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Three small employers in Montana filed suit against health insurance companies, alleging claims under the Employee Retirement Income Security Act of 1974 (ERISA), as well as state law claims based on defendants' representations. The Ninth Circuit affirmed the district court's dismissal of plaintiffs' ERISA claims and held that plaintiffs failed to state a claim for breach of fiduciary duty under 29 U.S.C. 1132(a)(2) where defendants did not exercise control over plan assets when charging or spending the allegedly excessive premiums. However, the panel reversed the district court's dismissal of plaintiffs' state law claims and held that ERISA did not expressly preempt state-law claims against an insurer that did not bear on an ERISA-regulated relationship. Furthermore, the state law claims were not barred by conflict preemption. The panel reversed the district court's dismissal with prejudice of the state-law claims so that plaintiffs may amend their complaint to state the fraud allegations with greater particularity. View "The Depot, Inc. v. Caring for Mountanans, Inc." on Justia Law

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Plaintiff filed suit against Anthem, the administrator of an Employee Retirement Income Security Act (ERISA) covered plan, after Anthem denied preauthorization for both bariatric surgery (weight loss surgery) and the follow-up surgery. The Fifth Circuit held that Anthem did not abuse its discretion in either the first- or second-level appeal of the denial of benefits. The court explained that Anthem satisfied the very low, very deferential abuse-of-discretion standard. Therefore, the court affirmed the district court's assessment of the first-level appeal, reversed the district court's assessment of the second-level appeal, and dismissed plaintiff's cross appeal as moot. View "Rittinger v. Healthy Alliance Life Insurance Co." on Justia Law

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Pursuant to a collective bargaining agreement, T&W regularly contributed on behalf of its employees to the Suburban Teamsters of Northern Illinois Pension Fund. In 2014 T&W ceased operations and cut off its pension contributions, prompting the Fund to assess withdrawal liability of $640,900 under the Employee Retirement Income Security Act (ERISA), 29 U.S.C. 1396. The Fund sought to collect payment by mailing a notice of the withdrawal liability to T&W and affiliated entities. Those efforts were ignored. The district court ordered T&W and several other individuals and entities under common control to pay the withdrawal liability. The defendants argued that their due process rights were violated when the Fund initiated collection by mailing notice to some but not all of them. The Seventh Circuit affirmed. Certain defendants forfeited all defenses to liability, including the defense that they were not members of a controlled group, by failing to arbitrate after receiving the Fund’s notice of withdrawal liability. Other defendants had no credible claim of surprise (at being a member of a controlled group) to sidestep ERISA’s arbitration requirement. Each defendant was a trade or business under common control with another party who received the notice and was liable under ERISA’s controlled group provision; each became jointly and severally liable for payment View "Trustees of the Suburban Teamsters of Northern Illinois Pension Fund v. E Co." on Justia Law

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The First Circuit affirmed the judgment of the district court rejecting Plaintiffs’ motion to set aside an earlier federal district court decision granting summary judgment in favor of Defendants on Plaintiffs’ claims seeking to recover lost benefits from their former employer, holding that the district court properly found that the judgment was not procured by “fraud on the court.” Plaintiffs claimed in their motion that various defendants made deliberate material misstatements in their answers and various sworn statements. The district court determined that the allegations did not warrant vacating the judgment. The First Circuit affirmed, holding that, even assuming the truth of Plaintiffs’ allegations, the allegations were not sufficient to constitute “fraud upon the court.” View "Torres v. Bella Vista Hospital, Inc." on Justia Law

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The Eighth Circuit affirmed the district court's grant of ex-wife's motion to dismiss an action brought by ex-husband, alleging violations of the anti-alienation provisions of the Employee Retirement Income Security Act of 1974 (ERISA), that arose from payments he made to her for almost three decades. The court held that a prior state court judgment was entitled to res judicata effect where ex-husband had an opportunity to litigate the question of whether the state court had jurisdiction to address his violations of ERISA claims. View "Schwartz v. Bogen" on Justia Law

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In these consolidated cases, out-of-network medical providers who United intentionally failed to fully pay for services rendered to United plan beneficiaries in order to offset overpayments to the same providers from other United administered plans filed a class action under the Employee Retirement Income Security Act (ERISA) on behalf of their patients, the plan beneficiaries. Providers claimed that the relevant claim plan documents did not authorize United to engage in cross-plan offsetting. The Eighth Circuit affirmed the district court's grant of partial summary judgment to providers on the issue of liability and held that nothing in the plan documents even comes close to authorizing cross-plan offsetting. Furthermore, the practice of cross-plan offsetting was in some tension with the requirements of ERISA. While the court need not decide whether cross-plan offsetting necessarily violated ERISA, the court held that United's interpretation of the documents was not reasonable. View "Louis J. Peterson, D.C. v. UnitedHealth Group Inc." on Justia Law

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In this action under the Employee Retirement Income Security Act (ERISA), the Second Circuit affirmed the district court's decision ordering Xerox and others to recalculate plaintiffs' retirement benefits as a matter of equitable reformation and to pay prejudgment interest at the federal prime rate. The court held that the district court did not abuse its discretion by selecting the new hire approach as an equitable remedy to redress the Plan Administrator's notice violations. The court affirmed the district court's decision to use the prime rate because the district court had broad discretion to grant prejudgment interest and to select a rate; carefully considered all the relevant factors in determining whether prejudgment interest was warranted, and, if so, what the rate should be; and thoroughly explained its reasoning for using the federal prime rate. View "Frommert v. Conkright" on Justia Law

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Plaintiff filed suit against the plan administrator for Xerox under the Employee Retirement Income Security Act (ERISA) for denial of benefits and breach of fiduciary duty. The Second Circuit held that plaintiff's denial of benefits claim was untimely and that the administrator, not plaintiff, was entitled to summary judgment on the fiduciary duty claim. The court held that a litigant may not bring a denial‐of‐benefits claim under ERISA when the limitations period is six years and his claim accrued twelve years before he sued. The court also held that Frommert v. Conkright, 433 F.3d 254 (2d Cir. 2006), did not order the plan administrator not to apply the so‐called "phantom account offset" to plan participants who did not bring timely denial of benefits claims. Accordingly, the court affirmed in part, reversed in part, and remanded for directions to enter judgment for the administrator and the Xerox Plan. View "Testa v. Becker" on Justia Law

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Plaintiffs appealed the district court's dismissal of their action against fiduciaries of IBM's employee stock option plan (ESOP), claiming that defendants violated their duty under the Employee Retirement Income Security Act (ERISA) to manage the ESOP's assets prudently. The Second Circuit reversed the district court's judgment against plaintiffs, holding that plaintiffs plausibly pleaded a duty‐of‐prudence claim even under the stricter "could not have concluded" test used by the district court. In this case, a prudent fiduciary in the Plan defendants' position could not have concluded that corrective disclosure would do more harm than good. View "Jander v. International" on Justia Law

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The Ninth Circuit affirmed the district court's judgment against Quad in an action brought under the Multiemployer Pension Plan Amendments Act of 1980 (MPPAA). In this case, after the last of Quad's employees voted to decertify the union as their bargaining representative, Quad completely withdrew from the fund. The panel held that the Fund correctly applied the partial withdrawal credit pursuant to 29 U.S.C. 1386(b) against Quad's complete withdrawal liability before calculating the twenty-year limitation on annual payments provided for in 29 U.S.C. 1399(c)(1)(B). View "GCIU-Employer Retirement Fund v. Quad/Graphics, Inc." on Justia Law