Mealey's ERISA

  • June 11, 2024

    9th Circuit Affirms ERISA Medical Necessity Ruling In Residential Treatment Row

    SAN FRANCISCO — Affirming summary judgment for an insured in a $182,410.14 dispute with a health insurer over reimbursement for a minor’s stay at a residential treatment facility, a Ninth Circuit U.S. Court of Appeals panel said in an unpublished memorandum disposition that the lower court didn’t abuse its discretion in considering two sets of guidelines and ruling the stay medically necessary.

  • June 11, 2024

    6th Circuit Affirms NLRB’s Jurisdiction In Audit Row Involving Multiemployer Funds

    CINCINNATI — In an unpublished opinion that drew a partial dissent, a Sixth Circuit U.S. Court of Appeals panel affirmed summary judgment against multiemployer trust funds that sought to compel an employer to submit to an audit under the Labor Management Relations Act (LMRA) and the Employee Retirement Income Security Act.

  • June 07, 2024

    LTD Benefits Cannot Be Offset By Social Security Retirement Benefits, Judge Says

    ALEXANDRIA, Va. — A disability insurer abused its discretion for a third time by ignoring the language of the disability policy and contending that a claimant’s monthly long-term disability (LTD) benefits amount should be offset by the amount of the claimant’s earned-income Social Security retirement benefits, a Virginia federal judge said after determining that the plan permits an offset only for Social Security benefits paid because of a claimant’s disability.

  • June 07, 2024

    Oral Arguments Scheduled In Dispute Over Proof Of Continued Disability

    PHILADELPHIA — The Third Circuit U.S. Court of Appeals scheduled oral arguments for July 9 in a disability plan’s appeal of a district court’s ruling that the plan abused its discretion when it terminated a claimant’s long-term disability (LTD) benefits for failure to provide proof of a continued disability.

  • June 07, 2024

    Judge Denies Dismissal Of Emergency Appendectomy ERISA Claims

    LOS ANGELES — A California federal judge has denied dismissal of two core Employee Retirement Income Security Act claims by an insured who says United Healthcare Insurance Co. failed to pay for her emergency appendectomy at a network rate as provided in the summary plan description (SPD).

  • June 07, 2024

    Retirees Follow 9th Circuit ERISA Accuracy Ruling With Reassignment, Fees Requests

    SAN FRANCISCO — After the Ninth Circuit U.S. Court of Appeals partly revived a putative class action over pension benefit statements for the second time, the parties are disputing a reassignment request in the Employee Retirement Income Security Act case, and the appellants have moved for $179,925 in attorney fees.

  • June 07, 2024

    Former NFL Player Files Notice Of Appeal After Dismissal Of Suit

    ATLANTA — A former National Football League player who claims that he is owed additional disability benefits filed a notice of appeal to the 11th Circuit U.S. Court of Appeals, seeking review of the lower court’s dismissal of his second amended complaint based on a finding that he failed to exhaust all administrative remedies and failed to show that exhaustion would be futile.

  • June 06, 2024

    Reconsideration Of Latest Postjudgment Ruling Disputed In ERISA Conversion Case

    NEW HAVEN, Conn. — Continuing their long history of postjudgment wrangling, Cigna Corp. and its pension plan (together, Cigna) and the class that succeeded in some parts in a challenge to the plan’s 1998 conversion are disputing whether a Connecticut federal court should reconsider denying the class’s motions for an accounting or postjudgment discovery and to strike parts of a sur-reply and declaration.

  • June 06, 2024

    2nd Circuit Affirms That ERISA Expressly Preempts Claims In Reimbursement Row

    NEW YORK — Rejecting a medical provider’s argument that its causes of action arose from a legal duty based in presurgery phone calls with a claims administrator, a Second Circuit U.S. Court of Appeals panel issued a summary order affirming dismissal of state law claims the panel ruled are “expressly preempted” by the Employee Retirement Income Security Act.

  • June 06, 2024

    Mental Illness Limitation Does Not Apply, Disability Claimant Says In Complaint

    PORTLAND, Maine — A disability plan participant filed suit in Maine federal court against a disability insurer, claiming that he is entitled to reinstatement of long-term disability (LTD) benefits because the insurer wrongfully applied the plan’s mental illness limitation when it terminated his LTD benefits.

  • June 06, 2024

    In Amicus Brief, DOL Urges 11th Circuit To Ditch ERISA Exhaustion Precedent

    ATLANTA — Urging initial hearing en banc in the 11th Circuit U.S. Court of Appeals, the U.S. Department of Labor (DOL) has filed an amicus curiae brief supporting appellants who seek the overturn of longstanding circuit precedent concerning exhaustion of administrative remedies in Employee Retirement Income Security lawsuits.

  • June 06, 2024

    Disability Claimant, Insurer Stipulate To Dismissal After Reaching Settlement

    KNOXVILLE, Tenn. — A disability insurer and a disability claimant filed a joint stipulation of dismissal in Tennessee federal court following the settlement of the claimant’s long-term disability (LTD) benefits suit.

  • June 06, 2024

    Parties Settle Disability Benefits Suit Stemming From Long COVID Diagnosis

    MIAMI — A Florida federal judge ordered the parties in a long-term disability (LTD) benefits suit stemming from a claimant’s diagnosis with long COVID to file a joint stipulation of dismissal and administratively closed the case after the parties notified the court that they reached a settlement.

  • June 06, 2024

    Pharmacy Benefit Managers Lose Motion To Dismiss Alaska’s Opioid Charges

    ANCHORAGE, Alaska — A group of pharmacy benefits managers (PBMs) lost in large part a bid to dismiss charges that they helped fuel the opioid epidemic in Alaska when a federal judge there ruled that the public nuisance and violation of the Alaska Unfair Trade Practices and Consumer Protection Act (CPA) claims can continue.

  • June 06, 2024

    University Of The Arts Employees File WARN Act Class Suit Following Closure

    PHILADELPHIA — Nine employees of a Philadelphia university that announced May 31 that it would be closing its doors one week later filed a class complaint in a federal court in Pennsylvania seeking 60 days of pay and Employee Retirement Income Security Act benefits, alleging that the school violated the Worker Adjustment and Retraining Notification Act (WARN Act).

  • June 05, 2024

    Judge Won’t Certify Interlocutory Appeal Over ERISA Record-Keeping Ruling

    MINNEAPOLIS — A motion focused on allegations of commoditized, fungible record-keeping fees in an Employee Retirement Income Security Act case was denied June 4, with a Minnesota federal judge refusing to certify a partial dismissal motion for interlocutory appeal.

  • June 05, 2024

    Attorneys Get 27% Of $20M ERISA Settlement With 2 Groups Of Class Members

    ALLENTOWN, Pa. — A Pennsylvania federal judge on June 4 granted final approval of a $20 million settlement in a change in control (CIC) dispute over early retirement pension benefits and pension supplements; the settlement treats the 340 class members differently depending on whether they were terminated.

  • June 05, 2024

    Disability Claimant Seeks De Novo Review, Says Additional STD Benefits Are Owed

    TULSA, Okla. — A de novo standard of review should be applied to the review of the denial of a short-term disability (STD) claim because the disability plan administrator committed a number of procedural irregularities in handling the claimant’s second appeal of the denial of his claim, the claimant says in an opening brief filed in Oklahoma federal court.

  • June 05, 2024

    9th Circuit: ERISA Preempts State Law Claims In Case Over Alleged Fee-Forgiving

    SAN FRANCISCO — Issuing separate rulings regarding Employee Retirement Income Security Act preemption and recovery of plan benefits, a Ninth Circuit U.S. Court of Appeals panel upheld summary judgment for defendants in a health insurance dispute reportedly involving more than $8.6 million in unreimbursed claims from a substance abuse treatment center and alleged fee-forgiving.

  • June 05, 2024

    Ex-NFL Player Granted Extension To Petition High Court In Disability Suit

    WASHINGTON, D.C. — The deadline for a former National Football League player to file a petition for writ of certiorari in the U.S. Supreme Court was extended by a month, giving the former player until July 13 to seek review of the Fifth Circuit U.S. Court of Appeals’ ruling that he failed to prove that he is entitled to additional disability benefits under the NFL’s benefits plan.

  • June 04, 2024

    Nonfiduciary ERISA Claim Against TIAA, Subsidiary Survives In Cross-Selling Case

    NEW YORK — A retooled putative class Employee Retirement Income Security Act case over cross-selling of TIAA Portfolio Advisor accounts has survived dismissal, with a New York federal judge ruling that a claim for nonfiduciary receipt of ill-gotten profits is sufficiently stated against a third-party service provider for numerous retirement plans and its subsidiary.

  • June 04, 2024

    Suit Over DOL’s New Investment Advice Fiduciary Rule Draws Proposed Amicus Briefs

    TYLER, Texas — The Hispanic Leadership Fund (HLF) and the Chamber of Commerce of the United States of America have asked a Texas federal court for permission to file amicus curiae briefs in the first suit challenging a new U.S. Department of Labor (DOL) rule that redefines and broadens who is an investment advice fiduciary under the Employee Retirement Income Security Act.

  • June 04, 2024

    5th Circuit Sets Argument In Appeal Over DOL’s ESG Investing Rule

    NEW ORLEANS — In a case that has drawn numerous amicus curiae briefs, the Fifth Circuit U.S. Court of Appeals has set oral argument for July 9 regarding a ruling that left in place the 2022 U.S. Department of Labor (DOL) investment rule concerning environmental, social and governance (ESG) factors.

  • June 04, 2024

    Awarding 1/3 Of $975,000 ERISA Settlement In Attorney Fees, Judge Gives Final OK

    NEW YORK — In orders that didn’t specifically address the lone objection to the class resolution of an Employee Retirement Income Security Act suit over alleged breach of the duty of prudence, a New York federal judge granted final settlement approval and awarded attorney fees totaling 33-1/3% of the $975,000 payment.

  • May 29, 2024

    COMMENTARY: U.S. Supreme Court Limits Appeals From Decisions Enforcing Arbitration Agreements

    By David N. Cinotti