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Mealey's ERISA

September 06, 2024
Disability Plan’s Special Conditions Limitation Rider Bars LTD Benefits Claim

BALTIMORE — A Maryland federal judge on Sept. 5 granted a disability insurer’s motion for summary judgment after determining that the disability plan’s special conditions limitation rider applies as a bar to the disability claimant’s long-term disability (LTD) benefits.
September 06, 2024
Disability Claimant Failed To Show Termination Of Benefits Was Arbitrary, Capricious

NEW YORK — A disability insurer’s termination of a long-term disability (LTD) benefits claim was not arbitrary and capricious because nothing in the medical record reviewed by the insurer and its reviewing physicians supported a finding that the claimant was disabled from working on a full-time basis, a New York federal magistrate judge said in recommending that the insurer’s motion for summary judgment be granted and that the disability claimant’s motion for summary judgment be denied.
September 06, 2024
7th Circuit Affirms ERISA Preemption Ruling In Suit Over Medical Bills

CHICAGO — Affirming dismissal of a suit over medical bills, a Seventh Circuit U.S. Court of Appeals panel ruled that the Employee Retirement Income Security Act preempts Illinois state law claims and that the “deemer” exception to ERISA’s saving clause applies.
September 06, 2024
Default Judgment Entered Against Disability Claimant For Failure To Repay Plan

CINCINNATI — A plan administrator is entitled to default judgment on a breach of fiduciary duty claim alleged against a disability claimant who failed to reimburse the long-term disability (LTD) plan for the overpayment of benefits following the claimant’s award of Social Security disability benefits because the claimant failed to respond to the plan administrator’s suit and breached his fiduciary duty by not repaying the plan as required by the plan’s terms, an Ohio federal judge said.
September 05, 2024
ERISA Suit Over Stripped Retirement Account Is Dismissed On Settlement Report

NEW YORK — Saying she was advised “that all claims asserted herein have been settled inprinciple,” a New York federal judge issued a Sept. 4 order of dismissal in an Employee Retirement Income Security Act case over whether a retirement plan administrator and record-keeper should have acted differently to keep a fraudster from stripping the plaintiff’s account.
September 05, 2024
3rd Circuit Affirms Rulings Against Claimant In Excess Pension Dispute

PHILADELPHIA — In nonprecedential disposition, a Third Circuit U.S. Court of Appeals panel upheld rulings against an individual who unsuccessfully argued that an excess pension program is a “top hat” plan governed by the Employee Retirement Income Security Act and that a settlement was improperly excluded from his benefits calculation.
September 05, 2024
Denial Of Attorney Fee Award To Disability Claimant Was Proper, Panel Says

CINCINNATI — A district court did not abuse its discretion in denying a disability claimant’s motion for attorney fees because the claimant failed to carry his burden of showing that the attorney fees he sought to recover were reasonable, the Sixth Circuit U.S. Court of Appeals said in affirming the lower court’s ruling.
September 04, 2024
8th Circuit Upholds Dismissal Of ERISA Excessive Fee Suit On Benchmarks Issue

ST. LOUIS — Repeatedly citing Matousek v. MidAmerican Energy Co. and ruling that there was “a lack of meaningful benchmarks suggesting that the costs are too high for a plan of its size,” an Eighth Circuit U.S. Court of Appeals panel affirmed dismissal of an Employee Retirement Income Security Act suit over a 401(k) plans fees and funds.
September 04, 2024
Attorney Fees, Costs Not Warranted, Minnesota Federal Judge Says

MINNEAPOLIS — A Minnesota federal judge denied a disability claimant’s motion for attorney fees and costs after determining that an award of fees and costs is not warranted because no other plan participant will benefit from the claimant’s suit and the suit did not resolve an important legal question.
September 03, 2024
ERISA-Based Injunction Bid Fails In Federal Suit Over N.J. Temp Worker Law

CAMDEN, N.J. — Denying a preliminary injunction motion concerning New Jersey’s Temporary Workers’ Bill of Rights (TWBR), a New Jersey federal judge on Aug. 30 said she “is hard pressed to imagine a situation that would upset the status quo more and detrimentally impact public interest.”
September 03, 2024
After Affirming Dismissal Of ERISA Offsetting Case, 8th Circuit Denies Rehearing

ST. LOUIS — The Eighth Circuit U.S. Court of Appeals has denied a petition for panel or en banc rehearing in a putative class suit over the practice known as “cross-plan offsetting”; in seeking rehearing, health plan participants argued that the ruling upholding dismissal ignored their “plausible allegations that the plans’ offset-authorizing terms are unenforceable and this Court’s prior decision in [Peterson v. UnitedHealth Group, Inc. (Peterson II)] holding that both patients and their doctors are obviously injured when they receive cross plan offsets instead of cash.”
August 30, 2024
ERISA Class Action Over BlackRock Index TDFs Survives Summary Judgment

RICHMOND, Va. — Two weeks after certifying a class in the Employee Retirement Income Security Act case over BlackRock LifePath Index target date funds (TDFs), a Virginia federal judge on Aug. 29 issued separate rulings denying the defendant's summary judgment motion and denying the plaintiffs’ motion to exclude experts Lorie L. Latham and Russell R. Wermers.
August 30, 2024
Oral Argument Including DOL Set In 9th Circuit ERISA Tobacco Surcharge Case

SAN FRANCISCO — With oral argument set for Sept. 12 in the Ninth Circuit U.S. Court of Appeals case involving the effective vindication doctrine, a health plan participant who filed the Employee Retirement Income Security Act case over a tobacco surcharge has filed a notice of supplemental authorities including a recent Sixth Circuit ruling.
August 30, 2024
After 16-Day Bench Trial, Judge Finds ESOP Price Too High, Rules Against Sellers

PHOENIX — Ruling that leaders of a recreational vehicle company breached their duties under the Employee Retirement Income Security Act in a $105 million employee stock ownership plan (ESOP) deal, an Arizona federal judge said the 16-day bench trial showed that the fair market value of the equity “was less than half” of what the ESOP paid.
August 29, 2024
6th Circuit Reverses Dismissal Of Misclassification Suit Involving ERISA Benefits

CINCINNATI — Reversing dismissal of a putative class action in which insurance agents assert Employee Retirement Income Security Act claims over alleged misclassification and denial of benefits, a Sixth Circuit U.S. Court of Appeals panel ruled that the lower court erred by relying on documents regarding which “there are legitimate questions” of whether they “are a full set of the relevant, governing plan documents.”
August 29, 2024
Dialysis Provider Apprises Court Of Potential AI Discovery Concerns

COLUMBUS, Ohio — A dialysis center says a health plan may be employing artificial intelligence in discovery without consultation or permission, telling the federal judge in Ohio overseeing its Employee Retirement Income Security Act (ERISA) case in a joint status report that the plan’s production of hundreds of thousands of documents is moving along at a “glacial” pace without any apparent intent to meet obligations in a stipulation. In their portion of the report, the health plan defendants say they disclosed their intent to use a “computer-assisted platform,” that even evidence identified by such tools requires validation and that perceived problems with production ignore those difficulties and the likelihood that deadlines will be met.
August 28, 2024
8th Circuit Vacates Summary Judgment In Suit Involving Subrogation Lien

ST. LOUIS — Ruling that there is no federal jurisdiction because “the plaintiffs could not have sued under” the Employee Retirement Income Security Act, an Eighth Circuit U.S. Court of Appeals panel vacated judgment in a suit involving a health plan’s subrogation lien.
August 28, 2024
Judge Denies Attorney Fees In First Impression Withdrawal Liability Case

HAMMOND, Ind. — On remand following reversal of a Multiemployer Pension Plan Amendments Act (MPPAA) ruling in a withdrawal liability dispute, an Indiana federal judge entered final judgment totaling $4,026,324.18 plus post-judgment interest for an employer but denied its opposed request for $217,249 in attorney fees.
August 28, 2024
6th Circuit Doesn’t Decide Preemption Question In Slayer Statute Ruling

CINCINNATI — Ruling around the Employee Retirement Income Security Act “preemption issue left open in” Egelhoff v. Egelhoff, a Sixth Circuit U.S. Court of Appeals panel affirmed summary judgment on the grounds that a man convicted of murdering his parents could not recover the proceeds of his mother’s insurance policies under either Tennessee or federal law.
August 27, 2024
1st Circuit Affirms Attorney Fees, Summary Judgment For Multiemployer Plan

BOSTON — Upholding judgment of more than $1.6 million against a Puerto Rican labor union affiliate “for substantially the same reasons” as the lower court, a First Circuit U.S. Court of Appeals panel in an unpublished opinion rejected various arguments regarding liabilities following a merger and attorney fees.
August 26, 2024
Bench Trial Yields Ruling For Defendants In ERISA Fees, Funds Challenge

SANTA ANA, Calif. — Noting in part that that she afforded “little to no weight” to the testimony of two of the class’s experts, a California federal judge ruled for the defendants on all claims after a bench trial, in a consolidated Employee Retirement Income Security Act suit over 401(k) fees and funds.
August 23, 2024
Excessive-Fee Claim Survives Dismissal In Multiemployer Health Plan ERISA Case

CHICAGO — Denying dismissal of an excessive-fee claim in a putative class Employee Retirement Income Security Act case concerning a national multiemployer health plan, an Illinois federal judge said the lack of “direct guidance” regarding the pleading standard for such a claim means that “the court must reason by analogy” to retirement plan cases.
August 23, 2024
Dismissal Bid Fails In ERISA Suit Against Health Plans’ TPA Over Tax Handling

MINNEAPOLIS — Saying, “Many issues in this case present close calls,” a Minnesota federal judge on Aug. 22 denied dismissal of a suit over U.S. Department of Labor (DOL) allegations that a third-party administrator (TPA) collected at least $66.8 million from self-funded health benefit plans without authorization between 2016 and 2020 for a Minnesota provider tax.
August 22, 2024
3rd Circuit Affirms Judgment For Insurer, Care Home In Medicare, Civil Rights Suit

PHILADELPHIA — The Third Circuit U.S. Court of Appeals affirmed judgment for an insurer and a skilled nursing facility (SNF) in an estate representative’s suit stemming from the Medicare Advantage plan’s failure to cover continued skilled nursing care and the facility’s failure to document a wound that led to the amputation of the patient’s leg, agreeing with the lower court that the representative failed to exhaust all administrative remedies under Medicare and failed to show that the woman’s wound changed during her stay at the facility.
August 21, 2024
6th Circuit Becomes Latest To Apply Effective Vindication Doctrine In An ERISA Case

CINCINNATI — The Sixth Circuit U.S. Court of Appeals on Aug. 20 became the fifth circuit court to rule an arbitration provision unenforceable on the grounds that it barred “effective vindication” of statutory Employee Retirement Income Security Act rights, reaching the result acting U.S. Department of Labor (DOL) Secretary Julie A. Su urged in an amicus brief.