Justia ERISA Opinion Summaries

A woman participated in an employee pension plan governed by the Employee Retirement Income Security Act of 1974 (ERISA). After being diagnosed with cancer and while hospitalized, she initiated an online election to receive her accrued pension benefits as a lump sum and designated her sister as the beneficiary. She died three days later, before completing a required second step of confirming her election and beneficiary designation, according to the plan’s administrative process. After her death, her sister submitted a claim seeking the lump sum benefit.The plan administrator denied the claim, reasoning that the decedent had not finalized her election and beneficiary designation, and that “substantial compliance” with the plan’s requirements was not sufficient under ERISA. On administrative appeal, the committee upheld the denial for the same reasons. The sister then filed suit in the United States District Court for the Northern District of California, alleging entitlement to the benefits. The district court dismissed her complaint with prejudice, holding that the complaint did not plausibly allege that she was entitled to the benefits, even under a substantial compliance theory.The United States Court of Appeals for the Ninth Circuit reviewed the case. The court held that the state law doctrine of substantial compliance is available under ERISA for benefit elections, just as it is for beneficiary designations, consistent with its previous decision in Becker v. Williams, 777 F.3d 1035 (9th Cir. 2015). The court clarified that the Supreme Court’s decision in Kennedy v. Plan Administrator for DuPont Savings & Investment Plan, 555 U.S. 285 (2009), did not eliminate the doctrine of substantial compliance. The Ninth Circuit concluded that the plaintiff’s complaint plausibly alleged substantial compliance with the plan’s requirements and reversed the district court’s dismissal, remanding for further proceedings. View "LIU V. KAISER PERMANENTE EMPLOYEES PENSION PLAN FOR THE PERMANENTE MEDICAL GROUP, INC." on Justia Law

A dispute arose concerning the payment rate for a surgical procedure performed at an out-of-network facility. The patient receiving the surgery was covered by an ERISA-governed health plan provided by the employer and administered by an insurance company. Prior to the surgery, the facility contacted the plan administrator to verify coverage and was told that the plan would reimburse at the usual, customary, and reasonable (“UCR”) rate, not the lower Medicare rate. Relying on this representation, the facility performed the surgery. However, the plan later paid only at the Medicare rate, far less than the full billed amount. The facility’s successor in interest, having obtained the rights to the claim, sought to recover the unpaid balance.The action was first brought in California state court, then removed to the United States District Court for the Central District of California. The plaintiff asserted both ERISA and state law claims. The district court dismissed the ERISA claim for lack of derivative standing, as the plaintiff was not properly assigned the right to sue under ERISA. The court also dismissed the state law claims for negligent misrepresentation and promissory estoppel, holding that these claims were preempted by ERISA because they related to an ERISA-covered plan.The United States Court of Appeals for the Ninth Circuit reviewed the case. It affirmed the district court’s dismissal of the promissory estoppel claim, holding that, under circuit precedent, such claims are preempted by ERISA. However, the Ninth Circuit reversed the dismissal of the negligent misrepresentation claim. The appellate court held that ERISA does not preempt a negligent misrepresentation claim by a provider’s successor in interest when the claim arises from representations made by the plan administrator during a pre-service verification call. The court concluded that such a claim does not sufficiently “relate to” an ERISA plan to trigger preemption, as it is not based on an ERISA-regulated relationship or enforceable under ERISA’s civil enforcement mechanism. The case was remanded for further proceedings on the negligent misrepresentation claim. View "HEALTHCARE ALLY MANAGEMENT OF CALIFORNIA, LLC V. WSP USA, INC." on Justia Law

A former employee brought suit against her previous employer and associated fiduciaries, alleging that they mismanaged the employer's retirement savings plan, which is a defined contribution plan governed by the Employee Retirement Income Security Act of 1974 (ERISA). She claimed that the fiduciaries retained underperforming investment options in the plan’s menu to generate transaction fees, in violation of their duties of prudence and loyalty, and sought plan-wide monetary and equitable relief on behalf of the plan.Previously, the United States District Court for the Central District of California reviewed the case. The defendants moved to compel arbitration, relying on provisions in the plan requiring arbitration of disputes and waiving participants’ rights to bring claims on a “class, collective, or representative basis.” The plaintiff argued that this waiver impermissibly precluded her from enforcing statutory rights under ERISA, which allow participants to sue on behalf of the plan for plan-wide relief. The district court denied the motion to compel arbitration, finding the waiver unenforceable under the effective-vindication doctrine and holding that the waiver provision was expressly non-severable, thus requiring the claims to proceed in court.On appeal, the United States Court of Appeals for the Ninth Circuit affirmed the district court’s denial of the motion to compel arbitration. The Ninth Circuit held that the plan’s waiver provision was unenforceable because it prevented the plaintiff from asserting her right under ERISA to bring representative claims for plan-wide relief—a right that ERISA expressly provides. The court further held that, under the plan’s own terms, once the waiver was found unenforceable, any representative claim must be adjudicated in court, not arbitration. Thus, the plaintiff’s breach-of-fiduciary-duty claims would proceed before the district court. View "POVER V. THE CAPITAL GROUP COMPANIES, INC." on Justia Law

JB Viva Vegas, L.P. challenged the assessment of withdrawal liability imposed by the Nevada Resort Association-International Alliance of Theatrical Stage Employees and Moving Picture Machine Operators of the US and Canada Local 720 Pension Trust under the Multiemployer Pension Plan Amendments Act (MPPAA). JB had contributed to the Trust’s pension plan for stagehands working on a theatrical production, which later closed. The Trust asserted withdrawal liability, arguing that its plan no longer qualified for the entertainment industry exception due to a shift in employee work from entertainment to convention-related activities.After JB’s request for review went unanswered, it initiated arbitration. The arbitrator initially ruled in JB’s favor, finding the plan qualified for the entertainment exception and ordering rescission of the withdrawal liability. The Trust then sought to vacate the arbitration award in the United States District Court for the District of Nevada. The district court vacated the award, reasoning that the relevant year for determining the plan’s status was the year JB withdrew, not when it joined, and remanded to the arbitrator. On remand, the arbitrator granted summary judgment to the Trust, concluding that the MPPAA was ambiguous as to how much entertainment work was required and that the plan did not “primarily” cover entertainment employees because less than half earned most of their wages from entertainment work. The district court affirmed the arbitrator’s decision, granting summary judgment to the Trust.On appeal, the United States Court of Appeals for the Ninth Circuit reviewed the district court’s summary judgment de novo. The court held that the MPPAA’s entertainment industry exception does not require a minimum amount of entertainment work for an individual to qualify as an “employee in the entertainment industry.” Therefore, the Trust’s plan primarily covers such employees if a majority perform any entertainment work. The Ninth Circuit reversed the district court’s decision and remanded the case. View "NEVADA RESORT ASSOCIATION-INTERNATIONAL ALLIANCE OF THEATRICAL STAGE EMPLOYEES AND MOVING PICTURE MACHINE OPERATORS OF THE US AND CANADA LOCAL 720 PENSION TRUST V. JB VIVA VEGAS, LP" on Justia Law

A construction company in southern Nevada ceased contributing to a multiemployer pension plan after it stopped operating in the state. The pension plan’s trustees assessed the company for withdrawal liability, asserting the company owed over $2.8 million under the Multiemployer Pension Plan Amendments Act (MPPAA). The company challenged the assessment, arguing it was exempt from liability because its asbestos abatement work qualified for the “building and construction industry” exception in the MPPAA. The company pointed out that asbestos abatement involves removing or remediating hazardous materials from buildings, including demolition and substantial alterations to structures.An arbitrator initially ruled in favor of the pension plan’s trustees, interpreting the “building and construction industry” narrowly to include only work that literally builds new structures, and finding that asbestos abatement did not meet this definition. The company then brought suit in the United States District Court for the District of Nevada to vacate or modify the arbitration award. The district court rejected the arbitrator’s and trustees’ narrow construction, instead adopting a broader understanding of the industry that includes maintenance, repair, alteration, and demolition. The district court granted summary judgment to the company, holding that its asbestos abatement work qualified for the statutory exception, and ordered the return of payments made toward the assessed liability.On appeal, the United States Court of Appeals for the Ninth Circuit affirmed the district court’s judgment. The Ninth Circuit held that the phrase “building and construction industry” in the MPPAA incorporates the definition established by the National Labor Relations Board under the Taft-Hartley Act, which includes erection, maintenance, repair, and alteration of buildings and structures. Applying this definition, the court ruled that asbestos abatement is covered by the exception, exempting the company from withdrawal liability. View "WALKER SPECIALTY CONSTR., INC. V. BD. OF TR. OF THE CONSTR. INDUS. AND LABORERS JOINT PENSION TRUST" on Justia Law

Several individuals, representing a class, challenged a health insurance company’s refusal to cover gender-affirming care for transgender individuals diagnosed with gender dysphoria. The company, acting as a third-party administrator for employer-sponsored, self-funded health plans, denied coverage for such treatments based on explicit plan exclusions requested by the employer sponsors. Some plaintiffs also alleged that they were denied coverage for treatments that would have been covered for other diagnoses, such as precocious puberty, but were denied solely because of the concurrent diagnosis of gender dysphoria.The United States District Court for the Western District of Washington certified the class and granted summary judgment in favor of the plaintiffs. The district court rejected the company’s arguments that it was not subject to Section 1557 of the Affordable Care Act because its third-party administrator activities were not federally funded, that it was merely following employer instructions under ERISA, and that it was shielded by the Religious Freedom Restoration Act (RFRA). The district court also found that the exclusions constituted sex-based discrimination under Section 1557.On appeal, the United States Court of Appeals for the Ninth Circuit agreed with the district court that the company is subject to Section 1557, that ERISA does not require administrators to enforce unlawful plan terms, and that RFRA does not provide a defense in this context. However, the Ninth Circuit held that the district court’s analysis of sex-based discrimination was undermined by the Supreme Court’s intervening decision in United States v. Skrmetti, which clarified the application of sex discrimination standards to exclusions for gender dysphoria treatment. The Ninth Circuit vacated the summary judgment and remanded the case for further proceedings to consider whether, under Skrmetti, the exclusions at issue may still constitute unlawful discrimination, particularly in cases involving pretext or proxy discrimination or where plaintiffs had other qualifying diagnoses. View "PRITCHARD V. BLUE CROSS BLUE SHIELD OF ILLINOIS" on Justia Law

Robert Platt, an employee of Sodexo, Inc., sued his employer, claiming that a monthly tobacco surcharge on his employee health insurance premiums violated the Employee Retirement Income Security Act (ERISA). Platt brought claims on behalf of himself and other plan participants to recover losses under ERISA § 502(a)(1)(B) and § 502(a)(3), and a breach of fiduciary duty claim on behalf of the employer-sponsored health insurance plan (the Plan) for losses under ERISA § 502(a)(2). Sodexo sought to compel arbitration based on an arbitration provision it unilaterally added to the Plan after Platt joined.The United States District Court for the Central District of California denied Sodexo’s motion to compel arbitration, holding that there was no enforceable arbitration agreement because Sodexo unilaterally modified the Plan to add the arbitration provision without Platt’s consent. The court found that Platt did not agree to arbitrate his claims.The United States Court of Appeals for the Ninth Circuit reviewed the case. The court agreed that an employer cannot create a valid arbitration agreement by unilaterally modifying an ERISA-governed plan to add an arbitration provision without obtaining consent from the relevant party. The court held that Platt is the relevant consenting party for claims under ERISA § 502(a)(1)(B) and § 502(a)(3) and that he did not consent to arbitration because he did not receive sufficient notice of the arbitration provision. However, the court held that the Plan is the relevant consenting party for the breach of fiduciary duty claim under ERISA § 502(a)(2) and that the Plan consented to arbitration.The Ninth Circuit affirmed the district court’s denial of Sodexo’s motion to compel arbitration for Platt’s claims under ERISA § 502(a)(1)(B) and § 502(a)(3). It reversed in part the district court’s denial of the motion to compel arbitration for the breach of fiduciary duty claim under ERISA § 502(a)(2) and remanded for the district court to consider Platt’s unconscionability defenses and the severability of the representative action waiver and any other arbitration clauses found unconscionable. View "PLATT V. SODEXO, S.A." on Justia Law

Peter Schuman and William Coplin, former employees of Atmel Corporation, were terminated without cause after Microchip Technology Inc. acquired Atmel. They were offered severance benefits significantly lower than those promised under Atmel's Employee Retirement Income Security Act (ERISA)-governed benefits plan, in exchange for signing a release of all potential claims. Schuman and Coplin signed the releases but later filed a class-action lawsuit on behalf of approximately 200 similarly situated former Atmel employees, alleging ERISA violations, including breach of fiduciary duty and denial of benefits, and challenging the enforceability of the releases.The United States District Court for the Northern District of California granted summary judgment in favor of Microchip against Schuman and Coplin, applying a six-part test to determine that the releases were signed knowingly and voluntarily. The court did not consider evidence of Microchip's alleged breach of fiduciary duties in its analysis. The district court denied summary judgment for the non-named plaintiffs, finding material disputes of fact regarding Microchip's knowledge of the Plan's intended interpretation. The court entered final judgment under Federal Rule of Civil Procedure 54(b) for Schuman and Coplin, certifying the question of the appropriate legal test for determining the enforceability of the releases.The United States Court of Appeals for the Ninth Circuit reversed the district court's summary judgment against Schuman and Coplin, holding that courts must evaluate the enforceability of ERISA releases by considering the totality of the circumstances, including any alleged improper conduct by the fiduciary. The court enumerated nine non-exhaustive factors for this evaluation. The case was remanded to the district court for further proceedings consistent with this opinion. The Ninth Circuit dismissed Microchip's cross-appeal for lack of jurisdiction, as the issue raised was not inextricably intertwined with the primary appeal. View "Schuman v. Microchip Technology Inc." on Justia Law

Winston R. Anderson, a former Intel employee, brought a putative class action under the Employee Retirement Income Security Act (ERISA) against the trustees of Intel Corporation’s proprietary retirement funds. Anderson alleged that the trustees breached their fiduciary duty of prudence by investing in hedge funds and private equity funds, and their duty of loyalty by steering retirement funds to companies in which Intel Capital had already invested.The United States District Court for the Northern District of California dismissed Anderson’s claims, concluding that he had not plausibly alleged a breach of either the duty of prudence or the duty of loyalty. The court found that Anderson failed to provide a meaningful benchmark to compare the performance of Intel’s funds and did not plausibly allege a real conflict of interest for the duty of loyalty claim. Anderson was granted leave to amend his complaint, but the district court dismissed the amended complaint with prejudice for the same reasons.The United States Court of Appeals for the Ninth Circuit affirmed the district court’s dismissal. The court held that Anderson did not state a claim for breach of ERISA’s duty of prudence because he failed to provide a sound basis for comparison, as the funds he compared to Intel’s funds had different aims, risks, and potential rewards. The court also held that Anderson did not state a claim for breach of the duty of loyalty because he did not plausibly allege a real conflict of interest, only the potential for one. The court emphasized that ERISA requires prudence based on the methods employed by fiduciaries, not the results achieved, and that generalized attacks on hedge funds and private equity funds as a category are insufficient to state a claim. View "Anderson v. Intel Corporation Investment Policy Committee" on Justia Law

California Insurance Code 10110.6(a) has voided provisions conferring discretionary authority to Employee Retirement Income Security Act (ERISA), 29 U.S.C. 1001 et seq., plan administrators such as Aetna. Plaintiff challenged Aetna's decision to terminate her long-term disability benefits under a plan created by Boeing. The Ninth Circuit reversed and remanded the district court's holding that California's statute did not apply to Boeing's plan and upholding Aetna's denial of benefits to plaintiff. The Ninth Circuit held that section 10110.6(a) was saved from ERISA preemption because the statute is directed toward entities engaged in insurance and substantially affects the risk-pooling arrangement between the insurer and the insured. The Ninth Circuit also held that section 10110.6 applied in this case because Boeing's policy renewed after section 10110.6's effective date. View "Orzechowski v. The Boeing Company Non-Union Long-Term Disability Plan" on Justia Law