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Court Permits Claims to Proceed Against ERISA Fiduciaries Related to Pension Benefit Misstatements

"this case is about a plan participant who was successful in defeating two motions to dismiss ERISA and state-law claims based on defendants' misrepresentations in overstating his pension benefits, misstatements on which the participant specifically relied in deciding to accept a severance package ending his long-term employment[.]" [Wallace v. Int'l Paper Co., No. 20-2478 (W.D. Tenn. Dec. 23, 2020)]

District Court Says Objective Evidence Is Not Necessary to Prove Disability

"In evaluating the evidence, the court rejected Aetna's argument that objective evidence was necessary to prove disability.... The court also discounted the opinions of Aetna's reviewing physicians. Judge Fischer acknowledged that she was not required to give deference to treating physicians, but found Plaintiff's treaters more credible." [Myers v. Aetna Life Ins. Co., No. 19-9555 (C.D. Cal. Dec. 17, 2020)]

District Court Orders Expansive Remedies in Class Actions Challenging Insurer's Processing of Mental Health Claims

"[T]he court found that [United Behavioral Health (UBH)] had long breached its fiduciary duties to the class members and as a result, 'each and every adverse benefit determination' within the class should be remanded to UBH for reprocessing under the manners consistent with the FFCL -- and all at UBH's expense, including the payment of interest. The court further concluded that class members had the right to submit new and additional information that supported their claim for benefits." [Wit v. United Behavioral Health, Nos. 14-2346, 14-5337 (N.D. Cal. Nov. 3, 2020)]

District Court Permits Retirees' Breach of Fiduciary Duty Claim Based on Misrepresentation of Lifetime Health Benefits

"Plaintiffs brought a claim for breach of fiduciary duty ... based on Defendants' misrepresentations that Plaintiffs' retiree benefits would vest for life once they reached the equated service date, as Plaintiffs alleged that Defendants fraudulently induced Plaintiffs into continuing their employment to their detriment as a result. The court ... denied Defendants' motion to dismiss this cause of action." [Fitzwater v. Consol Energy, Inc., No. 17-3861 (S.D.W. Va. Oct. 22, 2020)]

Eleventh Circuit Holds NFL Retirement Plan Abused its Discretion by Failing to Consider Evidence and Combined Effects of Plaintiff's Impairments

"Although the court found that the Board did not err in interpreting and applying the Plan's disability definition which only required that a player be able to work in any occupation earning up to $30,000 per year, it found that the Board did err in evaluating Plaintiff's medical information. The court reasoned that the Board claimed it had reviewed Plaintiff's entire file, however, the minutes of the Board's meeting did not include all medical records submitted, nor did the decision letter discuss evidence submitted by Plaintiff." [Mickell v. Bert Bell/Pete Rozelle NFL Players Retirement Plan, No. 19-10651 (11th Cir. Oct. 15, 2020; unpub.)]

Eighth Circuit Jettisons Prior Circuit Precedent Holding That Procedural Irregularities Can Justify a De Novo Standard of Review

"[A recent Eighth Circuit] decision ... clarified that when circumstances demand 'less deferential review,' this cannot mean de novo review.... [The panel ruled that] when faced with conflicting panel opinions, the law dictated the earliest opinion controlled. Thus, because 'all of our precedents' mischaracterized the [1998 holding in Woo v. Deluxe Corp.], it was Woo rather than the subsequent cases misstating (or misapplying) the holding in Woo that controlled. The review could not be de novo, but an abuse of discretion standard analysis that took into consideration the procedural irregularity." [McIntyre v. Reliance Standard Life Ins. Co., No. 19-2367 (8th Cir. Aug. 25, 2020)]

Eleventh Circuit Affirms Denial of Special Early Retirement Benefits to Factory Workers Following Sale of Employer by Parent Company

"Appellants claim they are entitled to [special early retirement] benefits after Mueller Group, LLC, the former parent company of U.S. Pipe, which employed them, sold its interest in U.S. Pipe to USP Holdings. Upon the sale, Appellants kept their same jobs at the same plant; the Bessemer plan never shut down.... The court rejected Appellants' 'metaphysical argument' that they were laid off because they lost their jobs with Mueller even though they kept their jobs at the Bessemer plant." [Hill v. Employee Benefits Admin. Comm. of Mueller Grp. LLC, No. 18-14026 (11th Cir. Aug. 24, 2020)]

Finding No ERISA Preemption, Third Circuit Revives Out-of-Network Provider Claims Against Aetna

"[At issue was the] remedy an out-of-network medical care provider has when an insurer ... [agrees] to pay reasonable rates for services that are not covered in the ERISA benefit plan ... only to later refuse to pay the provider's invoices.... The Third Circuit determined that the Surgery Center's causes of action for breach of contract and equitable estoppel did not 'reference' an ERISA plan because the side agreement does not require interpretation or analysis of the plan terms.... The Surgery Center's claims for breach of contract and equitable estoppel were also found not to have a 'connection' to any ERISA plan." [The Plastic Surgery Center., P.A. v. Aetna Life Ins. Co., No. 18-3381 (3d Cir. Jul. 17, 2020)]

In Life Insurance Coverage Dispute, a District Court Goes Against the Tide in Favor of Equitable Remedies

"The confusing nature of the pleadings aside, the Court's decision seems at odds with the recent trend in ERISA cases. All the relevant information was in the hands of the plan sponsor. Premiums were paid. Coverage was confirmed. Yet no liability was found." [Staropoli v. Metropolitan Life Ins. Co., No. 19-2850 (E.D. Penn. Jun. 8, 2020)]

When Does Fraud Not Mean Fraud? Second Circuit Further Educates Us About Equitable Remedies

"This week, the Second Circuit ... went back only 60 years to cite cases explaining that, in a court of equity, 'fraud' does not mean what you were taught in law school. Fraud has a broader meaning in equity than at law. The intention to defraud or to misrepresent are not a necessary. Rather, 'fraud' in a court of equity properly includes all acts, omissions, and concealments which involve a breach of legal or equitable duty, trust, or confidence, 'justly reposed, and are injurious to another.' You get this education for free. For Verizon, it might cost them $571,200 plus attorneys' fees and costs. Why?' [Sullivan-Mestecky v. Verizon Communications Inc., No. 18-1591 (2nd Cir. June 1, 2020)]