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Total Articles: 76

Eighth Circuit Rules on ERISA’s “Church Plan” Exemption

On March 27, 2020, the Eighth Circuit in Sanzone v. Mercy Health, 2020 U.S. App. LEXIS 9537 (8th Cir. March 27, 2020), ruled on several key issues on the “church plan” exemption to ERISA. As background, beginning in 2013, plaintiff’s counsel filed ERISA class-action cases across the country challenging the application of ERISA’s “church plan” exemption to non-profit church-affiliated hospital organizations. In 2017, the Supreme Court ruled in Advocate Health Care Network v. Stapleton, 137 S. Ct. 1652 (2017), that ERISA’s “church plan” exemption includes plans maintained by a church-affiliated organization whose principal purpose is the funding or administration of that plan. This meant that plans of non-profit church-affiliated hospitals, social service organizations, schools and the like could qualify for this exemption if they meet these statutory requirements.

The Supreme Court Defines Actual Knowledge

In a closely watched decision, Intel Corporation Investment Policy Committee v. Sulyma, Slip Op. No. 18-1116 (U.S. S. Ct., Feb. 26, 2020), construing ERISA’s three-year statute of limitations, see ERISA § 413(2), 29 U.S.C. § 1113(2), the Supreme Court held unanimously (J. Alito) that “actual knowledge” means “. . . when a plaintiff actually is aware of the relevant facts, not when he should be.”

Second Circuit Rules ERISA Plan Can Be Reformed Absent Any Mistakes, Fraud or Other Inequitable Conduct

The Second Circuit recently considered for the first time whether the equitable remedy of reformation was available under the Employee Retirement Income Security Act (ERISA) where a court determined that the written terms of a retirement plan violated ERISA but no allegation of fraud, mistake, or inequitable conduct existed. In Laurent v. PricewaterhouseCoopers LLP, the court found that “terms violative of ERISA” may serve an independent basis justifying an award of a reformation remedy as to a plan, indicating that its decision is in line with a “hint” from the Supreme Court in its 2011 decision in CIGNA Corp. v. Amara1 (referred to as “Amara III”) that courts should broadly construe remedies in equity under ERISA § 502(a)(3).2

"Medical Necessity" Isn’t Well-Defined Unless It Is Well-Defined

A U.S. District Court in Connecticut recently issued an order that highlights the importance of understanding exactly what the term “medically necessary” means in an ERISA health plan.1 This is another in a growing line of cases finding a disconnect between the term “medically necessary” in a health plan and the guidelines that third-party administrators use to determine whether treatment is “medically necessary.”

Going Paperless: DOL Proposes New Electronic Disclosure Safe Harbor

On October 23, 2019, the U.S. Department of Labor (DOL) published proposed rules addressing default electronic disclosures by employee benefits plans under the Employee Retirement Income Security Act of 1974 (ERISA). In doing so, the DOL finally accounted for the evolving landscape of technology while balancing competing factors such as the effectiveness of the disclosures, the accessibility of electronic information to the workforce, and the costs involved in disseminating required information.

ERISA-Exempt Governmental Plan Withstands Putative Class Action Challenge

Late last year, we wrote about Shore v. The Charlotte-Mecklenburg Hospital Authority, et al., in which former Atrium Health employees filed a putative class action in the U.S. District Court for the Middle District of North Carolina under the Employee Retirement Income Security Act of 1974 (ERISA).

North Carolina Court Awards $41 Thousand-Plus Penalty for Failure to Produce Documents Requested by Plan Participants

Section 104(b)(4) of ERISA provides that a plan administrator must respond to a written request for certain documents (including the plan documents and summary plan description) by a participant or beneficiary by providing the requested documents. Section 502(c)(1) of ERISA and Regulation § 2575.502(c)-1 provide that a plan administrator who fails to do so within thirty days is liable to such participant or beneficiary in an amount (as determined by the court in its discretion) of up to $110 per day.

Seventh Circuit Holds that a Deceleration of Withdrawal Liability is Unavailable Under ERISA’s Common Law

In Bauwnes v. Revcon Technology Group, Inc., the U.S. Court of Appeals for the Seventh Circuit held that the trustees of a multiemployer pension plan could not agree to an employer’s installment payment plan of its withdrawal liability after the trustees had demanded full payment following the employer’s default. This “no good deed goes unpunished” decision will likely make trustees much less likely to agree to subsequent payment plans after finding an employer in default.

Striking Down Decades-Old Precedent, Ninth Circuit Rules That ERISA Breach of Fiduciary Duty Claims May Be Arbitrated

On August 20, 2019, a three-judge panel of the U.S. Court of Appeals for the Ninth Circuit issued an opinion in Dorman v. Charles Schwab Corp.,1 overturning its 1984 position in Amaro v. Continental Can Co.2 that lawsuits filed under the Employee Retirement Income Security Act (ERISA) are not arbitrable. The court found that subsequent U.S. Supreme Court decisions mean that Amaro “is no longer good law.”

Third Circuit Joins Majority in Rejecting “De Facto Administrator” ERISA Theory

The U.S. Court of Appeals for the Third Circuit joins the Second, Seventh, Eighth, Ninth, and Tenth Circuits in declining to impose liability on alleged de facto plan administrators. Under Section 502(c) of ERISA, a plan administrator may be liable and subject to penalties for failing to comply with a participant’s request for information which the administrator must provide within 30-days from the request. The Third Circuit addressed whether a participant could sue a “de facto plan administrator” for failing to provide information timely.

Full and Fair Review Requirement under ERISA Gets a Full and Fair Review

On July 15, 2019, the U.S. Court of Appeals for the Tenth Circuit touched on the new regulations governing what constitutes a “full and fair review” of a claim for benefits under the Employee Retirement Income Security Act.1 The important question at the root of the case was whether one can lose discretionary authority in administering a claim by engaging in “procedural irregularities.” To be sure, the new regulations answer that question in the affirmative.2 Unfortunately, however, the Tenth Circuit was not called upon to determine whether the regulations are binding and enforceable. The court did, however, determine that what the plaintiff claimed were procedural irregularities decidedly were not.

Supreme Court to Review ERISA Statute of Limitations Case

In late 2018, in Sulyma v. Intel Corporation Investment Policy Committee, the Ninth Circuit Court of Appeals held that a plaintiff’s access to documents disclosing an alleged breach of fiduciary duty did not trigger the Employee Retirement Income Security Act’s (ERISA) statute of limitations. According to the court, actual knowledge is required to start the limitations period. The plaintiff testified that he was not aware of the investments at issue or the documents disclosing the investments, therefore, he did not have sufficient knowledge of the alleged breach.

District Court in California Denies Motion to Dismiss, Finds an Independent Review Organization to Be a Functional Fiduciary Under ERISA

In Josef K. v. California Physicians’ Service, No. 18-cv-06385-YGR (U.S. District Court for the Northern District of California, June 3, 2019), Judge Yvonne Gonzalez Rogers concluded that an independent medical review (IMR) organization can be subject to a claim under the Employee Retirement Income Security Act of 1974 (ERISA) as amended, 29 U.S.C. 1132(a)(3), for breach of fiduciary duties based on the review of a medical necessity appeal under an ERISA-governed employee welfare benefit plan.


The list of the federal courts of appeals enforcing unambiguous anti-assignment provisions in ERISA health benefit plans continues to grow: almost exactly one year ago, the Third Circuit joined its sister circuits in holding “that anti-assignment clauses in ERISA-governed health insurance plans as a general matter are enforceable.” As the Third Circuit opinion noted, every circuit court to address the issue – seven to date (the First, Second, Third, Fifth, Ninth, Tenth, and Eleventh) – has reached this same conclusion of law.

Eighth Circuit Casts Doubt on Cross-Plan Offsetting for ERISA Health Plans

Employers may soon find themselves reviewing and revising health plan master documents and summary plan descriptions (SPDs) and administrative service agreements with respect to an obscure claims administration practice known as “cross-plan offsetting”—following a recent federal appeals court ruling.

Insurance Agents Properly Classified as Independent Contractors, Circuit Court Rules

The Sixth Circuit ruled that agents were properly classified as independent contractors in an Employee Retirement Income Security Act (ERISA) class action brought on behalf of thousands of current and former insurance agents in Jammal v. American Family Insurance Co., No. 17-4125 (6th Cir. Jan. 29, 2019).

PODCAST: The Life of an ERISA Claim: Know the Basics and the Pitfalls

In this podcast, Byrne Decker and Steven Silver cover need-to-know basics on the Employee Retirement Income Security Act of 1974 (ERISA), including when ERISA applies, common challenges for employers, and how ERISA claims are litigated. They also discuss issues that may come up for sports industry employers such as handling disability claims involving concussions.

Under ERISA, Ignorance Is Bliss in the Ninth Circuit

In Sulyma v. Intel Corporation Investment Policy Committee, the Ninth Circuit Court of Appeals recently held that having access to documents disclosing an alleged breach of fiduciary duty is not sufficient to trigger the three-year statute of limitations under the Employee Retirement Income Security Act (ERISA) if the plaintiff does not have actual knowledge of the alleged breach.

Is Nothing Sacred? ERISA Attacks Move From Church Plans to Government Plans

Having settled many of its attacks on pension plans sponsored by several large church-affiliated healthcare organizations, the plaintiff’s bar appears to be shifting focus to pension and welfare benefit plans maintained by a healthcare entity that is at least nominally an instrumentality of a state.

Fifth Circuit Opines on when Claims may be Properly Maintained under ERISA § 502(a)(1)(B) Versus § 502(a)(3)

The U.S. Court of Appeals for the Fifth Circuit recently addressed “the labyrinthine complexities of ERISA law and practice.” Manuel v. Turner Industries Group, LLC, et al., No. 17-30835 (5th Cir. Oct. 1, 2018). In this wide-ranging opinion, the Fifth Circuit highlighted the importance of identifying the underlying purported injury to understand whether an ERISA § 502(a)(3) claim (a claim for equitable relief) is duplicative of a claim that could have been brought under ERISA § 502(a)(1)(B) (a claim to recover benefits or enforce a right under the terms of a plan), in which case it should be dismissed.

Are You “Doing Enough” to Avoid ERISA Statutory Penalties?

Clients often are surprised to learn they are liable for ERISA statutory penalties associated with participant document requests even though they have retained an independent third party to administer their ERISA welfare benefits plans (such as disability, life, and health plans). It is fairly well established in most of the federal circuits that only the plan administrator, as defined by ERISA, can be penalized for failure to respond to document requests.

Ninth Circuit Determines Employment Agreement Does Not Require Arbitration of Certain ERISA Claims

On July 24, 2018, the Ninth Circuit Court of Appeals ruled in Munro v. University of Southern California, No. 17-55550, that an employer/fiduciary of a 401(k) plan cannot force a fiduciary breach claim under Employee Retirement Income Security Act (ERISA) section 502(a)(2) into arbitration. In the case, the named plaintiffs signed mandatory arbitration agreements as part of their employment. The employees agreed to arbitrate “all claims . . . that Employee may have against the University or any of its related entities . . . and all claims that the University may have against Employee.” The court held that these agreements only applied to claims made by or against the employees and did not require arbitration of claims made under ERISA section 502(a)(2) because such claims are made on behalf of the benefit plan and are not individual claims.

A Uniform Standard of Review in ERISA Benefit Denial Cases: The Fifth Circuit Overrules Itself to Fall in Line with Other Courts

With its en banc decision in Ariana v. Humana Health Plan of Texas,1 the Fifth Circuit reconsidered the standard of review in an ERISA denial of benefits case.

Changes to ERISA’s Disability Claims Regulations Coming April 1

New handling regulations for ERISA disability claims will go into effect on April 1, 2018, the Department of Labor (DOL) has announced. The agency confirmed that the regulations are final, without changes.

Workflex in the 21st Century Act Could Modernize ERISA With Telecommuting, Job-Sharing, and More

On November 2, 2017, U.S. Representative Mimi Walters (R-CA) introduced the Workflex in the 21st Century Act, a bill that would amend the Employee Retirement Income Security Act of 1974 (ERISA). The legislation would allow employers to create an ERISA plan, known as a qualified flexible workplace arrangement plan, to offer employees a combination of guaranteed paid leave and increased work flexibility options.

Back to School for ERISA Fiduciary Claims: How to Prepare for This Trend in University Litigation

In the past 10 years, there have been an increasing number of lawsuits asserting Employee Retirement Income Security Act of 1974 (ERISA) fiduciary claims. These have been accompanied by an increased focus by the Department of Labor (DOL) on fiduciary matters. This trend began with lawsuits against 401(k) plan fiduciaries alleging poor investment options and has evolved into lawsuits challenging not only the performance of investments offered under the plan, but also the fees associated with those investments. In addition, almost all of the more recent lawsuits examine not only the expenses associated with the investments, but all of the fees that the plan pays. They also allege that plan participants suffered losses to the value of their retirement savings.

Court Rules that Company Discretionary Offer of Voluntary Separation Agreements Does Not Create an ERISA-Covered Severance Plan

It always has been difficult to give a consistent answer as to whether informal severance arrangements have created an ERISA-covered severance plan. In Mance v. Quest Diagnostics Inc., 2017 WL 684711 (DC NJ 2017), the U.S. District Court held that Quest’s decision to provide some departing employees with severance benefits under a voluntary separation agreement (“VSA”) process was provided on such a discretionary basis that it did not establish a plan under ERISA.

Supreme Court Confirms Retirement Plans of Church-Affiliated Organizations Can be Exempt from ERISA

In a much-anticipated ruling, the U.S. Supreme Court ruled on June 5 that retirement plans maintained by church-affiliated organizations can be exempt from the Employee Retirement Income Security Act (ERISA), regardless of which organization establishing the plan. While the ruling may provide some temporary relief to church-affiliated organizations, it also reveals what is likely to be the next wave of challenges in this area of the law.

Supreme Court Decision Offers Some Relief to Church-Affiliated Nonprofits Using ERISA Church Plan Exemption

Executive Summary: The U.S. Supreme Court’s decision in Advocate Health Care Network v. Stapleton serves as a reminder to church-affiliated hospitals and other organizations using the ERISA church plan exemption to review the basis for their plans’ exemptions and their plan governance structures.

U.S. Supreme Court Finds that Retirement Plans Sponsored by Religious Hospitals Are Exempt from ERISA

The United States Supreme Court has ruled that retirement plans sponsored by church-affiliated organizations, such as hospitals, are exempt from ERISA. ERISA’s “church plan exemption” provides that a retirement plan that is “established and maintained” by a church is exempt from ERISA’s funding, participation, vesting, and disclosure requirements, among other provisions. In a unanimous decision issued on June 5, 2017, the Court ruled in Advocate Health Care Network v. Stapleton that the church plan exemption applied to the retirement plans sponsored by three separate church-affiliated hospital systems, reversing decisions by the Third, Seventh, and Ninth Circuit Courts of Appeal. The Court stated that ERISA’s statutory language does not require that a plan be established directly by a church in order for the church plan exemption to apply.

Supreme Court Rules Pension Plans of Religiously Affiliated Organizations Exempt from ERISA By René E. Thorne an

ERISA’s “church plan” exemption applies to pension plans maintained by church-affiliated organizations such as healthcare facilities, even if the plans were not established by a church, the U.S. Supreme Court has ruled unanimously, 8-0. Advocate Health Care Network et al. v. Stapleton et al., Nos. 16-74; 16-86; 16-258 (June 5, 2017). (Justice Neil Gorsuch did not participate in the decision because the case was argued before he joined the Court.)

Church-Affiliated Employers Get Win As SCOTUS Clarifies ERISA Exemption

In a unanimous 8-0 decision published today, the U.S. Supreme Court (SCOTUS) ruled that employee benefit plans sponsored by church-affiliated organizations will qualify for the “church plan” exemption under the Employee Retirement Income Security Act (ERISA) regardless of whether the plan was originally adopted or established by a church. This decision is a huge win for those church-affiliated employers such as hospitals and schools which have historically relied on the exemption from ERISA in the design and administration of their benefit programs (Advocate Health Care Network v. Stapleton).


Today, the Supreme Court handed a long-awaited victory to religiously affiliated organizations operating pension plans under ERISA’s “church plan” exemption.


On Monday, the Supreme Court heard oral argument in the consolidated “church plan” cases, Advocate Health Care Network v. Stapleton, St. Peter’s Healthcare System v. Kaplan, and Dignity Health v. Rollins.


Courts continue to be split over the availability of disgorgement and “accounting for profits” in ERISA class actions involving in-house investment plans. On March 3, 2017, in Brotherston v. Putnam Investments, LLC, No. 1:15-cv-13825-WGY (D. Mass. March 3, 2017), the court declined to resolve the dispute at the summary judgment stage, allowing the certified class of employees to move forward with their claim that the company should be forced to disgorge profits earned from defendant’s in-house 401k plan. Previously, the court denied defendant’s motion to dismiss this claim.

U.S. Supreme Court to Consider ERISA Church Plan Exemption

In a decision that may have profound consequences for the funding and continued operation of defined benefit retirement plans covering employees at religiously affiliated organizations, the U.S. Supreme Court has decided to hear consolidated appeals from the Third, Seventh and Ninth Circuits to determine the scope of the “church plan” exemption under the Employee Retirement Income Security Act (ERISA). The Supreme Court’s decision will mainly affect pension plans sponsored by religiously affiliated hospital systems, but other church-associated social service organizations and educational institutions that rely on the church plan exemption may also be impacted.

The New ERISA Claims and Appeals Regulations for Disability Benefits

The Employee Benefits Security Administration of the U.S. Department of Labor recently published final regulations governing the ERISA claims and appeals process that will apply to all claims for disability benefits filed on or after January 1, 2018. These regulations add procedural safeguards to the claims and appeals process for disability benefits, and largely track the provisions of regulations proposed in 2015.

ERISA Cyber Security Threats and the Role of Human Resources

With the increasing threat to organizations from data breaches, HR plays a critical role in helping prevent and minimize the risk from cyber theft. This podcast will address how to identify potential cyber security problems, workforce challenges in data protection, and the use of policies, training and employee education that are designed to protect private and sensitive data.

Final Regulations Issued on Application of ERISA to State-Sponsored Retirement Programs for Private Sector Employees

The U.S. Department of Labor (“DOL”) has issued final regulations allowing states to implement state-sponsored retirement plans for private sector employees without running afoul of the Employee Retirement Income Security Act of 1974(“ERISA”). In recent years, several states have adopted or proposed laws aimed at implementing state-sponsored retirement programs for private sector employees. These state-sponsored retirement programs would require private sector employers that do not maintain their own retirement plans to remit a percentage of employee wages to a state-run retirement program for employees. For example, the Illinois Secure Choice Savings Program will require employers with fewer than 25 employees to remit three percent of each employee’s pay to a state-administered savings program. A list of the other states that have created or proposed such a retirement program is available here. A threshold issue for such states has been whether ERISA would apply to the programs, which would cause the programs to be subject to complex compliance obligations under federal law.

Key Arguments in Defending a Disability Claim Based on Subjective Complaints

Courts often do not clearly articulate what are key arguments in defending an action under the Employee Retirement Income Security Act of 1974 (ERISA) involving a claim for benefits based on subjective complaints. However, the stars recently aligned and U.S. District Judge Michael W. Fitzgerald of the Central District of California did just that in Haber v. Reliance Standard Life Insurance Company, No. 14-9566, 2016 WL 4154917 (August 4, 2016). He concluded that the plaintiff Orly Haber did not prove that her upper extremity pain complaints were severe enough to preclude her from performing an occupation normally performed in the national economy for which she was reasonably suited based upon her education, training, or experience (the “any occupation” standard). This article discusses the key points made by Judge Fitzgerald. The quotes in the subheadings below are taken from Judge Fitzgerald’s opinion.

DOL Rule Imposes Significant Increases in Penalties for Employee Benefit Plan Violations

On June 30, 2016, the U.S. Department of Labor (“DOL”) issued an interim final rule that significantly increases various penalties under the Employee Retirement Income Security Act of 1974 (“ERISA”). The interim rule is the result of a 2015 amendment to the Federal Civil Monetary Penalties Inflation Adjustment Act of 1990, which required federal agencies to issue an interim final rule by July 1, 2016, that adjusts civil penalties for inflation. The amendment further requires federal agencies to continue to adjust civil penalties for inflation on an annual basis.

What Does the Supreme Court’s Spokeo Decision Mean in the ERISA Litigation Context?

ERISA practitioners should be aware of the extent to which the United States Supreme Court’s decision in Spokeo, Inc. v. Robins may touch on ERISA claims and defenses. In Spokeo, decided 6 to 2 last month, the Supreme Court addressed the issue of constitutional standing under the Fair Credit Reporting Act (“FCRA”), and our FCRA litigation practice group has commented recently on the decision. However, the Spokeo decision likely will have a unique impact in the ERISA litigation context.

"Off the Rails:" A Plan Administrator’s Burden

When an ERISA plan provides the plan administrator with discretion to interpret the terms of the plan, the administrator’s claims and appeals decisions are generally reviewed by courts under a lenient standard of review such as “abuse of discretion.” In such cases, courts generally will not upset the plan administrator’s decision absent a clear error.

Spokeo—New Hope for Defending Against ERISA Claims?

Last month, the Supreme Court of the United States issued its decision in Spokeo, Inc. v. Robins, No. 13–1339 (May 16, 2016). Spokeo involved a lawsuit brought under the Fair Credit Reporting Act of 1970 (FCRA). However, the Court’s opinion in Spokeo may create some new opportunities for defending against a broad range of claims under the Employee Retirement Income Security Act of 1974 (ERISA), including at least some types of fiduciary breach cases and perhaps even claims against plan administrators for a statutory penalty based on an alleged failure to provide copies of plan documents on request.

(Video) Collective Investment Trusts as Retirement Plan Investment Options: Important Tax and ERISA Considerations

Nexsen Pruet tax and employee benefits attorney Sue Odom says retirement plan fees and expenses have been the “hot topic” for the past several years. We’ve seen increased regulation through disclosure requirements and increased litigation.

Casting a Wider Net: Court Finds Private Equity Funds Liable for ERISA Withdrawal Liability

On March 28, 2016, a district court in Massachusetts found two private equity funds (under the Sun Capital Partners, Inc. umbrella) jointly and severally liable for withdrawal liability imposed on one of its underlying portfolio companies, even though neither private equity fund owned 80 percent or more of the portfolio company. (Ownership of at least 80 percent is a statutory threshold for determining whether a parent-subsidiary controlled group exists.) The district court issued its opinion following remand from the First Circuit Court of Appeals in 2013.

(Video) ERISA Litigation Lessons

In her new video, Sue looks at litigation lessons that have come to light as a result of an increase in ERISA-related lawsuits over the past few years.

ERISA Preemption Made Easy? Supreme Court Sends Vermont All-Payer Database Back to the Drawing Board

On the first day of decisions since the unexpected passing of Justice Scalia, the Supreme Court of the United States ventured into the thorny area of preemption under the Employee Retirement Income Security Act (ERISA) and managed to articulate a reasonably clear standard for evaluating preemption issues involving employee benefit plans. However, several members of the Court weighed in separately, either in concurrence with the majority’s decision or dissenting from it, and their conclusions suggest that ERISA’s preemption provision will continue to provide fodder for the Court’s docket for years to come.


ERISA provisions are like fruity rum drinks. A little inattention and they can sneak up on you with most unpleasant consequences.

Important Development in Dave & Buster’s Lawsuit Regarding Whether Cutting Employee Work Hours Violates ERISA

In a case of first impression that is being closely watched by plaintiffs’ attorneys and large employers alike, a federal judge recently ruled against a motion brought by Dave & Buster’s, the restaurant chain, to dismiss a proposed class action lawsuit (Marin v. Dave & Buster’s, Inc., S.D.N.Y., No. 1:15-cv-03608) alleging that the company impermissibly reduced workers’ hours to avoid its obligations under the Affordable Care Act’s employer mandate. The ACA’s employer mandate generally requires large employers to offer affordable and minimum value health coverage to its full-time employees (defined as employees who regularly work an average of at least 30 hours per week). Employers are generally not required to offer coverage to employees working an average of less than 30 hours per week.

Courts Continue To Expand ERISA Church Plan Exemption

Most employers know that there is a federal law – the Employee Retirement Income Security Act, or ERISA – that governs employer-sponsored employee benefit plans. There are a few notable exceptions that could apply to healthcare employers, however. One, in particular, has received a fair amount of attention by courts in recent years: the church plan exemption. This exemption excuses certain church-related plans both from ERISA obligations and also from certain requirements of the Internal Revenue Code.

U.S. Supreme Court Clarifies the Scope of ERISA Fiduciary Obligations in Recent Stock Drop Decision February 2, 2016

In recent years, plaintiffs’ lawyers have brought numerous ERISA breach of fiduciary duty lawsuits against employers that offer employer stock funds in their 401(k) plans. These lawsuits are typically brought on behalf of plan participants who have lost money because the value of the company’s stock has dropped. For many years, plaintiffs faced uphill battles in these so-called “stock drop” suits as most federal appellate courts adopted a “presumption of prudence” that favored plan fiduciaries’ decisions with respect to the continued inclusion of company stock in 401(k) plans. In 2014, in Fifth Third Bancorp v. Dudenhoeffer, the U.S. Supreme Court weighed in on this issue and eliminated this presumption of prudence.

Supreme Court Limits ERISA Plans' Reimbursement Rights

In Montanile v. National Elevator Industry Health Benefit Plan (January 20, 2016), the U.S. Supreme Court dealt a blow to ERISA plans that seek to recover health benefits paid to participants who sustain injuries caused by third parties.

Which Way Did Our Money Go? Supreme Court Decides ERISA Subrogation Issue

On January 20, 2016, the Supreme Court of the United States addressed the first of several ERISA-related cases on its October 2015 docket, reversing the Eleventh Circuit Court of Appeals and concluding that the trustees of the National Elevator Industry Health Benefit Plan were a day late and dollar (or more) short in their attempts to secure reimbursement for benefits provided to a participant who was injured in an automobile accident. In Montanile v. Board of Trustees of the National Elevator Industry Health Benefit Plan, the Court ventured back to a topic—subrogation and reimbursement—with which it has wrestled several times in the past to resolve a question that remarkably had been left unanswered in prior decisions: whether a health plan can be reimbursed for benefits provided to a plan participant where the participant has recovered from a third party and spent the settlement proceeds on “nontraceable items” (i.e., services or consumables). In the hands of the lower federal courts, the scope of ERISA’s “other equitable relief” remedial provision has occasionally appeared to be pliable enough to allow plan fiduciaries to recover in these circumstances, but in Montanile, the Court emphasized the restrictive nature of equitable relief under the Employee Retirement Income Security Act (ERISA) of 1974, concluding that even when the basis of a plan’s reimbursement claim is equitable and the plan participant has wrongfully dissipated settlement proceeds to which the plan is entitled as a matter of equity, the plan fiduciaries may not glom onto the participant’s general assets to make the plan whole.

Supreme Court: ERISA Plan Cannot Recover Settlement Funds That Have Been Spent

The U.S. Supreme Court has narrowed, ever so slightly, the ever-changing definition of “appropriate equitable relief” under ERISA Section 502(a)(3). In Montanile v. Board of Trustees of the National Elevator Industry Health Benefit Plan,[1] the high court addressed whether a plan fiduciary can recover medical payments made on behalf of a participant when the plan fiduciary has not identified third-party settlement funds still in the participant’s possession at the time the plan fiduciary asserts its reimbursement claim. Yesterday, the Supreme Court held in an 8-1 ruling that when a plan participant has spent — on nontraceable items such as fees for services or travel — all the settlement proceeds that could have been used to reimburse the plan, the plan fiduciary may not reach the participant’s other assets as a broader means of recovery.

DOL Proposes More Robust Claims Procedures for ERISA Disability Claims

The Department of Labor (DOL) recently issued proposed regulations that would strengthen claim procedures for disability claims made under retirement and welfare plans subject to the Employee Retirement Income Security Act of 1974 (“ERISA”). The proposed rules would apply to both retirement and welfare plans that provide benefits conditioned upon a participant’s disability. Unlike the enhanced claims procedures added by the Affordable Care Act, which apply only to non-grandfathered health plans, these proposed regulations amend ERISA’s claims regulations for all plans, and therefore appear to apply to both grandfathered and non-grandfathered health and welfare plans. Below is a summary of the major provisions contained in the proposed regulations.

ERISA Plan Can't Shrink Deadlines Without Providing Notice, Says 3rd Circuit Court of Appeals

The 3rd Circuit Court of Appeals just ruled that an ERISA plan can’t shorten the deadline for filing a legal action challenging a denial of benefits unless the participant receives written communication of the plan’s altered deadline. Mirza v. Insurance Administrator of America, Inc.

Ninth Circuit Extends ERISA Deadline, Revives Untimely Appeal

Last week, the Ninth Circuit Court of Appeals issued its opinion in LeGras v. AETNA Life Insurance Company, No. 12-56541 (May 28, 2015), holding that the 180-day period to appeal a denial of a long-term disability claim was extended to the following Monday because the last day to submit the appeal fell on a Saturday. The court concluded that "where the deadline for an internal administrative appeal under an ERISA-governed insurance contract falls on a Saturday, Sunday, or legal holiday, the period continues to run until the next day that is not a Saturday, Sunday, or legal holiday."

Revisiting Rochow: The Sixth Circuit Rejects Earlier $3.8 Million Equitable Award in Recent En Banc Decision

Just over a year ago, a panel decision by the Sixth Circuit Court of Appeals in Rochow v. Life Insurance Company of North America, 737 F.3d 415 made big news when the court upheld the district court’s award of $3.8 million in equitable relief on a theory of unjust enrichment and held that an Employee Retirement Income Security Act (ERISA) plan participant can seek disgorgement of profits from an insurer in addition to a claim for denied benefits. The Sixth Circuit later granted the petition for hearing en banc and recently vacated the earlier panel opinion.

Happy 40th Birthday, ERISA!

Today, ERISA turns 40! It is hard to believe that the Employee Retirement Income Security Act (ERISA), the law that ignited pension reform in the United States, has been around for four decades. To celebrate the law’s long, lively journey since its birth on Labor Day 1974, we have compiled some employee benefits trivia that may surprise even the most ardent ERISA-watchers (and you know who you are!).

What Happens When The Limitations Provision in the Plan As Applied Creates An Impossible Accrual Date?

Approximately six months ago, the Supreme Court of the United States, in Heimeshoff v. Hartford Life & Accident Insurance Co., 134 S. Ct. 604 (2013), addressed whether an employee benefit plan covered by the Employee Retirement Income Security Act (ERISA) may include a particular limitations period that starts to run before the cause of action accrues, that is, when the plaintiff can file suit and obtain relief. The Supreme Court held that the plan’s three-year limitations provision was enforceable and barred the employee’s judicial action under ERISA.

Life, Health, Disability and ERISA - April 2014

Life, Health, Disability, and ERISA provides a summary of decisions from across the country concerning life, health, and disability policies, including those governed by ERISA. Following your review of Life, Health, Disability, and ERISA kindly feel free to contact attorneys and co-editors with any comments you may have, or with any topics you would like to see in upcoming newsletters.

High Court Limits Timing Of Certain ERISA Claims

The U.S. Supreme Court unanimously upheld a contractual clause that limited a participant’s ability to file a lawsuit pursuant to a long-term disability (LTD) policy. The contractual limitation was three years from the date proof of loss was required. The decision confirms that there is no requirement under the Employment Retirement Income Security Act (ERISA) that such a contractual clause be based on the time period after administrative remedies are exhausted and a participant is actually able to bring a lawsuit.

Rochow v. LINA: Can it Really be True that ERISA Benefit Claimants Can Recover Millions of Dollars in Disgorged Profits?

The federal district court decision in Rochow v. Life Insurance Company of North America, No. 04-73628 (March 23, 2012) went unnoticed by most ERISA practitioners after it was issued in 2012, even though the court awarded millions of dollars in disgorged profits to a benefit claimant as appropriate equitable relief under section 502(a)(3) of the Employee Retirement Income Security Act (ERISA). Frankly, most practitioners did not take it seriously. However, now that the decision has been affirmed by the Sixth Circuit Court of Appeals in a rather incredible split decision issued on December 6, 2013, it will likely receive substantial press coverage and be roundly praised and criticized, depending on whether one represents benefits claimants or benefits plans.

Investment Funds May Face Additional ERISA Exposure Following New England Teamsters Decision

Private equity funds often invest in troubled companies, planning to turn them around and sell them at a profit. Troubled companies sometimes have underfunded pension liabilities, which can be significant, particularly in the case of multiemployer (union) pension plans. The recent case of Sun Capital Partners III LP v. New England Teamsters & Trucking Indus. Pension Fund (1st Cir., No. 12-2312, July 24, 2013) highlights the need to carefully and strategically plan whether and how to acquire companies with pension liabilities.

Life, Health, Disability and ERISA

Life, Health, Disability, and ERISA – a summary of decisions from across the country concerning life, health, and disability policies, including those governed by ERISA.

Supreme Court Forbids Rewrite Of ERISA Plan

The supremacy of a written ERISA -governed plan still reigns as the U.S. Supreme Court reversed the ruling of an appellate court which had held that a court in equity can ignore unambiguous subrogation reimbursement language, and simply rewrite the terms of an ERISA-governed plan in line with its own ideas of what was “fair and equitable.” McCutchen v. U.S. Airways.

Legal Alert: PBGC Announces Pilot Program to Target ERISA 4062(e) Enforcement Efforts to At-Risk Pension Plans

Executive Summary: The Pension Benefit Guaranty Corporation ("PBGC") has adopted a new pilot program to enforce section 4062(e) of the Employee Retirement Income Security Act ("ERISA") that targets at-risk pension plans. The change comes in response to President Obama's Executive Order No. 13563, which asked federal agencies to review existing and pending regulations for possible modification or elimination.

DOL Service Provider Fee Disclosure Regulations To Go Into Effect in Early 2012

As discussed in a previous alert, the Department of Labor (DOL) issued new rules that will require certain types of ERISA retirement plan service providers to disclose new fee information directly to plans. Since our last alert, there have been a few developments on these new rules.

Supreme Court: Plan Participants Can Recover In ERISA Actions Without Showing Detrimental Reliance

On May 16, 2011, the Supreme Court clarified the showing of harm that a participant must demonstrate in order to recover on a claim involving a Summary Plan Description (SPD) that conflicts with the terms of its underlying plan document. The Supreme Court explained that the requisite level of harm for a particular case will be dependent upon the applicable equitable theory of relief. If a plaintiff can satisfy one of the standards, it may then be rebutted by the defendant – if the defendant can demonstrate that the inconsistency was a harmless error.

High Court Rules In ERISA Case.

The U.S. Supreme Court recently handed down an opinion interpreting Section 502(g)(1) of the Employee Retirement Income Security Act (ERISA) to grant district courts discretion to award attorneys' fees to either party, not just to a prevailing party. However, the Court also ruled that a district court's discretion to award attorneys' fees is triggered only if the party applying for the fee award "achieved `some degree of success on the merits.'" The Court noted that achieving a "purely procedural victory" does not satisfy this standard.

Supreme Court Holds ERISA-Based Attorneys' Fees Available.

On May 24, 2010 the U. S. Supreme Court held that a party does not need to be a "prevailing party" in order to be eligible for an attorneys' fees award under the Employee Retirement Income Security Act of 1974 (ERISA). In reaching this decision, the Court relied on the statutory language of the applicable statute, which does not include any "prevailing party" requirement, and noted that Congress is able to impose limitations on the availability of attorneys' fees when it deems fit. Hardt v. Reliance Standard Life Insurance Company.

Supreme Court Broadens Deference Granted to ERISA Plan Administrators.

Recognizing the complexities involved in the work of benefit plan administrators, the Supreme Court ruled that administrators of ERISA plans that provide for discretionary review are entitled to deferential judicial review of their plan interpretations, even if a previous interpretation of the same plan provision was unreasonable. “People make mistakes,” the Court acknowledged in Conkright v. Frommert, as five justices, in an opinion authored by Justice Roberts, applied the deferential standard of review for ERISA plan administrators’ interpretations.

High Court Rules ERISA Plan Administrator's Interpretation Is Entitled To Deference.

On April 21, with Chief Justice John Roberts writing for the majority, the U.S. Supreme Court upheld its Firestone Tire & Rubber Co. v. Bruch standard for reviewing the decisions of plan administrators where those decisions are made following a court determination that a previous interpretation of the same plan terms was arbitrary and capricious. Under Firestone and the terms of the Xerox Corporation pension plan at issue in this case, pension plan administrators would normally be entitled to deference when interpreting the plan. The Court held that the same deference also should apply where the administrator made a good faith error in its previous interpretation. The Court reversed the Second Circuit Court of Appeals' decision crafting an exception to Firestone deference and holding that a court need not apply a deferential standard when a plan administrator's previous construction of the same plan terms was found to violate the Employee Retirement Income Security Act (ERISA). Conkright v. Frommert, No. 08–810, U.S. Supreme Court (April 21, 2010).

New Michelle’s Law Extends Coverage for Dependent College Students.

In another federal coverage mandate, employer health plans and group health insurers will be required to continue coverage for one year for any dependent college student who would otherwise lose coverage due to a medically necessary leave of absence under an amendment to the Employee Retirement Income Security Act (ERISA) that was signed by President George W. Bush on October 9.

Dual-Role Administrators, Conflicts of Interest, and ERISA’s Deferential Standard of Review.

The Employment Retirement Income Security Act (ERISA) permits a person denied benefits under an employee benefit plan the opportunity to challenge that denial in federal court. Under ERISA, if an administrator has been given discretion to determine eligibility for benefits under the terms of the benefit plan in question, federal courts can overturn eligibility determinations only if they find that the administrator has “abused its discretion.” ERISA jurisprudence has long recognized that if an administrator is operating under a conflict of interest, that conflict of interest must be weighed as a factor in determining whether the administrator’s decision to deny benefits was an abuse of discretion. When the entity that administers an employee benefit plan is also the entity that funds the plan, the courts view that as giving rise to a conflict of interest.
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