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U.S. Court of Appeals for the Ninth Circuit Gives San Francisco Health Plan a Boost

Excerpt: A federal appeals court boosted San Francisco's hopes [yesterday] of reviving its plan to extend health coverage to all uninsured residents and make employers share the cost. Members of a three-judge panel of the Ninth U.S. Circuit Court of Appeals made it clear they thought U.S. District Judge Jeffrey White was on shaky ground last week when he struck down a key funding provision of the health program, which would require medium and large companies to offer insurance to their workers or pay a fee to the city.

Edison 401(k) Fees Case Will Be Reheard by the Ninth Circuit

"In April, the U.S. Court of Appeals for the Ninth Circuit entered what looked like the final chapter in the Edison 401(k) saga, when a three-judge panel ruled that the Edison workers who sued over the company's 401(k) fees forfeited their claim that plan fiduciaries failed to monitor these fees. The court announced on Aug. 5 that this decision will be reheard in front of a full panel of Ninth Circuit judges." [Tibble v. Edison Int'l, No. 10-56406 (9th Cir., order granting en banc rehearing Aug. 5, 2016)]

Text of Supreme Court Opinion Finding Ninth Circuit Had No Jurisdiction to Hear Appeal from District Court's Decision That California Prop. 8 Is Unconstitutional (PDF)

5-4 decision; opinion written by Justice Roberts; dissenting are Justices Alito, Kennedy, Sotomayor and Thomas. Excerpt: "We have never before upheld the standing of a private party to defend the constitutionality of a state statute when state officials have chosen not to. We decline to do so for the first time here. Because petitioners have not satisfied their burden to demonstrate standing to appeal the judgment of the District Court, the Ninth Circuit was without jurisdiction to consider the appeal. The judgment of the Ninth Circuit is vacated, and the case is remanded with instructions to dismiss the appeal for lack of jurisdiction. " [Hollingsworth v. Perry, No. 12-144 (U.S. June 26, 2013)]

Opt-Out Payments Can Create Overtime Liability in the Ninth Circuit

"If you are an employer within the jurisdiction of the Ninth Circuit Court of Appeals and offer cash payments to employees who opt out of group health coverage ('opt-out payments'), what you don't know about the court's 2016 opinion in Flores v. City of San Gabriel may hurt you. Specifically, the Ninth Circuit court held that opt-out payments had to be included in the regular rate of pay used to calculate overtime payments under the federal Fair Labor Standards Act (FLSA). In May 2017 the U.S. Supreme Court declined to review the opinion, making it controlling law within the Ninth Circuit[.]"

Text of Ninth Circuit Opinion Reversing District Court Order for Reprocessing of Claims and Partially Denying Class Certification (PDF)

37 pages. "[T]he district court did not err in certifying three classes to pursue the fiduciary duty claim. However, by certifying the denial of benefits classes without limiting the classes to those with claims that UBH denied under a specific Guidelines provision(s) challenged in this litigation that applied to the claimant's own request for benefits, the certification order improperly enlarged or modified Plaintiffs' substantive rights ... Accordingly, we reverse the district court's certification of the denial of benefits classes.... [T]he district court erred to the extent it determined that the Plans require the Guidelines to be coextensive with GASC. Therefore, the judgment on Plaintiffs' denial of benefits claim is reversed ... And we remand for the district court to answer the threshold question of whether Plaintiffs' fiduciary duty claim is subject to the exhaustion requirement." [Wit v. United Behavioral Health, Nos. 20-17363 and 21-15193 (9th Cir. Aug. 22, 2023)]

Text of Ninth Circuit Opinion: Deadline for Appeal of Benefit Claim Denial Extended to Monday When It Falls on a Weekend (PDF)

"In a letter denying LeGras's application for continued long-term disability benefits, AETNA informed LeGras that he could file an internal appeal of the decision within 180 days. The 180-day period ended on a Saturday. Although LeGras mailed his appeal the following Monday, AETNA denied it as untimely ... We hold that because the last day of the appeal period fell on a Saturday, neither that day nor Sunday count in the computation of the 180 days. As LeGras mailed his notice of appeal on Monday, it was timely. This method of counting time is widely recognized and furthers the goals and purposes of [ERISA]. We therefore adopt it as part of ERISA's federal common law." [LeGras v. Aetna Life Ins. Co., No. 12-56541 (9th Cir. May 28, 2015)]

Text of Superseding Ninth Circuit Opinion: District Court Directed to Consider Surcharge as Equitable Remedy Where Benefits Paid in Error (PDF)

37 pages. "The opinion filed on June 6, 2014 ... is withdrawn. [This] superseding opinion will be filed concurrently with this order.... [B]ecause the district court made its ruling prior to the Supreme Court's decision in CIGNA Corp. v. Amara, the district court did not consider the availability of the 'monetary remedy against a trustee, sometimes called a 'surcharge,' which the Court held may be 'appropriate equitable relief' for purposes of Section 1132(a)(3). Accordingly, we vacate the district court's ruling that Gabriel is not entitled to any form of 'appropriate equitable relief' and remand for the district court to reconsider the availability of surcharge in this case, and, if available, whether Gabriel has adequately alleged a remediable wrong." [Gabriel v. Alaska Electrical Pension Fund, No. 12-35458 (9th Cir. Dec. 16, 2014)]

Text of Ninth Circuit Opinion: Attorney Fee Award Considers Entire Litigation, Not Limited to Specific Issue on Appeal (PDF)

"[In] analyzing a party's request for appellate attorney's fees under the Hummell test, a court must consider the entire course of the litigation, rather than focusing exclusively on the prior appeal. Weighing the five Hummell factors in light of all of a defendant's conduct, from its wrongful denial of the plaintiff's claim for ERISA benefits to its filing of a petition for a writ of certiorari, the panel held that the moving party was entitled to attorney's fees for the prior appeal, in which the panel had affirmed an award of litigation attorney's fees." [Micha v. Sun Life Assurance of Canada, Inc., No. 16-55053 (9th Cir. Oct. 31, 2017)]

Ninth Circuit: Administrator of Self-Funded Plan Had Apparent Conflict, So Court Seeks Probative, Material Evidence (PDF)

Nord v. The Black & Decker Disability Plan, No.  00-55689 (9th Cir. Jul. 15, 2002). Excerpt: First, we must determine whether the affected beneficiary has provided material, probative evidence, beyond the mere fact of the apparent conflict, tending to show that the fiduciary's self-interest caused a breach ... [I]f the beneficiary has made the required showing, the principles of trust law require us to act very skeptically in deferring to the discretion of an administrator who appears to have committed a breach ...

Text of Ninth Circuit Opinion Awarding Surviving Spouse Benefits Under Private Plan to Domestic Partner, Reversing District Court (PDF)

"During either time the Committee evaluated the Plan's benefits in this case -- in 2009 or in 2016 -- California law afforded domestic partners the same rights, protections, and benefits as those granted to spouses.... Neither ERISA nor the Code provided binding guidance inconsistent with applying this interpretation of spouse to the Plan.... Therefore, because Reed and Gardner were domestic partners at the time of Gardner's retirement, the Committee should have awarded Reed spousal benefits in accordance with California law, as was required by the Plan's choice-of-law provision." [Reed v. KRON/IBEW Local 45 Pension Plan, No. 17-17176 (9th Cir. May 16, 2019; unpub.)]