispute.
Defendant's motion for summary judgment is denied. The court finds on its own summary judgment motion that the Fund's denial of Ritzer's claim based on Superb's "selective participation," in these circumstances, was arbitrary and capricious. The court further finds a genuine issue of material fact as to whether the Fund acted arbitrarily and capriciously in finding Ritzer individually ineligible to participate in the Fund in April 1991. Upon an adequate showing of fact, plaintiff may move for summary judgment.
Defendant's request to remove the case from the mandatory court-annexed arbitration program is granted.
Dated: Brooklyn, New York
November 30, 1992
Eugene H. Nickerson, U.S.D.J.
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