text: ERISA - Justia Case Law Summaries http://law.justia.com/summaryfeed/erisa/ 2016-02-10T09:47:34-08:00 Justia Inc http://www.justia.com/ Justia Law https://justatic.com/v/20151127a/shared/images/social-media/law.png Copyright 2014 Justia Inc http://law.justia.com/cases/federal/appellate-courts/ca6/15-3434/15-3434-2016-02-04.html United Food & Commercial Workers v. Rubber Assocs., Inc. 2016-02-04T09:30:52-08:00 2016-02-04T12:26:03-08:00 During negotiations, Rubber Associates proposed to the Union that it decrease its contribution rate to the United Food and Commercial Workers Union Employer Pension Fund (governed by the Employee Retirement Income Security Act (ERISA), 29 U.S.C. 1001) from 62 cents per hour to 30 cents per hour. The Fund's actuary opined that collecting withdrawal liability would result in a better funding status for the Fund than accepting reduced contributions. Rubber Associates agreed to maintain its previous contribution rate. Negotiations resumed without success. The Union authorized a strike, which lasted for 17 months. After the Union unilaterally disclaimed interest in representing its employees, Rubber Associates was deemed to have withdrawn from the Fund, pursuant to the Multiemployer Pension Protection Amendments Act (MPPAA). The Fund calculated Rubber Associates' withdrawal liability obligation at $1,713,169, which the arbitrator awarded in full. The Fund sued to enforce the award. Rubber Associates counterclaimed that, because withdrawal from the Fund was union-mandated, its liability should be calculated by an alternate method, making its liability only $312,000. The Sixth Circuit affirmed dismissal of the counterclaim, declining to recognize a claim under the federal common law of ERISA for equitable relief in the case of union-mandated withdrawals. View "United Food & Commercial Workers v. Rubber Assocs., Inc." on Justia Law 2016-02-04 federal U.S. Court of Appeals for the Sixth Circuit Gibbons 15-3434 http://law.justia.com/cases/federal/appellate-courts/ca8/14-3589/14-3589-2016-01-29.html Ingram v. Terminal Railroad Ass'n 2016-01-29T08:31:14-08:00 2016-01-29T17:10:48-08:00 Plaintiff filed suit under section 502(a)(1)(B) of the Employee Retirement Income Security Act (ERISA), 29 U.S.C. 1132(a)(1)(B), alleging that the Plan erroneously determined his pension benefits. The district court granted summary judgment to the Plan. The court concluded that none of the conflicts of interest and procedural irregularities alleged by plaintiff "caused a serious breach of the plan administrator's fiduciary duty" which warranted departure from the abuse-of-discretion standard of review. In this case, the district court correctly reviewed the decision of the Plan administrator for an abuse of discretion; substantial evidence supports the Plan administrator's decision to exclude a 2006 sign-on bonus from pension-qualifying earnings and there was no abuse of discretion; and the Plan administrator's interpretation of offsets for retirement benefits was reasonable because it was not inconsistent with Plan language, was consistent with Plan goals and ERISA, and rationally construed the offset so that the Normal Retirement Benefit under the Plan does not vary because of the form of payment chosen under another plan. Accordingly, the court affirmed the judgment. View "Ingram v. Terminal Railroad Ass'n" on Justia Law 2016-01-29 federal U.S. Court of Appeals for the Eighth Circuit James B. Loken 14-3589 http://law.justia.com/cases/federal/us/577/15-278/ Amgen Inc. v. Harris 2016-01-25T08:30:27-08:00 2016-01-25T09:39:11-08:00 The stockholders, former employees, who participated in employee stock option plans qualified under the Employee Retirement Income Security Act (ERISA), 29 U.S.C. 1107(d)(3)(A), sued fiduciaries for breach of the duty of prudence. The plan held the employer's stock, which dropped in value. On remand from the Supreme Court in 2014, the Ninth Circuit held that the complaint stated a claim. The Supreme Court again reversed and remanded. The Court has previously held that such ERISA fiduciaries are not entitled to a presumption of prudence but are "subject to the same duty of prudence that applies to ERISA fiduciaries in general, except that they need not diversify the fund's assets," and that Congress sought to encourage the creation of employee stock-ownership plans. Such fiduciaries confront unique challenges given "the potential for conflict." To state a claim for breach of the duty of prudence on the basis of inside information, a plaintiff must plausibly allege an alternative action that the defendant could have taken that would have been consistent with the securities laws and that a prudent fiduciary in the same circumstances would not have viewed as more likely to harm the fund. Courts must consider whether the fiduciary might have concluded that stopping purchases or publicly disclosing negative information would do more harm than good by causing a drop in the stock price and a concomitant drop in the value of the stock held by the fund. The Ninth Circuit failed to assess whether the complaint plausibly alleged that a prudent fiduciary in the same position "could not have concluded" that the alternative action "would do more harm than good." View "Amgen Inc. v. Harris" on Justia Law 2016-01-25 federal U.S. Supreme Court Per Curiam 15-278 http://law.justia.com/cases/federal/us/577/14-723/ Montanile v. Bd. of Trs. of Nat'l Elevator Indus. Health Benefit Plan 2016-01-20T07:30:26-08:00 2016-01-20T08:43:07-08:00 Employee benefits plans regulated by the Employee Retirement Income Security Act (ERISA) often contain subrogation clauses requiring participants to reimburse the plan for medical expenses if they later recover money from a third party. Montanile was seriously injured by a drunk driver. His ERISA plan paid more than $120,000 for his medical expenses. Montanile sued the drunk driver, obtaining a $500,000 settlement. The plan administrator sought reimbursement from the settlement. Montanile's attorney refused and indicated that the funds would be transferred from a trust account to Montanile unless the administrator objected. The administrator did not respond. Montanile received the settlement. Six months later, the administrator sued under ERISA 502(a)(3), which authorizes plan fiduciaries to file suit "to obtain . . . appropriate equitable relief . . . to enforce . . . the plan." 29 U.S.C. 1132(a)(3). The district court rejected Montanile's arguments, The Eleventh Circuit affirmed, holding that even if Montanile had completely dissipated the fund, the plan was entitled to reimbursement from Montanile's general assets. The Supreme Court reversed and remanded for determination of whether Montanile had dissipated the settlement. When an ERISA-plan participant wholly dissipates a third-party settlement on nontraceable items, the plan fiduciary may not bring suit under section 502(a)(3) to attach the participant's separate assets. Historical equity practice does not support enforcement of an equitable lien against general assets. View "Montanile v. Bd. of Trs. of Nat'l Elevator Indus. Health Benefit Plan" on Justia Law 2016-01-20 federal U.S. Supreme Court Clarence Thomas 14-723 http://law.justia.com/cases/federal/appellate-courts/ca8/15-1578/15-1578-2016-01-11.html Grasso Enter. v. Express Scripts 2016-01-11T08:30:51-08:00 2016-01-11T12:18:36-08:00 Plaintiffs filed suit, alleging that ESI is systematically denying payment of compound drug claims without adhering to the procedural requirements of the Employee Retirement Income Security Act's "Claims Regulation." 29 U.S.C. 1001 et seq. The court concluded that there is no need for injunctive relief under section 502(a)(3), or for equitable relief to enforce or clarify the beneficiary's rights under the plan under section 502(a)(1)(B). In this case, the district court did not abuse its discretion in denying the preliminary injunction requested by plaintiffs as assignees of plan beneficiaries because plaintiffs have cited no reported decision, and the court has found none, where a circuit court has upheld a private plaintiff's claim for injunctive relief mandating the future procedures an ERISA plan must follow to comply with the Claims Regulation. In the alternative, the court concluded that plaintiffs do not have standing under ERISA to assert harm to themselves because they are not ERISA beneficiaries. Accordingly, the court affirmed the judgment. View "Grasso Enter. v. Express Scripts" on Justia Law 2016-01-11 federal U.S. Court of Appeals for the Eighth Circuit James B. Loken 15-1578 http://law.justia.com/cases/federal/appellate-courts/ca8/15-1007/15-1007-2016-01-08.html McCaffree Fin. Corp. v. Principal Life Ins. Co. 2016-01-08T08:31:00-08:00 2016-01-08T17:41:15-08:00 McCaffree brought a class action suit on behalf of participating employees against Principal, the company with whom McCaffree had contracted to provide a retirement plan's investment options, alleging that Principal had charged McCaffree's employees excessive fees in breach of a fiduciary duty Principal owed to plan participants under the Employee Retirement Income Security Act (ERISA), 29 U.S.C. 1001 et seq. The court affirmed the district court's grant of Principal's motion to dismiss for failure to state a claim because McCaffree failed to demonstrate a valid claim under ERISA. In this case, McCaffree's first argument fails because Principal owed no duty to plan participants during its arms-length negotiations with McCaffree, and the remaining four arguments fail because McCaffree did not plead a connection between any fiduciary duty Principal may have owed and the excessive fees Principal allegedly charged. View "McCaffree Fin. Corp. v. Principal Life Ins. Co." on Justia Law 2016-01-08 federal U.S. Court of Appeals for the Eighth Circuit Raymond W. Gruender 15-1007 http://law.justia.com/cases/federal/appellate-courts/ca3/15-1172/15-1172-2015-12-29.html Kaplan v. Saint Peter's Healthcare Sys. 2015-12-29T13:00:04-08:00 2015-12-29T18:29:39-08:00 St. Peter's, a non-profit healthcare entity, runs a hospital, and employs over 2,800 people. It is not a church, but has ties to a New Jersey Roman Catholic Diocese. The Bishop appoints most members of its Board of Governors and retains veto authority over Board actions. The hospital has daily Mass and Catholic devotional pictures and statues throughout the building. In 1974, St. Peter's established a non-contributory defined benefit retirement plan; operated the plan subject to the Employee Retirement Income Security Act (ERISA); and represented that it was complying with ERISA. In 2006 St. Peter's filed an IRS application, seeking a church plan exemption from ERISA, 26 U.S.C. 414(e); 29 U.S.C. 1002(33), continuing to pay ERISA-mandated insurance premiums while the application was pending. In 2013, Kaplan, who worked for St. Peter's until 1999, filed a putative class action alleging that St. Peter's did not provide ERISA-compliant summary plan descriptions or pension benefits statements, and that, as of 2011, the plan was underfunded by more than $70 million. While the lawsuit was pending, St. Peter's received an IRS private letter ruling. affirming the plan's status as an exempt church plan for tax purposes. The Third Circuit affirmed denial of a motion to dismiss, concluding that St. Peter's could not establish an exempt church plan because it is not a church. View "Kaplan v. Saint Peter's Healthcare Sys." on Justia Law 2015-12-29 federal U.S. Court of Appeals for the Third Circuit Thomas L. Ambro 15-1172 http://law.justia.com/cases/federal/appellate-courts/ca5/15-40597/15-40597-2015-12-11.html Hagen v. Aetna Ins. Co. 2015-12-11T16:30:33-08:00 2015-12-11T21:34:12-08:00 Plaintiff filed suit against Aetna and Hewlett Packard to recover benefits as the beneficiary of her husband's group life insurance plan under the Employee Retirement Income Security Act (ERISA), 29 U.S.C. 1132(a)(1)(B). On appeal, plaintiff challenged the district court's final judgment affirming the decision of the ERISA plan administrator to deny benefits. The court concluded that plaintiff has not provided evidence that suggests that the method by which Aetna made its determination in her case was procedurally unreasonable; the court rejected plaintiff's claim that Aetna's conflict should be given greater weight in the district court's analysis because it has a history of biased claims administration; and evidence is sufficient to permit a reasonable mind to reach the conclusion that the husband's fall was due to or contributed to by illness. The court further stated that, even accounting for Aetna's conflict of interest as both insurer and plan administrator, Aetna did not abuse its discretion in determining that the husband's fall was not a covered "accident" under the terms of the Policy, negating recovery under the Policy. Because Aetna's denial of plaintiff's claim was not an abuse of discretion, the court affirmed the judgment. View "Hagen v. Aetna Ins. Co." on Justia Law 2015-12-11 federal U.S. Court of Appeals for the Fifth Circuit Catharina Haynes 15-40597 http://law.justia.com/cases/federal/appellate-courts/ca7/15-1269/15-1269-2015-11-24.html Mid-Central Illinois Reg'l v. Con-Tech Carpentry, LLC 2015-11-24T08:30:41-08:00 2015-11-24T18:59:05-08:00 Several multi-employer health and welfare funds filed this suit under the Employee Retirement Income Security Act seeking approximately $70,000 in alleged delinquent contributions. The assertedly delinquent employer, Con-Tech Carpentry, did not file an answer within the statutory period and was found in default. The district court subsequently entered a judgment in the funds' favor and awarded damages. Con-Tech subsequently filed a Fed. R. Civ. P. 60(b) motion, which also invoked Fed. R. Civ. P. 55(c). The judge denied the Rule 60(b) motion. The Seventh Circuit affirmed, holding that because Con-Tech made a deliberate decision to disregard the pending suit, there was no reason for the district judge to excuse Con-Tech's conduct in retrospect. View "Mid-Central Illinois Reg'l v. Con-Tech Carpentry, LLC" on Justia Law 2015-11-24 federal U.S. Court of Appeals for the Seventh Circuit Frank Hoover Easterbrook 15-1269 http://law.justia.com/cases/federal/appellate-courts/ca6/14-1491/14-1491-2015-11-10.html Pfeil v. State St. Bank & Trust Co. 2015-11-10T07:00:46-08:00 2015-11-10T10:50:45-08:00 Under the Employee Retirement Income Security Act, 29 U.S.C. 1001, plan fiduciaries have a duty of prudence that generally requires diversification. To "solve the dual problems of securing capital funds for necessary capital growth and of bringing about stock ownership by all corporate employees," Employee Stock Ownership Plans (ESOPs) are permitted to invest primarily in qualifying employer securities, rather than diversifying across securities of many companies. In 1995, the Third and Sixth Circuits adopted a presumption that an ESOP fiduciary's decision to remain invested in employer securities is prudent. In 2008, GM faced severe business problems that resulted in its bankruptcy. GM employees, invested in the GM ESOP, sued State Bank, the fiduciary of the GM Common Stock Plan. That Plan lost money in 2008, but State declined to stop buying GM stock until November, 2008, and did not sell GM stock until March, 2009. In 2010, the district court dismissed, applying the presumption of prudence. In 2012, the Sixth Circuit remanded. After class certification, the district court, applying the presumption, granted State summary judgment. In the meantime, the Supreme Court abrogated the presumption altogether. The Sixth Circuit affirmed summary judgment, noting that during the relevant period, State's managers repeatedly discussed whether to continue the GM investments, engaging in a "prudent process." View "Pfeil v. State St. Bank & Trust Co." on Justia Law 2015-11-10 federal U.S. Court of Appeals for the Sixth Circuit Danny Julian Boggs 14-1491 http://law.justia.com/cases/federal/appellate-courts/ca6/14-5648/14-5648-2015-11-06.html Durand v. Hanover Ins. Group, Inc. 2015-11-06T07:30:51-08:00 2015-11-06T09:46:09-08:00 In 2007, Durand filed an Employee Retirement Income Security Act, 29 U.S.C. 1001–1461 (ERISA) class action against her former employer and the pension plan it sponsors, challenging the projection rate used by the Plan to calculate the lump-sum payment Durand elected to receive after ending her employment at the Company in 2003. The Plan then used a 401(k)-style investment menu to determine the interest earned by members' hypothetical accounts. Durand alleged that it impermissibly used the 30-year Treasury bond rate instead of the projected rate of return on her investment selections in the "whipsaw" calculation required under pre-2006 law. The Sixth CIrcuit reversed dismissal for failure to exhaust administrative remedies. Defendants then answered the complaint and raised defenses, including that the claims of putative class members "who received lump-sum distributions after December 31, 2003" were barred due to an amendment to the Plan that took effect after that date. Plaintiffs argued that the 2004 Amendment was an illegal reduction or "cutback" in benefits. The Sixth Circuit affirmed that the "cutback" claims were time-barred and did not relate back to the "whipsaw" claim asserted in the original class complaint. View "Durand v. Hanover Ins. Group, Inc." on Justia Law 2015-11-06 federal U.S. Court of Appeals for the Sixth Circuit Eric L. Clay 14-5648 http://law.justia.com/cases/california/court-of-appeal/2015/a143399.html UFCW & Employers Benefit Trust v. Sutter Health 2015-10-27T16:34:59-08:00 2015-10-27T16:41:45-08:00 UEBT is a healthcare employee benefits trust governed by the Employee Retirement Income Security Act (ERISA), 29 U.S.C. 1001, and pays healthcare providers directly from its own funds for the services provided to enrollees in its health plans. UEBT contracted with a "network vendor," Blue Shield, to obtain access to Blue Shield's provider network at the rates Blue Shield had separately negotiated, and certain administrative services. One of Blue Shield's preexisting provider contracts was with Sutter, a group of health care providers in Northern California. UEBT sued Sutter, on behalf of a putative class of all California self-funded payors, alleging that Sutter's contracts with network vendors, such as Blue Shield, contain anticompetitive terms that insulate Sutter from competition and drive up the cost of healthcare. UEBT sought damages, restitution, and injunctive relief under the Cartwright Act (Bus. & Prof. Code 16720) and California's unfair competition law (section 17200). Sutter moved to compel arbitration, relying on an arbitration clause in the provider contract signed by Sutter and Blue Shield. The trial court denied Sutter's motion, concluding that UEBT was not bound to arbitrate its claims pursuant to an agreement it had not signed or even seen. The court of appeal affirmed. View "UFCW & Employers Benefit Trust v. Sutter Health" on Justia Law 2015-10-27 state California California Court of Appeal Terence L. Bruiniers A143399 http://law.justia.com/cases/federal/appellate-courts/ca8/14-3359/14-3359-2015-10-22.html Corrado v. Life Investors Ins. Co. 2015-10-22T07:30:43-08:00 2015-10-22T11:21:32-08:00 Plaintiff, the executrix of her husband's estate, along with her husband's former business, Federal City, filed suit against Life Investors for conversion and tortious interference with a contract. On appeal, plaintiffs challenged the district court's dismissal of the complaint. The court concluded that this action is not barred by claim preclusion because the claims brought are not based upon the same cause of action as the prior suit. In this case, plaintiffs allege claims for conversion and tortious interference with contract against Life Investors because Life Investors removed over $400,000 from certain accounts to cover expenses above the alleged debt plaintiffs owed Life Investors. Life Investors removed these funds after the decision in the Maryland district court. The Maryland court never determined that plaintiffs lacked any interest in the assets in the accounts. Instead, it decided that plaintiffs were time-barred from bringing claims from a 2000 request for withdrawal of the assets and that the Employee Retirement Income Security Act (ERISA), 29 U.S.C. 1001 et seq., claims were either time-barred or failed to allege a violation of ERISA law. Similarly, the claim is not barred by issue preclusion. Accordingly, the court reversed and remanded. View "Corrado v. Life Investors Ins. Co." on Justia Law 2015-10-22 federal U.S. Court of Appeals for the Eighth Circuit Bobby E. Shepherd 14-3359 http://law.justia.com/cases/federal/appellate-courts/ca8/14-1573/14-1573-2015-10-22.html Life Investors Ins. Co. v. Federal City Region 2015-10-22T07:30:42-08:00 2015-10-22T11:21:28-08:00 Life Investors filed suit against defendants, alleging breach of a settlement agreement that required defendants to repay advances of monies defendants received from Life Investors. On appeal, defendants challenged the district court's grant of summary judgment to Life Investors. The court affirmed, concluding that defendants' laches defense failed because they cannot show unreasonable delay on the part of Life Investors in bringing this suit nor can defendants show that they were prejudiced; even if the alleged inconsistencies were material, defendants chose not to investigate further and thus the determination that they ratified the Settlement Agreement was correct; the district court correctly granted summary judgment on the question of ratification of the Settlement Agreement after certifying that question to the Iowa Supreme Court and receiving its answer; and defendants' attempt to argue an Employee Retirement Income Security Act (ERISA), 29 U.S.C. 1001 et seq., violation as a defense in this action is barred as a matter of issue preclusion. View "Life Investors Ins. Co. v. Federal City Region" on Justia Law 2015-10-22 federal U.S. Court of Appeals for the Eighth Circuit Bobby E. Shepherd 14-1573 http://law.justia.com/cases/federal/appellate-courts/ca6/14-1479/14-1479-2015-10-02.html Waskiewicz v. UniCare Life & Health Ins. Co. 2015-10-02T06:30:49-08:00 2015-10-02T07:24:03-08:00 Waskiewicsz suffers from type-1 diabetes, major depression, and gender identity disorder She worked as a product design engineer for Ford from 1990 until October, 2010, when she suffered "a debilitating emotional breakdown." In December, after her father found her barricaded in her house, she sought long-term disability benefits under Ford's Plan, governed by the Employment Retirement Income Security Act, 29 U.S.C. 1001. Under the plan: An Active Employee whose employment is terminated . . . shall cease to be eligible for Benefits as of the earlier of: (a) the date the Employee has been notified; or (b) the day prior to the date of such termination (in the case of retroactive terminations) . .... An employee is required to notify the Claim Processor ... if the employee is absent for more than five (5) consecutive Workdays." She did not give notice within the five-day period and was, apparently, terminated in the interim. UniCare concluded that she did not qualify for benefits. The Sixth Circuit reversed. On remand, Waskiewicz must be given the opportunity to show that her alleged failure to comply with the requirements of the Plan was due to the very disability for which she seeks benefits. View "Waskiewicz v. UniCare Life & Health Ins. Co." on Justia Law 2015-10-02 federal U.S. Court of Appeals for the Sixth Circuit Alan Eugene Norris 14-1479 http://law.justia.com/cases/federal/appellate-courts/ca7/15-1274/15-1274-2015-10-01.html Pa. Chiropractic Ass'n v. Independence Hosp. Indem., Inc. 2015-10-01T12:30:49-08:00 2015-10-01T14:18:36-08:00 The insurer operates a preferred-provider system that offers patients better benefits, or lower co-payments, for patronizing medical providers who have agreed with the insurer to accept lower reimbursements (per procedure) in exchange for a better flow of business. The chiropractor plaintiffs signed such "participating provider" or "network" agreements. Providers bill the insurer directly regardless of whether a patient obtained coverage as part of an Employee Retirement Income Security Act (ERISA) welfare-benefit plan or through some other means, such as an affinity-group policy or an insurance exchange under the Affordable Care Act. Chiropractors sued, contending that, when determining how much to pay for services rendered to patients, the insurer failed to use the procedures required by ERISA, 29 U.S.C. 1133. The district court concluded that plaintiffs are beneficiaries under ERISA and awarded damages and injunctions requiring the insurer to follow section 1133 and Department of Labor regulations. The Seventh Circuit reversed, noting that plaintiffs concede that they are not participants under the ERISA definition and that a network contract between a medical provider and an insurer does not make that provider a "beneficiary" under ERISA. View "Pa. Chiropractic Ass'n v. Independence Hosp. Indem., Inc." on Justia Law 2015-10-01 federal U.S. Court of Appeals for the Seventh Circuit Frank Hoover Easterbrook 15-1274 14-2322 14-3174 http://law.justia.com/cases/federal/appellate-courts/ca3/14-1956/14-1956-2015-09-16.html Bd. of Trs. of the IBT Local 863 Pension Fund v. C&S Wholesale Grocers Inc 2015-09-16T09:00:06-08:00 2015-09-16T11:11:12-08:00 Until 2011, Woodbridge, the largest wholesale grocery distributor by revenue in the U.S., contributed to the fund pursuant to collective bargaining agreements (CBAs). Under the Employee Retirement Income Security Act (ERISA), 29 U.S.C. 1001, Multiemployer Pension Plan Amendments Act (MPPAA), 29 U.S.C. 1381-1461, employers withdrawing from multi-employer pension plans must pay the share of the fund's total unfunded vested benefits allocable to them. Woodbridge owes $189,606,875 and elected to satisfy its "withdrawal liability" through annual payments instead of a lump sum. Under the MPPAA, annual payments must be based on "the highest contribution rate at which the employer had an obligation to contribute under the plan." The plan's board claimed the single highest rate from the multiple contribution rates established in the three CBAs . Woodbridge argued that it was responsible only for a weighted average of those contribution rates. The board also claimed that Woodbridge's payments should include a 10 % surcharge it had been paying under the 2006 Pension Protection Act, 29 U.S.C. 1085. The Third Circuit affirmed that the annual withdrawal liability payment should be based on the single highest contribution rate, but should not include the surcharge. The "highest contribution" rate means the single highest contribution rate established under any of the CBAs. View "Bd. of Trs. of the IBT Local 863 Pension Fund v. C&S Wholesale Grocers Inc" on Justia Law 2015-09-16 federal U.S. Court of Appeals for the Third Circuit Theodore Alexander McKee 14-1956 http://law.justia.com/cases/federal/appellate-courts/ca9/12-17675/12-17675-2015-09-11.html Resilient Floor Covering Pension Trust Fund Bd. of Trs. v. Michael's Floor Covering 2015-09-11T09:01:24-08:00 2015-09-11T11:58:30-08:00 After a bench trial, the district court held that Michael's was not liable as a successor employer by weighing continuity of the workforce as the most important factor. At issue was: (1) whether a successor employer, both generally and in the construction industry in particular, can be subject to withdrawal liability under the Multiemployer Pension Plan Amendments Act (MPPAA), 29 U.S.C. 1381–1453, amendments to the Employee Retirement Income Security Act (ERISA), 29 U.S.C. 1001 et seq.; and (2) if so, what factors are most relevant to determining whether a construction industry employer is a successor for purposes of imposing MPPAA withdrawal liability. The court concluded that a construction industry successor employer can be subject to MPPAA withdrawal liability, so long as the successor took over the business with notice of the liability; that the most important factor in assessing whether an employer is a successor for purposes of imposing MPPAA withdrawal liability is whether there is substantial continuity in the business operations between the predecessor and the successor, as determined in large part by whether the new employer has taken over the economically critical bulk of the prior employer's customer base; and, in this case, the district court erred in weighing continuity of the workforce as the most important factor and applying an incorrect test to determine whether there was continuity of the workforce. Accordingly, the court reversed and remanded for further proceedings. View "Resilient Floor Covering Pension Trust Fund Bd. of Trs. v. Michael's Floor Covering" on Justia Law 2015-09-11 federal U.S. Court of Appeals for the Ninth Circuit Marsha Siegel Berzon 12-17675 http://law.justia.com/cases/federal/appellate-courts/ca3/14-2101/14-2101-2015-09-11.html N. Jersey Brain & Spine Ctr., v. Aetna Inc 2015-09-11T09:00:05-08:00 2015-09-11T09:21:24-08:00 NJBSC is a Bergen County neurosurgical medical practice. NJBSC treated three patients who were members of health-care plans governed by the Employee Retirement Income Security Act (ERISA), 29 U.S.C. 1001, and administered by Aetna. Before surgery, each patient executed an assignment to NJBSC. Following treatment, Aetna allegedly underpaid or refused to pay claims for each of the patients. NJBSC filed suit The district court dismissed NJBSC's complaint, holding that the assigned rights to payment did not give NJBSC standing to sue under ERISA. The Third Circuit reversed, holding that a patient's explicit assignment of payment of insurance benefits to her healthcare provider, without direct reference to the right to file suit, is sufficient to give the provider standing to sue for those benefits under ERISA. View "N. Jersey Brain & Spine Ctr., v. Aetna Inc" on Justia Law 2015-09-11 federal U.S. Court of Appeals for the Third Circuit Michael A. Chagares 14-2101 http://law.justia.com/cases/minnesota/supreme-court/2015/a13-872.html Engfer v. Gen. Dynamics Advanced Info. Sys., Inc. 2015-09-09T09:01:39-08:00 2015-09-09T13:28:49-08:00 After Employee ended his employment with Employer he applied for and received state unemployment benefits from the Department of Employment and Economic Development (DEED) and supplemental unemployment benefits (SUB) through a plan offered by Employer. DEED determined that the SUB plan payments counted as "wages" under Minn. Stat. 268.035(29)(A) and determined that Employee had been overpaid state unemployment benefits. An unemployment law judge affirmed. The court of appeals reversed, concluding that Employee was entitled to keep the state unemployment benefits. The Supreme Court affirmed, holding the SUB plan payments Employee received were not "wages" for purposes of his eligibility for state unemployment benefits, and therefore, Employee was not overpaid state unemployment benefits. View "Engfer v. Gen. Dynamics Advanced Info. Sys., Inc." on Justia Law 2015-09-09 state Minnesota Minnesota Supreme Court Christopher J. Dietzen A13-872 http://law.justia.com/cases/federal/appellate-courts/ca9/13-35555/13-35555-2015-09-08.html OR Teamsters Emp'ers Trust v. Hillsboro Garbage Disposal 2015-09-08T09:01:22-08:00 2015-09-08T20:22:49-08:00 OTET appealed the district court's grant of summary judgment for Hillsboro Garbage, Robert Henderson, and the Estate of Darrol Jackson. The district court granted summary judgment in favor of defendants on (1) OTET's breach of contract claims because the district court found those claims to be preempted by the Employee Retirement Income Security Act of 1974 (ERISA), 29 U.S.C. 1001 et seq.; and (2) OTET's restitution and specific performance claims because the district court concluded that those claims were not cognizable under ERISA as they sought legal - not equitable - relief. The court concluded that the district court properly dismissed the common law breach of contract claims as preempted by ERISA; the district court properly dismissed the restitution and specific performance claims where recent circuit precedent does not support OTET's argument; and the district court did not abuse its discretion in denying OTET the right to file a third amended complaint where OTET was given two opportunities to amend its complaint and unilaterally decided to eliminate the fraud count and it does not contend that it acquired any knew knowledge or that any misconduct occurred. Accordingly, the court affirmed the judgment. View "OR Teamsters Emp'ers Trust v. Hillsboro Garbage Disposal" on Justia Law 2015-09-08 federal U.S. Court of Appeals for the Ninth Circuit Baylson 13-35555 http://law.justia.com/cases/federal/appellate-courts/ca7/14-1984/14-1984-2015-09-04.html Fontaine v. Metropolitan Life Ins. Co 2015-09-04T13:00:50-08:00 2015-09-04T13:26:42-08:00 In 1989, the Supreme Court held that courts should apply de novo review in suits challenging denials of employee benefits governed by the Employee Retirement Income Security Act (ERISA), 29 U.S.C. 1132(a)(1), but if the benefit plan provided expressly for a different, more deferential standard of review, that specific provision would control over the default rule of de novo review. Insurance companies and plan sponsors began including such provisions in most benefit plans, typically saying the insurer or plan administrator would exercise discretionary judgment in interpreting a plan or deciding whether to pay benefits. Courts would then apply a deferential standard of review under which a denial would stand unless it was "arbitrary and capricious." Later, state laws were adopted to protect employees and plan beneficiaries from abuse of such discretion. An Illinois insurance law, prohibited provisions "purporting to reserve discretion" to insurers to interpret health and disability insurance policies. The Seventh Circuit rejected a preemption challenge and applied the state law in a case involving a challenge to an insurance provider's definition of "disability," The court did not address whether the denial of benefits was arbitrary and capricious. View "Fontaine v. Metropolitan Life Ins. Co" on Justia Law 2015-09-04 federal U.S. Court of Appeals for the Seventh Circuit HAMILTON 14-1984 http://law.justia.com/cases/federal/appellate-courts/ca8/14-3401/14-3401-2015-09-03.html Huang v. Life Ins. Co. of N. Am. 2015-09-03T07:31:25-08:00 2015-09-03T09:02:16-08:00 In 2009, Liu, a physician in a residency program, elected basic life insurance coverage from LINA through his employer's ERISA plan and elected supplemental coverage in an amount four times his salary. Asked whether, within the last five years he had been diagnosed with "Cancer, Tumor, Leukemia, Hodgkin's Disease, Polyps or Mole," he answered "no." One month after submitting his application, Liu received a cancer diagnosis. On March 1, 2010, the insurance became effective. On April 23, 2010, Liu died. LINA paid the basic benefit of $46,858.49, but reviewed Liu's medical records, which revealed that Liu had been experiencing symptoms without a diagnosis before submitting his November 12 application. LINA then issued a denial, stating: While the form was completed accurately at the time ... a diagnosis of cancer prior to the coverage approval date was not disclosed … [the] Form states ... any changes in your health prior to the insurance effective date must be reported. His wife responded that Liu was told he would not have to provide evidence of good health, but did not identify the person who made the alleged representation. The court rejected the wife's suit on summary judgment. The Eighth Circuit affirmed. Liu breached an application requirement by failing to notify LINA of a cancer diagnosis he received before a policy issued. View "Huang v. Life Ins. Co. of N. Am." on Justia Law 2015-09-03 federal U.S. Court of Appeals for the Eighth Circuit Melloy 14-3401 http://law.justia.com/cases/federal/appellate-courts/ca7/14-3726/14-3726-2015-09-02.html Michels Corp. v. Cent. States, SE & SW Areas Pension Fund 2015-09-02T13:31:21-08:00 2015-09-02T16:07:41-08:00 Michels is a member of the Pipe Line Contractors Association (PLCA), a trade association that negotiates collective bargaining agreements (CBAs) on behalf of its employer members with unions. In 2006, the PLCA and the Union entered into a CBA in "effect until January 31, 2011, and thereafter from year to year unless terminated at the option of either party after sixty (60) days' notice." The CBA required contributions to the Central States multiemployer pension plan, 29 U.S.C. 1000(2), (3), (37). In August 2010, the PLCA informed the Union that it intended to terminate the 2006 CBA on January 31, 2011, and begin negotiations for a new agreement; the parties signed eight extensions, the last ending November 15, 2011. Michels contributed to the pension plan throughout those extensions. The parties agreed that the employers would cease making contributions to the plan as of November 15, 2011; that they would make comparable payments to an escrow fund until a "mutually acceptable" fund was designated; and that they would otherwise extend the terms of the 2006 CBA until December 31, 2011. The fund claimed that the obligation to make contributions had not ended. The Seventh Circuit reversed the district court holding that this was not sufficient to end the duty to contribute. View "Michels Corp. v. Cent. States, SE & SW Areas Pension Fund" on Justia Law 2015-09-02 federal U.S. Court of Appeals for the Seventh Circuit Diane Pamela Wood 14-3726 14-3737 http://law.justia.com/cases/federal/appellate-courts/ca6/14-3997/14-3997-2015-09-02.html Bd. Trs. Local 17 Iron Workers Pension Fund v. Harris Davis Rebar LLC 2015-09-02T07:30:54-08:00 2015-09-02T08:41:08-08:00 The Iron Workers negotiated a contract that required JD Steel to make contributions, on behalf of its employees, to the pension funds for local unions in which the employees performed work, amounting $10.00 for every hour that a JD employee worked in the local union's territory. Later, the Iron Workers negotiated a similar contract with Davis Rebar, except that, rather than require contributions to the local unions' pension funds, the contract required Davis to make identical contributions to the local unions' defined-contribution plans, such as a 401(k) plan. In 2013, JD worked on a parking garage at Cleveland's Fairview Hospital while Davis worked on a garage at University Hospital. Both jobs were within the territory of the Local 17 Iron Workers Union. Davis apparently used equipment bearing JD's name and logo. The companies shared a foreman and supervisors. The pension plan sued under 29 U.S.C. 1132(a)(3), alleging that JD and Davis are actually the same company, so that Davis is bound by JD's contract and must make additional payments. Each company has made all payments required by its individual contract. The Sixth Circuit affirmed dismissal. Reasoning that the same association of unions negotiated and signed both agreements, the court declined to set aside the association's judgment regarding its members' best interests. View "Bd. Trs. Local 17 Iron Workers Pension Fund v. Harris Davis Rebar LLC" on Justia Law 2015-09-02 federal U.S. Court of Appeals for the Sixth Circuit Raymond M. Kethledge 14-3997 http://law.justia.com/cases/federal/appellate-courts/ca3/13-3535/13-3535-2015-08-26.html Mirza v. Ins. Admin. of Am., Inc 2015-08-26T09:00:06-08:00 2015-08-26T09:39:19-08:00 A Challenge employee consulted Dr. Mirza about back pain, agreed to undergo an endoscopic discectomy, and executed an assignment of her benefits under Challenge's plan. Mizra completed the procedure and submitted a claim for $34,500, which was denied. Mirza submitted additional documents. The claim was denied again. Mirza went through internal review and, on August 12, 2010, received a letter denying his final appeal, indicating that the procedure was not covered because it was medically investigational, and notifying Mirza of his right to bring a civil action under the Employee Retirement Income Security Act, 29 U.S.C. 1001. Neither the letter nor the earlier denials mentioned that, under the plan, Mirza had one year from the final denial to seek judicial review. While the parties debate the substance of an earlier phone call, the first time Mirza received written notice of the one-year deadline was April 11, 2011. On March 8, 2012, Mirza sued. The district court granted defendants summary judgment. The Third Circuit vacated. Plan administrators must inform claimants of plan-imposed deadlines for judicial review in their notifications denying benefits. The appropriate remedy is to set aside the plan's time limit and apply the limitations period from New Jersey's six-year deadline for breach of contract claims. View "Mirza v. Ins. Admin. of Am., Inc" on Justia Law 2015-08-26 federal U.S. Court of Appeals for the Third Circuit Julio M. Fuentes 13-3535 http://law.justia.com/cases/federal/appellate-courts/ca6/14-4048/14-4048-2015-08-25.html Bd. of Trustees v. Moore 2015-08-25T07:30:59-08:00 2015-08-25T13:16:43-08:00 The NEI Board administers a self-funded, multi-employer health plan covered by the Employee Retirement Income Security Act (ERISA), 29 U.S.C. 1001. A Trust Agreement, executed by the participating companies and the Board, does not specify Plan details, but provides that "[t]he detailed basis on which payment of benefits is to be made … shall be set forth in the Plan of Welfare Benefits … subject to amendment by the Trustees." The National Elevator Industry Health Benefit Plan Summary Plan Description, (SPD) provides the details and includes a subrogation provision: The Plan has the right to recover benefits advanced to a covered person for expenses or losses caused by another party. The Plan is only obligated to provide covered benefits resulting from that illness or injury that exceed amounts recovered from another party (regardless of whether designated to cover medical expenses). The Plan sought reimbursement for medical expenses paid on Moore's behalf, following Moore's settlement of a negligence action against entities responsible for injuries he suffered in an accident. Moore counterclaimed, alleging that the Board had violated its fiduciary duty by misrepresenting the Plan terms. The Sixth Circuit found that the SPD containing the subrogation provision set out the binding terms of the Plan and that the plain language of the provision required reimbursement. View "Bd. of Trustees v. Moore" on Justia Law 2015-08-25 federal U.S. Court of Appeals for the Sixth Circuit Martha Craig Daughtrey 14-4048 http://law.justia.com/cases/federal/appellate-courts/ca3/14-1481/14-1481-2015-08-24.html Stevens v. Santander Holdings USA Inc. 2015-08-24T09:00:06-08:00 2015-08-24T11:29:39-08:00 During his employment with a subsidiary of Santander Holdings, Stevens received treatment for ankylosing spondylitis, a chronic inflammatory disease, and participated in a short-term disability plan (STD) and a long-term disability plan (LTD). When Stevens' condition worsened, Liberty Mutual, the administrator of Santander's plans, initially awarded STD benefits to Stevens, then determined that Stevens no longer suffered from a qualifying disability and terminated his benefits. Stevens sued under the Employee Retirement Income Security Act (ERISA), 29 U.S.C. 1001. The district court found that Liberty Mutual's decision to terminate Stevens's STD benefits was arbitrary and capricious and remanded with instructions to reinstate Stevens's STD benefit payments retroactively and to determine his eligibility for LTD benefit payments. The Third Circuit dismissed an appeal for lack of jurisdiction, finding that the remand order to the plan administrator was not a "final decision" appealable pursuant to 28 U.S.C. 1291 at that time. The district court retained jurisdiction over the case and the order is not yet appealable. View "Stevens v. Santander Holdings USA Inc." on Justia Law 2015-08-24 federal U.S. Court of Appeals for the Third Circuit Greenburg 14-1481 http://law.justia.com/cases/federal/appellate-courts/ca2/14-20/14-20-2015-08-20.html N.Y. State Psychiatric Ass'n v. UnitedHealth Grp. 2015-08-20T06:30:04-08:00 2015-08-20T20:50:25-08:00 Plaintiffs filed suit against United, claiming that United had violated its fiduciary duties under the Employee Retirement Income Security Act (ERISA), 29 U.S.C. 1132(a)(1)(B), (a)(3), and the terms of ERSIA-governed health insurance plans administered by United, and the Mental Health Parity and Addiction Equity Act of 2008 (the Parity Act), 29 U.S.C. 1185a(a)(3)(A). Plaintiffs also brought three additional counts under New York State law. The district court granted United's motion to dismiss. The court concluded that NYSPA has standing at this stage of the litigation and that Plaintiff Denbo's claims, but not Plaintiff Dr. Menolascino's claims, should be permitted to proceed. Therefore, the court affirmed in part and vacated in part, remanding for further proceedings. View "N.Y. State Psychiatric Ass'n v. UnitedHealth Grp." on Justia Law 2015-08-20 federal U.S. Court of Appeals for the Second Circuit Raymond Joseph Lohier, Jr. 14-20 http://law.justia.com/cases/federal/appellate-courts/ca8/14-3364/14-3364-2015-08-12.html Nutt v. Osceola Therapy & Living Cntr., Inc. 2015-08-12T07:30:51-08:00 2015-08-12T14:42:20-08:00 Kevin and Lisa Nutt worked at Osceola Nursing Home. Funds were withheld from their paychecks as "pre-tax insurance." After Kevin was injured, they learned that Osceola had not paid premiums. Their policy had lapsed; the Nutts owed $233,000 for medical services. The insurer told Lisa that it could reinstate the policy and pay the bills if Osceola made the delinquent premium payments. Osceola did not do so. Osceola then entered into a contract with Cooper, who specialized in turning around financially troubled nursing homes. Cooper's company, Berryville, ultimately took title to the property. Before the closing, Cooper could assume management under a temporary lease. Cooper assigned this lease to OTLC, created for the project and owned by Hargis. Though OTLC was independent, Hargis regularly worked with Cooper in nursing-home ventures. OTLC operated the facility for Cooper and Berryville for three years. Nutt told Hargis about the outstanding bills. Days later, OTLC fired both Lisa and Kevin. They sued. The court entered default judgment against Osceola under the Employee Retirement Income Security Act, 29 U.S.C. 1001; found that they could not provide adequate relief; and, on a theory of successor liability, held OTLC liable. The Eighth Circuit reversed, stating that if successor liability required only subsequent operation, it would discourage the free transfer of assets to their most valuable uses. OTLC was not a party to the unlawful practices of Osceola and operated without significant connection to the culpable parties. View "Nutt v. Osceola Therapy & Living Cntr., Inc." on Justia Law 2015-08-12 federal U.S. Court of Appeals for the Eighth Circuit Raymond W. Gruender 14-3364 http://law.justia.com/cases/federal/appellate-courts/ca8/14-2376/14-2376-2015-08-10.html Cent. States, SE & SW Areas Health & Welfare Fund v. Student Assurance Servs., Inc. 2015-08-10T07:30:48-08:00 2015-08-10T11:24:58-08:00 Central States, a multi-employer trust fund governed by ERISA, provides health and welfare benefits to participants in the teamster industry. Student Assurance processed claims for student accident policies. Central States claimed that it paid medical expenses of $137, 204 for 13 junior high, high school, and college student-athletes who were covered dependents under its plan and who sustained athletic injuries. Central States sought reimbursement from Student Assurance, which refused to pay. Central States alleged that according to the coordination of benefits provision of its plan, the student accident policies supply primary coverage for the students' covered medical expenses. Student Assurance claimed that the student accident policies are excess policies, and that they are not obligated to pay until Central States has reached the maximum contribution under its plan. Central States sued, citing federal common law and section 502(a)(3) of ERISA, seeking declaratory relief, restitution, and the imposition of an equitable lien and constructive trust to secure reimbursement for the benefits paid on behalf of the common insureds. The district court dismissed, and the Eighth Circuit affirmed, holding that the claims, while ostensibly seeking equitable remedies, were actually for legal relief that is unavailable under section 502(a)(3). View "Cent. States, SE & SW Areas Health & Welfare Fund v. Student Assurance Servs., Inc." on Justia Law 2015-08-10 federal U.S. Court of Appeals for the Eighth Circuit Steven M. Colloton 14-2376 http://law.justia.com/cases/mississippi/supreme-court/2015/2014-ca-00322-sct.html In the Matter of the Guardianship of O. D. 2015-08-06T11:02:03-08:00 2015-08-06T16:02:17-08:00 Minor O.D. filed a petition for approval of a settlement her parents had negotiated with car insurance companies for injuries she had suffered in a car accident. On the day of the hearing, O.D.'s health insurance coverage provider Ashley Healthcare Plan, which had a subrogation lien against the proceeds of O.D.'s claim, removed the case to federal court, arguing that Mississippi Code Section 93-13-59 (which requires chancery court approval of settlement claims) was preempted by the federal Employment Retirement Income Security Act of 1974 ("ERISA"). The federal district court held that ERISA did not preempt the state law and remanded the case to the chancery court without awarding attorney's fees to O.D. On motion from O.D.'s parents, the Pontotoc County Chancery Court awarded O.D. attorney's fees, holding that Ashley Healthcare Plan's removal to federal court was contrary to clearly established law and that it was done for the purpose of delaying litigation. Ashley Healthcare Plan appealed the grant of attorney fees. The Mississippi Supreme Court affirmed. Although O.D. could have sought recovery of attorney's fees under Rule 54 of the Federal Rules of Civil Procedure, frivolous removals to federal court were also subject to the Mississippi Litigation Accountability Act. Furthermore, Ashley Healthcare Plan's removal to federal court was contrary to two decades of case law which uniformly held that Mississippi's law requiring chancery court approval of minors' settlements was not preempted by ERISA and that Ashley Healthcare Plan was seeking a remedy in federal court that was unavailable to it under the ERISA Civil Enforcement Clause. View "In the Matter of the Guardianship of O. D." on Justia Law 2015-08-06 state Mississippi Supreme Court of Mississippi James W. Kitchens 2014-CA-00322-SCT http://law.justia.com/cases/federal/appellate-courts/ca10/14-1315/14-1315-2015-07-29.html Martinez v. Plumbers & Pipefitters 2015-07-29T08:02:50-08:00 2015-07-29T12:04:08-08:00 Joseph Martinez was a participant in the Plumbers and Pipefitters National Pension Plan, (governed by the Employee Retirement Income Security Act (ERISA)). Following some health problems, Martinez retired from plumbing in 2004 at age 56 and took advantage of the Plan's early retirement pension. After a few years in retirement, he felt well enough to resume working, and his pension was suspended during that time according to rules that prohibit retirement benefits during disqualifying employment. When he retired again in 2009, he asked the National Pension Fund to allow him to convert the pension benefits he previously elected from an early retirement pension to a disability pension (a change that would have entitled him to higher monthly payments). The Fund denied the conversion and the district court upheld the denial. After review, the Tenth Circuit agreed with the district court that the Plan language was unambiguous and allowed Plan participants to apply for and receive only one type of pension benefit for life absent several clearly delineated exceptions, none of which applied to Martinez. Accordingly, the Court affirmed the Fund's denial of Martinez's claim for disability benefits. View "Martinez v. Plumbers & Pipefitters" on Justia Law 2015-07-29 federal U.S. Court of Appeals for the Tenth Circuit Timothy M. Tymkovich 14-1315 http://law.justia.com/cases/federal/appellate-courts/ca2/14-1179/14-1179-2015-07-23.html Laurent v. PricewaterhouseCoopers LLP 2015-07-23T06:30:10-08:00 2015-07-24T16:39:08-08:00 Plaintiffs, former employees of PwC, filed suit under the Employee Retirement Security Act of 1974 (ERISA), 29 U.S.C. 1001 et seq., alleging that PwC's retirement plan deprived them of so-called "whipsaw payments," which guarantee that plan participants who take distributions in the form of a lump sum when they terminate employment will receive the actuarial equivalent of the value of their accounts at retirement. The PwC plan defines "normal retirement age" as five years of service, so that it coincides with the time at which employees vest in the plan. The court held that the plan's definition of "normal retirement age" as five years of service violates the statute not because five years of service is not an "age," but because it bears no plausible relation to "normal retirement," and is therefore inconsistent with the plain meaning of the statute. Accordingly, the court affirmed the judgment of the district court, but for different reasons than those cited by the district court. The court did not reach the district court's alternative reasons for denying defendants' motion to dismiss. View "Laurent v. PricewaterhouseCoopers LLP" on Justia Law 2015-07-23 federal U.S. Court of Appeals for the Second Circuit Gerard E. Lynch 14-1179 http://law.justia.com/cases/federal/appellate-courts/ca1/14-1934/14-1934-2015-07-20.html Sirva Relocation, LLC v. Golar Richie 2015-07-20T10:00:05-08:00 2015-07-20T20:06:02-08:00 In Sprint Commc'ns, Inc. v. Jacobs, the Supreme Court revisited the doctrine of abstention enunciated in Younger v. Harris. That doctrine requires federal courts, in the absence of extraordinary circumstances, to refrain from interfering with certain state proceedings. In this case, David Knight, an employee of Sirva Relocation, LLC, filed a charge of discrimination with the Massachusetts Commission Against Discrimination (MCAD) alleging that Sirva and Aetna Life Insurance Company (together, Appellants) had discriminated against him on the basis of disability in violation of Mass. Gen. Laws ch. 151B and the Americans with Disabilities Act (ADA). Appellants filed a federal complaint against the Commonwealth of Massachusetts, the MCAD, its commissioners, and Knight, asking the court to enjoin the MCAD proceeding on the basis that ERISA preempted the chapter 151B claim. The MCAD and Knight moved to dismiss the complaint, entreating the district court to abstain. While the case was pending, the Supreme Court decided Sprint. The district court dismissed the federal court action, concluding that Younger abstention was appropriate in this case. The First Circuit affirmed the district court's decision to abstain and further clarified its own case law concerning the exception to the Younger doctrine for facially conclusive claims of preemption. View "Sirva Relocation, LLC v. Golar Richie" on Justia Law 2015-07-20 federal U.S. Court of Appeals for the First Circuit Selya 14-1934 http://law.justia.com/cases/federal/appellate-courts/ca2/13-3928/13-3928-2015-07-17.html Okun v. Montefiore Medical Center 2015-07-17T06:30:05-08:00 2015-07-17T08:10:32-08:00 Plaintiff, a physician, filed suit alleging that his employer Montefiore denied him severance benefits in violation of the Employee Retirement Income Security Act of 1974 (ERISA), 29 U.S.C. 1001 et seq. The district court dismissed the complaint for lack of jurisdiction. The court concluded, however, that on the facts alleged in the complaint, the severance policy at issue is a "plan" governed by section 1002(1) of ERISA. The court considered Montefiore's remaining arguments and concluded that they are without merit. Accordingly, the court vacated and remanded. View "Okun v. Montefiore Medical Center" on Justia Law 2015-07-17 federal U.S. Court of Appeals for the Second Circuit Raymond Joseph Lohier, Jr. 13-3928 http://law.justia.com/cases/federal/appellate-courts/ca2/14-3455/14-3455-2015-07-15.html Henry L. Rojas, M.D. v. Cigna Health and Life Ins. Co. 2015-07-15T06:30:04-08:00 2015-07-15T08:26:14-08:00 Plaintiffs, physicians, filed suit against Cigna alleging that Cigna violated the anti-retaliation provisions of ERISA. Plaintiffs moved for a temporary restraining order and preliminary injunction to prohibit Cigna from terminating plaintiffs from its provider network. The district court denied the injunction and plaintiffs appealed. The court held that healthcare providers are not "beneficiaries" of an ERISA welfare plan by virtue of their in‐network status or their entitlement to payment. Patients may assign to their doctors the right to collect payment on their behalf in exchange for medical services, but the doctors in this case do not seek payment; instead, they seek to assert anti‐retaliation protections which were not assigned to them. Accordingly, the court affirmed the judgment. View "Henry L. Rojas, M.D. v. Cigna Health and Life Ins. Co." on Justia Law 2015-07-15 federal U.S. Court of Appeals for the Second Circuit Richard C. Wesley 14-3455 http://law.justia.com/cases/federal/appellate-courts/ca3/14-1663/14-1663-2015-07-13.html Perelman v. Perelman 2015-07-13T09:00:05-08:00 2015-07-13T12:21:37-08:00 Jeffrey Perelman is a participant in the defined employee pension benefit plan of GRC and alleges that his father, Raymond, as chairman of GRC and trustee of the Plan, breached his fiduciary duties by covertly investing Plan assets in the corporate bonds of struggling companies owned and controlled by Jeffrey's brother, Ronald. Jeffrey claimed that these transactions were not properly reported; depleted Plan assets; and increased the risk of default, such that his own defined benefits are in jeopardy. The district court dismissed several claims for lack of standing; later granted summary judgment, rejecting all remaining claims; and denied Jeffrey attorneys' fees and costs under the Employee Retirement Income Security Act, 29 U.S.C. 1132. The Third Circuit affirmed, rejecting arguments that Jeffrey had standing to seek monetary equitable relief such as disgorgement or restitution under ERISA section 502(a)(3) because he suffered an increased risk of Plan default with respect to his defined benefits, and in seeking relief on behalf of the Plan, no showing of individual harm was necessary. The court upheld the denial of attorneys' fees and costs, rejecting claims that the lawsuit was a catalyst for the voluntary resolution of several issues, including Raymond's resignation as Trustee. View "Perelman v. Perelman" on Justia Law 2015-07-13 federal U.S. Court of Appeals for the Third Circuit Vanaskie 14-1663 http://law.justia.com/cases/federal/appellate-courts/ca9/13-55719/13-55719-2015-07-07.html Williams v. Nat'l Union Fire Ins. 2015-07-07T09:01:17-08:00 2015-07-07T11:29:43-08:00 Plaintiff filed suit against National Union under the Employee Retirement Income Security Act (ERISA), 29 U.S.C. 1001 et seq., which permits a beneficiary of an employee benefit plan to bring a civil action to recover benefits owed under the plan. Plaintiff claimed that her husband's death occurred as a result of an accident as defined by the policy. Plaintiff's husband died as a result of Deep Vein Thrombosis (DVT) shortly after he completed roughly 28 hours of air travel in a five-day period. The court concluded that regardless of whether the husband's death may be characterized as an externally caused "accident" when considering that word in isolation, his loss of life was not within the policy's coverage. His fatal injury did not directly result from an unintended and unanticipated happening "external to the body." Accordingly, the court affirmed the district court's grant of summary judgment for National Union. View "Williams v. Nat'l Union Fire Ins." on Justia Law 2015-07-07 federal U.S. Court of Appeals for the Ninth Circuit Lipez 13-55719 http://law.justia.com/cases/federal/appellate-courts/ca2/14-2487/14-2487-2015-07-01.html UFCW Local One Pension Fund v. Enivel Properties, LLC 2015-07-01T06:30:04-08:00 2015-07-01T12:12:19-08:00 The Fund filed suit against Empire under the Multiemployer Pension Plan Amendments Act of 1980 (MPPAA), 29 U.S.C. §§ 1381–1453, after Empire effected a "complete withdrawal" from the Fund. Steven Levine was the sole shareholder of Empire. The Fund also filed suit against Enivel to recover on its judgment against Empire, alleging that Enivel is a trade or business under common control with Empire such that it is jointly and severally liable for Empire's withdrawal liability. At issue was whether a separate business organization can be held responsible for the liabilities of another commonly controlled entity under the Employee Retirement Income Security Act of 1974 (ERISA), as amended by the MPPAA. The court concluded that, although Enivel and Empire are commonly controlled, Enivel's limited leasing and sales activity was personal in nature - not primarily for profit - and Enivel did not operate continuously and regularly. The owners did not fragment their business operations over several entities. Rather, Enivel's mission was primarily personal and any profit it derived was incidental. Therefore, the court concluded that Enivel is not a "trade or business" for the purposes of the MPPAA and affirmed the district court's judgment for Enivel. View "UFCW Local One Pension Fund v. Enivel Properties, LLC" on Justia Law 2015-07-01 federal U.S. Court of Appeals for the Second Circuit Richard C. Wesley 14-2487 http://law.justia.com/cases/federal/appellate-courts/ca11/14-13207/14-13207-2015-06-30.html Pruitt v. Suntrust Banks, Inc. 2015-06-30T08:30:58-08:00 2015-06-30T11:28:52-08:00 In these consolidated appeals, plaintiffs claimed that defendants breached their fiduciary duties under the Employee Retirement Income Security Act (ERISA), 29 U.S.C. 1001, et seq. While the appeals were pending, the Supreme Court issued its decision in Tibble v. Edison International, which held that a plaintiff can effectively allege that a defendant breached its duty of prudence under ERISA "by failing to properly monitor investments and remove imprudent ones[,] . . . [and] so long as the alleged breach of the continuing duty occurred within six years of suit, the claim is timely." The parties agreed that these cases should be remanded in light of Tibble. The court agreed and therefore vacated the judgments and remanded for further proceedings. The court declined to reassign the case to a new district judge. View "Pruitt v. Suntrust Banks, Inc." on Justia Law 2015-06-30 federal U.S. Court of Appeals for the Eleventh Circuit Per curiam 14-13207 14-13789 http://law.justia.com/cases/federal/appellate-courts/ca4/13-2403/13-2403-2015-06-29.html Trustees of the Plumbers v. Plumbing Svc. 2015-06-29T14:53:43-08:00 2015-06-29T21:58:35-08:00 After PSI stopped contributing to the Fund, a multiemployer pension benefit plan governed by the Employment Retirement Income Security Act of 1974 (ERISA), 29 U.S.C. 1001 et seq., the Fund informed PSI that it owed "withdrawal liability" pursuant to section 1381. The Fund filed suit against PSI after PSI failed to pay the sum owed. The court affirmed the judgment, finding that the district court had personal and subject matter jurisdiction, venue was proper in Virginia, and PSI bound itself to make contributions to the Fund. View "Trustees of the Plumbers v. Plumbing Svc." on Justia Law 2015-06-29 federal U.S. Court of Appeals for the Fourth Circuit Albert Diaz 13-2403 http://law.justia.com/cases/federal/appellate-courts/ca8/14-1655/14-1655-2015-06-17.html Munro-Kienstra v. Carpenters' Health & Welfare Trust Fund of St. Louis 2015-06-17T07:01:15-08:00 2015-06-17T10:44:16-08:00 Kienstra, a Missouri resident, received treatment for uterine fibroid tumors at the Mayo Clinic in 2008. Her health plan concluded that her treatment fell outside the plan's coverage as experimental and requiring prior approval. Internal appeals failed. The plan is a self-funded multiple employer plan, maintained pursuant to collective bargaining agreements, and subject to the Employee Retirement Income Security Act, 29 U.S.C. 1002(1). The plan specified that any civil action for wrongful denial of medical benefits under ERISA must be filed within two years of the final date of denial. Kienstra filed suit almost two and a half years after she learned her claim had been denied. She unsuccessfully argued that the contractual limitations period was invalid because the plan's rules of construction stated that its terms should be read to comply with Missouri law, that a 10-year Missouri statute of limitations governed, and that a separate statute barred contracting parties from shortening that limitations period. The Eighth Circuit affirmed. There is no conflict between the plan's contractual limitations period and Missouri law; state law does not "apply of its own force to a suit based on federal law—especially a suit under ERISA, with its comprehensive preemption provision." View "Munro-Kienstra v. Carpenters' Health & Welfare Trust Fund of St. Louis" on Justia Law 2015-06-17 federal U.S. Court of Appeals for the Eighth Circuit Murphy 14-1655 http://law.justia.com/cases/federal/appellate-courts/ca4/14-1011/14-1011-2015-06-08.html Pender v. Bank of America Corp. 2015-06-08T11:00:23-08:00 2015-06-08T19:09:17-08:00 Plaintiffs filed suit under the Employee Retirement Income Security Act of 1974 (ERISA), 29 U.S.C. 1001 et seq., seeking disgorgement from an employer who wrongly transferred assets from a pension plan that enjoyed a separate account feature to a pension plan that lacked one. The district court dismissed the complaint, holding that plaintiffs lacked statutory and Article III standing. The court held, however, that a defined contribution plan's separate account feature constitutes an "accrued benefit" that "may not be decreased by amendment of the plan" under section 204(g)(1). In this case, the transfers at issue resulted in a loss of the separate account feature and thus violated section 204(g)(1). Therefore, plaintiffs have statutory standing. Further, plaintiffs have Article III standing where plaintiffs incurred an injury in fact, and satisfied the causation and redressability requirements. Finally, the court joined the majority of its sister circuits and held that the transferor court's choice-of-law rules apply when a case has been transferred pursuant to 28 U.S.C. § 1404(a). Here, the court concluded that the statute of limitations cannot serve as a basis for affirming the district court's grant of summary judgment to the Bank. Accordingly, the court reversed and remanded for further proceedings. View "Pender v. Bank of America Corp." on Justia Law 2015-06-08 federal U.S. Court of Appeals for the Fourth Circuit James Andrew Wynn, Jr. 14-1011 http://law.justia.com/cases/federal/appellate-courts/ca2/13-4725/13-4725-2015-06-04.html Yale-New Haven Hosp. v. Nicholls 2015-06-04T06:30:05-08:00 2015-06-04T11:43:05-08:00 The Hospital filed an interpleader action under the Employee Retirement Income Security Act (ERISA), 29 U.S.C. 1001 et seq., to resolve competing claims by Barbara Nicholls and Clair Nicholls to certain funds held in the four retirement and pension plans of the late Harold Nicholls. Barbara is Harold's surviving spouse and Claire is Harold's former spouse. The district court granted summary judgment in favor of Claire because the divorce settlement agreement constitutes a qualified domestic relations order (QDRO). The court found that the divorce settlement agreement does not constitute a QDRO because the agreement fails to comply with the requirements of 29 U.S.C. § 1056(d)(3)(C); however, the nunc pro tunc orders constitute valid QDROs that assign funds to Claire from the three retirement and pension plans named in the orders; but because the nunc pro tunc orders do not clearly specify the fourth plan, the orders do not assign funds from that plan to Claire. Accordingly, the court affirmed in part and reversed in part. View "Yale-New Haven Hosp. v. Nicholls" on Justia Law 2015-06-04 federal U.S. Court of Appeals for the Second Circuit Chester J. Straub 13-4725 http://law.justia.com/cases/federal/appellate-courts/ca2/14-0877/14-0877-2015-06-01.html Ocampo v. Building Service 32B-J Pension Fund 2015-06-01T06:30:04-08:00 2015-06-01T07:22:10-08:00 Plaintiff filed suit under the Employee Retirement Income Security Act (ERISA), 29 U.S.C. 1001 et seq., seeking a pension based on permanent disability. On appeal, plaintiff challenged the district court's grant of defendants' motion for summary judgment. The district court granted the motion based on the ground that the Pension Plan gave defendants discretion to determine an applicant's eligibility for pension benefits and that defendants' reliance on SSA determinations, policies, and procedures in this matter was neither arbitrary nor capricious. The court rejected plaintiff's contentions that the real decisionmaker on her benefits applications was the SSA and that the Trustees exercised no discretion but simply rubber-stamped SSA decisions. The court concluded that the district court properly reviewed the Trustees' denial of plaintiff's application under the arbitrary-and-capricious standard. Further, the record also provides no support for plaintiff's contention that the Trustees' denial of her application for a permanent-disability pension was arbitrary and capricious. The court concluded that all of plaintiff's arguments are without merit and the court affirmed the judgment. View "Ocampo v. Building Service 32B-J Pension Fund" on Justia Law 2015-06-01 federal U.S. Court of Appeals for the Second Circuit Amalya Lyle Kearse 14-0877 http://law.justia.com/cases/federal/appellate-courts/ca9/12-56541/12-56541-2015-05-28.html LeGras v. AETNA Life Ins. Co. 2015-05-28T09:00:56-08:00 2015-05-28T09:07:51-08:00 Plaintiff filed suit against AETNA under the civil enforcement provision of the Employee Retirement Income Security Act (ERISA), 29 U.S.C. 1132. AETNA had denied plaintiff's application for continued long-term disability benefits and allowed plaintiff to file an internal appeal within 180 days. The district court dismissed the action for failure to exhaust administrative remedies. The court reversed, holding that because the last day of the appeal period fell on a Saturday, neither that day nor Sunday count in the computation of the 180 days. In this case, because plaintiff mailed his notice of appeal on Monday, it was timely. The court concluded that this method of counting time is widely recognized and furthers the goals and purposes of ERISA. and therefore, the court adopted it as part of ERISA's federal common law. View "LeGras v. AETNA Life Ins. Co." on Justia Law 2015-05-28 federal U.S. Court of Appeals for the Ninth Circuit Paez 12-56541 http://law.justia.com/cases/hawaii/supreme-court/2015/scwc-30286.html Rodrigues v. United Public Workers, AFSCME Local 646 2015-05-27T13:07:13-08:00 2015-05-27T18:14:35-08:00 Petitioner, the former State director of United Public Workers, AFSCME Local 646, FL-CIO (UPW) and a former administrator of UPW's Mutual Aid Fund trust (MAF), was held liable by a federal district court for negligently making loans under ERISA and thus breaching his fiduciary duties to the MAF. The court entered judgment against Petitioner in the amount of $850,000. Petitioner filed a complaint in the circuit court requesting that UPW indemnify him for the $850,000 on the grounds that his liability to the MAF arose from actions he took solely in his capacity as agent for UPW and/or that UPW ratified his actions. The circuit court granted summary judgment for UPW. The Intermediate Court of Appeals (ICA) affirmed, concluding that because Petitioner was responsible for his own conduct, he was not entitled to be indemnified for his negligent acts as a matter of law. Petitioner requested certiorari, claiming that the ICA erred in concluding that his negligence claim defeated his indemnification claim as a matter of law. The Supreme Court denied certiorari without reaching this issue, holding that ERISA preemption, not Petitioner's negligence, defeated Petitioner's state indemnity claims against UPW as a matter of law. View "Rodrigues v. United Public Workers, AFSCME Local 646" on Justia Law 2015-05-27 state Hawaii Supreme Court of Hawaii Michael D. Wilson SCWC-30286 http://law.justia.com/cases/federal/appellate-courts/ca7/14-2370/14-2370-2015-05-19.html Orr v. Assurant Emp. Benefits 2015-05-19T10:30:41-08:00 2015-05-19T10:58:32-08:00 Orr died in a motorcycle accident. His daughters sought benefits under a group life insurance policy governed by the Employment Retirement Income Security Act and issued by USIC to Orr's former employer. The policy provided accidental death, subject to exclusions, including one for loss resulting "directly or indirectly from … intoxication[.]" USIC asserted that Orr's death resulted from his intoxication. The letter explained that autopsy and toxicology reports revealed that Orr's blood alcohol level at the time of the accident exceeded the legal limit and that USIC's medical consultant opined that Orr "would have been impaired in attention, coordination, and balance," as a result. The letter advised the Orrs of their right to seek review and included a copy of USIC's Life Claims Denial Review Procedure, stating, in boldfaced, all-caps print, that a request for review must be submitted in writing within 60 days and warning: "If … you do not complete both the first and second review before filing a lawsuit, a court can dismiss your lawsuit." The document encourages claimants to call with any questions. The Orrs filed suit before completing the review process. The Seventh Circuit affirmed summary judgment in favor of USIC on grounds of failure to exhaust administrative remedies. View "Orr v. Assurant Emp. Benefits" on Justia Law 2015-05-19 federal U.S. Court of Appeals for the Seventh Circuit William Joseph Bauer 14-2370 http://law.justia.com/cases/federal/us/575/13-550/ Tibble v. Edison Int'l 2015-05-18T08:30:16-08:00 2015-05-18T08:45:05-08:00 In 2007, beneficiaries of the Edison 401(k) Savings Plan sued Plan fiduciaries, to recover damages for alleged losses suffered because of alleged breaches of fiduciary duties. The beneficiaries claimed violations with respect to mutual funds added to the Plan in 1999 and mutual funds added to the Plan in 2002, by acted imprudently in offering higher priced retail-class mutual funds as Plan investments when materially identical lower priced institutional-class mutual funds were available. Because ERISA requires a breach of fiduciary duty complaint to be filed no more than six years after "the date of the last action which constitutes a part of the breach or violation" or "in the case of an omission the latest date on which the fiduciary could have cured the breach or violation," 29 U.S.C. 1113, the district court found the complaint as to the 1999 funds untimely. The Ninth Circuit affirmed, concluding that beneficiaries had not established a change in circumstances that might trigger an obligation to conduct a full due diligence review of the funds within the six-year period. A unanimous Supreme Court vacated. ERISA's fiduciary duty is derived from the common law of trusts, which provides that a trustee has a continuing duty, separate from the duty to exercise prudence in initially selecting investments, to monitor, and remove imprudent trust investments. So long as a claim alleging breach of the continuing duty of prudence occurred within six years of suit, the claim is timely. The Court remanded for the Ninth Circuit to consider claims that the fiduciaries breached their duties within the relevant 6-year statutory period, considering analogous trust law. View "Tibble v. Edison Int'l" on Justia Law 2015-05-18 federal U.S. Supreme Court Stephen G. Breyer 13-550 http://law.justia.com/cases/federal/appellate-courts/ca2/13-4532/13-4532-2015-05-14.html Roganti v. Metro. Life Ins. Co. 2015-05-14T06:30:04-08:00 2015-05-14T20:17:48-08:00 MetLife appealed the district court's judgment in favor of plaintiff on his claim for pension benefits pursuant to the Employee Retirement Income Security Act (ERISA), 29 U.S.C. 1001 et seq. The court concluded that MetLife's denial of plaintiff's benefits claim was not arbitrary and capricious where MetLife's rationale for denying plaintiff's claim - that it was impossible to determine whether, or to the extent to which, a FINRA award represented back pay - was not, in fact, unreasonable. The court did not reach MetLife's alternative argument. Accordingly, the court reversed the district court's judgment granting plaintiff relief under ERISA. The court affirmed the denial of plaintiff's request for attorney's fees. View "Roganti v. Metro. Life Ins. Co." on Justia Law 2015-05-14 federal U.S. Court of Appeals for the Second Circuit Debra Ann Livingston 13-4532 http://law.justia.com/cases/federal/appellate-courts/ca5/14-20358/14-20358-2015-05-11.html Humana Health Plan v. Nguyen 2015-05-11T13:30:26-08:00 2015-05-11T13:45:44-08:00 Defendant, a participant in the API Enterprises Employee Benefits Plan, appealed the district court's grant of summary judgment in favor of Humana, API's Plan Manager. Humana filed suit under the Employee Retirement Income Security Act (ERISA), 29 U.S.C. 1001 et seq., against defendant seeking, inter alia, an injunction prohibiting him from disposing of an insurance payout and an "equitable lien to enforce ERISA and the terms of the Plan." The court concluded that the district court erred in determining that Humana is an ERISA fiduciary for two reasons: first, the district court's interpretation of the Plan Management Agreement (PMA) is not persuasive where the district court focused on the subrogation and recovery clause, which do not show that Humana had discretion over the Plan or its assets; and second, even if the court interpreted the PMA to give Humana broad power, the district court failed to explain why Humana is not a ministerial agent. Therefore, the court reversed and remanded for further proceedings. View "Humana Health Plan v. Nguyen" on Justia Law 2015-05-11 federal U.S. Court of Appeals for the Fifth Circuit Edith Brown Clement 14-20358 http://law.justia.com/cases/federal/appellate-courts/ca3/13-4493/13-4493-2015-05-08.html Templin v. Independence Blue Cross 2015-05-08T08:30:04-08:00 2015-05-08T11:14:57-08:00 Insurance companies allegedly refused to honor claims for payment of blood-clotting-factor products. After they paid the claims in full, the district court dismissed a complaint under the Employees Retirement Income Security Act (ERISA) and state law. Following dismissal, both the plaintiffs and defendants sought attorney's fees and costs. The Third Circuit affirmed denial, but remanded one issue: whether the plaintiffs were entitled to interest on the delayed payment of benefits. On remand, they sought interest of $1.5 to $1.8 million, primarily under the Maryland Code, with $68,000 based on the federal Treasury bill rate. The companies agreed to pay $68,000.00 in interest and the district court dismissed the case. Plaintiffs then sought attorney's fees and costs of $349,385.15. The district court denied the motion, finding that plaintiffs had failed to achieve "some degree of success on the merits" as required for an award of fees under ERISA. The Third Circuit reversed, holding that the court used an incorrect legal standard to evaluate eligibility for attorney's fees and misapplied the "Ursic" factors. The "catalyst theory" of recovery is available to the plaintiffs and judicial action is not required under that theory in order to establish some degree of success. View "Templin v. Independence Blue Cross" on Justia Law 2015-05-08 federal U.S. Court of Appeals for the Third Circuit Richard Lowell Nygaard 13-4493 http://law.justia.com/cases/federal/appellate-courts/ca7/14-2888/14-2888-2015-05-06.html Reilly v. Continental Cas. Co. 2015-05-06T08:31:08-08:00 2015-05-06T11:00:23-08:00 Reilly participated in a pension plan offered by Continental, which administers its own defined-benefit plan. The pension depends on the highest average compensation in any 60-month period of employment. "Compensation" includes regular salary, incentive compensation, and deferred compensation deposited in 401(k) plans. Educational bonuses, referral bonuses, overseas allowances, and some other items are not included. When Reilly left Continental's employ in 1999, he received a statement of qualifying compensation that implied a monthly benefit of about $5,400 starting in 2012, when he would turn 65. In 2012, Continental sent Reilly a different calculation, showing lower compensation and entitlement to $4,200 a month. After internal appeals, Reilly filed suit under the Employee Retirement Income Security Act, 29 U.S.C. 1132(a)(1)(B). The district judge concluded that Continental's decision was arbitrary and capricious and ordered it to pay monthly benefits of $5,400. The Seventh Circuit reversed. Reilly did not show that $5,400 is the only possible outcome of proper calculation, only that the calculation was improper. By working through the original compensation numbers, the parties may agree what the right pension is. If not, the district court must remand to Continental so that the administrator can make a fresh calculation, which then could be subjected to judicial review. View "Reilly v. Continental Cas. Co." on Justia Law 2015-05-06 federal U.S. Court of Appeals for the Seventh Circuit Frank Hoover Easterbrook 14-2888 http://law.justia.com/cases/federal/appellate-courts/ca1/14-2059/14-2059-2015-04-21.html Niebauer v. Crane & Co., Inc. 2015-04-21T12:00:21-08:00 2015-04-21T18:38:32-08:00 Plaintiff brought this complaint under the Employee Retirement Income Security Act (ERISA), alleging (1) the administrator of his former employer's executive severance plan denied him severance benefits after improperly determining that he had voluntarily retired from his position, and (2) his former employer impermissibly interfered with his protected rights under the plan. The district court granted summary judgment for Defendants on both counts. The First Circuit (1) affirmed the district court's judgment with regard to the plan administrator's decision to deny Plaintiff's claim for benefits, holding the decision was both supported by substantial evidence and procedurally proper; but (2) vacated the district court's judgment as to the interference claim, holding that the district court relied on the incorrect standard in assessing the interference claim. Remanded for application of the appropriate standard of review. View "Niebauer v. Crane & Co., Inc." on Justia Law 2015-04-21 federal U.S. Court of Appeals for the First Circuit Stahl 14-2059 http://law.justia.com/cases/federal/appellate-courts/ca9/12-17355/12-17355-2015-04-21.html Prichard v. Metro. Life Ins. Co. 2015-04-21T09:00:59-08:00 2015-04-21T19:40:01-08:00 After a series of unsuccessful appeals to an ERISA plan administrator after the administrator's decision to deny him long-term disability benefits, Plaintiff brought this action under 29 U.S.C. 1132(a)(1)(B). The district court affirmed. The Ninth Circuit vacated the district court's judgment, holding that the district court erred in reviewing the denial of benefits for an abuse of discretion, rather than de novo, when a Summary Plan Description conferred discretionary authority upon the plan administrator but an insurance certificate, a governing plan document, did not. Remanded for the district court to review the plan administrator's denial of benefits de novo. View "Prichard v. Metro. Life Ins. Co." on Justia Law 2015-04-21 federal U.S. Court of Appeals for the Ninth Circuit Wallace 12-17355 http://law.justia.com/cases/federal/appellate-courts/ca6/12-1786/12-1786-2015-04-20.html Operating Eng'rs Local 324 v. G & W Constr. Co. 2015-04-20T06:00:53-08:00 2015-04-20T07:46:21-08:00 Nine multi-employer pension and welfare fringe benefit trust funds sued G&W Construction and its president, under the Labor Management Relations Act, 29 U.S.C. 185(a), and the Employee Retirement Income Security Act (ERISA), 29 U.S.C. 1145, to recover delinquent fringe-benefit payments under a contract between G&W and the Union. The defendants raised affirmative defenses of laches, estoppel, and waiver, alleging that the Union led G&W to believe that fringe benefit payments were due only for union members and that G&W relied upon the acts and omissions of the Union and the funds by bidding and accepting work on the reasonable understanding that Union wages and benefits did not apply to non-members. The Funds moved to strike the affirmative defenses, arguing that ERISA bars equitable defenses. The district court denied the motion to strike. The Sixth Circuit reversed in part. The district court should have granted the motion to strike the defenses of laches and equitable estoppel; the court declined to consider the district court's ruling on the waiver defense. View "Operating Eng'rs Local 324 v. G & W Constr. Co." on Justia Law 2015-04-20 federal U.S. Court of Appeals for the Sixth Circuit Jane Branstetter Stranch 12-1786 http://law.justia.com/cases/federal/appellate-courts/ca1/14-1293/14-1293-2015-04-15.html McDonough v. Aetna Life Ins. Co. 2015-04-15T14:00:20-08:00 2015-04-15T18:28:51-08:00 Appellant was eligible for disability benefits through an employee welfare benefit plan underwritten by Aetna Life Insurance Company. Appellant successfully applied for long-term disability (LTD) benefits under his plan in 2009. Later that year, Appellant's LTD benefits were terminated. Appellant brought this suit against Aetna under the Employee Retirement Income Security Act of 1974 alleging wrongful termination of benefits. The federal district court granted summary judgment for Aetna on the benefits-termination claim but applied a $5,000 penalty against Aetna for its failure to produce all relevant plan documents within the statutorily prescribed time. The First Circuit (1) vacated summary judgment with respect to the termination of disability benefits and remanded the issue for further consideration by the claims administrator, holding that Aetna's decision to terminate Appellant's LTD benefits was not a reasoned determination; and (2) affirmed the district court's imposition of a $5,000 penalty for the belated production of a plan document, holding that the amount of the penalty imposed was within the district court's discretion. View "McDonough v. Aetna Life Ins. Co." on Justia Law 2015-04-15 federal U.S. Court of Appeals for the First Circuit Selya 14-1293 http://law.justia.com/cases/federal/appellate-courts/ca9/11-15472/11-15472-2015-04-07.html Barboza v. Cal. Ass'n of Prof'l Firefighters 2015-04-07T09:01:08-08:00 2015-04-07T19:21:03-08:00 This case arose out of a disability benefits dispute between Plaintiff, a retired firefighter for the City of Tracy, California, and the California Association of Professional Firefighters (CAPF), the manager of an employee welfare benefit plan. While a related action was ongoing, Plaintiff initiated a second lawsuit against CAPF, California Administration Insurance Services, Inc. (CAISI), and individual members of the board of directors for both CAPF and CAISI, alleging that Defendants had breached their fiduciary duties under ERISA in the management and administration of the plan. A panel of the Ninth Circuit affirmed in part and reversed in part the district court's judgment, holding that the district court (1) correctly granted summary judgment for Defendants on a claim that they breached their duty to hold plan assets in trust; (2) erred in granting summary judgment for Defendants on a claim that they breached their fiduciary duties by engaging in unlawful self-dealing; and (3) erred in granting partial summary judgment for Plaintiff where Defendants did not breach their fiduciary duties by failing to distribute a summary annual report. Remanded. View "Barboza v. Cal. Ass'n of Prof'l Firefighters" on Justia Law 2015-04-07 federal U.S. Court of Appeals for the Ninth Circuit Sandra S. Ikuta 11-15472 11-16024 11-16081 11-16082 http://law.justia.com/cases/federal/appellate-courts/ca1/14-1450/14-1450-2015-03-30.html Dutkewych v. Standard Ins. Co. 2015-03-30T13:30:20-08:00 2015-03-30T21:53:59-08:00 Plaintiff was a participant in a disability plan (Plan), which was insured and administered by Defendant under ERISA. The Plan limited long-term disability (LTD) benefits to twenty-four months for a disability caused or contributed to by mental disorders, substance abuse, or other limited conditions. Defendant terminated Plaintiff's benefits after twenty-four months after applying this limited conditions provision. After his unsuccessful administrative appeal, Plaintiff filed suit against Defendant for unpaid benefits. Specifically, Plaintiff argued that he had been diagnosed with chronic Lyme disease, a physical illness allegedly not limited under the terms of the Plan. The district court granted summary judgment in favor of Defendant. The First Circuit affirmed, holding that even if Plaintiff was disabled as a result of chronic Lyme disease, the mental disorder limitation nonetheless applied because Plaintiff's mental disorders contributed to his disability as of June 1, 2011. View "Dutkewych v. Standard Ins. Co." on Justia Law 2015-03-30 federal U.S. Court of Appeals for the First Circuit Sandra Lea Lynch 14-1450 http://law.justia.com/cases/federal/appellate-courts/ca2/13-3790/13-3790-2015-03-27.html Concerned Home Care Providers, Inc. v. Cuomo 2015-03-27T06:30:03-08:00 2015-03-27T07:43:34-08:00 Home health care plaintiffs sought to prevent the Commissioner of the New York State Department of Health, from enforcing the Wage Parity Law, which sets the minimum amount of total compensation that employers must pay home care aides in order to receive Medicaid reimbursements for reimbursable care provided in New York City and Westchester, Suffolk, and Nassau Counties, N.Y. Pub. Health Law 3614‐c. Plaintiffs claim the Law was either preempted by the National Labor Relations 8 Act, 29 U.S.C. 151, or the Employee Retirement Income Security Act, 29 U.S.C. 1001, or was unconstitutional under the Due Process and Equal Protection Clauses. The Second Circuit affirmed the district court conclusion that the state law, except for one severable provision subdivision that singles out Taft‐Hartley plans for special treatment, is neither preempted nor unconstitutional. View "Concerned Home Care Providers, Inc. v. Cuomo" on Justia Law 2015-03-27 federal U.S. Court of Appeals for the Second Circuit Debra Ann Livingston 13-3790 http://law.justia.com/cases/federal/appellate-courts/ca3/13-4633/13-4633-2015-03-18.html Cottillion v. United Ref. Co 2015-03-18T08:30:08-08:00 2015-03-18T10:24:41-08:00 Cottillion worked at United from 1960 until 1989; his benefits had vested under "the 1980 Plan." Cottillion, then age 54, was among "terminated vested participants" (TVPs), distinct from Early Retirees, who retired at an age older than 59½ or 60, but younger than 65. United informed Cottillion that he could elect to have his monthly retirement benefit begin after October, 1995 (age 60), and that his monthly benefit would be $573.70 at age 60. The letter did not state that the amount depended on whether he elected to receive it at age 60 or later. In 2002, United amended the plan, to comply with Employee Retirement Income Security Act amendments, and receive favorable tax treatment. Later Plans included language, absent from the 1980 and 1987 Plans, stating that the benefits of TVPs who receive pensions before age 65 would be "actuarially reduced to reflect the earlier starting date." In 2005, actuaries informed the plan that United had erroneously paid pensions that were not "actuarially reduced" to TVPs vested under the 1980 and 1987 Plans. Because deviations from the terms of ERISA-governed plans can jeopardize favorable tax treatment, United sought recoupment under the IRS's voluntary correction program. Cottillion's pension was eliminated, and he was told he should pay the Plan $14,475. The district court granted class certification and held that United's actions violated ERISA's anti-cutback rule, 29 U.S.C. 1054(g). The Third Circuit affirmed. View "Cottillion v. United Ref. Co" on Justia Law 2015-03-18 federal U.S. Court of Appeals for the Third Circuit Thomas L. Ambro 13-4633 http://law.justia.com/cases/federal/appellate-courts/ca6/12-2074/12-2074-2015-03-05.html Rochow v. Life Ins. Co. of North Am. 2015-03-05T10:00:52-08:00 2015-03-05T10:37:51-08:00 In 2000, Rochow sold his interest in Universico to Gallagher and became President of Gallagher. As Gallagher employee, Rochow was covered under a LINA disability policy. In 2001, Rochow began to experience short term memory loss, chills, sweating, and stress. Gallagher demoted Rochow and forced Rochow to resign in January, 2002. In February 2002, Rochow experienced amnesia, was hospitalized, and was diagnosed with HSV-Encephalitis, a rare, severely debilitating brain infection. LINA repeatedly denied Rochow benefits stating that Rochow's employment ended before his disability began. Rochow sued Cigna, LINA's parent company, alleging breach of fiduciary duty under ERISA, 29 U.S.C. 1104(a). In 2007 the Sixth Circuit affirmed a decision that denial of Rochow's claims was arbitrary and did not appear to have been made solely in the interest of the participants and beneficiaries or the exclusive purpose of providing benefits to participants and beneficiaries as required by ERISA. Rochow died in 2008. In 2009, the district court ordered an equitable accounting of profits and disgorgement of $3,797,867 under an equitable theory of unjust enrichment. The Sixth Circuit affirmed in 2013. Following rehearing en banc, the Sixth Circuit later vacated the disgorgement award and remanded the case to determine whether Rochow is entitled to prejudgment interest. View "Rochow v. Life Ins. Co. of North Am." on Justia Law 2015-03-05 federal U.S. Court of Appeals for the Sixth Circuit McKEAGUE 12-2074 http://law.justia.com/cases/federal/appellate-courts/ca10/13-3230/13-3230-2015-02-24.html Fulghum v. Embarq Corporation 2015-02-24T11:01:02-08:00 2015-02-25T04:38:53-08:00 Plaintiffs-appellants represent a class of retirees formerly employed by Sprint-Nextel Corporation, Embarq Corporation (or a predecessor and/or subsidiary company of either Embarq or Sprint). Plaintiffs sued after Defendants altered or eliminated health and life insurance benefits for retirees. Plaintiffs asserted Defendants: (1) violated the Employee Retirement Income Security Act of 1974 (ERISA) by breaching their contractual obligation to provide vested health and life insurance benefits; (2) breached their fiduciary duty by, inter alia, misrepresenting the terms of multiple welfare benefit plans; and (3) violated the Age Discrimination in Employment Act (ADEA) and applicable state laws by reducing or eliminating the same benefits. Defendants moved for summary judgment on the breach of fiduciary duty claims, the ADEA claims, the state-law age discrimination claims, and some of the contractual vesting claims. The district court granted Defendants' motions in part and Plaintiffs obtained a Rule 54(b) certification. The Tenth Circuit concluded Defendants did not contractually agree to provide Plaintiffs with lifetime health or life insurance benefits and thus affirmed in part the grant of summary judgment as to the contractual vesting claims. To the extent the district court granted summary judgment against class members whose contractual vesting claims arise, in whole or in part, from summary plan descriptions (other than those identified in Defendants' motion), the Court reversed the grant of summary judgment against those class members. The Court reversed the district court's dismissal of Plaintiffs' breach of fiduciary duty claims brought pursuant to 29 U.S.C. 1132(a)(3) and reversed the dismissal of Plaintiffs' remaining breach of fiduciary duty claims to the extent those claims were premised on a fraud theory. Finally, because Defendants' decision to reduce or terminate the group life insurance benefit was based on a reasonable factor other than age, their actions did not violate the ADEA, and the Tenth Circuit affirmed the grant of summary judgment in favor of Defendants on those claims. View "Fulghum v. Embarq Corporation" on Justia Law 2015-02-24 federal U.S. Court of Appeals for the Tenth Circuit Michael R. Murphy 13-3230 http://law.justia.com/cases/federal/appellate-courts/cadc/13-5254/13-5254-2015-02-20.html Deppenbrook v. Pension Benefit Guaranty Corp. 2015-02-20T07:31:14-08:00 2015-02-20T09:25:52-08:00 Plaintiff filed suit against PBGC, alleging claims under the Employee Retirement Income Security Act (ERISA), 29 U.S.C. 1001 et seq., and seeking to correct PBGC's benefit determinations. The court concluded that PBGC properly interpreted the provisions of ERISA and did not act arbitrarily or capriciously in declining to provide shutdown benefits to plaintiff; PBGC properly interpreted ERISA and did not act arbitrarily or capriciously in failing to insure plaintiff's individual account; and, assuming arguendo that PBGC in fact amended the pension plan, plaintiff cannot identify a statutory provision that bars PBGC from doing so. Accordingly, the court affirmed the district court's grant of summary judgment to PBGC. View "Deppenbrook v. Pension Benefit Guaranty Corp." on Justia Law 2015-02-20 federal U.S. Court of Appeals for the District of Columbia Circuit Henderson 13-5254 http://law.justia.com/cases/federal/appellate-courts/ca7/14-2034/14-2034-2015-02-06.html Hotel 71 Mezz Lender LLC v. National Retirement Fund 2015-02-06T12:00:51-08:00 2015-02-06T16:29:52-08:00 National Retirement Fund sought to hold Mezz Lender and Oaktree Capital responsible for multiemployer pension fund withdrawal liability under the Multiemployer Pension Plan Amendments Act of 1980, 29 U.S.C. 1381. Oaktree, through Mezz Lender, provided financing for the acquisition of a hotel by Chicago H&S. When H&S defaulted, it was taken into bankruptcy and the hotel was liquidated. NRF contends that the sale of the hotel triggered withdrawal liability on the part of H&S and any other "trade or business" under common control with it, including bot Oaktree and Mezz Lender. Oaktree and Mezz Lender, argued that the claim of withdrawal liability was barred by the bankruptcy reorganization plan pursuant to which the hotel was sold. On motions for summary judgment, the court stated that having decided that Oaktree and Mezz were not jointly and severally liable for H&S's withdrawal liability, "the Court need not address the parties' arguments as to [the Oaktree parties'] motion" concerning the bankruptcy. The Seventh Circuit vacated. The court decided in the absence of a cross-motion for summary judgment on the issue that it found to be dispositive, and without first giving the unsuccessful movant notice that it was entertaining the possibility of entering summary judgment against it or the opportunity to respond. View "Hotel 71 Mezz Lender LLC v. National Retirement Fund" on Justia Law 2015-02-06 federal U.S. Court of Appeals for the Seventh Circuit ROVNER 14-2034 http://law.justia.com/cases/federal/appellate-courts/ca2/14-1144/14-1144-2015-02-05.html Kirschenbaum v. U.S. Dept. of Labor 2015-02-05T07:30:07-08:00 2015-02-05T19:21:17-08:00 The Chapter 7 bankruptcy trustee appealed the district court's holding that the bankruptcy court did not have jurisdiction to order that he and his retained professionals be compensated for their services using the assets of a 401(k) plan pursuant to the Employee Retirement Income Security Act of 1974, 29 U.S.C. 1001 et seq. The court concluded that, in this case, no "arising under" jurisdiction exists and no "related to" jurisdiction exists. Accordingly, the court concluded that bankruptcy courts do not have jurisdiction to award compensation to the trustee in these circumstances and affirmed the judgment of the district court. View "Kirschenbaum v. U.S. Dept. of Labor" on Justia Law 2015-02-05 federal U.S. Court of Appeals for the Second Circuit Per Curiam 14-1144 http://law.justia.com/cases/federal/appellate-courts/ca9/13-35069/13-35069-2015-01-28.html Mays-Williams v. Williams 2015-01-28T10:01:14-08:00 2015-01-28T16:59:40-08:00 Before his retirement, Asa Williams, Sr. participated in various benefit programs (the Xerox Plans), which are subject to the Employee Retirement Income Security Act of 1974 (ERISA), 29 U.S.C. 1001 et seq. Asa married Carmen and designated Carmen as his beneficiary. After their divorce, Asa attempted to change his designated beneficiary from his ex-wife to his son (Asa, Jr.). After Asa, Sr.'s death, Carmen claimed to be the beneficiary under the Xerox Plans and Asa, Jr. likewise asserted the same claim. Carmen subsequently moved for summary judgment, asserting that because Asa, Sr. failed to fill out and to return the beneficiary designation forms, he did not properly designate Asa, Jr. as beneficiary in her place. The district court granted the motion. The court concluded that the district court erred in determining that Asa, Sr. was required to abide by the language contained in the forms - but not in the governing plan documents - to change his beneficiary from Carmen to Asa, Jr. Reviewing de novo whether Carmen or Asa, Jr. is entitled to plan benefits, the court concluded that based on the evidence, including Xerox's call log reflecting that Asa, Sr. called Xerox to change his beneficiary designation from Carmen to Asa, Jr., a reasonable trier of fact could determine that Asa, Sr. intended to change his beneficiary to Asa, Jr. and that his phone calls to Xerox constituted substantial compliance with the governing plan documents' requirements for changing his beneficiary designation. Accordingly, the court reversed and remanded. View "Mays-Williams v. Williams" on Justia Law 2015-01-28 federal U.S. Court of Appeals for the Ninth Circuit Diarmuid Fionntain O`Scannlain 13-35069 http://law.justia.com/cases/federal/us/574/13-1010/ M&G Polymers USA, LLC v. Tackett 2015-01-27T15:20:19-08:00 2015-01-27T15:44:30-08:00 M&G purchased the Point Pleasant Polyester Plant in 2000 and entered a collective bargaining agreement and a related Pension, Insurance, and Service Award Agreement with the union, providing that certain retirees, surviving spouses, and dependents, would "receive a full Company contribution towards the cost of [health care] benefits"; that such benefits would be provided "for the duration of [the] Agreement"; and that the Agreement would be subject to renegotiation in three years. After the expiration, M&G announced that it would require retirees to contribute to the cost of their health care benefits. Retirees sued, alleging that the 2000 Agreement created a vested right to lifetime contribution-free health care benefits. On remand, the district court ruled in favor of the retirees; the Sixth Circuit affirmed. The Supreme Court vacated and remanded, noting that welfare benefits plans are exempt from the Employee Retirement Income Security Act, 29 U.S.C. 1051(1), 1053, 1081(a)(2), 1083, and applying ordinary principles of contract law. The Court stated that Sixth Circuit precedent distorts ordinary principles of contract law, which attempt to ascertain the intention of the parties, "by placing a thumb on the scale in favor of vested retiree benefits in all collective-bargaining agreements." The Sixth Circuit did not consider the rules that courts should not construe ambiguous writings to create lifetime promises and that "contractual obligations will cease, in the ordinary course, upon termination of the bargaining agreement." View "M&G Polymers USA, LLC v. Tackett" on Justia Law 2015-01-26 federal U.S. Supreme Court Clarence Thomas 13-1010 http://law.justia.com/cases/federal/appellate-courts/cadc/13-5163/13-5163-2015-01-20.html Vanderkam v. Vanderkam 2015-01-20T07:31:12-08:00 2015-01-20T11:14:47-08:00 John and Melissa married in 1984. John enrolled in his employer's retirement plan and designated Melissa as the beneficiary of a qualified joint and survivor annuity. John retired in 1994. The survivor annuity irrevocably vested in Melissa; John began receiving benefits. In2002, they divorced, agreeing to a decree awarding John all "benefits existing by reason of [John's] past, present, or future employment." John remarried and sought to designate his new wife as the survivor annuity beneficiary. The plan advised John that this designation would be permissible if done by qualified domestic relations order (QDRO) that would not require the plan to increase benefits beyond actuarial estimates of John's and Melissa's life expectancies, 29 U.S.C. 1056(d)(3)(D). On John's motion, a Texas court entered a purported QDRO divesting Melissa of all ownership interests in the survivor annuity. The employer terminated its pension plan. Pension Benefit Guaranty Corporation (PBGC) became the plan's statutory trustee and determined that the supposed QDRO was invalid because it would require "a form of benefit, or [an] option, not otherwise provided under the plan" and because, unless waived in accordance with statutory procedures within 90 days, a spouse's right to the survivor annuity irrevocably vests on the annuity start date. The district court upheld the determination and found John's contract and unjust enrichment claims against Melissa preempted. The D.C. Circuit affirmed. View "Vanderkam v. Vanderkam" on Justia Law 2015-01-20 federal U.S. Court of Appeals for the District of Columbia Circuit David S. Tatel 13-5163 http://law.justia.com/cases/federal/appellate-courts/ca5/14-50368/14-50368-2015-01-15.html George v. Reliance Standard Life Ins. Co. 2015-01-16T05:00:54-08:00 2015-01-16T12:33:04-08:00 After RSL denied plaintiff's claim for long-term disability benefits, plaintiff, a helicopter pilot with an amputated leg, filed suit under the Employee Retirement Income Security Act (ERISA), 29 U.S.C. 1132(a)(1)(B). The district court held that the evidence supported RSL's determination that plaintiff's depression and PTSD contributed to his Total Disability. Therefore, RSL did not abuse its discretion by determining that the Exclusion Clause limited plaintiff's right to benefits. Declining to consider whether plaintiff carried his burden to show a right to benefits, the court held that RSL abused its discretion when it determined that plaintiff was not Totally Disabled where there was no evidence to show that he could earn a substantially similar salary in another position. Further, there is no rational connection between the fact that plaintiff can do sedentary work and the conclusion that he could earn a substantially similar salary in any alternative position. The court also held that RSL abused its discretion when it determined that the Exclusion Clause limited plaintiff's right to benefits, and when it affirmed RSL's determination on this basis. Accordingly, the court reversed and remanded, rendering judgment for plaintiff. View "George v. Reliance Standard Life Ins. Co." on Justia Law 2015-01-15 federal U.S. Court of Appeals for the Fifth Circuit Edith Brown Clement 14-50368 http://law.justia.com/cases/federal/appellate-courts/ca8/13-2645/13-2645-2014-12-30.html Johnson v. United of Omaha Life Ins. Co. 2014-12-30T08:31:05-08:00 2014-12-30T11:18:07-08:00 From 1995-2009, Johnson worked for CRE. In the last three years, Johnson worked from home, 8 hours a day at a computer. Johnson was covered under CRE's United disability insurance policy. In 1999, Johnson was diagnosed with fibromyalgia. In 2004, she underwent neck surgery for nerve injuries. On the day she resigned, Johnson visited MacDonald, her primary care physician, who diagnosed anxiety, depression, fibromyalgia, and chronic pain. Johnson completed a short-term disability form. MacDonald completed an Attending Physician's Statement. United denied the application. Based on the recommendations of its doctor, United denied Johnson's appeal. Johnson sought long-term disability benefits. MacDonald completed a Physician's Statement that imposed multiple limitations. United denied the claim. Johnson appealed. United referred Johnson's file and medical records to Boscardin, an orthopedic surgeon, who determined that, although Johnson experienced chronic pain in her neck and spine, Johnson's complaints were not supported by "conclusive, objective evidence." McClellan, Johnson's surgeon, responded that he "[o]verall" agreed with Boscardin. United denied the appeal. Johnson sued under ERISA. The district court granted Johnson summary judgment, finding that United failed to consider Johnson's condition as a whole. The Eighth Circuit reversed, finding the denial supported by substantial evidence. View "Johnson v. United of Omaha Life Ins. Co." on Justia Law 2014-12-30 federal U.S. Court of Appeals for the Eighth Circuit Bobby E. Shepherd 13-2645 http://law.justia.com/cases/federal/appellate-courts/ca8/13-3421/13-3421-2014-12-29.html Brake v. Hutchinson Tech., Inc., 2014-12-29T08:01:41-08:00 2014-12-29T09:25:07-08:00 In 1988, Brake began working at Hutchinson. She was diagnosed with multiple sclerosis (MS) in 2000, but continued to work. Brake purchased disability insurance through Hutchinson's plan in 1988. Hutchinson, as the plan administrator, ceded discretionary authority to Hartford to construe the plan and make eligibility determinations. In 2007, Brake purchased "buy-up" coverage that excluded a disability if medical treatment for that condition was rendered within 12 months prior to the effective date. The limitation ended after a year without a claim: if Brake was treated for MS between April 1, 2006, and April 1, 2007, and then became disabled as a result of MS before April 1, 2008, the exclusion would limit her benefits to core plan coverage. Brake began experiencing problems with her MS in 2007 and received benefits from a separate short-term disability plan. On March 25, 2008, she stopped working at Hutchinson. In May, she applied for LTD benefits, stating her onset of disability as July 27, 2007. Hartford informed her that her LTD benefits were approved, but not at the buy-up plan rate. Brake claimed that doctor visits during the 12 months were for a pap smear and a yearly routine MRI. Hartford cited the same records which indicated that Brake was increasingly less able to manage her MS conditions during the 12 months before her purchase of buy-up coverage. In Brake's suit under ERISA, 29 U.S.C. 1001, the district court found that Hartford did not abuse its discretion. The Eighth Circuit affirmed summary judgment in favor of Hartford. View "Brake v. Hutchinson Tech., Inc.," on Justia Law 2014-12-29 federal U.S. Court of Appeals for the Eighth Circuit Beam 13-3421 http://law.justia.com/cases/federal/appellate-courts/ca7/14-2507/14-2507-2014-12-24.html Matz v. Household Int'l Tax Reduction Inv. Plan 2014-12-24T12:31:31-08:00 2014-12-24T12:51:14-08:00 The class action suit, filed about 19 years ago, claimed that a defined‐contribution ERISA pension plan in which the employer matched contributions made by its employees was partially terminated, requiring vesting. After a previous remand, the district judge granted summary judgment in favor of the defendant and awarded $64,000 in costs. The Seventh Circuit affirmed. When a pension plan is terminated, the rights of the participants in the plan vest in full; none of the money contributed by the employer to the individual employees' retirement accounts is returned to the employer. Full vesting is required in the case of partial as well as total terminations, 26 U.S.C. 411(d)(3)(A). The district judge had to decide whether the series of reductions in the number of plan participants should be considered a single partial termination. The judge determined that there was no plan; decisions to sell particular subsidiaries were made sequentially, based on economic conditions in the particular market in which each operated. View "Matz v. Household Int'l Tax Reduction Inv. Plan" on Justia Law 2014-12-24 federal U.S. Court of Appeals for the Seventh Circuit Richard Allen Posner 14-2507 14-1683 http://law.justia.com/cases/federal/appellate-courts/ca2/13-447/13-447-2014-12-23.html Amara v. CIGNA Corp. 2014-12-23T07:31:14-08:00 2014-12-23T14:43:34-08:00 Plaintiffs, individual CIGNA Plan participants, filed suit on behalf of themselves and others similarly situated, alleging that CIGNA defendants made misleading communications in regards to the terms of the Plan. Subsequently, on remand, the court concluded that the district court acted within the scope of its discretion in denying CIGNA's motion to decertify the plaintiff class; the district court did not abuse its discretion in determining that the elements of reformation have been satisfied and that the Plan should be reformed to adhere to representations made by the plan administrator; and, in this case, the district court did not abuse its discretion in limiting relief to A+B benefits rather than ordering a return to the terms of CIGNA's original retirement plan. View "Amara v. CIGNA Corp." on Justia Law 2014-12-23 federal U.S. Court of Appeals for the Second Circuit Debra Ann Livingston 13-447 http://law.justia.com/cases/federal/appellate-courts/ca1/13-2065/13-2065-2014-12-18.html Guerra-Delgado v. Banco Popular de P.R. 2014-12-18T13:30:10-08:00 2014-12-19T00:47:40-08:00 In 1997, Appellant began working for Banco Popular de Puerto Rico (BPPR). After Appellant retired in 2009, BPPR made a final calculation of Appellant's pension, which yielded monthly payments significantly lower than earlier estimates had suggested. Seeking the higher amount he had expected, Appellant brought claims under ERISA, a theory of estoppel, and Puerto Rico contract law. The district court (1) dismissed the ERISA and contract claims, concluding that Appellant failed to state a claim under ERISA and that ERISA preempted the commonwealth claims; and (2) granted summary judgment against Appellant on the estoppel claim, concluding that the unambiguous terms of the benefits plan precluded a claim for estoppel. The First Circuit affirmed, holding (1) Appellant could not recover under ERISA because he could not be awarded relief under the terms of BPPR's retirement plan; (2) the district court properly held that Appellant's commonwealth claims "relate to" the ERISA-regulated plan and, accordingly, they were preempted; and (3) because Appellant did not show any ambiguity in the plan, his equitable estoppel claim necessarily failed. View "Guerra-Delgado v. Banco Popular de P.R." on Justia Law 2014-12-18 federal U.S. Court of Appeals for the First Circuit Kermit Victor Lipez 13-2065 http://law.justia.com/cases/federal/appellate-courts/ca8/13-3153/13-3153-2014-12-18.html Ibson v. United Healthcare Servs., Inc. 2014-12-18T08:31:44-08:00 2014-12-18T14:38:26-08:00 Ibson and her family were insured by UHS through a policy available to her to as a member of her law firm. Due to an error, UHS began informing Ibson's medical providers that Ibson and her family no longer had insurance coverage. Although UHS eventually paid the claims it should have paid all along, Ibson sued, raising state law claims of breach of contract, negligence, and bad faith, and seeking punitive damages. UHS responded that Ibson's claims were preempted by the Employee Retirement Income Security Act (ERISA) and barred by the policy's three-year contractual limitations period. The district court agreed and entered summary. The Eighth Circuit reversed and remanded, agreeing that Ibson's state law claims are preempted under ERISA, but rejecting entry of summary judgment on the basis of the three-year contractual limitations period. View "Ibson v. United Healthcare Servs., Inc." on Justia Law 2014-12-18 federal U.S. Court of Appeals for the Eighth Circuit Bobby E. Shepherd 13-3153 http://law.justia.com/cases/federal/appellate-courts/cadc/13-7093/13-7093-2014-12-16.html Holland v. Bibeau Construction Co. 2014-12-16T08:01:01-08:00 2014-12-16T11:45:35-08:00 Bibeau appealed the district court's grant of summary judgment and order directing it, as a related person to a disabled miner's former employer, to pay health insurance premiums, interest, and liquidated damages to the United Mine Workers of America 1992 Benefit Plan. The court concluded that Bibeau's laches claim was precluded under Petrella v. Metro-Goldwyn-Mayer, Inc. because each premium installment gives rise to a separate cause of action for legal relief for which Congress has enacted a statute of limitations to govern timeliness. Further, under the Coal Industry Retiree Health Benefit Act of 1992, 26 U.S.C. 9701-9722, which incorporates the Employee Retirement Income Security Act's (ERISA), 29 U.S.C. 1451(a)(1), enforcement scheme, the district court did not err in awarding interest and liquidated damages. Accordingly, the court affirmed the judgment. View "Holland v. Bibeau Construction Co." on Justia Law 2014-12-16 federal U.S. Court of Appeals for the District of Columbia Circuit Judith Ann Wilson Rogers 13-7093 http://law.justia.com/cases/federal/appellate-courts/cadc/13-7095/13-7095-2014-12-12.html Russell v. Harman Int'l Indus. 2014-12-12T07:31:06-08:00 2014-12-12T09:00:37-08:00 Plaintiff filed a class action suit against his former employer, Harman, under the Employee Retirement Income Security Act (ERISA), 29 U.S.C. 1001 et seq., alleging that Harman breached its fiduciary duties by making false and misleading statements to investment firms. On appeal, plaintiff challenged the district court's conversion of defendants' motion to dismiss under Federal Rule of Civil Procedure 12(b)(6)(d) and grant of summary judgment to defendants without giving plaintiff a reasonable opportunity to present evidence. The court did not reach the merits of the appeal, concluding that if the district court violated Rule 12(d), the error would be harmless in this case where discovery would be futile. Accordingly, the court affirmed the judgment. View "Russell v. Harman Int'l Indus." on Justia Law 2014-12-12 federal U.S. Court of Appeals for the District of Columbia Circuit Henderson 13-7095 http://law.justia.com/cases/federal/appellate-courts/ca4/13-2379/13-2379-2014-12-05.html Harrison v. Wells Fargo Bank, N.A. 2014-12-05T11:30:38-08:00 2014-12-05T16:31:22-08:00 Plaintiff filed suit against Wells Fargo under the Employee Retirement Income Security Act (ERISA), 29 U.S.C. 1132, alleging that the company improperly terminated her short-term disability benefits while she was undergoing a series of treatments for thyroid disease. The district court found insufficient evidence of disability under the Plan to conclude that Wells Fargo abused its discretion in denying plaintiff's claim. The court held that Wells Fargo failed to meet its statutory and Plan obligations to plaintiff as a beneficiary. By failing to contact plaintiff's psychologist when it was on notice that plaintiff was seeking treatment for mental health conditions and when it had his contact information, as well as properly signed release forms from plaintiff, the plan administrator chose to remain willfully blind to readily available information that may well have confirmed plaintiff's theory of disability. Accordingly, the court reversed and remanded with directions to return the case to Wells Fargo for a full and fair review of plaintiff's claims. View "Harrison v. Wells Fargo Bank, N.A." on Justia Law 2014-12-05 federal U.S. Court of Appeals for the Fourth Circuit James Harvie Wilkinson, III 13-2379 http://law.justia.com/cases/federal/appellate-courts/ca11/14-11349/14-11349-2014-11-25.html Witt v. Metropolitan Life Insurance Co., et al. 2014-11-25T09:02:12-08:00 2014-11-25T11:56:58-08:00 Plaintiff filed suit against MetLife, the administrator of a long-term disability insurance plan subject to the Employee Retirement Income Security Act (ERISA), 29 U.S.C. 1001 et seq., seeking to recover disability benefits. The court concluded that the six-year limitations period began to run on plaintiff's ERISA claim when the cause of action accrues; plaintiff's ERISA complaint in 2012 for benefits from May 1, 1997 forward is time-barred; the court rejected plaintiff's argument that his submission of post-1997 documentation is a new claim for benefits; and MetLife did not waive any defense based on the statute of limitations by failing to specify untimeliness as a basis for denying the claim after its courtesy review. Accordingly, the court affirmed the district court's grant of summary judgment. View "Witt v. Metropolitan Life Insurance Co., et al." on Justia Law 2014-11-25 federal U.S. Court of Appeals for the Eleventh Circuit Hull 14-11349 http://law.justia.com/cases/federal/appellate-courts/ca2/13-4834/13-4834-2014-11-14.html Cent. States, Se. & Sw Areas Health & Welfare Fund v. Gerber Life Ins. Co. 2014-11-14T07:30:08-08:00 2014-11-14T14:27:57-08:00 This case arose from injuries suffered by several students during scholastic athletic activities. The students were insured by Central States, an Employee Retirement Income Security Act (ERISA), 29 U.S.C. 1001 et seq., employee welfare benefit plan that provides health insurance to participating Teamsters and their dependents. The students were also directly insured by separate accident policies written by Gerber. Central States subsequently filed suit against Gerber, alleging various claims for declaratory judgment and injunctive relief pursuant to federal common law and ERISA section 502(a)(3). The court held that although Central States might well be left without an appropriate remedy as a result of this decision, and that in the future its beneficiaries may be put in the unfortunate position of having to sue their insurance companies to receive benefits to which they are indisputably entitled, the claims raised by Central States are legal, not equitable, and therefore may not be brought under section 502(a)(3). Accordingly, the court affirmed the district court's grant of Gerber's motion to dismiss under Rule 12(b)(6). View "Cent. States, Se. & Sw Areas Health & Welfare Fund v. Gerber Life Ins. Co." on Justia Law 2014-11-14 federal U.S. Court of Appeals for the Second Circuit Barrington D. Parker 13-4834 http://law.justia.com/cases/california/court-of-appeal/2014/d061956.html Graciano v. Mercury General Corp. 2014-11-13T10:00:59-08:00 2014-11-13T13:45:37-08:00 Plaintiff Sonia Graciano was injured after she was hit by a car driven by Saul Ayala. Ayala was insured by defendant California Automobile Insurance Company (CAIC). Three weeks after Graciano's attorney first contacted CAIC regarding the accident, Graciano misidentified both the driver and the applicable insurance policy. CAIC investigated the accident, identified the applicable policy and the correct driver, and offered to settle Graciano's claim with a "full policy limits offer." Graciano did not accept CAIC's full policy limits offer and, in this suit, alleged CAIC and its parent and affiliated companies acted in bad faith, based on an alleged "wrongful failure to settle." Graciano argued CAIC could have and should have earlier discovered the facts, and should have made the full policy limits offer more quickly. The jury found in favor of Graciano and this appeal followed. CAIC argued that, as a matter of law, there was no evidence to support the verdict that CAIC acted in bad faith by unreasonably failing to settle Graciano's claim against Saul. The Court of Appeal agreed, and reversed the judgment. View "Graciano v. Mercury General Corp." on Justia Law 2014-11-13 state California California Court of Appeal Alex C. McDonald D061956 http://law.justia.com/cases/federal/appellate-courts/ca9/12-17604/12-17604-2014-11-05.html Spinedex Physical Therapy v. United Healthcare 2014-11-05T10:30:07-08:00 2014-11-05T15:53:01-08:00 United is the claims administrator for Plans named as defendants in this suit and all of the Plans are governed by the Employee Retirement Income Security Act of 1974 (ERISA), 29 U.S.C. 1001 et seq. Spinedex, as assignee and would-be assignee of Plan beneficiaries, filed suit against United and the Plans seeking payment of denied benefit claims. ACS, as well as individual Plan beneficiaries, Jack Adams and Claude Aragon, joined the suit as plaintiffs. The district court granted summary judgment to defendants. The court reversed, concluding that Spinedex had Article III standing; Spinedex was not assigned the right to bring claims for breach of fiduciary duty; ACS does not have associational standing to bring suit against United; Adams' claim for breach of fiduciary duty is time-barred; Spindex's claims as assignee of beneficiaries under the Martz Agency Plan and the Acoustic Technologies Plan are not time-barred; and the anti-assignment provision of the Discount Tire Plan precluded assignment by Plan beneficiaries to Spinedex. The court vacated or reversed, and remanded for further proceedings, the district court's holdings that Aragon's claim for breach of fiduciary duty was not exhausted, that United is not a proper defendant for benefit claims under the American Express Plan, and that some of the claims assigned to Spinedex were not administratively exhausted. View "Spinedex Physical Therapy v. United Healthcare" on Justia Law 2014-11-05 federal U.S. Court of Appeals for the Ninth Circuit William A. Fletcher 12-17604 http://law.justia.com/cases/federal/appellate-courts/ca5/13-30639/13-30639-2014-10-27.html Rice, et al. v. Reliastar Life Ins. Co. 2014-10-28T08:57:09-08:00 2014-10-28T11:42:56-08:00 Plaintiffs filed suit against Deputy Arnold and Sheriff Graves, alleging violations of federal and state law after Arnold fatally shot their father while responding to a 911 call that the father was threatening to commit suicide. Plaintiffs also filed suit against ReliaStar to recover $179,000 they allege ReliaStar owes them under the father's accidental death policy. The district court granted Arnold and Grave's motions for summary judgment and granted ReliaStar's motion for summary judgment. The court held that Arnold did not violate the father's Fourth Amendment rights when he entered the father's home without a warrant because he had an objectively reasonable belief that the father would imminently seriously injure himself, and the district court did not err in granting Arnold's motion for summary judgment on the warrantless entry claim because Arnold is entitled to qualified immunity; Arnold is entitled to qualified immunity because he did not violate the father's constitutional right to be free from excessive force; the district court did not err in granting summary judgment for Arnold on the assault and battery claims, the false imprisonment claims, and the intentional infliction of emotional distress claim; the district court correctly granted Graves's motion for summary judgment; and the district court did not err in granting summary judgment for ReliaStar where the record was replete with factual evidence that ReliaStar relied on in determining that the father's death was not accidental, demonstrating that ReliaStar could have reached its determination without resorting to the conflict of interest at issue. Accordingly, the court affirmed the judgment of the district court. View "Rice, et al. v. Reliastar Life Ins. Co." on Justia Law 2014-10-27 federal U.S. Court of Appeals for the Fifth Circuit Edward C. Prado 13-30639 http://law.justia.com/cases/federal/appellate-courts/ca6/13-6347/13-6347-2014-10-23.html Girl Scouts of Middle TN, Inc. v. Girl Scouts of U.S.A. 2014-10-23T06:31:01-08:00 2014-10-23T06:57:51-08:00 In 2005, Girl Scouts of the United States (GSUSA) chartered 312 councils until it combined them into 112 councils. It merged councils that did not participate in the National Girl Scout Councils Retirement Plan with participating councils and made about 1,850 nonparticipating employees eligible for a lifetime pension benefit without having previously contributed to the Plan. In 2006, GSUSA added the Voluntary Early Retirement Incentive Plan, enabling participants to subsidize and accelerate eligibility for their pensions. Girl Scouts of Middle Tennessee (GSMT) sued, claiming that the realignment and the early retirement amendment caused GSMT to incur massive new liabilities. As of 2007, the Plan had a surplus of over $150 million, but by 2011, it had a deficit close to $340 million. GSUSA implemented an increase of its councils' contribution rates. GSMT wanted to withdraw from the Plan and form its own retirement plan. GSUSA would not grant GSMT permission to withdraw. GSMT sued under the Employee Retirement Income Security Act, federal and state common law, and Tennessee Code 48-53-104. The district court dismissed. The Sixth Circuit affirmed. GSMT has no claim under ERISA and the court declined to create federal common law. GSMT failed to properly plead its state law claim, which would fail as preempted by ERISA. View "Girl Scouts of Middle TN, Inc. v. Girl Scouts of U.S.A." on Justia Law 2014-10-23 federal U.S. Court of Appeals for the Sixth Circuit Siler 13-6347 http://law.justia.com/cases/federal/appellate-courts/ca7/13-3613/13-3613-2014-10-15.html Russ v. South Water Mkt, Inc. 2014-10-15T13:30:33-08:00 2014-10-15T14:00:54-08:00 South Water Market and Local 703 of the Teamsters Union had a collective bargaining agreement that ran from 2004 through April 30, 2007. On September 12, 2007, they reached a new agreement. Abramson, Market's bargaining representative, was supposed to draft the agreement. Murdoch, the Union's president reminded Abramson repeatedly. By February 2008 Murdoch was worried that pension and welfare funds covering the employees would cut off participation or sue. In March, Abramson begged off, stating: "I'm having trouble with my notes." On April 3 Murdoch sent Abramson a document with terms from Murdoch's notes. Abramson did not reply, but Market began paying wages, and making pension and welfare contributions specified in Murdoch's text. Murdoch also sent the document to the pension and welfare funds, which submitted bills calculated according to those terms. In July 2009 Castillo retired. He had been one of two workers in the highly-compensated "driver classification. The Murdoch document stated that Market would employ at least two drivers. After Castillo retired, it refused to provide more than one worker with the wages and benefits of the driver classification. The pension and welfare funds sued under the Employee Retirement Income Security Act, 29 U.S.C. 1145, seeking delinquent contributions for a second driver position. The district judge found that Market had not agreed to the terms. The Seventh Circuit reversed, reasoning that the Labor Management Relations Act makes a written agreement essential to participation in a pension or welfare plan, 29 U.S.C. 186(c)(5)(B), and Market does not contend that it wants to drop out of the plans or that it did withdraw Whatever reservations Abramson had were not conveyed to the funds until August 2009, much too late. View "Russ v. South Water Mkt, Inc." on Justia Law 2014-10-15 federal U.S. Court of Appeals for the Seventh Circuit Frank Hoover Easterbrook 13-3613 http://law.justia.com/cases/federal/appellate-courts/ca6/13-5492/13-5492-2014-10-14.html Roger Smith v. Aegon Companies Pension Plan 2014-10-14T08:53:24-08:00 2014-10-14T09:13:28-08:00 Smith was an employee CGC, which offered some employees, including Smith, enhanced compensation if they would remain with CGC through its merger with AEGON. Under the Voluntary Employee Retention and Retirement Program (VERRP) Smith would retire in 2000. Smith elected to receive $1,066.54 under the qualified plan and $1,122.97 under the non-qualified plan, through the "AEGON USA Pension Plan: Election for Distribution and Explanation of Benefits." An attachment informed Smith that "you will be entitled to receive additional benefits from the [CGC] Retirement Plan." The two plans subsequently merged. Smith retired and the Plan paid him a lump sum plus $2,189.51 per month. In 2007, AEGON amended the Plan to add a "Restriction on Venue. A participant or Beneficiary shall only bring an action in connection with the Plan in Federal District Court in Cedar Rapids, Iowa." In 2011, the Plan told Smith that it had overpaid him by $1,122.97 per month for 11 years and eliminated Smith's entire monthly payment to obtain recoupment. Smith exhausted administrative remedies then filed suit against CGC in state court, asserting breach of contract, wage and hour statutory violations, estoppel, and breach of the duty of good faith and fair dealing. CGC removed the action to federal court, which dismissed, finding that that the VERRP was regulated by ERISA, that Smith was suing to recover benefits under this ERISA plan, and that only the Pension Committee, not CGC, was a proper defendant. The Sixth Circuit affirmed. Smith filed suit against the AEGON Plan in the U.S. District Court for the Western District of Kentucky. The district court dismissed based on the venue selection clause. The Sixth Circuit affirmed, upholding the venue selection clause as applying to all actions brought by a participant or beneficiary, not just claims for benefits. View "Roger Smith v. Aegon Companies Pension Plan" on Justia Law 2014-10-14 federal U.S. Court of Appeals for the Sixth Circuit Alice Moore Batchelder 13-5492 http://law.justia.com/cases/federal/appellate-courts/ca8/13-2782/13-2782-2014-10-07.html Hampton v. Reliance Standard Life Ins. Co. 2014-10-07T07:09:33-08:00 2014-10-07T13:59:35-08:00 Plaintiff filed suit against Reliance and the Plan, under the Employee Retirement Income Security Act (ERISA), 29 U.S.C. 1001 et seq., claiming that Reliance abused its discretion in denying long-term disability benefits. The district court granted summary judgment to plaintiff. The court concluded that Reliance's interpretation of the Plan is reasonable. The loss-of-license provision states that the loss of a license for any reason is insufficient in and of itself to entitle a claim to benefits. In this case, plaintiff's diagnosis of diabetes mellitus was not enough by itself to justify benefits. Reliance's interpretation merely requires that the claimant show that the injury or sickness itself renders him unable to perform his occupation. Further, Reliance's determination that plaintiff was not totally disabled was supported by substantial evidence and its denial of benefits was reasonable. Accordingly, the court reversed the judgment of the district court. View "Hampton v. Reliance Standard Life Ins. Co." on Justia Law 2014-10-07 federal U.S. Court of Appeals for the Eighth Circuit Colloton http://law.justia.com/cases/federal/appellate-courts/ca1/13-2353/13-2353-2014-10-06.html Tetreault v. Reliance Standard Life Ins. Co. 2014-10-06T13:30:25-08:00 2014-10-06T19:16:43-08:00 Plaintiff received benefits under her employer's long-term disability benefit plan before the administrator for the long-term disability program determined she was no longer eligible for benefits. The administrator denied Plaintiff's appeal as untimely for her failure to appeal within the benefit plan's 180-day deadline. Plaintiff filed suit under the Employee Retirement Income Security Act of 1974 (ERISA), claiming that her failure to comply with the 180-day deadline should have been excused because the benefit plan's written instrument did not mention the deadline. The district court dismissed Plaintiff's benefits challenge as well as her two other ERISA claims for statutory penalties and for breach of fiduciary duty. The First Circuit affirmed, holding that the district court did not err in (1) dismissing Plaintiff's benefits challenge, as Plaintiff failed to meet the deadline for appealing internally the decision to cut off her long-term disability benefits, and the benefit plan had expressly incorporated that deadline into the benefit plan's written instrument; and (2) ruling that Plaintiff could not recover statutory penalties against the administrator or that she had waived her claim for breach of fiduciary duty. View "Tetreault v. Reliance Standard Life Ins. Co." on Justia Law 2014-10-06 federal U.S. Court of Appeals for the First Circuit David J. Barron http://law.justia.com/cases/federal/appellate-courts/ca6/12-4285/12-4285-2014-09-30.html Sherfel v. Newson 2014-09-30T06:31:43-08:00 2014-10-01T15:37:15-08:00 Nationwide, with 32,000 employees in 49 states, has an ERISA employee-benefits plan that provides short-term disability (STD), long-term disability (LTD), and "Your Time" benefits. An employee can receive Your Time benefits for personal reasons, such as vacation or illness. To receive STD benefits, an employee must be "STD Disabled," which means "a substantial change in medical or physical condition due to a specific illness that prevents an Eligible Associate from working their current position." Specific rules govern maternity leave. The first five days of paid maternity leave come out of an associate's Your Time benefits. Thereafter, a new mother is considered STD Disabled and entitled to STD benefits for six weeks following a vaginal delivery, or eight weeks following a cesarean section. Wisconsin's Family Medical Leave Act requires that employers allow six weeks of unpaid leave following "[t]he birth of an employee's natural child[.]" The Act's "substitution provision" requires employers to allow an employee to substitute "paid or unpaid leave of any other type provided by the employer" for the unpaid leave provided by the statute. A Wisconsin Nationwide employee had a baby. She received six weeks of STD benefits under Nationwide's plan. She then requested an additional period of STD benefits pursuant to the substitution provision. The plan denied the request, finding that she was no longer short-term disabled under the plan. The Wisconsin Supreme Court had held that, ERISA did not preempt the Wisconsin Act. The district court held that, under the Supremacy Clause, the administrator was required to comply with ERISA rather than the Wisconsin Act. The Sixth Circuit affirmed. View "Sherfel v. Newson" on Justia Law 2014-09-30 federal U.S. Court of Appeals for the Sixth Circuit Raymond M. Kethledge 12-4285 http://law.justia.com/cases/federal/appellate-courts/ca3/13-3467/13-3467-2014-09-26.html Santomenno v. John Hancock Life Ins. Co. 2014-09-26T08:30:12-08:00 2014-10-01T15:36:39-08:00 Plaintiffs, investors in 401(k) benefit plans, brought suit on behalf of themselves and a putative class of benefit plans and plan participants that have held or continue to hold group annuity contracts with John Hancock. They alleged that John Hancock charged excessive fees for its services in breach of its fiduciary duty under the Employee Retirement Income Security Act of 1974 (ERISA), 29 U.S.C. 1001. The Third Circuit affirmed dismissal of the suit, holding that John Hancock was not a fiduciary with respect to the alleged breaches with respect to setting fees. View "Santomenno v. John Hancock Life Ins. Co." on Justia Law 2014-09-26 federal U.S. Court of Appeals for the Third Circuit D. Michael Fisher 13-3467 http://law.justia.com/cases/federal/appellate-courts/ca11/13-11738/13-11738-2014-09-23.html AirTran Airways, Inc. v. Elem, et al. 2014-09-23T08:01:18-08:00 2014-10-01T15:35:22-08:00 After defendant Elem suffered injuries in a car accident, she and her attorney conspired to hide and disburse settlement funds from an employee welfare benefit plan she received after the accident. The parties filed cross motions for summary judgment and the district court granted summary judgment for the employer, as well as awarded attorney's fees and costs to the employer. The court affirmed, concluding that the district court had the authority to sanction defendants for their bad faith. The court also concluded that defendant's claim that the district court misapplied Federal Rule of Civil Procedure 70 was moot and dismissed the appeal. View "AirTran Airways, Inc. v. Elem, et al." on Justia Law 2014-09-23 federal U.S. Court of Appeals for the Eleventh Circuit William Holcombe Pryor, Jr. 13-11738 13-14912 http://law.justia.com/cases/federal/appellate-courts/ca2/11-192/11-192-2014-09-16.html Mead v. Reliastar Life Ins. Co. 2014-09-16T09:00:06-08:00 2014-10-01T15:33:04-08:00 Plaintiff filed suit against her employer, Reliastar, under the Employee Retirement Income Security Act of 1974 (ERISA), 29 U.S.C. 1001 et seq., after she was denied long term disability benefits. The district court found that Reliastar's benefits determination was arbitrary and capricious, and remanded to the company to calculate the amount of benefits owed. Reliastar appealed. The court dismissed the appeal for lack of appellate jurisdiction, holding that the remand order is not an immediately appealable final decision under either the traditional principles of finality or the court's precedents governing remands to administrative agencies. View "Mead v. Reliastar Life Ins. Co." on Justia Law 2014-09-16 federal U.S. Court of Appeals for the Second Circuit 11-192 http://law.justia.com/cases/federal/appellate-courts/ca9/12-36051/12-36051-2014-09-15.html Andersen v. DHL Retirement Pension Plan 2014-09-15T09:31:07-08:00 2014-10-01T15:32:53-08:00 Plaintiffs filed suit alleging that DHL's decision to eliminate plaintiffs' right to transfer their account balances from DHL's defined contribution plan to its defined benefit plan violated the "anti-cutback" rule of the Employee Retirement Income Security Act of 1974 (ERISA), 29 U.S.C. 1054(g), which prohibits any amendment of an employee benefits plan that would reduce a participant's "accrued benefit." The court, agreeing with the First Circuit and the district court, concluded that DHL's 2004 plan amendment did not, as a matter of law, violate the anti-cutback rule. The reduction of periodic benefits paid from the Retirement Income Plan that resulted from DHL's elimination of the transfer option did not violate section 1054(g)(1) where the accrued benefits of both the defined contribution and the defined benefit plan remained intact. The court further concluded that the 2004 amendment did not violate the anti-cutback rule as a matter of law where this case fits within the regulatory exception for elimination of an "optional form of benefit," even if the transfer option was such a benefit. Accordingly, the court affirmed the judgment of the district court. View "Andersen v. DHL Retirement Pension Plan" on Justia Law 2014-09-15 federal U.S. Court of Appeals for the Ninth Circuit Marsha Siegel Berzon 12-36051 http://law.justia.com/cases/federal/appellate-courts/ca8/13-3185/13-3185-2014-08-28.html Kern, et al. v. Goebel Fixture Co. 2014-08-28T07:07:25-08:00 2014-10-01T15:27:55-08:00 Two trustees of the Fund filed suit under section 301 of the Labor Management Relations Act (LMRA), 29 U.S.C. 185(a), and section 515 of the Employee Retirement Income Security Act (ERISA), 29 U.S.C. 1145, to collect unpaid benefit contributions allegedly owed by Goebel. On appeal, the Trustees challenged the dismissal of the ERISA claim. The court read the Trust Agreement to unambiguously require that an employee is actually represented by the Union at the time the Fund claims delinquent contributions were owed on behalf of that employee. As it is undisputed that the Union did not "represent" the employees at the times in question, the Trustees failed to demonstrate the Fund was entitled to the contributions they seek under the terms of the Trust Agreement. Accordingly, the court affirmed the district court's grant of summary judgment to Goebel. View "Kern, et al. v. Goebel Fixture Co." on Justia Law 2014-08-28 federal U.S. Court of Appeals for the Eighth Circuit James B. Loken 13-3185 http://law.justia.com/cases/federal/appellate-courts/ca1/13-2090/13-2090-2014-08-26.html Luitgaren v. Sun Life Assurance Co. of Canada 2014-08-26T10:30:07-08:00 2014-10-01T15:27:11-08:00 At issue in this case was the fiduciary implications of a life insurance company's decision to pay benefits through a retained asset account (RAA) that allows the insurance company to invest the retained assets for its own profit. In Merrimon v. Unum Life Insurance Co., decided also this year, the First Circuit held that an insurer, acting in the place and stead of a plan administrator, properly discharges its duties under ERISA when it pays a death benefit by establishing an RAA as long as that method of payment is called for by the terms of the particular employee welfare benefit plan. In this case, Appellant alleged that an Insurer's use of RAAs as a method of paying death benefits transgressed its ERISA-inspired fiduciary duties. The district court granted summary judgment in the Insurer's favor. The First Circuit affirmed largely on the basis of its opinion in Merrimon, holding that, under the circumstances of this case, the Insurer's choice to pay by means of an RAA did not violate its fiduciary duties. View "Luitgaren v. Sun Life Assurance Co. of Canada " on Justia Law 2014-08-26 federal U.S. Court of Appeals for the First Circuit Selya 13-2090 http://law.justia.com/cases/federal/appellate-courts/ca6/13-6446/13-6446-2014-08-22.html Butler v. United Healthcare of TN 2014-08-22T10:00:57-08:00 2014-10-01T15:25:57-08:00 More than nine years ago, Butler checked into a substance-abuse treatment facility to obtain inpatient rehabilitation for her alcohol addiction. She sought coverage for the treatment through her husband View "Butler v. United Healthcare of TN" on Justia Law 2014-08-22 federal U.S. Court of Appeals for the Sixth Circuit Jeffrey S. Sutton 13-6446 http://law.justia.com/cases/federal/appellate-courts/ca9/12-55210/12-55210-2014-08-20.html Pacific Shores Hospital v. UBH 2014-08-20T09:07:01-08:00 2014-10-01T15:25:09-08:00 PSH filed suit against the Wells Fargo & Company Health Plan, governed by the Employee Retirement Income Security Act (ERISA), 29 U.S.C. 1001 et seq., and UBH, seeking payment for additional days of inpatient treatment for an employee with severe anorexia nervosa. UBH is a third-party claims administrator of the Plan and UBH refused to pay for more than three weeks of inpatient hospital treatment for the employee. The court concluded that UBH did not follow procedures appropriate to the employee's case; materials outside the administrative record should have been considered by the district court in any review of UBH's benefits denial; and, even conducting an abuse of discretion review uninfluenced by any procedural irregularity or conflict of interest - and considering only the record that UBH had before it when it made its benefits determination - the court held that UBH improperly denied benefits to the employee. The court concluded that UBH improperly denied benefits under the Plan in violation of its fiduciary duty under ERISA. Accordingly, the court reversed the district court's judgment holding otherwise. View "Pacific Shores Hospital v. UBH" on Justia Law 2014-08-20 federal U.S. Court of Appeals for the Ninth Circuit Betty Binns Fletcher 12-55210 http://law.justia.com/cases/federal/appellate-courts/ca6/13-6319/13-6319-2014-08-18.html Hayden v. Martin Marietta Materials, Inc. 2014-08-18T09:31:04-08:00 2014-10-01T15:23:48-08:00 Hayden worked as an office manager at MMI beginning in 1997 and was covered by its long-term disability plan, insured and administered by Liberty and subject to the Employee Retirement Income Security Act, 29 U.S.C. 1001. Hayden suffers from chronic hepatitis C, pancreatitis, fibrocystic breast disease with breast implants, degenerative arthritis, breast carcinoma, hypothyroidism, hypotension, hypertension, and crepitation and decreased range of motion around her shoulders, cervical spine, hips, and knees. She stopped working in January 2010, and applied for benefits under the plan. She also submitted evidence from four doctors detailing general anxiety disorder, major depression, and insomnia. The district court affirmed the denial of benefits on Hayden's physical-disability claim but remanded her mental-disability claim because the plan administrator failed to consider medical evidence from three doctors. On remand, the plan again rejected Hayden's claim, and the district court affirmed. The Sixth Circuit affirmed with respect to Hayden's physical-disability claim but reversed with respect to her mental-disability claim, instructing the district court to award Hayden mental-health benefits consistent with the terms of the plan. View "Hayden v. Martin Marietta Materials, Inc." on Justia Law 2014-08-18 federal U.S. Court of Appeals for the Sixth Circuit Gibbons 13-6319