Justia ERISA Opinion Summaries

In 2000, Rochow sold his interest in Universico to Gallagher and became President of Gallagher. As an employee of Gallagher, Rochow was covered under a LINA disability policy. In 2001, Rochow began to experience short term memory loss, chills, sweating, and stress at work. Gallagher demoted Rochow to Sales Executive-Account Manager. Because of his inability to perform his job, Gallagher forced Rochow to resign in January, 2002. In February 2002, Rochow experienced amnesia, was hospitalized, and was diagnosed with HSV-Encephalitis, a rare, severely debilitating brain infection. LINA repeatedly denied Rochow benefits stating that Rochow’s employment ended before his disability began. In 2004, Rochow sued Cigna, LINA’s parent company, alleging breach of fiduciary duty under ERISA, 29 U.S.C.1104(a). In 2007 the Sixth Circuit affirmed a decision that denial of Rochow’s claims was arbitrary, not the result of a deliberate, principled reasoning process, and did not appear to have been made solely in the interest of the participants and beneficiaries or the exclusive purpose of providing benefits to participants and beneficiaries as required by ERISA. Rochow died in 2008. In 2009, the district court ordered an equitable accounting of profits and disgorgement of $3,797,867.92 under an equitable theory of unjust enrichment. The Sixth Circuit affirmed.View "Rochowl v. Life Ins. Co. of N. America" on Justia Law

Plaintiff appealed the district court's denial of her motion for judgment on the record, affirming Liberty's termination of long-term disability benefits and dismissal of the complaint with prejudice. The policy provided that an employee was not disabled if the employee was capable of performing any occupation for which he or she was reasonably fitted. The court concluded that Liberty did not abuse its discretion in determining that plaintiff was reasonably fitted to perform the occupation of ambulance/emergency service dispatcher. Therefore, the record reflected that Liberty's decision to terminate benefits was supported by substantial evidence and thus did not constitute an abuse of discretion. Accordingly, the court affirmed the judgment of the district court.View "Gerhardt v. Liberty Life Assurance Co., et al." on Justia Law

In 2000, physicians and physician associations imitated a group of class actions against various providers of health plans, which were consolidated into a multidistrict litigation. This appeal involves this complex, twelve-year-old multidistrict litigation, a related multidistrict litigation pending in another federal district, and whether the district court reasonably interpreted the Settlement Agreement in the first action. The court affirmed the Injunction as to plaintiffs' Racketeer Influenced and Corrupt Organizations Act (RICO), 18 U.S.C. 1961, and antitrust claims and as to the Employee Retirement Income Security Act of 1974, 29 U.S.C. 1001 et seq., claims based on the denial or underpayment of benefits following the Settlement Agreement's Effective Date. On remand, the district court will need to determine which of plaintiffs' ERISA claims fall on the permissible side of the line, and reconsider the assessment of sanctions. View "Medical Assoc. of GA, et al. v. Wellpoint, Inc." on Justia Law

Plaintiff received coverage under Johnson & Johnson’s Long-Term Disability Plan while working for a subsidiary of Johnson & Johnson. Later, Johnson & Johnson and Medical Card System, Inc. (together, Appellees) terminated Plaintiff’s long-term disability benefits. The district court upheld the denial, holding that the plan administrator had ample basis for finding Plaintiff did not cooperate fully during the Functional Capacity Examination (FCE) and was thus ineligible for continuing benefits. Plaintiff again appealed, arguing, among other things, that the plan administrator abused its discretion in crediting an examination by a physical therapist over the opinion of his treating physician. The First Circuit Court of Appeals affirmed, holding (1) the plan administrator’s finding that Plaintiff was uncooperative during his final FCE was supported by substantial evidence, and therefore, the administrator’s decision to terminate Plaintiff’s long-term disability benefits was neither arbitrary nor capricious; and (2) the administrator did not abuse its discretion in determining whether there existed grounds for termination of Plaintiff’s benefits. View "Ortega-Candelaria v. Johnson & Johnson" on Justia Law

From 1978 to 2000, Cerentano worked as a coal miner. He was injured in 15 mining incidents and received six separate awards of permanent partial disability, but was able to return to work after each injury. In 2000 Cerentano was wrongfully discharged after a false positive drug test. Months later, he was diagnosed with depression due to his firing and treated for dysthymia and anxiety. Eventually, Cerentano found work as a real estate agent and a vehicle transporter. In 2005, Cerentano’s car was hit, causing more injuries. Cerentano was awarded Social Security disability benefits. He was denied disability pension benefits under the United Mine Workers Pension Trust Plan, based on the trustees’ conclusion that there was no causal link between his mine injuries and the award of Social Security benefits. Cerentano sued under the Employee Retirement Income Security Act, 29 U.S.C. 1332(a)(1)(b). The district court granted summary judgment to the plan. The Seventh Circuit reversed and remanded. The trustees should have examined all of the injuries, severe and non‐severe, that the ALJ relied on in finding Cerentano disabled and should have determined which of those injuries were caused by mine accidents and whether, the mine‐related injuries, in combination, comprised “a causal link.”View "Cerentano v. UMWA Health & Retirement Funds" on Justia Law

The National Labor Relations Board found that HH3 Trucking had committed unfair labor practices and ordered back pay for its workers. HH3 failed to comply. The NLRB petitioned for judicial enforcement. HH3 did not reply to the petitions. The Seventh Circuit we enforced the orders summarily. HH3’s liability is $190,000 plus interest. After finding that HH3’s owners, the Hudsons, could comply but had chosen not to do so, the court held the Hudsons in civil contempt, and ordered them to pay at least $600 a month until the full judgment had been satisfied. Nothing happened. The court directed the Marshals Service to place the Hudsons in custody until they paid. They promised compliance and were released. They paid $600, then stopped. They went back to jail. After they asserted that they are no longer able to comply, the court allowed them to be transferred to home confinement and investigated. Finding that, although Gretchen Hudson considers herself retired and William Hudson had (recently) become medically unable to work, they remain able to pay something by drawing on savings and sources of current income that include benefits from a retirement plan. They argued that money received from a pension plan covered by the Employee Retirement Income Security Act (ERISA), as their plan is, is free of all legal claims by third parties, 29 U.S.C. 1056(d)(1). The Seventh Circuit rejected the argument and, noting that the “scofflaws” have begun to receive Social Security benefits, which themselves exceed $600 monthly, ordered them to pay at least that amount. View "Nat'l Labor Relations Bd. v. HH3 Trucking, Inc." on Justia Law

Plaintiff appealed the district court's dismissal of his claims against the Fund and others under the Employee Retirement Income Security Act of 1974 (ERISA), 29 U.S.C. 1001 et seq. For over three years, the Fund paid plaintiff monthly pension benefits he had not earned. This case arose from the events that occurred after the Fund discovered the error. The court concluded that it was bound by its own precedent, which correctly identifies surcharge as including only unjust enrichment and losses to the trust estate; the district court properly concluded that plaintiff was not entitled to relief based on estoppel as a matter of law; equitable remedies were not available to plaintiff where the order plaintiff sought necessarily would require violating the terms of the Plan by deeming an ineligible person to be eligible for pension benefits; and the surcharge remedy plaintiff sought would not restore the trust estate, but rather would wrongfully deplete it by paying him benefits he is not eligible to receive under the Plan. Accordingly, the court affirmed the district court's grant of summary judgment in favor of defendants on plaintiff's breach of fiduciary and co-fiduciary duty claims under section 1132(a)(3). The court rejected plaintiff's argument that the Fund failed to comply with ERISA procedural requirements, or that it waived its determination that plaintiff never vested. Therefore, the court affirmed the district court's deference to the Fund's denial of benefits. View "Gabriel v. Alaska Electrical Pension Fund, et al." on Justia Law

This case concerned a plumbers and pipefitters union ("the Union"), which established employee benefits plans. Among the pension benefits promised to Union employees were "banked hour" benefits, which were retroactively conferred during the course of employment. The Pension Trust sought to eliminate the benefits in an attempt to meet its obligations to a larger group of plan participants. Plaintiffs, now-retired union employees, filed this action against the Trustees, alleging that the cuts, which were effectuated through a plan amendment, violated the anti-cutback provisions ERISA, which protects "accrued benefits" against reduction by amendment. The district court entered summary judgment for Plaintiffs. The First Circuit Court of Appeals affirmed, holding that Plaintiffs' benefits were in fact "accrued" and that the plan amendment, if implemented, would violate the anti-cutback provisions of ERISA. View "Bonneau v. Plumbers & Pipefitters Local Union 51 Pension Trust Fund" on Justia Law

After discovering that she had lung cancer that had spread to her brain, Killian underwent aggressive treatment on the advice of her doctor. The treatment was unsuccessful and she died. Her husband submitted medical bills for the cost of the treatments to her health insurance company. The company denied coverage on most of the expenses because the provider was not covered by the insurance plan network. The husband filed suit, seeking benefits for incurred medical expenses, relief for breach of fiduciary duty, and statutory damages for failure to produce plan documents. The district court dismissed denial-of-benefits and breach-of-fiduciary-duty claims, but awarded minimal statutory damages against the plan administrator. In 2012, the Seventh Circuit affirmed the dismissals, rejecting an argument that the plan documents were in conflict, but remanded for recalculation of the statutory damages award. On rehearing, en banc, the Seventh Circuit affirmed the denial of benefits and statutory penalties holdings, but reversed on the breach of fiduciary duty claim. The instructions given in plan documents were deficient and a reasonable trier of fact could rule in favor of Killian, based on telephone conversations in which Killian attempt to determine whether the physicians who were about to perform surgery were within the network.View "Killian v. Concert Health Plan" on Justia Law

Plaintiffs, a class of individuals who participated in the Morgan Stanley 401(k) Plan and the Morgan Stanley Employee Stock Ownership Plan, filed suit alleging violations of the Employee Retirement Income Security Act of 1974 (ERISA), 29 U.S.C. 1001 et seq. In January 2007 and 2008, Morgan Stanley elected to make its employer contributions to the Plans in the form of Company Stock instead of cash. After the stock price plunged in conjunction with the broader economic downturn, plaintiffs sought to recover for losses the Plans suffered as a result of the drop in stock price. The Moench "presumption of prudence" is a pleading standard that presumes plan fiduciaries act in "compliance with ERISA when [a plan] fiduciary invests assets in the employer's stock." The district court found that the Moench presumption of prudence applied to defendants' conduct and that plaintiffs failed to rebut this presumption. The court affirmed the district court's motion to dismiss on the district court's alternative ground because the challenged conduct, even if it negatively impacted the Plans, did not occur in the performance of a fiduciary function and therefore could not trigger fiduciary liability under ERISA. Absent fiduciary liability, plaintiffs' secondary claims also failed. View "Coulter, et al. v. Morgan Stanley & Co. Inc., et al." on Justia Law