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Mealey's ERISA

  • May 20, 2025

    9th Circuit Mostly Affirms Claimant’s Victory In ERISA Coverage Lawsuit

    PASADENA, Calif. — In an unpublished memorandum disposition mostly affirming judgment against a multiemployer health plan in a coverage denial case, the Ninth Circuit U.S. Court of Appeals said in part that the appellee had been given “inadequate notice” that didn’t sufficiently explain that meeting the plan’s “definition of ‘medical necessity’ required attempting lower levels of care . . . before residential treatment.”

  • May 20, 2025

    Fighting Fees, NFL Plan Urges 5th Circuit To Say Disability Claimant Had No Success

    NEW ORLEANS — In its appellant brief urging the Fifth Circuit U.S. Court of Appeals to reverse an award of more than $1.25 million in attorney fees and costs, the Bert Bell/Pete Rozelle NFL Player Retirement Plan called the award “an unprecedented expansion of the availability of attorney’s fees to ERISA litigants who do not succeed on any legal claim and obtain no judicial relief.”

  • May 20, 2025

    ERISA Discovery In Benefit Denial Cases Is Focus Of Bid For High Court’s Review

    WASHINGTON, D.C. — Discovery in an Employee Retirement Income Security Act case is the focus of a petition for the U.S. Supreme Court to review a ruling for a multiemployer health plan, with the petitioner arguing that the “decision exacerbates both the ongoing split between Circuits as to determining what a plan administrator must do in order to satisfy its fiduciary obligation to perform a full and fair review, as well as the inconsistent factors that courts employ in order to determine whether discovery should be permitted,” and the plan contending that decision shows only “the routine exercise of judicial discretion in applying the same rule to differing facts.”

  • May 19, 2025

    Judgment Proposal, Fee Request Are Disputed In ERISA Spinoff Benefits Case

    PHILADELPHIA — Following a bench trial and numerous posttrial rulings in an Employee Retirement Income Security Act class action over corporate restructuring that affected retirement benefits, the parties are briefing disputes over the plaintiffs’ proposed final judgment, with their disagreements generally centering on whether certain groups of employees are included in the certified class.

  • May 19, 2025

    Chapter 13 Debtor Urges U.S. High Court To Stay Out Of Retirement Contributions Row

    WASHINGTON, D.C. — Contending that the petitioner’s “split argument is just a Trojan horse to smuggle in a merits argument in favor of a rule endorsed by precisely zero circuits,” a debtor on May 16 urged the U.S. Supreme Court to deny review of a ruling where a split Ninth Circuit U.S. Court of Appeals panel concluded “that voluntary retirement contributions do not constitute disposable income” in Chapter 13 bankruptcies.

  • May 19, 2025

    ‘First And Only’ Forfeiture Row To Reach Stage Could Settle For Nearly $2M

    SAN JOSE, Calif. — Calling the Employee Retirement Income Security Act lawsuit “the first and only case to reach settlement on this novel theory of recovery,” a plaintiff whose key claims regarding the use of forfeited nonvested retirement plan contributions to offset the plan sponsor’s future matching contributions survived dismissal asked a California federal court on May 16 for preliminary approval of a $1,995,000 class settlement.

  • May 16, 2025

    6th Circuit Finds No Abuse Of Discretion In Long COVID LTD Benefits Denial

    CINCINNATI — Ruling against a claimant who said in her opening brief that “this appears to be the first ‘Long COVID’ disability case to come before the Court,” the Sixth Circuit U.S. Court of Appeals on May 15 affirmed a judgment upholding denial of her claim for long-term disability (LTD) benefits, concluding that the insurer’s “decision was neither procedurally nor substantively unreasonable.”

  • May 16, 2025

    Class Would Get Up To $6.75M In Proton Beam Row Under Proposed Settlement

    BOSTON — A consolidated Employee Retirement Income Security Act suit over refusal to reimburse proton beam radiation therapy (PBRT) costs would be resolved under a settlement proposal granted preliminary approval in a Massachusetts federal court, with the settlement class getting up to $6.75 million and class counsel separately getting up to $2.5 million for attorney fees and costs.

  • May 16, 2025

    Debtors Seek Judgment In Bankruptcy Dispute Over Deferred Compensation Plans

    HOUSTON —  In the aftermath of a decision that two deferred compensation plans associated with Steward Health Care System LLC are “top hat” ones and therefore roughly $60 million in “rabbi trusts” used for them could be liquidated as part of Chapter 11 bankruptcies, the debtors urged a Texas federal bankruptcy court to rule that a putative class adversary complaint in which plan participants invoke the Employee Retirement Income Security Act “is foreclosed by the doctrines of law of the case and issue preclusion.”

  • May 15, 2025

    Parity Act Challenge Is Stayed So Agencies Can Reconsider Final Rules

    WASHINGTON, D.C. — A case challenging Mental Health Parity and Addiction Equity Act (MHPAEA or Parity Act) final rules issued in 2024 has been stayed at the request of three U.S. agencies that said they plan reconsideration, with a District of Columbia federal judge ordering quarterly progress reports starting in August.

  • May 14, 2025

    After Argument, 6th Circuit Asks What ‘Actuarial Equivalent’ Meant In 1974

    CINCINNATI — Following separate argument in two cases that involve use of decades-old mortality tables and whether part of the Employee Retirement Income Security Act requires “reasonable assumptions” in calculating certain pension benefits, a Sixth Circuit U.S. Court of Appeals panel on May 13 ordered supplemental briefing “on the meaning of the term ‘actuarial equivalent’ at the time of” ERISA’s 1974 enactment.

  • May 14, 2025

    Former Physician’s Assistant Whose LTD Benefits Were Nixed Sues For Reinstatement

    LYNCHBURG, Va. — Suing the claims administrator that terminated his long-term disability (LTD) benefits, a former emergency room physician’s assistant who says he “underwent a PET/CT scan that indicated Alzheimer’s dementia” argues in part that discovery from other lawsuits has shown that the insurer’s reviewer “denies 85-90% of all disability claims she reviews.”

  • May 14, 2025

    Insurer Gets LTD Benefits Case Transferred To Different California Federal Court

    SAN FRANCISCO — An Employee Retirement Income Security Act suit in which a claimant who says she has “disabling symptoms” of long COVID is challenging denial of her claim for long-term disability (LTD) and life insurance waiver of premium (LWOP) benefits will be transferred to a different federal court in California after a judge considered “deference owed to Plaintiff’s choice of forum, convenience, and the local interest in the case.”

  • May 14, 2025

    $8.25M Class Settlement Wins Initial OK In ERISA Recordkeeping Fees Row

    BOSTON — An Employee Retirement Income Security Act suit over allegedly excessive recordkeeping fees would be resolved under a proposed $8.25 million class settlement that a Massachusetts federal judge granted preliminary approval; the plaintiffs say the deal would represent 20% to 30% of their estimated “maximum potential damages.”

  • May 13, 2025

    Judge Upholds LTD Claim Denial Under Policy’s ‘Most Appropriate’ Requirement

    TACOMA, Wash. — Ruling in part that a pharmacist who has been diagnosed with functional neurological disorder (FND) and is being treated by naturopaths “has not met her burden of proving that she is under the continuing care of a medical doctor or a medical practitioner with the same authority as a medical doctor, in the most appropriate specialty for her condition,” a Washington federal judge affirmed denial of her claim for long-term disability (LTD) benefits.

  • May 13, 2025

    After LTD Case Remand To Plan, Parties Dispute Attorney Fee Request

    SAN FRANCISCO — Parties in a long-term disability (LTD) benefits case are disputing a $139,650 attorney fee request, with the claimant contending that “a remand for further administrative proceedings is not a trivial success where it is based on a court determination that ERISA rights were violated,” and the defendant arguing in part that no award is warranted under Hummel v. S.E. Rykoff & Co.

  • May 12, 2025

    Agencies Ask To Pause Parity Act Rules Challenge, Say They Plan Reconsideration

    WASHINGTON, D.C. — In a May 9 motion for abeyance of a suit filed by the ERISA Industry Committee (ERIC), three U.S. agencies told a District of Columbia federal court they plan to reconsider the 2024 Mental Health Parity and Addiction Equity Act (MHPAEA or Parity Act) final rules at issue.

  • May 09, 2025

    6th Circuit: Saving Clause Keeps ERISA From Preempting N.H. Regulatory Proceeding

    CINCINNATI — Affirming a ruling against BlueCross BlueShield of Tennessee Inc. (BlueCross or BCBST) in a dispute involving coverage for fertility treatments, the Sixth Circuit U.S. Court of Appeals on May 8 agreed with application of the Employee Retirement Income Security Act “saving clause” and a Tennessee federal court’s conclusion that the focus of a New Hampshire regulatory proceeding was BCBST’s role as an insurer, not its role as an ERISA fiduciary.

  • May 09, 2025

    On De Novo Review, Judge Rules That LTD Claimant Is Physically Disabled

    LOS ANGELES — Taking issue with numerous aspects of an insurer’s decision to terminate long-term disability (LTD) benefits, a California federal judge concluded that “[a] preponderance of the evidence shows [that the claimant’s] medical symptoms related to spondylolisthesis, lumbar region status post lumbar fusion, and chronic pain render him disabled under the terms of the Plan.”

  • May 09, 2025

    Magistrate Would Dismiss STD Benefits Case As Moot But Let Claimant Seek Fees

    CINCINNATI — Defendants that voluntarily reversed the challenged termination of short-term disability (STD) benefits and paid up after being sued could still be liable for attorney fees under the recommendation an Ohio federal magistrate judge issued in the Employee Retirement Income Security Act case.

  • May 07, 2025

    Citing Smith, 6th Circuit Affirms Dismissal Of ERISA Row Over Record-Keeping Fees

    CINCINNATI — Citing Smith v. CommonSpirit Health and saying that “many of our sister circuits have found implausible similar complaints,” the Sixth Circuit U.S. Court of Appeals on May 6 upheld dismissal of an Employee Retirement Income Security Act putative class action over 401(k) record-keeping and administrative (RKA) fees.

  • May 07, 2025

    5th Circuit Won’t Dismiss Attorney Fee Appeal In ERISA Disability Benefits Dispute

    NEW ORLEANS — Without explanation, a Fifth Circuit U.S. Court of Appeals panel denied a former National Football League player’s motion to dismiss the Bert Bell/Pete Rozelle NFL Player Retirement Plan’s appeal of an award of more than $1.25 million in attorney fees and costs.

  • May 06, 2025

    ERISA, Breach Of Contract Claims Fail In Row Over ‘Pre-Separation Programs’

    CHICAGO — Dismissing a putative class action over United Airlines Inc. early retirement programs with leave to amend but expressing skepticism “that the plaintiffs can cure the problems with the complaint,” an Illinois federal judge ruled in part that a policy the airline announced in 2017 “does not constitute an . . . employee welfare benefit plan” that is governed by the Employee Retirement Income Security Act.

  • May 06, 2025

    5th Circuit Upholds Ruling Against Decedent’s Children In ERISA Beneficiary Row

    NEW ORLEANS — In an unpublished per curiam opinion affirming dismissal of a lawsuit that a decedent’s children by his first wife filed over a distribution made to his second wife, the Fifth Circuit U.S. Court of Appeals agreed with the lower court that the children didn’t plausibly plead that the 401(k) plan sponsor and trustee were functional fiduciaries under the Employee Retirement Income Security Act and didn’t sufficiently plead that the plan administrator “conveyed a material misrepresentation or failed to provide adequate plan information.”

  • May 05, 2025

    Class Largely Prevails On Summary Judgment In ERISA Early Retirement Row

    KANSAS CITY, Kan. — An Employee Retirement Income Security Act class action is headed toward a bench trial on just a few remaining claims after a Kansas federal judge resolved exclusion and partial summary judgment motions, ruling in part that the plan at issue “does not permit Defendants to deny early retirement benefits regardless of the type of work the participants perform for Covered Employers.”