Articles Posted in ERISA

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The Ninth Circuit reversed the district court's denial of appellate attorney's fees under the Employee Retirement Income Security Act, 29 U.S.C. 1132(g)(1). The panel held that, pursuant to Sokol v. Bernstein, 812 F.2d 559, 561 (9th Cir. 1987), a court must consider the entire course of the litigation when analyzing a party's request for appellate attorney's fees within the Hummell v. S.E. Rykoff & Co., 634 F.2d 446 (9th Cir. 1980), rubric. Accordingly, the panel remanded to the district court for calculation of a reasonable award of fees and costs. View "Micha v. Sun Life Assurance of Canada" on Justia Law

Posted in: ERISA

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The Ninth Circuit reversed the district court's judgment in favor of MetLife in an action filed by plaintiff to seek life insurance benefits under a benefits plan governed by the Employee Retirement Income Security Act (ERISA), 29 U.S.C. 1001 et seq. The panel held that MetLife waived the evidence of insurability requirement because it did not ask plaintiff for a statement of health, even as it accepted her premiums for $250,000 in coverage. In this case, MetLife's purported ignorance of the facts did not negate its obligation to pay the entire $250,000 because, under agency law, the policyholder-employer's knowledge and conduct may be attributed to MetLife. View "Salyers v. Metropolitan Life Insurance Co." on Justia Law

Posted in: ERISA

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The Ninth Circuit reversed the district court's grant of summary judgment to defendants in an action under the Employee Retirement Income Security Act (ERISA). Plaintiff alleged that defendants failed to adequately disclose that the lifetime benefit maximum applied to the plan at issue. The panel held that ERISA, as amended by the Affordable Care Act, does not ban lifetime benefit maximums for certain retiree-only plans; defendants violated ERISA's statutory and regulatory disclosure requirements by providing a faulty summary of material modifications describing changes to the lifetime benefit maximum in September 2010; and genuine disputes of material fact preclude summary judgment on the breach of fiduciary duty claims. View "King v. Blue Cross and Blue Shield" on Justia Law

Posted in: ERISA

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After Aetna determined that plaintiff was not disabled and terminated her benefits, she filed suit under the Employee Retirement Income Security Act (ERISA), 29 U.S.C. 1001 et seq. The district court applied de novo review and held that Aetna improperly denied plaintiff's claim. The Ninth Circuit vacated the district court's judgment, holding that the district court should have reviewed the denial only for abuse of discretion. The panel held that the plan contained a discretionary clause and thus called for abuse of discretion review; Aetna provided no sound reason to depart from the text of section 22 of the California Insurance Code, which brought within the scope of Cal. Ins. Code 10110.6 Boeing's self-funded STD plan; ERISA preempted application of section 10110.6 to Boeing's self-funded plan; and remand was necessary to permit the district court to properly apply the abuse of discretion standard. View "Williby v. Aetna Life Insurance Co." on Justia Law

Posted in: ERISA

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The Ninth Circuit vacated the district court's grant of summary judgment in favor of plaintiffs in an Employee Retirement Income Security Act (ERISA) action. The panel held that the plan comprised of two documents: the Trust Agreement and the Summary Plan Description (SPD). The Supreme Court's decision in CIGNA Corp. v. Amara, 563 U.S. 421 (2011), was not to the contrary. An SPD may constitute a formal plan document, consistent with Amara, so long as the SPD neither adds to nor contradicts the terms of existing plan documents. In this case, the SPD was a part of the plan itself, and there was no conflict between the SPD and the Trust Agreement. Therefore, Amara did not prohibit this type of arrangement, and the district court erred in concluding that the SPD was not part of the plan. The panel remanded for further proceedings. View "Mull v. Motion Picture Industry Health Plan" on Justia Law

Posted in: ERISA

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Plaintiff filed a putative class action alleging that the Trustees breached the Pension Plan's terms, violated the Employee Retirement Income Security Act's (ERISA) sections 204 and 305, and breached their fiduciary duties by withholding $1.00 per hour from his employer contributions without providing an accrued benefit. The Ninth Circuit held that only amendment 14 was fully litigated; the district court correctly interpreted the interaction between Amendment 15, Article 5 of the Pension Plan, and the Reciprocal Agreement; ERISA section 305(e) does not apply before critical status certification; and because the panel held that the parties did not fully litigate withholdings under Amendment 24, it need not address whether the district court erred by failing to make specific findings about the alternative schedules in the Rehabilitation Plan. Accordingly, the panel affirmed in part, reversed in part, and remanded for further proceedings on the withholdings under Amendment 24. The panel vacated the award of attorneys' fees. View "Lehman v. Nelson" on Justia Law

Posted in: ERISA

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California Insurance Code 10110.6(a) has voided provisions conferring discretionary authority to Employee Retirement Income Security Act (ERISA), 29 U.S.C. 1001 et seq., plan administrators such as Aetna. Plaintiff challenged Aetna's decision to terminate her long-term disability benefits under a plan created by Boeing. The Ninth Circuit reversed and remanded the district court's holding that California's statute did not apply to Boeing's plan and upholding Aetna's denial of benefits to plaintiff. The Ninth Circuit held that section 10110.6(a) was saved from ERISA preemption because the statute is directed toward entities engaged in insurance and substantially affects the risk-pooling arrangement between the insurer and the insured. The Ninth Circuit also held that section 10110.6 applied in this case because Boeing's policy renewed after section 10110.6's effective date. View "Orzechowski v. The Boeing Company Non-Union Long-Term Disability Plan" on Justia Law

Posted in: ERISA

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Plaintiffs are health care providers who furnish medical services to subscribers of employee health benefits plans. Defendants are health insurers, plan administrators, and/or claims administrators for the relevant employee benefit plans. These two cases involved reimbursement disputes: In DB Healthcare, Blue Cross determined that certain blood tests were investigational and thus excluded from coverage; In Advanced Women's Health Center, Anthem determined that the Center used faulty practices to bill for the tests and so was not entitled to reimbursement. At issue was whether a health care provider designated to receive direct payment from a health plan administrator for medical services was authorized to bring suit in federal court under the Employee Retirement Income Security Act of 1974 (ERISA), 29 U.S.C. 1001 et seq. The court held before, and reiterated, that health care providers are not "beneficiaries" within the meaning of ERISA's enforcement provisions. Spinedex Physical Therapy USA Inc. v. United Healthcare of Arizona, Inc. emphasized this rule and held that a non-participant healthcare provider cannot bring claims for benefits on its own behalf but must do so derivatively. The court concluded that the providers in DB Healthcare lacked derivative standing because they do not hold valid assignments. The court also concluded that the Center lacked derivative authority because the claims fell outside the scope of those assigned rights. Accordingly, the court affirmed the judgment. View "DB Healthcare, LLC v. Blue Cross Blue Shield of Arizona, Inc." on Justia Law

Posted in: ERISA

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Plan beneficiaries (Plaintiffs) filed claims against their employer and its benefits plan administrator (collectively, Defendants) alleging breach of fiduciary duty in the selection and retention of certain mutual funds for a benefit plan governed by ERISA. The district court concluded that Plaintiffs' claims regarding the selection of mutual funds in 1999 were time-barred under the six-year limit of 29 U.S.C. 1113(1). The court of appeals affirmed. The Supreme Court vacated the decision of the court of appeals, holding that federal law imposes on fiduciaries an ongoing duty to monitor investments even absent a change in circumstances. On remand, the Fourth Circuit vacated the district court’s decisions regarding funds added to the ERISA plan before 2001, holding (1) Plaintiffs did not forfeit the ongoing-duty-to-monitor argument either in the district court or on appeal; (2) only a “breach of violation” need occur within the six-year statutory period, and the initial investment need not be made within the statutory period; and (3) the duty of prudence required Defendants to reevaluate investments periodically and to take into account their power to obtain favorable investment products. Remanded. View "Tibble v. Edison International" on Justia Law

Posted in: ERISA

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Plaintiff filed suit under the Employee Retirement Income Security Act (ERISA), 29 U.S.C. 1001 et seq., seeking judicial review of the denial of benefits under his long term disability policy sponsored by his employer and issued by Northwestern Mutual. The court held that the district court erred in denying plaintiff his long term disability benefits under the Plan where the administrative record plainly showed that plaintiff could not sit for more than four hours a day. Nonetheless, the district court upheld Northwestern Mutual’s determination that Armani could perform work at the “sedentary” level. The court agreed with other circuits and held that an employee who cannot sit for more than four hours in an eight-hour workday cannot perform “sedentary” work that requires “sitting most of the time.” Accordingly, the court vacated and remanded. View "Armani v. Northwestern Mutual Life Insurance Co." on Justia Law

Posted in: ERISA