Justia ERISA Opinion Summaries

MetLife appealed the district court's judgment in favor of plaintiff on his claim for pension benefits pursuant to the Employee Retirement Income Security Act (ERISA), 29 U.S.C. 1001 et seq. The court concluded that MetLife's denial of plaintiff's benefits claim was not arbitrary and capricious where MetLife's rationale for denying plaintiff's claim - that it was impossible to determine whether, or to the extent to which, a FINRA award represented back pay - was not, in fact, unreasonable. The court did not reach MetLife's alternative argument. Accordingly, the court reversed the district court's judgment granting plaintiff relief under ERISA. The court affirmed the denial of plaintiff's request for attorney's fees. View "Roganti v. Metro. Life Ins. Co." on Justia Law

Defendant, a participant in the API Enterprises Employee Benefits Plan, appealed the district court's grant of summary judgment in favor of Humana, API's Plan Manager. Humana filed suit under the Employee Retirement Income Security Act (ERISA), 29 U.S.C. 1001 et seq., against defendant seeking, inter alia, an injunction prohibiting him from disposing of an insurance payout and an "equitable lien to enforce ERISA and the terms of the Plan." The court concluded that the district court erred in determining that Humana is an ERISA fiduciary for two reasons: first, the district court's interpretation of the Plan Management Agreement (PMA) is not persuasive where the district court focused on the subrogation and recovery clause, which do not show that Humana had discretion over the Plan or its assets; and second, even if the court interpreted the PMA to give Humana broad power, the district court failed to explain why Humana is not a ministerial agent. Therefore, the court reversed and remanded for further proceedings. View "Humana Health Plan v. Nguyen" on Justia Law

Insurance companies allegedly refused to honor claims for payment of blood-clotting-factor products. After they paid the claims in full, the district court dismissed a complaint under the Employees Retirement Income Security Act (ERISA) and state law. Following dismissal, both the plaintiffs and defendants sought attorney’s fees and costs. The Third Circuit affirmed denial, but remanded one issue: whether the plaintiffs were entitled to interest on the delayed payment of benefits. On remand, they sought interest of $1.5 to $1.8 million, primarily under the Maryland Code, with $68,000 based on the federal Treasury bill rate. The companies agreed to pay $68,000.00 in interest and the district court dismissed the case. Plaintiffs then sought attorney’s fees and costs of $349,385.15. The district court denied the motion, finding that plaintiffs had failed to achieve “some degree of success on the merits” as required for an award of fees under ERISA. The Third Circuit reversed, holding that the court used an incorrect legal standard to evaluate eligibility for attorney’s fees and misapplied the “Ursic” factors. The “catalyst theory” of recovery is available to the plaintiffs and judicial action is not required under that theory in order to establish some degree of success. View "Templin v. Independence Blue Cross" on Justia Law

Reilly participated in a pension plan offered by Continental, which administers its own defined-benefit plan. The pension depends on the highest average compensation in any 60-month period of employment. “Compensation” includes regular salary, incentive compensation, and deferred compensation deposited in 401(k) plans. Educational bonuses, referral bonuses, overseas allowances, and some other items are not included. When Reilly left Continental’s employ in 1999, he received a statement of qualifying compensation that implied a monthly benefit of about $5,400 starting in 2012, when he would turn 65. In 2012, Continental sent Reilly a different calculation, showing lower compensation and entitlement to $4,200 a month. After internal appeals, Reilly filed suit under the Employee Retirement Income Security Act, 29 U.S.C. 1132(a)(1)(B). The district judge concluded that Continental’s decision was arbitrary and capricious and ordered it to pay monthly benefits of $5,400. The Seventh Circuit reversed. Reilly did not show that $5,400 is the only possible outcome of proper calculation, only that the calculation was improper. By working through the original compensation numbers, the parties may agree what the right pension is. If not, the district court must remand to Continental so that the administrator can make a fresh calculation, which then could be subjected to judicial review. View "Reilly v. Continental Cas. Co." on Justia Law

After a series of unsuccessful appeals to an ERISA plan administrator after the administrator’s decision to deny him long-term disability benefits, Plaintiff brought this action under 29 U.S.C. 1132(a)(1)(B). The district court affirmed. The Ninth Circuit vacated the district court’s judgment, holding that the district court erred in reviewing the denial of benefits for an abuse of discretion, rather than de novo, when a Summary Plan Description conferred discretionary authority upon the plan administrator but an insurance certificate, a governing plan document, did not. Remanded for the district court to review the plan administrator’s denial of benefits de novo. View "Prichard v. Metro. Life Ins. Co." on Justia Law

Plaintiff brought this complaint under the Employee Retirement Income Security Act (ERISA), alleging (1) the administrator of his former employer’s executive severance plan denied him severance benefits after improperly determining that he had voluntarily retired from his position, and (2) his former employer impermissibly interfered with his protected rights under the plan. The district court granted summary judgment for Defendants on both counts. The First Circuit (1) affirmed the district court’s judgment with regard to the plan administrator’s decision to deny Plaintiff’s claim for benefits, holding the decision was both supported by substantial evidence and procedurally proper; but (2) vacated the district court’s judgment as to the interference claim, holding that the district court relied on the incorrect standard in assessing the interference claim. Remanded for application of the appropriate standard of review. View "Niebauer v. Crane & Co., Inc." on Justia Law

Nine multi-employer pension and welfare fringe benefit trust funds sued G&W Construction and its president, under the Labor Management Relations Act, 29 U.S.C. 185(a), and the Employee Retirement Income Security Act (ERISA), 29 U.S.C. 1145, to recover delinquent fringe-benefit payments under a contract between G&W and the Union. The defendants raised affirmative defenses of laches, estoppel, and waiver, alleging that the Union led G&W to believe that fringe benefit payments were due only for union members and that G&W relied upon the acts and omissions of the Union and the funds by bidding and accepting work on the reasonable understanding that Union wages and benefits did not apply to non-members. The Funds moved to strike the affirmative defenses, arguing that ERISA bars equitable defenses. The district court denied the motion to strike. The Sixth Circuit reversed in part. The district court should have granted the motion to strike the defenses of laches and equitable estoppel; the court declined to consider the district court’s ruling on the waiver defense. View "Operating Eng'rs Local 324 v. G & W Constr. Co." on Justia Law

Appellant was eligible for disability benefits through an employee welfare benefit plan underwritten by Aetna Life Insurance Company. Appellant successfully applied for long-term disability (LTD) benefits under his plan in 2009. Later that year, Appellant’s LTD benefits were terminated. Appellant brought this suit against Aetna under the Employee Retirement Income Security Act of 1974 alleging wrongful termination of benefits. The federal district court granted summary judgment for Aetna on the benefits-termination claim but applied a $5,000 penalty against Aetna for its failure to produce all relevant plan documents within the statutorily prescribed time. The First Circuit (1) vacated summary judgment with respect to the termination of disability benefits and remanded the issue for further consideration by the claims administrator, holding that Aetna’s decision to terminate Appellant’s LTD benefits was not a reasoned determination; and (2) affirmed the district court’s imposition of a $5,000 penalty for the belated production of a plan document, holding that the amount of the penalty imposed was within the district court’s discretion. View "McDonough v. Aetna Life Ins. Co." on Justia Law

This case arose out of a disability benefits dispute between Plaintiff, a retired firefighter for the City of Tracy, California, and the California Association of Professional Firefighters (CAPF), the manager of an employee welfare benefit plan. While a related action was ongoing, Plaintiff initiated a second lawsuit against CAPF, California Administration Insurance Services, Inc. (CAISI), and individual members of the board of directors for both CAPF and CAISI, alleging that Defendants had breached their fiduciary duties under ERISA in the management and administration of the plan. A panel of the Ninth Circuit affirmed in part and reversed in part the district court’s judgment, holding that the district court (1) correctly granted summary judgment for Defendants on a claim that they breached their duty to hold plan assets in trust; (2) erred in granting summary judgment for Defendants on a claim that they breached their fiduciary duties by engaging in unlawful self-dealing; and (3) erred in granting partial summary judgment for Plaintiff where Defendants did not breach their fiduciary duties by failing to distribute a summary annual report. Remanded. View "Barboza v. Cal. Ass’n of Prof’l Firefighters" on Justia Law

Plaintiff was a participant in a disability plan (Plan), which was insured and administered by Defendant under ERISA. The Plan limited long-term disability (LTD) benefits to twenty-four months for a disability caused or contributed to by mental disorders, substance abuse, or other limited conditions. Defendant terminated Plaintiff’s benefits after twenty-four months after applying this limited conditions provision. After his unsuccessful administrative appeal, Plaintiff filed suit against Defendant for unpaid benefits. Specifically, Plaintiff argued that he had been diagnosed with chronic Lyme disease, a physical illness allegedly not limited under the terms of the Plan. The district court granted summary judgment in favor of Defendant. The First Circuit affirmed, holding that even if Plaintiff was disabled as a result of chronic Lyme disease, the mental disorder limitation nonetheless applied because Plaintiff's mental disorders contributed to his disability as of June 1, 2011. View "Dutkewych v. Standard Ins. Co." on Justia Law