CHICAGO — One of an insured’s providers falls outside the guise of a residential treatment program and is excluded by her health insurance, but her treatment at a second health care facility clearly constituted medically necessary care, a federal judge in Illinois held March 18 in partially granting judgment in an Employee Retirement Income Security Act case for both the insured and insurer (Alice F. v. Health Care Service Corp., et al., No. 17-3710, N.D. Ill., 2019 U.S. Dist. LEXIS 43150).
SAN FRANCISCO — A district court did not err in finding that a disability insurer’s denial of disability benefits under a plan’s any-occupation standard was justified because ample evidence in the record supports the insurer’s determination, the Ninth Circuit U.S. Court of Appeals said March 15 (Susan Beach v. Liberty Life Assurance Company of Boston, No. 17-16492, 9th Cir., 2019 U.S. App. LEXIS 7817).
NEW YORK — The Second Circuit U.S. Court of Appeals in a one-page order on March 13 denied a Columbia University trustees’ Federal Rule of Civil Procedure 23(f) petition for leave to appeal a lower court’s order granting class certification in a suit alleging that the university breached its duty of prudence to its retirement plan participants and beneficiaries by causing its retirement plans to incur excessive administrative fees and by failing to monitor the plans’ investment options (The Trustees of Columbia University in the City of New York, et al. v. Chandra Cates, et al., No. 18-3559, 2nd Cir.).
CHICAGO — The Seventh Circuit U.S. Court of Appeals on March 14 affirmed a district court’s finding that a disability plan’s denial of a claim for disability benefits was reasonable based on the medical evidence and the plan’s use of outside medical experts to evaluate the claim (Joseph Reinwand v. National Electrical Benefit Fund, et al., No. 18-2601, 7th Cir., 2019 U.S. App. LEXIS 7492).
WASHINGTON, D.C. — In a March 14 opposition brief, two retirement plan participants urge the U.S. Supreme Court to deny as “unnecessary” a petition for certiorari that seeks clarification on the burden of proof for establishing loss causation under the Employee Retirement and Income Security Act (Putnam Investments LLC, et al. v. John Brotherston, et al., No. 18-926, U.S. Sup.).
PHILADELPHIA — A Pennsylvania federal judge’s adoption of a recommendation that a prevailing counterclaimant be awarded $750,000 in damages under the Employee Retirement Income Security Act but denied an award of prejudgment interest was “well-reasoned” in view of “equity considerations” and “the unusual circumstances” of the case, the Third Circuit U.S. Court of Appeals ruled March 13 (Regional Employers Assurance League Voluntary Employees Beneficiary Association Trust, et al. v. Gretchen Hutto Castellano, No. 17-3753, 3rd Cir., 2019 U.S. App. LEXIS 7465).
BRIDGEPORT, Conn. — There is room for out-of-network health care providers to bring claims against Employee Retirement Income Security Act plan insurers, as long as the claims in no way implicate the plan contract, a federal judge in Connecticut held March 12 (Aesthetic and Reconstructive Breast Center LLC v. United Healthcare Group Inc., No. 18-608, D. Conn., 2019 U.S. Dist. LEXIS 39284; Taylor Theunissen, M.D. LLC v. United Healthcare Group Inc., et al., No. 18-606, D. Conn., 2019 U.S. Dist. LEXIS 39284).
PROVIDENCE, R.I. — Plaintiffs in a suit alleging that Brown University breached its fiduciary duty in violation of the Employee Retirement Income Security Act in its management of its retirement plans on March 11 filed an unopposed motion to preliminarily approve a $3.5 million class action settlement (Diane G. Short, et al. v. Brown University, No. 17-318, D. R.I.).
WASHINGTON, D.C. — The U.S. Supreme Court should grant review of the Second Circuit U.S. Court of Appeals’ decision that IBM employees plausibly asserted a duty-of-prudence claim against the fiduciaries of an IBM employee stock option plan (ESOP) under the Employee Retirement Income Security Act because the decision creates a conflict with the decisions of other courts of appeals and undermines a 2014 decision issued by the high court, the defendants contend in a March 4 petition for writ of certiorari (Larry W. Jander, et al. v. Retirement Plans Committee of IBM, et al., No. 18-1165, U.S. Sup.).
SAN FRANCISCO — The Ninth Circuit U.S. Court of Appeals on March 12 denied a disability claimant’s motion to supplement the record on appeal with documents from her Social Security Disability Insurance (SSDI) claim because the Social Security Administration’s (SSA) award of benefits was based on a different definition of disability than the “any occupation” definition relied on by the plan (Alice McBurnie v. Life Insurance Company of North America, No. 17-55915, 9th Cir., 2019 U.S. App. LEXIS 7254).
WASHINGTON, D.C. — The U.S. Chamber of Commerce and a number of other industry groups told the U.S. Supreme Court in an amicus curiae brief submitted Feb. 15 that the nation’s high court needs to determine which party has the burden of showing loss causation in a suits brought under the Employee Retirement and Income Security Act, explaining that “things will only get worse” if the First Circuit U.S. Court of Appeals’ ruling is allowed to stand (Putnam Investments LLC, et al. v. John Brotherston, et al., No. 18-926, U.S. Sup.)
ATLANTA — The 11th Circuit U.S. Court of Appeals on March 8 affirmed a lower federal court’s finding that the administrator of an Employee Retirement Income Security Act benefits plan properly found that a woman’s "partial hospitalization" at a specialized treatment facility for anorexia was no longer medically necessary and, therefore, was not covered (Alexandra H. v. Oxford Health Insurance, Inc., No. 18-11105, 11th Cir., 2019 U.S. App. LEXIS 6972).
CINCINNATI — Hoover Co. retirees filed a petition for rehearing en banc on March 1, approximately two weeks after a divided Sixth Circuit U.S. Court of Appeals panel held that the obligation to provide lifetime health care benefits promised in multiple collective bargaining agreements (CBA) ended when the last CBA ended (Joseph Zino, et al. v. Whirlpool Corp., et al., Nos. 17-3851/3860, 6th Cir.).
NEW YORK — In their breach of fiduciary lawsuit, participants of Cornell University’s retirement plans argue in a Feb. 25 brief that a New York federal court should deny summary judgment to a financial adviser, saying the adviser’s advice to Cornell “was too little, too late” (Casey Cunningham, et al. v. Cornell University, et al., No. 16-6525, S.D. N.Y.).
SAN FRANCISCO — A majority of the Ninth Circuit U.S. Court of Appeals on Feb. 13 refused to revisit its ruling that a defendant was acting as an employer and not a trustee when he retaliated against an internal auditor and, therefore, he did not violate Section 404 of the Employee Retirement Income Security Act, 29 U.S.C. § 1104 (R. Alexander Acosta v. Scott Brain, et al., Nos. 16-56529 and 16-56532, 9th Cir.).
CINCINNATI — In a March 6 amicus curiae brief, AARP told the Sixth Circuit U.S. Court of Appeals that it should grant a Feb. 26 petition for en banc rehearing filed by an Employee Retirement Income Security Act plaintiff class in a dispute over classification by American Family Insurance Co. of its insurance agents as independent contractors (Walid Jammal, et al. v. American Family Insurance Company, et al., No. 17-4125, 6th Cir.).
ST. LOUIS — UnitedHealth Group Inc. on March 5 filed a petition for a stay of mandate in the Eighth Circuit U.S. Court of Appeals, arguing that a stay of the court’s offsetting decision is warranted to allow it to file a petition for writ of certiorari in the U.S. Supreme Court because there is a reasonable probability that the high court will grant certiorari, the petition will raise a substantial question regarding the practice of cross-plan offsetting and United will suffer irreparable harm if a stay is not granted (Louis J. Peterson D.C., et al. v. UnitedHealth Group Inc., et al., No. 17-1744, 8th Cir.).
CINCINNATI — The majority of the Sixth Circuit U.S. Court of Appeal on March 5 reversed a district court’s ruling affirming an arbitrator’s award in a dispute over lifetime retirement health care benefits after determining that the arbitrator exceeded the scope of his authority and failed to properly apply the clear language of the collective bargaining agreement (CBA) at issue (International Union, et al. v. TRW Automotive U.S. LLC, No. 18-01160; TRW Automotive U.S. LLC v. International Union, et al., No. 18-1161, 6th Cir., 2019 U.S. App. LEXIS 6598).
SAN FRANCISCO — An insurer’s denial of coverage for intensive residential health care and substance abuse treatments violated generally accepted standards of care, a federal magistrate judge in California held March 5 in a pair of Employee Retirement Income Security Act class actions (David and Natasha Wit, et al. v. United Behavioral Health, No. 14-02346, Gary Alexander, et al. v. United Behavioral Health, No. 14-5337, N.D. Calif.).
DENVER — A Colorado federal judge on March 1 partially granted a motion for summary judgment filed by the defendants in an Employee Retirement Income Security Act lawsuit accusing Oracle Corp. of making imprudent investments and allowing the collection of excessive fees related to its 401(k) plan after determining that the plaintiffs failed to provide any evidence that the plan could have paid less for recordkeeping services than it did (Deborah Troudt, et al. v. Oracle Corporation, et al., No. 16-175, D. Colo., 2019 U.S. Dist. LEXIS 33017).