Medicare Supplement Plan Properly Discontinued by City
Post 5108
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New York’s Highest Court Approves Change in Medicare Plan
The City of New York decided to discontinue its Medicare supplemental plan, Senior Care, and enroll all retirees in a custom-designed Medicare Advantage Plan (MAP) managed by Aetna Life Insurance Company. Petitioners, consisting of nine retirees and one organization, initiated legal proceedings to prevent the City from eliminating their existing health insurance plans. They argued that the City had repeatedly promised to provide and pay for a Medicare supplemental plan upon retirement, and that they relied on these promises when making financial, employment, and retirement decisions.
In the Matter of Robert Bentkowski, et al. v. City of New York, et al., 2025 NY Slip Op 03690, No. 57, New York Court of Appeals (June 18, 2025) ruled in favor of the city.
The Trial Court
The Supreme Court ruled in favor of the petitioners on their promissory estoppel cause of action and their cause of action under Administrative Code of the City of New York and the Appellate Division affirmed. The City appealed.
The primary issue before the Court of Appeals was whether petitioners were entitled to judgment on their promissory estoppel cause of action. The Court of Appeals concluded that petitioners were not entitled to judgment on this cause of action, as they failed to establish the existence of a clear and unambiguous promise of Medicare supplemental insurance coverage for life.
Promissory Estoppel:
1. The Court found that the Summary Program Descriptions (SPDs) provided by the City were descriptive and for informational purposes only and did not constitute a clear and unambiguous promise of Medicare supplemental insurance coverage for life.
2. The affidavits submitted by the petitioners, including those from Lilliam Barrios-Paoli and hundreds of retirees, were based on the SPDs and did not establish a clear and unambiguous promise.
Administrative Code § 12-126 (b) (1):
The petitioners contended that the City was required to provide and pay for a Medicare supplemental plan under Administrative Code § 12-126 (b) (1). The Court rejected this contention, stating that the requirement prohibits the City from passing any portion of the cost up to the statutory cap on to its employees and retirees, but does not require the City to fund health insurance without the benefit of federal subsidies.
Conclusion:
The Court reversed the order of the Appellate Division and remitted the matter to Supreme Court for further proceedings in accordance with its opinion.
DISCUSSION
Respondents answered, arguing, among other things, that the City’s statements in the SPDs did not constitute “a clear and unambiguous forward-looking promise sufficient to support a promissory estoppel claim.” Furthermore, respondents stated that the Aetna MAP was the product of negotiation between the City, Aetna, and the Municipal Labor Committee (MLC), which represents over 100 municipal unions in the collective bargaining process. According to respondents, the Aetna MAP would allow the City to access federal subsidies, creating $500 million in savings to be allocated to a Health Benefits Stabilization Fund to provide sufficient reserves for future health benefits.
Any inference of a lifetime promise derived from the SPDs is even less plausible in light of the prefatory language employed therein and the mayoral cover letters. Because there is no clear and unambiguous promise in the SPDs, the affidavits of Barrios-Paoli and the hundreds of retirees likewise fail to establish the existence of such a promise.
The parties stipulated to the completeness of the record. On that record, petitioners failed to introduce sufficient evidence to establish that the City’s decision to shift retirees to the Aetna MAP constitutes a diminution in retiree benefits or the City’s contributions for those benefits.
The order of the Appellate Division reversed with costs, and matter remitted to Supreme Court, New York County, for further proceedings in accordance with the opinion herein.
ZALMA OPINION
Promises to provide health insurance coverage and Medicare Supplement Coverage must be clear and unambiguously to provide such services for the life of the employee or retired employee for a court to compel the city to keep the promises. The promises of coverage were not kept because they were not made to be a “forever benefit.” Shifting benefits from one program to another did not diminish the benefits promised.
(c) 2025 Barry Zalma & ClaimSchool, Inc.
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Arsonist Tried To Represent Himself, Failed, and Sought Habeas Relief
Post number 5357
Read the full article at https://www.linkedin.com/pulse/he-who-acts-his-own-lawyer-has-idiot-client-barry-zalma-esq-cfe-d4bwc, See the full video at and at and at https://zalma.com/blog.
Karacson’s Arson for Profit Attempt Required Skill & Experience to Succeed
In Steve Ellis Karacson v. David Shaver, Warden, No. 25-1089, United States Court of Appeals, Sixth Circuit (May 20, 2026) Steve Karacson was convicted in Michigan state court of arson and insurance fraud after evidence showed he burned his own insured home. Investigators found multiple points of origin, gasoline odor, and evidence tying him to the scene, including cell-phone location data and a receipt showing he had purchased a gas can and gloves shortly before the fire.
FACTS
Karacson initially had appointed counsel, but his relationships with both appointed attorneys ...
Foolish to Repeatedly Disobey Court Orders
All That Remains For Trial Is Plaintiff’s Damages On Each Of These Claims And Establishing Proximate Causation Of Those Damages.
Post number 5348
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In Linh Wang v. Esurance Insurance Company, No. C24-0447-JCC, United States District Court, W.D. Washington, Seattle (May 1, 2026) John C. Coughenour, United States District Judge, found that throughout this case, culminating with its briefing on Plaintiff’s renewed motion and that Defendant has subjected Plaintiff to unnecessary motion practice for clearly discoverable information and made dubious representations (including to the Court).
FACTUAL BACKGROUND
This case involves an underinsured/uninsured motorist insurance bad faith claim arising from a 2017 motor vehicle collision. The plaintiff, Linh Wang, alleges that Esurance Insurance ...
The Right to Negotiate with Insurer is Not an Assignment of Claims
Post number 5347
Read the full article at https://www.linkedin.com/pulse/ambiguous-contract-repair-assignment-barry-zalma-esq-cfe-2xppc, see the full video at https://rumble.com/v79is1s-ambiguous-contract-to-repair-not-an-assignment.html and at and at https://zalma.com/blog plus more than 5300 posts.
Nebraska Requires an Actual Assignment to Allow Contractor to Sue Insurer
In Millard Gutter Company, a corporation doing business as Millard Roofing and Gutter v. Farmers Mutual Insurance Company of Nebraska, also known as Farmers Mutual Insurance, also known as Farmers Mutual, No. A-24-818, Court of Appeals of Nebraska (May 5, 2026) Millard sued Farmers as an assignee of Jane Anzalone who had hired Millard Gutter to repair the roof of her home and agreed to allow Millard Gutter to coordinate with her insurer, Farmers Mutual, concerning reimbursement for repairs authorized under her insurance policy.
FACTUAL BACKGROUND
In ...
Qui Tam Case Without Evidence to Prove Fraud Fails
Post number 5369
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In People Of The State Of California Ex Rel. Heath & Yuen, APC v. Silver Bird Auto Leasing, LLC et al., B342847, California Court of Appeals, Second District, Eighth Division (June 5, 2026) Heath & Yuen, APC defended parties in an automobile collision case involving a McLaren and a tour van. After that case settled for $25,000, the firm filed a qui tam action under California’s Insurance Frauds Prevention Act (IFPA) against Silver Bird Auto Leasing, LLC, X-Law Group, PC, and Filippo Marchino. The firm alleged three fraudulent acts in the underlying litigation:
1. the complaint falsely stated the McLaren was making a “legal turn,”
2. respondents produced a fraudulent repair bill/estimate, and
3. respondents failed to disclose Marchino’s GEICO insurance and its payment for repairs....
Full Faith and Credit Act Controlled
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Posted on June 9, 2026 by Barry Zalma
Post number 5368
Posted on June 9, 2026 by Barry Zalma
In Prime Insurance Company, Inc. v. Medicab Transportation, LLC, Jason Rhodes, and Dale Johnson v. Prime Insurance Company, Inc and Prime Property & Casualty Insurance, Inc. No. 2:24-cv-421-SPC-KRH, United States District Court, M.D. Florida, Fort Myers Division (June 3, 2026) Medicab, a paratransit company, bought two policies in 2021: a Business Auto Policy from PPCI and a Commercial Liability Policy from Prime. Both policies, as originally written, appeared to cover injuries arising from loading and unloading patients from Medicab vans.
After a patient, Margaret St. Aubin, fell while being unloaded from a van and suffered injuries, her Estate made a $1 million demand. Prime and its claims administrator concluded that the Commercial Policy’s loading/unloading language had been included by mutual mistake, because...
Full Faith and Credit Act Controlled
Read the full article at https://lnkd.in/evHXiiFE and at https://zalma.com/blog.
Posted on June 9, 2026 by Barry Zalma
Post number 5368
Posted on June 9, 2026 by Barry Zalma
In Prime Insurance Company, Inc. v. Medicab Transportation, LLC, Jason Rhodes, and Dale Johnson v. Prime Insurance Company, Inc and Prime Property & Casualty Insurance, Inc. No. 2:24-cv-421-SPC-KRH, United States District Court, M.D. Florida, Fort Myers Division (June 3, 2026) Medicab, a paratransit company, bought two policies in 2021: a Business Auto Policy from PPCI and a Commercial Liability Policy from Prime. Both policies, as originally written, appeared to cover injuries arising from loading and unloading patients from Medicab vans.
After a patient, Margaret St. Aubin, fell while being unloaded from a van and suffered injuries, her Estate made a $1 million demand. Prime and its claims administrator concluded that the Commercial Policy’s loading/unloading language had been included by mutual mistake, because...
