Justia ERISA Opinion Summaries

The plaintiff stopped working in November, 2005, due to a variety of ailments, and filed a disability claim in August, 2007. The claim was denied in September. The plaintiff's appeal, received in April, 2008, 11 days after the stated 180-day deadline, was denied. She filed suit under the Employee Retirement Income Security Act (ERISA), 29 U.S.C. 1132. A magistrate upheld the denial. The Seventh Circuit affirmed. The plaintiff failed to exhaust administrative remedies. The plan has a clear deadline; the plaintiff was not denied meaningful access to review procedures and did not allege that pursuing administrative remedies would be futile. The court rejected a "substantial compliance" argument, noting that the plaintiff did not offer an explanation for the late filing. The Plan was not required to show prejudice as a result of the delay to justify rejecting the claim. Letters sent by the plaintiff could not reasonably be construed as notice of appeal. The Plan has procedures to minimize conflicts of interest and its refusal to consider the appeal was not arbitrary.

A recent retiree (employee) unsuccessfully tried to enroll her adult dependent child in the medical plan. The district court found the plan administrator's decision to be in violation of ERISA and imposed penalties. The Seventh Circuit vacated in part and remanded to allow the plan administrator to make a decision under the correct contract language. The denial was incorrectly based on a version of the plan in effect at the time of application, rather than that in effect when the employee's ability to comply with a condition precedent to enrollment expired, but the language of the earlier plan was ambiguous and the evidence of the employee's compliance was unclear. The court affirmed an award of a $3,780 for failure to timely comply with the employee's first request for documents, but reversed a penalty of $11,440 for a second request, calling for documents that were not essential to the claim. The court remanded an award of attorney fees, stating outcome was "some success on the merits" for the employee but that the plan's position was not without merit.

The employee attempted to enroll in his employer's ERISA-regulated health care plan. The employer deducted premiums, but did not enroll the employee, who subsequently left the company and fell ill. The employee won $157,182 plus attorney fees under ERISA, then filed state law claims of fraud, misrepresentation, and breach of contract, which the employer removed to federal court. The district court denied remand and dismissed the claims as res judicata. The Tenth Circuit ordered remand to state court, holding that the state law claims are not completely preempted by ERISA and that the federal court did not have jurisdiction over those claims. While he was employed by the company, the employee would have had standing, under ERISA, to challenge the actions underlying the state claims; at the time he filed the suit, he did not have standing. Having already won an ERISA award, the employee no longer qualified as a former employee with a colorable ERISA claim.

Participants in a defined-contribution retirement plan filed a class action suit under the Employee Retirement Income Security Act (ERISA, 29 U.S.C. 1002(34)), alleging mismanagement and payment of excessive funds. The district court certified the class, but entered summary judgment in favor of the defendants. The Seventh Circuit reversed in part, first upholding denial of a motion to amend the complaint and the court's decision to strike expert testimony relating to matters not in the original complaint. The court remanded a count it characterized as alleging that prudent fiduciaries, armed with the information presented to fiduciaries between 2002 and 2004, would have at least decided between maintaining the status quo and making changes to the common stock funds to limit investment and transactional drag. There is a genuine issue of material fact as to whether defendants breached the prudent man standard of care by failing to make a reasoned decision under circumstances in which a prudent fiduciary would have done so. The court also remanded a claim that prudent fiduciaries would have solicited competitive bids for record-keeping services on a periodic basis. The court affirmed summary judgment on a claim relating to the trustee's compensation including interest income from "float."