United States Second Circuit

ERISA plan's explicit language provides at best a very narrow exception to a blanket exclusion of full-time, in-home care, and given the administrator's determination, which was neither arbitrary nor capricious, that such care is not "Medically Necessary" within the meaning of the plan, the treatment plaintiffs request cannot fall within that exception.

Appellate Information

• Decided 03/28/2002
• Published 03/28/2002

Judges

• F.I. PARKER, Circuit Judge., Before KEARSE, MINER, and F.I. PARKER, Circuit Judges.

Court

• United States Second Circuit

Counsel

• For Appellant:
  
• Mark Scherzer, Law Office of Mark Scherzer, New York, NY, for Plaintiffs-Appellants., Michael Schuster, Law Office of Michael Schuster, Washington, DC, Stuart R. Cohen, Sara Lenz Lock, Dorothy Siemon, AARP Legal Foundation, for Amicus Curiae American Association of Retired People (“AARP”), Washington, DC., Anne Davis, New York City Chapter of the Multiple Sclerosis Society, New York, New York, for Amicus Curiae New York City Chapter of the Multiple Sclerosis Society.


• For Appellees:
  
• Allan B. Taylor, Day, Berry & Howard, Hartford, CT, Arthur J. Ciampi, Morrison, Cohen, Singer & Weinstein, LLP, New York, NY, for Defendant-Appellee Oxford Health Plan., Frederick A. Brodie, Winthrop, Stimson, Putnam & Roberts, New York, NY, for Defendant Mount Sinai Medical Center Point-of-Service-Plan.