Justia ERISA Opinion Summaries

Kevin Flowers, a participant in an employee benefits plan governed by the Employee Retirement Income Security Act of 1974 (ERISA), receives prescription drug benefits administered by Caremark, a pharmacy benefits manager. Flowers alleges that Caremark unjustly enriches itself by limiting maintenance prescription coverage to either CVS retail pharmacies or Caremark’s mail-order delivery service. He claims this violates Arkansas statutes requiring PBMs not to mandate home delivery and to provide reasonably adequate and accessible pharmacy networks, leading him and similarly situated individuals to pay out of pocket at local pharmacies.Reviewing the case, the United States District Court for the Western District of Arkansas granted Caremark’s motion to dismiss. The court determined that Flowers failed to plausibly plead a violation of the Mail Order Provision because Caremark did not require prescriptions to be filled solely through home delivery. Regarding the Network Adequacy Provision, the district court found that ERISA preempted the Arkansas requirements, particularly those imposing geographic coverage standards for pharmacy networks.On appeal, the United States Court of Appeals for the Eighth Circuit reviewed the district court’s dismissal de novo. The court affirmed the district court’s ruling, holding that Flowers did not plausibly allege a violation of the Mail Order Provision. The court also concluded that the geographic coverage requirements imposed by Arkansas regulations under the Network Adequacy Provision are preempted by ERISA, as they force PBMs to tailor their networks in ways that interfere with nationally uniform plan administration and constitute an impermissible connection with ERISA plans. The court expressly left open whether the Network Adequacy Provision, without its implementing regulations, would also be preempted. The court affirmed the district court’s dismissal of Flowers’s claims. View "Flowers v. Caremark PCS Health, LLC" on Justia Law

After the death of Dana Kleinsteuber, her husband, Charles Kleinsteuber, sought accidental death and dismemberment (AD&D) benefits under an ERISA-governed insurance plan administered and insured by Metropolitan Life Insurance Company (MetLife). Dana Kleinsteuber, who suffered from end-stage renal disease (ESRD) due to a long history of an eating disorder, was using home dialysis as treatment. On the day of her death, she apparently failed to properly close her chest port after a dialysis session, resulting in severe blood loss and subsequent cardiac arrest. Emergency responders stopped the bleeding, but she died shortly after.MetLife initially denied the claim on the basis that Dana’s death resulted from natural causes related to her ESRD, and that an exclusion in the plan applied for losses caused or contributed to by illness or its treatment. Following an extensive administrative appeal submitted by Mr. Kleinsteuber, which included evidence from Dana’s doctor and other records, MetLife reconsidered and acknowledged the death was accidental. However, it maintained the exclusion applied because the death was caused or contributed to by the treatment for her ESRD. After Mr. Kleinsteuber exhausted his administrative remedies, he filed suit in the United States District Court for the District of Minnesota. The district court granted summary judgment for MetLife, finding the exclusion applicable.The United States Court of Appeals for the Eighth Circuit reviewed the case. The court held that MetLife provided a full and fair review and that its conflict of interest deserved little weight. The court interpreted the plan exclusion de novo, finding that the ordinary meaning of “caused or contributed to” included Dana’s death under these circumstances. Applying an abuse-of-discretion standard to MetLife’s ultimate decision, the court found substantial evidence supported the denial. As a result, the Eighth Circuit affirmed the district court’s judgment, upholding MetLife’s denial of benefits. View "Kleinsteuber v. Metropolitan Life Ins. Co." on Justia Law

General Electric Company (GE) was assessed withdrawal liability by the Boilermaker-Blacksmith National Pension Trust (the Fund) under the Multiemployer Pension Plan Amendments Act of 1980 (MPPAA), which amended the Employee Retirement Income Security Act (ERISA). The Fund claimed that GE partially withdrew from the plan based on a 70% decline in contribution base units (CBUs) and the closure of a manufacturing facility in Chattanooga, resulting in liability assessments totaling over $227 million. GE disputed these assessments, arguing that it qualified for the “building and construction industry” (BCI) exception, which exempts certain employers from withdrawal liability if substantially all their covered employees perform work in the building and construction industry.An arbitrator considered the dispute and found in favor of GE, concluding that it met the requirements for the BCI exception. Both parties sought review in the United States District Court for the Western District of Missouri, which affirmed the arbitrator’s decision. The district court determined that the statutory language was ambiguous regarding how to count employees for the purpose of the BCI exemption and adopted GE’s cumulative headcount method rather than the Fund’s preferred monthly headcount method.On appeal, the United States Court of Appeals for the Eighth Circuit reviewed the district court’s legal conclusions de novo and examined the ambiguity in the statutory language. The Court held that, of the two methods presented, the cumulative headcount approach advanced by GE was more consistent with the purpose and legislative intent of the statute, which was designed to accommodate the fluctuating nature of employment in the building and construction industry. The Court affirmed the district court’s judgment, holding that GE qualified for the building and construction industry exemption and was not liable for withdrawal assessments. View "General Electric Company v. Boilermaker-Blacksmith National Pension Trust" on Justia Law

Edward Beard, a participant in an employer-sponsored ERISA plan administered by Lincoln National Life Insurance Company, died after suffering a fall and subsequent subdural hematoma. Mr. Beard had stage IV pancreatic cancer and was taking a blood thinner due to an increased risk of blood clots. The fall occurred while he was rushing to the bathroom, and although an initial hospital visit revealed no issues, he was found unresponsive the following day and died after a second hospital visit revealed a large subdural hematoma. His wife, Tina Beard, filed a claim for accidental death and dismemberment (AD&D) benefits, asserting that his death resulted from an accidental injury.The United States District Court for the Southern District of Iowa reviewed the administrative record after Lincoln Life denied the claim. Lincoln Life concluded that Mr. Beard’s death was not solely the result of an accidental injury and invoked a plan exclusion since his blood thinner, used to treat his cancer-related clotting risk, contributed to his death. The district court granted judgment in favor of Lincoln Life, finding its interpretation of the plan reasonable and supported by substantial evidence, including medical reports indicating the blood thinner contributed to the fatal outcome.On appeal, the United States Court of Appeals for the Eighth Circuit reviewed the plan administrator’s decision for abuse of discretion, as the plan granted Lincoln Life discretionary authority to interpret its terms. The appellate court found that Lincoln Life’s interpretation of the plan terms and application of the exclusion were reasonable and supported by substantial evidence. The court held that Mrs. Beard failed to prove the loss resulted solely from an accident, and that Lincoln Life established the plan exclusion applied because the blood thinner contributed to Mr. Beard’s death. Accordingly, the Eighth Circuit affirmed the district court’s judgment. View "Beard v. Lincoln Nat'l Life Ins. Co." on Justia Law

Barton Hankins was hired by Crain Automotive Holdings, LLC in 2019 as Chief Operating Officer and was offered a deferred compensation plan (DCP). After four years, Hankins resigned and sought compensation under the DCP, which Crain denied. Hankins then filed a lawsuit under the Employee Income Retirement Security Act of 1974 (ERISA) to claim his benefits. The DCP stipulated that Hankins could earn a percentage of Crain’s fair market value upon his exit, with full vesting at five years. Having served four years, Hankins was entitled to 80% of the benefits.The United States District Court for the Eastern District of Arkansas granted judgment in favor of Hankins, concluding that the DCP did not require the creation of an Employment Agreement or a Confidentiality, Noncompete, and Nonsolicitation Agreement for enforceability. The court found that Crain’s claims of misconduct by Hankins were unsubstantiated and awarded Hankins attorney’s fees, determining that Crain’s conduct was sufficiently culpable.The United States Court of Appeals for the Eighth Circuit reviewed the case. The court affirmed the district court’s judgment, holding that Crain’s interpretation of the DCP was unreasonable. The court found that the DCP’s Article 4, which mentioned the Employment and Confidentiality Agreements, did not create a condition precedent but rather a condition subsequent. The court also upheld the award of attorney’s fees, noting that Crain’s actions lacked merit and were raised only after Hankins sought his vested compensation. The appellate court concluded that the district court did not abuse its discretion in its rulings. View "Hankins v. Crain Automotive Holdings, LLC" on Justia Law

3M filed an insurance claim to recover losses incurred on a number of investments due to fraud perpetrated by its own investment advisors. The Eighth Circuit affirmed the district court's grant of summary judgment to the Insurers, holding that the ownership requirement of Endorsement 8 applies to the Employee Dishonesty provision. Therefore, 3M does not own the stolen earnings and cannot seek coverage for the earnings under the Policy. Until the earnings were distributed to the partners, the stolen earnings were property of WG Trading, not 3M. The court explained that it is fundamental that property acquired with partnership funds is partnership property, and individual partners do not own partnership assets until the winding up of the partnership. Finally, the Employee Retirement Income Security Act (ERISA), 29 U.S.C. 1001 et seq., does not alter general commercial property rights, but merely defines the nature and scope of the fiduciary duties owed to plan participants. View "3M v. National Union Fire Insurance" on Justia Law

Plaintiff filed suit under the Employee Retirement Income Security Act (ERISA), 29 U.S.C. 1001 et seq., for denial of benefits and breach of fiduciary duty. The district court dismissed the fiduciary claim as duplicative of the denial-of-benefits claim, and granted summary judgment against plaintiff on the denial-of-benefits claim. The Eighth Circuit explained that this court's cases conflict about whether a participant or beneficiary bringing a section 1132(a)(1)(B) claim "to recover benefits due to him under the terms of his plan" may also bring a section 1132(a)(3) claim to obtain benefits. The Eighth Circuit held that Silva v. Metropolitan Life Insurance Co. was controlling in this case, where an (a)(1)(B) claimant may seek relief under (a)(3); because the two claims in this case assert different theories of liability, the court reversed as to the (a)(3) claim; Aetna's no-disability determination as to the (a)(1)(B) claim was reasonable and the court rejected plaintiff's arguments to the contrary; the district court correctly struck the Supplemental Administrative Record materials that were not before the plan administrator when it made its discretionary determination; and the court declined to consider plaintiff's remaining arguments. Accordingly, the Eighth Circuit affirmed in part, reversed in part, and remanded for further proceedings. View "Jones v. Aetna Life Insurance Co." on Justia Law

The Eighth Circuit affirmed the dismissal of plaintiff's claims against Blue Cross in a suit filed under the Employee Retirement Income Security Act (ERISA), 29 U.S.C. 1001 et seq., after Blue Cross denied round-the-clock in-home health coverage. The district court properly dismissed Count I and II, because these claims for round-the-clock in-home nursing services were contrary to the plain meaning of the private-duty nursing exclusions in the 2012 and 2013 policies. The district court properly dismissed Count VI because the policy plainly excluded extended hours skilled nursing care, and plaintiffs may not use an estoppel theory to enlarge benefits under a written plan. View "Spizman v. BCBSM, Inc." on Justia Law

Plaintiffs, a class of employees who participated in ABB's retirement plans, filed suit alleging that ABB and its fiduciaries managed the plans for their own benefit, rather than for the participants. In an earlier appeal, the court directed the district court to "reevaluate" how the participants might have been injured if the ABB fiduciaries breached their fiduciary duties under the Employee Retirement Income Security Act of 1974 (ERISA), 29 U.S.C. 1001 et seq., when they changed the investment options for the plans. The district court misunderstood the court's direction for a definitive ruling on how to measure plan losses and thus entered judgment for the ABB fiduciaries even though the district court found that they breached their duties. Therefore, the court vacated the judgment on that claim and remanded for further consideration regarding whether the participants can prove losses to the plans. The court also vacated and remanded the district court's award of attorney fees because the court reopened one of the participant's substantive claims. View "Tussey v. ABB, Inc." on Justia Law

Plaintiff and eight others filed a class action against Anheuser-Busch under the Employee Retirement Income Security Act (ERISA), 29 U.S.C. 1001 et seq. Plaintiffs are participants in the Anheuser-Busch salaried employee pension plan and claim that they are entitled to enhanced pension benefits. At issue is the interpretation of Section 19.11(f) of the plan. Determining that it has jurisdiction over the appeal, the court concluded that Section 19.11(f) is unambiguous and agreed with the district court's adoption of the reasoning in the Sixth Circuit's case, Adams v. Anheuser-Busch Cos., that Section 19.11(f) entitled plaintiffs to enhanced benefits. Although the court affirmed on the merits, the court agreed with plaintiffs that the decision still must be reversed and remanded because the district court failed to make individual calculations of enhanced benefits owed to individual members of the class. Therefore, the court reversed and remanded with instructions to reconsider plaintiffs' prayer for relief and, to the extent requested and provable, calculate and award the benefits owed to plaintiffs by applying Section 19.11(f). The court noted that, upon remand, the district court may reconsider whether certain records will assist in its calculation of the requested benefits. View "Knowlton v. Anheuser-Busch" on Justia Law