Justia ERISA Opinion Summaries

Miller, a Fund beneficiary, fell from a ladder and was injured. He hired attorney Darr on a contingent fee basis to sue the person who was supposed to hold the ladder. The Fund advanced $86,709.73 in medical and disability benefits on the condition that Miller repay from any recovery, without deducting attorneys’ fees. Miller and Darr, signed a subrogation agreement. The lawsuit settled for $500,000. Calculating his fee based on $413,290.27, Darr submitted $57,806.48 to the Fund, stating that he was withholding $28,903.25 as a fee. To avoid jeopardizing Miller’s benefits Darr later submitted the $28,903.25. The Fund indicated that if Darr pursued his claim, it would consider Darr and Miller in breach of Plan terms and in repudiation of the subrogation agreement and would consider terminating coverage and seeking relief under ERISA. Darr sued the Fund in Illinois state court under the common fund doctrine, which permits a party who creates a fund in which others have an interest to obtain reimbursement for litigation expenses incurred in creating that fund. The district court enjoined Darr’s lawsuit. The Seventh Circuit vacated. A federal court may not enjoin “proceedings in a State court except as expressly authorized by Act of Congress, or where necessary in aid of its jurisdiction, or to protect or effectuate its judgments,” 28 U.S.C. 2283.View "Trs. of the Carptenters' Health & Welfare Trust v. Darr" on Justia Law

Four plaintiffs each established an employee benefit plan under the Employee Retirement Income Security Act funded by a combination of employer contributions and covered employee payroll deductions; each entered into a Benefit Management Service Agreement with PBA, which specified that PBA would provide services, such as paying medical providers for claims incurred under the Plans. Each Agreement required PBA to establish a segregated bank account for each Plan into which it would deposit the funds that it received from the corresponding plaintiff for paying the medical claims and authorized PBA to pay medical claims by writing checks from this account. PBA not only failed to use funds supplied by plaintiffs to pay the claims incurred under the corresponding Plan, but commingled and misappropriated Plan funds. PBA did not pay all claims, despite receiving money for payment of those claims from the respective plaintiffs. The amounts unpaid for the plaintiffs are: $501,380.75, $409,943.88, $384,574.17, and $44,290.12. The district court found that PBA was a fiduciary under ERISA (29 U.S.C. 1002(21)(A)), had breached its fiduciary duties, and that ERISA preempted Permco’s breach-of-contract claims. The Sixth Circuit affirmed. View "Guyan Int'l, Inc. v. Prof'l Benefits Adm'rs, Inc." on Justia Law

Jeranek, a beneficiary of the Humana Plan, was hospitalized in 2006. Three days later, she was admitted at Nu-Roc Nursing Home. She was 88 years old and suffered from a variety of maladies that required her to use 14 prescription medications. A physician estimated at the time of her admission that Jeranek had a life expectancy of about one year. Jeranek was a resident at Nu-Roc for 702 days. On several occasions she declined medical treatment and her physician understood that she was to receive comfort care only. From November 15 until November 19, 2006, Jeranek’s stay at Nu-Roc was paid for by Medicare. Humana paid $50,097.67 to Nu-Roc for services provided from November 20, 2006, to September 30, 2007, but later determined that its disbursement had been a mistake, reasoning that “custodial” care was not covered by the Plan. Humana sought reimbursement for its previous payments and denied coverage for October 1, 2007 through October 22, 2008, when costs for Jeranek’s care totaled $64,669.74. The district court determined that Humana’s denial of coverage was not arbitrary and granted summary judgment for the Plan. The Seventh Circuit affirmed. View "Becker v. Chrysler LLC Health Care Benefits Plan" on Justia Law

Multiemployer pension plans are created by collective bargaining agreements to provide benefits to employees of different firms. When an employer withdraws from an MPP, the plan remains liable to employees who have vested pension rights, but can no longer look to the employer to cover these obligations. The Multiemployer Pension Plan Amendments Act, 29 U.S.C. 1381-1461, assesses the employer with an exit price equal to its pro rata share of the funding shortfall (difference between present value of fund assets and present value of future obligations). Estimating the shortfall depends on estimating the amount by which current assets can be expected to grow with compound interest. To avoid having an employer new to a plan inherit withdrawal liability where existing members failed to fund the plan adequately in prior years, the statute creates default rules for assigning each employer a share of only so much of the shortfall as occurred while the employer was participating, 29 U.S.C. 1391(b)(2)-(4). Disputes about withdrawal liability are resolved by arbitration. The arbitrator in this case ruled that MMP trustees had over-assessed CPC’s withdrawal liability by $1,093,000. The district judge upheld the ruling. The Seventh Circuit affirmed, noting the “Hideous complexities” involved and its own lack of expertise. View "Chicago Truck Drivers, Helpers, & Warehouse Workers Union (Indep.) Pension Fund v. CPC Logistics, Inc." on Justia Law

The Fund is a multiemployer defined-benefit pension plan. Honerkamp, a New York employer, contributed to the Fund pursuant to collective bargaining agreements with its employees. In 2008, the trustees announced that the Fund was in critical status as defined by the Pension Protection Act of 1996, 29 U.S.C. 1085(b)(2) and began drafting a rehabilitation plan. Because the rehabilitation plan would figure prominently in negotiations between Honerkamp and the union, the parties extended existing agreements. The final rehabilitation plan set forth new schedules of reduced benefits and increased contributions. According to the plan, the Fund was unlikely to emerge from critical status within the statutory 10-year rehabilitation period because employer contribution rates required for that result would exceed amounts that employers would have had to pay to withdraw from the Fund. The trustees therefore designed schedules “to impose approximately the same burden actuarially on employers that a withdrawal from the [Fund] would produce.” Following negotiations, Honerkamp withdrew from the Fund. The trustees sued, arguing that the PPA prevented Honerkamp from withdrawing and required the company to make certain ongoing pension contributions pursuant to the rehabilitation plan. The district court granted summary judgment to Honerkamp. The Second Circuit affirmed. View "Trs. of Local 138 Pension Trust Fund v. F.W. Honerkamp Co. Inc." on Justia Law

In this ERISA benefits case, the plan administrator (Appellant) appealed the district court's judgment that a deceased plan participant's stepsons, rather than his siblings, were entitled to the deceased's benefits. Appellant interpreted the term "children" as used in the plan to mean biological or legally adopted children. The Fifth Circuit Court of Appeals reversed, holding that the district court erred when it set aside Appellant's decision and granted judgment for the deceased's stepchildren, as (1) Appellant's interpretation of the term "children" was legally correct; and (2) nothing in the plan or ERISA required Appellant to incorporate the concept of equitable adoption into the plan definition of "children." View "Herring v. Campbell" on Justia Law

The United Automobile, Aerospace, and Agricultural Implement Workers International Union and Local 997 appealed the district court judgment after a five-day bench trial declaring that Whirlpool Corporation may unilaterally modify the health care benefits it provided to retired hourly workers previously employed at the Newton, Iowa manufacturing facilities of Whirlpool's now-dissolved subsidiary, Maytag Corporation. The Eighth Circuit Court of Appeals affirmed, holding (1) the district court correctly found that a case or controversy existed when Whirlpool filed its declaratory judgment action; and (2) the retirees did not have a vested right to the previously granted health benefits under ERISA, as the benefits were provided in a collectively bargained agreement that had no express vesting provision. View "Maytag Corp. v. Int'l Union" on Justia Law

Aschermann suffers from degenerating discs and spondylolisthesis and had lumbar fusion operations in 2002 and 2004. Until 2003 she worked as a sales representative. Back pain left her unable to perform its duties. Between 2003 and 2009 she received disability payments under the employer’s disability plan, a welfare-benefit plan governed by the Employee Retirement Income Security Act. The policy provides that after the first two years of benefits, the question becomes whether the recipient can perform any job in the economy as a whole. Lumbermens stopped paying disability benefits to Aschermann in fall 2009, concluding that she could do sedentary work. The district court held that the decision to end her disability benefits was not arbitrary. The Seventh Circuit affirmed. Aschermann does not deny that her education B.S. in psychology and master’s degree in social work and experience suit her for many desk-bound positions, but claimed inability to work more than four hours a day. The insurer gave notice complying with ERISA, (29 U.S.C. §1133(1), that it wanted new diagnostic test results and other recent information; she was given a “reasonable opportunity” to supplement the file and receive a “full and fair review.” View "Aschermann v. Aetna Life Ins. Co." on Justia Law

Plaintiffs David McCorkle and William Pender appealed a district court order dismissing two of their class action claims against Bank of America Corporation for alleged violations of certain provisions of the Employment Retirement Income Security Act of 1974 (ERISA). Their claims centered on the Bank's use of a normal retirement age (NRA) that allegedly violated ERISA in calculating lump sum distributions and further ran afoul of ERISA's prohibition of "backloading" the calculation of benefit accrual. Upon review, the Fourth Circuit agreed with the district court's conclusion that Plaintiffs failed to state a claim upon which relief could be granted, and it affirmed the district court's judgment to dismiss those claims. View "Pender v. Bank of America Corp." on Justia Law

Aetna Life Insurance Company, as the plan administrator, determined Sharon Wade was no longer disabled and stopped paying long-term disability benefits from Wade's former employer's welfare benefit plan. Wade sought judicial review of Aetna's decision by filing a civil action under ERISA. The district court granted summary judgment in favor of Aetna, concluding that Aetna did not abuse its discretion in terminating Wade's benefits because substantial evidence supported the decision. The Eighth Circuit Court of Appeals affirmed, holding that the district court (1) applied the appropriate standard of review; (2) gave appropriate weight to the Social Security Administration's grant of long-term disability benefits to Wade; and (3) did not abuse its discretion by determining substantial evidence supported Aetna's termination of benefits. View "Wade v. Aetna Life Ins. Co." on Justia Law