Justia ERISA Opinion SummariesArticles Posted in US Court of Appeals for the Sixth Circuit
Wallace v. Oakwood Healthcare, Inc.
Wallace participated in Oakwood’s employee welfare benefit plan, which provided long-term disability (LTD) benefits, subject to the Employee Retirement Income Security Act of 1974 (ERISA), 29 U.S.C. 1001. Effective January 1, 2013, Oakwood switched the insurer responsible for that plan from Hartford to Reliance. Wallace took medical leave in October 2012, returning to work in April 2013. Wallace took medical leave again in May 2013 and has not returned to work. Reliance denied her claim for LTD benefits citing the pre-existing condition provision of its plan document and describing the review process, including that “failure to request a review within 180 days … may constitute a failure to exhaust the administrative remedies … and may affect ability to bring a civil action.” The plan document did not describe the review process or an exhaustion requirement. After discussions with Reliance, Wallace submitted an unsuccessful claim to Hartford. Wallace filed suit under ERISA. The district court granted Wallace judgment against Reliance based on the administrative record. The Sixth Circuit affirmed the denial of Reliance’s motion to dismiss on the basis of exhaustion. A plan document must detail claims review procedures and remedies. The court vacated the judgment on the record; further fact-finding is necessary to determine whether Wallace was eligible for LTD benefits and in what amount. Wallace may have been covered under transfer of insurance and pre-existing conditions limitation credit provisions, but the record does not permit a definitive finding. View "Wallace v. Oakwood Healthcare, Inc." on Justia Law
Morehouse v. Steak N Shake
Rebecca, employed by SNS, enrolled herself and her husband in SNS’s health-benefits coverage. In 2013, Rebecca fell at work and injured her knee. Her injury was too severe to permit her to continue working. She signed a form requesting to open a workers’ compensation claim and to receive a leave of absence. The form did not mention the “Family and Medical Leave Act.” SNS sent a letter instructing her to complete paperwork for processing her absence under the FMLA. She did so. SNS approved her leave of absence as FMLA leave (rather than paid leave) for the first 12 weeks, but did not give her any other written notice of that designation. SNS deducted her insurance contributions from her workers’ compensation checks. SNS notified Rebecca when her FMLA leave expired, stating that, if her employment was terminated, she could continue health benefits under the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA). Having received no premium payment weeks later, SNS notified Rebecca that the benefits had been discontinued. SNS terminated her employment. Rebecca sued, alleging that SNS failed to notify her of the right to temporarily continue health-benefit coverage under COBRA and breached its fiduciary duty under ERISA by failing to so notify her. The district court determined that a qualifying event occurred with the reduction in Rebecca’s work hours on the day after her injury, requiring notice. The Sixth Circuit reversed because the terms of Rebecca’s insurance coverage did not change upon her taking a leave of absence. No “qualifying event” occurred to trigger a COBRA notification obligation. View "Morehouse v. Steak N Shake" on Justia Law
K.B. v. Methodist Healthcare – Memphis Hospitals
Knox-Bender suffered injuries from a car accident. She sought medical treatment at Methodist Healthcare. Methodist billed her $8,000 for the treatment. Payments to Methodist were made on Knox-Bender’s behalf by her employer-sponsored healthcare plan, her automobile insurance plan, and her husband’s healthcare plan. Knox-Bender says that the insurance plans had already agreed with Methodist on the price of her care. She claims that, despite this agreement, Methodist overcharged her and that this was common practice for Methodist. She and a putative class of other patients, sued in Tennessee state court. During discovery, Methodist learned that Knox-Bender’s husband’s healthcare plan was an ERISA plan, 29 U.S.C.1001(b) that covered $100 of her $8,000 bill. Methodist removed the case to federal court claiming complete preemption under ERISA. The district court denied Knox-Bender’s motion to remand and entered judgment in favor of Methodist. The Sixth Circuit reversed. The complete preemption of state law claims under ERISA is “a narrow exception to the well-pleaded complaint rule.” Methodist has not met its burden to show that Knox-Bender’s complaint fits within that narrow exception. Since Knox-Bender has not alleged a denial of benefits under her husband’s ERISA plan, ERISA does not completely preempt her claim. Even if Methodist had shown that Knox-Bender alleged a denial of benefits, it would also have show that Knox-Bender complained only of duties breached under ERISA, not any independent legal duty. View "K.B. v. Methodist Healthcare - Memphis Hospitals" on Justia Law
Wilson v. Safelite Group, Inc.
Plaintiff filed suit against Safelite for breach of contract and negligent misrepresentation arising from the company's alleged mismanagement of its deferred compensation plan for executive employees. The Sixth Circuit affirmed the district court's grant of Safelite's motion for partial summary judgment, holding that the Safelite Plan qualifies as an employee pension benefit plan under 29 U.S.C. 1002(2)(A)(ii) and is not a bonus plan as defined in 29 C.F.R. 2510.3-2(c). Therefore, the Safelite Plan was not exempted from coverage under the Employee Retirement Income Security Act. View "Wilson v. Safelite Group, Inc." on Justia Law
Trustees of Operating Engineers Local 324 v. Bourdow Contracting, Inc.
Trucking, owned by Bourdow, his wife, and their sons, sold and transported dirt, stone, and sand throughout lower Michigan and engaged in construction site preparation and excavation. Trucking employed other members of the Bourdow family. Trucking executed collective bargaining agreements (CBAs), under which it made fringe benefit payments to the Union’s pension fund (Fund). Experiencing financial difficulties, Trucking terminated its CBA. In 2012, the Fund informed Trucking that it had incurred withdrawal liability ($1,163,279) under the Employee Retirement Income Security Act (ERISA), 29 U.S.C 1381(a). Trucking missed its first withdrawal liability payment. The Fund filed suit, which was stayed when Trucking filed for Chapter 7 bankruptcy. The Fund filed a proof of claim. Trucking did not object; the claim was allowed, 11 U.S.C. 502(a). The Fund received $52,034. Contracting was incorporated the day after Trucking missed its first withdrawal payment; it bid on its first project two days before Trucking's bankruptcy filing. Contracting engages in construction site preparation and excavation in lower Michigan. Contracting is owned by the Bourdow sons; it employs other family members and retains the services of other professionals formerly retained by Trucking. The Fund sought to recover the outstanding withdrawal liability, alleging that Contracting was created to avoid withdrawal liability, and is responsible for that liability under 29 U.S.C 1392(c), and that Contracting is the alter ego of Trucking. The Sixth Circuit affirmed summary judgment in favor of the Fund, applying the National Labor Relations Act’s alter-ego test and citing the factors of business purpose, operations, customers, supervision, ownership, and intent to evade labor obligations. View "Trustees of Operating Engineers Local 324 v. Bourdow Contracting, Inc." on Justia Law
Pension Benefit Guaranty Corp. v. Findlay Industries, Inc.
The Pension Benefit Guaranty Corporation (PBGC) insures uninterrupted payment of benefits under terminated private-sector pension and health plans subject to ERISA, 29 U.S.C. 1001–1461. PBGC is funded by insurance premiums paid by sponsoring companies and from assets acquired from terminated plans and recovered from underfunded plan sponsors in bankruptcy. The plan's sponsor and “trades or businesses” related to the sponsor through common ownership are jointly and severally liable for those liabilities. PBGC sued to collect $30 million in underfunded pension liabilities from Findlay Industries following its 2009 shutdown and looked to hold liable a trust started by Findlay’s founder, Philip Gardner, and to apply the federal-common-law doctrine of successor liability to hold Michael, Philip’s son, liable. Michael, a 45 percent shareholder and former CEO of Findlay, had purchased Findlay’s assets and started his own companies using the same land, hiring many of the same employees, and selling to Findlay’s largest customer. The district court ruled against PBGC. The Sixth Circuit reversed. An entity that owns land and leases it to an entity under common control should be considered, categorically, a “trade or business” under ERISA, to recognize the differences between ERISA and the tax code, satisfy the purposes of ERISA, and be consistent with other circuits. Refusing to apply successor liability here would allow Findlay to fail to uphold its promises to employees, then engage in clever financial transactions that leave PBGC to pay millions in pension liabilities. View "Pension Benefit Guaranty Corp. v. Findlay Industries, Inc." on Justia Law
Springer v. Cleveland Clinic Employee Health Plan Total Care
Springer, a Utah physician, began a fellowship at the Cleveland Clinic and enrolled his family in its employee benefit plan, administered by Antares. During the enrollment period, Springer had his 14-month-old son, J.S., transported from a Utah hospital to the Cleveland Clinic by Angel Jet’s air ambulance service. J.S. had been hospitalized since birth for multiple congenital abnormalities. He required a mechanical ventilator. J.S.’s physician prepared a letter of medical necessity for the service. Before the flight, Angel Jet contacted Antares, which was unable to confirm that Springer and his son were members of the plan and did not precertify the service. Angel Jet proceeded with the transportation and submitted a bill to Antares for $340,100. Antares denied it for failure to obtain precertification. The Plan affirmed the denial but paid $34,451.75, reflecting the amount their preferred provider would have charged. Angel Jet brought suit under the Employee Retirement Security Act. The district court dismissed the suit, finding that Springer had not properly assigned his rights under the plan to Angel Jet. Springer then brought his own claim under ERISA Section 502(a)(1)(B). The Sixth Circuit affirmed, first finding that Springer had standing despite having received the service and not being billed. The denial was not arbitrary and capricious because J.S.’s transportation was not an emergency or precertified as required for a nonemergency. View "Springer v. Cleveland Clinic Employee Health Plan Total Care" on Justia Law
Pearce v. Chrysler Group LLC Pension Plan
In 2008, facing insolvency, Chrysler offered certain employees incentives to take early retirement, in addition to benefits they had earned under its Pension Plan. Pearce, then 60 years old, had worked for Chrysler for 33 years, and was eligible for the buyout plus the Plan’s 30-and-Out benefits--a monthly pension supplement “to help early retirees make ends meet until eligible for Social Security.” Chrysler provided Pearce with Pension Statements that repeatedly advised him to consult the Summary Plan Document (SPD). The SPD cautioned that “[i]f there is a conflict ... the Plan document and trust agreement will govern.” With respect to the 30-and-Out benefits, the SPD stated: “You do not need to be actively employed at retirement to be eligible ... you must retire and begin receiving pension benefits within five years of your last day of work for the Company.” Pearce believed that he could not lose his 30-and-Out benefits if he lost his job and declined the buyout offer. Chrysler terminated him that same day. Pearce was told that, because he had been terminated before retirement, he was ineligible for the 30-and-Out benefits; the SPD omitted a clause contained in the Plan, which said that an employee who was terminated was ineligible. Pearce sued under the Employee Retirement Income Security Act, 29 U.S.C. 1001. The Sixth Circuit reversed the district court’s grant of summary judgment to the Plan on Pearce’s request for reformation, affirmed summary judgment rejecting Pearce’s request for equitable estoppel, and remanded. Analyzing Pearce’s request for reformation under contract law principles, the court should consider information asymmetry--Chrysler had access to the Plan while Pearce did not but repeatedly referred Pearce to the SPD--and other factors. View "Pearce v. Chrysler Group LLC Pension Plan" on Justia Law
Fletcher v. Honeywell International, Inc.
Plaintiffs, retirees who worked at Honeywell’s Greenville, Ohio plant, were members of a bargaining unit. The final collective bargaining agreement (CBA) did not expire until May 2014. Honeywell sold the plant in 2011 but continued to provide healthcare benefits for retirees after the CBA expired. The 2011 CBA stated that “[u]pon the death of a retiree, the Company will continue coverage for the spouse and dependent children for their lifetime.” In December 2015, Honeywell sent a letter stating that it intended to terminate the retiree medical and prescription drug coverage on December 31, 2016. Plaintiffs filed suit on behalf of themselves and similarly situated retirees and eligible dependents under the Labor Management Relations Act (LMRA), 29 U.S.C. 185, and the Employee Retirement Income Security Act (ERISA), 29 U.S.C. 1132, claiming that Honeywell was obligated to provide retirees with lifetime healthcare benefits. Honeywell argued that the CBA’s general durational clause, which stated that the agreement remained in effect until May 22, 2014, governed its duty to provide those benefits. The Sixth Circuit held that the CBAs were unambiguous and do not vest retiree healthcare benefits for life. A CBA’s general durational clause applies to healthcare benefits unless it contains clear, affirmative language indicating the contrary. Retirees are not entitled to lifetime benefits; only the dependents of retirees who died while the CBA was in effect are entitled to lifetime benefits. View "Fletcher v. Honeywell International, Inc." on Justia Law
Clemons v. Norton Healthcare Inc. Retirement Plan
In 1991, Norton merged predecessor retirement plans into one Plan governed by ERISA. As of 1997, the Plan included a traditional defined-benefit formula applicable to members of the predecessor plans and a cash-balance formula applicable to all other plans. In 2004, the Plan was amended to end accruals under the defined-benefit formulas and allow further accruals only under the cash-balance benefit formula. The Plan allows disability retirement, “normal” age 65 retirement, late retirement, and early retirement, for participants at least 55 years old with at least 10 years of service. The Plan allows retirees to take benefits in the “Basic Form” or in one of six alternative forms, including a lump-sum payment on the date of retirement. In 2008, the Retirees brought a putative class action, alleging Norton underpaid retirees who took a lump-sum payment. The court certified a class in 2011 and eventually granted the Retirees summary judgment. Damages were not reduced to a sum certain, but the court adopted the Retirees’ calculation formula, awarded fixed-rate pre-judgment interest, and entered final judgment. The Sixth Circuit vacated, finding the Plan ambiguous, with respect to calculation of benefits, and possibly noncompliant with ERISA, with respect to actuarial calculations. The court vacated class certification under Rule 23(b)(1)(A) and (b)(2). The court held that if the Plan clearly gives the administrator “Firestone” deference, interpretation against the draftsman has no place in reviewing the administrator’s decisions. The arbitrary-and-capricious standard stays intact. View "Clemons v. Norton Healthcare Inc. Retirement Plan" on Justia Law