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NORTHEAST DEPT. ILGWU HEALTH & WELFARE FUND v. TEA
December 30, 1983
NORTHEAST DEPARTMENT ILGWU HEALTH AND WELFARE FUND and Sol Hoffman, Plaintiffs,
TEAMSTERS LOCAL UNION NO. 229 WELFARE FUND, Defendant
The opinion of the court was delivered by: NEALON
This case is before the court based upon cross-motions for summary judgment. All of the material facts appear in the Stipulation, Document 7 of the Record, including, as Exhibit "A", plaintiffs' group insurance plan and, as Exhibit "B", defendant's group insurance plan. After careful consideration, the court will grant plaintiffs' motion for summary judgment and deny defendant's motion for the same.
The plaintiff, ILGWU Fund, is an employee benefit plan within the meaning of ERISA, 29 U.S.C. §§ 1002(1) and (3) and plaintiff Sol Hoffman is a fiduciary of the ILGWU Fund in accordance with 29 U.S.C. § 1002(21). Stipulation, Document No. 7 of the Record at 2. The defendant, Teamsters Fund, is also an employee benefit plan within the meaning of 29 U.S.C. §§ 1002(1) and (3). Id. The eligibility rules for the ILGWU Fund and the Teamsters Fund are promulgated by the trustees of their respective Funds through authority granted by the terms of their collective bargaining agreements. Id. at 2-3. The eligibility rules of the ILGWU Fund under review here state:
You are not eligible for hospital, medical-surgical, or Major Medical benefits under this plan if there exists at your spouse's place of employment a group plan which provides for family coverage of these types of benefits so long as 50% or more of the cost of such family coverage is paid by other than you or a member of your family.
Id. at 3, citing Summary Plan Description of the ILGWU Fund at 7. The applicable eligibility rules of the Teamsters Fund provide:
Our Group Insurance Plan contains a non-profit provision coordinating it with other plans under which an individual is covered so that the total benefits available will not exceed 100% of the allowable expenses. . . .
When a claim is made, the primary plan pays its benefits without regard to any other plans. The secondary plans adjust their benefits so that the total benefits available will not exceed the allowable expenses. No plan pays more than it would without the coordination provision.
A plan without a coordinating provision is always the primary plan. If all plans have such a provision: (1) the plan covering the patient directly, rather than as an employee's dependent, is primary and the others secondary, (2) if a child is covered under both parents' plans, the father's is primary, (3) if neither (1) nor (2) applies, the plan covering the patient longest is primary.
Id. at 4-5, citing Summary Plan Description of the Teamsters Fund at 35.
The issues for this court to address are:
(1) Whether the ILGWU Fund or the Teamsters Fund is responsible for Ruth ...
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