Scorsone v. United Food & Commercial Workers Union Local 1245

**What Happened** Lisa Scorsone was a union member whose health insurance fund denied coverage for ptosis repair surgery (a procedure to fix drooping eyelids). When she appealed the denial, the fund rejected her appeal without giving their reviewing doctor all the additional medical evidence she had submitted to support her case. **What the Court Decided** The Third Circuit Court of Appeals ruled in Scorsone's favor. The court found that the health insurance fund acted "arbitrarily and capriciously" - meaning unreasonably and unfairly - when they denied her appeal. The fund had failed to provide the reviewing physician with all the medical evidence Scorsone submitted, which meant the doctor couldn't make a fully informed decision about her case. **Why This Matters for Workers** This ruling protects workers' rights to fair treatment when appealing health insurance denials. It establishes that insurance funds must thoroughly review all medical evidence before rejecting claims - they can't simply ignore or fail to share important documents. Workers can use this precedent if their union health plans or employer insurance deny coverage without properly considering all their medical documentation during the appeals process.