District of Maryland Dismisses “Full and Fair Review” Claim Under ERISA for Lack of Private Right of Action

In Blackett v. Unum Life Insurance Company of America, No. CV 1:24-2259-CDA, 2025 WL 2781544 (D. Md. Sept. 30, 2025), Magistrate Judge Charles D. Austin granted UNUM’s partial motion to dismiss, holding that plaintiff’s claim under ERISA § 503 (29 U.S.C. § 1133) for failure to provide a “full and fair review” of her disability claim was not cognizable as a standalone cause of action. The decision underscores a recurring issue in ERISA litigation: whether plaintiffs may plead procedural violations of ERISA as independent claims for relief.

Background

Plaintiff, a Communications and Digital Media Specialist, suffered disabling post-concussion symptoms and migraines following a motor vehicle accident. After initially approving her for short- and long-term disability benefits, UNUM terminated her LTD benefits following multiple file reviews by physicians. Plaintiff appealed, submitting extensive supporting evidence from treating physicians, neuropsychologists, and other specialists, but UNUM upheld its denial in January 2024.

Plaintiff filed suit under ERISA, asserting (1) wrongful denial of LTD benefits under § 502(a)(1)(B), (2) failure to provide a full and fair review under § 503 (29 U.S.C. § 1133), and (3) denial of life insurance benefits. UNUM moved to dismiss Count II, arguing that § 1133 does not create a private right of action.

The Court’s Analysis

No Private Right of Action Under § 1133

The court agreed with UNUM that § 1133 provides no independent enforcement mechanism, citing Fourth Circuit precedent in Gagliano v. Reliance Standard Life Ins. Co., 547 F.3d 230 (4th Cir. 2008). The statute obligates plans to adopt reasonable claims procedures, but enforcement is limited to remedies available under ERISA’s civil enforcement provision, § 502(a). Courts nationwide have reached the same conclusion. Because Plaintiff did not contest this point in her opposition, the court found the argument conceded and dismissed Count II on this ground.

Fiduciary Duty Repackaging Barred

Plaintiff attempted to frame her “full and fair review” claim as a breach of fiduciary duty under § 502(a)(2) and (a)(3). The court rejected this repackaging, holding that the allegations sought individual benefits rather than relief on behalf of the plan, which is the only remedy available under § 502(a)(2). Citing Korotynska v. Metro. Life Ins. Co., 474 F.3d 101 (4th Cir. 2006), the court explained that allowing plaintiffs to recast a benefits-denial claim as a fiduciary breach would circumvent ERISA’s remedial scheme.

Equitable Relief Under § 502(a)(3) Not Properly Pleaded

The court also found no viable equitable claim under § 502(a)(3). While Plaintiff’s opposition brief argued for equitable remedies (e.g., de novo review, striking medical reports, broader discovery), the complaint itself did not plead or request such relief. Courts in the Fourth Circuit do not permit plaintiffs to amend their pleadings through briefing. Moreover, even if pleaded, equitable relief would be unavailable because § 502(a)(1)(B) provides an adequate remedy—payment of benefits if Plaintiff prevails.

The court dismissed Count II without prejudice, leaving Plaintiff’s claim for wrongful denial of LTD benefits under § 502(a)(1)(B) intact.

Takeaway

This decision is a reminder that procedural violations of ERISA’s claims regulations (§ 503 and related regulations at 29 C.F.R. § 2560.503-1) cannot be pleaded as standalone claims. Instead, such violations may inform the standard of review or bolster a § 502(a)(1)(B) claim for benefits, but they do not create independent causes of action. Plaintiffs and practitioners must frame their claims carefully, ensuring that any alleged fiduciary breach or request for equitable relief is tethered to remedies authorized under ERISA’s enforcement provisions.