Good morning! Hope your week is off to a running start. This past week there were a number of decisions involving breach of fiduciary duty claims. Since the Supreme Court’s 2011 decision in Cigna Corp. v. Amara, which gave teeth to ERISA’s edentulous civil enforcement scheme, it is no surprise that courts are now holding breaching fiduciaries responsible for harm caused by misinformation to plan participants. In Rees v. Iron Workers’ Local No. 25 Pension Fund, the court found that the Pension Fund was equitably estopped from revoking special retirement benefits, where the plaintiff’s decision to retire was influenced by a trustee’s representation that he could retire and use his “banked hours” (when apparently he could not). On the disability benefit front, the Sixth Circuit issued a plaintiff-friendly decision in Waskiewicz v. UniCare Life & Health Ins. Co., where it found that retroactive termination of employment and denial of disability benefits due to a failure to comply with reporting deadlines, which was ostensibly caused by the disability itself, is an abuse of discretion. My favorite quote from the decision: “Common sense convinces us that the denial of benefits in this case runs contrary to the spirit of ERISA, which is designed to protect employee benefits, not subject them to arbitrary termination . . .” If only every other court would drink that spirit of ERISA!
Below is Roberts Disability Law summary of this past week’s notable ERISA decisions.
Retroactive termination of employment and denial of disability benefits due to a failure to comply with reporting deadlines, which was caused by the disability itself, is an abuse of discretion. In Waskiewicz v. UniCare Life & Health Ins. Co., No. 14-1479, __F.3d___, 2015 WL 5751585 (6th Cir. Oct. 2, 2015), the court reversed the district court’s grant of summary judgment to UniCare based on its conclusion that Plaintiff did not qualify for long term disability benefits under the Plan because she had already been terminated by Ford when she sought those benefits. Plaintiff suffers from type-1 diabetes, major depression, and gender identity disorder. The Plan at issue included the following subsection:
An Active Employee whose employment is terminated under the Ford Involuntary Salaried Separation Policy (FISSP) … shall cease to be eligible for Benefits as of the earlier of:
(a) the date the Employee has been notified; or
(b) the day prior to the date of such termination (in the case of retroactive terminations) and shall cease to be a Covered Employee hereunder as of such date.
The Plan requires the employee to notify “the Claim Processor and the Company if the employee is absent for more than five (5) consecutive Workdays.” Plaintiff did not inform Ford within the five-day period. Plaintiff’s father notified UniCare of the disability claim on behalf of his daughter in December after losing contact with her for a couple of months and then finding her a “mess” barricaded in her house. Unicare denied the claim because Plaintiff was terminated effective October 26th and not eligible for benefits. Plaintiff did not seek medical help until November 24th and the doctor certified her disability as of October 25th.
The court found Ford’s retroactive termination of Plaintiff, which thereby deprived her of disability benefits, inconsistent with the spirit of employer-provided health care benefits generally and with this Plan specifically. The court was also “hard pressed to believe” that Plaintiff’s failure to comply with reporting deadlines prescribed by the Plan should result in the denial of benefits as long as the failure to comply was directly caused by the disability itself. On remand, the court instructed that Plaintiff shall be given the opportunity to show that her alleged failure to comply with certain of the requirements found in the Plan was due to the very disability for which she seeks benefits.
Select Slip Copy & Not Reported Decisions
Micha v. Sun Life Assur. Co. of Canada, No. 09CV2753 JM BGS, 2015 WL 5732124 (S.D. Cal. Sept. 30, 2015). Group Disability, an employee welfare plan, was sued by one of its participants when Sun Life denied his disability claim. It filed a cross-claim against Sun Life for declaration of comparative fault and indemnification. Following a settlement between the participant and Sun Life, Group Disability sought legal fees from Sun Life pursuant to 29 U.S.C. § 1132(g)(1). The court granted Group Disability’s motion for attorney’s fees, and awarded $36,216.75, which the Ninth Circuit upheld on appeal. Group Disability sought fees for defending Sun Life’s appeal and opposition to its fee motion. The court denied the fee motion, noting that this case involved a novel application of law regarding attorney’s fees in ERISA cases and application of the Hummell factors did not support a fee award.
Perez v. Bruister, No. 3:13CV1001-DPJ-FKB, 2015 WL 5712883 (S.D. Miss. Sept. 29, 2015). In a suit involving breach of fiduciary duty claims related to an ESOP’s purchase of inflated stock, the court found that attorneys’ fees and expenses should be awarded to Plaintiffs after it held that one participant had standing to sue and returned a judgment in his favor on behalf of the plan as a whole. The court awarded the Sealy Plaintiffs $416,052 in expenses and $2,700,459.25 in attorneys’ fees against Defendants.
Breach of Fiduciary Duty
Piacente v. Int’l Union of Bricklayers & Allied Craftworkers, No. 11 CIV. 1458 ER, 2015 WL 5730095 (S.D.N.Y. Sept. 30, 2015). Defendants counterclaimed against Plaintiff, alleging that he: (1) failed to administer the Fund assets in accordance with the Trust Agreement, as required under ERISA § 404(a)(1)(D), 29 U.S.C. § 1104(a)(1)(D); (2) failed to discharge his duties with respect to the Fund solely in the interest of the Fund participants as required under ERISA § 404(a)(1)(A); and (3) transferred value from the Fund to a party in interest. ERISA § 406(a)-(b), 29 U.S.C. § 1106(a)-(b). The court found that Plaintiff violated the trust agreement by executing checks with two union trustee signatures and no employer trustee signature. The court found that it does not have subject-matter jurisdiction over the third counterclaim and dismissed it.
Mintjal v. Prof’l Benefit Trust, No. 08-CV-5681, 2015 WL 5721612 (N.D. Ill. Sept. 29, 2015). Plaintiffs’ employer, General Produce Distributors, Inc., participated in the Professional Benefit Multiple Employer Welfare Benefit Plan & Trust (“the PBT Trust”), which provided death and living benefits to employees of participating employers. Plaintiffs were beneficiaries of the Trust between 1995 and 2006. Defendant Professional Benefit Trust, Ltd. (“PBT Ltd.”) was the trustee of the PBT Trust, Defendant PBT Administration, LLC (“PBT Administration”) was the administrator, and a company called Professional and Small Business Council Inc. was the trust sponsor. Plaintiffs allege that Tracy Sunderlage owned, controlled, and operated PBT, Ltd. and PBT Administration and that he was a fiduciary with respect to the PBT Trust. Tracy Sunderlage was the CEO and Chairman of the PBT Trust. Linda Sunderlage, Tracy’s wife and business partner, also was a fiduciary as she exercised discretionary authority and control over the management of the Trust. The court granted Plaintiffs’ motion on the issues of (1) liability against the Sunderlages for breaches of their fiduciary duties with regard to the transactions with Maven Assurance, Ltd. (a captive insurance company), (2) Maven’s liability as a party in interest in prohibited transactions with the named plan fiduciaries PBT Administration and PBT Ltd., (3) the termination of the PBT Trust, (4) the award of the $2,163,000 administrative fee when the PBT Trust was terminated, and (5) SRG Inc.’s liability and SRG International’s liability for aiding and abetting the breaches of fiduciary duties by Tracy Sunderlage. The Court denied Plaintiffs’ motion as to the 2002 and 2004 Loans from the PBT Trust to Dufferin (an offshore company located in Nevis in the Caribbean in which Tracy Sunderlage owned 50%). The court found that Plaintiffs claim arising from the transfer of assets is not time-barred.
Perez v. First Bankers Trust Servs., Inc., No. CV124450MASDEA, 2015 WL 5722843 (D.N.J. Sept. 29, 2015). In a matter arising from the SJP Group, Inc. Employee Stock Ownership Plan’s purchase of thirty-eight percent of the outstanding stock of SJP Group, Inc., a total of 380,000 shares, from DiPano for $16 million, the DOL brought this action alleging, among other things, that Defendant failed to conduct a thorough review of the valuation, to read and understand the valuation documents, to verify that the conclusions of the valuation were consistent with the data and analyses, to verify that the valuation was internally consistent and sensible, and to hire a second valuator if warranted. The court denied Plaintiff’s motion to preclude the expert opinions of Bradley Van Horn and Joel Stoesser without prejudice. It granted in part and denied in part Plaintiff’s motion to preclude the expert opinion of Steven Fischer. The court denied FBTS’s motion to preclude the expert opinion of Richard Puntillo without prejudice. Lastly, the court denied Defendants’ motions for summary judgment.
3M Co. v. Nat’l Union Fire Ins. Co. of Pittsburgh, No. 14-CV-1058 (PJS/JSM), 2015 WL 5687879 (D. Minn. Sept. 28, 2015). In this matter where Plaintiffs brought suit against their insurers seeking coverage for loss of returns through fraud of its investment providers, the court considered whether the lost earnings are deemed to be plan assets under ERISA regulations. The court found this to be a question of contract interpretation and the phrase “owned by the Insured” in Endorsement 8 should be construed to refer to a traditional notion of property rights, as governed by state law. The court rejected the argument that the phrase should encompass anything defined as a “plan asset” under an ERISA regulation, notwithstanding that the purpose of Endorsement 3 (the ERISA rider to the Policy) is to comply with ERISA’s bonding requirement.
Perez v. Am. Health Care, Inc. 401(k) Plan, No. CIV. 2:15-0377 WJM, 2015 WL 5682446 (D.N.J. Sept. 25, 2015). The court granted the Secretary of Labor’s motion to enter default judgment and appoint an independent fiduciary in order to terminate the America Health Care, Inc. 401(k) Plan and distribute its assets to its beneficiaries.
Jenkins-Dyer v. Drayton, No. 2:13-CV-02489-JAR, __F.Supp.3d___, 2015 WL 5671209 (D. Kan. Sept. 25, 2015). In a challenge by the deceased participant’s daughter for Savings Plan benefits paid to the surviving spouse, the court found that the terms of the Savings Plan undisputedly state that the participant’s spouse is the rightful beneficiary of the Plan; the participant’s child is a beneficiary only if the participant does not have a spouse. With respect to Plaintiff’s breach of fiduciary duty claims, the court found that because she has a potential remedy to recover the benefits to which she claims entitlement, she may not recover in equity for breach of fiduciary duty. Further, even if § 1132(a)(3) did provide for some remedy under these circumstances, Defendants would still be entitled to summary judgment on Plaintiff’s claim for breach of fiduciary duty because it enforced the plan according to its terms.
In re Trans-Indus., Inc., No. 06-43993, 2015 WL 5635278 (Bankr. E.D. Mich. Sept. 25, 2015). In this bankruptcy proceeding, the breach of fiduciary duty claims are based on (1) the Plan’s purchase of 19,000 shares of Series A Preferred Stock of Trans-Industries, Inc. on June 5, 2001 (the “Acquisition Claim”); (2) the Plan’s retention of that preferred stock for a period of several years thereafter, and the Plan’s retention of the Debtor’s common stock allegedly in amounts too great and for too long (the “Retention Claims”); and (3) a series of transactions between the Plan, Debtor, Coenen, and Fields in 2005, which resulted in Coenen and Fields receiving lump sum cash distributions of the entire amount of their vested interests in the Plan, and which left the Plan unable to satisfy its obligations to all of the other Plan participants (the “Distribution Claim”). The court concluded that 11 U.S.C. § 108(a) has no practical impact on ERISA’s statute of limitations for the Trustee’s breach of fiduciary duty claims and none of the Trustee’s claims are barred by ERISA’s 3-year statute of limitations. But, ERISA’s 6-year limitations period bars some, but not all, of the Trustee’s Retention Claims. It does not bar the Distribution Claim. The court denied summary judgment to any of the parties on the Trustee’s Retention Claim and Distribution Claim, finding the genuine issues of material fact include whether, during the time period after December 14, 2001, the Plan could have divested itself of the preferred and common stock in a way that would have avoided or reduced the alleged losses to the Plan, and if so, when and how this could have been done, and by how much this would have reduced or avoided the alleged losses to the Plan. The court rejected one defendant’s argument that he had no discretion in permitting the distributions to Coenen and Fields because the Plan required distributions of a participant’s entire vested balance if that individual was terminated. The court discusses in length who is an ERISA fiduciary.
GREENBRIER HOTEL CORPORATION, et al., Plaintiffs, v. UNITE HERE HEALTH, et al., Defendants., No. 5:13-CV-11644, 2015 WL 5626514 (S.D.W. Va. Sept. 24, 2015). The court denied summary judgment on the issues of whether the decision(s) of the Trustees to (i) amend Plan documents and (ii) not remit excess assets breached fiduciary duties. The court found that there remains a genuine dispute of material fact as to whether the Trustee-Defendants breached their fiduciary duties by amending the plan documents to purportedly bolster their (subsequent) position of denying a transfer of the excess assets. In the light most favorable to Plaintiffs, the facts and inferences therefrom indicate that the Defendants amended certain plan documents before making the decision not to transfer excess assets.
Disability Benefit Claims
Halley v. Aetna Life Ins. Co., No. 13 C 6436, 2015 WL 5731853 (N.D. Ill. Sept. 30, 2015). On de novo review, the court found in favor of Plaintiff on his claim for long term disability benefits where Plaintiff alleged disability from multiple spinal disorders and osteoarthritis. The court found that while Plaintiff-in theory-is now capable of working, the preponderance of the evidence shows that no “reasonable occupation” is available to him. A reasonable occupation does not include jobs where Plaintiff would earn 80% or less of his adjusted pre-disability earnings.
TERI HANING, Plaintiff, v. THE HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY, Defendant., No. 2:14-CV-308, 2015 WL 5729342 (S.D. Ohio Sept. 30, 2015). The court found that Hartford abused its discretion in terminating Plaintiff’s long term disability benefit claim and awarded judgment to her. The court agreed that that Hartford’s rejection of the opinions of her treating medical providers, one of whom had treated her for more than twenty years, did not demonstrate deliberate, principled reasoning. Particularly, the court found that evidence from Plaintiff’s treating medical providers was strong, where the doctors stated that in no uncertain terms that Plaintiff was disabled from returning to work. In contrast, the court found that opposing evidence (not including the file reviews) was weak. The court explained that “Hartford relies on an overly crabbed view of what constitutes ‘objective medical evidence’ and ‘documented clinical findings.’ Neither fibromyalgia nor depression easily lends itself to laboratory results or other quantitative medical testing.” The court agreed that Hartford’s (near) exclusive reliance on a series of file reviews submitted by paid consultants shows that its benefits termination was arbitrary and capricious. The court found that Plaintiff was clearly entitled to disability benefits and a retroactive award, rather than remand, is warranted. Further, Hartford did not argue that the court should remand the claim for reconsideration in the event that the court found the benefits termination arbitrary and capricious-thus forfeiting the issue.
HAROLD E. MASON, Plaintiff, v. RELIANCE STANDARD LIFE INSURANCE COMPANY, Defendant., No. 14-CV-01415-MSK-NYW, 2015 WL 5719648 (D. Colo. Sept. 30, 2015). On Plaintiff’s claim for long term disability benefits, the court found that Plaintiff demonstrated that Reliance’s denial of benefits is not supported by substantial evidence and therefore arbitrary and capricious. Reliance sought to conduct an in-person medical examination of Plaintiff, but he was unable to attend because he was hospitalized on that date. Instead of rescheduling, Reliance retained Dr. Manoj Mehta to conduct a record review of Plaintiff’s medical records. The court was critical of Dr. Mehta’s medical opinion. The court reversed and remanded for determination by the plan administrator, and with instructions to articulate the interpretation given to Policy terms, fully consider the evidence that was readily available, particularly as it relates to Plaintiff’s ability to perform the material duties of his occupation from July 2012 – July 2013.
ROBERT EMMERLING v. STANDARD INSURANCE COMPANY, No. CV 14-5202, 2015 WL 5729240 (E.D. Pa. Sept. 30, 2015). The court determined that Standard’s decision to not award Plaintiff short-term disability benefits was supported by substantial evidence and was not arbitrary and capricious, granting summary judgment in favor of Standard. The court found that Standard took steps to minimize any structural conflict and Drs. Jacob Hart and Mark Shih’s alleged conflicts of interest did not taint Standard’s decision.
GREGORY O’DELL, Plaintiff, v. ZURICH AMERICAN INSURANCE COMPANY, Defendant., No. 2:13-12894, 2015 WL 5724376 (S.D.W. Va. Sept. 29, 2015). The court denied the parties’ motions for summary judgment but found that Plaintiff’s claim was timely filed. The court remanded the matter to Zurich for further review, including to conduct a thorough inquiry into whether, and for what period of time, Plaintiff was permanently and totally disabled and make the full and fair review directed by the court in its opinion. The court further ordered that if Zurich concludes after reconsideration that Plaintiff’s claim should be denied, it must clearly explain the reasons supporting its decision and provide Plaintiff with a reasonable opportunity to obtain a full and fair review of that decision.
RANDY HATFIELD, Plaintiff, v. LIFE INSURANCE COMPANY OF NORTH AMERICA d/b/a CIGNA GROUP INSURANCE, Defendant., No. 5: 14-432-DCR, 2015 WL 5680347 (E.D. Ky. Sept. 25, 2015). The court denied Plaintiff’s motion for de novo review because the policy language entitles LINA to abuse of discretion review notwithstanding that it did not render a timely decision on Plaintiff’s long term disability claim.
ELIZABETH A. ROSS, Plaintiff, v. HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY, GENZYME CORPORATION, & GROUP LONG TERM DISABILITY PLAN FOR EMPLOYEES OF GENZYME CORPORATION, Defendants., No. 14-12748-GAO, 2015 WL 5680329 (D. Mass. Sept. 25, 2015). The court granted Hartford’s motion to dismiss, finding that Plaintiff does not state a claim for relief under the ADA by alleging that Defendants refused to extend a particular benefit for one disabled population to all disabled populations because it limits benefits for mental disabilities to 24 months. Because the ADA claim fails, the court also found that the ERISA claim for benefits cannot stand.
ROGER SCHLEBEN, Plaintiff, v. CARPENTERS PENSION TRUST FUND- DETROIT AND VICINITY, & TRUSTEES OF CARPENTERS PENSION TRUST FUND-DETROIT AND VICINITY, Defendants. THOMAS E. UNDERWOOD, individually & on behalf of all others similarly situated, Plaintiff, v. CARPENTERS PENSION TRUST FUND- DETROIT AND VICINITY, & TRUSTEES OF CARPENTERS PENSION TRUST FUND-DETROIT AND VICINITY, Defendants., No. 13-CV-14464, 2015 WL 5655838 (E.D. Mich. Sept. 25, 2015). The court resolved the following question: if an ERISA plan’s amendment procedure expressly prohibits amendments that reduce benefits for anyone already receiving them, can the Trustees amend the amendment procedure to allow them to do just that-reduce the benefits of someone already receiving them? The court concluded that the Plan gave Plaintiffs who had started to receive disability benefits a vested right to those benefits. To the extent that the amendments reduced benefits that Plaintiffs had already started to receive, the amendments violated the Plan and are thus unenforceable.
Koning v. United of Omaha Life Ins. Co., No. 14-2188, __Fed.Appx.___, 2015 WL 5603094 (6th Cir. Sept. 24, 2015). The Sixth Circuit remanded Plaintiff’s long term disability claim to the district court with instructions to remand to the Plan for appropriate consideration of the claim. The court found that United of Omaha Life ignored favorable evidence from Plaintiff’s treating physicians; selectively reviewed treating physician evidence; failed to conduct its own physical evaluation; and that Plaintiff may be able to meet her burden of showing a significant change in physical functional capacity as shown by objective evidence – hundreds of pages of medical records detailing back surgeries, physical therapy, and numerous pain treatment programs, and MRIs and other tests documenting degenerative disk disease.
Gladstein v. Lincoln Fin. Grp., No. CA 14-390-ML, 2015 WL 5615173 (D.R.I. Sept. 23, 2015). The court granted Lincoln’s motion for summary judgment on several issues related to Plaintiff’s long term disability claim. The court found that Lincoln’s acceptance of the annotated $90,000 check Plaintiff submitted as offset for the SSDI payments she received does not constitute full accord and satisfaction and she is obligated to repay the full amount of any overpayments she incurred. Further, the SSDI benefits awarded to Plaintiff’s daughter are included in “Other Income,” as defined in the Policy, and they must be included in the calculation of the overpayment which Plaintiff incurred. The court found that Lincoln is authorized to reduce LTD benefit payments awarded to Plaintiff until full reimbursement of the overpaid amounts were made.
Osberg v. Foot Locker, Inc., No. 07 CIV. 1358 KBF, 2015 WL 5707107 (S.D.N.Y. Sept. 29, 2015). Following a lengthy bench trial, the court found that the Class has proven by a preponderance of the evidence that Foot Locker violated ERISA §§ 404(a) and 102 by issuing false, misleading, and incomplete Plan descriptions. The court also found that the Class has proven by clear and convincing evidence that, as a result of Foot Locker’s ERISA violations, employees reasonably but mistakenly believed that growth in their cash balance benefit equaled growth in their pension benefit-and that Foot Locker obtained an undue advantage vis-à-vis its workforce. To remedy Foot Locker’s misrepresentations, the court found that the Plan must be reformed to actually provide the benefit that the misrepresentations inequitably caused Class members to reasonably expect.
RANDY HATFIELD, Plaintiff, v. LIFE INSURANCE COMPANY OF NORTH AMERICA d/b/a CIGNA GROUP INSURANCE, Defendant., No. 5: 14-432-DCR, 2015 WL 5722791 (E.D. Ky. Sept. 29, 2015). The court granted Plaintiff’s motion to compel Defendant Life Insurance Company of North America (“LINA”) to furnish more complete responses to discovery requests limited to issues addressing the conflict of interest issue. Specifically, LINA must provide the following information: payments made from 2005 to the present by LINA to third-parties who reviewed Plaintiff’s claim for the purpose of his most recent denial and appeal (and supporting documentation for those payments); statistical data for the years 2005 to the present for those individuals and entities who handled Plaintiff’s most recent denial and appeal; employee compensation, bonuses, and awards; and policies or procedures on which LINA relied in its most recent denial of Plaintiff’s claim.
ETTER WILKES PLAINTIFF v. NUCOR-YAMATO STEEL COMPANY DEFENDANT, No. 3:14-CV-00224-KGB, 2015 WL 5725771 (E.D. Ark. Sept. 29, 2015). The court found that because Plaintiff brings her claims under Title VII and the ADA, which are federal laws, ERISA preemption does not apply.
Medical Benefit Claims
Brooks v. Ryder Sys., Inc., No. CIV.A. H-14-2153, 2015 WL 5734704 (S.D. Tex. Sept. 30, 2015). In a suit challenging the denial of medical and wage replacement benefits, the court found that PartnerSource did not abuse its discretion in finding on the record before it that Plaintiff had missed two appointments and that his medical benefits should therefore be terminated based on the Plan’s requirements. The court also found that no Plan provision or any legal authority establishes that Plaintiff would be entitled to wage replacement benefits under the Plan if his termination was wrongful. Instead, under the plain language of the Plan, Plaintiff’s entitlement to wage replacement benefits only lasted until termination of his employment.
Pension Benefit Claims
DAVID M REES & WENDY REES, Plaintiffs, v. IRON WORKERS’ LOCAL NO. 25 PENSION FUND, et al., Defendants., No. 14-CV-12401, 2015 WL 5729087 (E.D. Mich. Sept. 30, 2015). The court found that the Pension Fund was equitably estopped from revoking special retirement benefits, where Plaintiff’s decision to retire was influenced by a trustee’s representation that Plaintiff could retire earlier than anticipated and use his “banked hours.” Plaintiff detrimentally relied on the fact that the Pension Fund did not take any action within 90 days to revoke his benefits, despite the Pension Plan requiring decisions to be made on pension applications within 90 days (120 for unusual circumstances). Because Plaintiff’s pension application was approved and his benefits were being paid, he did not have an opportunity to return to work and obtain the necessary hours without using the “banked hours.” Further, Plaintiffs suffered financial damage from the revocation of benefits and future reduction to the amount of benefits. The court found that these adverse changes in position as a result of Plaintiffs’ reliance on the Pension Fund’s representations amount to detrimental reliance.
BRYAN DONALD MURPHY, Plaintiff, v. INTERNATIONAL PAINTERS AND ALLIED TRADES INDUSTRYPENSION FUND, et al., Defendants., No. 3:13-CV-28760, 2015 WL 5722809 (S.D.W. Va. Sept. 29, 2015). Plaintiff challenged Defendants’ interpretation of the pension plan, which they interpreted as allowing them to use the date of disability onset as determined by the SSA. Plaintiff also contended that they misinterpreted the plan by not awarding him a 501-hour credit for each year that he has been absent from employment due to his disability. The court found that Plaintiff’s proposed interpretation of the plan asks the Trustees to comb through and interpret complex administrative law decisions, medical records, and state agency findings rather than look to the date of onset explicitly set by the SSA. The court found that Plaintiff offered no viable explanation to support his conclusion that this interpretation is reasonable yet Defendants’ simpler interpretation, which is consistent with the overall language of the plan, is not.
McKinney v. Line Const. Ben. Fund, No. 1:14-CV-066-NBB-SAA, 2015 WL 5692809 (N.D. Miss. Sept. 28, 2015). The court considered whether an employer’s requirement of a written statement repealing the plaintiffs’ interest in filing a workers’ compensation claim constitutes an abuse of discretion by the administrator. The court found no abuse of discretion as the employer is within reason to require written confirmation of a plan participant’s disavowed interest in filing a workers’ compensation claim after the administrator received contradictory notice that the same participant intended to file a workers’ compensation claim. The health plan contains a workers’ compensation limitation.
STEPHEN COLACO, et al., Plaintiffs, v. THE ASIC ADVANTAGE SIMPLIFIED EMPLOYEE PENSION PLAN, et al., Defendants. Additional Party Names: ASIC Advantage, Inc., David Lichtenstein, David Robertson, Michael Mullen, Microsemi Corp., Moddy Wong, Nhan Tran, Quy Lau, Sina Ma, Stephen Thomas, Terry Jones, Tom Gammon, Trinh Nguyen, No. 5:13-CV-00972-PSG, 2015 WL 5655465 (N.D. Cal. Sept. 24, 2015). In a lawsuit involving denial of Simplified Employee Pension (SEP) plan benefits, the court found that Defendants may not argue that separation agreements are a basis for denying Plaintiffs’ right to SEP benefits, but they may argue that the separation agreements bar this lawsuit.
Pleading Issues & Procedure
LAURAL O’DOWD, for herself & all others similarly situated, Plaintiff, v. ANTHEM HEALTH PLANS, INC., doing business as Anthem Blue Cross & Blue Shield, ROCKY MOUNTAIN HOSPITAL AND MEDICAL SERVICE, INC., doing business as Anthem Blue Cross & Blue Shield, & WELLPOINT, INC., Defendants., No. 14-CV-02787-KLM, 2015 WL 5728814 (D. Colo. Sept. 30, 2015). Plaintiff brought the following claims against Defendant Anthem: (1) a claim seeking a declaratory judgment that Defendant Anthem violated Colo. Rev. Stat. §§ 10-16-704, 10-16-104, and 10-16-107.7; (2) a claim seeking injunctive relief under ERISA, specifically 29 U.S.C. § 1132(a)(3); (3) a claim for payment of benefits and associated interest under ERISA, specifically 29 U.S.C. § 1132(a)(1)(B); and (4) a breach of fiduciary duty claim that mentions 29 U.S.C. §§ 1002 and 1104. Id. §§ 41-68. Anthem moved to dismiss. The court explained that while Plaintiff cannot obtain duplicative relief, she may pursue both her second and third claims. The court denied the motion to the extent it argues that claim one should be dismissed because Colo. Rev. Stat. § 10-16-104 is preempted by ERISA. But, the court granted the motion to the extent it seeks dismissal of the first claim to the extent it is premised on Colo. Rev. Stat. § 10-16-704.
GREENBRIER HOTEL CORPORATION, et al., Plaintiffs, v. UNITE HERE HEALTH, et al., Defendants., No. 5:13-CV-11644, 2015 WL 5626514 (S.D.W. Va. Sept. 24, 2015). With respect to the issue of standing to sue as an ERISA fiduciary, the court concluded that the Greenbrier has presented evidence that it is a fiduciary because it (i) exercised fiduciary control over plan assets-contributions-before they were remitted to the Fund, (ii) regularly audited employment rolls to ensure that correct amounts of contributions were being remitted and that only participants and their beneficiaries were receiving benefits from the Fund, and (iii) had a continuing duty to monitor the Trustees of the Fund once it became a party to the Trust Agreement. Although the court found that this evidence would not automatically result in fiduciary status for the Greenbrier for all aspects of Plan Unit 155, it is enough to bestow fiduciary status on the Greenbrier because the Greenbrier is suing the Trustee-Defendants in relation to its (and their) responsibilities to ensure adequate funding for the Plan, and the Greenbrier’s employees, themselves participants in the Fund, were remitting appropriate contributions.
Patterson v. Duke Univ., No. 14CV1062, 2015 WL 5608126 (M.D.N.C. Sept. 23, 2015). In granting unopposed motion to dismiss, the court dismissed Plaintiff’s second claim for relief under § 1132(a)(3), finding that Plaintiff has an adequate remedy for her claimed denial of disability benefits under § 1132(a)(1)(B). The court also found that ERISA preempts any claims that Plaintiff made under the North Carolina Declaratory Judgment Act.
Ret. Comm. of DAK Americas LLC v. Smith, No. 7:14-CV-36-FL, 2015 WL 5714579 (E.D.N.C. Sept. 29, 2015). Plaintiffs filed suit to recover alleged overpayments of pension benefits made to Defendants, seeking equitable restitution of the overpayments. One set of defendants paid back the money and then sought its return. The other set of defendants did not. With respect to the latter, the court granted Plaintiff’s claim for equitable restitution, finding that the alleged overpayments are specifically identifiable funds within the possession and control of defendants and constitute property belonging in good conscience to the Plan, based upon the correct interpretation of the Plan which did not authorize the overpayment. The court dismissed Defendants’ counterclaims premised upon the conduct of Plaintiff, including equitable estoppel, constructive fraud, breach of fiduciary duty/surcharge.
Withdrawal Liability & Unpaid Benefit Contributions
BOARDS OF TRUSTEES OF OHIO LABORERS’ FRINGE BENEFIT PROGRAMS, Plaintiffs, v. SOLID ROCK CONSTRUCTION SOLUTIONS, LLC, Defendant., No. 2:15-CV-2399, 2015 WL 5719582 (S.D. Ohio Sept. 30, 2015). The court found that Plaintiffs are entitled to judgment in the amount of $26,618.22 in unpaid fringe benefit contributions, liquidated damages, and prejudgment interest, and an award of attorney’s fees in the amount of $3,315.00.
Greater Pennsylvania Carpenter’s Pension Fund v. Novinger’s, Inc., No. CIV.A. 14-956, 2015 WL 5691093 (W.D. Pa. Sept. 28, 2015). The court found that Defendants are liable for liquidated damages, attorney fees and costs borne by Plaintiff but denied Plaintiff’s motion insofar as it seeks interim withdrawal payments.
Cent. States, Se. & Sw. Areas Pension Fund v. Bulk Transp., Corp., No. 13 C 9112, 2015 WL 5722822 (N.D. Ill. Sept. 28, 2015). The parties dispute whether the Pension Fund may require Bulk Transport to comply with the American Arbitration Association’s (“AAA”) current rules governing the initiation of withdrawal-liability arbitration. The court concluded that the Pension Fund may not require Bulk Transport to comply with the AAA’s current rules and directed the parties to comply with the Pension Benefit Guaranty Corporation’s (“PBGC”) default rules.
Trustees of the Local 888 Health Fund v. Kissler & Co., No. CIV. 14-8097 WJM, 2015 WL 5666203 (D.N.J. Sept. 25, 2015). In matter seeking delinquent contributions under a CBA, the court granted in part and denied in part Defendant’s motion to dismiss. The court denied Defendant’s motion to dismiss Plaintiff’s claim for $46,319.84 under the CBA, but granted the motion to dismiss Plaintiff’s claim for $98,970.50 under the MOU.
Raines v. Integrity Acoustic Solutions, Inc., No. CIV. 14-2900 PAM/JJK, 2015 WL 5638047 (D. Minn. Sept. 24, 2015). The court found that Integrity Acoustics did not maintain records sufficient to establish whether employees performed work covered by the CBA, and therefore Defendants have not carried their burden and Plaintiffs are entitled to summary judgment on their claim for unpaid fringe benefit contributions and related damages.
Gesualdi v. Tri-State Soil Solutions, LLC, No. 13-CV-5429 JS AKT, 2015 WL 5604150 (E.D.N.Y. Sept. 23, 2015). The court granted default judgment in favor of Plaintiffs and against Defendant, awarding the following damages: $123,533.13 in unpaid contributions; $83,650.13 in interest on the unpaid contributions and interest accruing at $60.911 per diem from September 20, 2014 through the date of judgment; $68,203.26 in liquidated damages and additional liquidated damages at $60.911 per diem from September 20, 2014 through the date of judgment; $33,731.75 in attorneys’ fees; and $27,195.18 in costs and expenses.
Trustees of Leather Goods, Plastics, Handbags & Novelty Workers Union Local 1 Joint Ret. Fund v. Key Handling Sys. Inc., No. 14-CV-2675 JS ARL, 2015 WL 5604178 (E.D.N.Y. Sept. 23, 2015). The court granted default judgment in favor of Plaintiffs and awarded damages against Key Handling as follows: $107,107.00 in damages based on Key Handling’s withdrawal liability; $8,945.88 in interest through November 21, 2014, plus additional interest at a daily rate of $17.61 per day from that date through the date judgment is entered; $21,421.40 in liquidated damages; $6,228.75 in attorneys’ fees; and costs in the amount of $600.00. The court dismissed the complaint against the unidentified XYZ defendants.
Trustees of Bldg. Trades Educ. Ben. Fund v. Fervent Elec. Corp., No. 14-CV-5511JS ARL, 2015 WL 5604220 (E.D.N.Y. Sept. 23, 2015). The court granted Plaintiffs’ motion for a default judgment to the limited extent that Plaintiffs are awarded $458, but denied Plaintiffs’ request for damages with leave to renew.
* Please note that these are only case summaries of decisions as they are reported and do not constitute legal advice. These summaries are not updated to note any subsequent change in status, including whether a decision is reconsidered or vacated. The cases reported above were handled by other law firms but if you have questions about how the developing law impacts your ERISA benefit claim, the attorneys at Roberts Disability Law may be able to advise you so please contact us. Case summaries authored by Michelle L. Roberts, Partner, Roberts Disability Law, 1050 Marina Village Pkwy., Ste. 105, Alameda, CA 94501; Tel: 510-230-2090.
LEAVE YOUR MESSAGE
We know how to get your insurance claim paid. Call today at: