"This decision reinforces that ERISA fiduciaries may face liability not only for misleading statements, but also for silence, where they possess specific knowledge that a participant is terminally ill or permanently disabled and at risk of losing valuable coverage. While routine, accurate plan communications may satisfy ERISA's baseline disclosure requirements, they may be insufficient in 'special circumstances' requiring affirmative disclosure of critical benefit protections." [Atkins v. Prudential Ins. Co. of Am., No. 25-2912 (N.D. Ga. Jan. 12, 2026)] MORE >>
"Although the plaintiff alleged that an accident in 2019 ultimately caused permanent blindness in one eye in 2023, the court held that the policy unambiguously required the physical loss to occur within 365 days of the accident. Because more than four years separated the alleged accident and the loss of vision, the court ruled that the plaintiff could not state a cognizable claim for benefits under ERISA Section 502(a)(1)(B) and granted MetLife's motion to dismiss." [Camardelle v. Metropolitan Life Ins. Co., No. 25-1382 (E.D. La. Dec. 19, 2025)] MORE >>
"If EOI is required, coverage does not exist until it is approved. However, courts often are unforgiving to employers when an EOI failure surfaces after death or disability, thus opening risk to breach of fiduciary duty claims or equitable relief. Plan administrators that proactively manage EOI and communicate clearly can avoid costly disputes when it matters most." MORE >>
"The Social Security Administration maintains the only federal database that insurers are required to periodically check for deaths. Issues with the database, however, have resulted in millions of families risking delayed or lost life insurance benefits." MORE >>
"The court found no evidence that any employer created, sponsored, or administered an ERISA plan. Instead, the record showed four individual life insurance policies purchased by individuals associated with a business, each naming the business as beneficiary. Under either version of ownership advanced by the plaintiff -- sole ownership or equal co-ownership -- the arrangement failed to satisfy ERISA's requirement that an employer establish or maintain a plan for the purpose of providing benefits to employees." [Aikens v. Colonial Life & Accident Ins. Co., No. 24-0580 (W.D. La. Dec. 11, 2025)] MORE >>
"For the second consecutive quarter, workplace life insurance premium rose year over year, overcoming a shaky start in the first quarter. In the third quarter of 2025, workplace life insurance new premium increased 9% to $691 million. In the first nine months of 2025, workplace life insurance new premium was $3.38 billion, down just 3% from last year's results. Despite the decline, a majority of carriers reported gains,with the top 10 companies generating 64% of the sales." MORE >>
"End of year is a great time to review and prepare for upcoming compliance deadlines related to your group health plan offerings. Here's what you need to know to prepare for a new year: [1] [ACA] ... [2] Gag clause attestation ... [3] Internet price comparison tool ... [4] Plan document updates ... [5] Nondiscrimination testing ... [6] Life insurance imputed income." MORE >>
"In the first nine months of 2025, new annualized premium totaled $12.7 billion, up 12% over the prior year. Policy count rose 6% year to date (YTD)." MORE >>
"The case ... underscores the broad discretion ERISA plan administrators hold in interpreting plan terms and determining beneficiaries.... Plan terms ... control the distribution of ERISA benefits. Even a common-law marriage finding under state law does not override a plan's definition of 'Domestic Partner.' " [Metropolitan Life Ins. Co. v. Wallace, No. 24-1520 (N.D. Tex. Oct. 22, 2025)] MORE >>
"This report updates the maximum statutory valuation rate and nonforfeiture interest rate for calendar year 2026 issues of life insurance products and the maximum statutory valuation interest rates for calendar year 2025 issues of annuity products." MORE >>
"[W]ith regards to the supplemental insurance claim, the court said that the employer's knowledge of the employee's condition ... created an affirmative duty to inform. None of the employer's communications with the employee and his spouse clearly communicated that a $400,000 supplemental policy was in force and also required conversion. [The court] ruled that if 'the written materials are inadequate, then the fiduciaries themselves must be held responsible for the failure to provide complete and correct material information.' " [Erban v. Tufts Medical Center, No. 22-11193 (D. Mass. Aug. 12, 2025)] MORE >>
"In the second quarter of 2025, total workplace life insurance new premium ticked up 1% year over year to $666 million. Year to date (YTD), total workplace life insurance new premium was $2.65 billion, down 7% from the same period in 2024.... Total workplace disability insurance new premium was $618 million in the second quarter of 2025, a 3% increase year-over-year. In the second quarter, short-term disability insurance new premium grew 7% and long-term disability insurance premium fell 3%." MORE >>
"[The District Court] granted a preliminary injunction preventing beneficiaries from pursuing claims in the Cheyenne River Sioux Tribal Court over disputed life insurance proceeds. The court held that because the benefits arose under an ERISA-governed plan, federal jurisdiction was exclusive and tribal courts lacked authority to adjudicate the dispute." [Metropolitan Life Ins. Co. v. Mundahl, No. 24-3029 (D.S.D. Sep. 19, 2025)] MORE >>
"Kimberly admitted she initialed the distribution terms and didn't claim fraud or any mutual legal mistake. Her objections didn't challenge the substance of the deal -- just side issues. So the court found the agreement binding.... Once material terms are clear, they're enforceable, ... The court didn't hesitate to sanction Kimberly via fee-shifting.... Lawyers aren't helpless just because they withdraw -- they're still owed fair compensation under quantum meruit." [Bennett v. The Prudential Ins. Co. of Am., No. 23-11070 (E.D. Mich. Aug. 26, 2025)] MORE >>
"How to be generous -- safely ... [1] Coordinate with legal and tax advisors before offering anything outside your standard policies. [2] Document the intent and structure of any payments. [3] Communicate clearly.... [D]evelop a formal process/checklist based on your employee population to help HR and payroll teams stay compliant, compassionate, and clear-headed." MORE >>
"[T]he court addressed whether Tufts Medical Center and its HR director breached their fiduciary duties under ERISA when they failed to advise [the doctor] and his widow ... of the option to continue his life insurance coverage following his terminal cancer diagnosis. The ruling offers important guidance on fiduciary obligations of plan administrators and HR personnel, particularly in situations where beneficiaries face life-altering illnesses." [Erban v. Tufts Med. Ctr. Physicians Org., Inc., No. 22-11193 (D. Mass. Aug. 12, 2025)] MORE >>
"When an employee passes away, employers are suddenly faced with a tangle of legal, tax, and benefits questions that don’t come up in your average HR handbook. Who gets the final wages? What about that bonus they were about to earn? Can we offer extra support to the family without triggering a tax nightmare? ... What happens to PTO, health insurance, retirement plans, and other benefits? ... The generous employer’s dilemma." MORE >>
"[T]he court found that MetLife reasonably determined that Troy's coverage terminated six months after he ceased active work, as defined by the plan. The court emphasized that Cleveland-Cliffs' support of the claim did not bind MetLife or override its policy interpretation.... [T]he court found no evidence that MetLife was even aware that Troy's coverage had lapsed, as Cleveland-Cliffs had continued paying premiums and apparently misinterpreted the policy. Without notice of the lapse, no duty to notify of conversion rights had yet been triggered on MetLife's part." [New v. Metropolitan Life Insurance Company, No. 24-0212 (S.D. W.Va. Aug. 7, 2025)] MORE >>
"The court found that EMC Corp., acting as an ERISA fiduciary, failed to meet its duty of care by not adequately informing a former employee about the need to convert their group life insurance coverage after employment ended. The Court found that although EMC Corp. had provided standard plan documents to the former employee, its response to the employee's direct inquiry lacked the clarity and completeness required under ERISA, ultimately leading to a loss of coverage and benefits." [Watson v. EMC Corp., No. 19-2667 (D. Colo. May 7, 2025)] MORE >>
"Minnesota Life later denied the beneficiaries' claim for the group policy benefit, asserting that DiNicola had lost eligibility when she resigned and that the previous confirmations of coverage were clerical errors.... The court found that Minnesota Life acted as a fiduciary when it repeatedly communicated to DiNicola that her group policy coverage remained intact.... Similarly, the court found that plaintiffs plausibly alleged an equitable estoppel claim under ERISA." [Fleming v. Minnesota Life Insurance Co.., No. 23-2558 (E.D. Pa. Jul. 29, 2025)] MORE >>
"Forfeitures cases proceed with mixed results & DOL weighs in.... Health insurer's alleged overcharges with 'flip logic' approach revived.... Incomplete email leaves employer responsible for lapsed $663,000 life insurance payout." MORE >>
"Group life is the redheaded stepchild of employee benefits, often added on by insurers on top of the primary products being sold to plan sponsors and employers, such as disability insurance.... [P]roblems tend to crop up in the administration of group life plans and in the payment of claims due to nothing more than the lack of attention that comes with being a relative afterthought." [Edwards v. Guardian Life Ins. of Am., No. 24-60381 (5th Cir. June 20, 2025)] MORE >>
"The employer here did many things right. They sent all the appropriate notices to the former employee and had proof of those mailings. They also responded to the former employee's request when it was made. However, this case is an example of just how far the duty of prudence may reach. The Court determined that the employer was expected to communicate thoroughly and with foresight, not just with a basic answer to the question posed." [Watson v. EMC Corp., No. 19-2667 (D. Colo. May 7, 2025)] MORE >>
"The court explained that although Guardian’s right to cancel vested in November of 2019, there was “a conspicuous 10-month gap between that date and when Guardian started ‘temporarily suspending’ plan cancellation in September 2020 due to COVID.” Furthermore, after its right to cancel vested, Guardian continued to accept 26 months’ worth of premiums." [Edwards v. Guardian Life Ins. of Am., No. 24-60381 (5th Cir. June 20, 2025)] MORE >>
"Though the business had only one employee when Pamela died, the court found that Allure's prior staffing history, payroll practices, and Pam's managerial control met ERISA's threshold for a covered employee benefit plan.... While Guardian did have contractual discretion to cancel coverage when participation fell below two employees, the court held that Guardian waived this right by continuing to accept premiums for more than two years after the right to cancel vested in November 2019." [Edwards v. Guardian Life Ins. of Am., No. 24-60381 (5th Cir. June 20, 2025)] MORE >>
