U.S. Fifth Circuit Affirms Dismissal of Claim for Disability Benefits where Loss of Eye from Fungal Infection not “Accident” under Plan

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The plaintiff traveled to West Texas twice in connection with his job, and developed a fungal infection in his right eye that was diagnosed as coccidioidomycosis. Medical providers determined that contact with a West Texas fungus caused the infection, which led to progressive loss of vision, and the ultimate removal of that eye. Disability benefits were denied based on the …

Southern District of New York Certifies (b)(1) Class Claims under ERISA for Mismanagement of 401(k) Plan

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“Defendants object to class certification under Rule 23(b)(1) as improper in the wake of the Supreme Court’s decisions in LaRue and Wal-Mart. Although courts are split over whether Rule 23(b)(1)(B) remains an appropriate class vehicle for fiduciary-breach claims under ERISA, a majority have held that it is…. “Defendants argue that, because the Supreme Court in LaRue held that §1132(a)(2) allows …

U.S. Fifth Circuit Grants Rehearing, En Banc, to Consider the Appropriate Standard of Review for Factual Determinations Where Plan Does Not Afford Administrator Discretion

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On July 10, 2017, the U.S. Fifth Circuit granted a Petition for Rehearing, En Banc, to consider the panel’s decision in Ariana M. v. Humana, 854 F.3d 753 (5th Cir. 2017), affirming the denial of medical benefits to a plan beneficiary who had been hospitalized due to serious mental health conditions.  Applying an abuse of discretion standard of review under the Circuit’s …

U.S. Fifth Circuit Affirms Order to Reimburse Plan and to Pay Attorneys Fees, Rejecting Participant’s Challenge to ERISA’s Written Instrument Requirements

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Rhea was the beneficiary of an employee benefit plan who suffered injuries from medical malpractice. The plan covered some of her medical expenses, and, after she settled the malpractice claim, sought reimbursement.  Rhea refused to reimburse the plan, claiming that it did not have an enforceable written instrument.  The court, on report and recommendation of the presiding Magistrate Judge, held that …

Fifth Circuit Throws Out ERISA Suit against BP over 2010 Spill

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On interlocutory appeal, the U.S. Fifth Circuit Court of Appeals reversed the denial of BP’s Rule 12 Motion to Dismiss the Amended Complaint of BP pension plan stockholders for breach of fiduciary duty. “In Fifth Third, the Supreme Court stated that the plaintiff’s proposed alternative must be one that ‘a prudent fiduciary in the same circumstances would not have viewed …

Eastern District of North Carolina Certifies Class and Grants Summary Judgment under ERISA on Unpaid Contributions

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Participants filed a putative class action against Trojan Horse and Glen Burnie Hauling for failing to make deposits into their defined contribution 401(k) plan, despite having continued to make such deductions and withholdings from plaintiffs’ wages.  The plaintiffs also joined Ascensus Trust, and sought summary judgment on fiduciary status and breach. The Court found that “the unpaid Plan contributions are …

U.S. Fifth Circuit Allows Action Against Parent Company for Alleged Breach of Voluntarily Assumed Duties

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Following the purchase of Acme Building Brands by Berkshire Hathaway, Acme reduced its contributions to Acme’s 401(k) plan, allegedly due to pressure from the new parent company, Berkshire Hathaway Get More Information. While the U.S. Fifth Circuit affirmed the dismissal of breach of fiduciary duty claims against Berkshire Hathaway and all ERISA claims against Acme, the Court reversed the District …

U.S. Fifth Circuit Affirms Denial under Active Serviceman Exclusion not in SPD

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Plaintiff purchased life insurance for herself and her husband through her employer, UPS. Her husband was an active-duty soldier in the United States Army. He was killed in a weekend motorcycle accident while off base and not on duty. Prudential denied his widow’s claim pursuant to an exclusion for active-duty servicemen. The district court granted summary judgment for Prudential and …

Fifth Circuit Affirms Breach of Fiduciary Duty regarding ESOP Transactions

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Bruister and Associates, Inc. was a home service provider that installed and serviced satellite television equipment for a sole client, DirecTV. It set up an employee stock ownership plan (ESOP) for its employees. In a three-year period from 2002 to 2005, Bruister’s owner, Herbert C. Bruister, sold 100% of his shares (also representing 100% of the company’s outstanding shares) to …

U.S. Supreme Court Holds that ERISA Preempts State Reporting Requirements for Insurance Companies

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Vermont’s law requires health insurers, health care providers, health care facilities, and governmental agencies to report any “information relating to health care costs, prices, quality, utilization, or resources required” by the state agency, including data relating to health insurance claims and enrollment. Health insurers must submit claims data on members, subscribers, and policyholders. The Vermont law defines health insurer to …