Mealey's ERISA : Mealey's : Legal News & Analysis

Mealey's ERISA

August 09, 2024
LTD Insurer Must Pay Retroactive, Future Benefits, Minnesota Federal Judge Says

MINNEAPOLIS — A disability plan participant is entitled to retroactive long-term disability (LTD) benefits and future LTD benefits because the plan participant met her burden of proving by a preponderance of the evidence that cognitive difficulties rendered her disabled from performing the duties of her own occupation as an attorney, a Minneapolis federal judge said in granting the plan participant’s motion for judgment on the administrative record.
August 08, 2024
7th Circuit Affirms Parity Act Ruling For Insurer In Autism Treatment Coverage Row

CHICAGO — Affirming summary judgment for an insurer in a Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA or Parity Act) suit over autism spectrum disorder (ASD) treatments, a Seventh Circuit U.S. Court of Appeals panel said a key shortcoming of the appellants’ argument was that their comparison focused only on pediatric chiropractic care while the statutory provision says “substantially all medical and surgical benefits.”
August 08, 2024
LTD Insurer’s Denial Of Benefits Was Not Abuse Of Discretion, Judge Says

PHILADELPHIA — A long-term disability (LTD) insurer did not abuse its discretion in denying a claim for LTD benefits because the claimant did not suffer any lost income based on the employer’s decision to continue paying the employee after he stopped working, a Pennsylvania federal judge said Aug. 7 in granting the insurer’s motion for summary judgment.
August 08, 2024
Stay Of DOL’s New Investment Advice Fiduciary Rule Expanded To Rest Of Changes

FORT WORTH, Texas — Agreeing with the reasoning of a peer who entered a nationwide stay of the effective date of a new U.S. Department of Labor (DOL) rule that redefines and broadens who is an investment advice fiduciary under the Employee Retirement Income Security Act, a Texas federal judge expanded the stay to related prohibited transaction exemption (PTE) amendments that weren’t at issue in the other suit.
August 08, 2024
9th Circuit Reverses Dismissal Of ERISA Case Over Structured Alpha Funds

SAN FRANCISCO — Reversing dismissal of a putative class action against the fiduciaries of union carpenters’ retirement plans, a Ninth Circuit U.S. Court of Appeals panel said in an unpublished memorandum disposition that the carpenters “have sufficiently alleged a relative loss based on” investments “in two volatility hedge funds managed by Allianz Global Investors U.S. LLC.”
August 07, 2024
District Court Erred In Finding Disability Plan Abused Its Discretion, Panel Says

PHILADELPHIA — A district court erred in finding that a disability plan abused its discretion when it terminated a claimant’s long-term disability (LTD) benefits for failure to provide proof of a continued disability because the plan properly considered all of the medical evidence and properly interpreted the plan’s “own occupation” language, the Third Circuit U.S. Court of Appeals said Aug. 6 in vacating and remanding the district court’s opinion.
August 06, 2024
Disability Claimant Says Award Of Benefits, Not Remand, Is Appropriate Remedy

BALTIMORE — Reconsideration of a Maryland federal judge’s decision to remand a long-term disability (LTD) benefits claim is warranted because an award of benefits, rather than remand of the claim, is the appropriate form of relief, a disability claimant says in a reply brief in support of her motion for partial reconsideration of the judge’s ruling.
August 06, 2024
Former NFL Player’s Motion To Reinstate Appeal Over Disability Benefits Granted

ATLANTA — The 11th Circuit U.S. Court of Appeals on Aug. 5 granted a former National Football League player’s motion to reinstate his appeal in a dispute over additional disability benefits owed under the NFL’s disability plan.
August 06, 2024
Disability Insurer’s Denial Of LTD Claim Was Not De Novo Wrong, Judge Says

FORT MYERS, Fla. — A disability insurer’s denial of a long-term disability (LTD) claim was not de novo wrong because its decision is supported by the evidence in the administrative record and the claimant failed to provide any evidence to rebut the insurer’s basis for denial, a Florida federal judge said in granting the insurer’s motion for summary judgment.
August 06, 2024
Denial Of STD Claim Reasonable Based On Lack Of Evidence, Federal Judge Says

BIRMINGHAM, Ala. — The denial of a short-term disability (STD) benefits claim following a treating physician’s failure to respond to the STD claims administrator’s repeated requests regarding the claimant’s medical condition and the claimant’s ability to return to work was reasonable and not wrong, an Alabama federal judge said in granting the disability plan defendants’ motion for summary judgment and in denying the claimant’s motion for summary judgment.
August 05, 2024
Upholding ERISA Fees And Funds Ruling, 11th Circuit Declines To Shift Burden

ATLANTA — Declining to revive a class action over retirement plan fees and funds and rejecting a request to join circuits that have adopted a burden-shifting framework, an 11th Circuit U.S. Court of Appeals panel ruled on Aug. 2 that a 1992 decision is circuit precedent and “the burden of proving loss causation lies with the plaintiff” in such Employee Retirement Income Security Act cases.
August 05, 2024
Association Urges U.S. High Court To Let 10th Circuit Ruling On PBM Law Stand

WASHINGTON, D.C. — Arguing in part that the case is “glaringly unsuitable as a vehicle for resolving either of the questions presented,” a trade association urged the U.S. Supreme Court to deny review of a ruling that the Employee Retirement Income Security Act and Medicare Part D partially preempt an Oklahoma pharmaceutical benefit manager (PBM) law.
August 05, 2024
3rd Circuit Appeal Filed Over Summary Judgment, Exclusion Ruling In ERISA Fees Row

PHILADELPHIA — An Employee Retirement Income Security Act class action over allegedly excessive record-keeping fees is being taken to the Third Circuit U.S. Court of Appeals, with the named plaintiff filing a notice of appeal regarding a denial of summary judgment ruling that involved excluding an expert whose testimony has had mixed fates under Daubert v. Merrell Dow Pharmaceuticals challenges in other courts.
August 02, 2024
Wells Fargo, Execs Sued Under ERISA For Prescription Drug Prices, PBM Fees

MINNEAPOLIS — In a putative class action similar to one pending against Johnson and Johnson, former participants in a Wells Fargo & Co. health plan filed a suit in Minnesota federal court under the Employee Retirement Income Security Act over alleged mismanagement of prescription drug benefits, with a focus on the plan’s pharmacy benefits manager (PBM).
August 02, 2024
STD, LTD Claims Remanded To Plan Administrator For Full, Fair Review

LOUISVILLE, Ky. — The denial of claims for short-term disability (STD) and long-term disability (LTD) benefits was arbitrary and capricious because the denials were not the result of a deliberate and principled reasoning process, a Kentucky federal judge said in remanding the claims to the plan administrator for a full and fair review.
August 01, 2024
District Court Properly Found Disability Claimant Is Totally Disabled, 8th Circuit Says

ST. LOUIS — A district court did not err in granting judgment in favor of a disability claimant because the claimant met her burden of showing that she is disabled from performing the duties of any occupation, the Eighth Circuit U.S. Court of Appeals said in affirming the lower court’s ruling.
July 29, 2024
Disability Claimant’s Suit Fails; Policy Rider Clearly Stated Terms, Judge Says

LOS ANGELES — A California federal judge granted a disability insurer’s motion for summary judgment and dismissed a breach of contract and bad faith suit filed against a disability income insurer after determining that the insurer’s termination of cost-of-living benefits was proper pursuant to the terms of the policy rider and its termination provision.
July 29, 2024
Mich. Panel: 401(k), Insurance Can Satisfy Estate Claim In Wrongful Death Shooting

DETROIT — In cases consolidated on appeal, a Michigan appellate court affirmed the portion of a probate court’s order allowing recovery of life insurance proceeds but reversed the portion of the probate court’s order not allowing recovery of the proceeds of a 401(k) account in a wrongful death judgment owed to a mother’s estate against the estate of her daughter implicated in a murder/suicide, finding that both the 401(k) and life insurance proceeds were available to satisfy the judgment.
July 29, 2024
Ex-NFL Player Seeks High Court Review, Says Wrong Standard Of Review Applied

WASHINGTON, D.C. — A former National Football League player filed a petition for writ of certiorari in the U.S. Supreme Court, contending that the high court should review the Fifth Circuit U.S. Court of Appeals’ ruling that he failed to prove that he is entitled to additional disability benefits under the NFL’s benefits plan because a de novo standard of review should have been applied based on the plan’s procedural violations.
July 29, 2024
NFL Disability Plan Says Former Player’s Appeal Should Not Be Reinstated

ATLANTA — The 11th Circuit U.S. Court of Appeals should summarily deny a former National Football League player’s motion to reinstate his appeal in a dispute over additional disability benefits owed under the NFL’s disability plan because the motion is untimely and because the former player failed to show any good cause to excuse the untimeliness of the appeal, the NFL plan maintains in response to the former player’s motion.
July 26, 2024
Parties Stipulate To Dismissal Of Long COVID Disability Benefits Suit After Settlement

MIAMI — Following a second order issued by a Florida federal judge, the parties in a long-term disability (LTD) benefits suit stemming from a claimant’s diagnosis with long COVID filed a joint stipulation of dismissal on July 25 after settling the LTD claim.
July 26, 2024
Judge Stays Effective Date Of DOL’s New Investment Advice Fiduciary Rule

TYLER, Texas — A Texas federal judge has ordered a nationwide stay of the effective date of a new U.S. Department of Labor (DOL) rule that redefines and broadens who is an investment advice fiduciary under the Employee Retirement Income Security Act, concluding in his July 25 ruling that the rule conflicts with ERISA by, among other things, “treating as fiduciaries those who engage in one-time recommendations to roll over assets from an ERISA plan to an IRA.”
July 25, 2024
With ERISA Issue Pending, 3rd Circuit Lets Denial Stand In N.J. Temp Worker Row

PHILADELPHIA — A Third Circuit U.S. Court of Appeals panel upheld denial of a preliminary injunction request that sought to halt New Jersey’s Temporary Workers’ Bill of Rights (TWBR), saying in a July 24 ruling that that staffing industry groups “failed to show they were likely to succeed” on the merits of their initial claims.
July 25, 2024
Citing Mator, 3rd Circuit Revives ERISA Suit Over Record-Keeping Fees

PHILADELPHIA — Noting a recent decision that “reversed the opinion on which the trial court relied and clarified the pleading standards for excessive fee claims under” the Employee Retirement Income Security Act, a Third Circuit U.S. Court of Appeals panel issued a nonprecedential July 24 opinion reviving a putative class action over record-keeping fees.
July 24, 2024
New Injunction Bid Based On ERISA Preemption Disputed In N.J. Temp Worker Row

CAMDEN, N.J. — Seeking a preliminary injunction to halt part of New Jersey’s Temporary Workers’ Bill of Rights (TWBR) under the Employee Retirement Income Security Act, staffing industry groups tell a New Jersey federal court that the case law regulators cite is distinguishable.