Showing posts with label ERISA. Show all posts
Showing posts with label ERISA. Show all posts

Tenth Circuit: C., et al. v. United Healthcare Insurance Company

 Despite the issue raised as to whether the plan's administrator complied with the procedures, deferential review of coverage decisions as arbitrary and capricious is appropriate, though the outcome would be the same here absent deference, under de novo review.

Administrator's second medical opinion disregarding independent grounds for coverage was arbitrary and capricious.

C., et al. v. United Healthcare Insurance Company

Second Circuit: Sacerdote v. New York University


Fiduciary's purchase of retail class shares rather than institutional class shares in 63 of 103 funds states an ERISA claim under duty of prudence. The subsequent finding of prudent revenue sharing doesn't make the error harmless.  Deft has burden to establish that the losses didn't flow from the imprudent acts.

Refusal of discretionary leave to amend under Rule 16  was an abuse of discretion, since the scheduling order only listed the date beyond which amendments of right would not be timely.  Denial of leave to amend prejudiced post-trial motions.  

Lack of timely response to motion to strike jury trial demand was sufficient waiver.

Trial court's use of written direct testimony is not per se an abuse of discretion.

No clear error in rejeciton of claim that the Plan should have consolidated its record-keeping, given the testimony on IT difficulties.

No clear error in discrediting expert testimony on fund benchmarking.

Judge was not disqualified from presiding by the implicaitons of the fact that she left the bench six months later to re-join a law firm whose chairman, her mentor, is on the University's Board of Trustees.

DISSENT IN PART:

Since retail class share enable revenue sharing to offset recordkeeping costs, no error in dismissal of claim of breach of duty of prudence in opting for retail rather than institutional class shares; the fiduciary followed a sufficiently deliberative process.  Scheduling order setting date beyond which pleadings can;t be amended without leave is sufficient to indicate that in the normal course, no pleadings may be amended.

https://www.ca2.uscourts.gov/decisions/isysquery/b3c5ec72-ddd7-427e-a6e6-2cf21cacd5eb/1/doc/18-2707_complete_opinion.pdf#xml=https://www.ca2.uscourts.gov/decisions/isysquery/b3c5ec72-ddd7-427e-a6e6-2cf21cacd5eb/1/hilite/

Second Circuit: Div. 1181 Amalgamated Transit Union-New York Emps. Pension Fund v. New York Dept of Education

 

Municipality that contracts with outside corporations isn't liable under ERISA for fund contributions, as contributions aren't required in the contracts or in the Fund's governing documents.  Munciplaity's requirement that contractors hire according to municipality's seniority lists and follow municipality's wage and labor rules constituted neither an ERISA pension agreement or CBA, nor is the munipality a fiduciary or liable due to having participated in prohibited transactions.

https://www.ca2.uscourts.gov/decisions/isysquery/b3c5ec72-ddd7-427e-a6e6-2cf21cacd5eb/3/doc/20-4012_opn.pdf#xml=https://www.ca2.uscourts.gov/decisions/isysquery/b3c5ec72-ddd7-427e-a6e6-2cf21cacd5eb/3/hilite/



Sixth Circuit: Leslie Nolan v. Detroit Edison Co.


Claims were timely filed, as the statute of limitations did not start to run until, taking all favorable inferences,  the claimant had actual knowledge of the claim or with reasonable diligence should have discovered the claim.

Allegation that plan documents did not make the effects of annuity disbursement, changes in interest rates, and possible negative effects of switching plans sufficiently clear to the average plan participant states a claim.

Despite being insufficient notice under the statute, Plan documents were not in bad faith, since they attempted to explain, compare and caution, and were multi-modal in nature, making a sufficient good-faith effort to convey the information.


Leslie Nolan v. Detroit Edison Co.

Fifth Circuit: Atkins, et al v. CB&I

 

Company's plant to pay employees who stay until the end of a project a bonus is akin to a severance scheme, but does not have the administrative complexity characteristic of an ERISA plan, and is therefore outside the reach of the statute, and of the federal courts.


Atkins, et al v. CB&I

Third Circuit: Dansko Holdings Inc v. Benefit Trust Co

 

Employer's contract claim against potential trustee of employee stock benefit plan is remote from the usual ERISA concerns, and therefore not preempted by the statute.

Implied spoken promise subsequent to execution of written contract can be the basis for a promissory estoppel claim.

Integration clause refers only to the time of formation -- when subsequent parties to the contract were substituted in, the integration clause still looked back to the time of initial formation.

A lie about a side issue in the course of a contractual breach is separately actionable as fraud where the lie implicates a broader social duty owed to all individuals.

By conceding valid substitution into the contract for the purposes of the breach claim, the plaintiff is estopped from arguing that the indemnification agreement compelling the payment of legal fees doesn't apply to the defendant.  Plain meaning of indemnify encompasses first party claims.  Under state law, it wouldn't be specific enough to cover any damages award.


Dansko Holdings Inc v. Benefit Trust Co

Sixth Circuit: Merrilee Stewart v. IHT Ins. Agency Group


ERISA claim  would be foreclosed by res judicata given the court proceedings related to the term of employment, even if the arbitration-ordered release of claims were to be vacated.


Merrilee Stewart v. IHT Ins. Agency Group

First Circuit: Wong v. FMR LLC


Court appropriately considered Plan Manager's contracts with employer in granting dismissal for not stating a claim; no discovery was required to establish authenticity.

Intermediary that compiles a list of investment options from which Plan Managers select fixed options (after selecting the intermediary) is not transformed into a Plan fiduciary by the infrastructure fees assessed to the providers of the investment options, the ability ot modify the array of options open to Plan Managers, or the funds provided by the participation by the Plan Beneficiaries.

Wong v. FMR LLC

Fourth Circuit: Jeffrey Quatrone v. Gannett Company, Inc.

  Plan's retention of substantial amounts of spun-off business' stock in a single stock fund states a claim against the Administrator's common law duty of prudence.

While allowing the participants to select funds can satisfy the statutory duty of diversification, it does not address common-law prudence.

Liability is possible where a frozen defined contribution plan does not timely divest the single-stock fund.

Dissent: 

Participants could allocate their investments.  The fact that prudence and diversification are codified separately means that they shouldn't be merged in common-law analysis.

[Again, folks, just my scribbling.  This is never legal advice.]



Jeffrey Quatrone v. Gannett Company, Inc.

Seventh Circuit: Central States Southeast and S v. Shelby Haynes



Where an ERISA third party beneficiary who becomes an adult between the coverage date and the date on which the paid claim arises wins a subsequent tort claim related to the covered injury, they are bound to any equitable repayment of the fiduciary specified in the Plan, as acceptance of the benefit signified assent to the terms of the Plan.

(Interesting Easterbrook cognomen for S. Ct. U.S.: "The Justices.")

Third Circuit: Plastic Surgery Center, P.A. v. Aetna Life Insurance Co


ERISA does not preempt state contract law as to claims by an out of network provider where the agreement with the provider only references the Plan for terms of payment, the reference is discernible in a cursory review, and no further construction of the plan is necessary to resolve the claim.

Court's subsequent construction of the plan to set damages in the legal action does not implicate this enmeshment consideration.

Similarly, express requirement for preapproval of procedures merely means that the out-of-network contract happens against the backdrop of the plan.

Where the contract is between the Plan and an out-of-network provider, it implicates a relationship that the Plan was never intended to govern, and therefore is not in connection with the Plan.

As judicial resolution of the claims addresses freestanding claims between the parties and not Plan benefits, it is not in connection with the plan; this accords with statutory purpose.

Unjust enrichment claims, on the other hand, are in connection with the Plan, as they implicate the Administrator's duties to the participants.


Second Circuit: In re: DeRogatis

Administrator's denial of full survivorship benefits was congruent with plan and statute, but the misstatements by plan employees, when speaking on behalf of the administrator, are subject to a fiduciary duty to the recipients, and the finder of fact may determine that an equitable remedy is in order.

http://www.ca2.uscourts.gov/decisions/isysquery/e79595db-c3ea-48e1-95ea-ab87f17d70cb/1/doc/16-977_16-3549_opn.pdf#xml=http://www.ca2.uscourts.gov/decisions/isysquery/e79595db-c3ea-48e1-95ea-ab87f17d70cb/1/hilite/


Fifth Circuit: David Hager v. Todd G. Rowan

Discharged employee retains ERISA standing to challenge COBRA notification.

Since the employee was no longer eligible for the plan, medical costs otherwise covered by the plan are not an appropriate remedy; as the remedy must be in equity, the medical costs are similarly an inappropriate award; the proper remedy is a penalty based on the seriousness o the violation, and it is entirely possible that the amount of the penalty is equal to the medical costs incurred.

First Circuit: Doe v. Harvard Pilgrim Health Care

The administrative record for the purpose of judicial review properly includes documentary evidence from the post-filing review process, where both parties consent to the addition of the record in the post-filing process.

ERISA appeals at summary judgment are governed by clear error; remand to allow the court to interpret the documents.

http://media.ca1.uscourts.gov/pdf.opinions/17-2078P-01A.pdf

Fifth Circuit: Thomas Martone v. Walter Robb, III, et al

Plaintiff need not sell stock to establish loss causation for standing -- purchase at inflated price and holding at reduced value suffices for particular injury.

Where there was no alternative that would have avoided the fall in stock price, the allegedly harmful timing of the disclosure might have been a legitimate business decision.  ANy hedging strategy would, as a matter of law, have required disclosure.  Additionally, the board could no have been certain that the employee stock plan would be a net purchaser during the period under consideration.


http://www.ca5.uscourts.gov/opinions/pub/17/17-50702-CV0.pdf







Seventh Circuit: Emma Cehovic-Dixneuf v. Lisa Wong

As the company retained administrative functions, the life insurance plan was within the statute, even though all premiums were paid by the employee; equitable reassignment of the beneficiary is therefore unavailable.

Where hearsay challenges are raised for the first time on a motion to reconsider summary judgment, the court may accept the challenged evidence as tending to point to some admissible method of proof, since the rules bar from the motion to reconsider any claims that might have been raised earlier on the merits.

http://media.ca7.uscourts.gov/cgi-bin/rssExec.pl?Submit=Display&Path=Y2018/D07-11/C:17-1532:J:Hamilton:aut:T:fnOp:N:2184892:S:0


Second Circuit: Allen v. Credit Suisse Secs. (USA) LLC

Bank foreign currency clearinghouses did not have sufficient control over Plan funds for a fiduciary duty or functional fiduciary duty to arise during arms length transactions that were allegedly fraudulent in their effects and structure.

No abuse of discretion in denial of leave to amend where the prospect of discovering contractual relationships was speculative.

http://www.ca2.uscourts.gov/decisions/isysquery/05194beb-c7ca-4533-89f8-3cdc4043f522/3/doc/16-3327_opn.pdf#xml=http://www.ca2.uscourts.gov/decisions/isysquery/05194beb-c7ca-4533-89f8-3cdc4043f522/3/hilite/

Sixth Circuit: Randy Pearce v. Chrysler Grp. LLC Pension Plan

Error for District Court to simultaneously bar challenges raised before the magistrate and hold all challenges not raised before the magistrate to be waived.

Employer had a duty to list the firing exception in the summary of plan benefits; this exclusion justifies reformation of the plan, which should be considered by the court sitting in equity as being similar to the fraud element of equitable estoppel.

As Plan provisions enabled the individual to accurately calculate benefits, standalone claim of equitable estoppel is not available.

http://www.opn.ca6.uscourts.gov/opinions.pdf/18a0114p-06.pdf






Fifth Circuit: Esther White v. Cigna Group Insurance

Abuse of discretion for the Plan Administrator not to mention insurer's medical report asserting that the level of drug intoxication was impossible to determine given the tests run, withhold the report from discovery, and deny the claim.

http://www.ca5.uscourts.gov/opinions/pub/17/17-30356-CV0.pdf

Fifth Circuit: Innova Hospital San Antonio LP v. Blue Cross & Blue Shield

ERISA action need not identify the specific language of every plan provision at issue to state a claim, so long as the pleading is not overly conclusory; the suit might be resolved using representative terms.

Under state law, similar analysis applied to the claim for breach of contract.

As a suit for monetary damages is possible, a suit for breach of fiduciary duty is barred by the statute and precedent.

No error in denial of leave to amend second amended complaint, as the request did not discuss the legal standard for untimely leave to amend.

http://www.ca5.uscourts.gov/opinions/pub/14/14-11300-CV0.pdf