Pover v. The Capital Grp. Companies, Inc., No. 24-5298, __ F.4th __, 2026 WL 2196257 (9th Cir. July 30, 2026) (Before Circuit Judges Nguyen, Forrest, and VanDyke)

The effective vindication doctrine has been a hot topic in ERISA in the last few years. For those who have not been keeping up, this doctrine is a judicially created exception to the Federal Arbitration Act (FAA) that allows courts to void arbitration agreements if they prevent parties from effectively pursuing their statutory rights. Federal appellate courts have consistently accepted that this doctrine applies in the ERISA context, including the Ninth Circuit last year in Platt v. Sodexo (Your ERISA Watch’s case of the week in our August 13, 2025 edition).

Employers and their benefit plans continue to push back, however, and in this appeal The Capital Group Companies, Inc., an investment management company, tried to chip away at Platt and the doctrine in general. Would it succeed?

The plaintiff in the case was Cathy Pover, who is a former employee of The Capital Group and a participant in the company’s ERISA-governed defined contribution retirement plan. As is typical, under the plan each participant maintains an individual account funded by employee and employer contributions plus investment earnings. Participants select investments from a menu of options.

Before this litigation began, the plan’s administrative committee amended the plan to add two provisions. The first was a mandatory arbitration requirement for “[a]ny claim, controversy or alleged breach or violation of law that arises out of or relates in any way to the Plan or a claimant’s participation in the Plan and seeks a remedy, ruling or judgment of any kind against the Plan.”

The second was a waiver provision which stated that participants “must bring any dispute in arbitration on an individual basis only, and not on a class, collective or representative basis[.]” The waiver provision also had a severability clause specifying that if the waiver were found unenforceable, “any claim on a class, collective, or representative basis shall be filed and adjudicated in a court of competent jurisdiction, and not in arbitration.”

Pover sued Capital Group and related entities under ERISA, alleging that they breached their duties of prudence and loyalty by retaining a set of underperforming mutual funds in the plan’s investment menu. Pover claims they did so because those funds generated “substantial transaction fees” for Capital Group.

Pover’s complaint asserted breach of fiduciary duty claims under ERISA § 409(a), 29 U.S.C. § 1109(a), enforced through ERISA § 502(a)(2), 29 U.S.C. § 1132(a)(2), which authorizes participants, beneficiaries, or fiduciaries to sue “for appropriate relief” under § 409(a) on behalf of the plan. Pover asserted she was suing “in a representative capacity on behalf of the Plan…, seeking appropriate relief…to protect the interests of the entire Plan.” As for remedies, Pover sought plan-wide monetary and equitable relief, including restitution, disgorgement, removal of breaching fiduciaries, and reformation of the plan.

Capital Group moved to compel arbitration under the FAA, relying on the plan’s arbitration provision. Pover countered that the plan’s representative-action waiver was unenforceable under the effective vindication doctrine, and the district court agreed. The court thus denied the motion, and Capital Group filed an interlocutory appeal under 9 U.S.C. § 16(a)(1).

In this published decision, the Ninth Circuit began by reviewing the interaction between Sections 409 and 502(a)(2). The court explained that Section 409 creates the fiduciary duty, and Section 502(a)(2) is “the enforcement mechanism” for any breaches of that duty. In Massachusetts Mutual Life Ins. Co. v. Russell (1985), a case involving a defined benefit plan, the Supreme Court explained that “plaintiffs bringing a claim under § 502(a)(2) proceed on the plan’s behalf.” The high court’s 2008 decision in LaRue v. DeWolff, Boberg & Associates, did not change this rule for defined contribution plans: “In either scenario, the plaintiff-participant proceeds on behalf of the plan and the remedies afforded by ERISA benefit the plan.”

Moving on to the FAA, the court explained that while the FAA generally requires enforcement of arbitration agreements, an exception – the effective vindication doctrine – applies where an arbitration provision operates as a prospective waiver of a party’s right to pursue statutory remedies. The court revisited its decision in Platt and reaffirmed that because claims under Section 502(a)(2) are “brought in a representative capacity on behalf of the plan as a whole,” an arbitration provision that prohibits claims brought “in any…representative proceeding” is unenforceable because it prevents a plaintiff “from obtaining the plan-wide relief available under § 409(a).”

Turning to Pover’s specific claims, the court stated, “We must answer two questions: (1) whether the waiver prevents Pover from bringing claims on behalf of the Plan and (2) whether ERISA limits a participant in a defined-contribution plan to seeking monetary recovery related only to her individual account.”

On the first question, the waiver provision prohibited participants from “bring[ing] any dispute…on a class, collective or representative basis.” Capital Group argued that the effective vindication doctrine posed no impediment to enforcing this provision because “representative” “refers only to collective actions, not to actions brought by a plan participant on behalf of the Plan.”

The court acknowledged that “the word ‘representative’…has two different meanings: one referring to a plaintiff’s statutory authority to sue on behalf of an absent principal, and the other referring to a plaintiff’s representation of a group of potential claimants.” However, under Section 502(a)(2), claims “are always ‘representative’ in the first sense because the participant-plaintiff ‘seeks recovery only for injury done to the plan.’”

Because of this, the Ninth Circuit concluded that “our decision in Platt controls.” The court saw “no meaningful difference” between the provision in Platt (which barred “any purported class or representative proceeding”) and the Capital Group provision (which barred claims brought “on a class, collective or representative basis”).

On the second question, Capital Group relied on LaRue to argue that the effective vindication doctrine did not apply because the plan was a defined contribution plan, and thus Pover was limited to only recovering losses in her individual account. The court disagreed: “Capital Group misunderstands both LaRue and ERISA.”

The court stated that while it was true that LaRue allows participants in a defined contribution plan to recover pro rata individual losses for a breach, nothing in that decision “limit[s] plaintiffs participating in defined-contribution plans to recovering losses suffered only by their individual accounts.”

Instead, LaRue stood for the proposition “that participants in defined-contribution plans can bring a § 502(a)(2) claim to recover for financial harm suffered plan-wide or by individual accounts because both are plan injuries.” The court suggested that Capital Group was improperly trying “to slice and dice individual plan participants’ and beneficiaries’ injuries” in a way that was unsupported by Sections 409 and 502(a)(2).

As for Pover, the court found that she “allege[] fiduciary breaches that harmed the Plan as a whole.” Her claim about retaining underperforming funds “‘falls squarely within th[e] category’ of duties that § 409(a) imposes on plan fiduciaries.” As a result, “under § 502(a)(2), Pover is entitled to bring an action on behalf of the Plan to recover any resulting losses, as well as ‘such other equitable or remedial relief as the court may deem appropriate.’” And because that claim “can only be brought in a representative capacity,” the court “conclude[s] that the Plan’s representative-action waiver prevents Pover from enforcing her substantive rights under ERISA” and “the waiver is unenforceable under the effective-vindication doctrine.”

Finally, the court addressed the severability issue, which the court found “easy.” The severance provision was not illegal, so “we enforce the Plan as written. Pover’s breach-of-fiduciary duty claims must be adjudicated in court rather than arbitration.” As a result, the decision below was affirmed, and the case will proceed in district court.

The always-entertaining Judge Lawrence VanDyke filed a dissent, however, making two arguments.

First, Judge VanDyke would have interpreted the waiver’s “class, collective, or representative” language as Capital Group argued, i.e., as referring only to class actions, not principal-agent representative suits like Section 502(a)(2) claims. He noted that this did result in some surplusage (why include “class” if “representative” means the same thing?), but concluded the better interpretation was that “the Plan’s drafters simply included a three-word list to refer exhaustively to the same type of collective representative action.” He further argued that Platt did not compel a contrary reading, criticizing it for lax reasoning (“a fact-bound decision with essentially no analysis”) and stating that it did not address his distinction between class actions and principal-agent actions.

Second, and more fundamentally, Judge VanDyke argued that the court should never have reached the interpretive question at all, because the plan’s incorporation of the American Arbitration Association’s rules “constitutes ‘clear and unmistakable’ evidence that the Plan delegated threshold arbitrability questions to the arbitrator.” Such threshold issues “include defenses like unconscionability and effective vindication.” Judge VanDyke acknowledged that Capital Group “failed to argue the issue before the district court,” but he was willing to throw them a lifeline because “the issue is purely legal, the record is fully developed, and there is no prejudice.”

His views did not prevail, however, so the effective vindication doctrine chalks up another victory.

Below is a summary of this past week’s notable ERISA decisions by subject matter and jurisdiction.

Breach of Fiduciary Duty

Sixth Circuit

Jones v. Zander Grp. Holdings, Inc., No. 3:23-CV-00687, 2026 WL 2168476 (M.D. Tenn. July 28, 2026) (Judge Eli Richardson). William H. “Chip” Jones, II worked as an IT manager for various (Dave Ramsey-approved) Zander Group Holdings entities from 2010 until 2014, and participated in both the company’s 401(k) plan and its Employee Stock Ownership Plan (ESOP). After leaving the company, Jones remained an ESOP participant for over seven years. However, according to Jones, in 2021 defendants began “pushing out” former employees from the ESOP through stock repurchases. Jones told defendants he wanted to keep his funds in the ESOP, but defendants told him that was “not an option,” and absent a choice of how to reinvest his funds, they would default to a transfer into the 401(k) plan. Jones hired an attorney who demanded more information, but he never made an election and eventually defendants transferred $781,879.76 from Jones’ ESOP account to his 401(k) account without his written approval. Jones filed this putative class action asserting (I) violation of ERISA’s notice requirement for benefit-accrual reductions, 29 U.S.C. § 1054(h); (II) breach of fiduciary duty, 29 U.S.C. § 1132(a)(3); (III) failure to furnish plan documents, 29 U.S.C. § 1024(b)(4); (IV) interference with protected rights, 29 U.S.C. § 1140; (V) equitable/injunctive relief, § 1132(a)(3); and, in the alternative, state-law claims for (VI) breach of contract and (VII) unjust enrichment. Defendants moved to dismiss for lack of standing and failure to state a claim. The court rejected defendants’ standing argument, which was that Jones’ injury was “self-inflicted” because he chose not to respond to their notices. The court distinguished between an injury a plaintiff affirmatively causes and one a plaintiff “willingly incurs” by not acting to prevent conduct which is traceable to the defendant. Because Jones’ inaction did not itself cause the harmful transfer, the injury remained traceable to defendants, and Jones had standing. Jones had less success on the merits. The court dismissed Count I because the ESOP did not qualify as an “applicable pension plan” under § 1054(h)(8)(B). The court held that the ESOP was a “stock bonus plan” statutorily exempted from the minimum funding standards of 26 U.S.C. § 412, and thus it was not subject to the notice requirement in 29 U.S.C. § 1054(h). The court rejected Jones’ theory that the plan lost its ESOP-qualifying status because defendants applied it inconsistently with its terms, noting that an employer’s noncompliance with plan terms does not strip a plan of its tax-qualified ESOP status. The court further dismissed Count II, ruling that this breach of fiduciary duty claim was “really a disguised benefits claim for which Plaintiff has an avenue for relief pursuant to § 1132(a)(1)(B).” Jones argued that he was not merely claiming benefits but was alleging that defendants violated “express terms of ERISA” and committed “multiple breaches of their fiduciary duties,” but the court disagreed, stating that Jones was “seeking solely benefits he believes he (and the putative class) is owed under the terms of the Plan[.]” Because the court recharacterized Jones’ claim as one for plan benefits, it next considered whether he had exhausted his administrative remedies and concluded that he had not. Jones contended that any appeals “would have been futile and wasted resources” because of the company’s reaction to his requests, but the court ruled that his complaint did not allege sufficient facts to support this argument. Next, the court dismissed Jones’ statutory penalty claim because Jones’ theory – that an undisclosed plan amendment authorizing the ESOP stock repurchase must exist and was being withheld – was pure speculation. The complaint did not contain any plausible allegations supporting such an amendment, and it was “at least equally possible” that defendants acted without one, regardless of whether it was required. The court also dismissed Jones’ interference claim, ruling once again that this was a repackaged benefits claim. The relief Jones sought under this claim was identical to that sought under his fiduciary duty claim, which meant that § 1132(a)(1)(B) was his appropriate remedy, and he had not exhausted his appeals under that remedy. Finally, the court dismissed Jones’ remaining claims, ruling that “equitable relief” is a remedy, not an independent cause of action, and that Jones could bring his state law claims in state court because the court, having dismissed all of Jones’ federal claims, declined to exercise supplemental jurisdiction over the state law claims. As a result, defendants may not have won on their standing arguments, but they got the dismissal they wanted nonetheless.

Seventh Circuit

Hendrickson v. Elevance Health Inc., No. 1:25-CV-01002-SEB-MG, 2026 WL 2167812 (S.D. Ind. July 28, 2026) (Judge Sarah Evans Barker). Holly Hendrickson brings this putative class action challenging how her employer, Elevance Health Inc. (formerly known as Anthem Inc.), and related defendants allocated forfeited employer contributions under the Elevance Health 401(k) Plan. Under the plan, employees forfeit unvested employer matching contributions upon early termination, and the plan gives Elevance discretion to apply these forfeitures to pay plan administrative expenses and/or reduce future employer contributions. Hendrickson alleges that from 2019 to 2023, defendants used forfeitures to pay nearly $4.3 million toward administrative expenses but over $23 million to offset Elevance’s contribution obligations. Furthermore, the proportion going to expenses shrunk every year even though Elevance’s revenues grew by $20.4 billion from 2022 to 2024. Hendrickson has alleged five claims under ERISA: “breach of ERISA’s fiduciary duties of prudence (Count I) and loyalty (Count II), 29 U.S.C. §§ 1104(a)(1)(A)-(B); breach of ERISA’s ‘anti-inurement’ provision, 29 U.S.C. § 1103(c)(1) (Count III); breach of duty to monitor the Committee and [plan administrator] as fiduciaries of the Plan (Count IV); and breach of ERISA’s prohibition against ‘self-dealing’ transactions, 29 U.S.C. § 1106(b) (Count V).” Defendants moved to dismiss for failure to state a claim. At the outset, the court rejected defendants’ three threshold arguments. First, defendants argued that Hendrickson sought benefits beyond the plan’s terms, but the court noted that “fiduciary duties ‘trump[] the instructions of a plan document,’” and thus “the fact that the Plan may permit Defendants’ actions is not itself dispositive[.]” Second, defendants argued that “proposed regulations, enacted regulations, and legislative history” supported its choice of how to allocate forfeitures, but the court stated that “[w]hile these sources may be relevant in assessing the merits of Plaintiff’s claims, they are also not dispositive.” Third, defendants contended that Hendrickson was challenging a “settlor” decision that did not involve fiduciary duties, but the court noted that “the Committee exercised the discretion the Plan provides it to allocate forfeitures between paying administrative expenses and offsetting employer contributions,” and this could be challenged under a fiduciary duty theory. Hendrickson’s fortune turned when the court examined her claims on the merits, however. On the duty of prudence, the court found no plausible inference of a flawed decision-making process. Because defendants voluntarily paid some administrative expenses each year (indeed, they “provided participants even more than what was technically required by the Plan”), this itself showed some deliberative process occurred. Hendrickson’s allegations that defendants acted “automatically” were thus conclusory. As for the duty of loyalty, the court adopted the rule of the majority of courts evaluating forefeiture allocations that fiduciaries with discretion do not violate loyalty duties merely by declining to maximize administrative-expense offsets. Because participants received their promised benefits, and ERISA does not impose a duty to maximize pecuniary benefits, the claim failed. The court acknowledged contrary district court decisions but declined to follow them, reasoning their holdings “would stretch the duty of loyalty beyond its legally enforceable bounds.” Under Hendrickson’s anti-inurement claim, the court found that this required actual diversion or reversion of plan assets to the employer, not just incidental financial benefit. Because forfeitures were used within the plan to fund matching contributions and expenses, and not removed from the plan, Elevance’s “savings” were an incidental side effect and thus did not rise to the level of a violation. Similarly, Hendrickson’s self-dealing claim was dismissed because “Plaintiff’s allegations, which involve only the movement of funds within the Plan and do not include any facts indicating that forfeitures were exchanged with another party, do not plausibly allege a ‘transaction’ prohibited by 29 U.S.C. § 1106.” Finally, Hendrickson’s failure to monitor claim was dismissed because it was derivative of her failed fiduciary breach claims. Thus, defendants’ motion to dismiss was granted; Hendrickson was given leave to amend.

Class Actions

Ninth Circuit

Munoz v. Alorica, Inc., No. 25-7359, __ F. App’x __, 2026 WL 2199195 (9th Cir. July 30, 2026) (Before Circuit Judges Rawlinson and Sanchez, and District Judge Sidney A. Fitzwater). The plaintiffs in this class action are former members of the Alorica 401(k) Retirement Plan. They allege that Alorica and other plan fiduciaries violated ERISA by (1) imprudently selecting and retaining certain investment options within the plan, and (2) breaching their fiduciary duty of prudence to plan participants by overpaying for recordkeeping services. The district court certified a class as to both theories, and defendants filed an interlocutory appeal challenging the certification. In this brief unpublished decision, the Ninth Circuit vacated the class certification order and remanded. On plaintiffs’ first theory, the court rejected defendants’ argument that the named plaintiffs lacked standing to pursue claims regarding investment options in which they personally never invested. Under Ninth Circuit precedent, once a named plaintiff establishes individual standing for at least one claim, the standing inquiry ends; differences between the named plaintiffs’ investments and those of absent class members are only relevant to the separate question of class certification. Here, “it is undisputed that both named plaintiffs invested in at least one of the challenged investment options.” The court arrived at the same conclusion regarding plaintiffs’ standing to bring their recordkeeping claim. Plaintiffs submitted a declaration from an expert showing that both named plaintiffs personally suffered overpayment injuries from the plan’s choice of recordkeeping services. This was sufficient at the certification stage to satisfy Article III’s injury requirement. As for the class certification itself, “the district court erred in failing to conduct a rigorous class certification analysis.” Specifically, the district court analyzed typicality only with respect to the recordkeeping theory and never addressed whether differences among individual investment options rendered the named plaintiffs’ claims atypical of the broader class’ investment-based claims. The Ninth Circuit “suggest[ed] no view on this issue,” but held that the district court’s failure to analyze it warranted vacatur. As for adequacy of representation, the appellate court held that the district court “failed to properly address Defendants-Appellants’ contention that Plaintiffs-Appellees’ loss theory gave rise to an irreconcilable class conflict.” Although the district court noted that the named plaintiffs’ own modest recordkeeping fees ($40/year) did not by themselves establish a conflict, “the district court did not sufficiently address the evidence presented by Defendants-Appellants that suggested that, even after the recordkeeping fees charged to Plan members were converted to asset-based fees, Plaintiffs-Appellees’ loss model would have resulted in certain class members paying higher recordkeeping fees than they actually did during the class period. The district court’s failure to resolve this key factual dispute was error.” As a result, while plaintiffs obtained confirmation that they had standing, they lost their class certification and will have to fight for it again in the district court.

Disability Benefit Claims

Ninth Circuit

O’Connor v. Metropolitan Life Ins. Co., No. 4:24-CV-08723-YGR, __ F. Supp. 3d __, 2026 WL 2220173 (N.D. Cal. July 29, 2026) (Judge Yvonne Gonzalez Rogers). Cheryl O’Connor worked at Salesforce for nearly ten years, culminating in an executive-level position as “Success Manager-Senior Director,” which had an annual salary of more than $324,000. Her job required exceptional communication, multitasking, and client-relationship skills. In 2021, at the age of 52, she stopped working due to sudden sensorineural hearing loss in her left ear, tinnitus, and associated cognitive impairment. She underwent cochlear implant surgery in 2022. MetLife, the insurer and administrator of Salesforce’s ERISA-governed long-term disability benefit plan, approved O’Connor’s claim. In 2024, however, MetLife terminated her benefits when the plan’s definition of disability shifted to the more demanding “any occupation” test, concluding her hearing had essentially normalized and there was no clinical evidence of cognitive impairment. Throughout the claims process, O’Connor’s treating providers maintained that her hearing loss caused ongoing cognitive difficulties (such as word-finding problems and processing delays) that precluded her from executive-level work, while MetLife’s retained physicians concluded there was no clinical impairment, relying on O’Connor’s average and above neuropsychological testing scores. However, the administering neuropsychologist, Dr. Rothke, explained that despite average test scores achieved in a controlled setting, O’Connor’s real-world cognitive and speech-processing difficulties would still preclude her from high-level executive functioning. MetLife disagreed and denied O’Connor’s appeal. After this final denial, O’Connor was awarded retroactive Social Security Disability benefits based on findings of moderate limitations in understanding, concentration, and social interaction linked to her hearing and cognitive impairments. O’Connor filed this action, asserting one claim under ERISA for plan benefits, 29 U.S.C. § 1132(a)(1)(B), and the case proceeded to cross-motions for judgment. The parties agreed that the appropriate standard of review was de novo. The court first addressed O’Connor’s motion to supplement the record with her Social Security award. The court acknowledged that under de novo review “exceptional circumstances” must exist to admit extra-record evidence, but found that test met for two reasons: “First, the decision is relevant to the question of whether she met the applicable standard of disability under the Plan at the time her LTD benefits were terminated… Second, the decision could not have been presented during the administrative process given that it was issued well after the administrative process closed.” The court then turned to the merits, and examined what “any occupation” meant. The court agreed with O’Connor that the relevant benchmark for this term was “an executive-level sales management position or a comparable position.” Under this standard, the court found that O’Connor proved her burden of showing that, as of her benefit termination, her cognitive deficits stemming from asymmetric hearing loss prevented her from engaging with reasonable continuity in an executive-level position. The court gave substantial weight to the opinions of O’Connor’s treating otolaryngologist and Dr. Rothke, and also credited corroborating lay evidence from O’Connor’s husband and a business colleague with executive-recruiting experience. The Social Security award further supported her claim. The court rejected MetLife’s arguments to the contrary. It found that MetLife’s reliance on O’Connor’s improved hearing was misplaced because her cognitive impairments persisted even after her cochlear implant. The court also accepted Dr. Rothke’s explanation that O’Connor’s neuropsychological scores did not predict real-world executive performance, and found that MetLife’s reviewing physicians never rebutted his explanation. The court gave minimal weight to MetLife’s physicians generally because none personally examined O’Connor, and further discounted its otolaryngologists’ opinions because they expressly disclaimed any opinion regarding cognitive impairment. Finally, the court rejected MetLife’s belated argument that the “any occupation” standard permitted consideration of “reasonable accommodations.” The court ruled that this argument was not raised during the administrative denial process, and furthermore, no plan language supported reading an accommodation requirement into the disability definition. Thus, the court granted O’Connor’s motion for judgment and denied MetLife’s. The parties were ordered to meet and confer on the amount of benefits due and submit a proposed judgment.

Discovery

D.C. Circuit

Georgetown Univ. v. Carfora, No. 26-MC-58 (TSC), 2026 WL 2211247 (D.D.C. July 31, 2026) (Judge Tanya S. Chutkan). This case is tied to the long-running ERISA class action pending in the Southern District of New York, Carfora v. Teachers Insurance and Annuity Association of America (TIAA). In that case a class of university professors and researchers from four university plans allege that TIAA is liable for breach of fiduciary duty under ERISA for driving plan participants away from their investments in their benefit plans, and into TIAA-sponsored higher-fee proprietary offerings, through “cross-selling.” (For more about the case, check out our discussion in our June 12, 2024 edition.) In February of 2025, the class served a document subpoena on Georgetown University, which produced some responsive documents but reported no responsive materials for certain other requests. Nearly a year later, the class served a deposition notice with eight proposed topics; after failed meet-and-confer efforts, the class served a deposition subpoena in April of this year. Georgetown thus filed this action to quash the subpoena or obtain a protective order. The class responded by moving under Federal Rule of Civil Procedure 45(f) to transfer the motion to the Southern District of New York where the main case is pending. (The court noted that two other non-parties in the same underlying litigation, Dartmouth College and the Pacific Institute for Research and Evaluation (PIRE), had previously filed substantially similar motions to quash deposition subpoenas, which the New York court had already denied.) Under Rule 45(f), a court may transfer motions to quash subpoenas upon a finding of “exceptional circumstances.” The court weighed three factors, “including (1) whether failure to transfer will disrupt the underlying litigation; (2) whether the issuing court is better positioned to rule on the issues; and (3) whether transfer will impose an undue burden or cost on the nonparty that seeks to obtain local resolution of the issues.” On the first two factors, the court found that the New York court’s “centralized” management of the litigation, which included comprehensive case management orders and substantial discovery oversight, weighed heavily toward transfer. Furthermore, Georgetown’s core arguments (that the subpoena sought irrelevant information and constituted an improper fishing expedition) “require[d] a close examination of the facts of the case and a comparison between the parties and nonparties,” which the court had little familiarity with. The court also emphasized that the New York court had already resolved substantially similar motions to quash filed by Dartmouth and PIRE, making it well-positioned to rule on Georgetown’s nearly identical objections and avoiding the risk of inconsistent rulings. The court further found that transfer would not unduly burden Georgetown. The court noted that the New York court had previously accommodated telephonic conferences, and Georgetown was “represented by sophisticated counsel who work at a major law firm with a large New York office and who have appeared in multiple ERISA cases in the Southern District and thus is familiar with both the action and the issuing court.” Indeed, retaining the dispute might burden Georgetown even more because the court might need to issue orders requesting supplemental briefing or hearings “to address any gaps in the court’s understanding of the underlying case.” As a result, the court granted the class’ motion to transfer Georgetown’s motion to quash to the New York court.

Sixth Circuit

Patterson v. Swagelok Co., No. 1:20-CV-566, 2026 WL 2206828 (N.D. Ohio July 31, 2026) (Judge J. Philip Calabrese). Speaking of long-running cases, the two consolidated cases here date back to 2020 and 2021. They involve a married couple who have asserted state and federal claims against various United Healthcare entities arising from separate automobile accidents. (For more background on this complicated case, see our January 14, 2026 edition.) The case centers on whether defendants were entitled to subrogation and reimbursement from the settlements that occurred after the accidents. The law firm of Kreiner & Peters represented the ERISA-governed benefit plan and other defendants, but in discovery, the firm withheld virtually all materials requested by the Pattersons. The firm cited attorney-client privilege and work-product protection, and refused to produce a Rule 30(b)(6) witness for deposition. The court requested briefing on the issue, and this order was the result. The court focused on three categories of information: (1) fee agreements and payment-source documentation; (2) communications regarding production or withholding of plan-related documents; and (3) the deposition of the firm. Defendants argued that Ohio law applied, but the court disagreed. It acknowledged that the case began in state court and that several state court theories had been advanced, but “the core issue in the cases involving both Eric and Laura Patterson concerned whether the Plan or summary plan document required subrogation and reimbursement.” Thus, “At bottom…the parties’ disputes in State court involved ERISA.” Thus, the court applied federal law to the discovery dispute, including ERISA’s fiduciary exception to the attorney-client privilege. Under that exception, an attorney advising a plan fiduciary on matters of plan administration represents the plan beneficiaries, not the administrator personally, meaning such communications are not privileged. The court followed longstanding Sixth Circuit precedent and held that fee and engagement agreements are generally not privileged, as the fact and amount of a client’s payment is not typically a matter of confidential communication. As for fund tracing, the court held that tracing the transfer of funds is an administrative/clerical function, not a confidential legal communication, and thus generally discoverable. The court noted that defendants never alleged or documented in their privilege log that specific payments were spent on counsel to defend against their own personal liability, which might have qualified for privilege. “To conclude otherwise would set law firms up as black boxes for money laundering or other clandestine activity as if they were Swiss banks.” Thus, “the tracing of funds is discoverable in this case under the fiduciary exception.” Regarding the firm’s communications, the court explained that “[t]o the extent communications concern the administration of the plan, those communications are discoverable,” while “communications concerning litigation are not discoverable, absent an exception or waiver.” Here, it was unclear from the firm’s privilege logs whether any third-party disclosure had taken place because the logs did not identify the recipients of its communications. Thus, “no determination regarding a claim of privilege can be made at this time.” Finally, the court required the firm to produce a witness for deposition: “Rule 30 does not preclude a party from deposing a law firm named as a defendant in litigation… Here, the firm likely has some discoverable information that falls within the fiduciary exception.” Thus, the firm “must provide discovery to allow Plaintiffs to evaluate its claims of privilege and to ascertain what discoverable fiduciary information it has. A blanket claim that it only possesses information on one side of that line does not withstand cursory review.” The court ended by ordering the parties to use this ruling as the basis for a meet and confer to resolve their remaining disputes, and scheduled a further status conference.

ERISA Preemption

Fifth Circuit

In re: Sunnova Energy Int’l Inc., No. 25-90160, 2026 WL 2189844 (Bankr. S.D. Tex. July 29, 2026) (Bankruptcy Judge Alfredo R Pérez). This is an adversary proceeding arising from the bankruptcy of Sunnova Energy International, a solar energy company that filed for Chapter 11 protection in 2025 and was later sold. The proceeding involves a class of employees that filed breach of contract claims alleging that Sunnova breached the terms of their release agreements (RA) by “failing to pay them the promised ‘higher of (a) the applicable severance provided for in the [separation pay plan (SPP)] or (b) the applicable amount that may be owed to [them] under [The Worker Adjustment and Retraining Notification (WARN) Act].’” These plaintiffs allege that Sunnova wrongly determined that they were WARN-ineligible and thus paid the class a lesser amount under the SPP only. Sunnova moved to dismiss, contending that (1) the SPP is an ERISA-governed plan, and (2) the class’ state law claims for breach of contract under the RA are preempted by ERISA. Plaintiffs opposed on the merits, and also argued that Sunnova should be judicially estopped from raising ERISA preemption at all, given its prior litigation positions. First, the court rejected plaintiffs’ estoppel argument. Applying the Fifth Circuit’s three-element test (‘“(i) [t]he party against whom it is sought has asserted a legal position that is plainly inconsistent with a prior position; (ii) a court accepted the prior position; and (iii) the party did not act inadvertently”), the court found no “plainly inconsistent” prior position. The court found that Sunnova’s “acceptance” of the breach of contract theory earlier in the litigation was in connection with unrelated issues, such as whether the RA was unenforceable and the scope of WARN eligibility. “Arguing for preemption while arguing against the predicate of the breach of contract theory is not necessarily an internal or external inconsistency.” The court also found no judicial acceptance of any inconsistent position, because prior rulings never addressed choice-of-law or ERISA preemption at all. As a result, judicial estoppel did not apply. On the merits of the preemption issue, the court held that the RA was not governed by ERISA. ERISA requires an “ongoing administrative program,” but the RA promised only a one-time payment requiring no discretionary eligibility determinations, ongoing benefit administration, or claims/appeals procedures. The court noted that WARN eligibility is a statutory question, not a matter of administrative discretion, and once the “higher of” amount was calculated and paid, Sunnova’s obligations under the RA were complete. The court further ruled that plaintiffs’ claims failed under both prongs of the Supreme Court’s complete preemption Davila test. Plaintiffs could not have brought their claims under ERISA § 502(a)(1)(B), because their right to WARN damages arose exclusively from the RA, not the SPP. Indeed, the SPP never promised WARN damages at all, and by signing the RA, plaintiffs had already released their independent WARN Act claims. Their suit sought benefits under a separate, freestanding contract, not benefits “due under the terms of” an ERISA plan. Furthermore, Sunnova’s obligation to pay accurate WARN-based amounts under the RA constituted an “independent legal duty” separate from any duty imposed by the SPP. Thus, there was no complete ERISA preemption. The court also found no conflict preemption. It held that the RA did not “relate to” the SPP merely because the documents were once attached and cross-referenced each other. Because Sunnova had already paid plaintiffs their SPP severance, resolving the RA breach claims required only calculating the difference between the SPP amount and any additional WARN damages owed, which did not require consulting or reinterpreting the SPP. The court also found that plaintiffs’ claims did not address an area of “exclusive federal concern” because they sought WARN (i.e., non-ERISA) benefits under the RA, rather than plan benefits. Furthermore, their claims did not “directly affect” the relationship among traditional ERISA entities, because a recovery under the RA did not expand rights under the SPP. As a result, the court denied Sunnova’s motion to dismiss.

Medical Benefit Claims

Seventh Circuit

M.F. v. Blue Cross Blue Shield of Illinois, No. 25 CV 15549, 2026 WL 2216059 (N.D. Ill. July 31, 2026) (Judge Jeremy C. Daniel). M.F. brought this action on behalf of M.F.’s minor child Z.F., who is a beneficiary under an ERISA-governed medical benefit plan administered by Blue Cross Blue Shield of Illinois. In 2021, Z.F. was treated at Innerchange Chrysalis, a Montana-licensed outdoor behavioral health program, for depression, anxiety, disruptive behavioral disorders, ADHD, and substance abuse disorder. Chrysalis charged approximately $113,500 for its services. Blue Cross accepted and paid for only a portion of Chrysalis’ treatment ($10,850, reimbursing $1,675) but denied the remaining claims, citing eligibility issues or requesting additional information. M.F. appealed, but Blue Cross upheld its decision, citing a plan exclusion for services at “wilderness programs” and other similar facilities, as well as the plan’s definition of “residential treatment center.” M.F.’s complaint asserts two claims: (1) wrongful denial of benefits under ERISA, 29 U.S.C. § 1132(a)(1)(B); and (2) violation of the Mental Health Parity and Addiction Equity Act, 29 U.S.C. § 1185a(a)(3)(A)(ii). Blue Cross moved to dismiss both counts for failure to state a claim. On M.F.’s first claim, Blue Cross argued Chrysalis did not qualify as a covered residential treatment center under the plan’s definition, which excludes wilderness programs and requires 24-hour medical monitoring and nursing, appropriate licensing, and other credentialing criteria. The court stated that “Blue Cross may ultimately be correct that the plaintiff cannot establish that the facility qualifies as an RTC under the Plan’s definition.” However, the court was not willing to jettison the claim at the pleading stage: “[T]he Court is not prepared to hold that the plaintiff was required to specifically allege satisfaction of each definitional component of the Plan’s coverage provisions. Whether Chrysalis in fact met those criteria, and whether Blue Cross may rely on that basis for denying benefits, are questions more appropriately addressed after the administrative record is before the Court at the merits stage.” The court thus denied Blue Cross’ motion as to M.F.’s first claim for plan benefits. As for M.F.’s Parity Act claim, the court found M.F.’s disparity allegations “conclusory at best.” The only specific factual support M.F. offered was that “Blue Cross did not address the Parity Act in its appeal denial.” However, “this is not a requirement of the statute. In the absence of allegations tied to specific requirements for mental health treatment that exceed requirements for general medical treatment, the Court finds that the plaintiff has not adequately pled a claim under the Parity Act.” Thus, the court granted Blue Cross’ motion as to Count II.

Tenth Circuit

B.M. v. Anthem Blue Cross & Blue Shield, No. 1:22-CV-00098-JNP-JCB, 2026 WL 2186263 (D. Utah July 29, 2026) (Judge Jill N. Parrish). Plaintiff B.M.’s daughter, C.M., suffered from severe mental health issues beginning in fifth grade, including depression, anxiety, self-harm, and suicidal ideation, which escalated by 2020 to include cutting, running away, and a bathroom lockdown with medication requiring police intervention. After a failed wilderness therapy placement and short-term stabilization, C.M. was admitted in August 2020 to Uinta Academy, a residential treatment center. Anthem, which administers B.M.’s ERISA-governed health plan, assumed coverage responsibility in February 2021 and denied payment for continued treatment, applying the “MCG Residential Behavioral Health Level of Care” guideline and concluding that C.M. was not a danger to herself or others and was not suffering from serious functional impairment. An appeal was unsuccessful, so B.M. brought this action, alleging one claim for benefits under ERISA § 1132(a)(1)(B) and another under the Mental Health Parity and Addiction Equity Act. Anthem moved to dismiss, arguing that B.M.’s claim for benefits was untimely under the plan’s one-year contractual limitation period, and the court agreed. (We covered this ruling in our February 7, 2024 edition.) That ruling left only B.M.’s Parity Act claim, on which the parties filed cross-motions for summary judgment, which were decided in this order. Anthem also moved under Federal Rule of Evidence 702 to exclude three opinions of B.M.’s expert, Dr. Jeffrey Kovnick. The court addressed standing first, rejecting Anthem’s argument that B.M. could not show the denial was “traceable” to the Parity Act violation. Because Anthem’s denial rested solely on the MCG Guideline and never engaged with substantial evidence of medical necessity submitted by C.M.’s treating providers, the court found that there was “sufficient evidence of causation” (although “by no means airtight”) to show that the Guideline was a but-for cause of the denial and thus Anthem’s denial was traceable to a violation. Moving on to Anthem’s Rule 702 motion, the court denied exclusion of Dr. Kovnick’s opinion as to “generally accepted standards of care,” reasoning that even though Parity Act compliance does not require conformity with standards of care, such standards are still probative of whether a disparity exists between mental-health and medical/surgical limitations. The court also rejected Anthem’s “specious” argument to exclude Dr. Kovnick’s opinion that the MCG Guideline effectively imposed acute-hospitalization criteria on residential admissions. The court found no inconsistency between his report and deposition testimony as argued by Anthem. However, the court granted exclusion of Dr. Kovnick’s opinion comparing skilled nursing criteria to residential treatment criteria because, as B.M. conceded, skilled nursing was “outside the scope of his expertise.” On the merits, the court first rejected Anthem’s proposed “safe harbor” theory in which it argued that “there can be no cognizable disparity” where mental-health and medical/surgical treatment limitations are “developed, adopted, and applied to particular benefits by Anthem using the same process.” The court held that the Parity Act was focused on standards, not processes: “[A]ny standard that Anthem uses to limit mental health benefits must be comparable to and no less restrictive than the standards it uses to limit analogous medical and surgical benefits, regardless of how the standards happened to be developed and whether the development process was comparable.” Under this interpretation, the court agreed with B.M. that there was an unlawful disparity. The MCG Guideline required both a “needs-based” showing (that the treatment was necessary and not feasible at a lower level of care) and a “symptom-based” threshold (requiring “particular symptoms at particular severity levels before they qualify for admission”). Meanwhile, Anthem’s skilled nursing criteria only imposed a “needs-based” justification. The court held this extra “hurdle” constituted the type of disparity the Parity Act was designed to prevent, and that Anthem failed to rebut Dr. Kovnick’s opinion that the added “symptom-based” requirements were medically inappropriate and unsupported by any legitimate clinical rationale. Next, the court addressed Anthem’s argument that “B.M. has failed to establish the availability of equitable remedies.” The court held that Anthem failed to meet its initial burden of showing that disgorgement, surcharge, and restitution were categorically unavailable. Anthem argued that these remedies “are not available in equity because they seek to impose liability on Anthem ‘for a contractual obligation to pay money,’” but the court noted that equitable relief can take the form of monetary payments. The court also ruled that B.M.’s time-barred benefits claim did not automatically foreclose equitable remedies, and noted that Anthem failed to address some of B.M.’s suggested remedies, such as an accounting of wrongfully withheld funds. As a result, the court denied Anthem’s summary judgment motion, granted B.M.’s, and ordered the parties to submit a proposed schedule for further proceedings on an appropriate remedy.

R.L. v. Aetna Life Ins. Co., No. 2:23-CV-00494-DBB-DAO, 2026 WL 2168881 (D. Utah July 28, 2026) (Judge David Barlow). Plaintiff R.L. brought this case individually and on behalf of his child, M.L., contending that defendant Aetna Life Insurance Company wrongfully denied claims for benefits R.L. submitted for M.L.’s treatment at Outback Therapeutic Expeditions (a wilderness-style program) and later at Vista Stage (a residential facility). Aetna denied coverage for Outback on the ground that wilderness programs are categorically excluded, and denied coverage for Vista on the ground that it lacked required accreditations and weekly psychiatrist treatment. R.L. exhausted two rounds of appeals for each denial, and also sent a letter requesting plan documents but did not receive them. In his complaint R.L. asserted (1) wrongful denial of benefits under ERISA for both the Outback and Vista claims, (2) violation of the Mental Health Parity and Addiction Equity Act (MHPAEA), and (3) entitlement to statutory penalties under 29 U.S.C. § 1132(c)(1) for defendants’ failure to timely produce plan documents. The parties filed cross-motions for summary judgment which were decided in this order. The court applied arbitrary and capricious review, finding that the plan “clearly grants” Aetna discretionary authority in interpreting the plan. It rejected R.L.’s argument that Aetna forfeited deferential review through procedural irregularities, ruling that Aetna considered licensing and accreditation materials submitted by R.L., and even if it did not, there was no “serious procedural deficiency.” The court also rejected R.L.’s argument that discretionary authority was barred by state law because R.L. did not sufficiently argue which state’s law applied or whether that law was preempted (the plan specified New York law governed, which does not ban discretionary clauses). The court then turned to the Outback denial and found it arbitrary and capricious. Defendants’ denial was premised on the rationale that “[w]ilderness programs are not a covered benefit under the plan,” but it cited no specific language in the plan to that effect, and instead cited only generic “services not listed are not covered” boilerplate. The denial did not engage with the specific mental health treatment section of the plan, or the definition of residential treatment facility invoked by R.L.’s appeal. Because Aetna failed to adequately explain its reasoning, the court remanded this claim for further review. As for Vista, the court upheld this denial as reasonable. While the “Eligible Services” section only required licensing “to the same level of treatment” as New York law, the court found it reasonable for Aetna to also apply the plan glossary’s more detailed “residential treatment facility” definition, which included additional accreditation and psychiatrist requirements. The court stated that it must interpret contracts so as to harmonize provisions rather than treat any as surplusage. As a result, Aetna’s interpretation prevailed because Vista did not meet the glossary requirements. On the Parity Act claim, the parties disagreed as to whether a disparity existed between the plan’s coverage of residential treatment facilities as opposed to their physical analog, skilled nursing facilities. Ultimately the court held that R.L. did not carry his burden. Although the mental health provisions were textually longer, the underlying substantive requirements (24/7 staffing, physician-level supervision, periodic assessments) were comparable to the “extensive” licensing requirements imposed on skilled nursing facilities under federal law. The court acknowledged that the requirements were “not exactly the same,” but they were “reasonably comparable on their face…[a]nd the differences may be easily explained by the differences necessary for mental health care versus medical health care.” In short, “the Parity Act only requires comparability, not equality,” and for the court, the plan was close enough. The court further rejected R.L.’s as-applied challenge in which R.L. argued that defendants “only covered mental health treatment ‘in very limited facilities.’” However, R.L. offered no evidence in support of this claim and did not provide any comparators. Finally, the court rejected R.L.’s statutory penalty claim. R.L.’s first request for plan documents was sent to Aetna, but there was no evidence it was an agent for the plan administrator. The second request “was sent to an outdated and incorrect address, despite Plaintiff having access to the correct, updated address.” Because no proper request was ever received, the 30-day statutory clock never began, and the court noted it would have exercised its discretion to reduce any penalty to zero regardless. As a result, the case was a partial victory (and loss) for both sides.

Pension Benefit Claims

Ninth Circuit

Raya v. Barka, No. 25-2394, __ F. App’x __, 2026 WL 2168772 (9th Cir. July 28, 2026) (Before Circuit Judges Nguyen, Miller, and Collins). Longtime readers of Your ERISA Watch are familiar with Robert Raya’s crusade against his former employer, Calbiotech, Inc. Raya, proceeding pro se, sued Calbiotech, the company’s 401(k) and pension plans, and three individual defendants, alleging they violated several provisions of ERISA in administering the plans. He also alleged that he was terminated in retaliation for requesting plan documents, seeking benefit information, and speaking with the Department of Labor (DOL) about an investigation into the administration of the plans. (The DOL ultimately took no action.) Defendants brought counterclaims against Raya, arguing that he knowingly and voluntarily waived his claims against them after signing a release agreement and accepting payment of $12,500. Defendants ultimately prevailed in August of 2024. The district court found that Raya knowingly and voluntarily waived his non-pension plan claims, that defendants were entitled to judgment in their favor as to their counterclaim for breach of contract and were entitled to damages in the amount of $12,500, and that defendants were entitled to judgment. Raya appealed, and the Ninth Circuit issued this unpublished opinion. First, the court affirmed regarding the admission of trial exhibits Raya claimed were untimely produced. The court stated that because the exhibits were emails to and from Raya, and thus in his possession already, he could show no prejudice. As for Raya’s waiver, the court affirmed the finding that it was valid, applying the Ninth Circuit’s nine-factor Schuman v. Microchip test. The court relied heavily on the fact that Raya had consulted with attorneys and contacted the DOL before signing, thus indicating that he was aware of the relevant facts and was knowingly giving up potential claims. As for Raya’s potential entitlement to benefits under Calbiotech’s pension plan, the court reversed. The district court had relied on a sworn declaration from Calbiotech asserting that a 2008 Amendment, which excluded Raya from benefits, was executed contemporaneously with the Plan’s Adoption Agreement. However, Raya contended that the Amendment named an employee who was not hired until 2011. The Ninth Circuit concluded that this discrepancy raised issues of fact, and that “a reasonable trier of fact could infer that the Amendment was backdated” and that the declaration to the contrary might not be credible. Thus, the court reversed, reviving Raya’s pension claim. Finally, the court addressed Raya’s appeal of the district court’s order declining to sanction defendants. Raya contended that defendants interfered with his subpoenas of non-parties, but the Ninth Circuit agreed with the district court that defendants’ objection letter was sent after the discovery cut-off and did not actually impede timely discovery. As for Raya’s claim that defendants “introduced forged 401(k) Plan Documents,” the district court permissibly deferred ruling on this issue until after trial because the falsification issue was intertwined with the merits. After trial, the district court agreed that there were “anomalies,” but explicitly found after receiving testimony that “the altered document was prepared by a since-deceased person who was apparently correcting a typographical error in the original document.” Thus, Raya had failed to prove any intentional attempt to mislead and the district court’s refusal to award sanctions was not clearly erroneous. Thus, most of the decisions below were affirmed, but Raya will get a second chance at proving his pension claim.

Trevillyan v. Western States Carpenters Pension Tr., No. CV 25-9043 PA (AJRX), 2026 WL 2164156 (C.D. Cal. July 23, 2026) (Judge Percy Anderson). M. Jeanine Trevillyan alleges she was a member of the Carpenters’ Union from 1977 to 1990 and became eligible to participate in the union’s multi-employer pension plan in March 1979. She alleges that the fund never sent her enrollment materials, summary plan descriptions, or annual benefit statements while she was working. In 1990, she discovered that fund had failed to credit hours she worked at C.F. Braun in 1980-81, as well as 144 hours of temporary disability from 1979. The fund “acknowledged” the discrepancy in 1991 but declined to bill the employer because a decade had passed. In 2023, after finally receiving a benefits statement, Trevillyan pursued the issue again. The fund eventually credited her C.F. Braun hours but still found she did not meet vesting requirements. The fund thus denied her pension application and her appeal, and she filed this pro se action asserting four ERISA claims: (i) benefits owed under 29 U.S.C. § 1132(a)(1)(B); (ii) statutory penalties for failure to furnish documents under § 1132(c)(1); (iii) breach of fiduciary duty/prohibited transactions under § 1104; and (iv) interference with protected rights under § 1140. The fund moved for judgment on the pleadings. The court granted the motion as to Trevillyan’s benefits claim because she conceded she accrued only 9.6 “Vesting Service Credits,” which was less than the 10.0 required under the plan’s vesting formula. Trevillyan argued in the alternative that she qualified under the plan’s five-year vesting option, but this option was in the 2022 summary plan description, and she did not allege that the option was available at the time of her prior participation. Furthermore, her multiple breaks in service effectively canceled her eligibility for benefits. Trevillyan also argued that the fund “did not provide Plaintiff with SPDs or annual benefits summaries or otherwise communicate with her regarding her accrual of Vesting Service Credits during her working years,” but even if true, the court found that this failure did not establish that she satisfied the plan’s vesting terms. Under Trevillyan’s statutory penalty claim, the court found that penalties tied to the fund’s failure to make disclosures or respond to her 1990 letters were time-barred under California’s three-year statute of limitations (borrowed for § 1132(c)(1) claims). However, the fund conceded it took 57 days (27 more than allowed) to respond to Trevillyan’s 2024 document request, so the court allowed her claim based on this request to proceed. On Trevillyan’s breach of fiduciary duty claim, the court dismissed it as time-barred under § 1113’s six-year/three-year limitations scheme. The alleged misclassification and disclosure failures occurred between 1979 and 1990, and Trevillyan had “actual knowledge” of the operative facts by 1991, regardless of when she later realized she might have a legal claim. Trevillyan argued that the fraudulent-concealment exception applied, contending that the fund engaged in a “scheme” with C.F. Braun to misclassify her, but the court found this theory conclusory and unsupported by plausible factual allegations. As for Trevillyan’s interference claim, the court dismissed it because “the Ninth Circuit has generally found Section 510 to apply only in the context of employee-employer relationships where the employee suffers adverse employment action.” Thus, it did not apply to the fund, and in any event, the claim failed because Trevillyan was not entitled to the benefits she sought in the first place. The court thus granted most of the motion to dismiss, but given Trevillyan’s pro se status, the court gave her leave to amend.

Pleading Issues & Procedure

First Circuit

Higgins v. Steere House, No. 25-CV-443-MRD-PAS, 2026 WL 2210925 (D.R.I. July 31, 2026) (Judge Melissa R. DuBose). Chelsie Higgins was the Director of Finance and Management Information Systems for Steere House Nursing and Rehabilitation Center. Higgins suffered from chronic medical conditions which prompted her to request a temporary schedule modification from Steere, but Steere denied her request. As a result, Higgins took FMLA leave in August 2023 and submitted her resignation three months later while on leave. Higgins alleges that before she left Steere, she raised concerns about misconduct by Steere’s human resources department, and after she complained, she was excluded from meetings and denied cooperation in managing compliance-related programs. This worsened her stress and medical conditions. For the purposes of our humble newsletter, she also contends that following her resignation, she never received timely COBRA notice of continuing medical insurance coverage. Her complaint asserts seven counts: violations of the Rhode Island Civil Rights Act (Count I), the Rhode Island Fair Employment Practices Act (Count II), the ADA (Count III), the Rhode Island Whistleblowers’ Protection Act (Count IV), the Rhode Island Parental and Family Medical Leave Act (Count V), FMLA (Count VI), and ERISA (Count VII). Steere moved to dismiss, and the court addressed the three federal claims (ADA, FMLA, ERISA) first. Under the ADA, the dispute centered on whether Higgins had suffered an adverse employment action. Higgins argued she was constructively discharged, but the court held that her allegations – which included exclusion from meetings, obstruction from completing her duties, and denial of cooperation on compliance matters – did not plausibly establish the “severe and oppressive” conditions required for constructive discharge. More importantly, Higgins failed to tie any of this alleged mistreatment to her disability; instead she tied them to her whistleblowing complaints. As a result, the ADA claim was dismissed. As for the FMLA claim, the court noted that it was “not robustly discussed” by either party. The court ultimately found Higgins’ allegations conclusory and unsupported: “Being granted leave under the FMLA is not a basis for liability under the statute, and Higgins has not directed the Court’s attention to any factual allegations to support her conclusory claim that Steere House has violated the FMLA in any other manner.” As a result, this claim was also dismissed. Moving on to ERISA, the court noted that this claim turned on whether Higgins received timely COBRA notice following her resignation, which was a “qualifying event” triggering notice obligations under 29 U.S.C. §§ 1163(2), 1166. Higgins alleged she never received timely notice, while Steere countered with a letter allegedly sent to Higgins, attached as an exhibit to its motion, which was purportedly sent by its third-party administrator. Higgins responded by challenging the letter as inauthentic, alleging that it “is plagued with metadata modifications.” Because this dispute raised issues of fact, the court could not resolve it on a motion to dismiss. Thus, the court ordered 30 days of limited discovery on two questions: (1) whether Higgins was properly noticed under COBRA, and (2) whether Steere itself (as opposed to the third-party administrator that actually issued the notice) could face liability. Because the court could not resolve all of the federal claims, it reserved decision on Steere’s motion as to Higgins’ state law claims pending the discovery results.

Fourth Circuit

Fitzwater v. CONSOL Energy, Inc., No. 1:17-CV-03861, 2026 WL 2170421 (S.D.W. Va. July 28, 2026) (Judge Joseph R. Goodwin). Plaintiff Allan H. Jack, Sr. was one of seven retired coal miners who sued CONSOL Energy after it terminated its retiree welfare benefits plan in 2015, alleging various ERISA violations. The district court held a bench trial in 2021 and then issued findings of fact and conclusions of law in 2024. The court ruled in favor of some of the plaintiffs on some of the issues, but Jack was not one of them. The court found that although Jack proved his breach of fiduciary duty claim on the merits, his claim was time-barred under ERISA’s statute of limitations. Specifically, Jack filed suit more than eight years after CONSOL’s last breach as to him and more than three years after he gained actual knowledge of the breach in 2014. The court also rejected application of ERISA’s fraud-or-concealment exception, finding that CONSOL’s conduct did not amount to a scheme “designed to conceal evidence.” (Your ERISA Watch covered the decision in our October 9, 2024 edition.) All plaintiffs appealed the case to the Fourth Circuit, where Jack argued that equitable tolling should apply to preserve his claims, but the appellate court declined to reach the argument “because Plaintiffs failed to preserve it below.” The judgment was affirmed in its entirety. (We covered this decision in our March 11, 2026 edition.) In May of this year the district court judge passed away at the ripe old age of 100. Jack has now filed a motion before the newly assigned judge (who is 83) for relief from judgment under Federal Rule of Civil Procedure 60(b)(5) and (b)(6). The court denied Jack’s motion for two reasons. First, “Although the mandate rule does not prevent the court from hearing Jack’s motion, the court finds that the rule does preclude Jack’s arguments for relief.” The court ruled that the Fourth Circuit had already addressed – and rejected as unpreserved – Jack’s equitable tolling theory. Under Fourth Circuit precedent, “[A]bsent exceptional circumstances, the mandate rule…forecloses relitigation of issues expressly or impliedly decided by the appellate court.” The court also observed that Jack did not brief the merits of his equitable tolling theory in his motion, and thus “without more, the court would not be able to grant Jack the specific relief he seeks.” Second, the court held that Jack “fails to satisfy his evidentiary burden under Rule 60(b).” The court found that Jack could not show that there was a significant change in fact or law under Rule 60(b)(5). The court noted that ERISA’s statutory provisions were unchanged, and the case law on which Jack relied preceded the filing of the complaint. Furthermore, there were no “exceptional circumstances” under Rule 60(b)(6). The court rejected Jack’s argument that CONSOL’s allegedly delayed assertion of its limitations defense constituted such circumstances, and further disagreed that the case’s broad public significance to retired miners justified relief because Jack “provides no relevant authority to which the court can look to make such a determination in this context.” As a result, Jack’s motion was denied.

Ninth Circuit

Karim v. International Alliance of Theatrical Stage Employees, No. 2:25-CV-11929-SPG-PD, 2026 WL 2185926 (C.D. Cal. July 27, 2026) (Judge Sherilyn Peace Garnett). Audra Karim is a wardrobe professional who has been a member of IATSE Local 768 since 2008. According to her pro se pleadings, Karim filed internal charges against former Local 768 officers for financial misconduct and retaliatory behavior. Karim’s charges proceeded to trial before a hearing officer, who found her charges were “interposed to intimidate” and fined her approximately $17,000 “without written notice, a hearing, or an opportunity to respond.” Since the hearing she “has been threatened with permanent expulsion, and her attempts to pay annual dues have been rejected.” Karim also alleges she was denied job referrals despite higher seniority, was excluded from arbitration settlement proceedings involving the Peacock Theatre, experienced discrepancies in her 401(k) contribution records, and was subjected to defamatory statements by the IATSE president, who characterized her charges as “specious,” “false,” and “maliciously referred.” Karim thus filed this sprawling action against IATSE, Local 768, and numerous individuals. One motion to dismiss has already been decided (see our April 15, 2026 edition for more details), and now defendants have filed a second motion attacking Karim’s second amended complaint, which asserts twelve claims for relief. The court granted the motion as to most of Karim’s claims. On Karim’s duty of fair representation claim, the court dismissed it regarding individual defendants, without leave to amend, because Ninth Circuit law holds that only the union can be liable for this duty. Against Local 768, the court found Karim’s grievance-based theory time-barred under the six-month limitations period, but allowed her arbitration-based and hiring-hall theories to proceed because the arbitration decision was issued within six months of filing and Karim’s referral-denial allegations plausibly showed discriminatory conduct. Karim’s breach of contract claim was dismissed with leave to amend because it was preempted by the Labor Management Relations Act, and because Karim never identified the actual substantive terms of the Local 768 Constitution which were breached. Karim’s trusteeship abuse claim was dismissed without leave to amend because enforcement authority on these issues is granted exclusively to the Secretary of Labor, not private plaintiffs. Karim’s defamation claim against the IATSE president was dismissed with leave to amend. The court found that the president’s statements were protected by California’s common-interest privilege, and Karim had not sufficiently pled the actual malice required to overcome the privilege. Finally, on the claims we’re all here for, the court dismissed Karim’s ERISA claims without leave to amend. As in her previous complaints, Karim still failed to allege that any defendant qualified as a fiduciary, or how any specific plan provisions were violated. Karim’s new ERISA claim, an interference theory based on 29 U.S.C. § 1140, exceeded the scope of amendment granted by the court previously, and in any event it failed to allege any qualifying adverse action or causal link to protected conduct. Furthermore, the court noted that some of Karim’s factual allegations actually contradicted her claimed ERISA violations. As a result, the case will continue, but our coverage of it likely ends here.

Provider Claims

Fourth Circuit

Mercy Med. Ctr. v. Fidelis Software Solutions, LLC, No. CV 26-292-BAH, 2026 WL 2199286 (D. Md. July 30, 2026) (Judge Brendan A. Hurson). Mercy Medical Center provided inpatient health care services in 2022 to a minor who was a dependent of an employee of Fidelis Software Solutions, LLC, who in turn was insured under the company’s employee healthcare plan. In this action Mercy contends that its charges were set by the Maryland Health Services Cost Review Commission (HSCRC), a state body empowered to review and approve hospital rates, but Fidelis paid at reduced rates and refused to correct the shortfall despite repeated requests. Mercy thus brought this case in Maryland state court against Fidelis and its claim administrator, Planned Administrators Inc. (PAI), alleging a single state law claim for breach of contract. PAI removed the case to federal court and moved to dismiss, arguing that (1) Mercy’s breach of contract claim is completely preempted by ERISA, and Mercy failed to allege exhaustion of administrative remedies, and (2) even absent preemption, Mercy failed to state a contract claim because PAI  was not in contractual privity with Mercy and owed it no duty. On preemption, the court extensively analyzed the Supreme Court’s Davila two-prong complete preemption test, focusing on the “right to payment” versus “rate/amount of payment” distinction drawn by the Second Circuit in Montefiore v. Teamsters Local 272 and the Fifth Circuit in Lone Star v. Aetna. These cases were ultimately unhelpful because they relied on a separate provider agreement that did not exist here; Mercy’s claims were based on Maryland law (HSCRC’s regulatory rate-setting authority) instead. As a result, the court was puzzled as to “what contractual obligation(s) does Mercy allege give(s) rise to Mercy’s legal right to reimbursement at a particular rate from PAI? The complaint fails to provide an answer.” PAI argued that Mercy’s claim could not be determined without interpreting the terms of the plan, but “the Court cannot, based on the allegations in the complaint alone, discern why that is so” because of the contractual void in Mercy’s complaint. Thus, the court abandoned the preemption issue and turned to the merits of Mercy’s claim. The court held that, even assuming the claim was not preempted, Mercy failed to state a claim because its complaint never identified any contract between Mercy and PAI, nor explained the specific nature of any obligation PAI owed. Instead, it merely asserted in a conclusory fashion that defendants “failed to pay the submitted bills at the rates set by the HSCRC.” Thus, PAI’s motion to dismiss was granted. The court granted Mercy 14 days to decide whether it wanted to seek leave to amend, and to update the court as to its intentions regarding Fidelis, which apparently had not yet been served.

Eleventh Circuit

Cousins v. Cigna Health & Life Ins. Co., No. 1:25-CV-22758-DPG, 2026 WL 2210123 (S.D. Fla. July 31, 2026) (Judge Darrin P. Gayles). Benjamin Cousins, M.D., P.A., is “a non-contracted, out-of-network medical services provider seeking payment for medical services rendered to eleven separate patients” who were beneficiaries of various ERISA-governed health plans. Cousins alleges that the patients assigned their insurance benefits to him so he could seek direct payment from Cigna, that Cigna failed to fully pay claims submitted for his services, and Cigna now owes him $167,947.86. Cousins’ complaint originally contained four claims: breach of contract (Count I), quantum meruit (Count II), account stated (Count III), and unjust enrichment (Count IV). However, the court dismissed Counts II-IV in an earlier unopposed motion, leaving only the breach of contract claim. Cigna filed a summary judgment motion on this remaining claim, which Cousins again did not oppose. Thus, it was no surprise that the court granted this motion as well in this brisk order. The court began with ERISA preemption, holding that Cousins’ breach of contract claim was preempted in its entirety because “Plaintiff alleges Cigna breached their insurance policies,” which had the requisite “connection with or reference to” an ERISA plan to support preemption. Next, the court found that three of the patient claims were untimely under Florida’s five-year limitations period for breach of contract claims. The court found that the undisputed record showed Cigna had processed and issued final appeal determinations on the three patients more than five years before the March 2025 complaint filing date. Next, the court found that anti-assignment provisions in the relevant benefit plans applied to the claims of nine of the patients. Relying on Eleventh Circuit precedent holding that unambiguous anti-assignment clauses in ERISA-governed plans are valid and enforceable, the court held these provisions independently precluded Cousins from maintaining any assignment-based claim. Finally, the court agreed with Cigna that “it was neither the insurer nor the claims administrator for the self-funded ERISA plan” that covered one of the patients, and thus no claim could be asserted against Cigna for that patient. Thus, Cigna’s motion was granted in full and judgment was entered in its favor.

Statute of Limitations

Fourth Circuit

Breeding v. United of Omaha Life Ins. Co., No. 1:26-CV-00037, 2026 WL 2210117 (W.D. Va. July 31, 2026) (Judge James P. Jones). Plaintiff Jack Breeding was married to Rosella Denene Breeding, who passed away in 2024 at the age of 52. In this action he seeks recovery of benefits under two ERISA-governed life insurance policies which he alleges covered Rosella. Under his theory of liability, Rosella became totally disabled in 2011, which under the policy terms relieved her of the obligation to pay premiums so long as she remained disabled. Rosella had this coverage until 2014, when United of Omaha, the plan’s insurer, notified her that it was terminating the policies for failure to provide annual proof of disability. United also informed Rosella that she could appeal the decision, and that she had the right to convert up to $143,000 of the terminating insurance to a new policy. Rosella did neither, and ten years later Jack filed this action in state court. United removed the case to federal court, asserting ERISA preemption, and moved to dismiss on the grounds that the action was barred by the applicable statute of limitations, and that the plan’s administrative appeals were not exhausted. Jack did not file a response to the motion. The court addressed the merits regardless, and granted the motion on statute of limitations grounds, without reaching the administrative exhaustion argument. The court began by confirming that the action was governed by ERISA and thus was properly removed to federal court. It noted that timeliness is normally an affirmative defense that is not well suited to rulings on the pleadings, but here “the facts as to when the limitations period began to run are clear and thus a motion to dismiss is a proper instrument to resolve the issue.” As for the appropriate limitation period, the court explained that ERISA itself supplies no limitations period for benefit-recovery suits, and thus courts borrow the most analogous state-law period. Here, the policies specified Tennessee law (which has a six-year limitations period for breach of contract) while Rosella resided in Virginia (which has a five-year period). The court held that Jack’s claims arose not at the time of Rosella’s 2024 death, but in 2014 when the policies were terminated: “The breach complained of is not a denial of payment upon the insured’s death in 2024, but a termination of the policies in 2014.” Because Jack filed suit more than ten years after that date, the claim was time-barred under any applicable limitation period. Finally, the court briefly addressed whether equitable tolling could rescue Jack’s claim. Such a defense is available “where an ERISA plan participant has ‘diligently pursued both internal review and judicial review but was prevented from filing suit [within the contractual period] by extraordinary circumstances.’” No such circumstances existed here. United sent Rosella multiple warning letters over time regarding her failure to submit proof of disability, followed by a clear termination notice detailing her administrative appeal rights and legal options. The complaint acknowledged receipt of the termination notice, and thus, “Nothing in the record suggests that the defendant ‘induced or tricked’ the plaintiff to file suit after the prescribed deadline.” The case was thus dismissed as untimely.

Venue

Ninth Circuit

Goldman v. Unum Life Ins. Co. of Am., No. 3:26-CV-01022-LJC, __ F. Supp. 3d __, 2026 WL 2184768 (N.D. Cal. July 21, 2026) (Magistrate Judge Lisa J. Cisneros). Kelsey Goldman, an attorney with Kirkland & Ellis LLP, was a participant in the firm’s ERISA-governed long-term disability benefit plan. She became disabled by long COVID in 2023 and submitted a claim to the plan’s insurer, Unum Life Insurance Company of America, which approved it in 2024. However, Unum subsequently terminated Goldman’s benefits. She unsuccessfully appealed and then brought this action. Unum responded by moving to transfer venue from the Northern District of California to the Eastern District of California under 28 U.S.C. § 1404(a). As a result, everyone’s location became relevant. Goldman worked at Kirkland & Ellis’ San Francisco office (in the Northern District of California) but resides in Woodland, California (in the Eastern District), where she also receives most of her medical treatment. She was evaluated by at least two healthcare providers with a Northern District presence (a neuropsychologist and a Workwell Foundation provider whose patient-testing facility is in Santa Rosa). Unum is a Maine corporation. The parties agreed that the plan was administered out of Kirkland & Ellis’ headquarters in Chicago, Illinois. The court began by confirming that the action could have been brought in the Eastern District because Unum was subject to ERISA’s nationwide service-of-process provision and had sufficient case-related contacts there under 29 U.S.C. § 1132(e)(2). As a result, “the Court turns to the discretionary factors of convenience and justice.” The court began with Goldman’s choice of forum, which “is entitled to deference,” particularly so under ERISA, which has “clearly struck the balance in favor of liberal venue.” Although Goldman’s residence outside the Northern District reduced that deference somewhat, the court found her choice still merited significant weight because multiple facts connected the case to the Northern District. After all, Goldman worked in San Francisco before her disability, and at least some treating/evaluating physicians relevant to her claim were located there. The court also rejected Unum’s forum-shopping argument, reasoning that seeking a forum with a faster trial docket – an interest the Ninth Circuit has expressly recognized as a legitimate transfer consideration – did not constitute “unusual gamesmanship.” In short, “Plaintiff filed in a venue permitted by ERISA’s liberal venue provisions, and with logical connections to her claim,” which she was permitted to do. The court then walked through the remaining factors and found most neutral or only marginally significant: convenience of the parties was neutral (neither party resided in the Northern District); convenience of witnesses marginally favored transfer but carried little weight because ERISA disability reviews are typically confined to the administrative record without live testimony; ease of access to evidence was neutral; familiarity with governing law was equal because ERISA is federal in nature; local interest and feasibility of consolidation were neutral or inapplicable; and relative court congestion weighed against transfer because the Northern District had a faster docket, although the court treated this as “at best, a minor factor in the section 1404 calculus.” Ultimately, because no factor strongly favored transfer and several were neutral or favored retention, the court denied Unum’s motion and the case will proceed where it was filed, in the Northern District of California.