Justia ERISA Opinion Summaries

The Ninth Circuit reversed the district court's judgment in favor of MetLife in an action filed by plaintiff to seek life insurance benefits under a benefits plan governed by the Employee Retirement Income Security Act (ERISA), 29 U.S.C. 1001 et seq. The panel held that MetLife waived the evidence of insurability requirement because it did not ask plaintiff for a statement of health, even as it accepted her premiums for $250,000 in coverage. In this case, MetLife's purported ignorance of the facts did not negate its obligation to pay the entire $250,000 because, under agency law, the policyholder-employer's knowledge and conduct may be attributed to MetLife. View "Salyers v. Metropolitan Life Insurance Co." on Justia Law

Union Pacific employee Dowling became totally disabled by multiple sclerosis in 1997. His disability benefits ended in 2012 when he reached age 65 and began to draw a pension. Instead of calculating Dowling’s pension based on Dowling’s last 10 years of actual work—ending in 1997—the administrator operated as if Dowling had worked and been paid his final base salary— $208,000 per year— for his credited years of service, until his retirement in 2012, even though Dowling had not actually worked during that period. Dowling is covered by a 277-page retirement plan composed of introductory material, 19 articles of content, and various appendices—none of which explicitly address Dowling’s precise situation. The administrator’s interpretation provides Dowling with a lower monthly payment than he expected. Dowling challenged the administrator’s decision as contradicting the plan’s plain language. In Dowling’s suit under ERISA, 29 U.S.C. 1132(a)(1)(B), the district court found the plan ambiguous and the administrator’s interpretation reasonable. The Third Circuit affirmed. The plan’s terminology, silence, and structure render it ambiguous, so the plan accords the plan administrator discretion to interpret ambiguous plan terms. The mere existence of a conflict of interest is alone insufficient to raise skepticism of the plan administrator’s decision. View "Dowling v. Pension Plan for Salaried Employees of Union Pacific Co." on Justia Law

Union Pacific employee Dowling became totally disabled by multiple sclerosis in 1997. His disability benefits ended in 2012 when he reached age 65 and began to draw a pension. Instead of calculating Dowling’s pension based on Dowling’s last 10 years of actual work—ending in 1997—the administrator operated as if Dowling had worked and been paid his final base salary— $208,000 per year— for his credited years of service, until his retirement in 2012, even though Dowling had not actually worked during that period. Dowling is covered by a 277-page retirement plan composed of introductory material, 19 articles of content, and various appendices—none of which explicitly address Dowling’s precise situation. The administrator’s interpretation provides Dowling with a lower monthly payment than he expected. Dowling challenged the administrator’s decision as contradicting the plan’s plain language. In Dowling’s suit under ERISA, 29 U.S.C. 1132(a)(1)(B), the district court found the plan ambiguous and the administrator’s interpretation reasonable. The Third Circuit affirmed. The plan’s terminology, silence, and structure render it ambiguous, so the plan accords the plan administrator discretion to interpret ambiguous plan terms. The mere existence of a conflict of interest is alone insufficient to raise skepticism of the plan administrator’s decision. View "Dowling v. Pension Plan for Salaried Employees of Union Pacific Co." on Justia Law

The Ninth Circuit reversed the district court's grant of summary judgment to defendants in an action under the Employee Retirement Income Security Act (ERISA). Plaintiff alleged that defendants failed to adequately disclose that the lifetime benefit maximum applied to the plan at issue. The panel held that ERISA, as amended by the Affordable Care Act, does not ban lifetime benefit maximums for certain retiree-only plans; defendants violated ERISA's statutory and regulatory disclosure requirements by providing a faulty summary of material modifications describing changes to the lifetime benefit maximum in September 2010; and genuine disputes of material fact preclude summary judgment on the breach of fiduciary duty claims. View "King v. Blue Cross and Blue Shield" on Justia Law

HCSC is an Illinois not-for-profit corporation that offers Blue Cross and Blue Shield insurance through licensed affiliates in five states and contracts with outside affiliates for prescription drug services, claim payments, and other administrative work. HCSC owns or controls its affiliates and places its officers on their boards. HCSC does not disclose the extent of these ties to its insureds. Its policies state that the affiliates pay it rebates, but it does not share those rebates with its customers. Alleging that these arrangements violated Illinois law and the Employee Retirement Income Security Act (ERISA), 29 U.S.C. 1001, Priddy and others filed a putative class. The district court certified four classes under Federal Rule of Civil Procedure 23(b)(3): employers who purchased HCSC plans for employees in any of the five states served by HCSC; beneficiaries of employer-furnished plans provided by HCSC in any of the five states; individuals who purchased insurance directly from HCSC in any of the five states; and Illinois insureds who were protected by Illinois insurance regulations. The four classes included approximately 10 million people. The Seventh Circuit vacated class certification. It is not clear that HCSC owed many class members any fiduciary duty. Three of the four classes certified include people whom HCSC does not insure and who do not pay it premiums. View "Priddy v. Health Care Service Corp." on Justia Law

Twin City filed suit seeking to recover unpaid fringe-benefit contributions allegedly due under a collective bargaining agreement (CBA). The district court granted summary judgment for the Association on the ground that WQS was precluded by a previous lawsuit from disputing liability for the contributions as an alter ego of a signatory of the agreement. The Eighth Circuit affirmed the district court's determination that WQS was liable for the unpaid fringe-benefit contributions where all of the elements required to apply issue preclusion were present. The court held that the Association has a right to collect contributions under the CBA, but that two categories of damages were not authorized by the Employee Retirement and Income Security Act, 29 U.S.C. 1132, 1145, and that the award should be reduced accordingly. The court also upheld the district court's grant of injunctive relief. The court remanded for the district court to exclude contributions due to the Working Fee and Industry Fund from the damages award, and to reduce the award of interest accordingly. View "Twin City Pipe Trades Service Assoc. v. Wenner Quality Services, Inc." on Justia Law

The Fund filed suit against defendants under the Employee Retirement Income Security Act (ERISA), 29 U.S.C. 1132(a)(3), alleging that it had a right to a portion of a negligence settlement attributable to medical expenses. The Eighth Circuit affirmed the district court's grant of summary judgment for the Fund, considering defendants' admissions that the settlement agreements included the claim for medical expenses. Therefore, the Fund was entitled to whatever was recovered for medical expenses in the settlement action. View "Mackey v. Johnson" on Justia Law

Plaintiff filed suit under Section 502(c)(1) of the Employee Retirement Income Security Act of 1974 (ERISA), 29 U.S.C. 1132(c)(1)(B), alleging that defendants failed to timely comply with her request for documents relating to her healthcare benefit plan. The Second Circuit affirmed the district court's dismissal of plaintiff's claim as time-barred. Because ERISA does not specify a statute of limitations for Section 502(c)(1) claims, the courts apply the state statute of limitations that is the nearest analogue. The court held that the most analogous statute of limitations in Connecticut was the one-year statute of limitations for actions to recover civil forfeitures. Applying the one-year limitation, the court held that plaintiff's claim was time-barred. View "Brown v. Rawlings Financial Services, LLC" on Justia Law

After Aetna determined that plaintiff was not disabled and terminated her benefits, she filed suit under the Employee Retirement Income Security Act (ERISA), 29 U.S.C. 1001 et seq. The district court applied de novo review and held that Aetna improperly denied plaintiff's claim. The Ninth Circuit vacated the district court's judgment, holding that the district court should have reviewed the denial only for abuse of discretion. The panel held that the plan contained a discretionary clause and thus called for abuse of discretion review; Aetna provided no sound reason to depart from the text of section 22 of the California Insurance Code, which brought within the scope of Cal. Ins. Code 10110.6 Boeing's self-funded STD plan; ERISA preempted application of section 10110.6 to Boeing's self-funded plan; and remand was necessary to permit the district court to properly apply the abuse of discretion standard. View "Williby v. Aetna Life Insurance Co." on Justia Law

Plaintiffs filed suit under the Employee Retirement Income Security Act (ERISA), 29 U.S.C. 1001 et seq., to recover alleged overpayments of retirement benefits to certain employees of DAK who were participants in the Plan. The Fourth Circuit held that the written language of the Plan clearly and unambiguously provided the lump sum elected by the employees was the actuarial equivalent of the Accrued Benefit payable at the employee's Normal Retirement Date. Therefore, the court affirmed the district court's award of summary judgment to plaintiffs on their equitable restitution claim. The court also held that the doctrine of equitable estoppel could not be used to require the payment of benefits that conflict with the express, written terms of the Plan; the court assumed, without deciding, that the particular facts of this case could establish a finding that plaintiffs breached their fiduciary duty and turned instead to consider whether any of the employees established a triable issue of fact as to "actual harm" in connection with their claims for a surcharge remedy; and Rodney B. Smith was the only employee with a viable surcharge claim for purposes of summary judgment. Accordingly, the court vacated the judgment against Smith and remanded for further proceedings. View "Retirement Committee of DAK Americas v. Brewer" on Justia Law