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Mealey's ERISA

September 19, 2025
LTD Claimant Urges 1st Circuit To Reverse Ruling That Hinges On ‘Working’

BOSTON — Arguing in part that a long-term disability (LTD) plan’s use of “working” is ambiguous and therefore must be construed in his favor, an independent financial adviser filed an appellant brief urging the First Circuit U.S. Court of Appeals to reverse summary judgment against him, to order that his benefits be reinstated and to award him interest and attorney fees and costs.
September 19, 2025
11th Circuit Affirms Ruling For Insurer That Wouldn’t Cover Nose Surgery

ATLANTA — Saying in part that reviewers highlighted the lack of “clinical documentation that the procedures performed were medically necessary,” the 11th Circuit U.S. Court of Appeals issued an unpublished per curiam opinion upholding summary judgment for a health insurer that wouldn’t cover nose surgery in a dispute that involves preauthorization.
September 18, 2025
Settlement Of Over $20.5M Wins Final OK In Medical Benefits For Retirees Case

SAN FRANCISCO — Noting that the claims relied “on evidence of oral misrepresentations and a lack of written plan amendment purporting to terminate the at-issue retiree medical benefits,” a California federal magistrate judge granted final approval to a $20,545,000 settlement under which the average gross recovery for members of the opt-out settlement class is estimated at $30,710.01.
September 18, 2025
3rd Circuit Rules Against Yellow Corp. In Regulatory Row Over Withdrawal Liability

PHILADELPHIA — Resolving a direct appeal that involved “the novel issue” of whether two Pension Benefit Guaranty Corp. (PBGC) regulations are valid, the Third Circuit U.S. Court of Appeals affirmed a Delaware federal bankruptcy judge’s ruling upholding the regulations in a multibillion-dollar withdrawal liability dispute regarding federal special financial assistance (SFA) that was awarded to multiemployer pension plans.
September 17, 2025
9th Circuit Won’t Let Bankrupt Company Assign Withdrawal Liability Deal

SAN FRANCISCO — Issuing a per curiam opinion in a dispute over a contract that greatly reduced withdrawal liability to a multiemployer pension fund, the Ninth Circuit U.S. Court of Appeals affirmed the challenged ruling on a different ground than the lower court had, holding “that the contract is a financial accommodation, without reaching whether it is executory”; the appellant, which signed the contract before filing for Chapter 11 bankruptcy, unsuccessfully sought a ruling that would let it assign the agreement to its acquirer.
September 17, 2025
Panel Rehearing Bid Fails In LTD Benefits Dispute Involving Jury Verdict

ATLANTA — In a per curiam order issued without explanation in a dispute where a federal jury sided with a long-term disability (LTD) insurer, the 11th Circuit U.S. Court of Appeals denied a petition for panel rehearing, letting stand its ruling vacating a judgment of nearly $450,000 for the insurer on its unjust enrichment claim but upholding dismissal of a breach of contract counterclaim.
September 17, 2025
4th Circuit Will Consider Standing Issue In ERISA Pension Risk Transfer Case

RICHMOND, Va. — The Fourth Circuit U.S. Court of Appeals has agreed to allow an interlocutory appeal of a ruling that retirees had standing to file a putative class lawsuit that is part of a much-watched recent string of Employee Retirement Income Security Act cases challenging pension risk transfers (PRTs) where, among other things, retirees allege that the use of offshore captive reinsurers makes annuity providers riskier.
September 17, 2025
Anticutback, Fiduciary Breach Claims Are Dismissed In Disability Benefits Case

CHICAGO — Saying in part that he rejected an “attempt to shift gears and do an about face,” an Illinois federal judge dismissed two claims in an Employee Retirement Income Security Act challenge to a multiemployer benefit plan amendment under which the end of a Social Security Administration (SSA) disability award results in termination of disability pension benefits.
September 16, 2025
Federal Judge Reduces Fees Insurer Must Pay In LTD Case To Just Over $314,000

MINNEAPOLIS — Saying in part “that counsel claims quite a large number of hours for tasks that likely could and should have taken less time,” a Minnesota federal judge who ordered that a long-term disability (LTD) claimant be paid a total of $741,085.31 in retroactive benefits and prejudgment interest also granted reduced attorney fees of $314,440.29 and reduced costs of $2,698.15.
September 12, 2025
DOL Tackles Deferred Incentive Compensation Issue In Advisory Opinion

WASHINGTON, D.C. — Weighing in on an issue that has recently featured prominently in dozens of arbitrations and several lawsuits, the U.S. Department of Labor (DOL) issued an advisory opinion taking the view that a certain deferred incentive compensation program is “a bonus program” not governed by the Employee Retirement Income Security Act.
September 11, 2025
Judge: Specific Diagnosis Not Required To Prove Disability Under Plan Terms

ANN ARBOR, Mich. — Saying in part that the Employee Retirement Income Security Act “does not require that a plaintiff show a particular etiology to prove they are disabled,” a Michigan federal judge dismissed breach of contract claims but otherwise ruled in favor of a pediatric dermatologist who challenged termination of her long-term disability (LTD) and residual disability benefits.
September 10, 2025
Judge: Integration Brought Owners-Only LTD Policy Under ERISA

SAN JOSE, Calif. — Dismissing bad faith and breach of contract claims that a PricewaterhouseCoopers LLP (PwC) equity owner who unsuccessfully sought long-term disability (LTD) benefits because of symptoms he attributed to long COVID asserted under California law, a California federal judge concluded that when “an employer integrates a pre-existing” policy that is not governed by the Employee Retirement Income Security Act “into a broader ERISA-governed plan, the non-ERISA policy becomes a part of the ERISA plan and is subject to the requirements and preemptive effect of ERISA.”
September 10, 2025
LTD Claimant Urges 11th Circuit To Reverse Summary Judgment In Tax Returns Row

ATLANTA — Urging the 11th Circuit U.S. Court of Appeals to take the position outlined in a report and recommendation that the lower court declined to adopt, a deaf engineer who received long-term disability (LTD) benefits for about a decade before they were terminated due to his refusal to provide personal tax returns argues in part that the insurer isn’t entitled to interpret the term “work” because it is not ambiguous.
September 10, 2025
Insurer Faulted For Terminating LTD Benefits In Case Involving Fatigue, COVID

TRENTON, N.J. — Citing “procedural irregularities and substantive errors” in an insurer’s handling of a long-term disability (LTD) claim for an individual whose diagnoses include myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) and long COVID, a New Jersey federal judge issued an unpublished opinion directing that the claimant receive about seven months of retroactive benefits and that her claim be remanded for a determination as to whether she remained eligible after her administrative appeal was denied.
September 09, 2025
6th Circuit Challenge To Ruling That PBM Is Partly Preempted Draws Amicus Input

CINCINNATI — An appeal of a ruling that parts of a Tennessee law regarding pharmacy benefit managers (PBMs) are “preempted to the extent they purport to govern self-funded [Employee Retirement Income Security Act] plans” has drawn input from numerous advocacy organizations, with two amicus curiae briefs supporting the appellee in urging the Sixth Circuit U.S. Court of Appeals to affirm the decision.
September 09, 2025
Challenge To Tobacco, Vaccination Surcharges Partly Survives Dismissal

CHARLOTTE, N.C. — Continuing a string of at least partial victories for plaintiffs in putative class cases over health plan tobacco surcharges, a North Carolina federal judge ruled that two of three claims against GardaWorld Cash Service Inc. survive dismissal; one of the surviving claims concerns the tobacco surcharge, and the other concerns a surcharge levied against those who didn’t show that they were fully vaccinated against COVID-19 by a certain date.
September 08, 2025
Defendants Get Reduced Attorney Fees In ERISA Liquidation Time Lawsuit

RICHMOND, Va. — A plaintiff dissatisfied that it took 10 days to liquidate his 401(k) plan has been ordered to pay attorney fees totaling $122,951 after a Virginia federal judge concluded in part that “a majority of this prolonged litigation could have been avoided had Plaintiff reviewed and authenticated” call transcripts that were at the heart of the Employee Retirement Income Security Act case.
September 08, 2025
8th Circuit Affirms Ruling Against Short-Term Disability Claimant

ST. LOUIS — The Eighth Circuit U.S. Court of Appeals on Sept. 5 briefly affirmed summary judgment against a short-term disability (STD) claimant in an unpublished per curiam opinion, saying in part that the insurer “did not abuse its discretion by relying on the opinions of its nurse consultants over those of [claimant Monty] Jones’s counselor” and was not “required to provide an independent medical examination (IME) of Jones before deciding his claim.”
September 05, 2025
Class Settlement Wins Final Approval In ERISA Case Over Alleged Cost-Shifting

ASHEVILLE, N.C. — A North Carolina federal judge granted final approval to a class settlement that resolves a long-running Employee Retirement Income Security Act suit over an alleged cost-shifting scheme concerning health plan administrative fees for chiropractic and physical therapy treatment; the deal includes gross amounts of $4.8 million for members of individual and plan classes and a separate $3.55 million for attorney fees and costs.
September 05, 2025
En Banc Rehearing Approaches In 5th Circuit No Surprises Act Case

NEW ORLEANS — En banc rehearing is scheduled for Sept. 24 in a dispute over regulations implementing the No Surprises Act (NSA), and three U.S. agencies have concluded the en banc briefing with a reply urging the Fifth Circuit U.S. Court of Appeals to reverse the lower court on the disputed qualifying payment amount (QPA) issues and rein in a “mistaken view” regarding universal vacatur.
September 05, 2025
PBGC Can’t Avoid Immediately Reconsidering Special Financial Assistance Decision

CENTRAL ISLIP, N.Y. — A government agency has been ordered to reconsider its decision that termination of a multiemployer fund rendered the fund ineligible for a special financial assistance (SFA) program under which the fund sought $132 million; the order is the result of a ruling that the agency has argued could cost the United States up to $6.6 billion and has shown interest in taking to the U.S. Supreme Court.
September 04, 2025
Review Standard Is Focus Of 2nd Circuit Briefing In Appeal Of LTD Benefits Denial

NEW YORK — Standard of review is the sole issue in a Second Circuit U.S. Court of Appeals challenge to a ruling upholding denial of long-term disability (LTD) benefits, with the insurer arguing in its answering brief first that it had discretionary authority under the plan and second that there are no grounds to disregard that grant because it complied with claim regulations.
September 04, 2025
Judge: Immunocompromised Doctor Deserves LTD Benefits Due To COVID-19 Risk

WINSTON-SALEM, N.C. — Following a bench trial on the administrative record regarding a clinical anesthesiologist with chronic lymphocytic leukemia (CLL) whose unsuccessful disability claim was based on his risk of exposure to COVID-19, a North Carolina federal judge concluded on de novo review that the anesthesiologist is entitled to retroactive long-term disability (LTD) benefits, prejudgment interest and the costs of the suit.
September 03, 2025
Ruling Challenge Was A New Claim, 7th Circuit Affirms Denial Of LTD Benefits

CHICAGO — Affirming summary judgment against a professional musician whose long-term disability (LTD) claim was denied under policy terms because she was not an active, full-time employee when she said long COVID symptoms made her unable to work, the Seventh Circuit U.S. Court of Appeals on Sept. 2 said the information submitted in her administrative appeal “in effect requested coverage for a different loss, and that meant she was submitting a new claim.”
September 03, 2025
Dismissal Recommended In Putative Class Suit Challenging PRTs With Athene

BOSTON — The tally on dismissal motions in a wave of putative class actions retirees have filed over pension risk transfers (PRTs) would stand at two granted, one denied if the recommendation of a Massachusetts federal magistrate judge were taken; among other things, the retirees allege that the use of offshore captive reinsurers makes annuity providers riskier.