ERISA - Justia Case Law Summaries

Trustees of the IAM National Pension Fund v. M & K Employee Solutions

2026-07-07T07:32:02-08:00

A group of affiliated truck dealerships in the Midwest operated through a complex structure of multiple limited liability companies. Each dealership location had a “Sales” company that owned assets and an “Employee Solutions” (ES) company that hired employees and leased them to the Sales company. The ES companies entered collective-bargaining agreements requiring pension contributions to a union fund. Over time, the ES companies stopped contributing and employing workers, transferring employees to newly created entities. One of the companies, ES Alsip, incurred withdrawal liability for ceasing contributions. The pension fund assessed over $6 million in liability, which was disputed and partially paid following an arbitration that substantially reduced the amount. Ultimately, higher courts reinstated the original liability. The United States District Court for the District of Columbia granted summary judgment to the pension fund, holding that ES Summit was liable for delinquent contributions for work performed at another dealership, ES Alsip’s withdrawal liability was properly calculated and subject to an increased interest rate, and that multiple affiliated entities and individuals were jointly and severally liable for the obligations. The court also imposed liability on successors and individual owners, the Bouchers, based on their house-flipping activities. On review, the United States Court of Appeals for the District of Columbia Circuit affirmed in part, reversed in part, and remanded. The court held that the delinquent-contribution claim against ES Summit was not adequately pleaded and reversed summary judgment on that issue. It affirmed the allocation of a partial payment to interest rather than principal, but reversed the application of an increased interest rate retroactively. The court affirmed the finding that each Sales entity was a single employer with its corresponding ES entity and upheld successor liability against Laborforce and ESI. However, it found genuine disputes of fact regarding the personal liability of the Bouchers and remanded that issue. View "Trustees of the IAM National Pension Fund v. M & K Employee Solutions" on Justia Law

Flowers v. Caremark PCS Health, LLC

2026-06-29T07:01:20-08:00

Kevin Flowers, a participant in an employee benefits plan governed by the Employee Retirement Income Security Act of 1974 (ERISA), receives prescription drug benefits administered by Caremark, a pharmacy benefits manager. Flowers alleges that Caremark unjustly enriches itself by limiting maintenance prescription coverage to either CVS retail pharmacies or Caremark’s mail-order delivery service. He claims this violates Arkansas statutes requiring PBMs not to mandate home delivery and to provide reasonably adequate and accessible pharmacy networks, leading him and similarly situated individuals to pay out of pocket at local pharmacies. Reviewing the case, the United States District Court for the Western District of Arkansas granted Caremark’s motion to dismiss. The court determined that Flowers failed to plausibly plead a violation of the Mail Order Provision because Caremark did not require prescriptions to be filled solely through home delivery. Regarding the Network Adequacy Provision, the district court found that ERISA preempted the Arkansas requirements, particularly those imposing geographic coverage standards for pharmacy networks. On appeal, the United States Court of Appeals for the Eighth Circuit reviewed the district court’s dismissal de novo. The court affirmed the district court’s ruling, holding that Flowers did not plausibly allege a violation of the Mail Order Provision. The court also concluded that the geographic coverage requirements imposed by Arkansas regulations under the Network Adequacy Provision are preempted by ERISA, as they force PBMs to tailor their networks in ways that interfere with nationally uniform plan administration and constitute an impermissible connection with ERISA plans. The court expressly left open whether the Network Adequacy Provision, without its implementing regulations, would also be preempted. The court affirmed the district court’s dismissal of Flowers’s claims. View "Flowers v. Caremark PCS Health, LLC" on Justia Law

Ahn v. Cigna Health and Life Insurance Co

2026-06-24T09:00:11-08:00

Dr. Jeffrey M. Ahn, an otolaryngologist practicing in New Jersey and New York, treated patients insured by Cigna Health and Life Insurance Company, which provides ERISA-governed health plans. After submitting claims for approximately fifty treatments, Dr. Ahn received denial notices from Cigna, many of which stated his claims were rejected because he was not a licensed provider. Upon appeal, Cigna sometimes reversed or modified the denial reasons. Dr. Ahn contended that these statements were defamatory and filed suit in New Jersey Superior Court, alleging defamation, defamation per se, and tortious interference. Cigna removed the case to the United States District Court for the District of New Jersey and sought dismissal or summary judgment, arguing ERISA preemption and a statute of limitations defense. Initially, the District Court deferred ruling on preemption, as it was unclear which claims related to ERISA plans. After discovery, Dr. Ahn withdrew two claims, leaving only defamation per se. Cigna again moved for summary judgment, submitting evidence that all relevant plans were governed by ERISA. Dr. Ahn presented no contrary evidence. The District Court found the plans were ERISA plans and held that Dr. Ahn’s defamation per se claim was preempted because it concerned statements made in explanation of benefits forms, which are part of ERISA plan administration. On appeal, the United States Court of Appeals for the Third Circuit reviewed the District Court’s decision de novo. The Third Circuit held that ERISA preempts a healthcare provider’s state-law defamation claim when the alleged defamatory statements appeared in explanation of benefits forms sent to beneficiaries of ERISA plans. The court reasoned that such communications are a central aspect of plan administration and that allowing state-law claims would undermine uniformity in ERISA administration. The Third Circuit affirmed the District Court’s grant of summary judgment in favor of Cigna. View "Ahn v. Cigna Health and Life Insurance Co" on Justia Law

Johnson v. Quest Diagnostics Inc

2026-06-22T09:00:11-08:00

Employees participating in a 401(k) plan offered by their employer, a clinical laboratory company, brought a class action alleging that the plan’s fiduciaries breached their duties under ERISA by retaining two particular investment options: the Fidelity Freedom Funds and the Invesco Global Real Estate Fund. The plaintiffs argued that these funds underperformed compared to alternatives, were riskier, and that the plan’s managers failed to remove them despite subpar performance. They also claimed that internal policy statements required the funds’ removal and that the plan’s managers failed in their duty to monitor investments and breached trust obligations. The United States District Court for the District of New Jersey initially denied a motion to dismiss the case, allowing discovery to proceed. After discovery, the District Court granted summary judgment in favor of the defendants. The court found that the plan’s fiduciaries had fulfilled their obligations by hiring investment advisors, regularly reviewing investment performance, seeking relevant training, and following up on concerns regarding the challenged funds. The court concluded there was no breach of fiduciary duty or related failures. On appeal, the United States Court of Appeals for the Third Circuit reviewed the District Court’s grant of summary judgment de novo, considering all facts and inferences in favor of the plaintiffs. The Third Circuit held that ERISA’s fiduciary standard is process-oriented, not outcome-based. The Court found that the fiduciaries had used a prudent process—hiring advisors, critically assessing their recommendations, meeting with fund managers, and maintaining regular oversight—even if the investments did not always outperform alternatives. The Court further held that internal policy statements were nonbinding and that the fiduciaries did not abuse their discretion. Consequently, the Third Circuit affirmed the District Court’s summary judgment in favor of the defendants on all claims. View "Johnson v. Quest Diagnostics Inc" on Justia Law

Justman v. Accenture LLP

2026-06-17T09:00:12-08:00

The appellant, Mark Justman, sought to recover accidental death life insurance benefits following the death of his wife, Karen Justman, who died from septic shock caused by a bacterial infection after eating raw oysters. At the time of her death, she was employed by Accenture LLP and was covered by both basic and optional accidental death and dismemberment (AD&D) insurance through a group plan. Prudential Insurance Company of America served as the Claims Administrator in 2021, while Accenture was designated as the Plan Administrator. After Prudential denied Justman’s claim on the grounds that the death was due to illness rather than an accident, Justman exhausted Prudential’s administrative appeals process without success. Justman then filed suit in the United States District Court for the Eastern District of Pennsylvania against both Prudential and Accenture, asserting wrongful denial of benefits under ERISA § 502(a)(1)(B) and breach of fiduciary duty for allegedly failing to provide required summary plan descriptions (SPDs). Prudential settled, leaving only Accenture as a defendant. The District Court dismissed Justman’s claims, finding insufficient factual allegations that Accenture controlled the benefits determination or failed to provide SPDs within statutory deadlines. The court allowed Justman to amend his complaint multiple times but found that further amendment would be futile and dismissed the case with prejudice. On appeal, the United States Court of Appeals for the Third Circuit affirmed the District Court’s rulings. The Third Circuit held that a proper defendant in an ERISA § 502(a)(1)(B) claim is the entity with authority over benefits determinations, which in this case was Prudential, not Accenture. The court also concluded that Justman’s claims regarding failure to provide SPDs and breach of fiduciary duty were not plausibly pleaded. The Third Circuit found no abuse of discretion in the denial of leave to amend or reconsideration and affirmed the dismissal with prejudice. View "Justman v. Accenture LLP" on Justia Law

Penske Truck Leasing, LP v. Central States Southeast and Southwest Areas Pensi

2026-05-29T08:30:45-08:00

A company operating a nationwide truck leasing business contributed to a multiemployer pension plan on behalf of employees in several bargaining units, including a group in Dallas, Texas (Local 745). After the company and Local 745 negotiated a one-year extension to their collective-bargaining agreement, the pension plan’s trustees rejected the extension, citing concerns that the company was aligning expiration dates to minimize future withdrawal liability. The plan subsequently notified the company that unless it agreed to treat any 2022 withdrawal of Local 745 as a 2021 withdrawal, the participation of Local 745 would be terminated. The company did not accept, and the trustees voted to terminate Local 745’s participation effective December 25, 2021. The company filed suit in the United States District Court for the Northern District of Illinois, seeking to enjoin the expulsion of Local 745 and arguing that the trustees lacked authority under the plan’s Trust Agreement. The district court initially granted a temporary restraining order but later vacated it and denied a preliminary injunction. After discovery, the district court granted summary judgment to the pension plan, finding the plan’s trustees had the authority to expel Local 745 and had not acted arbitrarily or capriciously. The district court also dismissed the plan’s counterclaim seeking a judicial declaration of Local 745’s withdrawal date, holding that this issue must first be resolved through mandatory arbitration under federal law. On appeal, the United States Court of Appeals for the Seventh Circuit affirmed the district court’s rulings. The appellate court held that the Trust Agreement granted the trustees discretionary authority to interpret plan provisions, and their decision to expel Local 745 was reasonable and not arbitrary or capricious. The court also affirmed the dismissal of the counterclaim, holding that disputes over withdrawal liability and related determinations must proceed to arbitration before judicial review. The case was remanded for further proceedings on attorney fees. View "Penske Truck Leasing, LP v. Central States Southeast and Southwest Areas Pensi" on Justia Law

Kleinsteuber v. Metropolitan Life Ins. Co.

2026-05-29T07:31:24-08:00

After the death of Dana Kleinsteuber, her husband, Charles Kleinsteuber, sought accidental death and dismemberment (AD&D) benefits under an ERISA-governed insurance plan administered and insured by Metropolitan Life Insurance Company (MetLife). Dana Kleinsteuber, who suffered from end-stage renal disease (ESRD) due to a long history of an eating disorder, was using home dialysis as treatment. On the day of her death, she apparently failed to properly close her chest port after a dialysis session, resulting in severe blood loss and subsequent cardiac arrest. Emergency responders stopped the bleeding, but she died shortly after. MetLife initially denied the claim on the basis that Dana’s death resulted from natural causes related to her ESRD, and that an exclusion in the plan applied for losses caused or contributed to by illness or its treatment. Following an extensive administrative appeal submitted by Mr. Kleinsteuber, which included evidence from Dana’s doctor and other records, MetLife reconsidered and acknowledged the death was accidental. However, it maintained the exclusion applied because the death was caused or contributed to by the treatment for her ESRD. After Mr. Kleinsteuber exhausted his administrative remedies, he filed suit in the United States District Court for the District of Minnesota. The district court granted summary judgment for MetLife, finding the exclusion applicable. The United States Court of Appeals for the Eighth Circuit reviewed the case. The court held that MetLife provided a full and fair review and that its conflict of interest deserved little weight. The court interpreted the plan exclusion de novo, finding that the ordinary meaning of “caused or contributed to” included Dana’s death under these circumstances. Applying an abuse-of-discretion standard to MetLife’s ultimate decision, the court found substantial evidence supported the denial. As a result, the Eighth Circuit affirmed the district court’s judgment, upholding MetLife’s denial of benefits. View "Kleinsteuber v. Metropolitan Life Ins. Co." on Justia Law

Messer v. Garrison Investment Group, LP

2026-05-26T11:01:01-08:00

A group of former employees of a company that operated a manufacturing facility in Virginia sued the company after it announced it would close and began terminating employees. They alleged violations of the Worker Adjustment and Retraining Notification Act (WARN Act) due to insufficient notice of the plant closure, and violations of the Employee Retirement Income Security Act (ERISA) relating to the improper termination of a severance plan. The employees initially named an investment group and several related parties as defendants, claiming they were alter egos or successors of the company and should be jointly liable. However, before trial, the employees voluntarily dismissed the investment group and related parties without prejudice, focusing instead on the liability of the company itself. The United States District Court for the Western District of Virginia granted summary judgment in part, including dismissing claims by employees who signed releases, and ultimately entered a money judgment against the company after a bench trial. The employees were unable to collect on this judgment due to the company's insolvency. They then filed a new lawsuit against the investment group and various related parties, seeking to enforce the prior judgment on alter ego and veil piercing theories and claiming federal jurisdiction under the WARN Act and ERISA. The United States Court of Appeals for the Fourth Circuit reviewed the district court's dismissal of the new lawsuit for lack of subject matter jurisdiction. The Fourth Circuit held that federal courts lack subject matter jurisdiction to enforce a prior federal judgment against parties not found liable in the original action, absent independent allegations of new federal statutory violations. The court affirmed the district court's dismissal, concluding that neither federal question jurisdiction nor ancillary jurisdiction applied because the plaintiffs did not allege new violations of the WARN Act or ERISA. View "Messer v. Garrison Investment Group, LP" on Justia Law

Drummond v. Southern Company Services, Inc.

2026-05-26T08:02:58-08:00

Two former employees of a large utility holding company, participants in the company’s defined-benefit pension plan, challenged the way their monthly retirement benefits were calculated. Both men, after vesting in the plan, selected joint-and-survivor annuities that would provide payments to their spouses if they died first. The plaintiffs argued that the plan used outdated and unreasonable actuarial assumptions—some based on mortality tables from 1951 or earlier—to determine both the conversion of their accrued single-life annuity benefit to a joint-and-survivor annuity and to calculate charges for mandatory preretirement survivor annuity coverage. They alleged these practices resulted in significantly lower monthly benefits than they would have received if reasonable, current actuarial assumptions had been used. The plaintiffs filed suit in the United States District Court for the Northern District of Georgia, asserting violations of the Employee Retirement Income Security Act of 1974 (ERISA). They claimed the plan failed to provide “actuarial equivalence” between single-life and joint-and-survivor annuities as required by ERISA, and that excessive reductions for preretirement survivor benefits amounted to unlawful forfeiture of accrued benefits. The district court dismissed the complaint for failure to state a claim. On appeal, the United States Court of Appeals for the Eleventh Circuit held that ERISA’s “actuarial equivalence” provision requires plans to use actuarial assumptions that a reasonable actuary would use at the time of benefit determination—not arbitrary or outdated assumptions. The court further held that employers cannot impose preretirement survivor benefit charges that exceed the actual, reasonably calculated cost of providing those benefits. Because the plaintiffs plausibly alleged violations of these standards, the Eleventh Circuit reversed the district court’s dismissal and remanded the case for further proceedings. View "Drummond v. Southern Company Services, Inc." on Justia Law

General Electric Company v. Boilermaker-Blacksmith National Pension Trust

2026-05-26T07:31:01-08:00

General Electric Company (GE) was assessed withdrawal liability by the Boilermaker-Blacksmith National Pension Trust (the Fund) under the Multiemployer Pension Plan Amendments Act of 1980 (MPPAA), which amended the Employee Retirement Income Security Act (ERISA). The Fund claimed that GE partially withdrew from the plan based on a 70% decline in contribution base units (CBUs) and the closure of a manufacturing facility in Chattanooga, resulting in liability assessments totaling over $227 million. GE disputed these assessments, arguing that it qualified for the “building and construction industry” (BCI) exception, which exempts certain employers from withdrawal liability if substantially all their covered employees perform work in the building and construction industry. An arbitrator considered the dispute and found in favor of GE, concluding that it met the requirements for the BCI exception. Both parties sought review in the United States District Court for the Western District of Missouri, which affirmed the arbitrator’s decision. The district court determined that the statutory language was ambiguous regarding how to count employees for the purpose of the BCI exemption and adopted GE’s cumulative headcount method rather than the Fund’s preferred monthly headcount method. On appeal, the United States Court of Appeals for the Eighth Circuit reviewed the district court’s legal conclusions de novo and examined the ambiguity in the statutory language. The Court held that, of the two methods presented, the cumulative headcount approach advanced by GE was more consistent with the purpose and legislative intent of the statute, which was designed to accommodate the fluctuating nature of employment in the building and construction industry. The Court affirmed the district court’s judgment, holding that GE qualified for the building and construction industry exemption and was not liable for withdrawal assessments. View "General Electric Company v. Boilermaker-Blacksmith National Pension Trust" on Justia Law

M & K Employee Solutions, Inc. v. Trustees of IAM Nat. Pension

2026-05-21T06:45:05-08:00

Four employers participating in an underfunded multiemployer pension plan withdrew from the plan in 2018. The plan’s trustees, using a newly adopted discount rate of 6.50% (previously 7.50%), calculated each employer’s withdrawal liability based on the plan’s unfunded vested benefits as of December 31, 2017. The change in the discount rate, adopted after the measurement date but before the calculation, significantly increased the amounts the employers owed. The employers challenged these assessments in arbitration, arguing that only actuarial assumptions in effect as of the measurement date could be used. Each arbitrator agreed with the employers, concluding that the plan should have used the discount rate in effect on the measurement date and requiring reassessment with the prior, higher rate. The fund’s trustees then sought review in the United States District Court for the District of Columbia, which disagreed with the arbitrators and held that it was permissible for the plan’s actuary to select assumptions after the measurement date. The United States Court of Appeals for the District of Columbia Circuit affirmed, reasoning that the statutory text did not require actuarial assumptions to be fixed as of the measurement date, and that assumptions could be adopted later as long as they reflected the best estimate as of that date. This decision created a conflict with a prior ruling by the United States Court of Appeals for the Second Circuit. The Supreme Court of the United States held that the relevant provisions of ERISA do not require the actuarial assumptions used to calculate withdrawal liability to be selected on or before the statutory measurement date. The Court affirmed the D.C. Circuit, concluding that, while the measurement date fixes the relevant factual data, the timing of selecting actuarial assumptions is not limited by statute. The Court also noted that the statute requires only that the assumptions be reasonable and reflect the actuary’s best estimate. View "M & K Employee Solutions, Inc. v. Trustees of IAM Nat. Pension" on Justia Law

Beard v. Lincoln Nat'l Life Ins. Co.

2026-05-11T07:30:55-08:00

Edward Beard, a participant in an employer-sponsored ERISA plan administered by Lincoln National Life Insurance Company, died after suffering a fall and subsequent subdural hematoma. Mr. Beard had stage IV pancreatic cancer and was taking a blood thinner due to an increased risk of blood clots. The fall occurred while he was rushing to the bathroom, and although an initial hospital visit revealed no issues, he was found unresponsive the following day and died after a second hospital visit revealed a large subdural hematoma. His wife, Tina Beard, filed a claim for accidental death and dismemberment (AD&D) benefits, asserting that his death resulted from an accidental injury. The United States District Court for the Southern District of Iowa reviewed the administrative record after Lincoln Life denied the claim. Lincoln Life concluded that Mr. Beard’s death was not solely the result of an accidental injury and invoked a plan exclusion since his blood thinner, used to treat his cancer-related clotting risk, contributed to his death. The district court granted judgment in favor of Lincoln Life, finding its interpretation of the plan reasonable and supported by substantial evidence, including medical reports indicating the blood thinner contributed to the fatal outcome. On appeal, the United States Court of Appeals for the Eighth Circuit reviewed the plan administrator’s decision for abuse of discretion, as the plan granted Lincoln Life discretionary authority to interpret its terms. The appellate court found that Lincoln Life’s interpretation of the plan terms and application of the exclusion were reasonable and supported by substantial evidence. The court held that Mrs. Beard failed to prove the loss resulted solely from an accident, and that Lincoln Life established the plan exclusion applied because the blood thinner contributed to Mr. Beard’s death. Accordingly, the Eighth Circuit affirmed the district court’s judgment. View "Beard v. Lincoln Nat'l Life Ins. Co." on Justia Law

Martin v. Fed. Rsrv. Bank of Cleveland

2026-05-07T12:30:34-08:00

The plaintiff worked as a Project Director and participated in her employer’s long-term disability (LTD) plan, which was administered by Matrix Absence Management on behalf of the Federal Reserve Bank of Cleveland. After taking leave due to ongoing symptoms from long-haul COVID-19, the plaintiff applied for LTD benefits under the plan, which required proof of total disability. Matrix reviewed the medical evidence—including opinions from both treating and independent physicians—and denied her claim, concluding that as of her leave date, she was not totally disabled under the plan’s terms. The plaintiff appealed this denial, but Matrix upheld its decision after additional review. The United States District Court for the Northern District of Ohio heard the plaintiff’s subsequent lawsuit against the Bank, Matrix, and the plan, asserting breach of contract and breach of fiduciary duty. The district court denied the plaintiff’s requests for discovery beyond the administrative record and granted judgment on the administrative record in favor of the defendants. The court found that New York contract law, not ERISA, applied, and review was limited to whether Matrix’s decision was arbitrary, made in bad faith, or the result of fraud, given the plan’s broad delegation of discretionary authority to Matrix. On appeal, the United States Court of Appeals for the Sixth Circuit affirmed the district court’s judgment. The Sixth Circuit held that the district court correctly applied New York contract law and the arbitrary-and-capricious standard of review. The appellate court found no abuse of discretion in denying discovery beyond the administrative record, as the plaintiff did not establish a colorable claim of conflict of interest or procedural defect. The Sixth Circuit concluded that Matrix’s denial had a reasonable basis in the administrative record and thus was not arbitrary or capricious. The judgment for the defendants was affirmed. View "Martin v. Fed. Rsrv. Bank of Cleveland" on Justia Law

Powell v. Ocwen Fin. Corp.

2026-04-22T06:30:04-08:00

A group of trustees managing an ERISA-regulated pension plan invested in six classes of residential mortgage-backed securities (RMBSs), some issued as notes under indenture agreements and others as trust certificates. The trustees alleged that companies servicing the underlying mortgages mismanaged the loans, acted in self-interest, and failed to protect investors’ interests, in violation of their fiduciary duties under ERISA. The investments included three classes of notes and three classes of trust certificates, each backed by pools of residential mortgages. The United States District Court for the Southern District of New York considered cross-motions for summary judgment on whether the underlying mortgages constituted plan assets under ERISA. The district court ruled that only the RMBSs themselves, not the mortgages behind them, were plan assets as defined by the Department of Labor’s regulation. Consequently, it granted summary judgment to all defendants, holding that the servicers did not owe ERISA fiduciary duties regarding the mortgages, and denied the trustees’ cross-motion. On appeal, the United States Court of Appeals for the Second Circuit reviewed the district court’s summary judgment ruling de novo. The Second Circuit agreed that the notes issued under indenture agreements were not equity interests and did not confer plan asset status on the underlying mortgages. However, it found that the trust certificates were beneficial interests in the trusts and thus qualified as equity interests under the Department of Labor’s regulation. As a result, the court affirmed the district court’s judgment in part (regarding the notes), vacated in part (regarding the trust certificates), and remanded for further proceedings, including determination of whether the servicers acted as fiduciaries with respect to the trust certificates. View "Powell v. Ocwen Fin. Corp." on Justia Law

Milligan v. Merrill Lynch, Pierce, Fenner & Smith, Inc.

2026-04-17T10:30:33-08:00

A financial advisory employee of a large securities firm participated in a compensation program called the WealthChoice Awards, which provided annual contingent cash awards to select high-performing advisors. To earn these awards, an advisor had to meet certain revenue thresholds and remain employed at the company for eight years after the award was granted. A notional, unfunded account tracked a benchmark investment, but no funds were set aside for the advisor during the vesting period. If the advisor left the company before vesting, the award was typically forfeited. After vesting, payment was mandatory and made promptly, usually while the advisor was still employed. The stated purpose of the program was to incentivize retention and productivity, not to provide retirement income. After voluntarily resigning and forfeiting unvested awards, the employee filed a putative class action in the United States District Court for the Western District of North Carolina. He alleged that the WealthChoice Awards program was an “employee pension benefit plan” under the Employee Retirement Income Security Act of 1974 (ERISA), and that it violated ERISA’s vesting and anti-forfeiture rules. The district court granted summary judgment to the employer, finding that the program was a bonus plan exempt from ERISA. On appeal, the United States Court of Appeals for the Fourth Circuit reviewed the district court’s grant of summary judgment de novo. The Fourth Circuit held that the WealthChoice Awards program is a bonus payment plan and not an ERISA-covered pension benefit plan. The court reasoned that the program’s primary purpose was to enhance retention and productivity, eligibility was limited, the awards were not funded with deferred employee income, and payment was not systematically deferred until employment termination or retirement. The judgment of the district court was affirmed. View "Milligan v. Merrill Lynch, Pierce, Fenner & Smith, Inc." on Justia Law

Invictus Global Management, LLC v. Invictus Special Situations Master I, L.P.

2026-04-13T12:31:52-08:00

A privately held investment fund with ERISA plan investors (the Fund) contained provisions in its governing agreements granting indemnification and advancement rights to its general partner, management company, and their principals, all of whom served as ERISA fiduciaries. After these fiduciaries were removed in late 2023, the Fund sued them in the Delaware Court of Chancery, alleging breach of contract and violations of the fund’s governing documents for withholding information and assets. The defendants counterclaimed, seeking advancement of their litigation expenses, as provided in the fund’s agreements. The Fund argued that advancement from ERISA assets was barred by section 1110 of the Employee Retirement Income Security Act (ERISA), which voids contractual provisions that relieve fiduciaries from responsibility or liability for their ERISA duties. The Court of Chancery held that, even though advancement was permitted under Delaware law, ERISA section 1110 rendered these advancement provisions void because they would improperly relieve fiduciaries from ERISA liability. The court also noted that a bar on advancement was appropriate since the fiduciaries had not shown an ability to repay advanced funds. The defendants appealed this ruling. The Supreme Court of the State of Delaware reviewed the case. It held that advancement of litigation expenses for the defense of state-law claims, subject to a written undertaking to repay if indemnification is ultimately unwarranted, does not violate ERISA section 1110. The Court distinguished advancement from indemnification, emphasizing that advancement with an undertaking does not abrogate the fund’s right to recover from fiduciaries for ERISA breaches. The Court also found that neither statutory language nor relevant federal case law categorically barred such advancement under these circumstances. Accordingly, the Supreme Court of Delaware reversed the Court of Chancery’s decision and remanded the matter. View "Invictus Global Management, LLC v. Invictus Special Situations Master I, L.P." on Justia Law

Geels v. Flottemesch

2026-04-08T07:33:36-08:00

A man designated his sister as the beneficiary of his employer-issued life insurance policies, amounting to $150,000, with instructions that she distribute the proceeds to his three daughters. The man, suffering from declining health, relied on his sister to manage his finances, legal affairs, and healthcare decisions, creating a fiduciary relationship. After his death, the sister claimed the insurance proceeds for herself, contrary to the instructions. The daughters sought a constructive trust over the proceeds, claiming the sister was to hold the funds in trust for them, while the sister denied any fiduciary breach and asserted entitlement under the policy. The Allen Superior Court, after a bench trial, found no undue influence or fraud in the beneficiary designation but concluded that the sister breached her fiduciary duty by failing to distribute the proceeds as instructed. The court imposed a constructive trust in favor of the daughters, finding by clear and convincing evidence that the deceased intended for them to receive the insurance money. The sister appealed, arguing that the Employee Retirement Income Security Act of 1974 (ERISA) preempted such state-law remedies and that the evidence did not meet the required standard. The Indiana Court of Appeals twice reversed the trial court, holding that ERISA preempted the remedy, but the Indiana Supreme Court remanded for application of the correct standard of proof without reaching the preemption issue. The Indiana Supreme Court, upon further review, held that the sister waived her ERISA preemption argument by not raising it in the trial court. The court affirmed the trial court's imposition of a constructive trust, concluding that the findings of a fiduciary relationship and breach of duty were supported by clear and convincing evidence. Accordingly, the Indiana Supreme Court affirmed the trial court’s judgment in favor of the daughters. View "Geels v. Flottemesch" on Justia Law

McKee Foods Corp. v. BFP Inc.

2026-04-07T12:30:36-08:00

A Tennessee-based commercial bakery, which provides a self-funded health benefits plan governed by ERISA for its employees, structured its prescription drug benefits through a pharmacy benefit manager (PBM) and created an in-house pharmacy offering lower copays to employees. Tennessee enacted laws targeting PBMs, requiring pharmacy network access for any willing provider and prohibiting cost-sharing incentives to steer participants to certain pharmacies, including those owned by the plan sponsor. The bakery and its PBM excluded a pharmacy from their network after an audit, and after the pharmacy filed administrative complaints under the new Tennessee law, the bakery sought declaratory and injunctive relief in federal court, claiming ERISA preempted these PBM-focused state laws. The United States District Court for the Eastern District of Tennessee found that the bakery, as plan fiduciary, had standing to bring a pre-enforcement challenge. The court concluded that the Tennessee PBM laws were preempted by ERISA because they required specific plan structures, governed central aspects of plan administration, and interfered with uniform national plan administration. The district court granted summary judgment in favor of the bakery, permanently enjoining the Tennessee Commissioner from enforcing the PBM laws against the bakery’s health plan or its PBM. On appeal, the United States Court of Appeals for the Sixth Circuit reviewed the case de novo. The court agreed with the district court’s analysis, holding that the challenged Tennessee PBM statutes have an impermissible connection with ERISA plans and are therefore preempted. The court found that the laws mandated network structure and cost-sharing provisions, interfering directly with ERISA plan administration. The Sixth Circuit also held that the ERISA saving clause did not preserve these laws from preemption due to the deemer clause’s application to self-funded plans. The judgment of the district court was affirmed. View "McKee Foods Corp. v. BFP Inc." on Justia Law

Rieth-Riley Construction Co. v. Operating Engineers Local 324

2026-04-03T10:31:25-08:00

A construction company and several employee plaintiffs were involved in a labor dispute with a group of union-affiliated fringe benefit funds and their trustees. The company had employed members of a local union and, under a collective bargaining agreement (CBA), was required to contribute to a set of employee benefit funds for each hour worked. When the CBA expired and was mutually terminated, the company and union failed to negotiate a new agreement. The company continued attempting to make contributions to the funds, but the funds’ trustees eventually refused to accept them unless the company provided written confirmation of its agreement to abide by the funds’ governing documents. The company declined, arguing that federal labor law required the funds to continue accepting contributions during negotiations. The funds then stopped accepting contributions, and the company placed the rejected payments into escrow. The company and employees filed suit in the United States District Court for the Eastern District of Michigan, asserting that the funds’ trustees had breached their fiduciary duties under the Employee Retirement Income Security Act (ERISA) by refusing the contributions, and seeking declaratory and injunctive relief. The district court dismissed the complaints, finding that the ERISA claims were preempted by the Garmon doctrine, which generally requires courts to defer to the National Labor Relations Board (NLRB) on matters arguably subject to sections 7 or 8 of the National Labor Relations Act (NLRA). The district court also denied motions for a preliminary injunction and for leave to amend the complaint. On appeal, the United States Court of Appeals for the Sixth Circuit affirmed the district court’s judgment. The Sixth Circuit held that the plaintiffs’ ERISA claims were preempted under the Garmon doctrine because they were inextricably linked to labor law questions subject to the NLRB’s primary jurisdiction. The court also found that the district court properly denied the requests for preliminary injunctive relief and for leave to amend the complaint, as any amendment would have been futile. View "Rieth-Riley Construction Co. v. Operating Engineers Local 324" on Justia Law

Powell v. Ocwen Fin. Corp.

2026-03-26T06:30:05-08:00

The trustees of an ERISA-regulated pension plan invested in six classes of residential mortgage-backed securities (RMBSs). Three of these investments were in notes issued by Delaware statutory trusts via indenture agreements, while the other three were in regular-interest certificates issued by trusts governed under New York law and classified as REMICs for tax purposes. The trustees alleged that the mortgage servicers mismanaged the loans and engaged in self-dealing, violating ERISA fiduciary duties. They also claimed that Wells Fargo, as master servicer for some trusts, failed to adequately supervise Ocwen (another servicer) and failed to pursue litigation on behalf of the trusts. The United States District Court for the Southern District of New York granted summary judgment in favor of all defendants, holding that, under the Department of Labor’s regulation, only the RMBSs themselves—not the underlying mortgages—were plan assets for ERISA purposes. The court determined that both the notes and the regular-interest certificates were treated as indebtedness without substantial equity features, so the look-through exception did not apply. The trustees’ cross-motion for partial summary judgment was denied. On appeal, the United States Court of Appeals for the Second Circuit affirmed in part, reversed in part, and remanded. The court agreed that the notes issued by the indenture trusts lacked substantial equity features and thus the underlying mortgages were not plan assets. However, it held that the regular-interest certificates represented beneficial interests in the REMIC trusts; under the controlling regulation, the assets of such a trust in which a plan holds a beneficial interest are themselves plan assets. The case was remanded to the district court to consider whether Ocwen acted as an ERISA fiduciary with respect to the mortgages underlying the REMIC trusts. View "Powell v. Ocwen Fin. Corp." on Justia Law

Reichert v. Kellogg Co.

2026-03-16T12:00:37-08:00

Retired employees of two companies, who participated in their employers’ defined benefit pension plans, brought class action lawsuits alleging violations of the Employee Retirement Income Security Act (ERISA). These plaintiffs, all married, claimed that their plans calculated joint and survivor annuity benefits using mortality tables based on outdated data from the 1960s and 1970s. Because life expectancies have increased since then, the plaintiffs asserted that using such outdated mortality assumptions improperly reduced their benefits, resulting in joint and survivor annuities that were not the actuarial equivalent of the single life annuities to which they would otherwise be entitled, as required by ERISA. Each group of plaintiffs filed suit in federal district court—one in the Eastern District of Michigan against the Kellogg plans and one in the Western District of Tennessee against the FedEx plan—asserting that the use of obsolete actuarial assumptions violated 29 U.S.C. § 1055(d) and constituted a breach of fiduciary duty under ERISA. The district courts in both cases dismissed the complaints for failure to state a claim, holding that ERISA does not require use of any particular mortality table or actuarial assumption in calculating benefits for married participants, and thus the allegations, even if true, did not establish a violation. The United States Court of Appeals for the Sixth Circuit reviewed the dismissals de novo. The court held that, under ERISA’s statutory requirement that joint and survivor annuities be “actuarially equivalent” to single life annuities, plans must use actuarial assumptions, including mortality data, that reasonably reflect the life expectancies of current participants. The court concluded that plaintiffs had plausibly alleged that the use of outdated mortality tables was unreasonable and could violate ERISA. Accordingly, the Sixth Circuit reversed the district courts’ judgments and remanded both cases for further proceedings. View "Reichert v. Kellogg Co." on Justia Law

Trauernicht v. Genworth Financial Inc.

2026-03-10T11:00:33-08:00

Two former employees of a financial services company, each a participant in the employer’s defined contribution retirement plan, sued the company on behalf of themselves and other similarly situated plan participants. They alleged that the company, as plan sponsor and fiduciary, breached its duties under the Employee Retirement Income Security Act (ERISA) by selecting and retaining certain BlackRock LifePath Index Funds as investment options, which they claimed were imprudent and caused monetary losses to their individual plan accounts. The plaintiffs sought recovery of losses under ERISA sections 502(a)(2) and 409(a). The United States District Court for the Eastern District of Virginia denied the defendant’s motion to dismiss most of the claims, holding that the plaintiffs plausibly alleged a breach of fiduciary duty. It then certified a class of all plan participants and beneficiaries with investments in the BlackRock funds during the relevant period, under Federal Rule of Civil Procedure 23(b)(1), finding that ERISA fiduciary-duty claims are inherently suitable for class treatment because they are brought on behalf of the plan and that allowing individual suits would risk inconsistent standards or impair interests of absent participants. The district court also found that the commonality requirement of Rule 23(a)(2) was satisfied. On interlocutory appeal, the United States Court of Appeals for the Fourth Circuit reversed and vacated the class certification order. The Fourth Circuit held that, in the context of a defined contribution plan, claims under ERISA § 502(a)(2) for monetary losses to individual accounts are inherently individualized and cannot be joined in a mandatory class under Rule 23(b)(1), which does not provide for notice or opt-out rights. The court also held that the claims failed to satisfy the commonality prerequisite because many class members did not experience the same injury. The district court’s order was thus reversed and vacated. View "Trauernicht v. Genworth Financial Inc." on Justia Law

Cogdell v. Reliance Standard Life Insurance Company

2026-03-03T12:01:58-08:00

An employee of MITRE Corporation, serving as a Principal Business Process Engineer, contracted COVID-19 twice. After experiencing long-COVID symptoms that prevented her from returning to her occupation, she applied for long-term disability (LTD) benefits under her employer’s ERISA-governed plan, administered by Reliance Standard Life Insurance Company. Reliance denied her claim, asserting she was not “Totally Disabled.” She submitted further medical documentation and filed an internal appeal. The plan and ERISA regulations required Reliance to respond within 45 days, extendable by another 45 days only for “special circumstances,” with written notice specifying the reason and expected decision date. Reliance took more than 45 days to issue a decision, did not specify a date for resolution, and cited only routine medical review as justification for delay. The employee sued in the United States District Court for the Eastern District of Virginia after Reliance failed to timely decide her appeal. The district court found that Reliance had not complied with ERISA’s timing and notice requirements, held that de novo review (rather than deferential review) was appropriate, and ruled in favor of the employee, awarding LTD benefits and interest. On appeal, the United States Court of Appeals for the Fourth Circuit reviewed whether Reliance’s delay deprived it of deferential review of its benefit determination. The court held that, because Reliance failed to decide the internal appeal within the required time and had not justified its delay with a special circumstance, it forfeited any entitlement to deference. The Fourth Circuit affirmed that de novo review applied, found no error in the district court’s factual findings or legal conclusions, and upheld the award of benefits to the employee. View "Cogdell v. Reliance Standard Life Insurance Company" on Justia Law

RTI Restoration Technologies Inc v. International Painters and Allied Trades Industry Pension Fund

2026-03-03T11:01:01-08:00

The case involves a multi-employer pension fund seeking to collect withdrawal liability under the Multiemployer Pension Plan Amendments Act of 1980 from two corporate entities, which the fund alleged were successors to a defunct contributing employer. The companies denied any liability, contending they had never agreed to make contributions to the fund, were not under common control with the original employer, and were not otherwise subject to the fund’s claims. After the fund notified the companies of the alleged liability several years after the original employer ceased operations, the companies sought a declaratory judgment in federal court to clarify that they were not liable. The fund counterclaimed for withdrawal liability, as well as damages and interest. The United States District Court for the District of New Jersey found genuine disputes of material fact regarding whether the companies could be treated as employers under the applicable law, thus precluding summary judgment on that issue. Nevertheless, the District Court granted judgment in favor of the companies on a separate basis: it concluded that the fund’s eight-year delay in providing notice and demanding payment of withdrawal liability failed to meet the statutory requirement under 29 U.S.C. § 1399(b)(1) that such notice be given “as soon as practicable.” The court reasoned that this requirement is an independent statutory element—not an affirmative defense subject to waiver or arbitration—and that the fund’s failure to comply with it barred any recovery. On appeal, the United States Court of Appeals for the Third Circuit affirmed the District Court’s decision. The Third Circuit held that timely notice and demand is a necessary element for a withdrawal liability claim to accrue under the MPPAA; if the fund fails to act “as soon as practicable,” its claim cannot proceed, regardless of whether the issue is raised in arbitration or by the parties. Arbitration was not required in this circumstance, and the District Court properly resolved the question. View "RTI Restoration Technologies Inc v. International Painters and Allied Trades Industry Pension Fund" on Justia Law

Mar-Can Transp. Co. v. Loc. 854 Pension Fund

2026-02-18T08:00:06-08:00

In this case, a school bus company’s employees voted in 2020 to change their union representation, shifting from a Teamsters local to an Amalgamated Transit Workers local. As a result, the company was required under federal law to withdraw from the multiemployer pension plan affiliated with the old union and begin contributing to a new plan aligned with the new union. This withdrawal triggered several obligations under ERISA, including the company’s duty to pay “withdrawal liability” to the old plan and the old plan’s obligation to transfer certain assets and liabilities to the new plan relating to the employees who switched unions. After the old pension fund assessed withdrawal liability of approximately $1.8 million, the company argued that, under 29 U.S.C. § 1415(c), this liability should be reduced by the difference between the liabilities and assets transferred to the new plan. The old plan disagreed, interpreting the statute differently and contending that no reduction should occur. The United States District Court for the Southern District of New York granted summary judgment to the company, holding that the statute required a $1.8 million reduction in withdrawal liability. On appeal, the United States Court of Appeals for the Second Circuit reviewed the District Court’s interpretation of the statute de novo. The Second Circuit found that the phrase “unfunded vested benefits” in Section 1415(c) is ambiguous, but, after examining the statute’s structure and purpose, concluded that the District Court’s interpretation was correct. The court held that “unfunded vested benefits allocable to the employer” under Section 1415(c) refers to the entire amount of liabilities transferred to the new plan, not reduced by transferred assets. As a result, the Second Circuit affirmed the District Court’s judgment, approving the $1.8 million withdrawal liability reduction and dismissing the company’s cross-appeal as moot. View "Mar-Can Transp. Co. v. Loc. 854 Pension Fund" on Justia Law

Parrott v. International Bank

2026-02-10T10:30:53-08:00

A former employee of a bank holding company, who participated in a company-sponsored retirement savings plan, brought suit alleging that the bank, the plan’s administrative committee, and a subsidiary breached their fiduciary duties under ERISA, resulting in financial loss to his plan distribution. After the employee’s separation and payout, the company amended the plan in early 2024 to add a retroactive arbitration clause that required all claims to proceed individually in arbitration, barred class or representative actions, and included a jury trial waiver and a provision that only individual relief could be awarded. The United States District Court for the Western District of Texas denied the defendants’ motion to compel arbitration, holding that the arbitration agreement was not valid under Texas law due to lack of consideration. The company appealed, arguing that the plan’s consent, not the individual participant’s, was sufficient to bind parties to arbitration for claims brought on behalf of the plan under 29 U.S.C. § 1132(a)(2), and that the arbitration clause was enforceable. The company also preemptively addressed potential objections under the effective vindication doctrine and claims that the arbitration provisions unlawfully limited statutory remedies. The United States Court of Appeals for the Fifth Circuit reversed the denial of arbitration as to the § 1132(a)(2) claim, holding that the plan’s consent through its unilateral amendment provision was sufficient to bind the participant to arbitration for plan-based claims, but affirmed the denial as to the participant’s individual claims because he had not consented. The court further held that the arbitration clause’s prohibition on representative actions and its limitation to individual relief violated the effective vindication doctrine, and voided the standard-of-review provision to the extent it applied to fiduciary-breach claims. The case was remanded for the district court to determine whether the offending arbitration provisions could be severed. View "Parrott v. International Bank" on Justia Law

Duke v. Luxottica U.S. Holdings Corp.

2026-02-05T08:00:05-08:00

Janet Duke, after retiring from Luxottica U.S. Holdings Corp., elected to receive pension benefits through a joint and survivor annuity (JSA), calculated using actuarial assumptions set by her employer’s defined benefit pension plan. Duke alleged that her plan used outdated assumptions—specifically, a 7% interest rate and life expectancy tables from 1971—to convert single life annuities (SLA) into JSA benefits, resulting in lower monthly payments for her and similarly situated retirees. She claimed this systematic practice violated ERISA’s requirements for actuarial equivalence and compliance, thereby potentially harming the plan’s participants and the plan itself. In the United States District Court for the Eastern District of New York, Duke filed a putative class action seeking relief under ERISA Sections 502(a)(2) and 502(a)(3), including plan reformation and monetary repayments to the plan. The district court initially found Duke lacked standing for Section 502(a)(2) claims but later reversed itself and held that she did have standing for both plan reformation and monetary payments. The court compelled individual arbitration of her Section 502(a)(3) claims under a dispute resolution agreement but held that the “effective vindication” doctrine prevented mandatory arbitration of her Section 502(a)(2) claims. Defendants’ motion for a mandatory stay of litigation pending arbitration was denied. The United States Court of Appeals for the Second Circuit reviewed the district court’s rulings. It held that Duke has Article III standing to pursue plan reformation under Section 502(a)(2) because her alleged injury—reduced benefits due to outdated assumptions—could be redressed by reformation of the plan. However, Duke lacks standing to seek monetary payments to the plan, as such relief would not redress any personal injury she suffered. The Second Circuit also held that the effective vindication doctrine precludes mandatory individual arbitration of her Section 502(a)(2) claim and affirmed the district court’s discretionary denial of a mandatory stay. The order was affirmed in part and reversed in part. View "Duke v. Luxottica U.S. Holdings Corp." on Justia Law

Packaging Corporation of America Thrift Plan for Hourly Employees v. Langdon

2026-02-02T09:30:59-08:00

Carl Kleinfeldt was a longtime employee who participated in his employer’s retirement plan. He originally designated his wife, Dená Langdon, as the primary beneficiary and his sisters as contingent beneficiaries. After divorcing Langdon in September 2022, Kleinfeldt sent a fax to his employer’s benefits center requesting that Langdon be removed as beneficiary from his retirement accounts. Although the employer updated Langdon’s status from “spouse” to “ex-spouse,” she remained listed as the primary beneficiary at the time of Kleinfeldt’s death in January 2023. Following Kleinfeldt’s death, the employer planned to distribute the retirement account funds to Langdon. Both Langdon and Kleinfeldt’s estate submitted competing claims to the employer, which denied the estate's claim but allowed an appeal. When conflicting claims persisted, the employer filed an interpleader action in the United States District Court for the Western District of Wisconsin and deposited the funds with the court. During litigation, the district court determined that Kleinfeldt’s sister, Terry Scholz, also had a potential claim as a surviving contingent beneficiary and joined her estate as a necessary party. After cross-motions for summary judgment, the district court denied both and instead granted summary judgment sua sponte to Scholz’s estate, finding that Kleinfeldt had substantially complied with the plan’s requirements to remove Langdon as beneficiary. On appeal, the United States Court of Appeals for the Seventh Circuit reviewed the district court’s summary judgment de novo. The appellate court held that Kleinfeldt did not meet the requirements of substantial compliance because he failed to follow the plan’s specified procedures for changing a beneficiary, which required contacting the benefits center or updating beneficiaries online—not simply sending a fax. The Seventh Circuit reversed the district court’s judgment and remanded with instructions to enter judgment in favor of Langdon as the primary beneficiary. View "Packaging Corporation of America Thrift Plan for Hourly Employees v. Langdon" on Justia Law

International Painters and Allied Trades Industry v. Florida Glass of Tampa Bay, Inc.

2026-01-26T11:30:36-08:00

A multiemployer pension plan regulated under ERISA and the Multiemployer Pension Plan Amendments Act (MPPAA) sought to recover withdrawal liability from Florida Glass of Tampa Bay and related entities after Florida Glass ceased performing covered work and entered bankruptcy. In 2016, the pension plan filed a contingent proof of claim in Florida Glass’s bankruptcy proceedings, but did not clearly determine or assert withdrawal liability at that time. Several years later, after confirming withdrawal had occurred, the plan issued a formal notice and demand for payment. The defendants did not timely seek arbitration under the statutory process, and, when sued to collect the withdrawal liability, argued that the plan’s earlier bankruptcy filing constituted both a statutory notice and demand and an acceleration of liability, thus triggering the statute of limitations before the suit was filed. The United States District Court for the District of Maryland rejected the defendants’ statute of limitations defense. The court held that the 2016 contingent proof of claim was neither a notice and demand nor an acceleration under the MPPAA, so the limitations period did not begin until the 2022 notice and demand letter. Alternatively, the court reasoned that even if the 2016 filing qualified as a notice and demand, the defendants had waived any related defenses by failing to timely arbitrate. The court granted summary judgment for the pension plan and awarded damages, interest, attorney’s fees, and costs, minus the bankruptcy distribution already received. The United States Court of Appeals for the Fourth Circuit affirmed. The court held that a contingent proof of claim does not constitute a notice and demand, nor an acceleration, unless it clearly satisfies the statutory requirements. Since the 2016 filing was ambiguous and labeled contingent, it did not trigger the statute of limitations, rendering the suit timely. The court affirmed the judgment and associated relief for the pension plan. View "International Painters and Allied Trades Industry v. Florida Glass of Tampa Bay, Inc." on Justia Law

T. E. v. Anthem Blue Cross Blue Shield

2026-01-22T11:30:12-08:00

A parent enrolled his teenage son, who had a history of serious behavioral and mental health issues, in a residential treatment center after other interventions failed. The family’s health insurer initially approved and paid for the first 21 days of residential treatment, then denied further coverage, asserting that the treatment was no longer medically necessary. The parent appealed this decision through the insurer’s internal process, submitting medical records and opinions from the child’s treating clinicians that supported the need for continued residential care. The insurer upheld its denial after cursory reviews that did not address the treating clinicians’ recommendations or key evidence of the child’s ongoing difficulties. The parent filed suit in the United States District Court for the Western District of Kentucky, alleging that the insurer’s denial was arbitrary and capricious under the Employee Retirement Income Security Act (ERISA) and violated the Mental Health Parity and Addiction Equity Act. The district court granted summary judgment to the insurer on both claims, finding that the decision to deny coverage was not arbitrary and capricious and that there was no evidence of a parity violation. On appeal, the United States Court of Appeals for the Sixth Circuit found that the insurer’s coverage decision was procedurally arbitrary and capricious, as it failed to consider the treating clinicians’ opinions, selectively reviewed the medical record, and did not adequately explain its change from initially approving coverage to denying it. The appellate court vacated the district court’s judgment on the ERISA claim and remanded with instructions to send the matter back to the insurer for a full and fair review. However, it affirmed the district court’s judgment on the Parity Act claim, holding that the parent failed to produce evidence showing that the insurer’s limitations on mental health treatment were more restrictive than those applied to medical or surgical benefits. View "T. E. v. Anthem Blue Cross Blue Shield" on Justia Law

NEVADA RESORT ASSOCIATION-INTERNATIONAL ALLIANCE OF THEATRICAL STAGE EMPLOYEES AND MOVING PICTURE MACHINE OPERATORS OF THE US AND CANADA LOCAL 720 PENSION TRUST V. JB VIVA VEGAS, LP

2026-01-06T09:00:33-08:00

JB Viva Vegas, L.P. challenged the assessment of withdrawal liability imposed by the Nevada Resort Association-International Alliance of Theatrical Stage Employees and Moving Picture Machine Operators of the US and Canada Local 720 Pension Trust under the Multiemployer Pension Plan Amendments Act (MPPAA). JB had contributed to the Trust’s pension plan for stagehands working on a theatrical production, which later closed. The Trust asserted withdrawal liability, arguing that its plan no longer qualified for the entertainment industry exception due to a shift in employee work from entertainment to convention-related activities. After JB’s request for review went unanswered, it initiated arbitration. The arbitrator initially ruled in JB’s favor, finding the plan qualified for the entertainment exception and ordering rescission of the withdrawal liability. The Trust then sought to vacate the arbitration award in the United States District Court for the District of Nevada. The district court vacated the award, reasoning that the relevant year for determining the plan’s status was the year JB withdrew, not when it joined, and remanded to the arbitrator. On remand, the arbitrator granted summary judgment to the Trust, concluding that the MPPAA was ambiguous as to how much entertainment work was required and that the plan did not “primarily” cover entertainment employees because less than half earned most of their wages from entertainment work. The district court affirmed the arbitrator’s decision, granting summary judgment to the Trust. On appeal, the United States Court of Appeals for the Ninth Circuit reviewed the district court’s summary judgment de novo. The court held that the MPPAA’s entertainment industry exception does not require a minimum amount of entertainment work for an individual to qualify as an “employee in the entertainment industry.” Therefore, the Trust’s plan primarily covers such employees if a majority perform any entertainment work. The Ninth Circuit reversed the district court’s decision and remanded the case. View "NEVADA RESORT ASSOCIATION-INTERNATIONAL ALLIANCE OF THEATRICAL STAGE EMPLOYEES AND MOVING PICTURE MACHINE OPERATORS OF THE US AND CANADA LOCAL 720 PENSION TRUST V. JB VIVA VEGAS, LP" on Justia Law

WALKER SPECIALTY CONSTR., INC. V. BD. OF TR. OF THE CONSTR. INDUS. AND LABORERS JOINT PENSION TRUST

2026-01-05T09:00:31-08:00

A construction company in southern Nevada ceased contributing to a multiemployer pension plan after it stopped operating in the state. The pension plan’s trustees assessed the company for withdrawal liability, asserting the company owed over $2.8 million under the Multiemployer Pension Plan Amendments Act (MPPAA). The company challenged the assessment, arguing it was exempt from liability because its asbestos abatement work qualified for the “building and construction industry” exception in the MPPAA. The company pointed out that asbestos abatement involves removing or remediating hazardous materials from buildings, including demolition and substantial alterations to structures. An arbitrator initially ruled in favor of the pension plan’s trustees, interpreting the “building and construction industry” narrowly to include only work that literally builds new structures, and finding that asbestos abatement did not meet this definition. The company then brought suit in the United States District Court for the District of Nevada to vacate or modify the arbitration award. The district court rejected the arbitrator’s and trustees’ narrow construction, instead adopting a broader understanding of the industry that includes maintenance, repair, alteration, and demolition. The district court granted summary judgment to the company, holding that its asbestos abatement work qualified for the statutory exception, and ordered the return of payments made toward the assessed liability. On appeal, the United States Court of Appeals for the Ninth Circuit affirmed the district court’s judgment. The Ninth Circuit held that the phrase “building and construction industry” in the MPPAA incorporates the definition established by the National Labor Relations Board under the Taft-Hartley Act, which includes erection, maintenance, repair, and alteration of buildings and structures. Applying this definition, the court ruled that asbestos abatement is covered by the exception, exempting the company from withdrawal liability. View "WALKER SPECIALTY CONSTR., INC. V. BD. OF TR. OF THE CONSTR. INDUS. AND LABORERS JOINT PENSION TRUST" on Justia Law

Aramark Services v. Aetna Life Insurance

2025-12-18T10:30:12-08:00

Aramark, a company that self-funds employee health benefit plans governed by ERISA, contracted with Aetna to serve as third-party administrator for these plans. Under the agreement, Aetna was responsible for processing claims, managing provider networks, and handling various administrative tasks. Aramark alleged that Aetna breached its fiduciary duties by paying improper or fraudulent claims, retaining undisclosed fees, providing inadequate subrogation services, making post-adjudication adjustments detrimental to Aramark, and commingling plan assets. Aramark filed suit in the United States District Court for the Eastern District of Texas, asserting ERISA claims for breach of fiduciary duty and prohibited transactions. Aetna responded by seeking to compel arbitration in a Connecticut federal district court, relying on the arbitration clause in the parties’ Master Services Agreement (MSA), and moved to stay the Texas proceedings pending arbitration. The district court denied the stay, holding that the parties had not “clearly and unmistakably” delegated the threshold question of arbitrability to an arbitrator. The court found that the MSA's arbitration clause carved out disputes seeking equitable relief—such as Aramark’s ERISA claims—from arbitration and that these claims were equitable in nature. On appeal, the United States Court of Appeals for the Fifth Circuit reviewed the district court’s denial of a motion to stay litigation pending arbitration de novo. It held that the threshold issue of arbitrability was not clearly and unmistakably delegated to an arbitrator under the terms of the MSA, especially given the placement of the carve-out for equitable relief. The Fifth Circuit further held that Aramark’s ERISA claims constituted equitable, not legal, relief under Supreme Court and Fifth Circuit precedent. The Fifth Circuit affirmed the district court’s orders, finding no error or abuse of discretion. View "Aramark Services v. Aetna Life Insurance" on Justia Law

Cloud v. NFL Player Retirement Plan

2025-12-18T10:30:11-08:00

A former professional football player sought disability benefits from a retirement plan administered under the Employee Retirement Income Security Act (ERISA), arguing that he qualified for the highest tier of benefits due to multiple concussions suffered during his career. The plan granted him some benefits but denied the top category. He filed suit, claiming improper denial of benefits and lack of a full and fair review. The United States District Court for the Northern District of Texas ruled in favor of the plaintiff, ordering the plan to award the higher benefits and granting approximately $1.2 million in attorney’s fees, plus $600,000 in conditional fees. On appeal, however, a panel of the United States Court of Appeals for the Fifth Circuit reversed the district court’s judgment, holding that the plaintiff was not entitled to reclassification to the highest benefits tier due to his failure to immediately appeal the denial, making any further review futile. The panel remanded for entry of judgment for the plan. On remand, the district court nonetheless reaffirmed its prior fee award, reasoning that the plaintiff’s success in exposing flaws in the plan’s review process, as reflected in favorable factual findings, constituted sufficient success to support attorney’s fees. The United States Court of Appeals for the Fifth Circuit, reviewing the fee award for abuse of discretion, reversed the district court’s decision. The Fifth Circuit held that under 29 U.S.C. § 1132(g)(1), attorney’s fees may only be awarded if a party achieves “some degree of success on the merits,” which requires more than favorable factual findings or moral victories. Because the plaintiff received no relief—monetary, injunctive, or declaratory—the award of attorney’s fees was improper. The court reversed the fee award. View "Cloud v. NFL Player Retirement Plan" on Justia Law

Williams v. Shapiro

2025-12-15T11:03:29-08:00

Several participants in a terminated employee stock ownership plan asserted claims under the Employee Retirement Income Security Act (ERISA) following the sale and dissolution of their plan. The plan, created by A360, Inc. in 2016, purchased all company stock and became its sole owner. In 2019, A360 and its trustee sold the plan’s shares to another entity, amending the plan at the same time to include an arbitration clause that required all claims to be resolved individually and prohibited representative, class, or group relief. The plan was terminated shortly thereafter, and the proceeds were distributed to participants. The plaintiffs alleged that the defendants undervalued the shares and breached fiduciary duties, seeking plan-wide monetary and equitable relief. The United States District Court for the Northern District of Georgia considered the defendants’ motion to compel arbitration based on the plan’s amended arbitration provisions. The district court determined that although the plan itself could assent to arbitration, the arbitration provision was unenforceable because it precluded plan-wide relief authorized by ERISA. The court found that the provision constituted a prospective waiver of statutory rights and concluded that, per the plan amendment’s own terms, the arbitration provision was not severable and thus entirely void. The United States Court of Appeals for the Eleventh Circuit reviewed the district court’s denial of the motion to compel arbitration de novo. The Eleventh Circuit held that the arbitration provision was unenforceable under the effective vindication doctrine because it barred participants from seeking plan-wide relief for breaches of fiduciary duty, as provided by ERISA. The court joined other circuits in concluding that such provisions violate ERISA’s substantive rights and affirmed the district court’s invalidation of the arbitration procedure and denial of the motion to compel arbitration. View "Williams v. Shapiro" on Justia Law

Gasper v. EIDP, Inc.

2025-12-08T11:30:15-08:00

After divorcing in 2010, a former employee and his ex-spouse entered into a court-approved domestic relations order in North Carolina that divided his employer-sponsored retirement plan benefits. The order stipulated that the ex-spouse would be treated as a surviving spouse, entitling her to survivor benefits under the plan, and stated that her portion of the benefit "may be reduced as necessary" to cover the cost of the survivor annuity. Years later, when the employee retired and began receiving benefits, he argued that the plan administrator improperly reduced his monthly payment by factoring the cost of the survivor annuity into his share, rather than allocating the cost solely to his ex-spouse’s portion. He also claimed that the plan administrator failed to timely provide all requested plan documents, warranting statutory penalties. The United States District Court for the Western District of North Carolina granted summary judgment for the employer and plan administrator. The court found that the plan administrator correctly interpreted the qualified domestic relations order (QDRO) to permit, but not require, allocating the cost of the survivor annuity to the ex-spouse’s share, and that the benefit calculation was consistent with the plan terms and not an abuse of discretion. Additionally, the court held that the plaintiff was not prejudiced by any delay in receiving plan documents and denied statutory penalties. On appeal, the United States Court of Appeals for the Fourth Circuit affirmed. The Fourth Circuit concluded that de novo review was appropriate for interpreting the QDRO, while the plan administrator’s benefit calculations were reviewed for abuse of discretion. The court held that the QDRO’s language was unambiguous and permissive, not mandatory, regarding who should bear the cost of the survivor annuity. The court also upheld the denial of statutory penalties, finding no prejudice or bad faith. The district court’s summary judgment for the defendants was affirmed. View "Gasper v. EIDP, Inc." on Justia Law

Patterson v. UnitedHealth Group, Inc.

2025-12-02T12:30:18-08:00

An individual received health insurance through his employer, with the plan administered by a third-party insurer. After being injured in a car accident, he recovered damages from the other driver’s employer and, based on communications from his insurer and its agent, paid $25,000 in reimbursement to the plan. He later learned that the full plan document did not contain a reimbursement obligation, contrary to what was represented in the summary plan description. A similar situation occurred when his wife was injured in a separate accident; litigation in state court ultimately resulted in a declaratory judgment that the plan did not provide for reimbursement, and this was affirmed on appeal. The individual then sued the insurer, its agent, and his employer in federal court under the Employee Retirement Income Security Act of 1974 (ERISA), alleging he was defrauded into paying reimbursement. The United States District Court for the Northern District of Ohio dismissed most claims, but allowed one ERISA claim under § 1132(a)(3) to proceed. While his federal appeal was pending, the plaintiff filed state law claims in state court, which were removed to federal court. The district court held that these state law claims were completely preempted by ERISA and dismissed the action, reasoning that the claims were duplicative of the pending federal lawsuit and arose from the same events. On appeal, the United States Court of Appeals for the Sixth Circuit affirmed the district court’s dismissal. The appellate court held that the plaintiff’s state law claims were completely preempted by ERISA under the standard articulated in Aetna Health Inc. v. Davila, because the claims sought relief for benefits allegedly due under the terms of an ERISA-governed plan and did not rely on a legal duty independent of ERISA or the plan. The court further concluded that dismissal, rather than remand or amendment, was appropriate due to the duplicative nature of the proceedings. View "Patterson v. UnitedHealth Group, Inc." on Justia Law

Johnson v. Reliance Standard Life Insurance Company

2025-11-21T13:32:33-08:00

Cheriese Johnson began experiencing a range of symptoms, including coughing and pain in her hands and feet, prior to her employment in July 2016 with The William Carter Company. She purchased a long-term disability insurance policy from Reliance Standard that became effective in October 2016. During the three months before her coverage began, Johnson sought medical care for various symptoms and received several diagnoses, but not scleroderma. In early 2017, after her policy was active, she was diagnosed with scleroderma—a rare autoimmune disease—following a lung biopsy. Johnson then filed a claim for long-term disability benefits, which Reliance Standard denied, arguing her disability was caused by a preexisting condition for which she had received treatment during the policy’s lookback period. After her claim was denied and her appeal was unsuccessful, Johnson sued Reliance Standard in the United States District Court for the Northern District of Georgia under the Employee Retirement Income Security Act (ERISA). She moved for judgment on the administrative record, while Reliance Standard sought summary judgment. The district court granted summary judgment to Reliance Standard, finding its decision to deny benefits was correct under the terms of the policy. On appeal, the United States Court of Appeals for the Eleventh Circuit reversed the district court’s judgment. Applying ERISA’s interpretive framework and reviewing the plan administrator’s decision de novo, the Eleventh Circuit held that Reliance Standard’s interpretation of the policy was both incorrect and unreasonable. The court concluded that Johnson had not received medical treatment “for” scleroderma during the lookback period because neither she nor her doctors suspected or intended to treat that specific condition at that time. The court found that Reliance Standard’s interpretation was arbitrary and capricious, and remanded for further proceedings consistent with its opinion. View "Johnson v. Reliance Standard Life Insurance Company" on Justia Law

PRITCHARD V. BLUE CROSS BLUE SHIELD OF ILLINOIS

2025-11-17T09:30:56-08:00

Several individuals, representing a class, challenged a health insurance company’s refusal to cover gender-affirming care for transgender individuals diagnosed with gender dysphoria. The company, acting as a third-party administrator for employer-sponsored, self-funded health plans, denied coverage for such treatments based on explicit plan exclusions requested by the employer sponsors. Some plaintiffs also alleged that they were denied coverage for treatments that would have been covered for other diagnoses, such as precocious puberty, but were denied solely because of the concurrent diagnosis of gender dysphoria. The United States District Court for the Western District of Washington certified the class and granted summary judgment in favor of the plaintiffs. The district court rejected the company’s arguments that it was not subject to Section 1557 of the Affordable Care Act because its third-party administrator activities were not federally funded, that it was merely following employer instructions under ERISA, and that it was shielded by the Religious Freedom Restoration Act (RFRA). The district court also found that the exclusions constituted sex-based discrimination under Section 1557. On appeal, the United States Court of Appeals for the Ninth Circuit agreed with the district court that the company is subject to Section 1557, that ERISA does not require administrators to enforce unlawful plan terms, and that RFRA does not provide a defense in this context. However, the Ninth Circuit held that the district court’s analysis of sex-based discrimination was undermined by the Supreme Court’s intervening decision in United States v. Skrmetti, which clarified the application of sex discrimination standards to exclusions for gender dysphoria treatment. The Ninth Circuit vacated the summary judgment and remanded the case for further proceedings to consider whether, under Skrmetti, the exclusions at issue may still constitute unlawful discrimination, particularly in cases involving pretext or proxy discrimination or where plaintiffs had other qualifying diagnoses. View "PRITCHARD V. BLUE CROSS BLUE SHIELD OF ILLINOIS" on Justia Law

Mass v. Regents of the University of California

2025-10-28T14:31:25-08:00

Two former employees of the University of California, after leaving their positions, delayed applying for retirement benefits under the University of California Retirement Plan (the Plan) until several years after reaching the normal retirement age of 60. When they eventually applied, both requested retroactive monthly retirement payments dating back to when they first became eligible. The Regents of the University of California denied these requests, interpreting the Plan to provide benefits only from the date of application forward. The plaintiffs, representing a class of similarly situated former employees, argued that the Plan entitled them to retroactive benefits or, alternatively, that The Regents breached a fiduciary duty by failing to inform them that retroactive benefits were unavailable. The Superior Court of Alameda County granted summary adjudication to The Regents on the breach of contract claim, finding that the Plan did not provide for retroactive monthly benefits prior to a member’s application. The court later held a bench trial on the breach of fiduciary duty claim, ultimately concluding that The Regents had not breached its duty to inform members about their retirement options, as the Plan documents and related communications were sufficient to fully and fairly inform a reasonable plan beneficiary. The California Court of Appeal, First Appellate District, Division Four, reviewed the case. It held that the Plan’s language unambiguously requires a member to apply for retirement benefits before those benefits become payable, and that retroactive monthly benefits are not available for periods before an application is filed. The court also affirmed that The Regents met its fiduciary duty of disclosure by providing adequate information about the Plan and its options. The judgment in favor of The Regents was affirmed. View "Mass v. Regents of the University of California" on Justia Law

Bolton v. Inland Fresh Seafood Corporation of America, Inc.

2025-10-15T11:03:26-08:00

In this case, several former employees of a seafood company participated in an employee stock ownership plan (ESOP) that was funded by a $92 million loan used to purchase all outstanding company stock from four directors and officers. The plaintiffs alleged that these directors and officers manipulated sales projections and inventory figures to inflate the stock’s valuation, causing the ESOP to overpay by tens of millions of dollars. They further claimed that the plan’s trustee failed to conduct proper due diligence before agreeing to the purchase price. The plaintiffs sought restoration of plan losses, disgorgement of profits, and other equitable relief under ERISA, asserting breaches of fiduciary duty. The plaintiffs filed suit in the United States District Court for the Northern District of Georgia without first exhausting the plan’s internal administrative remedies, despite acknowledging that the plan provided such procedures. They argued that exhaustion was not required for their claims and, alternatively, that they were excused from exhausting due to futility and inadequacy of the remedy. The defendants moved to dismiss on exhaustion grounds. The district court granted the motions, finding that Eleventh Circuit precedent required exhaustion for ERISA claims, and rejected the plaintiffs’ arguments for excusal. The court also denied the plaintiffs’ request for a stay to allow exhaustion, but did not specify whether the dismissal was with or without prejudice. On appeal, the United States Court of Appeals for the Eleventh Circuit affirmed the district court’s dismissal. The appellate court held that ERISA plaintiffs must exhaust available administrative remedies before seeking judicial review, including for breach of fiduciary duty claims, and that no valid excuse relieved the plaintiffs of this obligation. The court also remanded the case for the district court to clarify whether the dismissal was with or without prejudice. View "Bolton v. Inland Fresh Seafood Corporation of America, Inc." on Justia Law

SuperValu, Inc. v. UFCW Unions and Employers Midwest Pension Fund

2025-10-09T13:00:49-08:00

SuperValu, Inc. participated in a multiemployer pension plan, contributing on behalf of its employees for over a decade. In September 2018, SuperValu sold several stores to Schnuck’s Markets, Inc., with five of those stores employing workers covered by the pension plan. This sale qualified for a statutory “safe harbor,” meaning SuperValu did not incur withdrawal liability for the sold stores, as Schnuck’s agreed to continue contributions. Later, SuperValu closed its remaining stores and fully withdrew from the plan, triggering withdrawal liability. The pension fund calculated SuperValu’s total liability and the annual installment payments required, using statutory formulas. In calculating the payment schedule, the fund deducted the sold stores’ contribution base units for only the most recent five years, not the entire ten-year lookback period, which resulted in higher annual payments for SuperValu. SuperValu challenged the fund’s calculation, arguing that the contribution base units for the sold stores should have been excluded for all ten years, not just five. The dispute was submitted to arbitration under federal law, where the arbitrator ruled in favor of the fund. SuperValu then sought review in the United States District Court for the Northern District of Illinois, Eastern Division. The district court granted summary judgment to the fund, holding that the relevant statutory text did not require the deduction of the sold stores’ units for the entire ten-year period, and that SuperValu’s arguments based on legislative history and statutory purpose could not override the plain language. On appeal, the United States Court of Appeals for the Seventh Circuit reviewed the district court’s decision de novo. The Seventh Circuit held that the statute governing the payment schedule for withdrawal liability does not require a pension fund to deduct contribution base units for stores sold under the safe harbor provision for the entire ten-year lookback period. The court affirmed the district court’s judgment. View "SuperValu, Inc. v. UFCW Unions and Employers Midwest Pension Fund" on Justia Law

In re: Yellow Corporation

2025-09-16T09:00:41-08:00

Yellow Corporation, a major trucking company, ceased operations and filed for bankruptcy in 2023. As a result, it withdrew from several multiemployer pension plans, triggering withdrawal liability—an amount owed to the pension plans to cover unfunded vested benefits for employees. The pension plans, which had received substantial federal funds under the American Rescue Plan Act of 2021 (ARPA) to stabilize their finances, filed claims against Yellow’s bankruptcy estate for withdrawal liability. The dispute centered on how much of the ARPA funds should be counted as plan assets when calculating Yellow’s liability, as well as whether certain contractual terms could require Yellow to pay a higher withdrawal liability than statutory minimums. The United States Bankruptcy Court for the District of Delaware reviewed the claims. It upheld two regulations issued by the Pension Benefit Guaranty Corporation (PBGC): the Phase-In Regulation, which requires ARPA funds to be counted as plan assets gradually over time, and the No-Receivables Regulation, which bars plans from counting ARPA funds as assets before they are actually received. The Bankruptcy Court found these regulations to be valid exercises of PBGC’s authority and not arbitrary or capricious. It also ruled that two pension plans could enforce a contractual provision requiring Yellow to pay withdrawal liability at a higher, agreed-upon rate, rather than the rate based solely on its actual contributions. On direct appeal, the United States Court of Appeals for the Third Circuit affirmed the Bankruptcy Court’s order. The Third Circuit held that the PBGC’s regulations were valid under ARPA and ERISA, as Congress had expressly delegated authority to the PBGC to set reasonable conditions on the allocation of plan assets and withdrawal liability. The court also held that pension plans could enforce contractual terms requiring higher withdrawal liability, as the statutory scheme sets a floor, not a ceiling, for such liability. View "In re: Yellow Corporation" on Justia Law

Moratz v. Reliance Standard Life Insurance Co.

2025-09-02T12:00:33-08:00

A professional musician employed by the Indianapolis Symphony Orchestra was placed on furlough in March 2020 due to the COVID-19 pandemic. In December 2020, she developed severe symptoms, including dizziness and tinnitus, after contracting COVID-19, which rendered her unable to perform. She was rehired by the orchestra in September 2021 but soon went on sick leave because her symptoms persisted. In February 2022, she applied for long-term disability benefits under her employer’s group policy, stating that her last day of work was in March 2020 and that her disability began in December 2020. The insurance company denied her claim, reasoning that she was not an “active, full-time employee” at the time her disability began, as required by the policy. The claimant appealed internally, submitting new information that she had returned to work in September 2021 but was again unable to perform due to her illness. The insurer treated this as a fundamentally different claim, maintaining its denial and advising her to file a new application based on the later date. She then filed suit under the Employee Retirement Income Security Act (ERISA) in the United States District Court for the Southern District of Indiana. Both parties moved for summary judgment, and the district court granted summary judgment in favor of the insurer, finding that she was not eligible for benefits based on her initial application and that her new information constituted a separate claim for a different loss. On appeal, the United States Court of Appeals for the Seventh Circuit reviewed the case de novo and affirmed the district court’s judgment. The court held that the claimant was not eligible for benefits for a disability beginning in December 2020, and that her subsequent information regarding a September 2021 onset constituted a new claim, requiring exhaustion of administrative remedies before judicial review. View "Moratz v. Reliance Standard Life Insurance Co." on Justia Law

Bernitz v. USAble Life

2025-08-27T13:30:02-08:00

The appellant, a former Senior Vice President of Corporate Development at a pharmaceutical company, had a longstanding history of back and hip problems, leading him to stop working in 2014. He received long-term disability benefits under an insurance plan administered by USAble Life for several years. In 2019, USAble terminated his benefits, citing evidence of significant improvements in his physical condition, including weight loss, increased exercise, travel, and other activities inconsistent with total disability. The termination was based on updated medical records, surveillance, and reviews by independent physicians, despite continued support for disability from some of the appellant’s treating doctors. After the termination, the appellant pursued multiple rounds of internal appeals with USAble, submitting additional medical and vocational evidence. USAble obtained further independent medical reviews, which consistently concluded that the appellant was no longer disabled under the plan’s definition. The appellant then filed suit in the United States District Court for the District of Massachusetts, which granted summary judgment in favor of USAble, finding that the insurer’s decision was reasonable and supported by substantial evidence. On appeal, the United States Court of Appeals for the First Circuit reviewed the district court’s summary judgment ruling de novo but applied a deferential “arbitrary and capricious” standard to USAble’s benefits determination, as required under ERISA. The First Circuit held that USAble’s decision to terminate benefits was reasoned and supported by substantial evidence, that USAble properly applied the plan’s definition of disability, and that it adequately explained its disagreement with the appellant’s treating physicians. The court also found that any structural conflict of interest was sufficiently mitigated. Accordingly, the First Circuit affirmed the district court’s judgment in favor of USAble. View "Bernitz v. USAble Life" on Justia Law

Hoak v. NCR Corp.

2025-08-26T10:34:13-08:00

NCR Corporation established five “top hat” retirement plans to provide supplemental life annuity benefits to senior executives. Each plan promised participants a fixed monthly payment for life, with language allowing NCR to terminate the plans so long as no action “adversely affected” any participant’s accrued benefits. In 2013, NCR terminated the plans and paid participants lump sums it claimed were actuarially equivalent to the promised annuities, using mortality tables, actuarial calculations, and a 5% discount rate. NCR knew that, statistically, about half of the participants would outlive the lump sums if they continued to withdraw the same monthly benefit, resulting in some participants receiving less than they would have under the original annuity. Participants filed a class-action lawsuit in the United States District Court for the Northern District of Georgia, alleging breach of contract and seeking either replacement annuities or sufficient cash to purchase equivalent annuities. The district court certified the class and granted summary judgment for the participants, finding that NCR’s lump-sum payments adversely affected the accrued benefits of at least some participants, in violation of the plan language. The court ordered NCR to pay the difference between the lump sums and the cost of replacement annuities, plus prejudgment and postjudgment interest. On appeal, the United States Court of Appeals for the Eleventh Circuit reviewed the district court’s summary judgment order de novo. The Eleventh Circuit held that the plan language was unambiguous and did not permit NCR to unilaterally replace life annuities with lump sums that reduced the value of accrued benefits for any participant. The court affirmed the district court’s judgment, including the remedy of requiring NCR to pay the cost of replacement annuities and awarding prejudgment interest. View "Hoak v. NCR Corp." on Justia Law

KING v. US

2025-08-18T08:33:02-08:00

In this case, a group of pensioners from a multiemployer retirement fund governed by ERISA challenged the reduction of their pension benefits following the enactment of the Multiemployer Pension Reform Act of 2014 (MPRA). The MPRA allowed plan administrators to reduce benefits for current and future beneficiaries in order to prevent plan insolvency, subject to certain procedural safeguards and approval by the U.S. Department of the Treasury. The plaintiffs, who had vested rights to their pension benefits, argued that these reductions constituted an uncompensated taking under the Fifth Amendment. The United States Court of Federal Claims granted summary judgment in favor of the government. The Claims Court found that while the plaintiffs had a cognizable property interest in their vested pension benefits, the reduction of those benefits did not amount to a physical taking. Instead, the court analyzed the claim as a regulatory taking under the Penn Central framework and concluded that the economic impact, interference with investment-backed expectations, and the character of the government action did not support a finding of a taking. On appeal, the United States Court of Appeals for the Federal Circuit affirmed the Claims Court’s decision. The Federal Circuit held that the MPRA’s reduction of pension benefits was not a physical taking because the plaintiffs had only a contractual right to payment, not a property interest in the plan’s assets, and the government did not appropriate any specific property for itself or a third party. The court further held that, under the Penn Central test, the reduction did not constitute a regulatory taking, as the economic impact was not severe, the plaintiffs’ expectations were not unduly interfered with given the heavily regulated nature of pension plans, and the government action served a substantial public purpose. The judgment for the government was affirmed. View "KING v. US " on Justia Law

Collins v. Ne. Grocery, LLC

2025-08-18T06:30:12-08:00

Four former employees of grocery store chains, who participated in a defined contribution 401(k) retirement plan, brought a putative class action under the Employee Retirement Income Security Act of 1974 (ERISA). They alleged that the plan’s fiduciaries mismanaged the plan by failing to prudently select and monitor investment options, failing to act solely in the interest of plan participants, and allowing excessive fees and improper compensation arrangements. The plaintiffs sought monetary and injunctive relief on behalf of themselves, the plan, and a proposed class of similarly situated participants. The United States District Court for the Northern District of New York dismissed several of the plaintiffs’ claims for lack of Article III standing, finding that the plaintiffs had not alleged any concrete injury to their individual accounts from the alleged mismanagement of certain investment options or from the plan’s compensation arrangements. The district court concluded that because the plaintiffs had not invested in the specific funds they challenged, or had not shown that the alleged breaches affected their own accounts, they lacked standing to pursue those claims. The court did find standing for some claims related to funds in which the plaintiffs had invested, but ultimately dismissed those claims for failure to state a claim and denied leave to amend. The United States Court of Appeals for the Second Circuit reviewed the case and affirmed the district court’s dismissal of the claims for lack of standing. The Second Circuit held that participants in a defined contribution plan must plausibly allege a concrete, individualized financial injury to establish Article III standing for monetary relief under ERISA. Because the plaintiffs did not allege that they suffered losses in their own accounts from the challenged conduct, they lacked both individual and class standing for those claims. The court affirmed in part and vacated in part the district court’s judgment, remanding for further proceedings consistent with its opinion. View "Collins v. Ne. Grocery, LLC" on Justia Law

Schuyler v. Sun Life Assurance Company of Canada

2025-08-14T07:00:10-08:00

The plaintiff, a former employee of a dental supply company, suffered a traumatic brain injury and later filed a claim for long-term disability (LTD) benefits under her employer’s LTD plan, which was insured and administered by an independent insurance company. After her claim was denied, she left her job and entered into a separation agreement with her employer. This agreement included a broad release of claims against the employer and its “parents, subsidiaries, related or affiliated entities,” as well as their agents, including claims under the Employee Retirement Income Security Act of 1974 (ERISA). Before signing, the plaintiff sought clarification from her employer about whether the release would affect her ability to pursue her LTD claim against the insurer. The employer’s representatives assured her that the insurer was a separate, independent entity and that the agreement would not impact her ability to appeal the denial of her LTD claim. After the insurer denied her appeal, the plaintiff sued the insurer in the United States District Court for the Southern District of New York, alleging violations of ERISA. The insurer moved for summary judgment, arguing that the release in the separation agreement barred her claims. The district court agreed, holding that the insurer was covered by the release and that the plaintiff knowingly and voluntarily waived her ERISA claims against it. The court granted summary judgment in favor of the insurer, and the plaintiff appealed. The United States Court of Appeals for the Second Circuit reviewed the case de novo. The court held that, based on the totality of the circumstances, the plaintiff did not knowingly and voluntarily release her ERISA claims against the insurer. The court emphasized the employer’s express assurances to the plaintiff that the release would not affect her LTD claim and found no evidence to create a genuine dispute on this point. The Second Circuit vacated the district court’s judgment and remanded the case for further proceedings. View "Schuyler v. Sun Life Assurance Company of Canada" on Justia Law

United States v. Wynder

2025-08-07T06:30:12-08:00

Two fiduciaries, who managed retirement and welfare funds for a New York City law enforcement union, were found to have improperly withdrawn over $500,000 from the union’s annuity fund. The withdrawals, which occurred over several years, were facilitated by one defendant preparing false authorization forms and the other signing and submitting them to the fund’s custodian. The funds were then transferred to the union’s operating account and used for unauthorized purposes, including personal enrichment and unrelated union expenses. The defendants misrepresented the nature of these withdrawals to both the fund’s custodian and union members, and they continued the scheme even after being warned by auditors that their actions were improper. The United States District Court for the Southern District of New York presided over a joint jury trial, where both defendants were convicted of wire fraud and conspiracy to commit wire fraud. One defendant was also convicted of conspiracy to defraud the United States and multiple counts of tax evasion. The district court denied motions to sever the trials, found the evidence sufficient to support the convictions, and imposed restitution and forfeiture orders. The court also addressed government discovery errors by granting a continuance and requiring early disclosure of materials, but declined to impose harsher sanctions. On appeal, the United States Court of Appeals for the Second Circuit reviewed claims of improper joinder, insufficient evidence, prosecutorial misconduct, ineffective assistance of counsel, and errors in restitution calculation. The court held that joinder was proper because the indictment sufficiently linked the fraud and tax offenses, the evidence was sufficient to support the convictions, and the attorney’s illness did not constitute per se ineffective assistance. The court also found no abuse of discretion in the district court’s handling of discovery issues or restitution calculation, and no reversible prosecutorial misconduct. The Second Circuit affirmed the district court’s judgment. View "United States v. Wynder" on Justia Law

Ace-Saginaw Paving Co. v. Operating Engineers Local 324

2025-08-06T11:01:02-08:00

A multiemployer pension fund managed by the Operating Engineers Local 324 Pension Fund assessed withdrawal liability against Ace-Saginaw Paving Company after Ace partially withdrew from the fund in December 2018. The dispute centered on the interest rate assumption used to calculate the withdrawal liability. Ace argued that the rate should match the fund’s minimum funding interest rate of 7.75%, resulting in a lower liability, while the fund’s actuary used a much lower rate of 2.27% (the PBGC rate), resulting in a significantly higher liability. The actuary’s choice of rate was based on policy considerations and a desire to protect the fund’s remaining employers, rather than his best estimate of the fund’s anticipated investment experience. The parties proceeded to arbitration, as required by ERISA. The arbitrator found that the actuary’s use of the 2.27% rate violated 29 U.S.C. § 1393(a)(1) because it was not the actuary’s best estimate of anticipated experience under the plan. The arbitrator ordered the fund to recalculate Ace’s withdrawal liability using a rate that complied with the statutory requirements. The United States District Court for the Eastern District of Michigan affirmed the arbitrator’s findings and granted summary judgment to Ace on the statutory violation, but declined Ace’s request to require use of the minimum funding rate as the remedy, instead allowing the fund’s actuary another opportunity to select a compliant rate. The United States Court of Appeals for the Sixth Circuit reviewed the case and affirmed the district court’s judgment. The court held that the actuary’s use of the PBGC rate was not his best estimate and thus violated ERISA. The court also held that, on remand, the actuary may use a different rate from the minimum funding rate only if it is justified by factors that improve the accuracy of the withdrawal liability calculation, not by policy considerations. The court denied both parties’ requests for attorney’s fees. View "Ace-Saginaw Paving Co. v. Operating Engineers Local 324" on Justia Law

PLATT V. SODEXO, S.A.

2025-08-04T08:00:45-08:00

Robert Platt, an employee of Sodexo, Inc., sued his employer, claiming that a monthly tobacco surcharge on his employee health insurance premiums violated the Employee Retirement Income Security Act (ERISA). Platt brought claims on behalf of himself and other plan participants to recover losses under ERISA § 502(a)(1)(B) and § 502(a)(3), and a breach of fiduciary duty claim on behalf of the employer-sponsored health insurance plan (the Plan) for losses under ERISA § 502(a)(2). Sodexo sought to compel arbitration based on an arbitration provision it unilaterally added to the Plan after Platt joined. The United States District Court for the Central District of California denied Sodexo’s motion to compel arbitration, holding that there was no enforceable arbitration agreement because Sodexo unilaterally modified the Plan to add the arbitration provision without Platt’s consent. The court found that Platt did not agree to arbitrate his claims. The United States Court of Appeals for the Ninth Circuit reviewed the case. The court agreed that an employer cannot create a valid arbitration agreement by unilaterally modifying an ERISA-governed plan to add an arbitration provision without obtaining consent from the relevant party. The court held that Platt is the relevant consenting party for claims under ERISA § 502(a)(1)(B) and § 502(a)(3) and that he did not consent to arbitration because he did not receive sufficient notice of the arbitration provision. However, the court held that the Plan is the relevant consenting party for the breach of fiduciary duty claim under ERISA § 502(a)(2) and that the Plan consented to arbitration. The Ninth Circuit affirmed the district court’s denial of Sodexo’s motion to compel arbitration for Platt’s claims under ERISA § 502(a)(1)(B) and § 502(a)(3). It reversed in part the district court’s denial of the motion to compel arbitration for the breach of fiduciary duty claim under ERISA § 502(a)(2) and remanded for the district court to consider Platt’s unconscionability defenses and the severability of the representative action waiver and any other arbitration clauses found unconscionable. View "PLATT V. SODEXO, S.A." on Justia Law

Perfection Bakeries Inc v. Retail Wholesale & Dept Store International Union

2025-08-01T12:02:05-08:00

Perfection Bakeries Inc. paid into the Retail, Wholesale and Department Store International Union’s Industry Pension Fund for its employees in Michigan and Indiana. The company later ceased contributions, first in Michigan and then in Indiana, incurring "withdrawal liability" under the Multiemployer Pension Plan Amendments Act of 1980. The Fund calculated this liability using a four-step formula outlined in 29 U.S.C. § 1381. Perfection Bakeries challenged the Fund's calculation, arguing that a specific calculation was performed at the wrong step. The United States District Court for the Northern District of Alabama reviewed the case. The district court granted summary judgment in favor of the Fund, holding that the statutory text unambiguously required the credit to be applied as part of the second adjustment step. The United States Court of Appeals for the Eleventh Circuit reviewed the case. The court affirmed the district court's judgment, agreeing that the Fund correctly applied the partial-withdrawal credit at step two of the four-step formula. The court concluded that the statute's language and structure supported the Fund's interpretation, which incorporated all of section 1386, including the credit for previous partial withdrawals, at step two. The court found that this interpretation was consistent with the statutory context and the repeated cross-references to section 1386 throughout the four-step formula. The court rejected Perfection Bakeries' arguments, including the contention that the partial-withdrawal credit should be applied after all four steps, and upheld the Fund's calculation method. View "Perfection Bakeries Inc v. Retail Wholesale & Dept Store International Union" on Justia Law

Int'l Union of Painters & Allied Trades v. Smith

2025-07-31T11:01:46-08:00

The case involves a dispute over the management of an ERISA fund, specifically the Southern Ohio Painters Health and Welfare Plan and Trust. Plaintiffs, including union-appointed trustees and the International Union of Painters and Allied Trades District Council No. 6, allege that two union-appointed trustees, Smith and Clark, have engaged in actions that violate their fiduciary duties. These actions include procedural changes that benefit themselves and undermine the union's authority, such as amendments to the Trust Agreement that make it difficult to remove trustees and provide benefits to retired trustees. The United States District Court for the Southern District of Ohio dismissed the plaintiffs' claims against the employer-appointed trustees and denied the plaintiffs' request for a preliminary injunction. The plaintiffs sought to remove Smith and Clark as trustees, terminate their employment with the Fund, and prevent the Fund from paying their legal expenses, among other relief. The district court found that the plaintiffs failed to demonstrate irreparable harm, a necessary requirement for a preliminary injunction. The United States Court of Appeals for the Sixth Circuit reviewed the district court's denial of the preliminary injunction. The appellate court affirmed the district court's decision, agreeing that the plaintiffs did not show they would suffer irreparable harm without the injunction. The court noted that the plaintiffs' concerns about self-dealing and the inability to exercise fiduciary duties were speculative and could be addressed through monetary damages. The court also declined to exercise pendent jurisdiction over the district court's dismissal of the claims against the employer-appointed trustees, as the issues were not inextricably intertwined with the appeal of the preliminary injunction denial. View "Int'l Union of Painters & Allied Trades v. Smith" on Justia Law

Grand Traverse Band of Ottawa & Chippewa Indians v. Blue Cross Blue Shield of Michigan

2025-07-28T11:00:35-08:00

The Grand Traverse Band of Ottawa and Chippewa Indians and its employee welfare plan (the Plan) alleged that Blue Cross Blue Shield of Michigan (Blue Cross) breached fiduciary duties under ERISA and related duties under Michigan state law. The Tribe claimed that Blue Cross submitted false claims, causing the Tribe to overpay for hospital services. The Tribe also alleged violations of the Michigan Health Care False Claims Act (HCFCA) and sought to amend its complaint to include additional facts. The United States District Court for the Eastern District of Michigan dismissed the Tribe’s ERISA and common-law fiduciary duty claims as time-barred, granted summary judgment to Blue Cross on the HCFCA claim, and denied the Tribe’s motion for leave to amend its complaint a second time. The court found that the Tribe had actual knowledge in 2009 that it was not receiving Medicare-Like Rates (MLR) and thus the claims were time-barred. The court also concluded that Blue Cross was not directly governed by the MLR regulations, and therefore, the Tribe could not prove a violation of the HCFCA based on Blue Cross’s failure to apply MLR. The United States Court of Appeals for the Sixth Circuit affirmed the district court’s decisions. The appellate court agreed that the Tribe’s fiduciary duty claims were time-barred because the Tribe knew in 2009 that it was not receiving MLR. The court also upheld the summary judgment on the HCFCA claim, finding that the MLR regulations did not apply to Blue Cross. Additionally, the court found no error in the district court’s denial of the Tribe’s motion for leave to amend its complaint, as the proposed amendments would not have cured the deficiencies in the ERISA claim. View "Grand Traverse Band of Ottawa & Chippewa Indians v. Blue Cross Blue Shield of Michigan" on Justia Law

Aldridge v. Regions Bank

2025-07-17T12:00:19-08:00

A group of former managers of Ruby Tuesday, Inc. participated in two top-hat retirement plans administered by Regions Bank. These plans were unfunded and designed for high-level employees, meaning they were exempt from certain ERISA fiduciary duties. When Ruby Tuesday filed for bankruptcy, the managers lost their benefits and sued Regions Bank, alleging breaches of state-law fiduciary, trust, contract, and tort duties. They also sought equitable relief under ERISA to recover their lost benefits. The United States District Court for the Eastern District of Tennessee dismissed the state-law claims, ruling that ERISA preempted them. The court also granted summary judgment to Regions Bank on the ERISA claim, concluding that the requested monetary relief did not qualify as equitable relief under ERISA. The United States Court of Appeals for the Sixth Circuit reviewed the case. The court affirmed the district court's decision, holding that ERISA preempted the state-law claims because they related to an ERISA-covered plan. The court emphasized that allowing state-law claims would undermine ERISA's uniform regulatory scheme. Additionally, the court held that the monetary relief sought by the plaintiffs did not qualify as equitable relief under ERISA. The court reasoned that the plaintiffs' request for an "equitable surcharge" was essentially a request for legal damages, which ERISA does not permit under its equitable relief provision. Thus, the Sixth Circuit affirmed the district court's judgment in favor of Regions Bank, concluding that the plaintiffs could not pursue their state-law claims or obtain the requested monetary relief under ERISA. View "Aldridge v. Regions Bank" on Justia Law

Railroad Maintenance and Industrial Health & Welfare Fund v. Mahoney

2025-07-17T10:30:46-08:00

Clinton Mahoney, the sole member and manager of Mahoney & Associates, LLC, signed an agreement obligating the company to contribute to the Railroad Maintenance and Industrial Health and Welfare Fund, an employee benefit fund. When the Fund could not collect delinquent contributions from Mahoney & Associates, it sued Mahoney personally, citing a personal liability clause in the agreement. The district court granted summary judgment to the Fund, concluding that Mahoney was personally liable based on the clause. The United States District Court for the Central District of Illinois initially entered judgment on July 31, but it did not comply with Federal Rule of Civil Procedure 58. Mahoney filed a notice of appeal on September 26, and the district court later entered a corrected judgment on October 11. Mahoney filed a second notice of appeal the same day. The district court had awarded the Fund attorneys’ fees based on the trust agreement. The United States Court of Appeals for the Seventh Circuit reviewed the case de novo. The court found that there was a genuine dispute of material fact regarding Mahoney’s intent to be personally bound by the trust agreement, as he signed the memorandum in a representative capacity, which conflicted with the personal liability clause. The court concluded that this issue could not be resolved at summary judgment. The court also addressed Mahoney’s laches defense but found it waived due to his failure to address relevant complications. Consequently, the Seventh Circuit reversed the district court’s grant of summary judgment and vacated the award of attorneys’ fees, remanding the case for further proceedings. View "Railroad Maintenance and Industrial Health & Welfare Fund v. Mahoney" on Justia Law

Nalco Company LLC v. Bonday

2025-07-10T09:07:46-08:00

Laurence Bonday, a former employee of Nalco Company LLC, filed an arbitration demand against Nalco, alleging that the company violated its severance plan by demoting him without offering severance pay. Nalco argued that a court needed to determine the scope of the arbitration agreement before proceeding. However, the arbitrator concluded that Bonday’s severance claim fell outside the scope of the arbitration agreement and awarded him nothing on that claim. Instead, the arbitrator awarded Bonday $129,465.50 on an ERISA discrimination claim that he never raised. Nalco moved to vacate the arbitration award, arguing that the arbitrator exceeded her powers by deciding the scope of the arbitration agreement and awarding relief on a claim Bonday never made. The United States District Court for the Middle District of Florida granted Nalco's motion, concluding that the arbitrator exceeded her powers by interpreting the scope of the arbitration agreement and awarding relief on an unraised ERISA discrimination claim. The United States Court of Appeals for the Eleventh Circuit reviewed the case and affirmed the district court's decision. The appellate court agreed that the arbitrator exceeded her powers by granting relief on an ERISA discrimination claim that Bonday did not submit for arbitration. The court emphasized that an arbitrator can only bind the parties on issues they have agreed to submit and that the arbitrator's decision to award relief on an unsubmitted claim was beyond her authority. The court did not address the district court's first reason for vacating the award, as the second reason was sufficient to affirm the decision. View "Nalco Company LLC v. Bonday" on Justia Law

Stark v. Reliance Standard Life Insurance Company

2025-07-08T07:00:52-08:00

Nancy Stark, as the legal guardian and mother of Jill Finley, an incapacitated person, filed a lawsuit against Reliance Standard Life Insurance Company. Finley, who suffered a hypoxic brain injury in 2007, was initially approved for long-term disability benefits by Reliance. However, in 2022, Reliance terminated her benefits, claiming recent testing did not support her total disability. Stark appealed, and Reliance reinstated the benefits in 2023. Stark then sued, seeking a surcharge for financial harm caused by the wrongful termination, claiming breach of fiduciary duty for not providing internal records, and contesting the deduction of social security payments from Finley's disability payments. The United States District Court for the Western District of Oklahoma granted Reliance's motion to dismiss under Rule 12(b)(6) for failure to state a claim. The court found that Stark did not plausibly allege a claim for equitable relief under ERISA, nor did she demonstrate that Reliance's actions violated the terms of the insurance policy or breached fiduciary duties. The United States Court of Appeals for the Tenth Circuit reviewed the case. The court affirmed the district court's dismissal, holding that Stark was not entitled to attorney’s fees incurred during the administrative appeal under ERISA’s § 1132(a)(3) or § 1132(g). The court also found that Stark's claims regarding the SSD offset were time-barred and waived due to failure to exhaust administrative remedies. Additionally, the court concluded that Stark did not allege any concrete harm resulting from Reliance's alleged failure to provide requested records during the administrative appeal. Consequently, the Tenth Circuit affirmed the district court's decision to dismiss all of Stark's claims. View "Stark v. Reliance Standard Life Insurance Company" on Justia Law

AMISUB (SFH), Inc. v. Cigna Health & Life Ins. Co.

2025-07-01T10:30:51-08:00

Two hospitals in Tennessee, Saint Francis Hospital and Saint Francis Hospital-Bartlett, sued Cigna Health and Life Insurance Company, claiming that Cigna routinely underpaid them for emergency services provided to Cigna members. The hospitals, which are out-of-network providers for Cigna, argued that Cigna had a quasi-contractual obligation to pay the reasonable value of their services based on federal and state laws requiring hospitals to treat emergency patients and insurers to cover emergency care. The United States District Court for the Western District of Tennessee dismissed the hospitals' claims. The court found that the hospitals' complaint did not meet the pleading standards of Rule 8, that Tennessee common law did not support their claims, and that the Employee Retirement Income Security Act (ERISA) preempted their claims. The United States Court of Appeals for the Sixth Circuit reviewed the case and affirmed the district court's dismissal. The Sixth Circuit held that neither federal law (specifically the Affordable Care Act) nor Tennessee law imposed a duty on Cigna to pay the full value of out-of-network emergency services. The court noted that the ACA's requirement for insurers to provide "coverage" for emergency services did not mean that insurers had to pay the full cost. The court also found that Tennessee common law did not support the hospitals' claims for quantum meruit and unjust enrichment, as there was no contractual or statutory duty for Cigna to pay the full value of the services. The Sixth Circuit concluded that the hospitals' claims failed because they could not establish that Cigna had a legal obligation to pay more than what was stipulated in its contracts with its members. The court did not address the ERISA preemption issue, as the dismissal was affirmed on other grounds. View "AMISUB (SFH), Inc. v. Cigna Health & Life Ins. Co." on Justia Law

Edwards v. Guardian Life Insurance

2025-06-20T17:30:16-08:00

Pamela Edwards, owner of Allure Salon in Starkville, Mississippi, was diagnosed with cancer in 2019 and passed away in 2022. After her death, her husband, Jimmy Edwards, sought payment from her life insurance policy with Guardian Life Insurance. Guardian denied the claim, stating the policy had been canceled because the number of insured employees at Allure dropped to one, triggering their right to cancel the policy. Jimmy Edwards was unaware of the policy until informed by the insurance agent, Debbie Jaudon, who also did not receive a cancellation notice from Guardian. Jimmy Edwards sued Guardian in the Northern District of Mississippi, bringing claims under Mississippi common law and arguing that ERISA entitled him to recover benefits. Guardian moved for partial summary judgment, asserting that ERISA governed the plan and preempted the common-law claims. The district court granted Guardian’s motion, and Jimmy Edwards appealed. The United States Court of Appeals for the Fifth Circuit reviewed the case. The court determined that ERISA applied to the Allure policy, as the salon technicians were considered employees under federal common law. The court found that Guardian had waived its right to cancel the policy by continuing to accept premium payments for 26 months after the right to cancel vested. The court held that Guardian could not avoid its obligation to pay the claim after accepting premiums for such an extended period. Consequently, the Fifth Circuit reversed the district court's judgment and rendered judgment in favor of James Edwards. View "Edwards v. Guardian Life Insurance" on Justia Law

Orabona v. Santander Bank, N.A.

2025-06-16T13:00:02-08:00

Lorna Orabona, a high-earning mortgage development officer, was terminated by Santander Bank, N.A. for allegedly violating the company's Code of Conduct by forwarding company emails to her private email address. As a result, she was deemed ineligible for severance benefits under Santander's Employee Retirement Income Security Act (ERISA) Severance Policy. Orabona claimed that her termination was a pretext to avoid paying her severance benefits, especially since Santander was planning a large-scale layoff in her department shortly after her termination. The case was initially filed in Rhode Island Superior Court but was removed to the United States District Court for the District of Rhode Island. Santander moved to dismiss the case, arguing that Orabona's claims were preempted by ERISA. The district court allowed limited discovery to determine the applicability of the ERISA plan. After discovery, the district court granted summary judgment in favor of Santander, holding that all of Orabona's state law claims were preempted by ERISA because they related to the Severance Policy and required reference to it for determining liability and damages. The United States Court of Appeals for the First Circuit reviewed the case and affirmed the district court's decision. The court held that Orabona's claims were preempted by ERISA under section 514(a) because they related to the Severance Policy. The court also found that her claims seeking relief for the denial of severance benefits conflicted with the remedial scheme established by ERISA section 502(a). The court emphasized that determining liability and damages for Orabona's claims would require interpreting the terms of the ERISA-regulated Severance Policy, thus necessitating preemption. View "Orabona v. Santander Bank, N.A." on Justia Law

Oye v Hartford Life and Accident Insurance Company

2025-06-12T09:01:56-08:00

Olayinka Oye, a director at PricewaterhouseCoopers, applied for long-term disability benefits through her employer's plan, administered by Hartford Life and Accident Insurance Company, due to fibromyalgia. Initially, Hartford denied her claim but later reversed its decision and awarded her benefits. In 2020, Hartford reevaluated her condition and terminated her benefits, concluding she was no longer disabled. Oye filed a lawsuit seeking to reinstate her benefits under the Employee Retirement Income Security Act (ERISA). The United States District Court for the Northern District of Illinois conducted a "paper trial" and found that Oye's fibromyalgia, while limiting, did not render her disabled under the plan. The court noted that consultative reports from Hartford's doctors, which were detailed and tied to Oye's medical records, outweighed the brief and conclusory letters from Oye's treating physicians. Additionally, the court found that Oye's mental health issues contributed significantly to her limitations, disqualifying her from additional benefits under the plan. The United States Court of Appeals for the Seventh Circuit reviewed the case. The court affirmed the district court's decision, emphasizing that the district court owed no deference to Hartford's prior determination of disability. The appellate court found no clear error in the district court's findings, noting that the district court carefully considered the evidence and provided adequate reasoning for its decision. The court also addressed Oye's contention that the district court should have discussed a 2017 consultative report, concluding that the district court was not obligated to address every piece of evidence and had reasonably focused on more recent reports. The Seventh Circuit affirmed the district court's judgment in favor of Hartford. View "Oye v Hartford Life and Accident Insurance Company" on Justia Law

Karkare v. International Ass'n of Bridge, Structural, Ornamental & Reinforcing

2025-06-09T06:30:10-08:00

Nakul Karkare, a surgeon affiliated with AA Medical, P.C., brought an action against the International Association of Bridge, Structural, Ornamental & Reinforcing Iron Workers Local 580 (the Union) to recover unpaid benefits under section 502(a)(1)(B) of the Employee Retirement Income Security Act of 1974 (ERISA). Karkare, holding a power of attorney for Patient JN, claimed the Union failed to fully reimburse AA Medical for surgical services provided to Patient JN, a beneficiary under the Union’s self-funded insurance plan. The Union reimbursed only $1,095.92 of the $153,579.94 billed by AA Medical. The United States District Court for the Eastern District of New York dismissed the complaint sua sponte, concluding that a power of attorney did not permit Karkare to maintain an ERISA cause of action on behalf of Patient JN, as it was distinct from an assignment of claim. Karkare did not provide proof of a valid assignment but argued that the power of attorney was sufficient. The district court disagreed and dismissed the complaint, later denying Karkare’s motion for reconsideration. The United States Court of Appeals for the Second Circuit reviewed the case and concluded that Karkare lacked standing under Article III of the United States Constitution to bring the action. The court determined that Karkare was suing in his own name and not on behalf of Patient JN, despite holding a power of attorney. The court held that a power of attorney does not confer Article III standing to file suit in the attorney-in-fact’s own name. However, the court remanded the case to the district court to consider whether Patient JN should be permitted to be substituted into the action pursuant to Federal Rule of Civil Procedure 17. The judgment was affirmed in part, vacated in part, and remanded for further proceedings. View "Karkare v. International Ass'n of Bridge, Structural, Ornamental & Reinforcing" on Justia Law

Schuman v. Microchip Technology Inc.

2025-06-05T09:02:35-08:00

Peter Schuman and William Coplin, former employees of Atmel Corporation, were terminated without cause after Microchip Technology Inc. acquired Atmel. They were offered severance benefits significantly lower than those promised under Atmel's Employee Retirement Income Security Act (ERISA)-governed benefits plan, in exchange for signing a release of all potential claims. Schuman and Coplin signed the releases but later filed a class-action lawsuit on behalf of approximately 200 similarly situated former Atmel employees, alleging ERISA violations, including breach of fiduciary duty and denial of benefits, and challenging the enforceability of the releases. The United States District Court for the Northern District of California granted summary judgment in favor of Microchip against Schuman and Coplin, applying a six-part test to determine that the releases were signed knowingly and voluntarily. The court did not consider evidence of Microchip's alleged breach of fiduciary duties in its analysis. The district court denied summary judgment for the non-named plaintiffs, finding material disputes of fact regarding Microchip's knowledge of the Plan's intended interpretation. The court entered final judgment under Federal Rule of Civil Procedure 54(b) for Schuman and Coplin, certifying the question of the appropriate legal test for determining the enforceability of the releases. The United States Court of Appeals for the Ninth Circuit reversed the district court's summary judgment against Schuman and Coplin, holding that courts must evaluate the enforceability of ERISA releases by considering the totality of the circumstances, including any alleged improper conduct by the fiduciary. The court enumerated nine non-exhaustive factors for this evaluation. The case was remanded to the district court for further proceedings consistent with this opinion. The Ninth Circuit dismissed Microchip's cross-appeal for lack of jurisdiction, as the issue raised was not inextricably intertwined with the primary appeal. View "Schuman v. Microchip Technology Inc." on Justia Law

Anderson v. Intel Corporation Investment Policy Committee

2025-05-22T08:30:28-08:00

Winston R. Anderson, a former Intel employee, brought a putative class action under the Employee Retirement Income Security Act (ERISA) against the trustees of Intel Corporation’s proprietary retirement funds. Anderson alleged that the trustees breached their fiduciary duty of prudence by investing in hedge funds and private equity funds, and their duty of loyalty by steering retirement funds to companies in which Intel Capital had already invested. The United States District Court for the Northern District of California dismissed Anderson’s claims, concluding that he had not plausibly alleged a breach of either the duty of prudence or the duty of loyalty. The court found that Anderson failed to provide a meaningful benchmark to compare the performance of Intel’s funds and did not plausibly allege a real conflict of interest for the duty of loyalty claim. Anderson was granted leave to amend his complaint, but the district court dismissed the amended complaint with prejudice for the same reasons. The United States Court of Appeals for the Ninth Circuit affirmed the district court’s dismissal. The court held that Anderson did not state a claim for breach of ERISA’s duty of prudence because he failed to provide a sound basis for comparison, as the funds he compared to Intel’s funds had different aims, risks, and potential rewards. The court also held that Anderson did not state a claim for breach of the duty of loyalty because he did not plausibly allege a real conflict of interest, only the potential for one. The court emphasized that ERISA requires prudence based on the methods employed by fiduciaries, not the results achieved, and that generalized attacks on hedge funds and private equity funds as a category are insufficient to state a claim. View "Anderson v. Intel Corporation Investment Policy Committee" on Justia Law

Tiara Yachts, Inc. v. Blue Cross Blue Shield of Michigan

2025-05-21T11:00:20-08:00

Tiara Yachts, Inc. hired Blue Cross Blue Shield of Michigan (BCBSM) to administer its self-funded healthcare benefits plan. Tiara Yachts alleges that BCBSM systematically overpaid certain claims, thereby squandering plan assets, and then profited from these overpayments through a program that clawed back the overpayments and kept a portion of the recovered funds. Tiara Yachts sued BCBSM under the Employee Retirement Income Security Act (ERISA), claiming breaches of fiduciary duty and self-dealing. The United States District Court for the Western District of Michigan granted BCBSM's motion to dismiss, holding that Tiara Yachts had not plausibly alleged that BCBSM acted as an ERISA fiduciary. The court also held that ERISA’s remedial provisions could not provide the relief Tiara Yachts sought. The United States Court of Appeals for the Sixth Circuit reviewed the case and reversed the district court's decision. The appellate court held that Tiara Yachts plausibly alleged that BCBSM acted as an ERISA fiduciary by exercising control over plan assets when it overpaid claims and by exercising discretion over its compensation through the Shared Savings Program (SSP). The court found that BCBSM’s control over the claims-processing apparatus and its ability to profit from overpayments through the SSP indicated fiduciary status. The Sixth Circuit also held that Tiara Yachts could seek recovery on behalf of the plan under 29 U.S.C. § 1132(a)(2) and could seek equitable relief, such as restitution and disgorgement, under 29 U.S.C. § 1132(a)(3). The court concluded that Tiara Yachts’ claims for restitution and disgorgement were equitable in nature and that the complaint plausibly alleged that BCBSM retained specific funds from the SSP, satisfying the traceability requirement for equitable relief. The case was remanded for further proceedings consistent with the appellate court's opinion. View "Tiara Yachts, Inc. v. Blue Cross Blue Shield of Michigan" on Justia Law

J.H. v. Anthem Blue Cross Life and Health Insurance

2025-05-21T08:03:32-08:00

J.H. participated in an employee welfare-benefit plan insured by Anthem Blue Cross Life and Health Insurance Company, with her son, A.H., as a beneficiary. After seeking benefits for A.H.'s yearlong stay at a mental-health treatment center, Anthem denied coverage, and Plaintiffs' appeal to Anthem was unsuccessful. Over a year after their final appeal through Anthem was decided, Plaintiffs filed a lawsuit to recover benefits under § 502(a)(1)(B) of the Employee Retirement Income Security Act of 1974 (ERISA). The United States District Court for the District of Utah dismissed the action, concluding it was time-barred under a provision of the Plan that required civil actions under ERISA § 502(a) to be brought within one year of the grievance or appeal decision. Plaintiffs argued that another sentence in the Plan set a three-year limitations period, creating an ambiguity that should be interpreted in their favor. The United States Court of Appeals for the Tenth Circuit reviewed the case and held that the two provisions were not inconsistent and both applied. The court explained that the one-year limitations period for § 502(a) actions and the three-year limitations period for other actions were distinct and could both be applicable. The court affirmed the district court's dismissal, concluding that Plaintiffs' action was time-barred as it was filed beyond the one-year limitations period specified in the Plan. View "J.H. v. Anthem Blue Cross Life and Health Insurance" on Justia Law

BlueCross BlueShield of Tennessee v. Nicolopoulos

2025-05-08T10:30:40-08:00

BlueCross BlueShield of Tennessee (BlueCross) is an insurer and fiduciary for an ERISA-governed group health insurance plan. A plan member in New Hampshire sought coverage for fertility treatments, which BlueCross denied as the plan did not cover such treatments. The Commissioner of the New Hampshire Insurance Department initiated an enforcement action against BlueCross, alleging that the denial violated New Hampshire law, which mandates coverage for fertility treatments. BlueCross sought to enjoin the state regulatory action, arguing it conflicted with its fiduciary duties under ERISA. The United States District Court for the Eastern District of Tennessee denied BlueCross's request for relief and granted summary judgment to the Commissioner. The court found that the Commissioner’s enforcement action was against BlueCross in its capacity as an insurer, not as a fiduciary, and thus was permissible under ERISA’s saving clause, which allows state insurance regulations to apply to insurers. The United States Court of Appeals for the Sixth Circuit reviewed the case and affirmed the district court’s decision. The Sixth Circuit held that the Commissioner’s action was indeed against BlueCross as an insurer, aiming to enforce New Hampshire’s insurance laws. The court noted that ERISA’s saving clause permits such state actions and that BlueCross could not use its fiduciary duties under ERISA to evade state insurance regulations. The court also referenced the Supreme Court’s decision in UNUM Life Insurance Co. of America v. Ward, which established that state insurance regulations are not preempted by ERISA when applied to insurers. Thus, the Sixth Circuit concluded that ERISA did not shield BlueCross from the New Hampshire regulatory action. View "BlueCross BlueShield of Tennessee v. Nicolopoulos" on Justia Law

England v. DENSO International America, Inc.

2025-05-06T08:30:18-08:00

Plaintiffs, current and former employees of DENSO International America, Inc., alleged that the company's 401(k) Plan overpaid for recordkeeping and administrative services, breaching the fiduciary duty of prudence under the Employee Retirement Income Security Act of 1974 (ERISA). They claimed that the Plan's fiduciaries failed to use their significant bargaining power to negotiate lower fees, resulting in excessive costs compared to similar plans. The United States District Court for the Eastern District of Michigan dismissed the plaintiffs' complaint, stating that it failed to provide the necessary "context specific" facts to support an ERISA overpayment-for-recordkeeping-services claim. The court found that the plaintiffs did not sufficiently detail the types and quality of services provided to the Plan compared to those provided to other plans. The United States Court of Appeals for the Sixth Circuit reviewed the case and affirmed the district court's decision. The Sixth Circuit held that the plaintiffs did not plausibly allege a breach of the duty of prudence because they failed to provide specific details about the services received by the Plan and how they compared to those received by the comparator plans. The court emphasized that a meaningful benchmark is necessary to evaluate whether the fees were excessive relative to the services rendered. The court also noted that general allegations about the fungibility of recordkeeping services and the bargaining power of mega plans were insufficient without specific context. The Sixth Circuit concluded that the plaintiffs' complaint did not meet the required pleading standards and affirmed the district court's dismissal of the case. View "England v. DENSO International America, Inc." on Justia Law

Bd. of Trs. of the Bakery Drivers Loc. 550 v. Pension Benefit Guaranty Corporation

2025-04-29T06:30:09-08:00

The case involves the Board of Trustees of a multiemployer pension plan primarily benefitting unionized bakery drivers in New York City, which applied for Special Financial Assistance (SFA) in 2022. The Pension Benefit Guaranty Corporation (PBGC) denied the application, citing the plan's termination in 2016 as a disqualifying factor. The Fund, asserting it was in "critical and declining status," sued under the Administrative Procedure Act (APA). The United States District Court for the Eastern District of New York granted summary judgment in favor of the PBGC, agreeing that the plan's termination made it ineligible for SFA. The court also concluded that a terminated plan could not be restored under ERISA, thus affirming the PBGC's denial of the Fund's application. The United States Court of Appeals for the Second Circuit reviewed the case. The court held that the SFA statute does not exclude plans based solely on a prior termination. The court found that the statute's reference to "critical and declining status" incorporates the definition from 29 U.S.C. § 1085(b)(6) without importing limitations from other sections. Consequently, the court reversed the district court's judgment and remanded the case with instructions to enter summary judgment for the Fund, vacate the PBGC's denial of the SFA application, and remand to the PBGC for reconsideration. View "Bd. of Trs. of the Bakery Drivers Loc. 550 v. Pension Benefit Guaranty Corporation" on Justia Law

In re Marriage of DeBenedetti

2025-04-24T12:30:53-08:00

Christina DeBenedetti and Morgan Ensburg were involved in a marital dissolution case where the trial court assigned four of Morgan’s ERISA-governed retirement accounts to Christina through Qualified Domestic Relations Orders (QDROs). This assignment was to satisfy an award made against Morgan after the court found he breached his fiduciary duty to Christina, resulting in a loss of community property. The total amount ordered for reimbursement and attorney fees exceeded $2 million. The Superior Court of San Diego County initially issued QDROs dividing the community property interests in Morgan’s retirement accounts. After a trial on reserved financial disputes, the court found Morgan had mismanaged community property and awarded Christina $1,831,250 for her share of the lost assets and $230,000 in attorney fees. Christina later sought to enforce this award through new QDROs, which the trial court granted, assigning her 100% of Morgan’s remaining interests in the retirement plans. The Court of Appeal, Fourth Appellate District, Division One, State of California, reviewed the case. Morgan argued that the QDROs did not relate to “marital property rights” and violated ERISA’s purpose of protecting retirement income. He also claimed the QDROs were invalid under California law and that the trial court did not value the retirement accounts. The appellate court rejected Morgan’s contentions, holding that the QDROs related to marital property rights, complied with ERISA, and that California laws cited by Morgan were either preempted by ERISA or did not invalidate the orders. The court also found that Morgan’s argument regarding the valuation of the retirement accounts was not raised in the trial court and could not be considered on appeal. The appellate court affirmed the trial court’s orders. View "In re Marriage of DeBenedetti" on Justia Law

Central States, Southeast and Southwest Areas Pension Fund v. Event Media Inc.

2025-04-24T06:30:18-08:00

Event Media Inc. and Pack Expo Services, LLC, were contributing employers to the Central States, Southeast and Southwest Areas Pension Fund. Both companies withdrew from the Fund and incurred withdrawal liability obligations. The dispute centers on how to calculate these obligations, specifically whether post-2014 contribution rate increases should be included in the calculation. The United States District Court for the Northern District of Illinois, Eastern Division, held that the employers' post-2014 contribution rate increases should be excluded from the calculation of their withdrawal liability payments. The court reasoned that these increases were required by a rehabilitation plan and thus should be disregarded under 29 U.S.C. § 1085(g)(3). The United States Court of Appeals for the Seventh Circuit reviewed the case and affirmed the district court's decision. The appellate court held that the post-2014 contribution rate increases were indeed required by the rehabilitation plan and should be excluded from the calculation of the employers' withdrawal liability payments. The court concluded that neither of the exceptions outlined in 29 U.S.C. § 1085(g)(3)(B) applied in this case, as the increases were not due to increased levels of work, employment, or periods for which compensation is provided, nor were they used to provide an increase in benefits permitted by subsection (f)(1)(B). Therefore, the Fund must use the 2014 contribution rate, not the higher 2019 rate, in calculating the employers' withdrawal liability payments. View "Central States, Southeast and Southwest Areas Pension Fund v. Event Media Inc." on Justia Law

Cunningham v. Cornell University

2025-04-17T07:35:05-08:00

Petitioners, representing a class of current and former Cornell University employees, participated in two defined-contribution retirement plans from 2010 to 2016. They sued Cornell and other plan fiduciaries in 2017, alleging that the plans engaged in prohibited transactions by paying excessive fees for recordkeeping services to Teachers Insurance and Annuity Association of America-College Retirement Equities Fund and Fidelity Investments Inc., in violation of the Employee Retirement Income Security Act of 1974 (ERISA) §1106(a)(1)(C). The District Court dismissed the prohibited-transaction claim, requiring plaintiffs to allege self-dealing or disloyal conduct. The Second Circuit affirmed the dismissal but on different grounds, holding that plaintiffs must plead that the transaction was unnecessary or involved unreasonable compensation, incorporating §1108(b)(2)(A) exemptions into §1106(a) claims. The Supreme Court of the United States reversed and remanded the case. The Court held that to state a claim under §1106(a)(1)(C), a plaintiff need only plausibly allege the elements contained in that provision itself, without addressing potential §1108 exemptions. The Court determined that §1108 sets out affirmative defenses, which must be pleaded and proved by defendants. The Court emphasized that the statutory text and structure do not impose additional pleading requirements for §1106(a)(1) claims and that the burden of proving exemptions rests on the defendants. View "Cunningham v. Cornell University" on Justia Law

Central States Southeast & Southwest Areas Pension v. Laguna Dairy S.de R.L. de C.V.

2025-03-27T09:00:09-08:00

The case involves the Central States, Southeast and Southwest Areas Pension Fund (the "Fund") seeking to collect withdrawal liability payments from several companies (the "Related Employers") that were commonly controlled with Borden Dairy Company of Ohio, LLC and Borden Transport Company of Ohio, LLC (the "Borden Ohio entities"). The Borden Ohio entities had previously withdrawn from the Fund and entered into a settlement agreement with the Fund during an arbitration process, which revised their withdrawal liability payments. The Borden Ohio entities later went bankrupt and ceased making payments, prompting the Fund to seek payment from the Related Employers. The United States District Court for the District of Delaware dismissed the Fund's suit under Federal Rule of Civil Procedure 12(b)(6), ruling that the Multiemployer Pension Plan Amendments Act (MPPAA) does not provide a statutory cause of action to enforce a private settlement agreement. The District Court also concluded that the Fund failed to meet the procedural requirements for notice and demand outlined in 29 U.S.C. § 1399(b)(2). The United States Court of Appeals for the Third Circuit reviewed the case and concluded that the settlement agreement is properly understood as a revision to the withdrawal liability assessment under the MPPAA. Since no employer began an arbitration with respect to the revised assessment, the Fund has a cause of action under 29 U.S.C. § 1401(b)(1). The Court also determined that the Fund met the procedural requirements for notice and demand under 29 U.S.C. § 1399(b)(1). Consequently, the Third Circuit reversed the District Court's order dismissing the Fund's suit and remanded the case for further proceedings. View "Central States Southeast & Southwest Areas Pension v. Laguna Dairy S.de R.L. de C.V." on Justia Law

Cannon v. Blue Cross and Blue Shield of Massachusetts, Inc.

2025-03-19T13:30:04-08:00

Scott Cannon, individually and as the personal representative of the estate of Blaise Cannon, filed a wrongful death and punitive damages claim against Blue Cross and Blue Shield of Massachusetts (BCBS). Cannon alleged that BCBS's denial of coverage for a specific inhaler led to asthma-related complications that contributed to Blaise's death. Blaise was a beneficiary of his partner's BCBS health insurance policy, which was governed by the Employee Retirement Income Security Act of 1974 (ERISA). The United States District Court for the District of Massachusetts granted summary judgment to BCBS on the grounds of ERISA preemption. The court found that Cannon's wrongful death claim was preempted by ERISA because it related to an employee benefit plan and arose from the denial of benefits under that plan. The court also held that the claim conflicted with the remedial scheme established by ERISA, which provides specific civil enforcement mechanisms. The United States Court of Appeals for the First Circuit reviewed the case de novo and affirmed the district court's decision. The appellate court held that Cannon's claim was statutorily preempted under ERISA because it had a connection with the ERISA-regulated health insurance plan. The court also found that the claim was preempted under ERISA's civil enforcement provisions, as it sought remedies for the denial of benefits under the plan. The court rejected Cannon's argument that the Supreme Court's decision in Rutledge v. Pharmaceutical Care Management Association altered the preemption analysis, reaffirming that ERISA preempts state laws that relate to employee benefit plans. The court concluded that Cannon's wrongful death claim was derivative of Blaise's potential claim for benefits, which would have been preempted by ERISA. View "Cannon v. Blue Cross and Blue Shield of Massachusetts, Inc." on Justia Law

Hankins v. Crain Automotive Holdings, LLC

2025-02-28T08:30:21-08:00

Barton Hankins was hired by Crain Automotive Holdings, LLC in 2019 as Chief Operating Officer and was offered a deferred compensation plan (DCP). After four years, Hankins resigned and sought compensation under the DCP, which Crain denied. Hankins then filed a lawsuit under the Employee Income Retirement Security Act of 1974 (ERISA) to claim his benefits. The DCP stipulated that Hankins could earn a percentage of Crain’s fair market value upon his exit, with full vesting at five years. Having served four years, Hankins was entitled to 80% of the benefits. The United States District Court for the Eastern District of Arkansas granted judgment in favor of Hankins, concluding that the DCP did not require the creation of an Employment Agreement or a Confidentiality, Noncompete, and Nonsolicitation Agreement for enforceability. The court found that Crain’s claims of misconduct by Hankins were unsubstantiated and awarded Hankins attorney’s fees, determining that Crain’s conduct was sufficiently culpable. The United States Court of Appeals for the Eighth Circuit reviewed the case. The court affirmed the district court’s judgment, holding that Crain’s interpretation of the DCP was unreasonable. The court found that the DCP’s Article 4, which mentioned the Employment and Confidentiality Agreements, did not create a condition precedent but rather a condition subsequent. The court also upheld the award of attorney’s fees, noting that Crain’s actions lacked merit and were raised only after Hankins sought his vested compensation. The appellate court concluded that the district court did not abuse its discretion in its rulings. View "Hankins v. Crain Automotive Holdings, LLC" on Justia Law

Kramer v. American Electric Power Service Corp. Executive Severance Plan

2025-02-10T13:00:30-08:00

Derek Kramer, the plaintiff, joined American Electric Power Service Corporation (AEP) in 2018 and later participated in the AEP Executive Severance Plan. In 2020, AEP terminated Kramer’s employment due to his executive assistant’s misuse of a company credit card and Kramer’s alleged interference with an investigation into his company-issued cell phone. Kramer applied for severance benefits under the Plan, but AEP denied his claim, citing termination for cause. Kramer appealed the decision, but the Plan’s appeal committee upheld the denial. Kramer then filed an ERISA action in the United States District Court for the Southern District of Ohio, seeking benefits and alleging interference. He also demanded a jury trial. The district court struck his jury demand, limited discovery to procedural claims, and denied his motion to compel the production of documents protected by attorney-client privilege. The court ultimately granted judgment in favor of AEP and the Plan, finding that the denial of benefits was not arbitrary and capricious. The United States Court of Appeals for the Sixth Circuit reviewed the case. The court affirmed the district court’s rulings, holding that the Plan was a top-hat plan exempt from ERISA’s fiduciary requirements, thus the fiduciary exception to attorney-client privilege did not apply. The court also upheld the district court’s decision to strike Kramer’s jury demand, citing precedent that ERISA denial-of-benefits claims are equitable in nature and not subject to jury trials. Finally, the court found that the district court correctly applied the arbitrary-and-capricious standard in reviewing the denial of benefits and that the decision was supported by substantial evidence. The Sixth Circuit affirmed the district court’s judgment in favor of AEP and the Plan. View "Kramer v. American Electric Power Service Corp. Executive Severance Plan" on Justia Law

Smith v. Cox Enterprises, Inc. Welfare Benefits Plan

2025-02-04T11:30:34-08:00

Jeremy Smith, a customer care technician for Cox Enterprises, Inc., received long-term disability benefits for seven years due to severe back pain and multiple surgeries. In 2019, Aetna, the plan administrator, terminated his benefits, concluding he could work under certain conditions. Smith appealed, providing additional medical evidence, including a consultative examination from Dr. Harris, which supported his disability claim. Aetna upheld the termination, leading Smith to file a lawsuit under the Employee Retirement Income Security Act (ERISA). The United States District Court for the Eastern District of Virginia granted summary judgment in favor of Cox Enterprises, Inc. Welfare Benefits Plan. The court found that Aetna's decision was supported by substantial evidence and that it was reasonable for Aetna to discount the opinions of Smith's primary care physician and the Social Security Administration's disability determination. The United States Court of Appeals for the Fourth Circuit reviewed the case. The court held that Aetna abused its discretion by failing to adequately discuss and consider conflicting evidence, particularly Dr. Harris's consultative examination and the Social Security Administration's disability determination. The court found that Aetna did not engage in a deliberate and principled reasoning process, as required by ERISA regulations. Consequently, the Fourth Circuit reversed the district court's decision and remanded the case for further proceedings, instructing the district court to remand the matter to Aetna for reconsideration of Smith's claim. View "Smith v. Cox Enterprises, Inc. Welfare Benefits Plan" on Justia Law

Estate of Gifford v Operating Engineers 139 Health Benefit Fund

2025-01-13T11:30:15-08:00

Michael Gifford, a beneficiary of the Operating Engineers 139 Health Benefit Fund, sought reimbursement for out-of-network medical expenses incurred during his treatment for a stroke and subsequent brain aneurysm surgery. The Fund denied the claim, stating the services were not provided in an emergency and were not medically necessary. Gifford's wife, Suzanne, appealed the decision, but the Fund upheld the denial after consulting two independent medical reviewers who concluded the surgery was not an emergency and not medically necessary. The United States District Court for the Eastern District of Wisconsin granted the Fund's motion for summary judgment, agreeing that the Fund's decision was not arbitrary and capricious. The court also granted the Fund's motion for a protective order, limiting discovery to the administrative record. The Estate of Michael Gifford, represented by Suzanne, appealed the decision, arguing that the Fund failed to conduct a full and fair review by not considering a surgical note from Dr. Ahuja, which was not included in the administrative record. The United States Court of Appeals for the Seventh Circuit affirmed the district court's decision. The appellate court held that the Fund's denial of benefits was not arbitrary and capricious, as the Fund reasonably relied on the independent medical reviewers' reports and the administrative record. The court also found that the Fund was not required to seek out additional information not provided by the claimant. Additionally, the court upheld the district court's grant of the protective order, finding no abuse of discretion in limiting discovery to the administrative record. The court concluded that the Fund provided a full and fair review of the claim, and the denial of benefits was reasonable. View "Estate of Gifford v Operating Engineers 139 Health Benefit Fund" on Justia Law

Lubin v. Starbucks Corporation

2024-12-16T06:00:43-08:00

Ariel Torres, a former Starbucks employee, and Raphyr Lubin, the husband of another former Starbucks employee, filed a putative class action against Starbucks. They alleged that Starbucks sent them deficient health-insurance notices under the Employee Retirement Income Security Act (ERISA), as amended by the Consolidated Omnibus Budget Reconciliation Act (COBRA). Starbucks moved to compel arbitration based on employment agreements signed by Torres and Lubin’s wife. Torres agreed to arbitration, but Lubin opposed it, arguing he was not a party to his wife’s employment agreement. The United States District Court for the Middle District of Florida denied Starbucks’s motion to compel arbitration for Lubin. The court found that Lubin was not a party to his wife’s employment agreement and was not suing to enforce it. Instead, Lubin sought to enforce his own statutory right to an adequate COBRA notice. The court held that no equitable doctrine of Florida contract law required Lubin to arbitrate and that Starbucks waived its argument that Lubin’s rights were derivative of his wife’s rights. The United States Court of Appeals for the Eleventh Circuit reviewed the case and affirmed the district court’s decision. The court held that Lubin, not being a party to the arbitration agreement, could not be compelled to arbitrate. The court also found that the arbitration agreement’s delegation clause did not apply to Lubin, as he was not a party to the agreement. Additionally, the court rejected Starbucks’s arguments based on equitable estoppel, third-party beneficiary doctrine, and the derivative claim theory, concluding that none of these principles required Lubin to arbitrate his claim. The court affirmed the district court’s order denying Starbucks’s motion to compel arbitration. View "Lubin v. Starbucks Corporation" on Justia Law

Singh v. Deloitte LLP

2024-12-10T07:30:07-08:00

Participants in Deloitte LLP’s 401(k) retirement plan filed a class action lawsuit against the plan fiduciaries, alleging that they breached their fiduciary duty under the Employee Retirement Income Security Act (ERISA) by allowing excessive administrative and recordkeeping fees. The plaintiffs claimed that the fees were higher than those of comparable plans and that the fiduciaries failed to obtain lower fees. The United States District Court for the Southern District of New York dismissed the action, finding that the plaintiffs did not plausibly allege that the fees were excessive relative to the services provided. The court also denied the plaintiffs' motion to file an amended complaint, deeming it futile as the proposed amendments did not cure the deficiencies in the original complaint. The United States Court of Appeals for the Second Circuit reviewed the case and affirmed the district court's decision. The appellate court agreed that the plaintiffs failed to provide sufficient factual allegations to support a plausible inference that the defendants breached their duty of prudence. The court noted that the plaintiffs did not adequately compare the services provided by the plan to those of the comparator plans, nor did they provide context to show that the fees were excessive. The court also upheld the dismissal of the derivative claim for failure to monitor, as it was dependent on the primary claim of breach of fiduciary duty. View "Singh v. Deloitte LLP" on Justia Law

Johnson v. Parker-Hannifin Corp.

2024-11-20T12:00:57-08:00

Five current and former employees of Parker-Hannifin Corporation, representing a class of participants in the Parker Retirement Savings Plan, filed a lawsuit against Parker-Hannifin Corporation and related entities. They alleged that Parker-Hannifin violated the Employee Retirement Income Security Act of 1974 (ERISA) by imprudently retaining the Northern Trust Focus Funds, providing higher-cost shares, and failing to monitor its agents in their fiduciary duties. The United States District Court for the Northern District of Ohio dismissed the plaintiffs' claims. The court found that the plaintiffs did not state a viable claim of breach of fiduciary duty because they failed to identify meaningful benchmarks for comparison, and their evidence of high turnover rates and limited performance history was insufficient. The court also found the plaintiffs' allegations regarding higher-cost shares to be speculative and conclusory. Consequently, the court dismissed the failure-to-monitor claim as it was contingent on the success of the other claims. The United States Court of Appeals for the Sixth Circuit reviewed the case and reversed the district court's judgment. The appellate court held that the plaintiffs sufficiently pleaded facts to state a claim for imprudent retention of the Focus Funds, noting that the funds' high turnover rates and underperformance could indicate a flawed decision-making process. The court also found that the plaintiffs plausibly alleged that Parker-Hannifin failed to negotiate for lower-cost shares, which could constitute a breach of the duty of prudence. The court remanded the case for further proceedings consistent with its opinion. View "Johnson v. Parker-Hannifin Corp." on Justia Law

Romano v. John Hancock Life Insurance Company (USA)

2024-10-30T12:31:02-08:00

Eric and Todd Romano, trustees of the Romano Law, PL 401(k) Plan, filed a class action against John Hancock Life Insurance Company. They claimed that John Hancock breached its fiduciary duties under the Employee Retirement Income Security Act of 1974 (ERISA) by not passing through the value of foreign tax credits received from mutual funds to the defined-contribution plans. The Romanos argued that John Hancock should have used these credits to reduce the administrative fees charged to the plans. The United States District Court for the Southern District of Florida granted summary judgment in favor of John Hancock, concluding that John Hancock was not an ERISA fiduciary regarding the foreign tax credits and did not breach any fiduciary duties. The court also ruled that the Romanos and the class lacked Article III standing because they failed to establish loss causation. The United States Court of Appeals for the Eleventh Circuit reviewed the case and affirmed the district court's decision. The appellate court held that John Hancock was not an ERISA fiduciary concerning the foreign tax credits because these credits were not plan assets. The court explained that the foreign tax credits were a result of John Hancock's ownership of mutual fund shares and were not held in trust for the benefit of the plans. Additionally, the court found that John Hancock did not have discretionary authority over the management or administration of the separate accounts that would make it a fiduciary under ERISA. Consequently, the Romanos' claims for breach of fiduciary duty and engaging in prohibited transactions failed as a matter of law. View "Romano v. John Hancock Life Insurance Company (USA)" on Justia Law

In re: Gilbert

2024-10-24T09:00:10-08:00

Eric Gilbert filed for Chapter 7 bankruptcy, listing his interest in retirement accounts worth approximately $1.7 million. The issue was whether these accounts could be accessed by creditors due to alleged violations of federal law governing retirement plans. The Bankruptcy Court ruled that the accounts were protected from creditors, and the District Court affirmed this decision. The Bankruptcy Court dismissed the trustee John McDonnell's complaint, which sought to include the retirement accounts in the bankruptcy estate, arguing that the accounts violated ERISA and the IRC. The court found that the accounts were excluded from the estate under § 541(c)(2) of the Bankruptcy Code, which protects interests in trusts with enforceable anti-alienation provisions under applicable nonbankruptcy law. The District Court upheld this ruling, agreeing that ERISA's anti-alienation provision applied regardless of the alleged violations. The United States Court of Appeals for the Third Circuit reviewed the case and affirmed the lower courts' decisions. The court held that the retirement accounts were excluded from the bankruptcy estate under § 541(c)(2) because ERISA's anti-alienation provision was enforceable, even if the accounts did not comply with ERISA and the IRC. The court also dismissed McDonnell's claims regarding preferential transfers and fraudulent conveyances, as the transactions in question did not involve Gilbert parting with his property. Additionally, the court found no abuse of discretion in the Bankruptcy Court's decisions to dismiss the complaint with prejudice, shorten the time for briefing, and strike certain items from the appellate record. View "In re: Gilbert" on Justia Law

M.S. v. Premera Blue Cross

2024-10-01T14:00:35-08:00

Plaintiffs M.S. and L.S. sought insurance coverage for mental health treatments for their child, C.S., under a health benefits plan provided by M.S.'s employer, Microsoft Corporation. The plan, administered by Premera Blue Cross, is subject to ERISA and the Parity Act. Premera denied the claim, stating the treatment was not medically necessary. Plaintiffs pursued internal and external appeals, which upheld the denial. Plaintiffs then sued in federal district court, alleging improper denial of benefits under ERISA, failure to produce documents in violation of ERISA’s disclosure requirements, and a Parity Act violation for applying disparate treatment limitations to mental health claims. The United States District Court for the District of Utah granted summary judgment to Defendants on the denial-of-benefits claim but ruled in favor of Plaintiffs on the Parity Act and ERISA disclosure claims. The court found that Defendants violated the Parity Act by using additional criteria for mental health claims and failed to disclose certain documents required under ERISA. The court awarded statutory penalties and attorneys’ fees to Plaintiffs. The United States Court of Appeals for the Tenth Circuit reviewed the case. The court vacated the district court’s grant of summary judgment on the Parity Act claim, finding that Plaintiffs lacked standing to bring the claim. The court reversed the district court’s ruling that Defendants violated ERISA by not disclosing the Skilled Nursing InterQual Criteria but affirmed the ruling regarding the failure to disclose the Administrative Services Agreement (ASA). The court upheld the statutory penalty for the ASA disclosure violation and affirmed the award of attorneys’ fees and costs to Plaintiffs. View "M.S. v. Premera Blue Cross" on Justia Law

Shopmen’s Local No 499, Bd of Trustees v. Art Iron, Inc.

2024-09-26T11:00:15-08:00

Art Iron, Inc. faced a lawsuit from the Board of Trustees of the Shopmen’s Local 499 Pension Plan seeking over one million dollars in withdrawal liability under ERISA. The key issue was whether Robert Schlatter, Art Iron’s sole shareholder, and his wife, Mary Schlatter, were personally liable for this withdrawal liability due to their operation of businesses allegedly under common control with Art Iron. The United States District Court for the Northern District of Ohio granted summary judgment in favor of the Board, finding both Robert and Mary Schlatter personally liable. The court determined that Robert’s consulting business and Mary’s jewelry-making activities were trades or businesses under common control with Art Iron, thus making them jointly and severally liable for the withdrawal liability. The United States Court of Appeals for the Sixth Circuit reviewed the case. The court affirmed the district court’s judgment regarding Robert Schlatter, agreeing that his consulting business was a trade or business under common control with Art Iron. The court applied the Groetzinger test, which considers whether the activity is continuous and regular and primarily for income or profit, and found that Robert’s consulting business met these criteria. However, the court reversed the district court’s judgment regarding Mary Schlatter. It found that her jewelry-making activities did not constitute a trade or business under the Groetzinger test, as her activities lacked the necessary continuity and regularity in 2017, the year of Art Iron’s withdrawal from the Plan. Consequently, Mary Schlatter was not personally liable for the withdrawal liability. The Sixth Circuit thus affirmed the district court’s judgment as to Robert Schlatter and reversed and remanded the judgment as to Mary Schlatter. View "Shopmen’s Local No 499, Bd of Trustees v. Art Iron, Inc." on Justia Law

Knudsen v. MetLife Group Inc

2024-09-25T09:00:16-08:00

Plaintiffs Marla Knudsen and William Dutra, representing a class of similarly situated individuals, filed a class action lawsuit under the Employee Retirement Income Security Act (ERISA) against MetLife Group, Inc. They alleged that MetLife, as the administrator and fiduciary of the MetLife Options & Choices Plan, misappropriated $65 million in drug rebates from 2016 to 2021. Plaintiffs claimed this misappropriation led to higher out-of-pocket costs for Plan participants, including increased insurance premiums. The United States District Court for the District of New Jersey dismissed the case for lack of standing. The court concluded that the plaintiffs did not demonstrate a concrete and individualized injury. It reasoned that the plaintiffs had no legal right to the general pool of Plan assets and had not shown that they did not receive their promised benefits. The court found the plaintiffs' claims that they paid excessive out-of-pocket costs to be speculative and lacking factual support. The United States Court of Appeals for the Third Circuit affirmed the District Court's dismissal. The Third Circuit held that the plaintiffs failed to establish an injury-in-fact, as their allegations of increased out-of-pocket costs were speculative and not supported by concrete facts. The court noted that the plaintiffs did not provide specific allegations showing how the misappropriated drug rebates directly caused their increased costs. The court emphasized that financial harm must be actual or imminent, not conjectural or hypothetical, to satisfy Article III standing requirements. Consequently, the plaintiffs lacked standing to pursue their ERISA claims. View "Knudsen v. MetLife Group Inc" on Justia Law

Dwyer v. United Healthcare

2024-09-19T09:30:45-08:00

Kelly Dwyer sought to recover mental health benefits for his minor daughter, E.D., under his employee group benefit health plan issued by United Healthcare Insurance Company. E.D. suffered from severe anorexia nervosa, leading her parents to admit her to a residential treatment facility, Avalon Hills. Initially, United approved full hospitalization benefits, but later reduced the coverage to partial hospitalization and eventually denied further hospitalization benefits, suggesting outpatient treatment instead. Despite E.D.'s doctors' objections and evidence of her ongoing severe symptoms, United maintained its decision. The United States District Court for the Western District of Texas conducted a bench trial and ruled in favor of United, finding that the insurer had not improperly withheld benefits. The court's decision was based on the administrative record and the arguments presented during the trial. The United States Court of Appeals for the Fifth Circuit reviewed the case and reversed the district court's judgment. The appellate court found that United's denial of benefits was both substantively and procedurally deficient. Substantively, the court held that United's decision was not supported by concrete evidence and contradicted the medical records. Procedurally, United failed to provide a meaningful dialogue or adequate explanation for its denial, violating ERISA requirements. Additionally, the court found that United improperly failed to process claims at the MultiPlan rate, as it did not respond to Mr. Dwyer's administrative appeal regarding this issue. The Fifth Circuit reversed the district court's judgment and remanded the case for the calculation of damages, statutory penalties, attorneys' fees, and other relief for Mr. Dwyer. View "Dwyer v. United Healthcare" on Justia Law

Barrett v. O'Reilly Automotive, Inc.

2024-08-29T07:30:39-08:00

Erica Barrett and other employees of O’Reilly Automotive, Inc. alleged that the company’s 401(k) plan managers breached their fiduciary duty by imposing high recordkeeping expenses and inflated expense ratios on the plan, resulting in less money for the participants. They claimed that these high costs were due to either incompetence or laziness on the part of the plan managers. The United States District Court for the Western District of Missouri dismissed the complaint. The court found that the plaintiffs failed to provide meaningful benchmarks to support their claim that the plan’s fees were excessive. Specifically, the court noted that the plaintiffs did not adequately compare the costs of O’Reilly’s plan with those of similar plans offering the same services. The United States Court of Appeals for the Eighth Circuit reviewed the dismissal de novo. The court affirmed the district court’s decision, agreeing that the plaintiffs did not provide meaningful benchmarks to show that the plan’s fees were excessive. The court emphasized that the plaintiffs’ comparisons were flawed because they did not account for the different services included in the fees of the comparator plans. Additionally, the court found that aggregate data from the Investment Company Institute was insufficient to establish a plausible claim of mismanagement. The court also dismissed the failure-to-monitor claim against O’Reilly and its board of directors, as it was derivative of the primary claim. Finally, the court held that the district court did not abuse its discretion in dismissing the complaint with prejudice, as the plaintiffs did not formally request leave to amend their complaint. View "Barrett v. O'Reilly Automotive, Inc." on Justia Law

Moyer v. GEICO

2024-08-26T13:30:16-08:00

James Moyer and other captive insurance agents sued GEICO, claiming they were misclassified as independent contractors and denied benefits under the Employee Retirement Income Security Act of 1974 (ERISA). They argued that GEICO should have classified them as employees, making them eligible for various benefits plans. The agents did not attach the relevant benefits-plan documents to their complaint, which are integral to their claims. The United States District Court for the Southern District of Ohio ordered the parties to provide the relevant plan documents. GEICO submitted documents it claimed governed the dispute, but the agents argued that the court could not rely on these documents without converting the motion to dismiss into a summary judgment motion and requested additional discovery. The district court disagreed, relied on the documents provided by GEICO, and dismissed the complaint, finding that the agents lacked statutory standing as they were not eligible for the benefits under the plan documents. The United States Court of Appeals for the Sixth Circuit reviewed the case and found that there were legitimate questions about whether GEICO had provided a complete set of the relevant plan documents. The court noted issues with the authenticity and completeness of the documents, including redlines, handwritten notes, and missing pages. The court held that the district court should not have relied on these documents to dismiss the complaint without allowing the agents to conduct discovery. Consequently, the Sixth Circuit reversed the district court's decision and remanded the case for further proceedings. View "Moyer v. GEICO" on Justia Law

Kellum v. Gilster-Mary Lee Corporation Group Health Benefit

2024-08-26T07:30:21-08:00

Mychal Byrd was injured in an automobile accident caused by an unknown motorist and subsequently died from his injuries. Byrd's medical expenses, totaling $474,218.24, were covered by the Gilster-Mary Lee Corporation Group Health Benefit Plan, a self-funded plan subject to ERISA. Byrd had an automobile insurance policy with Nationwide Insurance Company, which provided $50,000 in uninsured-motorist coverage. After Byrd's death, his family sued Nationwide in state court to collect the insurance proceeds. The Plan intervened, removed the case to federal court, and claimed an equitable right to the insurance proceeds. The United States District Court for the Eastern District of Missouri granted summary judgment in favor of the Plan, determining that the Plan was entitled to the insurance proceeds under the plan document. The plaintiffs, initially proceeding pro se, did not respond to the motion for summary judgment. After obtaining counsel, they moved for reconsideration, which the district court denied. The plaintiffs then appealed the decision. The United States Court of Appeals for the Eighth Circuit reviewed the case and concluded that the district court lacked subject-matter jurisdiction. The appellate court determined that the plaintiffs' claim did not fall within the scope of ERISA's civil enforcement provisions because the plaintiffs were neither plan participants nor beneficiaries. Consequently, the claim was not completely preempted by ERISA, and the federal court did not have jurisdiction. The Eighth Circuit vacated the district court's judgment and remanded the case with instructions to return it to Missouri state court. View "Kellum v. Gilster-Mary Lee Corporation Group Health Benefit" on Justia Law

Carnes v. HMO Louisiana, Inc.

2024-08-20T14:00:18-08:00

Paul Carnes, an employee of Consolidated Grain and Barge Co., was diagnosed with degenerative disc disease in 2019 and received medical treatment for it. HMO Louisiana, Inc., the administrator of Consolidated Grain’s employer-sponsored health plan governed by ERISA, paid for some of Carnes’s treatments but not all. Carnes filed a workers’ compensation claim against his employer, which was settled without the employer accepting responsibility for his medical claims. With an outstanding medical balance of around $190,000, Carnes sued HMO Louisiana, alleging it violated Illinois state insurance law by not paying his medical bills and sought penalties for its alleged "vexatious and unreasonable" conduct. The United States District Court for the Central District of Illinois dismissed Carnes’s complaint on the grounds that his state law insurance claim was preempted by ERISA. The court allowed Carnes to amend his complaint to plead an ERISA claim, but instead, Carnes moved to reconsider the dismissal. The district court denied his motion and ordered the case closed. Carnes then appealed the final order. The United States Court of Appeals for the Seventh Circuit reviewed the case de novo. The court affirmed the district court’s decision, agreeing that Carnes’s state law claim was preempted by ERISA. The court noted that ERISA’s broad preemption clause supersedes any state laws relating to employee benefit plans, and Carnes’s claim fell within this scope. The court also found that ERISA’s saving clause did not apply because the health plan in question was self-funded, making it exempt from state regulation. The court concluded that Carnes’s attempt to frame his suit as a "coordination of benefits dispute" was an impermissible effort to avoid ERISA preemption. Consequently, the court affirmed the dismissal of Carnes’s case. View "Carnes v. HMO Louisiana, Inc." on Justia Law

Parker v. Tenneco, Inc.

2024-08-20T11:00:18-08:00

Two employees, Tanika Parker and Andrew Farrier, participated in 401(k) plans managed by subsidiaries of Tenneco Inc. The plans were amended to include mandatory individual arbitration provisions, which required participants to arbitrate disputes individually and barred representative, class, or collective actions. Parker and Farrier alleged that the fiduciaries of their plans breached their fiduciary duties under ERISA by failing to prudently manage the plans, resulting in higher costs and reduced retirement savings. They sought plan-wide remedies, including restitution of losses and disgorgement of profits. The United States District Court for the Eastern District of Michigan denied the fiduciaries' motion to compel individual arbitration. The court found that the arbitration provisions limited participants' substantive rights under ERISA by eliminating their ability to bring representative actions and seek plan-wide remedies, which are guaranteed by ERISA. The United States Court of Appeals for the Sixth Circuit reviewed the case and affirmed the district court's decision. The Sixth Circuit held that the individual arbitration provisions were unenforceable because they acted as a prospective waiver of the participants' statutory rights and remedies under ERISA. The court emphasized that ERISA allows participants to sue on behalf of a plan and obtain plan-wide relief, and the arbitration provisions' restrictions on representative actions and plan-wide remedies violated these statutory rights. Consequently, the arbitration provisions were invalid, and the district court's judgment was affirmed. View "Parker v. Tenneco, Inc." on Justia Law

Standard Insurance Co. v. Guy

2024-08-19T11:30:18-08:00

Joel M. Guy, Jr. murdered his parents in 2016 with the intent to collect the proceeds from his mother’s insurance plans. His mother had life insurance and accidental death and dismemberment insurance through her employer, naming Guy and his father as beneficiaries. Guy was convicted of first-degree premeditated murder, felony murder, and abuse of a corpse by a Tennessee jury. The United States District Court for the Eastern District of Tennessee determined that Guy would be entitled to the insurance proceeds if not disqualified. However, the court ruled that Guy was disqualified under Tennessee’s slayer statute or federal common law, which prevents a murderer from benefiting from their crime. The court granted summary judgment in favor of Guy’s family members, who argued that Guy was not entitled to the benefits. Guy appealed, arguing that ERISA preempts Tennessee’s slayer statute and that no federal common-law slayer rule applies. The United States Court of Appeals for the Sixth Circuit reviewed the case de novo. The court held that ERISA does not explicitly address the issue of a beneficiary who murders the insured, and thus, either Tennessee law or federal common law must apply. The court found that both Tennessee’s slayer statute and federal common law would disqualify Guy from receiving the insurance proceeds. The court affirmed the district court’s decision, concluding that Guy’s actions disqualified him from benefiting from his mother’s insurance plans under both state and federal law. View "Standard Insurance Co. v. Guy" on Justia Law

Trustees of Iron Workers Defined Contribution Pension Fund v. Next Century Rebar, LLC

2024-08-15T11:30:20-08:00

Next Century Rebar, LLC (NCR) worked on a project in Detroit, Michigan, within the jurisdiction of Local Union Number 25 (Local 25). Due to a shortage of Local 25 iron workers, NCR hired workers from out-of-state unions, Local 416 and Local 846. NCR made benefits contributions to the funds associated with these out-of-state unions. In 2021, Local 25 Funds conducted an audit and found that NCR had not made contributions to the Local 25 Funds for these out-of-state employees. NCR contested this, arguing that it had already made contributions to the out-of-state funds. The Local 25 Funds filed a lawsuit under 29 U.S.C. § 1145, seeking unpaid contributions. The United States District Court for the Eastern District of Michigan granted summary judgment in favor of the Local 25 Funds, awarding them $1,787,300.75 in unpaid contributions, $143,075.41 in interest, and $288,598.80 in liquidated damages. The court also awarded $18,233.15 in costs and $99,812.25 in attorney fees. NCR appealed, arguing that the district court applied the wrong summary-judgment standard, improperly granted summary judgment despite genuine disputes of material fact, and abused its discretion by not awarding a setoff for contributions made to out-of-state funds. The United States Court of Appeals for the Sixth Circuit reviewed the case. The court found that the Local 25 CBA required contributions based on the specific employee’s gross earnings for the vacation fund and base wages for the pension fund. However, it was unclear whether the audit used the correct wage rates. The court also found that the Local 25 Funds' request for contributions violated the International Agreement’s prohibition on double payments. Consequently, the court affirmed the district court’s decision in part, reversed it in part, and remanded the case for further proceedings. View "Trustees of Iron Workers Defined Contribution Pension Fund v. Next Century Rebar, LLC" on Justia Law

Pessin v. JPMorgan Chase

2024-08-13T06:30:07-08:00

Plaintiff Joseph Pessin, representing himself and others similarly situated, sued JPMorgan Chase & Company (JPMC), the JPMorgan Chase Retirement Plan, and its fiduciaries under the Employee Retirement Income Security Act of 1974 (ERISA). Pessin alleged that the Defendants failed to provide adequate disclosures to pension plan participants after converting the retirement plan from a traditional defined benefit plan to a cash balance plan. Specifically, Pessin claimed that the Defendants did not properly inform participants about the "wear-away" effect, which could freeze their benefits until the cash balance exceeded the previously accrued benefits. The United States District Court for the Southern District of New York dismissed Pessin’s amended complaint for failure to state a claim. The court found that the Defendants had provided sufficient disclosures explaining the retirement plan's workings and did not mislead participants about the conversion's impact on their accrued benefits. The court concluded that the summary plan descriptions (SPDs) and benefit statements were adequate and that the Defendants did not breach their fiduciary duties under ERISA. The United States Court of Appeals for the Second Circuit reviewed the case. The court agreed with the district court that the Defendants sufficiently disclosed the wear-away effect and that the SPDs clearly explained how benefits would be calculated. However, the appellate court disagreed with the district court's finding that the Defendants complied with ERISA § 105(a) regarding annual pension benefit statements. The court held that the benefit statements did not properly indicate the total benefits accrued, as they only included the cash balance amount and not the higher minimum benefit from the prior plan. Consequently, the court found that Pessin adequately alleged a breach of fiduciary duty by the JPMC Board for failing to monitor the JPMC Benefits Executive's performance regarding the benefit statements. The Second Circuit affirmed the district court's decision in part, reversed it in part, and remanded the case for further proceedings consistent with its opinion. View "Pessin v. JPMorgan Chase" on Justia Law

Midthun-Hensen v. Group Health Cooperative of South Central, Inc.,

2024-08-05T10:00:18-08:00

Angela Midthun-Hensen and Tony Hensen sought insurance coverage for therapies for their daughter K.H.'s autism from Group Health Cooperative between 2017 and 2019. The insurer denied coverage, citing a lack of evidence supporting the effectiveness of speech therapy for a child K.H.'s age and sensory-integration therapy for autism at any age. The family's employer-sponsored plan only covered "evidence-based" treatments. After several medical reviews and appeals upheld the insurer's decision, the parents sued, alleging violations of the Employee Retirement Income Security Act (ERISA) and state law regarding autism coverage. The United States District Court for the Western District of Wisconsin ruled in favor of the insurer, finding no violations of state law or ERISA. The plaintiffs then focused on their claim that the insurer's actions violated the Mental Health Parity and Addiction Equity Act (MHPAEA), which mandates equal treatment limitations for mental and physical health benefits. They argued that the insurer applied the "evidence-based" requirement more stringently to autism therapies than to chiropractic care, which they claimed lacked scientific support. The United States Court of Appeals for the Seventh Circuit reviewed the case and affirmed the district court's decision. The appellate court found that the insurer's reliance on medical literature, which varied in its recommendations based on patient age, was permissible under the Parity Act. The court also noted that the plaintiffs failed to demonstrate that the insurer's treatment limitations for mental health benefits were more restrictive than those applied to "substantially all" medical and surgical benefits, as required by the statute. The court concluded that the plaintiffs' focus on a single medical benefit was insufficient to prove a violation of the Parity Act. View "Midthun-Hensen v. Group Health Cooperative of South Central, Inc.," on Justia Law

Pizarro v. The Home Depot, Inc.

2024-08-02T13:00:49-08:00

The case involves a class of current and former Home Depot employees who alleged that Home Depot failed to prudently manage its 401(k) retirement plan, resulting in excessive fees and subpar returns. The plaintiffs argued that Home Depot did not adequately monitor the fees charged by the plan’s financial advisor and failed to prudently evaluate four specific investment options, leading to financial losses for the plan participants. The United States District Court for the Northern District of Georgia found that there were genuine disputes of material fact regarding whether Home Depot had complied with its duty of prudence in monitoring plan fees and three of the four challenged funds. However, the court concluded that the plaintiffs had not met their burden of proving loss causation for any of their claims. The court also found no genuine dispute regarding the prudence of Home Depot’s monitoring process for the Stephens Fund and ruled that the plaintiffs had forfeited their requests for equitable relief by not arguing them at the summary judgment stage. The United States Court of Appeals for the Eleventh Circuit affirmed the district court’s decision. The court held that the plaintiffs bear the burden of proving loss causation in ERISA breach-of-fiduciary-duty claims. The court found that the plaintiffs failed to show that the fees charged by the financial advisors were objectively imprudent, given the size and complexity of Home Depot’s plan. The court also determined that the plaintiffs did not provide sufficient evidence to prove that the four challenged funds were objectively imprudent investments. Additionally, the court agreed with the district court that the plaintiffs had forfeited their claims for equitable relief by not raising them at the summary judgment stage. Therefore, the court affirmed the district court’s grant of summary judgment in favor of Home Depot. View "Pizarro v. The Home Depot, Inc." on Justia Law

Mullins v. Consol Energy Inc Long Term Disability Plan

2024-07-29T13:00:09-08:00

Timothy Mullins, a coal miner, suffered an ankle stress fracture in 2015 while working as a Section Supervisor at a coal mine owned by CONSOL Energy, Inc. He initially received long-term disability benefits under CONSOL's ERISA-governed Long-Term Disability Plan, administered by Lincoln Financial Group. However, his benefits were terminated in 2020 after Lincoln determined, based on medical evaluations and a vocational assessment, that Mullins did not demonstrate "total disability" as required under the Plan. Lincoln's decision was based on a vocational report that incorrectly listed Mullins's job as "Mine Superintendent" rather than Section Supervisor. The United States District Court for the Western District of Pennsylvania upheld Lincoln's decision to terminate Mullins's benefits, granting summary judgment in favor of the Plan. The District Court found that Lincoln's decision was supported by substantial medical and vocational evidence and was not arbitrary and capricious. Mullins appealed the decision, arguing that Lincoln's reliance on the incorrect job title in the vocational report led to an erroneous termination of his benefits. The United States Court of Appeals for the Third Circuit reviewed the case and found that Lincoln's reliance on the incorrect vocational report was arbitrary and capricious. The court noted that the error in the job title led to an incorrect assessment of Mullins's qualifications and experience, which in turn resulted in the wrongful termination of his benefits. The Third Circuit vacated the District Court's judgment and remanded the case for reinstatement of Mullins's long-term disability benefits. The court also instructed the District Court to consider Mullins's claim regarding the improper offset of benefits due to Social Security disability benefits. View "Mullins v. Consol Energy Inc Long Term Disability Plan" on Justia Law