Mealey's ERISA
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December 06, 2021
Disability Claimant Denied Full, Fair Review Under ERISA, 1st Circuit Panel Says
BOSTON — The First Circuit U.S. Court of Appeals on Nov. 10 vacated a district court’s ruling in favor of a disability insurer after finding that a disability plan participant’s claim must be remanded to the plan administrator for a full and fair review because the insurer did not allow the claimant the opportunity to respond to the findings of an independent medical exam.
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December 03, 2021
District Court Did Not Err In Finding Claimant Is Disabled From Any Occupation
CHICAGO — While a district court erred in resolving factual disputes on motions for summary judgment, the district court did not err in finding that a disability claimant is unable to perform the duties of any occupation, the Eighth Circuit U.S. Court of Appeals said Nov. 30.
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December 03, 2021
5th Circuit: Retirement Required COBRA Notice Due To Contribution Change
NEW ORLEANS — An employee’s retirement required notice under the Consolidated Omnibus Reconciliation Act of 1985 (COBRA) because within 18 months, it changed her contribution required to continue health insurance coverage, a Fifth Circuit U.S. Court of Appeals panel ruled Nov. 30, partly reversing a Louisiana federal court’s ruling.
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December 03, 2021
Estate Administrator Petitions High Court Over Denial Of Life Insurance Benefits
WASHINGTON, D.C. — An estate administrator who was denied life insurance benefits when an insured died without naming a beneficiary asserts in an Oct. 5 petition for a writ of certiorari that the U.S. Supreme Court should review the Second Circuit U.S. Court of Appeals’ ruling in favor of the life insurer to “establish uniformity related to interpretations of group life insurance provisions.”
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December 02, 2021
2nd Circuit Vacates Judgment In ERISA Fiduciary Ruling On Multiemployer Plans
NEW YORK — Trustees do not act in a fiduciary capacity under the Employee Retirement Income Security Act “when they pass amendments to a multiemployer benefit plan,” the Second Circuit Court of Appeals ruled Nov. 30, vacating a New York federal court’s grant of summary judgment and remanding the case.
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December 02, 2021
Magistrate Recommends Mostly Granting Bill Of Costs Against Government In ESOP Suit
HONOLULU — A federal magistrate judge in Hawaii on Nov. 18 recommended mostly granting a $78,341.39 bill of costs filed against the federal government by defendants in a lawsuit over an employee stock ownership plan (ESOP), with an exception for what was deemed defense counsel misconduct.
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November 30, 2021
Termination Of Benefits Was Arbitrary, Capricious, 3rd Circuit Panel Says
PHILADELPHIA — A disability insurer’s termination of benefits was arbitrary and capricious because the insurer “deviated significantly from its normal eligibility-review processes” by requesting an outside evaluation of the claimant, the Third Circuit U.S. Court of Appeals said Nov. 26 in affirming a district court’s decision to reinstate a disability claimant’s benefits.
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November 30, 2021
Preliminary Approval Of $1.85M Class Settlement Sought In ERISA Excessive Fee Suit
MIAMI — Defined contribution plan participants on Nov. 23 moved for preliminary approval of a class action settlement to resolve their putative class fiduciary duty lawsuit in exchange for a $1.85 million cash payment and other relief from the University of Miami; in a contemporaneous first amended complaint, the participants expanded the number of retirement plans at issue to five.
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November 30, 2021
ERISA Exclusion Bars Professional Liability Coverage For DOL Suit, Panel Affirms
CINCINNATI — The Sixth Circuit U.S. Court of Appeals on Nov. 24 affirmed a lower federal court’s grant of summary judgment in favor of a professional liability insurer, finding that the policy’s Employee Retirement Income Security Act exclusion bars coverage for an underlying lawsuit brought against the insureds by the former U.S. secretary of Labor.
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November 29, 2021
In Appeal Of Denied Benefits, Panel Says Merits Challenge Forfeited
WASHINGTON, D.C. — The District of Columbia U.S. Circuit Court of Appeal on Nov. 23 rejected efforts by an appellant to obtain coverage under his Employee Retirement Income Security Act-governed benefits plan for mental health treatment sought by a dependent, leaving intact findings by a District of Columbia federal judge that the denial of benefits was supported by substantial evidence.
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November 24, 2021
Judge Dismisses 401(k) ERISA Fiduciary Breach Suit With Leave To Amend
SAN JOSE, Calif. — Participants in a LinkedIn Corp. 401(k) plan did not adequately allege Article III standing and stated a claim for breach of fiduciary duty only as to the selection and retention of active suite rather than index suite target date funds, a California federal judge ruled Nov. 16 after considering numerous decisions from other courts in the district, dismissing the class complaint with leave to amend.
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November 24, 2021
Judge Further Trims Insurer’s Fraudulent Billing Claims Against Laboratories
BRIDGEPORT, Conn. — An insurer’s claims that laboratories fraudulently billed it are subject to the presumption of laches but not barred by the doctrine, but it states a claim against only two of the six defendants, a federal judge in Connecticut said Nov. 22 in partially granting a motion to dismiss.
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November 23, 2021
High Court Petitioners: 4th Circuit 401(k) Diversification Ruling Creates Split
WASHINGTON, D.C. — In a Nov. 22 supplemental brief supporting their petition seeking U.S. Supreme Court review of a dispute over the Employee Retirement Income Security Act’s diversification requirement, Gannett Co., Inc. and The Gannett Benefit Plans Committee contest the argument in an amicus curiae brief filed by the U.S. government that they misread the Fourth Circuit U.S. Court of Appeals’ ruling.
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November 23, 2021
Judge: Fiduciary Claims Impermissibly Seek Damages, ERISA Preempts State Claim
ST. LOUIS — Plaintiffs’ Employee Retirement Income Security Act fiduciary claims impermissibly seek damages, and the statute preempts state law parity act claims in a residential treatment case against a self-funded plan, a federal judge in Missouri said Nov. 19 in dismissing claims.
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November 23, 2021
Citing Hughes, NYU Seeks High Court’s Review Of 2nd Circuit’s ERISA Prudence Ruling
WASHINGTON, D.C. — Arguing that the relevant share-class allegations are “nearly identical” to those in a case the U.S. Supreme Court has already agreed to review — Hughes v. Northwestern University — New York University (NYU) on Nov. 12 filed a certiorari petition regarding a Second Circuit U.S. Court of Appeals ruling that retirement plan participants stated a claim of imprudence against it under the Employee Retirement Income Security Act.
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November 22, 2021
U.S. High Court Denies Certiorari Petition Regarding AD&D ‘Crime’ Benefits Denial
WASHINGTON, D.C. — The U.S. Supreme Court on Nov. 22 denied a beneficiary’s petition for a writ of certiorari on an Eighth Circuit U.S. Court of Appeals decision that overturned a lower court’s ruling and upheld a life and accident plan’s denial of benefits under a “crime” exclusion on the basis that the insured was speeding and passing improperly.
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November 19, 2021
8th Circuit On Remand: ERISA Doesn’t, Part D Partly Does Preempt N.D. PBM Law
ST. LOUIS — On remand following the U.S. Supreme Court’s ruling in Rutledge v. Pharmaceutical Care Management Association, the Eighth Circuit U.S. Court of Appeals on Nov. 17 reversed its prior holding that the Employee Retirement Income Security Act preempts two sections of a North Dakota law regulating pharmaceutical benefit manager (PBM) practices; the Eighth Circuit also concluded that Medicare Part D preempts more provisions than the trial court ruled it did.
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November 18, 2021
DOL’s Tobacco Wellness Claims Proceed; Out-Of-Network ERISA Payment Claims Fail
COLUMBUS, Ohio — The secretary of Labor lacks authority to challenge out-of-network reimbursement methodology under the Employee Retirement Income Security Act because there are no alleged plan losses, but some of the claims stemming from a self-insured wellness plan’s failure to provide tobacco users an alternative means of meeting a health-related reward may proceed, a federal judge in Ohio said Nov. 17 in a mixed ruling on motions to dismiss.
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November 16, 2021
9th Circuit Upholds Benefits Plan Administrator’s Device Exclusion Under ERISA
SAN FRANCISCO — A Ninth Circuit U.S. Court of Appeals panel on Nov. 12 upheld the dismissal of class allegations over denial of coverage for a nerve stimulation pain management treatment, ruling in an unpublished memorandum disposition that the plan incorporated a policy stating that the treatment is investigative and not medically necessary.
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November 16, 2021
Preliminary Approval Of $2.8M Settlement Sought In ERISA Mortality Table Dispute
NEWPORT NEWS, Va. — The plaintiff of an employee class action on Nov. 12 moved in a Virginia federal court for preliminary approval of an agreement under which a shipbuilder would pay additional benefits “with an estimated present value of $2.8 million” to settle allegations that the use of a 50-year-old mortality table to calculate benefits for some retirees violated of the Employee Retirement Income Security Act.