Justia ERISA Opinion Summaries

Hartford is the administrator of Wal-Mart’s Group Disability Plan, which is covered by the Employee Retirement Income Security Act. The policy requires any suit to recover benefits pursuant to ERISA, 29 U. S. C. 1132(a)(1)(B), to be filed within three years after “proof of loss” is due. Heimeshoff filed a claim for long-term disability benefits. Following mandatory administrative review process, Hartford issued a final denial. Almost three years after the final denial but more than three years after proof of loss was due, Heimeshoff sought judicial review under ERISA. The district court dismissed, reasoning that while ERISA does not provide a statute of limitations, the contractual limitations period was enforceable under state law and Circuit precedent. The Second Circuit affirmed. The Supreme Court affirmed, finding the limitations provision enforceable. A participant’s ERISA cause of action does not accrue until the plan issues a final denial, but it does not follow that a plan and its participants cannot agree to commence the limitations period before that time. The Court noted that contractual limitations provisions should ordinarily be enforced as written. The period at issue is not unreasonably short and does not undermine ERISA’s two-tiered remedial scheme by causing participants to shortchange the internal review process. If administrators attempt to prevent judicial review by delaying the resolution of claims in bad faith, the penalty for failure to meet regulatory deadlines is immediate access to judicial review for the participant and courts can apply waiver or estoppel. Plans offering appeals beyond what is contemplated in the internal review regulations must agree to toll the limitations provision during that time, 29 CFR 2560.503–1(c)(3)(ii). View "Heimeshoff v. Hartford Life & Accident Ins. Co." on Justia Law

The US Airways health benefits plan paid $66,866 in medical expenses for injuries suffered by McCutchen, its employee, in a car accident caused by a third party. The plan entitled US Airways to reimbursement if McCutchen recovered money from the third party. McCutchen’s attorneys secured $110,000 in payments, and McCutchen received $66,000 after deducting the contingency fee. US Air¬ways demanded reimbursement of the full $66,866 and filed suit under section 502(a)(3) of the Employee Retirement Income Security Act, which authorizes health-plan administrators to bring a civil action “to obtain ... appropriate equitable relief ... to enforce .. the plan.” The district court granted US Airways summary judgment. The Third Circuit vacated, reasoning that equitable doctrines and defenses overrode the reimbursement clause, which would leave McCutchen with less than full payment for his medical bills and give US Airways a windfall. The Supreme Court vacated and remanded, holding that the plan’s terms govern. An administrator can use section 502(a)(3) to obtain funds that its beneficiaries promised to turn over. ERISA focuses on what a plan provides; section 502(a)(3) does not authorize “appropriate equitable relief” at large,” but only relief necessary to enforce “the terms of the plan” or the statute. While equitable rules cannot trump a reimbursement provision, they may aid in construing it. The plan is silent on allocation of attorney’s fees, and the common¬fund doctrine provides the appropriate default rule. View "US Airways, Inc. v. McCutchen" on Justia Law

Respondents, on behalf of beneficiaries of the CIGNA Corporation's ("CIGNA") Pension Plan, challenged the new plan's adoption, claiming that CIGNA's notice of the changes was improper, particularly because the new plan in certain respects provided them with less generous benefits. At issue was whether the district court applied the correct legal standard, namely, a "likely harm" standard, in determining that CIGNA's notice violations caused its employees sufficient injury to warrant legal relief. The Court held that although section 502(a)(1)(B) of the Employee Retirement Income Security Act of 1974 ("ERISA"), 29 U.S.C. 1022(a), 1024(b), 1054(h), did not give the district court authority to reform CIGNA's plan, relief was authorized by section 502(a)(3), which allowed a participant, beneficiary, or fiduciary "to obtain other appropriate relief" to redress violations of ERISA "or the [plan's] terms." The Court also held that, because section 502(a)(3) authorized "appropriate equitable relief" for violations of ERISA, the relevant standard of harm would depend on the equitable theory by which the district court provided relief. Therefore, the Court vacated and remanded for further proceedings. View "CIGNA Corp. v. Amara et al." on Justia Law

Fifth Third maintains a defined-contribution retirement savings plan for its employees. Participants may direct their contributions into any of several investment options, including an “employee stock ownership plan” (ESOP), which invests primarily in Fifth Third stock. Former participants sued, alleging breach of the fiduciary duty of prudence imposed by the Employee Retirement Income Security Act (ERISA), 29 U.S.C. 1104(a)(1)(B) in that the defendants should have known—on the basis of both public information and inside information available to Fifth Third officers—that the stock was overpriced and risky. The price of Fifth Third stock fell, reducing plaintiffs’ retirement savings. The district court dismissed; the Sixth Circuit reversed. A unanimous Supreme Court vacated. ESOP fiduciaries are not entitled to any special presumption of prudence, but are subject to the same duty that applies to ERISA fiduciaries in general, except that they need not diversify the fund’s assets. There is no requirement that plaintiffs allege that the employer was, for example, on the “brink of collapse.” Where a stock is publicly traded, allegations that a fiduciary should have recognized, on the basis of publicly available information, that the market was over- or under-valuing the stock are generally implausible and insufficient to state a claim. To state a claim, a complaint must plausibly allege an alternative action that could have been taken, that would have been legal, and that a prudent fiduciary in the same circumstances would not have viewed as more likely to harm the fund than to help it. ERISA’s duty of prudence never requires a fiduciary to break the law, so a fiduciary cannot be imprudent for failing to buy or sell in violation of insider trading laws. An allegation that fiduciaries failed to decide, based on negative inside information, to refrain from making additional stock purchases or failed to publicly disclose that information so that the stock would no longer be overvalued, requires courts to consider possible conflicts with complex insider trading and corporate disclosure laws. Courts confronted with such claims must also consider whether the complaint has plausibly alleged that a prudent fiduciary in the same position could not have concluded that stopping purchases or publicly disclosing negative information would do more harm than good to the fund. View "Fifth Third Bancorp v. Dudenhoeffer" on Justia Law

Hartford is the administrator of Wal-Mart’s Group Disability Plan, which is covered by the Employee Retirement Income Security Act. The policy requires any suit to recover benefits pursuant to ERISA, 29 U. S. C. 1132(a)(1)(B), to be filed within three years after “proof of loss” is due. Heimeshoff filed a claim for long-term disability benefits. Following mandatory administrative review process, Hartford issued a final denial. Almost three years after the final denial but more than three years after proof of loss was due, Heimeshoff sought judicial review under ERISA. The district court dismissed, reasoning that while ERISA does not provide a statute of limitations, the contractual limitations period was enforceable under state law and Circuit precedent. The Second Circuit affirmed. The Supreme Court affirmed, finding the limitations provision enforceable. A participant’s ERISA cause of action does not accrue until the plan issues a final denial, but it does not follow that a plan and its participants cannot agree to commence the limitations period before that time. The Court noted that contractual limitations provisions should ordinarily be enforced as written. The period at issue is not unreasonably short and does not undermine ERISA’s two-tiered remedial scheme by causing participants to shortchange the internal review process. If administrators attempt to prevent judicial review by delaying the resolution of claims in bad faith, the penalty for failure to meet regulatory deadlines is immediate access to judicial review for the participant and courts can apply waiver or estoppel. Plans offering appeals beyond what is contemplated in the internal review regulations must agree to toll the limitations provision during that time, 29 CFR 2560.503–1(c)(3)(ii). View "Heimeshoff v. Hartford Life & Accident Ins. Co." on Justia Law

Village Fuel appealed the district court's denial of attorney's fees in an Employee Retirement Income Security Act (ERISA), 29 U.S.C. 1001 et seq., action. The court concluded that Village Fuel obtained some degree of success on the merits in defeating GHI's restitution claims and that, under ERISA, a favorable court judgment was not required to satisfy the threshold of awarding attorney's fees. The court vacated and remanded to the district court for further proceedings to determine a reasonable amount of attorney's fees, if any, to be awarded to Village Fuel. View "Scarangella & Sons v. Group Health, Inc." on Justia Law

Unum denied plaintiff's claims of long-term disability and sought more than $1 million in reimbursements for benefits paid. Unum denial was based on emails it had received from plaintiff's former companion indicating that plaintiff was engaged in activities that were inconsistent with her asserted disability. The district court found that there was substantial evidence to support Unum's denial of benefits, but, nonetheless, held that the denial was procedurally unreasonable because Unum did not fulfill its duty to "consider the source" of the emails. The court concluded that, in evaluating whether a plan administrator wrongfully denied benefits under the Employee Retirement Income Security Act (ERISA), 29 U.S.C. 1001 et seq., it has never imposed a duty to investigate the source of the evidence. The court held that the burden was on the claimant to discredit evidence relied on by the plan administrator. Accordingly, the court reversed the judgment of the district court, finding that Unum did not act arbitrarily and capriciously in denying plaintiff benefits. View "Truitt v. Unum Life Ins. Co. of America" on Justia Law

In 1999 Brooks, an assembly-line operator for Prairie Packaging, was seriously injured on the job and lost his left hand, wrist, and forearm. He filed a workers’ compensation claim seeking recovery for permanent and total disability, which remains pending. Prairie treated Brooks as a disabled employee on a company-approved leave of absence, so that he continued to receive healthcare coverage. Pactiv acquired Prairie in 2007 and continued this arrangement. In 2010 Pactiv sent Brooks a letter instructing him to submit documents verifying his ability to return to work; failure to submit would mean termination of employment. Because his injury was totally disabling, Brooks did not submit verification and Pactiv fired him; he lost his healthcare coverage under the employee-benefits plan. Brooks sued Pactiv and Prairie under the Employee Retirement Income Security Act, 29 U.S.C. 1001–1461, for benefits due and breach of fiduciary duty and asserted an Illinois law claim for retaliatory discharge. The district court dismissed. The Seventh Circuit affirmed with respect to ERISA because Brooks did not allege that the employee-benefits plan promised him post-employment benefits. Pactiv acted as an employer, not as a fiduciary, in terminating Brooks’s employment and cancelling his health insurance. The court reinstated the state law claim. View "Brooks v. Pactiv Corp." on Justia Law

Plaintiffs filed suit under the Employee Retirement Income Security Act of 1974 (ERISA), 29 U.S.C. 1001 et seq., after the Trustees' of their pension plan determined that plaintiffs' respective post-retirement jobs as traffic flagger and snow plow operator fell into the same "job classification" as their former union jobs as skilled mechanics. Therefore, plaintiffs were precluded from working these jobs if they wanted to collect retirement benefits. The court concluded that common sense strongly suggested that a position flagging traffic or plowing snow was not in the same "job classification" as a skilled mechanic repairing heavy equipment utilizing special skills acquired over a long career. The court reversed the district court's judgment because it was unable to see how any sensible application of the skills and duties test to the established facts could support the Trustees' conclusion. Accordingly, the court reversed the judgment. View "Tapley v. Locals 302 and 612" on Justia Law

Laskin worked for Jefco from 1966-1974 and participated in the company pension plan, accumulating a fully vested retirement account balance of $5,976.09. Soon after she left the company Laskin contacted Siegel, a trustee of the pension plan, and asked whether she could withdraw the funds to buy real estate. Siegel sent Laskin a letter explaining that her account would accrue interest at the passbook rate and that the plan had been amended in 1975, raising the retirement eligibility age from 55 to 65. Over the next 10 years, Laskin received statements, indicating that she was receiving from 5% to 5.5% interest on her balance. In 1988, a statement indicated that her balance was $12,602.86. The pension plan dissolved on December 31, 1991. In 2008, Laskin contacted Siegel’s son (who had purchased his father’s interest in Jefco) and was told that pension funds had been completely disbursed and that she did not receive a payout because she could not be located. The district court dismissed her claims as barred by the limitations period in the Employee Retirement Income Security Act, 29 U.S.C. 1113. The Seventh Circuit affirmed. View "Laskin v. Siegel" on Justia Law