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Mealey's ERISA

September 25, 2025
Former CEO Wins Retroactive LTD Benefits In Case Involving Occupational Duties

CHATTANOOGA, Tenn. — Finding in part that the former leader of a software company sufficiently showed “that the important duties of the average CEO include working sixty hours a week or more with frequent travel,” a Tennessee federal judge on Sept. 24 ordered that his long-term disability (LTD) benefits be reinstated retroactively through March 2021.
September 25, 2025
ERISA Complaints Target Health Plans For Offering Allegedly ‘Dominated’ Option

Two sets of plaintiffs represented by the same counsel have filed similar putative Employee Retirement Income Security Act class complaints against sponsors and administrators of self-funded health plans set up on a preferred provider organization (PPO) basis, alleging in part that they “have breached their fiduciary duty of prudence by assembling a menu of PPO options where there is no financial benefit to selecting” one option.
September 25, 2025
LTD Insurer Wins On Setoff, But Claimant Gets Attorney Fees Of Over $460K

NEW YORK — After a second bench trial on the stipulated record in a case challenging termination of long-term disability (LTD) benefits, a New York federal judge resolved calculation issues largely in favor of the insurer and resolved an attorney fee dispute in favor of the claimant.
September 24, 2025
In Advisory Opinion, DOL Weighs In On Lifetime Income Strategy Program

WASHINGTON, D.C. — In a Sept. 23 advisory opinion, the U.S. Department of Labor (DOL) addressed a question regarding whether a lifetime income strategy (LIS) program can meet certain qualified default investment alternative (QDIA) requirements.
September 24, 2025
Judge Talks Attorney Fees Justification In Granting Final OK To $7.9M ERISA Deal

NEW HAVEN, Conn. — Devoting several pages to explaining why he overruled the lone objection to awarding a third of the $7.9 million class settlement for attorney fees, a Connecticut federal judge granted final approval to the deal resolving an Employee Retirement Income Security Act case concerning alleged underperformance that the plaintiff claimed was caused by a now-bankrupt hedge fund management company directing all the assets of its 401(k) plan into proprietary hedge and mutual funds that used “alternative” investment strategies.
September 23, 2025
Claimant With Back Pain Is Due LTD Benefits Under ‘Regular Occupation’ Standard

EUGENE, Ore. — Saying in part that reviewers “discredited Plaintiff’s subjective symptom testimony of chronic pain in contradiction to objective medical evidence in the record without providing a reasonable explanation,” an Oregon federal judge ruled that a desk worker was entitled to benefits during the plan’s “regular occupation” period but that the question of whether she was disabled under the subsequent “any occupation” period “is not properly before the court.”
September 23, 2025
Magistrate Judge OKs Attorney Fees In Case Where She Ordered LTD Claim Remanded

SAN FRANCISCO — Saying in part that the balance of the considerations outlined in Hummell v. S.E. Rykoff & Co. supports the request, a California federal magistrate judge granted the requested $139,770 in attorney fees and costs in a long-term disability (LTD) case where she previously concluded “that the plan did not follow the administrative rules or apply the correct plan definition” and remanded “without ordering reinstatement of the policy or an award of retroactive payments.”
September 22, 2025
Suit Over Out-Of-Network Mental Health Providers Partly Survives Dismissal

MINNEAPOLIS — Ruling that some claims asserted under the No Surprises Act (NSA) and Employee Retirement Income Security Act survive dismissal in a putative class action concerning out-of-network mental health providers, a Minnesota federal judge concluded in a Sept. 19 order that the named plaintiff sufficiently alleged that the health plan sponsor and claims administrator “breached a fiduciary duty when they failed to inform [her] of material information, including” non-network provider reimbursement rate (NNPRA) “pricing methods and methodology used to calculate reimbursement rates.”
September 22, 2025
Split 3rd Circuit Reverses Ruling Against Employer In Overtime Contribution Case

PHILADELPHIA — Saying in part that “the phrase ‘hours paid’ does not require increased contributions to multiemployer plans for overtime hours,” a split Third Circuit U.S. Court of Appeals panel issued a nonprecedential opinion on Sept. 19 reversing judgment against an employer; the majority did not reach “questions relating to determining pre- and post-judgment interest under” the Employee Retirement Income Security Act, but the dissenter opined that, among other things, imposing 18% postjudgment interest on delinquent contributions was an abuse of discretion.
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.