SAN FRANCISCO — Nothing in the Patient Protection and Affordable Care Act (ACA) requires an insurer to cover out-of-network lactation services when if offers in-network care, which means that the named plaintiffs’ full-and-fair review claims under the Employee Retirement Income Security Act fail for lack of redressable injury, that the claims reprocessing class was properly rejected and that the judge improperly failed to look at the universe of communications in granting the denial letter class, a Ninth Circuit panel held Sept. 16.
LOS ANGELES — Finding that plan participants’ putative class complaint had stated claims for breach of fiduciary duty and co-fiduciary liability under the Employee Retirement Income Security Act in relation to a merger and benefit cuts, a federal judge in California on Aug. 30 denied a motion to dismiss by the boards and trustees of union health plans.
WASHINGTON, D.C. — A multiemployer pension plan’s conclusion that a union worker who was not part of a collective bargaining unit was not a participant and not due benefits was reasonable, and the plan did not impermissibly subdelegate its decision to a union, the District of Columbia Circuit U.S. Court of Appeals ruled Sept. 3 in an unpublished per curiam judgment affirming a lower court’s ruling.
SAN JUAN, Puerto Rico — A reinsurer should be forced to comply fully with an administrative subpoena that seeks information on all of its services to employee welfare benefit plans under the Employee Retirement Income Security Act, the U.S. Department of Labor says in an Aug. 31 petition before a federal court in Puerto Rico.
SAN FRANCISCO — The Ninth Circuit U.S. Court of Appeals on Sept. 13 reversed a portion of a district court’s summary judgment ruling in favor of an employee welfare benefit plan after determining that a question of fact exists as to whether the plan administrator misrepresented that an executive medical retirement plan provided lifetime health insurance benefits.
CHICAGO — The fiduciaries of an employee stock ownership plan can’t compel arbitration of a plan participant’s putative class claims alleging financial misconduct because the plan’s arbitration provision prohibits relief expressly permitted by the Employee Retirement Income Security Act, the Seventh Circuit U.S. Court of Appeals ruled Sept. 10.
WASHINGTON, D.C. — Participants in Northwestern University’s defined-contribution Employee Retirement Income Security Act plans have plausibly alleged imprudence by the university, Northwestern University Retirement Investment Committee and the committee members (collectively, Northwestern) causes them to pay excessive fees, the United States argues in an amicus curiae brief filed Sept. 10 in the U.S. Supreme Court.
MEMPHIS, Tenn. — A disability claimant alleges in a Sept. 7 complaint that he was denied a full and fair review of his short-term disability benefits claim under Employee Retirement Income Security Act because the claims administrator refused to provide him with additional time to file an appeal despite the U.S. Department of Labor’s emergency regulation, issued in response to the COVID-19 pandemic, which extended the amount of time to appeal an adverse benefits decision.
NEW ORLEANS — Participants in a 401(k) plan say that although they have not invested in all of the funds challenged under the Employee Retirement Income Security Act, their claims are typical of the class because the claims “arise out of the fiduciaries’ uniform conduct directed at the plan as a whole”; their Sept. 1 appellees’ brief of an interlocutory appeal before the Third Circuit U.S. Court of Appeals urges the court to uphold a federal judge in Pennsylvania’s grant of class certification.
CINCINNATI — A disability plan’s denial of disability benefits was not arbitrary and capricious because the plan’s denial was reasonable based on the available medical evidence, the Sixth Circuit U.S. Court of Appeals said Sept. 3 in affirming a district court’s ruling in favor of the plan.
WASHINGTON, D.C. — On Sept. 6, an insurance company that was sued by its agents for misclassification under the Employee Retirement Income Security Act waived its right to respond to the agents’ petition for writ of certiorari that was filed in the U.S. Supreme Court and argued in part that the Sixth Circuit U.S. Court of Appeals erred in dismissing their second appeal for lack of jurisdiction.
GRAND RAPIDS, Mich. — A Michigan federal judge on Aug. 9 denied a motion to dismiss a putative class action suit alleging claims for breach of the fiduciary duties of loyalty and prudence and failure to monitor the investments of a 401(k) plan after determining that the plaintiffs sufficiently alleged facts in support of their claims that the plan and its fiduciaries failed to consider other investment options that would benefit plan participants.
NEW YORK — The Second Circuit U.S. Court of Appeals on Aug. 12 affirmed a district court’s ruling in favor of a disability insurer after determining that the lower court properly applied an arbitrary and capricious standard of review because California’s law banning the inclusion of discretionary authority provisions does not apply as the claimant is a resident of New York and not California.
ST. LOUIS — The Eighth Circuit U.S. Court of Appeals on Aug. 6 affirmed a district court’s award of more than $4,600 in prejudgment interest and more than $39,000 in attorney fees to plaintiffs for an employer’s delinquent contributions to health and pension plans after determining that the awards were justified.
WASHINGTON, D.C. — The dismissal of their Employee Retirement Income Security Act duty-of-prudence claims “cannot be squared” with the U.S. Supreme Court’s decision in Tibble v. Edison International, participants in Northwestern University defined-contribution retirement plans argue in their Sept. 3 opening petitioners’ brief before the high court.
NEW ORLEANS — A district court did not err in dismissing an employee’s complaint against her employer for breach of fiduciary duty because she failed to show that her employer was acting in a fiduciary capacity when taking the actions alleged in the complaint, the Fifth Circuit U.S. Court of Appeals ruled Aug. 16.
CHICAGO — A putative class complaint filed by current and former Kraft Heinz Food Co. workers who accuse retirement plan fiduciaries and the executives tasked with monitoring them of failing to release information about the company that resulted in falsely inflated stock prices and impacted the plan that contained an employee stock option was dismissed for failure to state a claim by a federal judge in Illinois on Aug. 23; the workers were given until Sept. 13 to file a second amended complaint.
NEW YORK — A retirement plan committee’s removal of a fund it deemed as underperforming did not constitute breach of fiduciary duty, a federal judge in New York ruled Aug. 19, rejecting the committee’s claim that the Employee Retirement Income Security Act’s safe harbor provision protected it from a pro se lawsuit by a plan participant who wanted his retirement savings to remain in that fund and instead finding that the committee had no duty to keep a fund that “may be suitable for one” and “wholly inadequate . . . for another.”
RICHMOND, Va. — The government was entitled to seize an employee’s 401(k) account to satisfy his criminal restitution under the Mandatory Victim Restitution Act (MVRA)’s broad enforcement standards, but a district court failed to consider whether there were conditions that limited the employee’s present property rights and, in turn, limited the government’s rights, the Fourth Circuit U.S. Court of Appeals ruled Aug. 10, remanding to the trial court.
WASHINGTON, D.C. — Petitioners including an individual who has health coverage through Anthem Inc. on June 25 moved the U.S. Supreme Court for leave to file a petition for a writ of certiorari with the supplemental appendix under seal, seeking review of a Second Circuit U.S. Court of Appeals panel ruling affirming that Anthem and Express Scripts Inc. (ESI) were not acting as fiduciaries under the Employee Retirement Income Security Act when they set prescription drug prices.