In Brown v. Rawlings Financial Services, LLC, Docket No. 16-3748 (2nd Circuit 2017), a participant in a healthcare benefit plan covered by ERISA requested documents pertaining to her plan but did not receive them promptly. She sought statutory damages pursuant to ERISA Section 502(c)(1), which imposes personal liability on ERISA plan administrators that fail to provide plan documents to participants within thirty days of a request. On motion, the United States District Court for the District of Connecticut dismissed the suit as untimely, applying Connecticut’s one-year statute of limitations for actions to recover civil forfeitures, and the plaintiff failing to file her claim within the one-year period.

Since ERISA does not specify a statute of limitations for Section 502(c)(1) claims, courts apply the state statute of limitations that is the nearest analogue. On appeal, Brown argued that the proper statute of limitations is either Connecticut’s six-year statute of limitations for breach of contract, or the three-year statute of limitations for violations of the Connecticut Unfair Trade Practices Act (“CUTPA”) and the Connecticut Unfair Insurance Practices Act (“CUIPA”).

Upon reviewing the case, the Second Circuit Court of Appeals (the “Court”) said that it agreed with the district court that Connecticut’s civil forfeiture statute of limitations (with its one year filing period) provides the appropriate limitations period, and because the plaintiff filed her complaint more than one year after her claim accrued, the Court affirmed the district court’s dismissal.

In Mackey v. Johnson, No.16-1886 (8th Cir. 2017), Terri Johnson (“Johnson”) brought a wrongful-death action against the Duluth Clinic (the “Clinic”), alleging that the Clinic was negligent in its treatment of the lung cancer of her brother, Tim Scherf (“Scherf”). Scherf was a participant in the Minnesota Laborers Health and Welfare Fund (the “Fund”), and the Fund paid for his medical treatment. Johnson settled her claim with the Clinic. The Fund then sued Johnson, her legal counsel Meshbesher & Spence (“Meshbesher”), and the Clinic under ERISA § 1132(a)(3). The Fund alleged that it had a right to a portion of the settlement with the Clinic attributable to medical expenses. The district court agreed, on the grounds that the Fund was entitled to the medical expenses included in the settlement proceeds under the terms of the Fund document and a subrogation agreement that Johnson and a Meshbesher attorney had signed. It granted summary judgment for the Fund in the amount of $236,700.16.

On appeal, Johnson and Meshbesher challenged the district court’s ruling. However, the Eighth Circuit Court of Appeals (the “Court”) rejected their arguments, since the settlement agreement included medical expenses and the subrogation agreement applied to “any recovery” (as opposed to expenses incurred due to the Clinic’s negligence).  Accordingly, the Court affirmed the district court’s judgment.

 

In Dakotas and Western Minnesota Electrical Industry Health & Welfare Fund v. First Agency, Inc. ,  Dockets: 16-1846, 16-3319, 16-3375 (8th Cir. 2017), Jacob Plassmeyer incurred medical expenses after injuring his knee during a collegiate baseball practice in February 2014. Jacob’s college provided its student athletes insurance covering accidental injuries under a blanket policy issued by First Agency, Inc., as appointee of Guarantee Trust Life Insurance Company (collectively referred to as “FA”). Jacob’s father is also an insured participant in the Dakotas and Western Minnesota Electrical Industry Health and Welfare Fund (“Dakotas”), an employee welfare benefit plan. Jacob is covered under this ERISA plan as a dependent of his father. Jacob timely filed claims with both insurers. Though it is undisputed his baseball injuries are covered by both policies, both insurers refused to pay. FA claimed that Dakotas must pay first because FA’s policy is “excess only.” Dakotas claimed that, under the plan’s coordination of benefits (“COB”) provision, FA’s coverage is primary. Jacob’s claim remains unpaid.

 

The trustees of  Dakotas brought this declaratory judgment action against FA under § 502(a)(3) of ERISA, seeking an order enforcing the COB provisions in the Dakotas plan by declaring that FA’s policy provides primary coverage of Jacob’s claim for medical expenses already incurred. The district court  denied FA’s motion to dismiss and granted Dakotas’ motion for summary judgment, concluding that (i) § 502(a)(3) allows ERISA plan trustees to bring a declaratory judgment action to determine the extent of the plan’s liability, and (ii) under the plan’s COB provision FA has primary responsibility for Jacob’s covered medical expenses. FA appeals those rulings. Reviewing de novo, the Eighth Circuit Court of Appeals affirmed the district courts’ rulings.

In Mull v. Motion Picture Industry Health Plan, No. 15-56246 (9th Cir. 2017), a panel of the Ninth Circuit Court of Appeals (the “Panel”) vacated the district court’s grant of summary judgement in favor of the plaintiffs in an ERISA action.

The district court had enjoined an ERISA plan and its board of directors from enforcing Summary Plan Description provisions regarding reimbursement of benefits previously paid upon a plan participant’s receipt of a third-party recovery. The district court had ruled that these reimbursement/recoupment provisions were not enforceable under ERISA because they were found only in the Summary Plan Description and not in any document that constituted the ERISA plan.

The Panel concluded that a Motion Picture Industry Plan Agreement and Declaration of Trust, along with the Summary Plan Description, together comprised the ERISA plan because only the Summary Plan Description provided the basis on which payments were made to and from the plan. Hence, since the Summary Plan Description is part of the plan,  the reimbursement provisions (often referred to as a “subrogation provisions”) in the Summary Plan Description could be enforced. The Panel distinguished CIGNA Corp. v. Amara, 563 U.S. 421 (2011), which held that summary documents do not constitute the terms of an ERISA plan when there exists both a governing plan document and a summary plan description as separate documents. The Panel vacated the district court’s grant of summary judgment and remanded for further proceedings.

In Pasternack v. Shrader, Docket Nos. 16-217 (Lead), 16-218 (Con) (2nd Cir. 2017), retired officers of Booz Allen Hamilton (“Booz Allen”) allege that they received insufficient payment in connection with Booz Allen’s sale of a division to another company. They sue Booz Allen and others in the United States District Court for the Southern District of New York, asserting liability under ERISA,  the Racketeer Influenced and Corrupt Organizations Act (“RICO”), federal securities law, and common law. Each claim was resolved adversely to plaintiffs, either by dismissal or by denial of leave to amend.

Upon review by the Second Circuit Court of Appeals (the “Court”), the Court affirmed the district court’s dismissal of the ERISA claims because the plan through which Booz Allen distributed its stock to plaintiffs is not an employee pension benefit plan within the meaning of ERISA. The plan did not provide retirement income or defer income until or termination of employment, as required for a plan to be subject to ERISA, as the dominant benefits were the ownership stake in the enterprise and the corresponding rights of management—and these rights were exercised before retirement and ended with the retirement process.

In Williby v. Aetna Life Insurance Co., No. 15-56394, (9th Cir. 2017), a panel of the Ninth Circuit Court of Appeals (the “Panel”) vacated the district court’s judgment in favor of the plaintiff in an action under ERISA, challenging the termination of short-term disability benefits. The plan administrator had terminated the benefits, finding that the plaintiff was not disabled.

The Panel held that the district court erred by reviewing the denial by the plan administrator of the plaintiff’s benefits claim de novo, rather than for an abuse of discretion. The short-term disability plan included a discretionary clause, and thus by its terms called for abuse of discretion review. The Panel held that California Insurance § 10110.6, which invalidates such discretionary clauses in insurance plans, applied even though the disability plan was self-funded. ERISA, however, preempted § 10110.6 insofar as it applied. The Panel remanded for the district court to review the benefits denial under the correct (abuse of discretion) standard.

In the case of In Re: George W. Mathias, No. 16-308 (7th Cir. 2017), a mandamus petition raised a question of first impression in the Seventh Circuit: Does ERISA’s venue provision, 29 U.S.C. § 1132(e)(2), preclude enforcement of a forum-selection clause in an employee-benefits plan? George Mathias, the plan beneficiary and mandamus petitioner here, argues that it does; the Secretary of Labor, as amicus curiae, supports that interpretation. The respondent health plans argue that § 1132(e)(2) is permissive only and does not invalidate a forum-selection clause contained in plan documents.

Only one circuit has addressed this question. The Sixth Circuit has held that an ERISA plan’s forum-selection clause is enforceable even if it overrides the beneficiary’s choice of a venue permitted by § 1132(e)(2). Smith v. Aegon Cos. Pension Plan, 769 F.3d 922, 931-34 (6th Cir. 2014), cert. denied, No. 14-1168 (Jan. 11, 2016). The court reasoned that because the statute is phrased in permissive terms—it states that a suit “may be brought” in one of several federal judicial districts—it does not preclude the parties from contractually channeling venue to a particular federal district. Id. at 932. The Seventh Circuit Court of Appeals said that it agrees, and joins the Sixth Circuit in holding that ERISA’s venue provision does not invalidate a forum-selection clause contained in plan documents.

 

In Studer v. Katherine Shaw Bethea Hospital, No. 16-3728 (7th Cir. 2017), Katherine Shaw Bethea  Hospital  is a not-for-profit healthcare provider in Dixon, Illinois. Heather Studer worked at the hospital as an occupational therapist until she resigned. After she resigned, she filed a small-claims complaint in Illinois state court, alleging that the hospital violated certain provisions of the Illinois Wage Payment and Collection Act (“IWPCA”) by failing to pay her money that she had accrued under the hospital ‘s Paid Days Leave policy. The hospital removed the suit to federal court, claiming that Studer’s claim was completely preempted by ERISA.

Studer then filed a motion to remand her suit to state court, challenging the hospital’s preemption claim and asserting that the district court did not have jurisdiction over her state-law claim; the hospital  filed a motion for summary judgment. The district court denied Studer’s  motion to remand, holding that it had federal-question jurisdiction because ERISA completely preempted the state-law claim. The court then granted the hospital’s motion for summary judgment, holding that Studer had failed to name the welfare benefit plan as a defendant, which ERISA requires in most instances. In granting the motion, the court permitted  Studer to file an amended complaint naming the appropriate defendant and to issue summons.

But instead of filing an amended complaint, Studer filed a Rule 59(e) motion to alter or amend the judgment, again arguing that ERISA did not completely preempt her claim. The district court denied that motion, and this appeal followed. On appeal, Studer again contends that her IWPCA claim was not completely preempted by ERISA. The Seventh Circuit Court of Appeals agreed with the district court, that ERISA completely completely preempted the claim with its expansive preemptive power, and affirmed the district court’s ruling.

 

In Osberg v. Foot Locker, Inc., Docket No. 15-3602-cv (2nd Cir. 2017), the defendants, Foot Locker, Inc. and Foot Locker Retirement Plan (together, the “Defendants”), appeal from a judgment entered by the district court.

Following a two week bench trial, the district court held that the Defendants violated §§ 102 and 404(a) of ERISA by, among other things, failing to disclose “wear-away” caused by the Company’s introduction of a new employee pension plan – a phenomenon which effectively amounted to an undisclosed freeze in pension benefits.  Drawing on its equitable power under § 502(a)(3) of ERISA, the district court ordered reformation of the plan to conform to plan participants’ reasonably mistaken expectations, which the district court found to have resulted from the Defendant’s materially false, misleading, and incomplete disclosures. On appeal, the Defendants do not challenge the district court’s determination that they  violated ERISA.  Instead, they quarrel with the district court’s award of equitable relief under § 502(a)(3), advancing several arguments.  Upon analyzing the case, the Second Circuit Court of Appeals (the “Court”) rejected the Defendants’ challenges to the district court’s award of equitable relief and affirmed the district court’s judgment.

In so acting, the Court held that the district court did not err in: (i) rejecting the Defendants’ position that the plaintiff’s claims were time-barred (the §102 claims were filed on a timely basis after the plaintiffs learned about the “wear-away”, and the §404(a) claims were filed timely, having been filed within the 6 year period of ERISA section 413 for claims of fraud or concealment ); (ii) ordering class-wide relief on participants’ section 404(a) claims without requiring individualized proof of detrimental reliance (noting that neither the statutory text of § 404(a) nor the equitable remedy of reformation requires a showing of detrimental reliance); and (iii) concluding that mistake, a prerequisite to the equitable remedy of reformation, had been shown by clear and convincing evidence as to all class members, based on the Defendant’s arguments and the record as a whole. Finally, the Court found that the district court did not abuse its discretion or make a clear error of law by awarding equitable relief.

In Cooper v. Metropolitan Life Insurance Company, No. 16-3429 (8th Cir. 2017), Michelle Cooper  (“Cooper”) had brought this action pursuant to ERISA section 502(a)(1)(B), claiming that Metropolitan Life Insurance Company (“MetLife”) improperly denied her long term disability (“LTD”) benefits under a group insurance plan sponsored by her former employer, Anheuser-Busch Companies, LLC (“Anheuser-Busch”). The district court entered summary judgment in favor of MetLife, finding that there was no abuse of discretion. Cooper now appeals from that decision, arguing that the court erred in applying an abuse of discretion standard of review to MetLife’s decision, and that it improperly excluded two physician’s affidavits from the record. Alternatively, Cooper contends that MetLife abused its discretion in denying LTD benefits.

Upon reviewing the case, the Eighth Circuit Court of Appeals (the “Court”) found no error by the district court. The Court said that Cooper presented no evidence of a  conflict of interest, or other indicia of biased decision making, by MetLife. Further, found the Court, the district court did not err by excluding the two affidavits from the record. Finally, the Court found that MetLife did not abuse its discretion by denying LTD benefits to Cooper where MetLife properly considered all medical records, APS reports, comments, and other information submitted by Cooper and her physicians.  Accordingly, the Court affirmed the district court’s summary judgment.