Justia ERISA Opinion Summaries

A company sponsored a health benefit plan for its employees, which was administered by another entity. An employee under this plan, referred to as Patient AA, sought medical treatment from several out-of-network providers. Before providing care, these providers contacted the plan administrator to confirm the reimbursement rate. The administrator’s employees orally stated that reimbursement would be at the usual, customary, and reasonable (UCR) rate, a standard commonly used in the industry. Relying on these assurances, the providers treated Patient AA. When they later sought payment, they were reimbursed at a much lower rate, calculated according to Medicare rates, not the promised UCR rate.The providers sued both the employer and the plan administrator, asserting state-law claims for negligent misrepresentation and promissory estoppel based on the oral statements about reimbursement. The action began in California state court but was removed to federal court and transferred to the United States District Court for the Eastern District of Michigan. The defendants moved to dismiss the complaint, arguing that the claims were preempted by the Employee Retirement Income Security Act of 1974 (ERISA). The district court agreed, applying the Sixth Circuit’s decision in Cromwell v. Equicor-Equitable HCA Corp., and dismissed the complaint with prejudice, finding that the claims “related to” the ERISA plan and were thus preempted. The district court also denied the providers’ post-judgment request for leave to amend their complaint.The United States Court of Appeals for the Sixth Circuit affirmed. The court held that, under its precedent in Cromwell, ERISA expressly preempts state-law negligent-misrepresentation and promissory-estoppel claims by third-party healthcare providers when those claims are based on oral assurances regarding the terms of coverage or reimbursement under an ERISA-governed plan. The district court’s dismissal with prejudice was upheld. View "Laurel Hill Mgmt. Servs., Inc v. La-Z-Boy Inc." on Justia Law

An employee of Royal Caribbean participated in the company’s retirement plan and invested in a series of target date funds managed by Russell. She, on behalf of a class, alleged that Royal Caribbean, as plan sponsor and fiduciary under ERISA, breached its duty of prudence by selecting and retaining the Russell Target Date Funds (TDFs) instead of alternatives like those from Vanguard or American Funds. The complaint highlighted that the Russell TDFs underperformed their peers and benchmarks, charged higher fees, and had features—such as a particular glidepath and asset allocation—that allegedly made them a poor fit for plan participants. Internal communications from Russell and Royal Caribbean raised concerns about the performance and cost of the Russell TDFs.The United States District Court for the Southern District of Florida granted summary judgment to Royal Caribbean. It reasoned that, in order to prove the investment was objectively imprudent, the plaintiff was required to present “apples-to-apples” comparator evidence—showing the Russell TDFs were worse than another fund with the same investment strategy and risk profile. The district court found that the plaintiff’s comparators, such as the Vanguard and American Funds TDFs, were not proper because they differed in strategy and structure from the Russell funds.The United States Court of Appeals for the Eleventh Circuit reviewed the case. It held that an ERISA plaintiff is not always required to provide an “apples-to-apples” comparator to establish that an investment was objectively imprudent. The court explained that evidence of objective imprudence can be qualitative or quantitative, and the inquiry is context-specific, depending on all relevant facts and circumstances. The Eleventh Circuit reversed the district court’s grant of summary judgment and remanded the case for further proceedings. View "Johnson v. Russell Investments Trust Company" on Justia Law

An aluminum company had, through various collective bargaining agreements (CBAs), promised certain healthcare benefits to retirees, their spouses, and dependents. The agreements did not specify the duration of these benefits, but the company had been providing lifetime healthcare coverage to individuals who retired before June 1, 1993. In August 2020, the company announced it would transition these pre-1993 retirees to a new health reimbursement arrangement starting January 1, 2021, under which the company reserved the right to terminate benefits at any time. Over 3,000 affected individuals, including the widow of a former employee, challenged this change, alleging that it breached the CBAs and violated federal labor and benefits laws.The United States District Court for the Southern District of Indiana certified a class of affected retirees and their eligible spouses and dependents. After discovery, the court granted summary judgment as to liability in favor of the plaintiffs, relying on judicial estoppel. The court found that the company was barred from arguing that benefits were not vested for life because it had previously taken the opposite position in earlier litigation. As a result, the district court declared that class members were entitled to lifetime healthcare benefits and issued a permanent injunction requiring reinstatement of the prior plan and allowing claims for expenses incurred since January 1, 2021.The United States Court of Appeals for the Seventh Circuit reviewed the case and affirmed the district court’s certification of the class under Rule 23(b)(2), finding no abuse of discretion. However, it reversed the grant of summary judgment as to liability. The appellate court concluded that judicial estoppel did not apply because the company’s prior statements in earlier litigation were not clearly inconsistent with its current position. The case was remanded for further proceedings on the merits. View "Kaiser v Alcoa USA Corp." on Justia Law

A dispute arose concerning the payment rate for a surgical procedure performed at an out-of-network facility. The patient receiving the surgery was covered by an ERISA-governed health plan provided by the employer and administered by an insurance company. Prior to the surgery, the facility contacted the plan administrator to verify coverage and was told that the plan would reimburse at the usual, customary, and reasonable (“UCR”) rate, not the lower Medicare rate. Relying on this representation, the facility performed the surgery. However, the plan later paid only at the Medicare rate, far less than the full billed amount. The facility’s successor in interest, having obtained the rights to the claim, sought to recover the unpaid balance.The action was first brought in California state court, then removed to the United States District Court for the Central District of California. The plaintiff asserted both ERISA and state law claims. The district court dismissed the ERISA claim for lack of derivative standing, as the plaintiff was not properly assigned the right to sue under ERISA. The court also dismissed the state law claims for negligent misrepresentation and promissory estoppel, holding that these claims were preempted by ERISA because they related to an ERISA-covered plan.The United States Court of Appeals for the Ninth Circuit reviewed the case. It affirmed the district court’s dismissal of the promissory estoppel claim, holding that, under circuit precedent, such claims are preempted by ERISA. However, the Ninth Circuit reversed the dismissal of the negligent misrepresentation claim. The appellate court held that ERISA does not preempt a negligent misrepresentation claim by a provider’s successor in interest when the claim arises from representations made by the plan administrator during a pre-service verification call. The court concluded that such a claim does not sufficiently “relate to” an ERISA plan to trigger preemption, as it is not based on an ERISA-regulated relationship or enforceable under ERISA’s civil enforcement mechanism. The case was remanded for further proceedings on the negligent misrepresentation claim. View "HEALTHCARE ALLY MANAGEMENT OF CALIFORNIA, LLC V. WSP USA, INC." on Justia Law

The plaintiff, a former employee of a company participating in a deferred profit-sharing plan, sought to liquidate his 401(k) account in anticipation of a post-election stock market increase. He requested that the plan’s record keeper, Fidelity, complete the liquidation rapidly and in a manner advantageous for tax purposes. The plaintiff claimed that Fidelity’s communications led him to believe he would have quicker access to his funds than ultimately occurred, resulting in a missed investment opportunity. Additionally, he alleged that the plan administrator, Altria, failed to provide him with a copy of the administrative services agreement (ASA) between Altria and Fidelity, which he requested under ERISA.After the plaintiff’s formal complaint was denied by the plan administrator, he appealed to the plan’s management committee, which upheld the denial. He then filed suit in the United States District Court for the Eastern District of Virginia, raising claims for denial of benefits, breach of fiduciary duty, and failure to provide plan documents. The district court granted summary judgment to the defendants on all remaining claims, finding that the plan administrator’s denial was reasonable, that Fidelity was not acting as a fiduciary or had not breached any fiduciary duties, and that the ASA was not a document required to be disclosed under ERISA.The United States Court of Appeals for the Fourth Circuit reviewed the case. The appellate court affirmed the district court’s rulings on the denial of benefits and breach of fiduciary duty claims, concluding that the plan administrator’s decision was reasonable and that Fidelity was not a fiduciary in this context or had not breached any such duty. However, the Fourth Circuit reversed the district court’s decision regarding the ASA, holding that it was a document under which the plan was operated and remanded for consideration of statutory penalties. The court affirmed the award of attorney’s fees to the defendants. View "Kelly v. Altria Client Services, LLC" on Justia Law

A former employee brought suit against her previous employer and associated fiduciaries, alleging that they mismanaged the employer's retirement savings plan, which is a defined contribution plan governed by the Employee Retirement Income Security Act of 1974 (ERISA). She claimed that the fiduciaries retained underperforming investment options in the plan’s menu to generate transaction fees, in violation of their duties of prudence and loyalty, and sought plan-wide monetary and equitable relief on behalf of the plan.Previously, the United States District Court for the Central District of California reviewed the case. The defendants moved to compel arbitration, relying on provisions in the plan requiring arbitration of disputes and waiving participants’ rights to bring claims on a “class, collective, or representative basis.” The plaintiff argued that this waiver impermissibly precluded her from enforcing statutory rights under ERISA, which allow participants to sue on behalf of the plan for plan-wide relief. The district court denied the motion to compel arbitration, finding the waiver unenforceable under the effective-vindication doctrine and holding that the waiver provision was expressly non-severable, thus requiring the claims to proceed in court.On appeal, the United States Court of Appeals for the Ninth Circuit affirmed the district court’s denial of the motion to compel arbitration. The Ninth Circuit held that the plan’s waiver provision was unenforceable because it prevented the plaintiff from asserting her right under ERISA to bring representative claims for plan-wide relief—a right that ERISA expressly provides. The court further held that, under the plan’s own terms, once the waiver was found unenforceable, any representative claim must be adjudicated in court, not arbitration. Thus, the plaintiff’s breach-of-fiduciary-duty claims would proceed before the district court. View "POVER V. THE CAPITAL GROUP COMPANIES, INC." on Justia Law

A participant in two ERISA-qualified retirement plans at a university sought to change the beneficiary designation shortly before his death, naming trust accounts for his grandchildren as primary beneficiaries and removing his wife as a primary beneficiary. The plan documents required spousal consent for such changes. The participant’s wife, who was still living at the time, had previously executed a Wisconsin statutory power of attorney appointing her son-in-law as her agent. The agent signed the spousal consent form on her behalf, but the power of attorney did not expressly grant authority to waive her spousal survivor annuity rights. The plan recordkeeper rejected the beneficiary change form as deficient, and the participant died soon thereafter. The wife died about a year later. The plaintiffs, including family members and trustees, sought to enforce the beneficiary change, arguing that the power of attorney provided sufficient authority.After the recordkeeper’s rejection, the plaintiffs made a claim for benefits with the university as plan administrator. The university denied the claim, determining that Wisconsin law required a specific grant of authority in the power of attorney to waive spousal survivor benefits, which was absent in this case. The plaintiffs appealed the denial, but the university upheld its decision. Plaintiffs then filed suit in the United States District Court for the Northern District of Illinois, asserting claims under ERISA for benefits, breach of fiduciary duty, and negligence. The district court granted summary judgment for the defendants, concluding the waiver was invalid and finding no merit in the other claims.The United States Court of Appeals for the Seventh Circuit affirmed the district court’s judgment. The Seventh Circuit held that under Wisconsin law, specifically Wis. Stat. § 244.41(1)(f), a power of attorney must expressly grant authority to an agent to waive spousal rights to a joint and survivor annuity. Because the power of attorney did not contain such an express grant, the attempted waiver was invalid, and the plaintiffs’ ERISA claim failed. The court also affirmed dismissal of the fiduciary duty and negligence claims and denied the plaintiffs’ motion to certify a question to the Wisconsin Supreme Court. View "Havlik v. University of Chicago" on Justia Law

Segerdahl Corporation, a direct-mail printing company wholly owned by an employee stock ownership plan (ESOP), was sold to a private equity firm in 2016. Bruce Rush, a senior manager and ESOP shareholder, alleged that the sale was improperly organized and approved for less than the company’s fair market value. He claimed that the Defendants—the ESOP trustee GreatBanc and several Segerdahl Board members—breached their fiduciary duties under ERISA by favoring financial buyers, inadequately marketing the company, and failing to secure a higher sale price. The sale process involved negotiations led by JP Morgan, with only financial buyers considered, culminating in an agreement with ICV Partners for $265 million.The United States District Court for the Northern District of Illinois, Eastern Division, certified a class of ESOP shareholders and denied summary judgment for most claims. After a three-week bench trial, the district court issued a comprehensive opinion finding in favor of Defendants on all counts. The court determined that the Defendants did not intentionally depress the sale price, had obtained the best possible price given Segerdahl’s declining performance, and had fulfilled their fiduciary obligations. The district court also found no prohibited transactions under ERISA and concluded that Rush failed to prove damages, rejecting expert testimony that relied on hypothetical buyers and unsupported valuations.On appeal, the United States Court of Appeals for the Seventh Circuit reviewed the district court’s legal conclusions de novo and factual findings for clear error. The appellate court affirmed the district court’s judgment, holding that there was no clear error in the findings that Defendants did not breach their fiduciary duties, did not engage in prohibited transactions, and that the sale price reflected fair market value. The district court’s decision was affirmed in full. View "Rush v GreatBanc Trust Co." on Justia Law

A group of affiliated truck dealerships in the Midwest operated through a complex structure of multiple limited liability companies. Each dealership location had a “Sales” company that owned assets and an “Employee Solutions” (ES) company that hired employees and leased them to the Sales company. The ES companies entered collective-bargaining agreements requiring pension contributions to a union fund. Over time, the ES companies stopped contributing and employing workers, transferring employees to newly created entities. One of the companies, ES Alsip, incurred withdrawal liability for ceasing contributions. The pension fund assessed over $6 million in liability, which was disputed and partially paid following an arbitration that substantially reduced the amount. Ultimately, higher courts reinstated the original liability.The United States District Court for the District of Columbia granted summary judgment to the pension fund, holding that ES Summit was liable for delinquent contributions for work performed at another dealership, ES Alsip’s withdrawal liability was properly calculated and subject to an increased interest rate, and that multiple affiliated entities and individuals were jointly and severally liable for the obligations. The court also imposed liability on successors and individual owners, the Bouchers, based on their house-flipping activities.On review, the United States Court of Appeals for the District of Columbia Circuit affirmed in part, reversed in part, and remanded. The court held that the delinquent-contribution claim against ES Summit was not adequately pleaded and reversed summary judgment on that issue. It affirmed the allocation of a partial payment to interest rather than principal, but reversed the application of an increased interest rate retroactively. The court affirmed the finding that each Sales entity was a single employer with its corresponding ES entity and upheld successor liability against Laborforce and ESI. However, it found genuine disputes of fact regarding the personal liability of the Bouchers and remanded that issue. View "Trustees of the IAM National Pension Fund v. M & K Employee Solutions" on Justia Law

Kevin Flowers, a participant in an employee benefits plan governed by the Employee Retirement Income Security Act of 1974 (ERISA), receives prescription drug benefits administered by Caremark, a pharmacy benefits manager. Flowers alleges that Caremark unjustly enriches itself by limiting maintenance prescription coverage to either CVS retail pharmacies or Caremark’s mail-order delivery service. He claims this violates Arkansas statutes requiring PBMs not to mandate home delivery and to provide reasonably adequate and accessible pharmacy networks, leading him and similarly situated individuals to pay out of pocket at local pharmacies.Reviewing the case, the United States District Court for the Western District of Arkansas granted Caremark’s motion to dismiss. The court determined that Flowers failed to plausibly plead a violation of the Mail Order Provision because Caremark did not require prescriptions to be filled solely through home delivery. Regarding the Network Adequacy Provision, the district court found that ERISA preempted the Arkansas requirements, particularly those imposing geographic coverage standards for pharmacy networks.On appeal, the United States Court of Appeals for the Eighth Circuit reviewed the district court’s dismissal de novo. The court affirmed the district court’s ruling, holding that Flowers did not plausibly allege a violation of the Mail Order Provision. The court also concluded that the geographic coverage requirements imposed by Arkansas regulations under the Network Adequacy Provision are preempted by ERISA, as they force PBMs to tailor their networks in ways that interfere with nationally uniform plan administration and constitute an impermissible connection with ERISA plans. The court expressly left open whether the Network Adequacy Provision, without its implementing regulations, would also be preempted. The court affirmed the district court’s dismissal of Flowers’s claims. View "Flowers v. Caremark PCS Health, LLC" on Justia Law