Justia ERISA Opinion Summaries

Plaintiff brought this action under 29 U.S.C. 1132(a)(1)(B) claiming that Hartford wrongfully terminated her long-term disability benefits under an employee welfare benefit plan governed by the Employee Retirement Income Security Act of 1974 (ERISA), 29 U.S.C. 1001-1461. The court affirmed the judgment of the district court granting summary judgment in favor of Hartford where plaintiff failed to exhaust her administrative remedies by failing to file a timely administrative appeal. The letter at issue could have reasonably been construed by Hartford as a request for documents rather than a request for an appeal. View "Reindl v. Hartford Life and Accident Ins." on Justia Law

Kathy Joy Kirkendall and her co-plaintiffs filed this putative class action suit, pursuant to the Employee Retirement Income Security Act (ERISA), 29 U.S.C. 1002-1461, which included claims for redetermination of benefits and for improper amendment of plan terms. Plaintiffs filed suit without first availing themselves of the procedure described for "benefits claims" in pension plan documents and the district court dismissed based on Kirkendall's failure to exhaust her administrative remedies. The court held that because Kirkendall reasonably interpreted the plan's exhaustion requirement not to apply to a determination of future benefits and did not exhaust her administrative remedies as a result, she was not required to exhaust her administrative remedies. The court also held that Halliburton's actions did not constitute an amendment within the meaning of ERISA section 204(g). View "Kirkendall et al v. Halliburton, Inc. et al" on Justia Law

Hostess provided an "employee welfare benefit plan" under the Employee Retirement Income Security Act of 1974, 29 U.S.C. 1002(1). In this appeal, appellant challenged the order of the district court affirming the grant of summary judgment by the bankruptcy court in favor of Hostess on his claim for civil penalties for Hostess's failure to give notice of certain health insurance coverage rights required under the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA), 29 U.S.C. 1166(a), and the denial of attorney's fees. Although it was undisputed that Hostess failed to provide two notices required by COBRA, the court rejected appellant's arguments and held that the bankruptcy court did not err in granting summary judgment to Hostess on his claim for civil penalties. The court agreed with the bankruptcy court that it could not "fairly call the outcome of the litigation some success on the merits" as required to award attorney's fees and costs to appellant. View "Deckard v. Interstate Bakeries Corp., et al" on Justia Law

Plaintiff was a partner in a medical practice where she served as a staff anesthesiologist. When Plaintiff's dependence on opioids came to light, her employer had in force a group employee benefit plan, underwritten and administered by Union Security Insurance Company & Management Company for Merrimack Anesthesia Associates Long Term Disability Plan (USIC), which included long-term disability (LTD) benefits. When Plaintiff applied for those benefits, USIC refused to pay benefits past the point when Plaintiff was discharged from a treatment center, finding that Plaintiff's risk for relapse was not the same as a current disability. Plaintiff brought suit in the federal district court. The district court ultimately awarded Plaintiff LTD benefits for the maximum time available under the plan, concluding that categorically excluding the risk of drug abuse relapse was an unreasonable interpretation of the plan. The First Circuit Court of Appeals affirmed, holding that, in an addiction context, a risk of relapse can be so significant as to constitute a current disability. View "Colby v. Union Sec. Ins. Co." on Justia Law

Plaintiffs brought this civil enforcement action under the Employee Retirement Income Security Act of 1974 (ERISA), 29 U.S.C. 1001 et seq., alleging that defendants, the Bank, and individual members of the Bank's Corporate Benefits Committee, engaged in prohibited transactions and breached their fiduciary duties by selecting and maintaining Bank-affiliated mutual funds in the investment menu for the Bank's 401(k) Plan and the Bank's separate but related Pension Plan (collectively, the Plans). The court affirmed the district court's dismissal of the Pension Plan claims in the Second Amended Complaint on the basis that plaintiffs lacked Article III standing. The district court correctly determined that plaintiffs' remaining claims were time-barred under the limitations period in 29 U.S.C. 1113(1)(A). Finally, the district court's dismissal of the Third Amended Complaint with prejudice did not constitute an abuse of discretion where plaintiffs failed to file a motion to amend and had already amended their original complaint three times. Accordingly, the court affirmed the judgment of the district court. View "David v. Alphin" on Justia Law

In this case, participants in the Thunderbird Mining Company Pension Plan sought "shutdown" pension benefits. The PBGC, the government agency that administered pension termination insurance under Title IV of the Employee Retirement Income Security Act of 1974 (ERISA), 29 U.S.C. 1001-1461, denied the participants' request. These early retirement benefits were triggered by a permanent shutdown of a plant and were payable to plan participants who met certain age and years-of-service requirements. The court held that the agency's determination was not arbitrary or capricious where the record provided sufficient support for the agency's judgment that a permanent shutdown had not occurred before Eveleth's pension plan was terminated on July 24th, 2003. Accordingly, the court affirmed the district court's grant of summary judgment in favor of the agency. View "United Steel, et al. v. Pension Benefit Guaranty Corp." on Justia Law

This appeal arose from a dispute between Unum and the late Kevin Sullivan over long-term disability benefit payments. Sullivan sued Unum, arguing that the termination of his benefits violated the Employee Retirement Income Security Act of 1974 (ERISA), 29 U.S.C. 1001 et seq., and Unum counterclaimed for overpayment of benefits. The court concluded that it was not an abuse of discretion for the administrator to determine that the large payments that Sullivan received in 2004 were payments for the sale of a business for the purpose of calculating his benefits. Unum asserted that the payments were salary, not income. The court reversed the district court's grant of summary judgment and award of attorney's fees, remanding for consideration of Unum's counterclaims. View "Sullivan v. Unum Life Ins. Co., et al" on Justia Law

Plaintiff appealed the district court's grant of summary judgment to the Plan on his claim under the Employee Retirement Income Security Act (ERISA), 29 U.S.C. 1001 et seq. Plaintiff asserted that the Plan did not comply with procedures set out by ERISA by changing its basis for denial on administrative appeal and by not identifying the independent physician reviewer who recommended denial on administrative appeal. Because plaintiff did not specify the failure to identify the physician in his amended complaint, the court did not address this issue. The court agreed with plaintiff, however, that the Plan did not substantially comply with ERISA procedures by changing its basis for denying coverage on administrative appeal. The court concluded that remand to the Plan for a full and fair review was appropriate. View "Rossi v. Precision Drilling Oilfield Svcs. Corp. Emp. Benefits Plan" on Justia Law

A third-party administrator of medical benefits plans, IMA, denied claims made on behalf of two patients who received treatment from the same medical provider, LifeCare. The court held that IMA incorrectly interpreted the plans because it categorized LifeCare as a skilled nursing facility (SNF) without finding that LifeCare "fully meets all of" the plans' seven SNF factors. IMA abused its discretion because categorizing LifeCare as an SNF without considering the seven-factors SNF test contradicted the plain language of the plans. The court found that the district court correctly held that LifeCare could maintain an action against IMA pursuant to 29 U.S.C. 1132(a)(1)(B) and that IMA was liable for exercising actual control over the claims process. The court further held that the district court did not abuse its discretion in awarding attorneys' fees. View "Lifecare Mgmt. Svcs., LLC v. Ins. Mgmt. Admins. Inc, et al" on Justia Law

Plaintiff, a former software developer for Lockheed Martin Corporation, brought this action for judicial review after Connecticut General terminated his disability benefits in 2007. The court held that the district court properly applied an abuse of discretion standard; on the record, it was not an abuse of discretion to terminate plaintiff's benefits; and the district court did not err in denying plaintiff an opportunity to depose the expert at issue. Accordingly, the court affirmed the judgment. View "Siegel v. Connecticut General Life Ins., et al" on Justia Law