Justia ERISA Opinion Summaries

Plaintiff filed suit against his former employer, Medtronic, alleging that the company improperly denied his claim for benefits under a long-term disability plan governed by the Employee Retirement Income Security Act (ERISA), 29 U.S.C. 1001 et seq. The court held that the district court did not abuse its discretion by admitting Medtronic's supplemental evidence for the limited purpose of determining the proper standard of review. The Plan provided Medtronic with complete and total discretionary authority to interpret and administer its provisions and this language is sufficient to trigger a deferential abuse-of-discretion standard of review and plaintiff failed to establish a procedural irregularity that would alter this standard or weigh in the court's consideration under it. Under this standard, the court agreed with the district court that Medtronic did not abuse its discretion in denying plaintiff's claim for "any occupation" long-term disability benefits. Accordingly, the court affirmed the judgment of the district court. View "Waldoch v. Medtronic, Inc." on Justia Law

Windstream filed suit against defendant and other retirees who challenged company authority to modify retiree benefits unilaterally. The court concluded that there was no evidence indicating that Windstream was required to obtain retiree consent. The court also concluded that the benefits were not permanently vested. Accordingly, the court affirmed the judgment in favor of Windstream. View "Windstream Corporation,., et al. v. Lee, et al." on Justia Law

Plaintiffs challenged an insurance company's use of "retained asset accounts" (RAAs) as a method of paying life insurance benefits in the ERISA context. They presented the district court with two basic questions: (1) whether the insurer's method of paying death benefits in the form of RAAs constitute self-dealing in plan assets in violation of ERISA section 406(b); and (2) whether this redemption method offended the insurer's duty of loyalty toward the class of beneficiaries in violation of ERISA section 404(a). The district court answered the first question in favor of the insurer and the second in favor of the plaintiff class. The court then awarded class-wide relief totaling more than $12,000,000. Both sides appealed. Upon review, the First Circuit Court of Appeals agreed with the district court that the insurer's use of RAAs in this case did not constitute self-dealing in plan assets. However, the Court disagreed with the district court's answer to the second question and held that the insurer's use of RAAs did not breach any duty of loyalty owed by the insurer to the plaintiff class. View "Merrimon, et al v. Unum Life Insurance Company" on Justia Law

Plaintiffs filed suit under the Employee Retirement Income Security Act of 1974 (ERISA), 29 U.S.C. 1001 et seq., against Xerox, the Plan, and the Plan Administrator. The Supreme Court reversed the court's most recent decision, holding that the court had erred in holding that, having found the Administrator's first interpretation of the retirement plan to be invalid, the district court properly refused to defer to the plan administrator's subsequent interpretation of the plan. On remand, the district court applied deferential review, holding that the Administrator's proposed offset was a reasonable interpretation of the retirement plan. The court held, however, that the proposed offset was an unreasonable interpretation of the retirement plan and that it violated ERISA's notice provisions. Although the court upheld the challenged discovery order, the court vacated the judgment and remanded for further proceedings.View "Frommert v. Conkright" on Justia Law

Plaintiff filed suit alleging that the International Plan denied him benefits to which he was entitled. The parties disputed whether plaintiff accrued enough credit under an earlier plan, the Local 963 Plan, which was later merged into the International Plan. On appeal, at issue was whether, because of the procedural irregularities in the administrator's handling of the claim, the district court should have applied a de novo standard of review. The court concluded that the district court applied the correct standard and affirmed the judgment, concluding that plaintiff had not alleged Employee Retirement Income Security Act (ERISA), 29 U.S.C. 1001 et seq., violations that rose to a level requiring a more stringent standard of review.View "James v. Int'l Painters, et al." on Justia Law

Central States, an employee benefit plan governed by the Employee Retirement Income Security Act, provides health insurance for Teamsters and their families. Guarantee Trust provides sports injury insurance for student athletes. Each of 13 high school and college athletes, all children of Teamsters, holds general health insurance from Central and sports injury insurance from Guarantee. Each suffered an injury while playing sports (most often football) between 2006 and 2009, and sought coverage from both companies. Each time Guarantee refused to pay the athlete’s medical expenses, and each time Central paid the bill under protest. The district court entered a declaratory judgment under ERISA, 29 U.S.C. 1132(a)(3)(B), that, when coverage of student athletes overlap, Guarantee must pay, and ordered Guarantee to reimburse Central for the payouts to the 13 students. The Sixth Circuit, affirmed in part characterizing the case as a “you first” paradox, or ‘gastonette.” An ERISA plan may coordinate benefits with another policy, but may not redefine the coverage of another policy. Absent the Central plan, the Guarantee policy would cover the sports injuries at issue without question. An ERISA plan must keep doing what it would do in another plan’s absence. That amounts to coordinating benefits, not redefining coverage. View "Cent St, SE & SW Areas Health & Welfare Fund v. First Agency, Inc." on Justia Law

Plaintiff filed suit against her former employer, Andalex, alleging claims of discrimination, retaliation, and hostile work environment under federal and state law, as well as claims that Andalex failed to notify her of her right to continuing health care coverage under the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA), 29 U.S.C. 1166 et seq. The district court granted summary judgment in favor of Andalex and dismissed her claims. The court affirmed the district court's judgment except with respect to plaintiff's retaliation claims. Based on the discrepancies between the EEOC statement and subsequent testimony, a reasonable juror could infer that the explanation given by Andalex was pretextual, and that, coupled with the temporal proximity between the complaint and the termination, the complaint at issue was a but-for cause of defendant's termination. Accordingly, there was sufficient evidence to require denial of the summary judgment motion on the retaliation claims. View "Kwan v. The Andalex Group LLC" on Justia Law

Plaintiffs filed suit claiming denial of medical insurance, Medicare premiums, and deductible reimbursements. The district court held that the pension plan benefit plan was a "governmental plan" exempt from the Employee Retirement Income Security Act (ERISA), 29 U.S.C. 1001 et seq., and granted defendants' motion to dismiss for lack of subject matter jurisdiction. The court vacated and remanded, concluding that the district court employed the wrong procedural mechanism for analyzing this case. Because a federal district court has jurisdiction to decide whether or not a plan is an ERISA plan as claimed by plaintiffs, the court concluded that, under Supreme Court precedent and ACS Recovery Services, Inc. v. Griffin, the proper procedural vehicle to raise the question of whether a purported ERISA plan is a "governmental plan" is either Rule 12(b)(6) or, if factual information outside the pleadings is needed, Rule 56. View "Smith, et al. v. Regional Transit Auth., et al." on Justia Law

Plaintiff, a large Employee Retirement Income Security Act (ERISA), 29 U.S.C. 1001 et seq., provider, sought a declaration that defendants, three independent, non-ERISA insurance providers, were bound by the terms of the ERISA plan and primarily liable for injuries sustained by individuals covered by the parties. The district court granted defendants' motion to dismiss. The court concluded that the Central States have failed to state a claim for equitable relief as required by Section 502(a)(3) of ERISA; there was no gap in ERISA's enforcement scheme requiring a federal common law claim for unjust enrichment; and Count I does not adequately state a claim for equitable relief under ERISA 502. Accordingly, the court affirmed the judgment of the district court. View "Central States, SE and SW Areas Health and Welfare Fund v. Health Special Risk, Inc., et al" on Justia Law

Plaintiffs, a group of retired U.S. Airways pilots, filed a class action seeking interest for the period of delay in the payment of their retirement benefits. The district court refused to certify the class. The court reversed and remanded, holding that the class members were not required to exhaust internal remedies before bringing their claims in court because they sought enforcement of the Employee Retirement Income Security Act's (ERISA), 29 U.S.C. 1001 et seq., substantive guarantees rather than contractual rights. View "Stephens, et al. v. US Airways Group, Inc., et al." on Justia Law