Articles Posted in U.S. 5th Circuit Court of Appeals

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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

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Plaintiffs filed suit against their former employer seeking deferred compensation payments. The district court held that plaintiffs' deferred compensation arrangements in their Employment Agreement contracts with the employer constituted a plan under the Employment Retirement Income Security Act (ERISA), 29 U.S.C. 1001 et seq. Because plaintiffs' deferred compensation arrangements did not necessitate an ongoing administrative scheme, there was no ERISA plan. Accordingly, the court reversed and remanded, concluding that plaintiffs' state law claims were not preempted by ERISA. View "Cantrell, et al. v. Briggs & Veselka Co." on Justia Law

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Plaintiff brought a class action suit under the Employee Retirement Income Security Act (ERISA), 29 U.S.C. 1001 et seq., alleging various breaches of fiduciary duty to plan participants. The district court dismissed the complaint for failure to state a claim. The court concluded that the district court correctly dismissed Counts I and IV of the amended complaint which alleged that Idearc Defendants breached their fiduciary duties by allowing plan participants to buy and hold Idearc stock when it was no longer prudent to do so where the amended complaint failed to allege sufficient facts to overcome the "presumption of prudence" the court adopted in Kirschbaum v. Reliant Energy Inc. The court also concluded that the district court correctly dismissed plaintiff's claim for inaccurate disclosures and nondisclosures (Count II) where plaintiff alleged no specific circumstance or specific injury mandating the Idearc Defendants disclose non-public information to plan participants and no general duty to disclose non-public information existed under ERISA or under the court's precedents. The court affirmed the district court's dismissal of plaintiff's remaining claims. View "Kopp v. Klein, et al." on Justia Law

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This case arose when plaintiff filed suit against Conoco for breach of the Offer Letter and breach of its obligations under a severance plan (the Plan). The court concluded that plaintiff waived any challenge to the Trustee's application of the common law presumption of integration or Texas's parol evidence rule; plaintiff's arguments regarding his change in title were unpersuasive; plaintiff's "at will" employment argument relied on outdated and out-of-context Texas authority and was unpersuasive; the waiver was not invalid and unenforceable on account of fraud in the inducement; plaintiff ratified an alleged fraud, thereby preserving the validity and enforceability of the waiver regardless by submitting a claim to Conoco Human Resources but then continuing to work at Conoco; the Employee Retirement Income Security Act (ERISA), 29 U.S.C. 1132(a)(1)(B), civil enforcement provision "completely preempts" plaintiff's state law claims against Conoco and the district court did not err by denying plaintiff's first motion for remand; the district court correctly denied plaintiff's renewed motion for remand; plaintiff was not entitled to recover attorneys' fees; and plaintiff waived his claim for breach of the Offer Letter, pertaining to a substantial reduction in his post-merger job position and responsibilities, for failure to plead with specificity. Accordingly, the court affirmed the district court's grant of summary judgment against plaintiff. View "Clayton v. ConocoPhillips Co., et al" on Justia Law

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Plaintiff appealed from the district court's dismissal of his suit alleging claims of equitable estoppel and breach of fiduciary duties pursuant to the Employee Retirement Income Security Act of 1974 (ERISA), 29 U.S.C. 1001 et seq. The district court dismissed the complaint for failure to state a claim. The court held that plaintiff stated a claim for relief that was cognizable under ERISA, in light of CIGNA Corp. v. Amara. Because relief was available under the surcharge doctrine under Amara, the court did not address the equitable estoppel claim and the district court was free to consider that claim on remand. Finally, the district court did not err in dismissing Defendant Entergy Mississippi where plaintiff failed to allege that Entergy Mississippi sponsored or administered the plan or made any decisions with respect to his benefits. View "Gearlds, Jr. v. Entergy Services, Inc., et al" on Justia Law

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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

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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

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Plaintiff, a former NFL player, filed suit seeking more generous disability benefits under the Bert Bell/Pete Rozelle NFL Player Retirement Plan. The district court granted summary judgment in favor of the Plan, affirming its benefits determinations that plaintiff was only eligible for "Inactive" player disability benefits instead of the more generous "Football Degenerative" disability benefits he sought. The court held that the district court did not err by applying abuse of discretion review to the Retirement Board's 2011 benefits determination; the district court did not err in using abuse of discretion instead of a heightened standard of review when considering the arbitrator's decision; and the district court's decision affirming the Retirement Board's 2006 and 2011 benefits determination on the merits under the abuse of discretion standard was correct. Accordingly, the court affirmed the district court's grant of summary judgment in favor of the Plan. View "Atkins v. Bert Bell/Pete Rozelle NFL, et al" on Justia Law

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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

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LINA appealed the decision of the district court holding that it abused its discretion in its denial of benefits to plaintiff under the Employee Retirement Income Security Act (ERISA), 29 U.S.C. 1001 et seq. Plaintiff alleged that LINA wrongly denied her the benefits of her common-law husband's ERISA-governed Group Accident Policies where her husband participated in two accidental death and dismemberment policies. The court affirmed the district court's holding that the common law definition of "accident" adopted in Todd v. AIG Life Insurance Co., was controlling in all ERISA accidental death and dismemberment plans where the term "accident" was undefined, irrespective of whether the plan administrator was given discretion to interpret the plan. View " Firman v. Beacon Construction Co., Inc." on Justia Law