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Santola v. Blue Cross/Blue Shield

Appellate Division of the Supreme Court of New York, Fourth Department
Feb 21, 1986
117 A.D.2d 974 (N.Y. App. Div. 1986)

Opinion

February 21, 1986

Appeal from the Supreme Court, Onondaga County, Tenney, J.

Present — Dillon, P.J., Callahan, Doerr, Boomer and Pine, JJ.


Order and judgment unanimously reversed, on the law, without costs, and summary judgment granted, in accordance with the following memorandum: Special Term erred in granting plaintiff summary judgment, declaring that defendants were equitably estopped from refusing to pay for physical therapy provided to his birth-injured son by therapists not qualified under the benefit plan pursuant to collective bargaining agreements between Chrysler and the UAW because a prior plan administrator had paid those therapists for some eight years. Plaintiff was given notice in advance that payments to those therapists would cease. Furthermore, covered sources of physical therapy exist, and the only possible prejudice shown was that the original therapists' staff had good rapport with the boy and that he had shown improvement. This falls far short of the unconscionable injury to plaintiff required to justify equitable estoppel (see, American Bartenders School v. 105 Madison Co., 59 N.Y.2d 716). Accordingly, defendants are entitled to judgment declaring that they are not estopped from denying plaintiff's claim for physical therapy benefits under the benefit plan (see, Holliswood Care Center v. Whalen, 58 N.Y.2d 1001, 1004).


Summaries of

Santola v. Blue Cross/Blue Shield

Appellate Division of the Supreme Court of New York, Fourth Department
Feb 21, 1986
117 A.D.2d 974 (N.Y. App. Div. 1986)
Case details for

Santola v. Blue Cross/Blue Shield

Case Details

Full title:JOSEPH SANTOLA, Individually and as Parent of JOSHUA SANTOLA, an Infant…

Court:Appellate Division of the Supreme Court of New York, Fourth Department

Date published: Feb 21, 1986

Citations

117 A.D.2d 974 (N.Y. App. Div. 1986)