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Mealey's ERISA

June 24, 2025
In Mixed Ruling, 9th Circuit Approves Denial Of Coverage For Wilderness Program

SAN FRANCISCO — In an unpublished June 23 memorandum disposition issuing a mixed ruling in a mental health and substance use coverage dispute, the Ninth Circuit U.S. Court of Appeals said that coverage for a wilderness program was properly denied; that coverage for residential treatment was not properly denied but the correct remedy is reprocessing because factual disputes remain; and that an award of nearly $50,000 for attorney fees and costs can’t stand because it was based on determinations that the appellate court reversed.
June 23, 2025
Citing Delay, Premiums, 5th Circuit Rules For Life Insurance Beneficiary

NEW ORLEANS — The Fifth Circuit U.S. Court of Appeals on June 20 granted judgment for the beneficiary in a life insurance dispute involving a policy that the issuer terminated months after it said it temporarily changed its cancellation practices because of COVID-19; the dispute concerned whether the Employee Retirement Income Security Act applies and whether a small business owner had employees, and the panel concluded that the answer to both questions is yes.
June 23, 2025
High Court Won’t Review Discovery Ruling In ERISA Health Benefit Denial Dispute

WASHINGTON, D.C. — The U.S. Supreme Court in its June 23 order list denied a petition to review an Employee Retirement Income Security Act discovery ruling in favor of a multiemployer health plan; the petitioner had argued that the “decision exacerbates both the ongoing split between Circuits as to determining what a plan administrator must do in order to satisfy its fiduciary obligation to perform a full and fair review, as well as the inconsistent factors that courts employ in order to determine whether discovery should be permitted,” and the plan countered that the decision shows only “the routine exercise of judicial discretion in applying the same rule to differing facts.”
June 23, 2025
U.S. High Court Won’t Tackle Bankruptcy Dispute Involving Retirement Contributions

WASHINGTON, D.C. — In its June 23 orders list, the U.S. Supreme Court declined to review a ruling where a split Ninth Circuit U.S. Court of Appeals panel concluded “that voluntary retirement contributions do not constitute disposable income” in Chapter 13 bankruptcies.
June 23, 2025
9th Circuit Orders Briefs On Skrmetti In Appeal Of Ruling That TPA Discriminated

PASADENA, Calif. — The same day the U.S. Supreme Court issued its ruling in United States v. Skrmetti, the Ninth Circuit U.S. Court of Appeals ordered supplemental briefing in an appeal where a third-party administrator (TPA) seeks reversal of a ruling that it violated the Patient Protection and Affordable Care Act (ACA)’s discrimination provision by administering exclusions of gender-affirming care; the parties are to address “how, if at all, this case is affected” by Skrmetti.
June 23, 2025
After Claims Of Info Sharing For Class Actions, OIG To Look At DOL Practices

WASHINGTON, D.C. — Plans have been revealed for an Office of Inspector General (OIG) audit of “how the U.S. Department of Labor [DOL] has shared investigative information with non-governmental entities involved in class action litigation and the extent of any related controls.”
June 23, 2025
High Court Development Is Flagged In Challenge To Class Certification In TDF Row

RICHMOND, Va. — Filing a notice of supplemental authority in the interlocutory appeal, an employer that was sued over the decision to offer BlackRock LifePath Index target date funds (TDFs) in its retirement plan told the Fourth Circuit U.S. Court of Appeals that a recent U.S. Supreme Court development means that Alig v. Shea “remains controlling and requires reversal of” the certification of a mandatory class.
June 18, 2025
CVS Asks Court To Halt Law Barring PBMs From Operating Pharmacies In Arkansas

LITTLE ROCK, Ark. — CVS Pharmacy Inc. and its subsidiaries urged an Arkansas federal court to put on hold an Arkansas law that “adopts an unprecedented prohibition on pharmacies that are affiliated with pharmacy benefit managers (commonly referred to as PBMs) continuing to operate in the State” while the companies challenge the law’s constitutionality.
June 18, 2025
9th Circuit Won’t OK Interlocutory Appeal In Class Row Over Reprocessing

SAN FRANCISCO — Without substantive explanation, two Ninth Circuit U.S. Court of Appeals judges denied permission to appeal the addition of a subclass in a case seeking reprocessing of mental health and substance use disorder treatmentclaims; disputes concerning the impact of certain rulings in the similar Employee Retirement Income Security Act case Wit v. United Behavioral Health figured largely in the petition and opposition.
June 18, 2025
Judge Lets Class Definitions Stand In ERISA Case Over Retirement Benefits

PHILADELPHIA — Denying what he construed as a motion to alter judgment in the class action where he recently entered final judgment for the plaintiffs after a bench trial, a Pennsylvania federal judge briefly rejected the defendants’ arguments that he had improperly expanded two class definitions; the Employee Retirement Income Security Act dispute centered on corporate restructuring that affected retirement benefits.
June 17, 2025
COVID-19 Testing Lab Seeks Dismissal Of Insurer’s $30M Overpayment Counterclaim

NEWARK, N.J. — In a lawsuit brought by a medical testing lab seeking reimbursement from health insurers for COVID-19 testing, the lab and its billing company moved to dismiss the insurers’ counterclaims and third-party counterclaims alleging that the lab and billing company caused the insurers to overpay the lab for basic testing services by at least $30 million.
June 17, 2025
1st Circuit Affirms ERISA Preemption In Termination Row Involving Severance

BOSTON — Affirming summary judgment against an appellant who had asserted wrongful termination and other claims under Rhode Island state law in a dispute involving severance benefits, the First Circuit U.S. Court of Appeals on June 16 ruled that the Employee Retirement Income Security Act preempts all her claims.
June 16, 2025
4th Circuit Upholds LTD Benefits Ruling Involving ‘Objective Evidence’ Exception

RICHMOND, Va. — Saying in part that “a patient’s self-reported symptoms of pain and fatigue are the exact sort of evidence that the objective-evidence bar is designed to eliminate,” the Fourth Circuit U.S. Court of Appeals issued an unpublished June 13 opinion affirming judgment for a long-term disability (LTD) insurer that terminated benefits under a maximum lifetime limitations provision for neuromuscular, musculoskeletal and soft tissue disorders.
June 16, 2025
4th Circuit Rules 2-1 For LTD Claimant, Avoids Deciding Review Standard Question

RICHMOND, Va. — In an unpublished opinion that drew a one-paragraph dissent, the Fourth Circuit U.S. Court of Appeals on June 13 upheld summary judgment for a long-term disability (LTD) claimant, saying in part that it didn’t need to decide whether the lower court’s use of de novo review was improper because the insurer’s termination of benefits “does not withstand scrutiny even under the less-rigorous abuse of discretion standard.”
June 16, 2025
Putative Class Lawsuit Challenges Revision To American Airlines LTD Plan

FORT WORTH, Texas — In a putative class complaint filed in Texas federal court, a disabled pilot sued American Airlines Inc. (AA) and related defendants under the theory that a May 2024 revision of its long-term disability (LTD) plan improperly excluded “vacation, ratification bonuses, profit sharing, one-time supplemental payment, bereavement, grievance payouts, extended sick bank, and Special Assignment” from average monthly compensation, resulting in underpayment of LTD benefits.
June 13, 2025
ERISA Suit Over Allegedly Underperforming Target Date Funds Settles For $69M

MINNEAPOLIS — A $69 million deal that the class representative called “the largest-ever ERISA settlement alleging breach of fiduciary duty for failure to remove underperforming investment options” has been granted final approval, a text-only June 13 docket entry in Minnesota federal court shows.
June 13, 2025
5th Circuit Rules That No Surprises Act Lacks Private Right Of Action

NEW ORLEANS — Ruling in part that the No Surprises Act (NSA)“does not contain a private right of action,” the Fifth Circuit U.S. Court of Appeals on June 12 upheld dismissal of a suit that air ambulance providers filed over “alleged failure to timely pay” independent dispute resolution (IDR) awards; amici curiae that weighed in on the appeal included the U.S. government, which participated in oral argument and urged reversal.
June 13, 2025
7th Circuit Affirms Ruling Against LTD Claimant Who Has Fibromyalgia

CHICAGO — Calling the challenged decision “detailed and diligent,” the Seventh Circuit U.S. Court of Appeals on June 12 ruled that a district court properly found that a former PricewaterhouseCoopers LLP (PwC) director failed to satisfy her burden of proving that she remained disabled from working in a sedentary occupation as a result of symptoms related to fibromyalgia.
June 13, 2025
Claimant With Long COVID To Challenge LTD Benefit Denial In 9th Circuit

SAN DIEGO — A claimant who unsuccessfully sought long-term disability (LTD) benefits due to symptoms he attributed to long COVID and cardiac issues is taking his case to the Ninth Circuit U.S. Court of Appeals after a California federal judge upheld denial of his claim on de novo review.
June 12, 2025
10th Circuit Affirms Default Judgment, Injunction In ERISA Fiduciary Row

DENVER — Affirming entry of default judgment and a permanent injunction in an Employee Retirement Income Security Act case where the U.S. Department of Labor (DOL) got the administrator and trustee of an employee stock ownership plan (ESOP) removed from their positions as fiduciaries, the 10th Circuit U.S. Court of Appeals said in an unpublished per curiam order that the lower court did not abuse its discretion.
June 12, 2025
2nd Circuit Affirms Lack Of Article III Standing In ERISA Reimbursement Row

NEW YORK — Partly vacating dismissal of an Employee Retirement Income Security Act concerning payment for surgical services, the Second Circuit U.S. Court of Appeals concluded that the appellant lacks standing because even though he says he holds a power of attorney for a patient, the allegations show that he “is suing in his own name and not on behalf of” the patient.
June 11, 2025
Judge Denies Transfer Bid LTD Insurer Didn’t Make With ‘Reasonable Promptness’

MIAMI — Noting that recently produced medical records are generally not admissible in the original jurisdiction but would be where the defendant sought transfer, a Florida federal judge denied a long-term disability (LTD) insurer’s motion, saying it “plainly did not act with reasonable promptness to request transfer.”
June 11, 2025
2nd Circuit Affirms That ERISA Preempts N.Y. Law Provision In Collection Row

NEW YORK — Affirming that the anti-alienation provision of the Employee Retirement Income Security Act preempts a New York law under which the appellant sought to restrain retirement accounts to satisfy a money judgment, the Second Circuit U.S. Court of Appeals said in a June 10 per curiam opinion that “the plain language of ERISA and the precedent interpreting it make clear that pension plan funds are exempt from attachment to satisfy a money judgment.”
June 10, 2025
Judge Won’t Stay Fees Bid Pending Appeal Of LTD Ruling For Claimant

PITTSBURGH — A motion for more than $126,000 in attorney fees will proceed after a Pennsylvania magistrate judge denied an insurer’s request for a stay pending resolution of its appeal of a summary judgment ruling in favor of a physician who successfully challenged denial of her claim for long-term disability (LTD) benefits.
June 10, 2025
Class Definitions Are Focus Of Reconsideration Bid After Judgment In Benefits Row

PHILADELPHIA — A Pennsylvania federal judge who after a bench trial entered final judgment in favor of plaintiffs and awarded class counsel $9,149,204.25 in attorney fees has been asked to reconsider what the defendants argue was improper expansion of class definitions; the Employee Retirement Income Security Act dispute centers on corporate restructuring that affected retirement benefits.