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Mealey's ERISA

June 25, 2024
Judge: No Private Right Of Action In CARES Act For COVID Test Reimbursement

BROOKLYN, N.Y. — A New York federal judge on June 24 granted a consolidated motion to dismiss filed by a group of health insurers in lawsuits brought by a COVID-19 testing lab seeking reimbursement for testing it claims the insurers should have paid for on behalf of its insureds during the pandemic.
June 25, 2024
DOL Reports To Congress On Its Review Of Pension Risk Transfer Guidance

WASHINGTON, D.C. — In a June 24 report to Congress noting the increasing use of pension risk transfers (PRTs) and the growth of reinsurance activity in the life insurance industry, the Employee Benefits Security Administration (EBSA) of the U.S. Department of Labor (DOL) said more exploration is needed before deciding whether some factors in guidance it issued nearly three decades ago “need revision or supplementation and whether additional guidance should be developed.”
June 25, 2024
Petitioners Urge U.S. High Court To Review Split 9th Circuit EAJA Fee Denial

WASHINGTON, D.C. — The government has been granted more time to respond to a certiorari petition in which an engineering firm and the individuals who owned it before an employee stock ownership plan (ESOP) deal that the U.S. Department of Labor (DOL) unsuccessfully challenged argue that denial of their Equal Access to Justice Act (EAJA) request for attorney fees and nontaxable costs “deepens confusion among the lower courts and creates a circuit split on a matter of great practical importance.”
June 24, 2024
7th Circuit OKs Appeal On Representative Capacity Question In ERISA Row

CHICAGO — Without explanation, a Seventh Circuit U.S. Court of Appeals panel allowed an interlocutory appeal regarding what the petitioner argues is a question of first impression for the circuit regarding whether a plaintiff whose class certification motion was denied due to conflict within the proposed class can pursue plan-wide relief in a representative capacity under provisions of the Employee Retirement Income Security Act.
June 24, 2024
Attorney Fees In ERISA Class Settlement Are Cut To 30% Of $6.1M Common Fund

BIRMINGHAM, Ala. — Granting final approval of a $6.1 million class settlement over alleged mismanagement of a retirement plan, an Alabama federal judge awarded attorney fees of $1.83 million rather than the requested $2,033,333.13.
June 24, 2024
Class Counsel Get A Third Of $6M Settlement In Case Over Bank’s Former ESOP

CHARLOTTESVILLE, Va. — Granting final approval of a $6 million settlement in an Employee Stock Ownership Plan (ESOP) case that the plaintiff estimated will give dozens of class members awards averaging more than $30,000, a Virginia federal judge approved paying from that total $2 million for attorney fees plus $104,186.34 for litigation costs.
June 24, 2024
States, Other Amici Back Review Bid For Ruling That PBM Law Is Partly Preempted

WASHINGTON, D.C. — Five recently filed amicus curiae briefs urging the U.S. Supreme Court to review the decision that the Employee Retirement Income Security Act and Medicare Part D partially preempt an Oklahoma pharmaceutical benefit manager (PBM) law include one from dozens of states and one from “a broad coalition of pharmacists and pharmacy owners.”
June 21, 2024
Summary Judgment Bid Fails In ERISA Row Focused On Fund Managers’ ESG Efforts

FORT WORTH, Texas — A bench trial is scheduled to start June 24 in a high-profile class action over environmental, social and governance (ESG) considerations and the purported proxy voting activism of investment management firms, with a Texas federal judge denying the defendants’ summary judgment motion on June 20.
June 21, 2024
Claimant Failed To Meet Burden Of Showing He Is Disabled From Own Occupation

CONCORD, N.H. — A disability claimant is not entitled to long-term disability (LTD) benefits because he failed to meet his burden of proving by a preponderance of the evidence that he is disabled as a result of narcolepsy from performing the duties of his own occupation, a New Hampshire federal judge said in denying the claimant’s motion for judgment on the administrative record and in granting the disability insurer’s motion for judgment on the administrative record.
June 21, 2024
Disability Suit Dismissed For Failure To Timely File Suit, Exhaust All Benefits

NASHVILLE, Tenn. — A disability claimant’s suit against a disability insurer and employer must be dismissed because the claim based on a denial of short-term disability (STD) benefits is barred by the disability plan’s one-year limitations period for filing suit and the claim based on a denial of long-term disability (LTD) benefits cannot proceed based on the claimant’s failure to exhaust all available STD benefits under the plan, a Tennessee federal judge said.
June 21, 2024
Termination Of Benefits Under Any-Occupation Standard Was Reasonable, Judge Says

COLUMBIA, Tenn. — A Tennessee federal judge adopted a magistrate judge’s report and recommendation to grant a disability insurer’s motion for judgment on the administrative record, agreeing with the magistrate judge’s finding that the disability insurer’s decision to terminate the claimant’s benefits was reasonable and not arbitrary and capricious.
June 20, 2024
Termination Of LTD Benefits Was Not Abuse Of Discretion, Arizona Federal Judge Says

PRESCOTT, Ariz. — A disability insurer did not abuse its discretion in terminating a long-term disability (LTD) benefits claim because the termination was reasonable based on a lack of medical evidence in support of the claim, an Arizona federal judge said in entering judgment for the insurer.
June 19, 2024
Former NFL Player’s Appeal Dismissed By 11th Circuit For Want Of Prosecution

ATLANTA — The 11th Circuit U.S. Court of Appeals on June 18 dismissed a former National Football League player’s appeal in a dispute over additional disability benefits for want of prosecution because the former NFL player failed to file required disclosures and forms as required by the court.
June 19, 2024
2nd Dismissal Ruling In ERISA Forfeiture Reallocation Cases Disagrees With 1st

SAN JOSE, Calif. — Taking issue with the only other dismissal ruling in recent Employee Retirement Income Security Act cases filed against retirement plan sponsors for allegedly not putting forfeited nonvested matching contributions toward administrative expenses, a California federal judge granted dismissal with leave to amend a complaint that she called “a swing for the fences.”
June 19, 2024
Oklahoma Federal Judge Says Disability Claimant’s Suit Fails To State A Claim

OKLAHOMA CITY — An Oklahoma federal judge granted a disability insurer’s motion to dismiss a disability claimant’s suit after determining that the claimant failed to plausibly plead claims for a denial of benefits or a breach of fiduciary duty.
June 11, 2024
9th Circuit Affirms ERISA Medical Necessity Ruling In Residential Treatment Row

SAN FRANCISCO — Affirming summary judgment for an insured in a $182,410.14 dispute with a health insurer over reimbursement for a minor’s stay at a residential treatment facility, a Ninth Circuit U.S. Court of Appeals panel said in an unpublished memorandum disposition that the lower court didn’t abuse its discretion in considering two sets of guidelines and ruling the stay medically necessary.
June 11, 2024
6th Circuit Affirms NLRB’s Jurisdiction In Audit Row Involving Multiemployer Funds

CINCINNATI — In an unpublished opinion that drew a partial dissent, a Sixth Circuit U.S. Court of Appeals panel affirmed summary judgment against multiemployer trust funds that sought to compel an employer to submit to an audit under the Labor Management Relations Act (LMRA) and the Employee Retirement Income Security Act.
June 07, 2024
LTD Benefits Cannot Be Offset By Social Security Retirement Benefits, Judge Says

ALEXANDRIA, Va. — A disability insurer abused its discretion for a third time by ignoring the language of the disability policy and contending that a claimant’s monthly long-term disability (LTD) benefits amount should be offset by the amount of the claimant’s earned-income Social Security retirement benefits, a Virginia federal judge said after determining that the plan permits an offset only for Social Security benefits paid because of a claimant’s disability.
June 07, 2024
Oral Arguments Scheduled In Dispute Over Proof Of Continued Disability

PHILADELPHIA — The Third Circuit U.S. Court of Appeals scheduled oral arguments for July 9 in a disability plan’s appeal of a district court’s ruling that the plan abused its discretion when it terminated a claimant’s long-term disability (LTD) benefits for failure to provide proof of a continued disability.
June 07, 2024
Judge Denies Dismissal Of Emergency Appendectomy ERISA Claims

LOS ANGELES — A California federal judge has denied dismissal of two core Employee Retirement Income Security Act claims by an insured who says United Healthcare Insurance Co. failed to pay for her emergency appendectomy at a network rate as provided in the summary plan description (SPD).
June 07, 2024
Retirees Follow 9th Circuit ERISA Accuracy Ruling With Reassignment, Fees Requests

SAN FRANCISCO — After the Ninth Circuit U.S. Court of Appeals partly revived a putative class action over pension benefit statements for the second time, the parties are disputing a reassignment request in the Employee Retirement Income Security Act case, and the appellants have moved for $179,925 in attorney fees.
June 07, 2024
Former NFL Player Files Notice Of Appeal After Dismissal Of Suit

ATLANTA — A former National Football League player who claims that he is owed additional disability benefits filed a notice of appeal to the 11th Circuit U.S. Court of Appeals, seeking review of the lower court’s dismissal of his second amended complaint based on a finding that he failed to exhaust all administrative remedies and failed to show that exhaustion would be futile.
June 06, 2024
Reconsideration Of Latest Postjudgment Ruling Disputed In ERISA Conversion Case

NEW HAVEN, Conn. — Continuing their long history of postjudgment wrangling, Cigna Corp. and its pension plan (together, Cigna) and the class that succeeded in some parts in a challenge to the plan’s 1998 conversion are disputing whether a Connecticut federal court should reconsider denying the class’s motions for an accounting or postjudgment discovery and to strike parts of a sur-reply and declaration.
June 06, 2024
2nd Circuit Affirms That ERISA Expressly Preempts Claims In Reimbursement Row

NEW YORK — Rejecting a medical provider’s argument that its causes of action arose from a legal duty based in presurgery phone calls with a claims administrator, a Second Circuit U.S. Court of Appeals panel issued a summary order affirming dismissal of state law claims the panel ruled are “expressly preempted” by the Employee Retirement Income Security Act.
June 06, 2024
Mental Illness Limitation Does Not Apply, Disability Claimant Says In Complaint

PORTLAND, Maine — A disability plan participant filed suit in Maine federal court against a disability insurer, claiming that he is entitled to reinstatement of long-term disability (LTD) benefits because the insurer wrongfully applied the plan’s mental illness limitation when it terminated his LTD benefits.