Justia ERISA Opinion SummariesArticles Posted in U.S. 3rd Circuit Court of Appeals
Edmonson v. Lincoln Nat’l Life Ins. Co.
Edmonson’s husband was insured under a Lincoln group life insurance policy, established under an Employee Retirement Income Security Act employee benefit plan. When her husband died, Edmonson was entitled to a $10,000 benefit. The policy states that benefits, “will be paid immediately after the Company receives complete proof of claim.” It does not state that Lincoln will pay benefits using a retained asset account. Edmonson submitted a Lincoln claim form that stated that Lincoln’s usual method of payment is to open a SecureLine Account in the beneficiary’s name. Lincoln set up an interest-bearing SecureLine Account in Edmonson’s name in the amount of $10,000, and sent her a checkbook. In using retained asset accounts, an insurance company does not deposit funds, but merely credits the account; when a beneficiary writes a check on the account, the insurer transfers funds to cover the check. Three months after Lincoln set up the account, Edmonson withdrew the full amount. Lincoln paid $52.33 in interest. Edmonson contends that the profit Lincoln earned from investing the retained assets was greater than that amount and that Lincoln made $5 million in profit in 2009 by investing retained assets. Edmonson brought an ERISA claim claiming violation of fiduciary duties, 29 U.S.C. 1002(21)(A). The district court granted Lincoln summary judgment, concluding Lincoln was not acting in a fiduciary capacity when it took the challenged actions. The Third Circuit affirmed. View "Edmonson v. Lincoln Nat'l Life Ins. Co." on Justia Law
Cappello v. Iola
Barrett, a financial planner, induced the plaintiffs, small New Jersey corporations and their owners, to adopt an employee welfare benefit plan known as the Employers Participating Insurance Cooperative (EPIC). EPIC was promoted as a multiple employer welfare benefit plan for which contributions were deductible under 26 U.S.C. 419A(f)(6), but in fact was a method of deferring compensation. After the Internal Revenue Service audited the plans and disallowed deductions claimed on federal income tax returns, plaintiffs sued Barrett and other entities involved in the scheme, asserting claims under the Employee Retirement Income Security Act of 1974, 29 U.S.C. 1001-1461; the civil component of the Racketeer Influenced and Corrupt Organization Act, 18 U.S.C. 1961-1968; and New Jersey statutory and common law. A jury found Barrett liable of common law breach of fiduciary duty, but not liable on the RICO claim. The district court held a bench trial on the ERISA claim and issued partial judgment for plaintiffs. The Third Circuit affirmed in part, but vacated holdings that deemed certain state law causes of action preempted by ERISA, found certain ERISA claims time-barred, and limited the jury‘s consideration of one RICO theory of recovery. View "Cappello v. Iola" on Justia Law
Fleisher v. Std. Ins. Co.
While working as a dentist, Fleisher obtained long-term disability insurance coverage under separate policies. He obtained the North American policy by membership in a professional organization. The Standard policy is an employee benefit, governed by the Employee Retirement Income Security Act, 29 U.S.C. 1132(a)(1)(B) and provides for monthly benefits to a maximum of "$10,000 before reduction by Deductible Income," defined to include "[a]ny amount you receive or are eligible to receive because of your disability under another group insurance coverage," but to exclude benefits paid under "any individual disability insurance policy." In 2008, Fleisher became disabled and claimed benefits under both policies. Shortly after Fleisher began collecting under both policies, Standard reduced his monthly benefits from $10,000 to $8,500 based on its determination that the North American policy was another group insurance coverage, and that the $1,500 in benefits he receives under it is deductible income. The district court dismissed his ERISA suit. The Third Circuit affirmed, finding the decision supported by substantial evidence and not unreasonable. View "Fleisher v. Std. Ins. Co." on Justia Law
Santomenno v. John Hancock Life Ins. Co.
Participants in an employer-sponsored 401(k) plan brought suit under the Employment Retirement Income Security Act of 1974, 29 U.S.C. 1001, and the Investment Company Act of 1940, 15 U.S.C. 80a-1, claiming excessive fees on annuity insurance contracts offered to plan participants. The district court dismissed the ICA claims because only those maintaining an ownership interest in the funds could sue under the derivative suit provision and the participants are no longer investors in the funds in question. As to the ERISA claims, the court dismissed because participants failed to make a pre-suit demand upon the plan trustees to take appropriate action and failed to join the trustees as parties. The Third Circuit affirmed with regards to the ICA claims, but vacated on the ERISA counts, holding that the statute does not require pre-suit demand or joinder of trustees. View "Santomenno v. John Hancock Life Ins. Co." on Justia Law
Sec’y of Labor v. Doyle
In 2005, the Secretary of Labor filed suit for breach of fiduciary duty, alleging that defendants had established a health benefit plan that was a multi-employer welfare arrangement governed by the Employee Retirement Income Security Act. Defendants had retained, as compensation, a substantial portion of payments made by businesses to enroll their employees. The complaint alleged improper diversion of funds and that defendants were required by ERISA to use the assets only for the defraying reasonable plan expenses for the benefit of plan participants. The district court ruled in favor of defendants. The Third Circuit vacated, characterizing the scheme appearing to be "an aggressively marketed, but inadequately funded health benefit plan masquerading as an ERISA-exempt plan in order to evade the solvency controls imposed by state insurance regulation."View "Sec'y of Labor v. Doyle" on Justia Law
Estate of Kensinger v. URL Pharma Inc.
When William and Adele divorced in 2008, she waived her right to proceeds from his 401(k) plan, governed by the Employee Retirement Income Security Act, 29 U.S.C. 1001-1461. He did not replace her as named beneficiary before he died intestate, nine months later. Because of a 2009 Supreme Court case, Kennedy v. Plan Administrator, 555 U.S. 285, the plan was obligated to pay the proceeds to Adele in accordance with plan documents regardless of the waiver. The district court held that estate could not attempt to recover the funds by bringing suit directly against Adele to enforce her waiver. The Third circuit reversed in part. Permitting suits against beneficiaries after benefits have been paid does not implicate any concern of expeditious payment or undermine any core objective of ERISA. View "Estate of Kensinger v. URL Pharma Inc." on Justia Law
Shaver v. Siemens Corp.
Plaintiffs brought a class action against their former employer, Siemens, and its retirement plans, claiming violation of the Employee Retirement Income Security Act in refusing to provide permanent job separation (PJS) pension benefits when Siemens terminated their employment. The Third Circuit reversed in part and directed entry of judgment in favor of Siemens on all issues. By their plain terms, the Siemens plans do not provide for PJS benefits. Siemens did not establish an ERISA section 204 "transition" plan by virtue of 13-day arrangement in 1998 that was part of Siemens' purchase of a business unit from Westinghouse, nor was Siemens obligated to provide PJS benefits under section 208, based on the purchase from Westinghouse. View "Shaver v. Siemens Corp." on Justia Law
US Airways, Inc v. McCutchen
After defendant was in a serious automobile accident, a benefit plan administered by plaintiff paid $66,866 for his medical expenses. Defendant then recovered $110,000 from third parties, with the assistance of counsel. Plaintiff, which had not sought to enforce its subrogation rights, demanded reimbursement of the entire $66,866 it had paid without allowance for legal costs, which had reduced defendant's net recovery to less than the amount it demanded. Plaintiff sued for "appropriate equitable relief" pursuant to the Employee Retirement Income Security Act, 29 U.S.C. 1132(a)(3) B). The district court ordered plaintiff to pay the entire. $66,866. The Third Circuit vacated, holding that defendant may assert equitable limitations, such as unjust enrichment, on plaintiff's equitable claim. View "US Airways, Inc v. McCutchen" on Justia Law
Renfro v. Unisys Corp, l
Representatives of a putative class of participants in a 401(k) sued under the Employment Retirement Income Security Act, 29 U.S.C. 1001, claiming breach of fiduciary duty. They alleged that defendants inadequately selected investment options to include in the plan. The district court dismissed Fidelity defendants, holding they were not fiduciaries, and dismissed others for failure to state a claim. The Third Circuit affirmed. Fidelity did not a function as a fiduciary with respect to selecting and maintaining the range of investment options; its status as a directed trustee does not subject it to liability for these activities. There was no claim that Fidelity knew the selection of investment options constituted a breach of fiduciary duty and Fidelity is not liable as a non-fiduciary. Plaintiffs did not state a plausible claim. An ERISA defined contribution plan should offer participants meaningful choices about how to invest retirement savings. The plan at issue contains a variety of investment options including company stock, commingled funds, and mutual funds, with 73 distinct investment options. Among the retail mutual funds specifically targeted in the complaint were funds with a variety of risk and fee profiles, including low-risk and low-fee options. View "Renfro v. Unisys Corp, l" on Justia Law
Funk v. CIGNA Grp. Ins.
Employee, suffering depression and related disorders, received short-term disability benefits for 26 weeks. The administrator denied the employee long-term disability benefits. The district court ruled in favor of the employee in a suit under the Employee Retirement Income Security Act, 29 U.S.C.1132(a)(1)(B) and denied the plan's claim for overpaid benefits. The Third Circuit vacated and remanded. The administrator acted consistently with a plan provision requiring it to determine whether employee was incapable of performing the requirements of any job for any employer … for which the individual is qualified or may reasonably become qualified … , other than a job that pays less than 60 percent of his former pay.The administrator acted without meaningful conflict of interest.The plan specifies the receipt of Social Security benefits as a particular fund from which reimbursement is to be made and gives rise to an equitable lien by agreement over those funds that are overpayments under the plan. View "Funk v. CIGNA Grp. Ins." on Justia Law