Opinion ID: 773515
Heading Depth: 2
Heading Rank: 2

Heading: Likelihood of Success on the Merits/Sufficiently Serious Questions Going to the Merits

Text: 34 A party seeking a preliminary injunction ordinarily must show: (a) that it will suffer irreparable harm in the absence of an injunction and (b) either (i) a likelihood of success on the merits or (ii) sufficiently serious questions going to the merits to make them a fair ground for litigation and a balance of hardships tipping decidedly in the movant's favor. 9 See, e.g., Polymer Technology Corp. v. Mimran, 37 F.3d 74, 77-78 (2d Cir. 1994). 35 We begin by considering the second set of factors-likelihood of success on the merits and sufficiently serious questions going to the merits. 10 As to these, our conclusions are straightforward. 36 First, for substantially the reasons stated by the District Court, we believe that Zervos has not yet demonstrated that there is even a remote possibility that he will be entitled to relief on the basis of his ADA claim. See Zervos, 2001 WL 253377, at . 37 Second, we are convinced that Zervos has not shown a likelihood of success on his Title VII claim-the crux of which is that Empire has discriminated on the basis of sex in its provision of coverage for HDCT. The District Court found that Empire has covered (or not covered) HDCT without regard to the sex of those that apply for it. See id. at . We perceive no clear error in this factual finding, and therefore we agree with the District Court that Zervos has not established that there is any chance that his Title VII claim may be meritorious. See id. 38 Finally, we agree with the District Court that Zervos has not demonstrated-at least on the administrative record, see Miller v. United Welfare Fund, 72 F.3d 1066, 1071 (2d Cir. 1995) (review [of a decision of a plan administrator] under the arbitrary and capricious standard is limited to the administrative record)-that there is any realistic possibility that he may be entitled to relief on his ERISA claim. The District Court found that Empire's Technological Assessment Committee (TAC) decided after a March 2000 meeting that it would no longer cover HDCT, and that TAC made this decision only after review[ing] the scientific data available to them and considering all of the medical evidence of HDCT's unproven benefit. Id. at . Moreover, the TAC concluded, on an adequate record, that HDCT was not superior to conventional therapy, Empire denied coverage on this basis, and the District Court upheld the reasonableness of Empire's decision on this ground. 39 In so ruling, the District Court did not abuse its discretion in concluding that Zervos's ERISA claim is insufficiently substantial to support preliminary injunctive relief. The parties agree that Empire's decision not to cover HDCT can be displaced only if it was arbitrary and capricious, and there is simply no basis in the record for concluding that such may have been the case here. Indeed, Empire's decision to stop covering HDCT appears to have been both procedurally sound (in that it was based on the advice of TAC experts who consulted relevant scientific data) and substantively sound (in that none of the evidence supports the conclusion that HDCT is anything but Experimental/ Investigational). See generally Pagan v. NYNEX Pension Plan, 52 F.3d 438, 442 (2d Cir. 1995) (Under the arbitrary and capricious standard of review, we may overturn a decision to deny benefits only if it was without reason, unsupported by substantial evidence or erroneous as a matter of law.) (internal quotation marks omitted). 40 In sum, we hold that the District Court did not abuse its discretion in deciding that Zervos was not entitled to a preliminary injunction. That decision was not based on an error of law or on a clearly erroneous finding of fact. And because Zervos has not shown that there is a likelihood that he will succeed on the merits of any of his claims, or that there are sufficiently serious questions going to the merits of his claims so as to make them a fair ground for litigation, Polymer Tech. Corp., 37 F.3d at 77-78, we hold that the District Court's decision not to enter a preliminary injunction in this case did not fall outside of the range of alternative decisions that it was permitted to make. See ante at 168-69. See generally Alliance Bond Fund, Inc. v. Grupo Mexicano de Desarrollo, S.A., 143 F.3d 688, 692-93 (2d Cir. 1998) (The [district] court is vested with full discretion to determine whether to grant . . . [an] injunction and its scope.) (citing Hecht Co. v. Bowles, 321 U.S. 321, 329 (1944)), reversed on other grounds by 527 U.S. 309 (1999). 41 Before concluding, we pause here to commend Judge Daniels for ruling expeditiously on Zervos's motion for a preliminary injunction. In this case-whatever it may ultimately require-justice can tolerate no substantial delays. Accordingly, we trust that if Zervos opts to proceed further, Judge Daniels will continue to treat this matter as an urgent one, and will impress upon the parties the need for prompt action. 42 Our decision today does not necessarily mean that Zervos may not be able to develop a successful federal claim. For example, Zervos suggested at oral argument that he hopes to determine in discovery whether Empire's decision to deny his coverage request was tinged by a conflict of interest. If Empire was in fact operating under such a conflict, Zervos's ERISA claim would necessarily stand on relatively more solid ground. See generally Firestone Tire & Rubber Co. v. Bruch, 489 U.S. 101, 115 (1989) (if a benefit plan gives discretion to an administrator or fiduciary who is operating under a conflict of interest, that conflict must be weighed as a factor in determining whether there is an abuse of discretion) (internal quotation marks and brackets omitted). On such an issue, which is distinct from the reasonableness of the plan administrators' decision, the district court will not be confined to the administrative record. 43 Similarly, Zervos may be able to establish that, under the plan, the focus of an arbitrary and capricious inquiry should not be on Empire's initial decision to deny coverage for HDCT-that is, the decision that Empire made after the TAC meeting. Rather, Zervos may be able to show (1) that judicial review here should focus on the final, definitive decision to deny coverage (which was all but made by an external reviewer); (2) that in this case that decision was the one communicated to Zervos by letter dated October 24, 2000; and (3) that that decision was arbitrary and capricious because it was based on a material misunderstanding of what is meant under the plan by the term Experimental/ Investigational. 11 Compare The Plan at 6 (defining Experimental/ Investigational as services . . . which are not of proven benefit for the . . . treatment of the Covered Person's condition, or are not generally recognized by the medical community as effective or appropriate for that condition) with Letter from Empire to Zervos (Oct. 24, 2000) (We are unable to authorize [HDCT] for the following reason: `There are no convincing data to show that [HDCT] is superior to conventional chemotherapy alone for males with metastatic breast cancer.' [HDCT] remains denied as experimental and investigational.') (emphasis added) and Letter from Thomas R. Spitzer to Mary E. Picerno (Oct. 20, 2000) ([HDCT] appears to be as effective as prolonged combination chemotherapy for metastatic breast cancer) (emphasis added). See generally Gallo v. Madera, 136 F.3d 326, 330 (2d Cir. 1998) (Even when trustees of a pension plan are entitled to deference in interpreting the terms of the plan, deference cannot be so broad as to permit them to graft additional requirements onto unambiguous plan definitions.).