Category Archives: Benefit Claims & Claims Process Litigation

Third Circuit – Failure to Identify Plan’s Limitation Period in Denial Letter Precludes Enforcing Deadline

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In 2013, the Supreme Court reaffirmed that ERISA plans can impose shorter limitations periods than would otherwise be the case if the plan was silent. Nevertheless, the United States Court of Appeals for the Third Circuit recently held that, even though there was evidence that a claimant had notice that of the plan’s limitations period, which had expired, that limitations period could not prevent his lawsuit. What led the Court to this decision? Read on to find out. In Mirza v. Insurance Administrator of America, Inc., No. 13-3535, 2015 WL 5024159 (3d Cir. Aug. 26, 2015), the plaintiff was [...] Read more

Pat DiCarlo and Emily Hootkins Published in Law360 – “6th Circ. Rejection Of Disgorgement Brings ERISA Relief”

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On rehearing en banc, the Sixth Circuit has restored order for individual benefits cases by rejecting a judgment ordering Life Insurance Co. of North America to disgorge nearly $3.8 million in profits after wrongfully withholding long-term disability benefits from a plan participant. The majority agreed that allowing a disgorgement award in addition to requiring the insurer to pay the individual disability benefits would be an “impermissible duplicative recovery” under ERISA. To read the full article, please click here. [...] Read more

Supreme Court Agrees To Consider Yet Another “Presumption” Out Of The Sixth Circuit: That Retiree Health Care Benefits Are Intended To Be Vested For Life, Absent Clear Plan Or Bargaining Agreement Language To The Contrary

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In the ERISA world, the Supreme Court has already granted a petition for certiorari of a Sixth Circuit case in order to consider one significant “presumption” this term – when it agreed to evaluate whether the Moench “presumption of prudence” regarding employer stock is a proper legal standard for evaluating breach of fiduciary duty claims. However, on May 5, the high court granted a petition for certiorari of yet another Sixth Circuit case regarding yet another significant presumption – this time, the judicially-crafted presumption that retiree health benefits [...] Read more

Controversial Sixth Circuit Panel’s Decision on Disgorgement of Profits in ERISA Disability Benefits Case Set for Oral Argument in Rehearing En Banc

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In Rochow v. Life Ins. Co. of Am., 737 F.3d 415 (6th Cir. 2013), a panel of judges for the Sixth Circuit awarded an ERISA disability benefits claimant’s estate not only the amount of benefits that the participant was owed, but also a disgorgement award under ERISA § 502(a)(3). Dissenting, the Hon. David McKeague remarked that the Sixth Circuit panel took “an unprecedented and extraordinary step to expand the scope of ERISA coverage. The disgorgement of profits undermines ERISA’s remedial scheme and grants the plaintiff an astonishing $3,797,867.92 windfall under the catchall [...] Read more

Unresolved Claim For Attorney’s Fees Does Not Prevent Judgment From Becoming “Final”

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The facts of Ray Haluch Gravel Co. v. Cent. Pension Fund of Int’l Union of Operating Engineers & Participating Employers, 134 S. Ct. 773 (2014)are straightforward. Petitioner Ray Haluch Gravel Co. (“Haluch”) is a landscape supply company required to pay contributions to union-affiliated benefit funds under a collective-bargaining agreement. Respondents are various funds who sued under ERISA for the required contributions. During the lower court proceedings, the district court entered judgment on the merits in favor of the funds. At the time the judgment was entered, the funds [...] Read more

Supreme Court Upholds Plan’s Limitation Period That Begins To Run Before A Final Denial

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ERISA does not generally provide a statute of limitations for claims for benefits. Therefore, courts will generally use the statute of limitations for breach of contracts action from the state where the court is located to determine the appropriate limitations period. In other words, if a case is filed, as this case was, in the United States District Court for the District of Connecticut, the court will use the Connecticut state law statute of limitations for breach of contract actions for ERISA benefit claims. However, ERISA plans may set their own contractual limitations periods which will be [...] Read more

Tenth Circuit Says “Enough is Enough” And Rejects Plan Participants’ Belated Attempt To Add Vague Claims For “Equitable Relief” Post-Amara

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In Jensen, pension plan participants brought a putative class action against Solvay (the “Company”) arising from the Company’s decision to convert the pension plan from a “fixed-benefit” to “cash-balance formula.” Though ERISA did not prohibit Solvay (both the plan’s sponsor and its administrator) from making this move, ERISA did require the Company to provide its employees with detailed notice of the changes. See ERISA § 204(h), 29 U.S.C. § 1054(h). The employees brought suit, and after the District Court ruled in favor of the Company, [...] Read more

Seventh Circuit: Participant May Be Entitled To “Make-Whole” Surcharge If Incorrect Coverage Information Caused Decision To Have Surgery

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In Kenseth v. Dean Health Plan, Inc., No. 11-1560, 2013 WL 2991466 (7th Cir. June 13, 2013) (“Kenseth II”), the plaintiff had undergone gastric banding in 1987 which, 18 years later in 2005, caused severe acid reflux and other complications. Plaintiff’s doctor recommended that she have another procedure to remedy the problems caused by the prior surgery. The plan at issue, insured by the defendant, excluded coverage for surgical treatment of morbid obesity and services related to a non-covered benefit. However, the plan certificate instructed participants to call a phone number [...] Read more

Rosy Relief in Sight for the Plan in CGI Technologies & Solutions v. Rose

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On April 22, 2013, the Supreme Court granted the petition for a writ of certiorari in CGI Technologies & Solutions v. Rose, et al., and then immediately vacated and remanded the Ninth Circuit’s judgment in light of US Airways, Inc. v. McCutchen, No. 11-1285, 2013 WL 1567371 (U.S. Apr. 16, 2013). In McCutchen, the Supreme Court issued a two-part opinion in which it held that (1) equitable principles cannot override clear plan terms, but (2) equitable principles can be used to construe ambiguous or missing plan terms. Last June, we blogged about CGI Technologies & Solutions v. Rose [...] Read more

Fourth Circuit Joins Third Circuit In Holding ERISA Does Not Preempt Post-Distribution Suits Against Beneficiaries

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The situation in Andochick is not at all uncommon when couples divorce: Scott Andochick and Erika Byrd were married. During the marriage, Erika participated in a 401(k) plan and a life insurance plan with her employer, and executed beneficiary designations for both plans, naming Scott as her primary beneficiary. Scott and Erika separated and entered into a marital settlement agreement. In the agreement, Scott “waive[d] any interest, including but not limited to any survivor benefits, which he may have” in Erika’s 401(k) plan, and he released and relinquished any future rights [...] Read more