Justia ERISA Opinion Summaries
Pharmaceutical Care v. Mulready, et al.
In 2019, the Oklahoma legislature unanimously passed the Patient’s Right to Pharmacy Choice Act. In response to the Act’s passage, the Pharmaceutical Care Management Association (PCMA), a trade association representing PBMs, sued to invalidate the Act, alleging that the Employee Retirement Income Security Act of 1974 (ERISA), and Medicare Part D, preempted the Act. The district court ruled that ERISA did not preempt the Act but that Medicare Part D preempted six of the thirteen challenged provisions. PCMA appealed the court’s ERISA ruling on four provisions of the Act and the court’s Medicare Part D ruling on one provision. After its review, the Tenth Circuit determined ERISA and Medicare Part D preempted the four challenged provisions, and therefore reversed. View "Pharmaceutical Care v. Mulready, et al." on Justia Law
P., et al. v. United Healthcare Insurance, et al.
Plaintiffs David P. and his daughter L.P. sought to recover health care benefits under a medical plan David P. obtained through his employer. The district court awarded Plaintiffs benefits, determining that the manner in which Defendants processed Plaintiffs’ claims for coverage violated ERISA. The Tenth Circuit Court of Appeals agreed: Defendants’ deficient claims processing circumvented the dialogue ERISA mandates between plan participants claiming benefits and the plan administrators processing those benefits claims. The Court disagreed, however, with the district court as to the appropriate remedy for the violations of ERISA’s claims-processing requirements at issue here. "Rather than outright granting Plaintiffs their claimed benefits, we conclude, instead, that Plaintiffs’ claims for benefits should be remanded to Defendants for proper consideration." The case was remanded to the district court with directions to remand Plaintiffs’ benefits claims to Defendants. View "P., et al. v. United Healthcare Insurance, et al." on Justia Law
ROBERT BUGIELSKI, ET AL V. AT&T SERVICES, INC., ET AL
Plaintiffs brought this class action against the Plan’s administrator, AT&T Services, Inc., and the committee responsible for some of the Plan’s investment-related duties, the AT&T Benefit Plan Investment Committee (collectively, “AT&T”). Plaintiffs alleged that AT&T failed to investigate and evaluate all the compensation that the Plan’s recordkeeper, Fidelity Workplace Services, received from mutual funds through BrokerageLink, Fidelity’s brokerage account platform, and from Financial Engines Advisors, L.L.C. Plaintiffs alleged that (1) AT&T’s failure to consider this compensation rendered its contract with Fidelity a “prohibited transaction” under ERISA Section 406, (2) AT&T breached its fiduciary duty of prudence by failing to consider this compensation, and (3) AT&T breached its duty of candor by failing to disclose this compensation to the Department of Labor. The Ninth Circuit affirmed in part and reversed in part the district court’s summary judgment in favor of Defendants. The panel reversed the district court’s grant of summary judgment on the prohibited transaction claim. Relying on the statutory text, regulatory text, and the Department of Labor’s Employee Benefits Security Administration’s explanation for a regulatory amendment, the panel held that the broad scope of Section 406 encompasses arm’s-length transactions. The panel held that the broad scope of § 406 encompasses arm’s-length transactions. Disagreeing with other circuits, the panel concluded that AT&T, by amending its contract with Fidelity to incorporate the services of BrokerageLink and Financial Engines, caused the Plan to engage in a prohibited transaction. The panel remanded for the district court to consider whether AT&T met the requirements for an exemption from the prohibited transaction bar. View "ROBERT BUGIELSKI, ET AL V. AT&T SERVICES, INC., ET AL" on Justia Law
Patterson v. United Healthcare Insurance Co.
United provided Patterson's medical insurance under a plan subject to the Employee Retirement Income Security Act (ERISA), 29 U.S.C. 1101. Patterson received a summary plan description, an ERISA-mandated synopsis of important plan terms but was not given a plan document with all of a plan’s governing language. The summary said that if a beneficiary recovered from a third party for an insured incident, the plan had a right to reimbursement. Patterson was injured in a traffic accident. United covered his medical expenses and notified Patterson it would invoke the reimbursement right. Patterson sued the other driver in state court and joined the plan, seeking a declaratory judgment that it had no reimbursement right. United’s lawyers claimed that no plan document existed. Patterson recovered and settled with the plan for $25,000. Months later, Patterson’s wife suffered injuries in another traffic accident. United paid her medical expenses. Patterson’s wife sued the driver in state court. She obtained a declaratory judgment after the plan's lawyers produced a plan document, stating that it took precedence over the summary and not including a reimbursement right.Patterson then filed a purported class action under ERISA, seeking the return of the $25,000. The district court dismissed the complaint. The Sixth Circuit affirmed in part. Patterson had standing to sue only on his own behalf but has cognizable claims for breach of fiduciary duty and engagement in prohibited transactions. View "Patterson v. United Healthcare Insurance Co." on Justia Law
Kairys v. Southern Pines Trucking, Inc
The owner and CEO of Southern Pines (Pat) recruited Kairys as Vice President of Sales to grow the company’s cryogenic trucking services. Soon after he started the job, Kairys required hip replacement surgery. Kairys had surgery and missed seven days of work. Southern was self-insured. Kairys’s surgery caused its health insurance costs to rise markedly. According to Kairys, after he returned to work, Pat’s brother (the VP) told him to “lay low” because Pat was upset. Four months later, Pat fired Kairys, claiming that Southern had “maxed out” its sales potential in cryogenic trucking. Weeks later, Souther hired a part-time worker in a hybrid role that included work that had been done by Kairys.Kairys sued, alleging discrimination and retaliation, citing the Americans with Disabilities Act, the Age Discrimination in Employment Act, the Employee Retirement Income Security Act (ERISA), 29 U.S.C. 1001, and state laws. A jury rejected Kairys’s ADA and ADEA claims and returned an advisory verdict for Southern on the ERISA claim.The district court independently considered the ERISA claim and found that Kairys had proved retaliation for using ERISA-protected benefits and interfered with his right to future benefits. The court awarded Kairys $67,500 in front pay and $111, 981.79 in attorney fees. The Third Circuit affirmed. The judgment for Kairys on the ERISA claim was not inconsistent with the jury’s verdict on the other claims and was supported by sufficient evidence. View "Kairys v. Southern Pines Trucking, Inc" on Justia Law
Melissa McIntyre v. Reliance Standard Life
Plaintiff sued Reliance Standard Life Insurance Company under 29 U.S.C. Section 1132(a)(1)(B), seeking to recover long-term disability benefits. The district court granted Plaintiff’s motion for summary judgment and denied Reliance’s cross-motion. Reliance appealed, and the Eighth Circuit reversed. The court explained that the cases cited do not demonstrate that Reliance has a history of biased claims administration. Nor do they show some other systemic flaw in its claims review process that affected Reliance’s review of Plaintiff’s claim. On the other hand, Reliance does not argue that it maintained structural separations to minimize its conflict of interest. Therefore, the conflict of interest, in this case, deserves “some weight,” but the court concluded that it does not indicate that Reliance abused its discretion. The court wrote that substantial evidence supports Reliance’s decision, and neither the decisional delay in this case nor the purported conflict of interest leads us to conclude that Reliance abused its discretion. View "Melissa McIntyre v. Reliance Standard Life" on Justia Law
Benjamin Reetz v. Aon Hewitt Investment Consulting, Inc.
On behalf of a class, Plaintiff sued Aon Hewitt Investment Consulting for investment advice given to Lowe’s Home Improvement to help manage its employees’ retirement plans. Aon, first as an investment consultant and later as a delegated fiduciary, owed the plan fiduciary duties under the Employee Retirement Income Security Act. Plaintiff claimed that Aon’s conduct violated the core duties of loyalty and prudence. After a five-day bench trial, the district court held that Aon, in fact, did not breach its fiduciary duties. Plaintiff appealed. The Fourth Circuit affirmed. The court explained that the district court that Aon’s recommendation was not motivated by self-interest. And Plaintiff’s contention that Aon’s research conducted before it was Lowe’s delegated fiduciary could not discharge its duty of prudence also falls short. Aon engaged in a reasoned decision-making process by reviewing comparable funds. It makes no difference here that the review occurred when it established the fund (which was before Aon became Lowe’s delegated fiduciary). Plus, it continued to monitor the fund. So Aon did not violate the duty of prudence. View "Benjamin Reetz v. Aon Hewitt Investment Consulting, Inc." on Justia Law
Berkelhammer v. ADP TotalSource Group Inc.
Berkelhammer and Ruiz participated in the ADP TotalSource Retirement Savings Plan, an investment portfolio managed by NFP. They filed suit under section 502(a)(2) of the Employment Retirement Income Security Act of 1974 (ERISA), 29 U.S.C. 1132, for their own losses and derivatively on behalf of the Plan. The Plan’s contract with NFP contained an agreement to arbitrate disputes between the two entities. Berkelhammer and Ruiz argued that since they did not personally agree to arbitrate, the arbitration provision did not reach their claims. The district court disagreed, holding that Berkelhammer and Ruiz stand in the Plan’s contractual shoes and must accept the terms of the Plan’s contract.The Third Circuit affirmed. Civil actions under section 502(a)(2) “for breach of fiduciary duty [are] brought in a representative capacity on behalf of the plan as a whole” to “protect contractually defined benefits.” Because the plaintiffs’ claims belong to the Plan, the Plan’s consent to arbitrate controls. The presence or absence of the individual claimants’ consent to arbitration is irrelevant. View "Berkelhammer v. ADP TotalSource Group Inc." on Justia Law
Lane v. Structural Iron Workers Local No. 1 Pension Trust Fund
Eligibility for disability payments from the Fund turns on how many credits an ironworker has accumulated (a credit is equal to 1,000 hours of work on union jobs in a given year); those with more than five but fewer than 15 credits are entitled to disability benefits if “totally and permanently disabled as the result of an accident sustained while on the job and employed by a Contributing Employer.” Lane, with nine credits as a union ironworker, applied for disability benefits. Lane was approved for Social Security Disability Insurance. The Fund’s Administrator requested information to connect Lane’s disability to an on-the-job injury. Lane explained that he suffered on-the-job injuries to his shoulder and knee and sent medical records, none of which connected his disability to the cited May 2014 accident. Lane admitted that his SSA award was determined by a combination of factors, not just the 2014 accident. A letter from Lane’s physician referred to several work-related injuries without identifying the work-related events or whether those injuries were the sole basis for the SSA’s disability award.After review by the Medical Review Institute of America concluded that the records did not establish that the SSA disability related to the 2014 accident, the Fund’s Trustees affirmed the denial of Lane’s Claim. The Seventh Circuit affirmed summary judgment in favor of the Fund under the Employee Retirement Income Security Act, 29 U.S.C. 1002, characterizing the denial as “not downright unreasonable.” View "Lane v. Structural Iron Workers Local No. 1 Pension Trust Fund" on Justia Law
Henry v. Wilmington Trust NA
Henry participated in an employee stock ownership plan (ESOP) sponsored by his employer. After the ESOP purchased stock at what Henry believed was an inflated price, Henry filed a lawsuit against the plan’s trustee and executives of his employer, alleging that the defendants breached fiduciary duties to the ESOP imposed by the Employment Retirement Income Security Act (ERISA), 29 U.S.C. 1001, and engaged in transactions prohibited by ERISA. The defendants argued that an arbitration provision, added to the ESOP’s plan documents after Henry joined the ESOP, barred Henry from pursuing his claims in federal court. The district court denied their motion to dismiss, reasoning that all parties to an arbitration agreement must manifest assent to the agreement, and Henry did not manifest his assent to the addition of an arbitration provision to the ESOP plan document.The Third Circuit affirmed, first confirming its jurisdiction. The motion to dismiss was effectively a motion to compel arbitration, 9 U.S.C. 16(a) provides appellate jurisdiction to review the denial of that motion. The class action waiver (and, by extension, the arbitration provision as a whole) is not enforceable because it requires him to waive statutory rights and remedies guaranteed by ERISA. View "Henry v. Wilmington Trust NA" on Justia Law