There was no notable decision this week in ERISAland, as the federal judiciary was undoubtedly too busy watching the NBA Finals (congrats Knicks), the NHL Stanley Cup Final (congrats Hurricanes), and the beginning of the FIFA World Cup (congrats…Cape Verde?).

However, while all four of Monday’s World Cup matches ended in a tie, the first time in 68 years, there are no ties in federal court! Read on to learn about this week’s winners and losers, which include (1) a health plan participant’s unsuccessful effort to get his insurer to pay for his GLP-1 medication (Hamburger v. CareFirst); (2) two life insurance cases discussing the “substantial compliance” doctrine (Adams v. MetLife, Unum v. Crane), with the latter featuring the memorable line, “And tomorrow I’m fixing my life insurance policies I’m going to erase this mistake in my past. Enjoy destroying another man”; (3) a serial litigator getting her comeuppance (Clark v. DaVita); and last, but not least, (4) a cautionary tale from Puerto Rico in which a defendant successfully removed a case to federal court but unwittingly gained a jury at the same time (Morales-Álvarez v. Intelvox).

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

Attorneys’ Fees

Tenth Circuit

C.J. v. United Healthcare Ins. Co., No. 2:22-CV-00092-DBB-CMR, 2026 WL 1678251 (D. Utah June 10, 2026) (Judge David Barlow). C.J. is a participant in an employee medical benefit plan and her teenage daughter, F.R., is a plan beneficiary. F.R. was admitted to New Haven, a residential mental health treatment center in Utah. C.J. began submitting claims for her treatment to the plan’s claim administrator, United Healthcare, which approved them. However, defendant Cigna Health and Life Insurance Company took over the plan’s administration on July 1, 2019, and immediately denied coverage after that date, contending that F.R.’s residential treatment was not medically necessary. Plaintiffs unsuccessfully appealed and then filed this action, ultimately dismissing the two United defendants and pursuing claims only against the remaining Cigna defendants. In September of 2024 plaintiffs prevailed on their claim for plan benefits, but not on their claim under the Mental Health Parity and Addiction Equity Act because the court deemed the latter claim moot. The court determined that defendants’ denial was arbitrary and capricious: “Defendants’ denial letters did not meet ERISA’s minimum standards because they were conclusory, failed to state what clinical information was used to make the denial decision, did not cite to medical records, and failed to grapple with facts that could have justified awarding benefits.” Furthermore, “Defendants did not consider relevant medical necessity opinion letters and failed to engage in a meaningful dialogue with Plaintiffs.” On remand, defendants again denied coverage, and plaintiffs “chose not to pursue further review.” However, plaintiffs did file a motion for attorney’s fees, which the court adjudicated in this order. At the outset, the court determined that plaintiffs were eligible for fees because they achieved “some degree of success on the merits.” The court acknowledged that “[a] remand order by itself may not always constitute some success on the merits,” but here the court’s finding that defendants’ denial was arbitrary and capricious “was not merely a procedural victory for Plaintiffs; it was based on a finding that Defendants failed provide a full and fair review as required by ERISA.” Next, the court applied the Tenth Circuit’s five-factor test to decide whether fees should be awarded. The court found that (1) defendants were culpable because “it was Defendants’ failure to comply with ERISA requirements and engage in meaningful dialogue and full and fair review in the first instance that made the current proceedings necessary,” (2) defendants did not dispute their ability to satisfy an award of fees, (3) awarding fees would deter similar misconduct by ERISA plan administrators, (4) plaintiffs were not primarily seeking to benefit all plan participants or resolve an important legal question, which weighed against awarding fees, and (5) plaintiffs’ position was meritorious regarding the sufficiency of defendants’ review, as the denial was arbitrary and capricious. The fact that plaintiffs did not challenge the renewed denial on remand was relevant, but “[e]ven if Cigna’s denial of coverage was ultimately upheld on remand, the initial denial that made this lawsuit necessary was arbitrary and capricious and failed to follow ERISA’s minimum requirements.” The court then turned to the reasonableness of plaintiffs’ fee request. The court applied the lodestar method of reasonable hours expended multiplied by a reasonable rate to determine the amount. Plaintiffs requested $58,660 in fees, which included 40 hours worked by Brian King at $600 per hour and 84 hours worked by Brent Newton at rates between $325 and $425 per hour. Defendants argued that Mr. King’s $600 hourly rate was excessive and should be reduced to $500, but the court disagreed, noting that although Mr. King’s rate had been reduced in past cases, more recent cases supported a $600 rate due to his “tremendous experience and specialization in the field of ERISA litigation,” and the “increasing hourly rates for ERISA litigation in Salt Lake City.” The court reduced the total fee by $1,645 related to discovery on the Parity Act claim, which plaintiffs did not contest, and further reduced fees by $1,180 for work solely related to the dismissed defendants. Defendants’ other requested reductions were rejected. As a result, the court granted plaintiffs’ motion in part, awarding $55,835 in attorney’s fees and $400 in costs.

Breach of Fiduciary Duty

Ninth Circuit

Alas v. AT&T Inc., No. 2:17-CV-08I06-SPG-RAO, 2026 WL 1671492 (C.D. Cal. June 4, 2026) (Judge Sherilyn Peace Garnett). This is a nine-year-old case that has been up to the Ninth Circuit and back. (The Ninth Circuit’s decision, which was Your ERISA Watch’s case of the week in our August 9, 2023 edition, held in part that ERISA’s prohibited transactions provision included “arm’s-length service transactions.” This holding was vindicated by the Supreme Court in 2025 in Cunningham v. Cornell). The case involves the AT&T Retirement Savings Plan, a defined-contribution 401(k) plan. The plaintiffs, Robert J. Bugielski and Chad S. Simecek, allege that AT&T and the plan’s investment committee violated ERISA by failing to account for indirect compensation paid to the plan’s recordkeeper, Fidelity Workplace Services LLC, in connection with two transactions: the “BrokerageLink Transaction” and the “Financial Engines Transaction.” The plan’s contracts with Fidelity included a “most favored customer” clause, and plaintiffs contend that through these contracts indirect compensation was paid to Fidelity through revenue sharing fees from mutual funds available through BrokerageLink and through fees paid by Financial Engines to Fidelity for access to its platform and user data. The plaintiffs brought the following claims under ERISA: (1) violation of the fiduciary duty of prudence by failing to adequately monitor recordkeeping expenses and forms of indirect compensation; (2) prohibited transactions by failing to obtain required disclosures of indirect compensation; and (3) violation of the fiduciary duty of candor by erroneously reporting in Form 5500s that Fidelity’s indirect compensation was ‘eligible indirect compensation.” The case was originally assigned to a different judge, who granted summary judgment in defendants’ favor. As mentioned above, the Ninth Circuit reversed, and the parties renewed their summary judgment motions. In this order the court granted in part and denied in part both parties’ motions. The court started with the prohibited transaction claims, addressing the BrokerageLink Transaction first. The court granted plaintiffs summary judgment on the issue of liability, finding that defendants failed to comply with 29 U.S.C. § 1108(b)(2), rendering the arrangement “unreasonable.” Specifically, the disclosure provided by Fidelity was untimely and lacked sufficient information to evaluate the reasonableness of the compensation. Defendants conceded that they “never ‘directly’ got information about Fidelity’s indirect compensation through BrokerageLink” and instead had to estimate it. Because defendants did not meet their burden to prove that Fidelity made the statutorily required disclosures, “the arrangement cannot be considered reasonable.” As for the Financial Engines Transaction, the court granted summary judgment to defendants on the issue of whether they entered into a “reasonable arrangement” within the meaning of 29 U.S.C. § 1108(b)(2), which plaintiffs “do not appear to dispute.” However, the court found a triable issue of fact regarding whether “no more than reasonable compensation” was paid to Fidelity, precluding summary judgment for either party on this issue. Fidelity presented sufficient evidence to avoid summary judgment for plaintiffs, but that evidence hinged largely on the deposition testimony of one AT&T vice president whose credibility was at issue. Furthermore, plaintiffs pointed to other evidence which “suggest[ed]that Defendants gave little consideration to Fidelity’s indirect compensation and could support a factual finding that Defendants paid more than reasonable compensation.” Because the issue of reasonable compensation is a “heavily factual inquiry,” the court determined that summary judgment was inappropriate. The court then turned to damages and ruled that there was a genuine dispute of material fact on this issue as well. The court noted that plaintiffs had made a prima facie showing of the total cost of the prohibited transactions, shifting the burden to the defendants to show any offsets due to benefits conferred upon the plan. Defendants offered evidence, but again it was subject to credibility challenges, which created a triable issue of fact. Finally, the court addressed plaintiffs’ duty of prudence claim, resolving it similarly to the prohibited transactions claim. For the BrokerageLink Transaction, the court found a breach of the duty of prudence due to the lack of required disclosures, which prevented defendants from acting prudently. For the Financial Engines transaction, there was a triable issue of fact regarding whether defendants acted prudently, as a reasonable jury could find that more than reasonable compensation was paid. As a result, while the court resolved some issues, this case is still heading for trial.

Life Insurance & AD&D Benefit Claims

Fifth Circuit

Adams v. Metropolitan Life Ins. Co., Civ. No. 24-668-SDD-RLB, 2026 WL 1662073 (M.D. La. June 9, 2026) (Judge Shelly D. Dick). Audrey Adams was a long-time participant in an ERISA-governed life insurance employee benefit plan sponsored by General Motors and insured by Metropolitan Life Insurance Company. In 1976, Adams designated her parents as beneficiaries. However, in 2022, while experiencing health issues and receiving assistance from her caregiver, Sefera Givens, Adams called the GM Benefits and Services Center and, in a recorded telephone conversation, changed her beneficiary designation to Givens. When Adams died, her daughters, the plaintiffs in this case, contended the change was improper and that benefits should instead be paid to them as the default beneficiaries because Adams’ parents were both deceased. MetLife disagreed and paid the benefits to Givens. This action followed in which plaintiffs argued that the Givens beneficiary designation was invalid because (1) the plan required beneficiary changes to be made in writing, making the telephonic change ineffective, and (2) the change should be set aside due to fraud/undue influence by Givens. The parties filed cross-motions for judgment which were reviewed de novo by the court because the plan did not contain language granting MetLife discretionary authority. The court rejected both of plaintiffs’ arguments. First, the court acknowledged that the certificate of insurance required beneficiary changes to be in writing. Thus, Adams “did not technically comply with the terms of the Plan.” However, the summary plan description allowed changes to be made on the internet and by telephone. The court applied the doctrine of substantial compliance to resolve the issue. Under that doctrine, a beneficiary change is effective if the insured “(1) evidences his or her intent to make the change and (2) attempts to effectuate the change by undertaking positive action which is for all practical purposes similar to the action required by the change of beneficiary provisions of the policy.” The court found that the recorded call showed that Adams repeatedly and clearly expressed her intent to name Givens as the sole beneficiary and “undertook positive action by verbally affirming her desire for Givens to receive the benefits.” As a result, “the Insured substantially complied with the terms of the Plan in designating Givens as beneficiary. The purpose of the doctrine is to give effect to an insured’s intention to name a beneficiary despite technical noncompliance with the required procedures.” Turning to plaintiffs’ undue influence argument, the court stated that it was “not especially inclined to create federal common law on an issue not addressed by the Fifth Circuit in the context of ERISA, and based on a theory that Plaintiff recognizes is not supported by Louisiana law in the context of life insurance.” Furthermore, the court held that even if such an argument were viable, the facts in the administrative record did not support a finding of undue influence. The court found that the recording reflected that Adams could answer key questions and affirm her choice, and did not demonstrate coercion or incapacity sufficient to invalidate her designation. “The Insured was clear in giving the representative permission to speak to Givens during the call, and the Insured personally verified that she wanted Givens to be the beneficiary. Without more, the audio recording cannot provide sufficient factual support for a claim of undue influence.” Finally, the court addressed evidence plaintiffs sought to introduce from outside the administrative record. Plaintiffs’ evidence was intended to show that, if Givens were removed, they would be next in line as default beneficiaries. (MetLife had conducted a public records search that suggested one of Adams’ parents was still alive.) The court refused, relying on Fifth Circuit authority which limits courts to the administrative record in deciding ERISA benefits cases. As a result, the court held that even if plaintiffs could undermine Givens’ designation, the record still did not establish that they were entitled to the benefits. As a result, MetLife’s motion for judgment was granted, and plaintiffs’ was denied.

Sixth Circuit

Unum Life Ins. Co. of Am. v. Crane, No. 5:24-CV-00230-MAS, 2026 WL 1706791 (E.D. Ky. June 12, 2026) (Magistrate Judge Matthew A. Stinnett). John D. Crane was covered under an ERISA-governed group life insurance policy insured by Unum Life Insurance Company of America. He made a beneficiary designation in favor of Sarah Carta, with whom he began a romantic relationship in 2019-20. At that time Carta was embroiled in litigation over her previous romantic relationship, with William Brent Bundy. According to court records Carta logged into Bundy’s work-related benefits portal and changed Bundy’s life insurance beneficiary designation to herself. Bundy killed himself shortly thereafter and in litigation the court “ruled that Carta had lied about the events and granted the benefits to Bundy’s default beneficiaries, his parents.” According to Carta, Crane knew all about these events. In 2022 Crane and Carta began splitting up, and in late 2022 Crane sent texts to Carta indicating that he wanted to remove her as his beneficiary. However, although Crane accessed his employer benefits portal, there was no record that he initiated or submitted a beneficiary-change transaction. Unpleasant texts between the two continued. Crane told Carta that she “won’t get a dime. Bundy’s was your last death insurance check you will ever get.” Crane also told Carta, “[Y]ou been gone for over two weeks because you thought you could keep your shit here and not pay a storage bill and strong [sic] old dumb John on. Well you fucked up. This dogs done with you kicking me. Its not worth it. So again stay away from my house.” He reiterated that he was going to remove Carta as his life insurance beneficiary: “And tomorrow I’m fixing my life insurance policies I’m going to erase this mistake in my past. Enjoy destroying another man.” However, Crane never followed through and died in August of 2023. Unum received competing claims from Carta and Crane’s children, filed this interpleader action, and deposited the funds at issue with the court. Before the court here were competing motions for summary judgment from the potential beneficiaries. The court explained, “All parties agree that the express beneficiary of Crane’s life insurance policies was Carta… The sole issue before the Court is not Crane’s intent but whether Crane’s actions demonstrate that he substantially complied with removing Carta as the beneficiary.” The court stated that “substantial compliance is deemed sufficient ‘when the insured had done all he could do under the circumstances; all he believed necessary to effect the change or what the ordinary layman would believe was all that was necessary to accomplish the change.’” Under this standard, the court ruled in Carta’s favor. The court acknowledged that “cases considering substantial compliance are always difficult,” and emphasized that its role was not to answer the question of “does the named beneficiary deserve to receive the proceeds of this policy?” Indeed, “it is axiomatic that the court will not decide whom the insured should have named as beneficiary.” Thus, Crane’s intent was insufficient; substantial compliance required action. The court found there was no evidence that Crane did all he reasonably could under the circumstances to effect a beneficiary designation change. Crane’s children “want to assume that Crane removed Carta as his beneficiary in November 2022 but for some procedural snafu,” but although there was evidence that Crane accessed his employer’s benefits portal there was no evidence that he actually made any changes. Indeed, testimony indicated that any changes Crane might have intended were left pending in the portal and never submitted. The court also rejected the Crane children’s reliance on the Bundy case, explaining that (1) “the facts at issue in [the] Bundy Case stand in stark contrast to those in this litigation” because here there was no “clear evidence that Carta had accessed and unilaterally changed the beneficiary,” and (2) Carta’s credibility was not at issue in this case because “[n]one of the critical facts listed above come from Carta.” Thus, “In the end, Crane certainly expressed an intent to remove Carta as a beneficiary. However, there is no evidence that he took any actions to reflect that intent, much less substantially complied with fulfilling that intent.” As a result, the court granted Carta’s summary judgment motion, denied the Crane children’s cross-motion, and directed the clerk to pay the interpleaded funds to Carta.

Medical Benefit Claims

Eighth Circuit

Paul P. v. Anthem Blue Cross & Blue Shield, No. 4:25-CV-00991-SRC, 2026 WL 1723665 (E.D. Mo. June 15, 2026) (Judge Stephen R. Clark). B.P., a minor, suffers from mental health and substance abuse issues. After he underwent unsuccessful outpatient treatment, his father, Paul P., admitted him to blueFire, an outdoor behavioral health treatment center in Idaho. B.P. received treatment there for over three months, which improved his condition. The treatment cost $70,485, but Anthem, the administrator of Paul’s ERISA-governed health benefit plan, denied his claims for reimbursement, labeling the services as investigational and not medically necessary. Paul’s appeals were unsuccessful, so he and B.P. brought this action alleging two claims for relief under ERISA against Anthem, his employer, and the plan, asserting: (1) a wrongful denial of benefits claim under 29 U.S.C. § 1132(a)(1)(B), and (2) a Mental Health Parity and Addiction Equity Act claim under 29 U.S.C. § 1185a for appropriate equitable relief. Defendants responded by moving to dismiss the Parity Act claim. The court noted that “[t]he parties do not cite, and the Court has not found, binding precedent interpreting the Parity Act.” The court concluded that, “To establish a violation, [Plaintiffs] must [plausibly] show that the ‘treatment limitations’ on mental-health care are ‘more restrictive’ than or ‘separate’ from the treatment limitations…‘applied to substantially all medical and surgical benefits covered by the plan.’” Under this framework defendants argued that the Parity Act failed “for two independent reasons… One, Plaintiffs failed to plausibly plead a Parity Act claim… And two, Plaintiffs cannot seek ‘equitable relief’ under the Parity Act for ‘a purported wrongful denial of benefits.’” The court addressed each argument. First it ruled that plaintiffs plausibly pled a Parity Act claim by alleging that Anthem’s denial of coverage was an as-applied violation, even though they conceded their facial challenge. The court noted that plaintiffs had alleged that “Anthem/the Plan declined to produce the requested documents and materials requested by Plaintiffs.” As a result, pleading on information and belief was permissible; “the unique posture of this case presents an instance where certain facts necessary to state a plausible claim ‘tend systemically to be in the sole possession of defendants.’” As for defendants’ second argument, that plaintiffs improperly asserted duplicative claims under 29 U.S.C. §§ 1132(a)(1)(B) and 1132(a)(3), the court rejected it. The court held that plaintiffs were permitted to plead both claims because “they assert different theories of liability.” Thus, it was premature to determine at the motion to dismiss stage “whether the relief available under section 1132(a)(1)(B) would adequately remedy Plaintiffs’ alleged injuries if they were to prevail.” The court thus denied defendants’ motion to dismiss.

D.C. Circuit

Hamburger v. CareFirst BlueCross BlueShield, No. 1:25-CV-03000 (TNM), 2026 WL 1678249 (D.D.C. June 10, 2026) (Judge Trevor N. McFadden). “Recent years have seen the meteoric rise of GLP-1 drugs,” noted the court, and plaintiff Martin Hamburger would like his insurance company to pay for his prescription for one of those drugs, Zepbound. Hamburger is a participant in an ERISA-governed health plan sponsored by Destination DC, a tourism non-profit, and was prescribed Zepbound by his doctor to treat obstructive sleep apnea. Zepbound has been approved by the Food and Drug Administration for treating obstructive sleep apnea in adults with obesity, to be used alongside a reduced-calorie diet and increased physical activity. However, when Hamburger sought coverage for Zepbound from his plan’s insurer, CareFirst BlueCross BlueShield, its pharmacy benefit manager, Caremark, denied it on the ground that his plan did not cover the medication. Hamburger’s appeal was unsuccessful, so he brought this putative class action against CareFirst and Caremark, asserting two claims under ERISA: one for denial of benefits under 29 U.S.C. § 1132(a)(1)(B) and another for breach of fiduciary duty under 29 U.S.C. § 1132(a)(3). Defendants filed a motion to dismiss for failure to state a claim. Addressing Hamburger’s denial of benefits claim first, the court found that it was based on a “false premise” because the plan excluded coverage for Zepbound, citing Exclusion 13, which stated that “[b]enefits will not be provided” for “Prescription Drugs for weight loss.” Hamburger “trie[d] to recast Zepbound as something other than a weight-loss drug” by arguing that it was also prescribed for obstructive sleep apnea and citing the FDA’s approval for that purpose. However, “the FDA’s authorization hurts him more than it helps” because “the FDA approved Zepbound for obstructive sleep apnea only in adults with obesity, to be used in combination with a reduced-calorie diet and increased physical activity… In other words, Zepbound helps with sleep apnea because it promotes weight loss, not as a separate, unrelated benefit. If anything, then, the FDA’s approval confirms that Zepbound is a weight-loss drug.” As for Hamburger’s second claim, the court ruled that he could not pursue a breach of fiduciary duty claim under § 1132(a)(3) because he had an adequate remedy under § 1132(a)(1)(B) for the denial of benefits. The court admitted that the D.C. Circuit “has not weighed in” on this issue, but declared that “judges in this district have ‘followed the view of the majority of circuits that a breach of fiduciary [duty] claim under § 1132(a)(3) cannot stand when a plaintiff has an adequate remedy for her injuries under § 1132(a)(1)(B).’” In any event, the court found that Hamburger could not state a claim even if it were allowed, as the denial of coverage adhered to the plan’s terms, and defendants had no obligation to consider Hamburger’s request for a non-formulary exception when Zepbound was already on the formulary. The court also found that defendants gave Hamburger adequate notice and explanation for why his claim had been denied. Finally, the court dismissed the putative class action because Hamburger, having failed to state a viable individual claim, could not serve as a class representative. Thus, defendants’ motion to dismiss was granted: “Hamburger can pay for Zepbound himself or lobby his employer to renegotiate the terms of the Group Contract, but he cannot use ERISA to force CareFirst to pay for a drug it specifically excluded in its agreement with his employer.”

Pleading Issues & Procedure

First Circuit

Morales-Álvarez v. Intelvox LLC, No. CV 26-1256 (FAB), __ F. Supp. 3d __, 2026 WL 1693838 (D.P.R. June 11, 2026) (Judge Francisco A. Besosa). Erick Iván Morales-Álvarez was the Chief Financial Officer of Intelvox LLC from 2019 through February of 2026, when he was terminated at the age of 68. Morales contends that his termination was “performed irregularly” because he did not receive a termination letter, Intelvox refused to return his belongings, and he was replaced by a 27-year-old employee. Morales filed suit in Puerto Rico court, asserting various claims under Puerto Rico law and one under ERISA for failure to pay 401(k) plan benefits. Intelvox removed the complaint to federal court. Morales did not contest the removal but made a demand for a jury trial, which Intelvox moved to strike. Intelvox contended that Puerto Rico, as a civil law jurisdiction, does not provide for civil jury trials, and removal to federal court does not create a jury trial right where none existed before. Intelvox also argued that none of Morales’ claims contained a statutory jury trial provision. The court disagreed, stating that because the case had been removed to federal court, federal law applied and thus “[t]he Seventh Amendment guarantees a right to trial by jury in federal courts ‘[i]n Suits at common law, where the value in controversy shall exceed twenty dollars.’” The court noted that this right extends to statutory claims that are legal in nature. Thus, because Morales’ claims under Puerto Rico Law 80 (severance for unjust dismissal), Law 100 (age discrimination), and Law 180 (vacation and sick leave) sought monetary relief and were legal in nature he was entitled to a jury trial on those claims. As for Morales’ ERISA claim, the parties did not dispute, and the court acknowledged, that “Morales lacks the right to a jury trial on his ERISA claim. Remedies available under ERISA are widely acknowledged to be equitable rather than legal, and consequently, actions under ERISA generally do not trigger the Seventh Amendment right to a jury trial… Accordingly, Morales is not entitled to trial by jury on his ERISA claim.” As a result, Morales’ ERISA claim will be tried by the court, but a jury will decide his remaining claims arising under Puerto Rico law. Intelvox might be rethinking that removal decision.

Third Circuit

Clark v. DaVita Inc., No. CV 26-23, 2026 WL 1723469 (E.D. Pa. June 15, 2026) (Judge Karen S. Marston). Joy Lucretia Clark was employed by DaVita Inc. and participated in its ERISA-governed employee benefits plan. She alleges that while she was on approved leave from her job, she lost access to DaVita’s employee and benefits online portal. She missed open enrollment periods, affecting her long-term disability coverage, and was provided “inconsistent information” about her benefits status. She thus filed this pro se action in which she asserted claims that included failure to disclose requested documents, breach of fiduciary duty, interference with her right to access the benefits portal, and failure to provide a full and fair review of her benefits denial. She sought injunctive and declaratory relief, as well as monetary damages. The court granted Clark’s application to proceed in forma pauperis and screened the complaint under 28 U.S.C. § 1915(e)(2)(B)(ii) to determine if it failed to state a claim. The court expressed frustration with Clark’s complaint because she “provides no information whatsoever about the benefits plan, its term provisions or requirements, or her enrollment. No information is provided about the benefits she was purportedly entitled to during her medical leave or even those she participated in before she purportedly took leave in November 2024.” Nonetheless, the court addressed each of Clark’s claims in order. On her first two counts for failure to disclose plan documents, the court found that Clark’s “threadbare” allegations were insufficient to state a plausible claim because she did not clearly allege she was a plan participant or beneficiary, did not specify the documents requested, or to whom the request was directed. As for Clark’s next two claims regarding portal access and benefits, the court determined that these claims “involve the interpretation of the plan itself and Clark must exhaust administrative remedies first before seeking relief here.” Her allegations of breach of fiduciary duty were deemed conclusory and lacking specific facts about the fiduciary’s duty, breach, and any loss to the plan: “she has simply made wholly conclusory and vague allegations of liability, which will not do to state a claim.” On Clark’s fifth count for failure to provide a full and fair review, the court dismissed this claim because “she does not affirmatively allege that she submitted a claim for benefits that Defendants denied. In any event, courts have held that Section 503 does not confer a private right of action.” Finally, the court noted that “Clark has now filed a total of eleven civil actions in this Court since October 2024,” and that it had warned Clark after her seventh filing “against abusing the judicial process and the consequences for doing so.” This warning “failed to deter Clark,” as she filed yet more actions, and “[a]s of the date of this Memorandum, she has yet to state a claim in any case filed, and three of the four recent cases have been dismissed with prejudice.” As a result, the court issued an order to show cause “why her ability to file future lawsuits pro se in this Court without paying the filing fee should not be enjoined unless she includes with her complaint and in forma pauperis application (1) a certification indicating that the claims she seeks to present have arguable merit, (2) that is signed by a licensed attorney, and (3) includes that attorney’s bar number and contact information.” The complaint was thus dismissed, although Clark was given leave to amend.

Eighth Circuit

Benotti v. Lockton, Inc., No. 4:26-CV-00188-DGK, 2026 WL 1701049 (W.D. Mo. June 11, 2026); Benotti v. Lockton, Inc., No. 4:26-CV-00188-DGK, 2026 WL 1701050 (W.D. Mo. June 11, 2026) (Judge Greg Kays). These two procedural orders are the result of two motions filed by plaintiff Elizabeth Benotti, a participant in Lockton, Inc.’s ERISA-governed 401(k) plan. In this putative class action Benotti contends, among other things, that Lockton and other plan fiduciaries “failed to remove the America Century Target Date Fund series as an investment option in the Plan,” which constituted a breach of fiduciary duty. Benotti’s first motion sought to consolidate this case with a related case, Fritts v. Lockton, Inc., which was pending in the same judicial district. In connection with this motion Benotti sought appointment of class counsel and an extension of pleading and motion deadlines. The plaintiffs in Fritts did not oppose the motion, and neither did the Lockton defendants. The court approved the motion pursuant to Fed. R. Civ. P. 42(a), stating that “[t]he cases involve the same defendants and have overlapping legal and factual issues. The cases involve identical ERISA claims against Defendants… Because the legal claims are the same in each case, the cases will have near-identical discovery, evidence, and witnesses. Given this significant factual, legal, and evidentiary overlap, consolidating the cases will reduce costs for the parties and save the parties, the Court, and the jury an immense amount of time.” The court ordered all future filings to be submitted under the Fritts docket, approved Alexandr Rudenco of Milberg PLLC and Mark Gyandoh of Capozzi Adler, P.C., as interim co-lead class counsel, and Maureen Brady of McShane Brady Law as interim liaison counsel. The court also set a new schedule, which included a deadline for plaintiffs to file a consolidated class complaint. In Benotti’s second motion, she sought to transfer the case to Judge Stephen R. Bough in the same judicial district. Defendants opposed this motion, and the court denied it. Benotti contended that her case was related to Doll v. Evergy Inc., which was pending in front of Judge Bough, arguing that the facts, allegations, and legal issues were similar in both cases. The court noted that the local rules required transfer when a case is “related to another case filed in the District.” However, “In general, a case is ‘related’ to another case for purposes of transfer when the cases involve ‘the same principal defendant, the same cause of action, and similar factual allegations.’” Benotti admitted that the cases involved different parties. As a result, “the cases are not related for purposes of transfer.” Thus, the new consolidated case will proceed in front of Judge Kays.

Venue

Third Circuit

Byers v. Sunrise Senior Living, LLC, No. CV 26-448, 2026 WL 1679067 (E.D. Pa. June 10, 2026) (Judge Gerald J. Pappert). The plaintiffs in this putative class action are employees of Sunrise Senior Living LLC, which is headquartered in McLean, Virginia, and participants in Sunrise’s ERISA-governed 401(k) retirement plan. Plaintiffs allege that the plan fiduciaries violated ERISA by (1) selecting or retaining an imprudent investment option (a Prudential guaranteed income fund), (2) failing to adequately monitor the plan committee’s investment decisions, and (3) violating ERISA’s prohibited-transaction provision by allowing Prudential to earn excessive fees for managing the guaranteed income fund. Defendants responded with a motion to transfer the case to the Eastern District of Virginia under 28 U.S.C. § 1404(a), which allows for the transfer of a civil action for the convenience of parties and witnesses and in the interest of justice. The court evaluated six private-interest factors and six public-interest factors to determine whether the transfer was appropriate. First, the court found that the private-interest factors favored transfer. Although the plaintiffs’ choice of forum is usually given “paramount consideration,” the court noted that less deference is given in class actions, especially when the class is large and “scattered all over the Nation,” as in this case. The court also found that the core allegations and operative facts of the lawsuit had a more significant connection to Virginia than Pennsylvania, as the committee’s decision-making process occurred primarily in Virginia. The convenience of the parties and witnesses was neutral. Sunrise is located in Virginia and administered the plan there, but defendants failed to show that litigating in the Eastern District of Pennsylvania would be inconvenient. Books and records were not a factor: “Though the defendants argue the books and records are in Virginia, they do not explain why those materials could not be produced in Pennsylvania.” Turning to the public interest factors, the court found that the Eastern District of Virginia was less congested than the Eastern District of Pennsylvania, supporting transfer. Furthermore, the Virginia court would have subpoena power over a key non-party witness. The court also emphasized the “public interest in having cases adjudicated where their operative facts occurred.” Because the fiduciary conduct was most connected to Virginia, Virginia had the stronger local interest. As a result, “On balance, the private and public interests favor transferring this case to the Eastern District of Virginia.” Defendants’ motion was thus granted.

You will no doubt be relieved to learn that this week, unlike the last two weeks, we are not featuring a case of the week about actuarial calculations. In fact, it was a relatively light week in the federal courts for ERISA cases, with no decision standing out as meriting individual attention.

Still, there was plenty of action. Read on to learn about (1) two preliminary approvals of class action settlements – one arising from allegedly illegal tobacco surcharges in welfare plans (Bailey v. Sedgwick), and one arising from the alleged misuse of retirement plan forfeitures (Halter v. Providence); (2) a denial of a motion to decertify a class in a ten-year-old case, with trial scheduled for next month (Schuman v. Microchip); (3) the latest battle in the war between Envision Healthcare and United Healthcare (Envision v. United Healthcare); (4) an appellate court reversal finding that Cigna erred in denying a claim for artificial disc replacement surgery (Roggenkamp v. Morgan Stanley); and (5) three more cases concluding that the independent dispute resolution process established by the No Surprises Act does not give providers a private right of action in federal court (SpecialtyCare Inc. v. HCSC (IL, NM, TX)).

We’ll be back next week!

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

Class Actions

Sixth Circuit

Bailey v. Sedgwick Claims Mgmt. Servs., Inc., No. 2:24-CV-02749-TLP-TMP, 2026 WL 1649991 (W.D. Tenn. June 8, 2026) (Judge Thomas L. Parker). Plaintiff Korine Bailey filed this class action against Sedgwick Claims Management Services, Inc., alleging that the tobacco surcharge in Sedgwick’s welfare benefits plan violated ERISA’s anti-discrimination provisions, fiduciary duty provisions, and prohibited transaction provisions. Bailey further contended that Sedgwick impermissibly imposed higher premiums for life insurance benefits based on tobacco use, which violated ERISA’s anti-discrimination provisions. In September of 2025 the court allowed the case to proceed past the pleading stage, and the parties subsequently reached a settlement. Bailey filed an unopposed motion for preliminary approval of the settlement agreement, which the court granted in this brief order. The court confirmed it had jurisdiction over the matter and preliminarily found that the settlement class met the requirements of Federal Rule of Civil Procedure 23(a) because the class was ascertainable, with common questions of fact or law, and the claims of Bailey, who would adequately protect the interests of the class, were typical of the class. The court also found that the settlement class met the requirements of Federal Rule of Civil Procedure 23(b)(1), certifying a non-opt-out class which was defined to include plan participants or beneficiaries who paid a tobacco or nicotine surcharge without full reimbursement during the specified period. The court approved the terms of the settlement, finding that “(a) the proposed Settlement resulted from arm’s-length negotiations; (b) the Agreement was executed only after Class Counsel had researched and investigated multiple legal and factual issues pertaining to Plaintiff’s claims; (c) there is a genuine controversy between the Parties involving Defendant’s compliance with the requirements of ERISA; (d) the Settlement appears on its face to be fair, reasonable, and adequate; and (e) the Settlement is sufficiently fair, reasonable, and adequate to warrant sending notice to the Settlement Class.” The court further found the proposed plan of allocation to be “fair, reasonable, and adequate.” (The details were not set forth in the order, but the total settlement is $3 million). The court also approved the form and content of the settlement notice and outlined the process for class members to object to the settlement. The final approval hearing was scheduled for October 9, 2026.

Ninth Circuit

Halter v. Providence Health & Servs., No. 2:25-CV-00210-JNW, 2026 WL 1601689 (W.D. Wash. June 4, 2026) (Judge Jamal N. Whitehead). This is a class action in which participants of the Providence Health & Services 401(k) Savings Plan contend that Providence Health & Services and the Providence Health & Services Total Rewards Management Committee breached their fiduciary duties under ERISA by mismanaging the plan. Specifically, plaintiffs contended that defendants used forfeited employer contributions to reduce Providence’s contributions to the plan instead of using them to pay plan expenses in accordance with plan documents. In this brief order the court granted plaintiffs’ unopposed motion for preliminary approval of a class action settlement. The court found that the settlement was reached after plaintiffs received sufficient information from defendants to ensure that plaintiffs were informed and had a thorough understanding of the case, followed by arm’s-length negotiations overseen by a neutral mediator. The court emphasized that if the settlement had not been achieved, the class “faced the expense, risk, and uncertainty of protracted litigation,” and that the settlement amount – which was not mentioned in the order but apparently totals $42,724,532 – was “fair, reasonable, and adequate, taking into account the costs, risks, and delay of litigation, trial, and appeal.” The method of distributing the settlement funds was deemed efficient, as it relied on existing records and required no filing of claims. The court also preliminarily certified the class, finding that the class was sufficiently numerous that joinder of all members was impracticable, there were common issues of law and/or fact, the claims of the class representative were typical of the claims of the class, the class representative would fairly and adequately protect the interests of the class, and the prosecution of separate actions by individual members of the class would create a risk of inconsistent or varying adjudications. The court set a fairness hearing for October 20, 2026, to determine whether to grant final approval of the settlement and to address any motions for attorneys’ fees, costs, and service awards. Additionally, the court approved Analytics Consulting LLC as the settlement administrator to manage the settlement process.

Schuman v. Microchip Technology Inc., No. 16-CV-05544-HSG, 2026 WL 1603305 (N.D. Cal. June 4, 2026); Schuman v. Microchip Technology Inc., No. 16-CV-05544-HSG, 2026 WL 1613729 (N.D. Cal. June 4, 2026) (Judge Haywood S. Gilliam, Jr.). These are the latest two orders in a ten-year-old class action against Microchip Technology Inc., Atmel Corporation, and the ERISA-governed Atmel Corporation U.S. Severance Guarantee Benefit Program in which plaintiffs contend that that they were entitled to benefits from the plan when Atmel was acquired by Microchip. The plan was set to terminate on November 1, 2015, unless an “Initial Triggering Event” occurred, which would extend the plan for 18 months. An agreement with Dialog Semiconductor in September 2015 was considered an Initial Triggering Event, but the merger with Dialog did not close because Microchip made a better offer, which led to an Atmel-Microchip merger in April 2016. The central dispute in the case is whether the Initial Triggering Event with Dialog extended the plan if Atmel never closed its merger deal with Dialog. Plaintiffs alleged that Atmel executives assured employees that the plan remained in place, but after the merger, Microchip’s CEO stated that the plan had expired and offered reduced severance benefits if employees signed a release. Most plaintiffs signed the release in exchange for partial benefits. The district court originally certified the class, but on summary judgment it agreed with defendants that the named plaintiffs (Peter Schuman and William Coplin) were precluded by the releases from suing and representing others who had signed releases. (Your ERISA Watch covered this ruling in our August 30, 2023 edition.) Plaintiffs appealed, and in June of 2025 the Ninth Circuit reversed, announcing a new nine-factor test for determining when releases of rights under ERISA should be enforced. (This decision was the case of the week in our June 11, 2025 edition.) On remand, defendants filed a motion to decertify the class, which the district court evaluated in the first order listed above. The court found that the requirements of Federal Rule of Civil Procedure 23(a) were still met, including numerosity, commonality, typicality, and adequacy of representation. Numerosity and adequacy were not disputed. On commonality, the court emphasized that common questions, such as whether Microchip violated its fiduciary duty by claiming the plan had expired, remained central to the case and could “generate common answers” for the class. The court rejected defendants’ argument that “the validity of the releases is a threshold, individual question that will ‘swamp[]’ any common question,” noting that the Ninth Circuit’s decision highlighted the importance of considering alleged improper conduct by the fiduciary in obtaining the releases. For similar reasons, the court also found typicality, noting that it had already rejected defendants’ similar arguments at the class certification stage, “and the Ninth Circuit’s recent decision simply underscores that the Court must consider a fiduciary’s alleged improper conduct when considering whether a waiver is knowing and voluntary.” The court also found Rule 23(b)(2) satisfied because the primary relief sought was injunctive, and the court had broad authority to invalidate claims releases that were not knowing and voluntary or violated public policy. The court disagreed with defendants’ assertion that the injunctive relief sought was merely a disguised request for monetary relief: “That an injunction may ultimately clear the way for the class to receive a monetary payment does not render the injunction a nullity or somehow transform Plaintiffs’ requested injunctive relief into one for monetary damages.” As for Rule 23(b)(3), the court found that common issues predominated over individual ones, particularly the central issue of whether defendants engaged in improper conduct in obtaining the releases. The court rejected defendants’ “attempt to leverage the tension in the Court’s prior class certification order and order granting summary judgment,” noting that the court did not have the benefit of the Ninth Circuit’s test on summary judgment, and thus “did not consider the class-wide communications allegedly misrepresenting the terms of the Plan as part of its evaluation of whether the releases were entered into knowingly and voluntarily.” The court also minimized defendants’ argument that individualized inquiries would need to be made as to the enforceability of each release, stating that “[t]he heart of Plaintiffs’ case is – and has always been – whether Defendants mischaracterized the Atmel Plan and thus misled employees about their rights under the Plan.” This central issue of “fiduciary misconduct could predominate over the other factors.” Finally, the court found that class treatment was superior to other methods of adjudicating the controversy, as “it would be spectacularly inefficient to have over 200 trials here when the most critical facts that the Ninth Circuit has indicated ‘warrant serious consideration’ and ‘may weigh particularly heavily’…overlap as to all of the class members.” As a result, defendants’ motion to decertify the class was denied. In the court’s second order, it considered defendants’ motion to amend the scheduling order to reopen discovery. Defendants contended that discovery was necessary because the Ninth Circuit’s opinion “transforms the nature of this case.” However, “As the Court already explained in denying the motion for decertification, the Court disagrees that the opinion has such sweeping implications.” The court noted that trial was set to begin on July 13, less than six weeks from the ruling, and thus “the breadth and burdensome nature of the discovery now sought by Defendants ensures that it could not possibly be completed or digested before trial.” Furthermore, the court “has some concern that Defendants’ request is a strategic choice to further delay this decade-old case.” The court noted that defendants could have sought their proposed discovery earlier but chose not to do so. Moreover, “even after the case was reopened following the Ninth Circuit appeal, Defendants still waited six months to file this motion… Defendants offer no real explanation for this delay.” As a result, the court ruled that defendants had not shown good cause to reopen discovery and denied their motion. However, the court left open the possibility of revisiting the issue if necessary, after “the common factual record regarding Defendants’ conduct in interpreting the Atmel Plan and communicating with class members” has been developed.

ERISA Preemption

Sixth Circuit

Envision Healthcare Operating, Inc. v. United Healthcare Servs., Inc., No. 3:22-CV-00693, 2026 WL 1623108 (M.D. Tenn. June 4, 2026) (Judge Eli Richardson). This case is part of a long-running dispute between plaintiff Envision Healthcare Operating, Inc., a provider of emergency medical services, and defendants United Healthcare Services, Inc. and United Healthcare Insurance Company. (In 2023 Envision obtained a $91 million arbitration award against UnitedHealthcare.) Envision alleges that after its network agreements with defendants expired in 2020, defendants denied or reduce payments for services Envision provided to defendants’ insureds. Envision contends that this was done fraudulently and was “part of a coercive campaign to force Envision to accept unfavorable contract terms and to suppress Plaintiff’s business in favor of Defendants’ subsidiary, Optum, Inc. (‘Optum’), a non-party in this case.” As part of their scheme, defendants allegedly “implemented several specific strategies to achieve their goals, including pre-payment review practices, claim denials and adjustments, and extended delays in claim processing.” Envision’s complaint contained eight counts: two under the Racketeer Influenced and Corrupt Organizations Act (RICO), one under a Tennessee Prompt Pay statute, and several state-law causes of action including fraud, civil conspiracy, unjust enrichment, breach of implied-in-fact contract, and quantum meruit. Defendants filed a motion to dismiss for failure to state a claim. Because this is Your ERISA Watch, we will start at the end of the order and discuss the court’s ruling on defendants’ argument that all of Envision’s state law claims were preempted by ERISA. Crucially, the court noted that defendants conceded that preemption only applied “[t]o the extent [that] these claims are based on an assignment of benefits by an individual covered under an ERISA-governed plan.” The court explained that complete preemption was “inapplicable here because the propriety of removal has never been at issue in this case (which was originally filed in this Court), and Defendants have made no challenge to subject-matter jurisdiction.” Thus, the only question was whether express preemption applied to Envision’s state law claims. The court agreed with Envision that “none of its claims are based at all on an assignment of benefits by an individual covered under an ERISA-governed plan, and that therefore Defendants’ argument for preemption… is simply inapplicable.” As for the merits of Envision’s claims, the court (1) dismissed the RICO claims, finding that Envision failed to adequately plead the existence of a distinct RICO enterprise; (2) dismissed the fraud claim for failing to allege specific details regarding the alleged misrepresentations, such as the speaker, time, place, and reliance; (3) dismissed the Prompt Pay claim, ruling that the statute does not provide a private right of action for healthcare providers; (4) dismissed the civil conspiracy claim, noting that it is not a standalone cause of action but a theory to extend tort liability; (5) dismissed the unjust enrichment and quantum meruit claims because Envision did not adequately allege that defendants received a benefit from the services provided; and (6) allowed the breach of implied-in-fact contract claim to proceed, finding that the complaint contained sufficient factual matter to plausibly suggest the existence of an implied contract. As a result, only Envision’s implied contract claim passed muster; the court granted defendants’ motion to dismiss the remaining claims.

Ninth Circuit

Providence Mission Hosp. v. UFCW Unions & Food Employers Benefit Fund, No. 8:26-CV-00495-DOC-ADS, 2026 WL 1603910 (C.D. Cal. June 3, 2026) (Judge David O. Carter). The plaintiffs in this case are four related medical facilities which allege that they have a written healthcare services contract with Anthem Blue Cross which requires them to provide medical services to enrollees of Anthem and other payors, such as defendant UFCW Unions and Food Employers Benefit Fund, in exchange for reimbursement at rates specified in the contract. Although the fund is not a signatory to the contract, it is part of the Anthem network. Plaintiffs provided medical services to the fund’s participants and allege that they were not fully reimbursed by the fund for those services, resulting in an outstanding balance of $538,111.31. Plaintiffs filed this action in California state court asserting state law claims of breach of implied contract and quantum meruit. The fund removed the case to federal court, asserting ERISA preemption, and plaintiffs responded by filing a motion to remand, arguing that their claims were not preempted and arose independently from their contract with Anthem. The court applied the Supreme Court’s two-prong test from Aetna Health Inc. v. Davila to determine who should prevail. Under the first prong, the court found that plaintiffs could not have brought their claims under ERISA § 502(a)(1)(B) because the claims did not seek to recover benefits owed under an ERISA plan. Instead, the claims were based on an implied contract with the fund, independent of any ERISA plan. The fund contended that plaintiffs could bring suit as assignees of the plan participants, but the court was unimpressed with this hypothetical claim: “[T]he matter of assignment is irrelevant here since Plaintiffs’ claims to recover further payment from Defendant arise under Plaintiffs’ separate rate agreement contract with Anthem (which Defendant is contracted with).” The court also found that the second prong of the Davila test was not met because “the obligations arising from Defendant’s contract with Anthem Blue Cross would have existed regardless of the existence of the patients’ ERISA plans and arise from an independent legal duty.” The court ruled that “the claims brought by Plaintiffs…rely on an implied contract between a provider (themselves) and insurer (Defendant) and flow from this legal relationship rather than an ERISA plan… Therefore, their claims are based on legal duties independent of ERISA and the second prong of the Davila test is also not satisfied.” Because neither prong was satisfied, the court concluded that plaintiffs’ claims were not preempted by ERISA. The court thus determined that it lacked subject matter jurisdiction and granted plaintiffs’ motion to remand the case back to state court.

Medical Benefit Claims

Ninth Circuit

Roggenkamp v. Morgan Stanley Med. Plan, No. 24-7864, __ F. App’x __, 2026 WL 1625357 (9th Cir. June 5, 2026) (Before Circuit Judges Lee, Bumatay, and Sung). Marc Roggenkamp brought this action against the Morgan Stanley Medical Plan to recover ERISA-governed medical benefits. Cigna, the administrator of the plan, denied Roggenkamp’s pre-authorization request for a two-level artificial disc replacement (ADR) surgery. Cigna’s denial was based on its internal guidance, Medical Coverage Policy No. 0104 (MCP), which “categorically excludes two-level ADR as ‘experimental.’” The district court ruled in the plan’s favor, and Roggenkamp appealed to the Ninth Circuit. First, the appellate court affirmed the district court’s conclusion that Cigna did not operate under a conflict of interest. The parties agreed that the plan granted discretionary authority to Cigna, but “Roggenkamp has provided no evidence of a financial conflict, as he cannot show that Cigna both determines eligibility and pays for benefits.” Furthermore, the court found no conflict in Roggenkamp’s “allegations that Cigna delayed during the administrative and legal process, repeated the same conclusory language in its denial letters, and interrupted Roggenkamp’s physician in a peer-to-peer phone call[.]” The court rejected the idea that Cigna’s actions were attributable to the plan, noting its conclusion in Salyers v. Metropolitan Life Ins. Co. that “[o]ur holding in this case does not mean that a policy-holder employer is always an agent of the insurer in every aspect of plan administration in which it participates.” However, the court agreed with Roggenkamp that the district court erred in upholding the denial of his claim. ERISA regulations require a notice of claim denial to contain specific reasons and references to plan provisions, but Cigna’s denial letters cited only the MCP, not the governing summary plan description (SPD), which “does not categorically exclude two-level ADR.” The district court’s reliance on the SPD’s definition of “experimental, investigational or unproven” services was a “‘post-hoc rationalization[] that [was] not presented to the claimant…during the administrative process,’ and thus, an improper basis for affirming the denial of benefits.” Cigna only relied on the MCP, and thus “the district court could not construe Cigna’s denial as impliedly relying on the SPD because the plan administrator must ‘specific[ally] reference [] the plan provisions that form the basis of the denial,’ and the MCP and SPD are meaningfully different.” Finally, the court ruled that the district court erred in concluding that Cigna did not abuse its discretion in denying Roggenkamp’s claim. The court agreed with Roggenkamp that he did not receive a “full and fair review” as required by ERISA because Cigna’s denial letters did not reference the SPD’s definition of “experimental, investigational or unproven” services or explain how two-level ADR qualified under that definition. “Thus, Cigna did not ‘interpret’ the SPD at all, much less interpret it reasonably.” Furthermore, the court ruled that “Cigna abused its discretion by failing to meaningfully address the information Roggenkamp provided in his appeals.” As a result, “we reverse and remand with directions to remand to Cigna for reevaluation of the merits of Roggenkamp’s claim under the SPD definition, not the MCP definition.”

Pleading Issues & Procedure

Fourth Circuit

Vickers v. Cigna, No. 25-CV-17425 (MEF)(LDW), 2026 WL 1590595 (D.N.J. June 1, 2026) (Judge Michael E. Farbiarz). Stanley Vickers was enrolled in the multi-employer MILA National Health Plan, which is self-funded by the MILA Managed Case Health Care Trust Fund. Vickers’ specific benefits were administered by Cigna. Vickers brought this action against multiple Cigna entities, which responded by filing a motion to dismiss, contending that they are not proper parties to the action. In support of their argument they provided a declaration and a copy of the benefit plan. However, the court ruled that “from the get-go, there is a threshold problem with the Defendants’ argument – it relies on materials that are outside of the pleadings… The complaint here does not mention MILA. Let alone its funding structure. Or its relationship with any of the Defendants. Indeed, for their factual account of all of this (MILA, etc.), the Defendants rely on a declaration… But the declaration is an outside-of-the-pleadings item. It is plainly out of bounds for now. It cannot be considered here, at the motion-to-dismiss stage.” Defendants argued that the court could at least consider the plan because it was integral to Vickers’ allegations, but the court stated that “the fact that a plan document can be considered does not mean that this plan document can be considered. And without the Defendants’ outside-of-the-pleadings assertions as to MILA, there is no way to know whether the operative ERISA plan here is the MILA plan document or some other plan document.” The court thus determined that it could not rule on defendants’ motion as presented, and instead converted it into a motion for summary judgment. The court also ruled that “the parties will be permitted to now conduct rapid and highly targeted discovery, as to: MILA; MILA’s relationship to the Plaintiff; MILA’s relationship to the Defendants; and any closely related subject, all in the discretion of the United States Magistrate Judge.” The court stated that it would revisit defendants’ proper-party arguments after the completion of this discovery. The court also allowed Vickers to amend his complaint to add claims against two MILA defendants.

Provider Claims

Seventh Circuit

SpecialtyCare Inc. v. Health Care Serv. Corp. d/b/a Blue Cross Blue Shield of Illinois, No. 25 CV 12935, 2026 WL 1556442 (N.D. Ill. June 2, 2026); SpecialtyCare Inc. v. Health Care Serv. Corp. d/b/a Blue Cross Blue Shield of New Mexico, No. 25 CV 12902, 2026 WL 1556244 (N.D. Ill. June 2, 2026); SpecialtyCare Inc. v. Health Care Serv. Corp. d/b/a Blue Cross Blue Shield of Texas, No. 25 CV 12945, 2026 WL 1556346 (N.D. Ill. June 2, 2026) (Judge Manish S. Shah). These three cases were brought by medical providers SpecialtyCare Inc., Remote Neuromonitoring Physicians, and Sentient Physicians against three different Blue Cross Blue Shield entities. Plaintiffs contend that they treated certain patients who assigned their entitlement to ERISA-governed benefits to plaintiffs, but those benefits were underpaid by defendants. The parties engaged in the independent dispute resolution (IDR) process established by the No Surprises Act, 42 U.S.C. § 300gg-111 et seq., in which plaintiffs prevailed. However, they allege that all three defendants failed to comply with the IDR award (which involved paying $274,434 (BCBS Illinois), $42,312 (BCBS New Mexico), and $1,864,562 (BCBS Texas)). Plaintiffs thus brought this action; defendants responded by moving to dismiss for lack of subject-matter jurisdiction and failure to state a claim. Addressing plaintiffs’ ERISA claims first, the court agreed that plaintiffs, as assignees of plan participants, were considered “beneficiaries” under the statute. However, “plaintiffs do not allege that payment was denied, rather, they allege that they were underpaid for their services… There is a difference between a claim that implicates the rate of payment, and one that implicates the right to payment.” The court ruled that “[t]he ‘right to payment’ falls within ERISA’s ‘zone of interests’ because an outright denial of payment is a denial of benefits, but the ‘rate of payment’ does not, because the rate depends on terms outside the plans themselves (here, the [IDR] process).” The patients were not and could not have been parties to the IDR process, so there was no assigned right the providers could assert as an ERISA plan beneficiary: “While the ultimate effect on [plaintiffs] may be the same (i.e., nonpayment), [plaintiffs’] grievance with Blue Cross is uniquely its own; it is not derivative of [plaintiffs’] patients.” Turning to plaintiffs’ claims under the Federal Arbitration Act (FAA), the court dismissed them, reasoning that the FAA requires an arbitration agreement between the parties, which was absent in this case. The IDR process was statutory, not contractual, and thus Section 9 of the FAA did not apply. Furthermore, the No Surprises Act did not incorporate Section 9. The court also found no implied private right of action under the No Surprises Act. It noted that private rights of action must be created by Congress, and there was no express right of action detailed in the Act. The Act’s enforcement mechanism, which allows the Department of Health and Human Services to assess penalties against non-compliant insurers, suggested that Congress did not intend to create a private remedy for providers. Finally, the court dismissed plaintiffs’ state law claims without prejudice, declining to exercise supplemental jurisdiction because “there are no federal claims remaining and there is no complete diversity between the parties.” Defendants’ motions were thus granted and all three cases were terminated.

Remedies

Seventh Circuit

Appvion, Inc. Retirement Savings & Employee Stock Ownership Plan v. State St. Bank & Trust Co., No. 18-C-1861, 2026 WL 1623068 (E.D. Wis. June 5, 2026) (Judge William C. Griesbach). Appvion, Inc. was a Wisconsin-based paper company that established an employee stock ownership plan (ESOP) in 2001, fell on hard times, and went bankrupt in 2017. The bankruptcy court appointed Grant Lyon to act on behalf of the plan and help the ESOP participants recover some of their losses. As a result, he brought this wide-ranging action in which the ESOP asserted 37 causes of action against seven entities and 19 individuals. The claims included breach of fiduciary duty under 29 U.S.C. § 1104, co-fiduciary liability under 29 U.S.C. § 1105, and prohibited transactions under 29 U.S.C. § 1106. (For more details, check out our summary of the Seventh Circuit’s 2024 opinion, which revived the case after most of it was dismissed by the district court.) Lyon eventually settled with former Appvion directors and officers, and also settled a related state law case against one of Appvion’s pre-bankruptcy accounting firms. As a result, Lyon has at this point obtained almost $16 million in settlement proceeds. He has already distributed $10 million of these proceeds to himself, his lawyers, and his expert witnesses, and intends to distribute the remaining $6 million to ESOP participants. Before the court here was a motion by defendants State Street Bank & Trust Company and Argent Trust Company “to Establish Due Process and Fairness Protections Related to Settlement Funds.” These defendants wanted the court to enter an order “either (1) directing Lyon to submit to the court a detailed procedure to protect the due process interests of the ESOP and its participants or (2) establishing a constructive trust with terms acceptable to the court over the settlement proceeds pending final judgment or other resolution of the case.” In the event this request is denied, defendants requested in the alternative that “disbursement be preceded by procedural safeguards of due process and fairness, such as giving notice to ESOP participants and other stakeholders of the settlement terms and proposed allocation of the settlement proceeds, an opportunity for ESOP participants or other stakeholders to file objections to the planned allocation of settlement proceeds, and a fairness hearing before the court.” At the outset, the court partially granted related motions from both sides to restrict public access to certain documents. The court concluded that “the public does not have to know which parties settled and how much was paid by them or on their behalf. It is enough that the total amount of the settlement proceeds and how it is to be disbursed are disclosed.” As for defendants’ “due process” motion, the court denied it. The court reasoned that no statute or rule required or allowed it to impose such protections, as this was not a class action or derivative claim, and Federal Rules of Civil Procedure 23 and 23.1 did not apply. Additionally, the court found that Lyon’s and his counsel’s fees were consistent with the bankruptcy court’s confirmation order and similar contingency fees approved in other cases. The court emphasized that Lyon, as a fiduciary, had an exclusive duty of loyalty to act solely in the interest of the ESOP beneficiaries, and participants had remedies against him if he failed to do so, “[b]ut that would be a separate case.” The court further noted that “neither State Street nor Argent have been found liable in this case. Should they be found liable at trial and seek an offset against any damages or attorneys’ fees they are ordered to pay for any amounts already paid by settling co-defendants, they are free to raise the issue at that time.” With that, the court denied defendants’ motion.

Ninth Circuit

Brian W. v. Premera Blue Cross of Wash., No. C24-0154-KKE, 2026 WL 1552524 (W.D. Wash. June 2, 2026) (Judge Kymberly K. Evanson). Brian W. brought this action arising from residential mental health treatment his son, A.W., received at two facilities: Cherry Gulch and Heritage School. Brian W. paid for A.W.’s treatment out of pocket and then submitted claims under his ERISA-governed health benefit plan. However, the plan’s administrator, Premera Blue Cross of Washington, denied his claims. Brian W. then brought this action and prevailed in March of this year on cross-motions for judgment. (Your ERISA Watch covered this decision in our March 18, 2026 edition.) In this order the court addressed several post-judgment issues. First, Brian W. argued he was entitled to reimbursement for the Heritage School charges at the higher in-network rate (90%) under a plan provision allowing in-network reimbursement for out-of-network care when a covered service is “not available from an in-network provider.” The court disagreed, noting that that the plan stated that “[i]f a covered service is not available from an in-network provider…you must request this before you get the care.” Brian W. did not do so and thus he was only entitled to “the out-of-network rate: 50% of billed costs after any annual deductibles.” Next, the court addressed Premera’s motion to seal its list of in-network residential treatment providers, which it submitted in support of its argument that in-network alternatives were available to A.W. Because the court had just ruled that the out-of-network rate applied, the court denied Premera’s motion as moot and struck the list from the docket. The court then moved on to Brian W.’s motion to strike documents offered by Premera suggesting that it had made partial payments on some of A.W.’s claims. He contended that Premera did not disclose these documents during litigation, and furthermore, these documents would have undermined Premera’s earlier position that the claims were not payable at all. The court acknowledged that “Brian W.’s point is well taken,” but noted that Premera had not requested any offsets for prior payments in its proposed judgment and thus denied Brian W.’s motion as moot. Finally, the judge addressed the appropriate prejudgment interest rate. The court stated that under Ninth Circuit precedent, the default prejudgment interest rate in ERISA cases is “the weekly average 1-year constant maturity Treasury yield, as published by the Board of Governors of the Federal Reserve System, for the calendar week preceding,” pursuant to 28 U.S.C. § 1961, and “substantial evidence” is required to deviate from this rate, which the parties agreed was 3.66%. The parties originally agreed on this rate but Brian W. changed course and argued for Washington’s 12% statutory interest rate instead, submitting a declaration stating he had made “early withdrawals from [his] retirement and brokerage accounts” to fund treatment, and that his “investments have generally tracked the S&P 500 index,” which since 2016 “has averaged approximately 11.3%” according to a “very basic web search[.]” This was not good enough for the court, which found that his “generic statement” “does not specify how much he withdrew from his retirement or brokerage accounts; nor does he present evidence supporting the rates of return for either account.” As a result, the court ruled that 3.66% was the appropriate interest rate. As for the accrual date, the parties had originally agreed to a “‘midpoint accrual approach’ based on the midpoint of the relevant period when Brian W. was paying for A.W.’s care.” However, this time it was Premera which changed its mind; it argued interest should only begin accruing from the dates it actually received Brian W.’s claims. The court rejected this proposal because it was “unworkable and unfair in this case.” Premera’s administrative failures, which included losing submissions, forcing resubmission, and making contradictory determinations about when claims were received, made it impractical to reliably identify submission dates. Furthermore, the court reasoned that “the purpose of prejudgment interest in the ERISA context…is to fully compensate the plaintiff for ‘losses incurred as a result of [the defendant’s] nonpayment of benefits,’” and thus it was disinclined to reward Premera for its deficient claim administration. The court thus adopted the originally agreed-upon midpoint date. The parties were ordered to submit a proposed judgment conforming with this ruling.

Venue

Ninth Circuit

Ventura v. Lithia Motors, Inc., No. 2:26-CV-01786-HDV-RAO, 2026 WL 1625362 (C.D. Cal. June 2, 2026) (Judge Hernán D. Vera). David Ventura is a California resident who was employed at the California automobile dealership Lexus of Valencia, which was owned by Lithia Motors, Inc., from May 2023 to May 2025. Lithia Motors is headquartered in Medford, Oregon, and operates more than 450 dealerships, including several in California. While employed by Lithia, Ventura participated in the company’s ERISA-governed 401(k) plan, which is administered by a committee of seven senior Lithia employees, four of whom are based in Oregon. The committee meets quarterly at Lithia’s headquarters in Oregon where it receives investment advice from Deschutes Investment Consulting, LLC, which is also based in Oregon. Ventura contends in this action that Lithia breached its fiduciary duties under ERISA by, “among other things, using forfeited Plan assets to offset employer contributions rather than to reduce administrative fees, charging excessive administrative fees, and offering imprudent collective investment trust options… He seeks relief on behalf of a putative nationwide class of Plan participants.” Lithia filed a motion to transfer venue from the Central District of California to the District of Oregon pursuant to 28 U.S.C. § 1404(a). The court conducted a two-step process, determining first if the action could have been brought in the transferee district, and second, whether convenience, fairness, and justice considerations militated in favor of transfer. The court agreed that the action could have been brought in Oregon because Lithia is headquartered there and the plan was administered there. However, venue was also proper in California because “the breach occurs where the Plan participant expects to receive benefits.” The court then addressed plaintiff’s choice of forum, which the court found was “entitled to reduced – but not minimal – deference” because he was bringing a nationwide class action in which he “purports to represent class members located across multiple districts.” As for the convenience of witnesses, Lithia argued that most of the key witnesses were in Oregon, but the court found this factor “insufficient to tip the balance decisively toward transfer” because Lithia identified only one non-party witness, Deschutes, and did not provide evidence that witnesses from Deschutes were unwilling to testify in California. The court highlighted “the modern litigation environment where remote and video testimony are widely available and accepted.” The court also stated that Lithia’s witnesses in Oregon could be compelled to testify due to their employment relationship with Lithia, and that “Ventura and his California-based witnesses, including his former supervisors, are relevant to establishing the circumstances of his Plan participation and the claims as they relate to California-based employees.” As a result, “the witness convenience factor is, at best, neutral.” Finally, the court considered the interests of justice, noting that Lithia did not establish that litigation costs would be significantly cheaper in Oregon or that the Central District of California’s caseloads, even if higher than Oregon’s, would impede efficient case management. “In sum, transfer under § 1404(a) is not designed to shift inconvenience from one party to the other. Lithia has not demonstrated that Ventura’s choice of forum and California’s connections to the case are outweighed substantially by the convenience of adjudicating this case in Oregon.” Defendants’ motion to transfer venue was thus denied.

Drummond v. Southern Co. Servs., Inc., No. 24-12773, __ F.4th __, 2026 WL 1465861 (11th Cir. May 26, 2026) (Before Circuit Judges Rosenbaum, Grant, and Brasher)

It was a busy week for the federal appellate courts, as they issued no fewer than five published opinions on ERISA matters. However, because last week’s notable decision (the Supreme Court’s ruling in M&K Employee Solutions, LLC v. Trustees of the IAM Nat’l Pension Fund) was about actuarial calculations, we here at Your ERISA Watch are going to keep the streak alive and discuss the topic once again.

Wait! Don’t tap out yet! This time we are not conducting another deep dive into discount rates. Instead, we are focusing on the more prosaic issue of life expectancy. As Judge Rosenbaum reminds us in this week’s notable decision, the average life expectancy in the time of George Washington was about 36 years, but that statistic has now more than doubled. One would expect pension plans to use actuarial assumptions that keep up with the times, and take this progress into account when calculating benefits, but the plaintiffs in this case contend that their employer’s plan has failed to do just that.

First, a quick primer on how ERISA-regulated pension plans work. These are often called “defined benefit plans” because they pay a specific recurring benefit amount, as opposed to more modern “defined contribution plans,” such as 401(k)s, in which the benefit varies depending on how contributions to the plan are invested.

For unmarried participants, pensions are fairly simple. ERISA requires plans to offer unmarried participants a single life annuity (SLA), which pays a fixed amount until death.

For married participants, it gets more complicated. Plans must offer these participants a joint-and-survivor annuity (JSA), which pays out over the joint lives of the participant and his or her spouse. A JSA allows plans to pay one benefit starting at retirement, through the death of the participant, which is then followed by another benefit to the spouse, which must be at least 50% of the initial benefit. ERISA also requires plans to offer pre-retirement survivor annuities to married participants. This benefit allows for payments to the plan participant’s spouse if the participant dies before retiring.

Crucially, both JSAs and pre-retirement survivor annuities (which, if they qualify under ERISA’s requirements, are called QJSAs and QPSAs) have a statutorily imposed “actuarial equivalence” requirement. ERISA Section 1055 provides that (1) JSAs must be calculated in a way that makes them the “actuarial equivalent” of an SLA, and (2) QPSAs must be calculated in a way that makes them the “actuarial equivalent” of the survivor annuity payment under a JSA. Furthermore, both of these benefits, like SLAs, are protected under ERISA by anti-forfeiture and anti-cutback rules, which prohibit plan administrators from taking away or reducing a pension benefit once it is vested.

This brings us to the plaintiffs in the case, Richard Odom and William Drummond, who are vested participants in the Southern Company Pension Plan, which covers more than 56,000 participants with $16 billion in assets. Both plaintiffs worked for Southern Company and had vested pensions in the plan. (Odom selected a JSA with a 50% survivor annuity, while Drummond chose a 100% JSA.)

Both Odom and Drummond allege that the plan used outdated and unreasonable actuarial assumptions to calculate their retirement benefits. Both challenged (1) what they call the plan’s “QPSA charge,” which is the amount the plan charged them to account for the pre-retirement survivor annuity, and (2) the calculation of their JSAs. They contend that both calculations used outdated mortality assumptions. Specifically, Drummond challenged the plan’s use of the 1951 (!) Group Annuity Mortality Table to calculate his QPSA charge.

Odom and Drummond filed this action in 2023 against Southern Company, the plan, and the plan’s administration committee, asserting four causes of action: (1) violation of Section 1055’s “actuarial equivalence” requirement; (2) unlawful forfeiture under Section 1053; (3) excessive QPSA charges based on outdated actuarial assumptions, and (4) breach of the fiduciary duties of loyalty, prudence, and disclosure. They sought declaratory relief, reformation of the plan to increase annuity payments and decrease QPSA charges, disgorgement of profits, and restitution.

Defendants responded by filing a motion to dismiss for failure to state a claim, which the district court granted. Plaintiffs appealed, and several amici filed briefs on both sides, including the Department of Labor in favor of plaintiffs and the Chamber of Commerce in favor of defendants.

The Eleventh Circuit organized its discussion into three topics: (1) whether ERISA’s actuarial equivalence rule requires “reasonable” assumptions; (2) whether the JSA conversions amounted to forfeitures; and (3) whether the QPSA charges amounted to forfeitures.

On the first topic, the court held that ERISA’s “actuarial equivalence” provision required the use of “reasonable” actuarial assumptions, agreeing with the Sixth Circuit’s decision in March of this year in Reichert v. Kellogg. (Reichert was the case of the week in our March 25, 2026 edition.)

The court found that “ERISA’s definition of ‘present value,’ our past engagement with the same concept, and professional norms in the actuarial industry point in the same direction. Each source shows that actuarial equivalence connotes a degree of connection to empirical grounding and realistic expectations about the future.”

The court noted that ERISA defined “present value” as “the value adjusted to reflect anticipated events,” and that “anticipated events” contemplated “a connection to real-world data and realistic premises.” Furthermore, Department of Treasury regulations have interpreted the “actuarial equivalent” phrase “to require conversion from the plan’s ‘normal form of life annuity’ using ‘consistently applied reasonable actuarial factors.’” The court also invoked more generally ERISA’s purpose of protecting plan beneficiaries in imposing a “reasonableness” requirement.

The Eleventh Circuit stated that this conclusion was also supported by professional actuarial guidelines, which advised actuaries “to take ‘reasonable’ steps, make ‘reasonable’ inquiries, select ‘reasonable’ assumptions or methods, or otherwise exercise professional judgment to produce a ‘reasonable’ result when rendering actuarial services.” These guidelines also “direct[] actuaries to use actual-participant mortality data or ‘recently published relevant and generally available mortality tables’ rather than ‘mortality tables that substantially predate’ newer data.”

Defendants contended that “actuarial equivalence” only required “mathematical equivalency”; thus, any assumptions could be used so long as they were documented in the plan and employed in a uniform fashion. Indeed, defense counsel “agreed at oral argument that Section 1055(d) would even allow plans to use mortality data from 1789[.]” However, based on the above authorities, the court rejected this approach: “the meaning of ‘actuarial equivalent’ can’t support Defendants’ proffered ‘anything goes (as long as you wrote it down)’ interpretation of Section 1055(d).”

Defendants offered two other arguments as well. First, they contended that other statutes in ERISA explicitly imposed a “reasonableness” requirement, but Section 1055 did not, suggesting that Congress did not intend one. The court disagreed, noting that these other statutes were enacted after Section 1055 and were “different from Section 1055(d) both linguistically and conceptually.”

Second, defendants advanced “purpose- and policy-based arguments,” contending that a reasonableness requirement “would impose unmanageable costs on plans, and that it’s better to leave actuarial assumptions up to negotiations in the labor market.” Furthermore, it would “open a costly ‘floodgate of litigation.’”

However, the court noted that ERISA was not a market-based statute, and that “Congress’s overarching ambition” was to “ensure that employees would receive the benefits they had earned… We don’t see how it serves this goal to let plans transform annuities into a form that is worth far less than the benefit a worker earned.” The court also noted that “reasonableness” was quite broad and “permits plans to use any of a range of reasonable mortality and interest-rate assumptions,” which would limit arguments against them..

Moving on to the second topic, the Eleventh Circuit found that Odom’s theory that defendants’ conversion of his SLA to a JSA constituted a “forfeiture” under Section 1053(a) was plausible. Defendants contended that ERISA’s anti-forfeiture provision only created a right to receive a benefit, and did not “guarantee a particular amount or a method for calculating” that benefit, relying on the Supreme Court’s 1981 decision in Alessi v. Raybestos-Manhattan, Inc.

The court disagreed. First, the court rejected defendants’ reliance on Alessi, explaining that Alessi focused on the initial calculation of a benefit, while this case focused on “what happens after the plan calculates his normal retirement benefit.”

Furthermore, the court cited a Seventh Circuit decision (Contilli v. Local 705 International Brotherhood of Teamsters Pension Fund) and Treasury regulations, which both supported the conclusion that “a reduction in the total value of all monthly benefits is a kind of forfeiture,” and that “[c]ertain adjustments to plan benefits such as adjustments in excess of reasonable actuarial reductions, can result in rights being forfeitable.” Thus, if a plan provides a participant “a benefit less valuable than his ‘normal retirement benefit’…this reduction in value compromises his unconditional claim to the value of his normal retirement benefit” and acts as a forfeiture.

As for the third topic, the court held that plaintiffs plausibly alleged that the QPSA charges also violated ERISA’s nonforfeiture rule. The court explained that ERISA allows plans to deduct charges for providing a preretirement survivor annuity, but under Treasury regulations these charges must “reasonably reflect[] the cost of providing the QPSA[.]” For the reasons already advanced by the court, calculation of these charges required “reasonable, realistic actuarial assumptions.”

Defendants challenged the assumptions proposed by plaintiffs in their complaint, but the court declined to wade in: “Defendants will have the opportunity to present evidence of their own at later stages of this litigation. Perhaps they will be able to establish that the Plan’s mortality assumptions were appropriate… But either way, that isn’t an issue to resolve on a motion to dismiss.”

As a result, plaintiffs are now 2-0 in the appellate courts in asserting that ERISA requires plans to use reasonable actuarial assumptions in calculating pension benefits. There are certainly district court cases in other circuits that have gone the other way (including a case from April in the Ninth Circuit), so we will keep you posted as to whether this trend continues.

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

Breach of Fiduciary Duty

First Circuit

Bowers v. Russell, No. 22-CV-10457-PBS, __ F. Supp. 3d __, 2026 WL 1506413 (D. Mass. May 29, 2026) (Judge Patti B. Saris). This 76-page order constituted the court’s findings of fact and conclusions of law following a twelve-day bench trial involving the termination of an employee stock ownership plan (ESOP) of a family business called Russelectric. The court began by quoting the HBO show Succession: “‘Family and business are dangerously close.’ This litigation exemplifies that lesson.” The ESOP was created by the company’s owner, Raymond Russell, and was terminated after his death by his son John, after which its shares were redeemed. Plan participants received payments for allocated shares but not for unallocated ones. Later, the company was sold to Siemens, which triggered clawback payments to plan participants, but only for allocated shares. In connection with this sale, bonuses were awarded to the Russell family (John and his sisters Suzanne and Lisa), as well as members of company management; these bonuses reduced the payments to participants. The plaintiffs in this action are former employees and ESOP participants who alleged violations of ERISA by Russell family members in connection with the redemption transaction and the clawback. “The crux of Plaintiffs’ claims is that Defendants should have included unallocated shares in the clawback provision, that all shares were undervalued in the redemption transaction, and that Defendants unlawfully reduced the clawback payments by awarding bonuses.” Ten of the claims were against John, and four were against Suzanne and Lisa for knowingly participating in, and benefitting from, the violations. The court addressed the affirmative defenses first, rejecting defendants’ arguments that plaintiffs’ claims were barred by the statute of limitations and that plaintiffs had released their claims. The court found that plaintiffs did not have actual knowledge of the alleged violations within the three-year “actual knowledge” timeframe and that the releases signed by the plaintiffs did not cover the claims at issue: “In the Court’s view, the severance agreements are best read as releasing claims only against previous Siemens directors,” not Russelectric directors. The court then turned to the four “buckets of claims” against John. The court ruled that (1) John was a fiduciary with respect to the clawback negotiation claims, but did not breach his fiduciary duties because he recused himself from the negotiations, and in any event “Plaintiffs have failed to show that excluding unallocated shares from the provision was imprudent or disloyal”; (2) John was a fiduciary regarding the redemption transaction claims, but “the redemption transaction was for adequate consideration and thus was compliant with fiduciary obligations and exempt from ERISA’s prohibited transaction provisions”; (3) ERISA governed the clawback administration claims even though the ESOP had been terminated, John was a functional fiduciary regarding the clawback payments, and John breached fiduciary duties by awarding excessive bonuses that reduced clawback payments to plan participants (for example, John awarded himself “a whopping $14 million for his bonus” even though his salary was approximately $160,000); and (4) John was entitled to judgment on the equitable claims related to the clawback negotiation and redemption transaction, as no breach of fiduciary duties occurred, but was liable in equity regarding the excessive bonuses. As for the claims against Suzanne and Lisa, the court issued similar rulings, finding that they were entitled to judgment on most of the claims, but also finding that they “had actual or constructive knowledge” of the unlawful bonuses, and thus “could be held liable as ‘nonfiduciary parties in interest.’” The court concluded by ordering supplemental briefing “regarding the exact calculation of damages in this complex case.”

Second Circuit

Humphries v. Mitsubishi Chemical Am., Inc., No. 1:23-CV-06214 (JLR), 2026 WL 1493504 (S.D.N.Y. May 28, 2026) (Judge Jennifer L. Rochon). Plaintiffs Robert Humphries and Dennis Mowry filed this putative class action against their former employer, Mitsubishi Chemical America, Inc., and the Administrative Committee of the Mitsubishi Chemical America Employees’ Savings Plan, alleging that defendants violated their fiduciary obligations under ERISA in administering the plan. Initially, the court dismissed the complaint for lack of standing and failure to state a claim but allowed Humphries to replead. (Your ERISA Watch covered this ruling in our November 13, 2024 edition.) After plaintiffs filed an amended complaint, the court partially granted and denied defendants’ motion to dismiss, allowing plaintiffs to proceed on the theory that defendants breached their fiduciary duty by offering more expensive mutual fund share classes when cheaper, identical share classes were available. (The court dismissed plaintiffs’ recordkeeping fees claims and their claims against the board of directors. We covered this decision in our August 27, 2025 edition.) Before the court here was plaintiffs’ motion to amend their complaint to add sixteen new defendants, each allegedly a member of the Administrative Committee and a fiduciary of the plan. Defendants opposed the motion, arguing that “(1) the Plan documents vest fiduciary authority only in the Administrative Committee, not in its Individual Members, and therefore only the Administrative Committee can be held liable for fiduciary decisions with respect to the Plan…and (2) Plaintiffs’ allegations as to the Individual Members’ conduct are insufficient to plead that they breached any fiduciary duties[.]” The court rejected both arguments. The court noted that fiduciary status does not hinge on whether a plan specifically grants fiduciary authority; rather, it includes anyone who exercises such authority. The court cited numerous cases from within the Second Circuit finding “plausible claims for breach of fiduciary duty against individual committee members despite their presence on a formal committee.” The court distinguished defendants’ cases, emphasizing that plaintiffs’ complaint passed muster because “the Individual Members are alleged to have discretionary authority over the Plan rather than mere decision-making capacity at Mitsubishi Chemical generally.” Defendants also argued that adding the individuals “would not…entitle[ ] [Plaintiffs] to any additional relief from the Individual Members beyond what they might recover from the existing [D]efendants for any alleged loss to the Plan.” However, the court noted that plaintiffs sought equitable relief, which might include removal of the individuals from the Committee, which in turn “requires naming the Individual Members as defendants.” Turning to the sufficiency of plaintiffs’ allegations, the court found that the proposed second amended complaint sufficiently alleged that the individual members engaged in conduct constituting a breach of fiduciary duties. The allegations tied the individual members’ purported fiduciary status to their function on the Administrative Committee, rather than their mere positions within Mitsubishi Chemical. The court also dismissed defendants’ argument that the complaint engaged in impermissible group pleading, noting that the allegations provided sufficient notice of the claims against each defendant. However, the court warned plaintiffs of its “expectation that Plaintiffs will move expeditiously to voluntarily dismiss Individual Members from this action if they learn, during discovery, facts suggesting that those Individual Members should not be subjected to liability.” Finally, the court determined that allowing the amendment would not unduly prejudice defendants. The court noted that adding the individual members enabled the plaintiffs to seek equitable relief that might otherwise be unavailable, and “complaints of ‘the time, effort and money expended in litigating the matter,’ without more, [do not] constitute prejudice sufficient to warrant denial of leave to amend.” Plaintiffs’ motion to amend was thus granted, and the lawsuit now has sixteen new defendants.

Disability Benefit Claims

First Circuit

Sargent v. Sun Life Assur. Co. of Canada, No. CV 24-11500-BEM, 2026 WL 1506531 (D. Mass. May 29, 2026) (Judge Brian E. Murphy). Mary Sargent was employed as a senior director of business development for Philips North America LLC until December 31, 2018, when she stopped working due to “significant pain, fatigue, a lack of endurance, and cognitive limitations stemming from a non-work-related shoulder injury.” Her conditions were later diagnosed as “fibromyalgia, bilateral occipital neuralgia, dysthymia, cervical degenerative disc disease, temporomandibular dysfunction, and trigeminal neuralgia.” Sargent applied for benefits under Philips’ ERISA-governed long-term disability plan, which was insured by Sun Life Assurance Company of Canada. Sun Life approved her claim beginning in July of 2019. However, in September of 2022 Sun Life terminated Sargent’s benefits, determining that she was no longer “unable to perform with reasonable continuity any Gainful Occupation for which [she is] or could become reasonably qualified for by education, training and experience.” Sargent unsuccessfully appealed and then filed this action, seeking reinstatement of her benefits. She claimed that Sun Life failed to apply the “reasonable continuity” component of the plan’s definition of disability and did not provide a sufficient explanation for terminating her benefits. Sargent also argued that Sun Life improperly dismissed the reports of her treating physicians and failed to credit the Social Security Administration’s (SSA) decision to award her disability benefits. The case proceeded to cross-motions for summary judgment, which were decided in this order. Because the plan granted Sun Life discretionary authority to determine benefits eligibility, the court employed the arbitrary and capricious standard of review. Addressing Sargent’s “reasonable continuity” argument first, the court found “no meaningful basis” to conclude that Sun Life failed to apply this provision, as Sun Life’s experts concluded that Sargent could work “full-time,” which in the court’s view was functionally equivalent. The court also determined that Sun Life provided a sufficient explanation for its decision: “The mere fact that Sun Life failed to repeatedly use the phrase ‘reasonable continuity’ throughout its explanation does not demonstrate that it failed to apply the correct standard.” The court then addressed three procedural issues raised by Sargent. First, the court acknowledged a structural conflict of interest in the plan because Sun Life both evaluated and paid claims, but the court stated that this conflict was “not an important factor” because Sun Life used independent physicians, a separate appeals unit, and made good-faith benefit payments during the appeal process. Second, the court found that Sun Life provided sufficient explanation for terminating Sargent’s benefits by detailing the claim history, policy terms, evidence considered, and opinions from both Sargent’s and Sun Life’s doctors. Sargent contended that she was not given an opportunity to respond to two doctors’ opinions, but the court concluded that Sargent did not identify “any new evidence or rationale in those final reports for which Sargent lacked the opportunity to respond.” Third, the court found that Sun Life’s decision was reasonable. The court concluded that Sun Life’s decision was supported by substantial evidence, including opinions from independent physicians and consultants who concluded that Sargent could work full-time. The court noted that administrators are not required to give special deference to treating physicians’ opinions and that Sun Life reasonably credited opinions based on objective evidence over those based on subjective symptom reports. The court further stated that SSA determinations “are not binding on disability insurers,” and furthermore, “there is limited value in the SSA’s benefits decision where it is based on an eligibility review that predates the termination of plan benefits.” In any event, the court found that Sun Life adequately explained its disagreement with the SSA’s determination, citing differences in criteria and reliance on updated records and opinions not available to the SSA. As a result, the court granted Sun Life’s motion for summary judgment, and denied Sargent’s, upholding the termination of her benefits.

Fifth Circuit

King v. Unum Life Ins. Co. of Am., No. CV H-25-1850, 2026 WL 1494238 (S.D. Tex. May 28, 2026) (Judge Lee H. Rosenthal). David King worked as a staff process engineer for the energy company Valero. He had a history of syncope (fainting symptoms) dating back to 2016, but was able to continue working after his diagnosis. However, in 2023, he reported worsening symptoms and stopped working, asserting he could not safely perform key job demands, particularly climbing and driving, because of the risk of losing consciousness. He sought long-term disability benefits under Valero’s ERISA-governed benefit plan, which was insured by Unum Life Insurance Company of America. Unum denied King’s claim, concluding that the medical evidence did not support restrictions or limitations that would prevent him from performing his occupation’s material and substantial duties. King’s appeal was unsuccessful, so he brought this action under ERISA Section 502(a)(1)(B) challenging Unum’s denial. The case proceeded to cross-motions for summary judgment; the parties agreed that the default de novo review standard of review applied. The court granted Unum’s motion, and denied King’s, for three reasons. First, the court stated that King’s long work history despite having the same diagnosis weakened his claims regarding the severity of his symptoms: “King’s significant post-diagnosis work regimen undercuts the claim that his illness prevents him from performing his job’s material and substantial duties.” Second, “King did not approach his illness and symptoms as if they were so debilitating that he could not work.” The court found that King’s “medical file is relatively sparse in comparison to the seriousness of the disability he claims,” noting no medical visits between 2016 and 2023. The court found it suspicious that King visited his doctor “after he submitted his claims for disability to Valero and just before he submitted his claim to Unum,” and never went to the emergency room despite his doctor’s “instruction to King to go to the emergency room if he experienced worsening symptoms.” He also did not visit a recommended neurologist, and his self-reported activity involved “inconsistent statements and allegedly rapid physical decline,” which “coincide[d] substantially with the progress of his claim and lack[ed] documented medical evidence[.]” Third, the court credited Unum’s medical reviewers, who “described ample bases for their conclusion.” Those doctors concluded that the evidence did not support restrictions or limitations precluding King’s ability to perform his work duties, highlighting (a) a lack of documented syncopal events during the relevant period, (b) generally normal examination findings, and (c) the view that King’s symptoms were manageable with medication. The court found that these opinions were more persuasive than King’s self-reports and supporting statements from family members. As a result, the court entered judgment in Unum’s favor.

Life Insurance & AD&D Benefit Claims

Fifth Circuit

Richards v. LifePoint Health Welfare Benefits Plan, No. 3:25-CV-03541-X, 2026 WL 1480796 (N.D. Tex. May 27, 2026) (Judge Brantley Starr). Dustin Richards began working for LifePoint on November 25, 2024, and enrolled in the company’s ERISA-governed life insurance benefit plan, naming his wife, Tiffany Richards, as his beneficiary. The policy had an “Eligibility Waiting Period,” which explained that participants had to be in “continuous…Active Employment in an eligible class to reach your Eligible Date,” which was defined as the “[f]irst of the month following 30 days of continuous, Active Employment.” “Active Employment” was defined as “a minimum of 30 regularly scheduled hours per week.” Dustin worked full-time until he collapsed on December 26, 2024, and did not return to work before his death on February 2, 2025. Tiffany filed a claim for the $480,000 life insurance benefit, which was denied by the plan’s insurer, Lincoln National Life Insurance Company, on the ground that Dustin did not satisfy the waiting period. According to Lincoln, Dustin had to be in “active employment” until January 1, 2025 in order to be eligible for coverage. Tiffany’s appeal was unsuccessful, so she filed this action under ERISA against the plan. LifePoint moved to dismiss for failure to state a claim, asserting that Dustin did not meet the eligibility requirements under the terms of the insuring policy. The court applied an abuse of discretion standard because the policy gave Lincoln the authority to determine eligibility and construe the policy’s terms. Under this standard, the court ruled, “It is not unreasonable to conclude that the Policy requires continuous Active Employment for the entire Eligibility Waiting Period under these terms. The Eligibility Waiting Period seemingly includes more days than just the 30 days of continuous, Active Employment. So the Court cannot conclude that Lincoln abused its discretion. To be sure, the Policy doesn’t expressly require this reading. And this reading may be low on the reasonableness scale. But the Court cannot find abuse of discretion on that basis.” However, the court mentioned that if Tiffany could show that Lincoln and LifePoint treated similarly situated claimants differently, it might “constitute an abuse of discretion. Or at least a pleading dispute that necessitates discovery.” As a result, the court granted LifePoint’s motion to dismiss, albeit without prejudice to Tiffany filing an amended complaint within 28 days.

Eighth Circuit

Kleinsteuber v. Metropolitan Life Ins. Co., No. 25-2860, __ F.4th __, 2026 WL 1502873 (8th Cir. May 29, 2026) (Before Circuit Judges Shepherd, Erickson, and Grasz). This case involves the tragic death of Dana Kleinsteuber, who suffered from end-stage renal disease (ESRD). In January of 2022, when administering her own at-home dialysis treatment, she failed to close the chest port, which resulted in severe blood loss, cardiac arrest, and then death. Her husband, Charles Kleinsteuber, submitted claims for life insurance and accidental death benefits under an ERISA-governed plan administered by Metropolitan Life Insurance Company. MetLife paid the life insurance claim, but denied the accidental death claim, contending that (1) Mrs. Kleinsteuber’s death was not an accident because it resulted from natural causes, citing the death certificate, and (2) the claim was barred by the policy’s exclusion for “any loss caused or contributed to by…physical or mental illness or infirmity, or the diagnosis or treatment of such illness or infirmity.” On appeal, MetLife abandoned the argument that Mrs. Kleinsteuber’s death was not an accident, but upheld its denial based on the exclusion: “Mrs. Kleinsteuber’s home dialysis, which she used to treat her ESRD, ‘caused or contributed’ to her death.” Mr. Kleinsteuber thus brought this action, but the district court agreed with MetLife and upheld the denial of his claim. (Your ERISA Watch covered this decision in our August 27, 2025 edition.) Mr. Kleinsteuber appealed, raising four issues, which the Eighth Circuit took in turn in this published decision. First, the appellate court found that MetLife provided a full and fair review of the claim. The court faulted Mr. Kleinsteuber for “zero[ing] in on MetLife’s denial letter” because “[w]e consider all the plan administrator’s communications to the insured in deciding whether it satisfied ERISA’s notice requirements, not just its initial letter.” The court found that MetLife “adequately informed Mr. Kleinsteuber that it denied his claim based on the exclusion[.]” Furthermore, MetLife could not be blamed for not “provid[ing] a description of any additional material or information necessary for [him] to perfect his claim,” because “MetLife denied Mr. Kleinsteuber’s claim based on its application of the exclusion’s language to the undisputed facts of this case, rather than on missing information.” Second, the court evaluated MetLife’s conflict of interest, noting that Mr. Kleinsteuber supported his argument by identifying ten problems with MetLife’s handling of his claim. The court acknowledged that a conflict existed, because MetLife both determined eligibility and paid benefits, but agreed with the district court that this conflict should be given “minor to moderate weight” because Mr. Kleinsteuber “did not identify any evidence tying the problems he perceived with its investigation to its decision denying his claim.” Specifically, the court stated that while “Mr. Kleinsteuber suggests MetLife needed to expressly address all the arguments and evidence he submitted with his administrative appeal,” this was incorrect because “ERISA’s regulations only require a plan administrator to ‘take[] into account’ the information a claimant submits…  They ‘do[] not require the plan administrator to discuss specific evidence submitted by the claimant.’” Third, the court examined the interpretation of the plan exclusion. It noted that “we would ordinarily review MetLife’s interpretation of the exclusion for abuse of discretion,” but stated “there is a problem” because MetLife “did not explain how it interpreted the exclusion’s terms.” Thus, even though the parties had agreed that abuse of discretion review applied in interpreting the exclusion, the Eighth Circuit applied de novo review: “when the plan administrator chooses not to exercise its discretion to interpret a term, as was the case here, we must decide what the term means de novo.” After consulting popular dictionaries, the court concluded that “the exclusion applied if either Mrs. Kleinsteuber’s ESRD or home dialysis brought about or was one of the reasons for her death.” This led to the decisive fourth argument, which was whether substantial evidence supported MetLife’s decision to deny benefits under that interpretation. The court concluded that MetLife did not abuse its discretion. Examining the medical reports, and statements indicating that Mrs. Kleinsteuber’s failure to close her dialysis port led to the blood loss causing her death, the court concluded that a reasonable mind could accept this evidence as adequate to support MetLife’s determination that “Mrs. Kleinsteuber’s home dialysis caused or contributed to her death.” Mr. Kleinsteuber argued that “closing a chest port is not part of dialysis, that the exclusion does not apply because Mrs. Kleinsteuber’s dialysis only contributed to her accident, rather than her death, and that MetLife wrongly weighed some of the evidence in the record.” However, the Eighth Circuit disagreed, stating that (1) “closing a chest port is the final step of dialysis treatment,” (2) “substantial evidence supports MetLife’s conclusion that Mrs. Kleinsteuber’s home dialysis contributed to her death, as her failure to close her port necessarily led to the blood loss that caused her death,” and (3) “it is well settled that we cannot substitute our own weighing of the evidence for MetLife’s.” As a result, the Eighth Circuit affirmed the judgment below in MetLife’s favor.

Plan Status

Fifth Circuit

Principal Life Ins. Co. v. Jones, No. 3:25-CV-00221, 2026 WL 1480286 (S.D. Tex. May 27, 2026) (Magistrate Judge Andrew M. Edison). Kenneth N. Ellis purchased a $2 million life insurance policy from Principal Life Insurance Company, naming his wife, Kathleen Anne Jones, as the sole beneficiary. Ellis and Jones later initiated divorce proceedings, and on May 14, 2025, they entered into a binding informal settlement agreement, which included a stipulation that each party would retain his or her own life insurance policies and release all claims against the other. Ellis died less than two weeks later, on May 27, 2025, before the divorce was final. Jones then attempted to revoke the agreement and claim the insurance proceeds. The administrator of Ellis’ estate informed Principal of the divorce agreement and objected to any payment to Jones. Principal responded by filing this interpleader action, naming Jones and Ellis’ estate as defendants. Principal deposited the contested funds into the court’s registry and was dismissed, after which the defendants filed cross-motions for summary judgment, each asserting entitlement to the benefits. The motions were referred to the assigned magistrate judge, who issued this report and recommendation. The magistrate’s first job was to determine whether the policy was governed by ERISA; Jones contended that it was while the estate argued that it was not. The court agreed with the estate, finding that Ellis was the sole owner of the policy, and that it did not cover any other employees, and thus “the Policy is excluded from ERISA.” Jones pointed to premium payments made by Ellis’ company for his coverage, arguing that this brought the policy within ERISA’s ambit. However, “this argument fails to move the needle. Without another employee-participant in the Policy, the Policy covers only Ellis and fails to qualify as an ERISA plan.” The court thus applied Texas law to determine who was entitled to the benefits. The court determined that the agreement between Ellis and Jones was enforceable and irrevocable under Texas Family Code § 6.604, which governs whether agreements between divorcing spouses are binding. The magistrate found that the agreement met the statutory requirements, including being signed by both parties and Ellis’ attorney. The agreement was thus effective immediately, and because it stated it was “not subject to revocation,” Jones was stuck with it. The court further found that the agreement divested Jones of her status as the policy’s beneficiary, as it included a mutual release of claims and awarded all life insurance policies to the respective policyholders. As a result, the magistrate recommended that the estate’s motion be granted, and Jones’ motion denied.

Pleading Issues & Procedure

Fourth Circuit

Messer v. Garrison Inv. Grp., LP, No. 25-1657, __ F.4th __, 2026 WL 1465139 (4th Cir. May 26, 2026) (Before Circuit Judges King, Gregory, and Thacker). The plaintiffs in this case are former employees of Bristol Compressors International, LLC (BCI) who brought a class action against BCI for violating the Worker Adjustment and Retraining Notification Act (WARN Act) and ERISA. The conduct at issue occurred in 2018 when BCI announced its closure, which led to employment terminations without sufficient notice and termination of the company’s severance plan. Plaintiffs initially included Garrison Investment Group, LP as a defendant in the case, claiming it was a jointly liable alter ego and successor of BCI because it had a financial interest in BCI and “participated in or directed” its closure operations. However, during the litigation plaintiffs voluntarily dismissed Garrison to focus on BCI. Plaintiffs prevailed on their WARN Act claim but not on their ERISA claim; the district court ruled that although the plan was governed by ERISA, BCI did not violate ERISA in terminating it. On appeal, the Fourth Circuit reversed, ruling that BCI did not properly terminate the plan. On remand, plaintiffs successfully moved for summary judgment on their claims. (Due to its insolvency, BCI “did not appear or file a response.”) As one might expect, plaintiffs had a difficult time collecting on their judgment against BCI. As a result, they filed this new action in which they sought to hold Garrison liable based on alter ego and veil piercing theories. However, the district court dismissed the case for lack of subject matter jurisdiction, explaining that plaintiffs improperly sought to enforce a previous judgment against a party not found liable in the original case. The court also considered whether ancillary jurisdiction could apply but concluded it did not extend to new actions seeking to impose liability on parties not previously liable. (Your ERISA Watch covered this decision in our May 21, 2025 edition.) Plaintiffs appealed, and this published opinion from the Fourth Circuit was the result. The appellate court noted, “There are two relevant avenues that could provide federal jurisdiction over this lawsuit. The first is 28 U.S.C. § 1331 which provides federal question jurisdiction. And the second is federal common law ancillary jurisdiction.” Addressing Section 1331 first, the court found that it did not apply because plaintiffs did not allege any new violations of ERISA or the WARN Act beyond those in the original case. The court relied heavily on the Supreme Court’s 1996 decision in Peacock v. Thomas, which held that federal jurisdiction requires an underlying violation of the statute, and piercing the corporate veil is not an independent cause of action under ERISA. As for the WARN Act, the court held that it does not allow for alternative theories of liability like veil piercing because the Act provides exclusive remedies for violations. Furthermore, Department of Labor regulations indicate that veil-piercing and alter ego theories are already “factors to be considered” when determining liability, and thus plaintiffs’ arguments were “redundant.” As for ancillary jurisdiction, the court acknowledged that a federal court “may exercise ancillary jurisdiction to enforce its judgments” even where subject matter jurisdiction is lacking. However, “Although federal courts have the authority to exercise this power, the Supreme Court has nonetheless outlined certain types of enforcement proceedings that do not fall within the ambit of ancillary jurisdiction – one of which is the circumstance we face in this case.” Citing Peacock again, the Fourth Circuit explained that “ancillary jurisdiction does not extend to ‘new actions in which a federal judgment creditor seeks to impose liability for a money judgment on a person not otherwise liable for the judgment.’” In other words, “subsequent suits to enforce judgments entered in prior federal actions must have their own source of federal jurisdiction when they involve new theories of liability, such as fraudulent conveyances or piercing the corporate veil.” In the end, the Fourth Circuit endorsed Garrison’s attorney’s characterization of the case: “this is ‘not a case of Garrison…not being willing to face the music. It’s a case of the plaintiffs not doing their job.” The appellate court thus affirmed, ruling that it had no jurisdiction to entertain plaintiffs’ claims against Garrison.

Provider Claims

Third Circuit

Abira Medical Laboratories, LLC v. Blue Cross Blue Shield of Alabama, No. CV 23-5132, 2026 WL 1483479 (E.D. Pa. May 27, 2026) (Judge Kelley B. Hodge). Frequent litigant Abira Medical Laboratories, LLC, doing business as Genesis Diagnostics, was a Pennsylvania medical testing laboratory service. At issue in this case are 155 patients who purportedly assigned their benefits to Abira to submit claims and pursue remedies under the patients’ health plans, six of which were governed by ERISA. Abira alleged that Blue Cross and Blue Shield of Alabama (BCBSAL), the administrator of these plans, failed to respond to claims or refused to make payments. Abira’s operative second amended complaint alleged (1) a claim under ERISA for unpaid benefits related to the six ERISA plans, (2) a breach of contract claim for the remaining 149 non-ERISA plans, and (3) a quantum meruit/unjust enrichment claim for the non-ERISA plans. BCBSAL moved to dismiss, contending that (1) Abira lacked derivative standing to sue under ERISA due to anti-assignment provisions in the ERISA plans, (2) Abira failed to exhaust administrative remedies under its ERISA claims, (3) claims under the Blue Advantage Plan were preempted by the Medicare Act, and (4) the breach of contract and unjust enrichment claims were not adequately pled. Addressing the ERISA claims first, the court found that Abira lacked derivative standing for claims under two of the ERISA plans due to enforceable anti-assignment provisions. Abira attempted to distinguish “between an anti-assignment provision related to payments only as opposed to an anti-assignment provision for litigation of wrongful denial of claims,” but the court found this “perplexing given that Abira’s Second Amended Complaint asserts that Abira is rightfully entitled to payments because of these assignments. Abira is not seeking to vindicate some other right it claims to have been assigned. The anti-assignment provision explicitly prevents the assignment that Abira seeks to rely on. Abira cannot have it both ways.” The court further found that BCBSAL did not waive the anti-assignment provisions through its “routine” claim processing. For three other ERISA plans the court ruled that Abira failed to plead that it exhausted its appeals under those plans, and further failed to allege a “clear and positive showing” that the administrative process would be futile. (The court did not rule on the sixth ERISA plan because the plan documents were not in the record.) As for the non-ERISA plans, the court dismissed claims under the Blue Advantage Plan because they were preempted by the Medicare Act and Abira failed to exhaust the mandatory administrative remedies. The court also dismissed the breach of contract claim because Abira did not adequately allege the existence of a contract, as it relied on unexecuted assignments of benefits. The court rejected Abira’s argument for an implied contract based on conduct, as the complaint did not allege such a basis other than non-payment. Finally, the court dismissed Abira’s unjust enrichment claim, ruling that Abira did not adequately allege that BCBSAL’s retention of benefits was inequitable. The court noted that allegations of a deceptive campaign by BCBSAL could not be based on non-payment alone. Thus, BCBSAL’s motion was almost completely granted; the only exception was a single claim based on a single ERISA plan. The dismissal was without prejudice.

Tenth Circuit

Servicios Medicos Para Todos SA de CV v. Blue Cross & Blue Shield of Kansas, Inc., No. CV 25-4094-KHV, 2026 WL 1469792 (D. Kan. May 26, 2026) (Judge Kathryn H. Vratil). Servicios Medicos Para Todos SA de CV, d/b/a Hospital Quirurgica Del Sur, is a Mexican hospital that treated Catarina Rziha in its emergency room in 2022, where she racked up charges of $130,073.41. Rziha was covered under an ERISA-governed health plan insured and administered by Blue Cross and Blue Shield of Kansas, Inc. (BCBS). Rziha’s guardian executed an assignment of benefits in favor of the hospital, which purported to transfer to the hospital the right to receive payment and “all medical benefits and/or insurance reimbursement” otherwise payable for the services rendered. The hospital alleged that it contacted BCBS to verify eligibility and that BCBS did so. However, BCBS later took the position that the services were excluded from coverage and paid only a small portion because the provider was “out of network.” The hospital’s appeals were unsuccessful, so it brought this action in state court, asserting one claim for plan benefits under ERISA against BCBS, and three state law claims against Rziha. BCBS removed the case to federal court and filed a motion for judgment on the pleadings, contending that the benefit plan contained an anti-assignment provision, thus barring the hospital’s claims. The hospital responded that “the anti-assignment provision should not be enforced, that BCBS waived that provision and that BCBS is equitably estopped from invoking the anti-assignment clause.” The court noted that the specific anti-assignment language – “However, an Insured’s rights accrued hereunder or under applicable state or federal law (including but not limited to ERISA) are not assignable to any person or entity” – was not in dispute. Thus, the issue was how to interpret this provision. The court held: “Though the plan states that the rights ‘are not assignable to any person or entity,’ it is ambiguous as to what rights are not assignable – all rights under the plan or appeal rights arising under the plan or ERISA. The provision’s use of ‘hereunder’ is likewise ambiguous, since it could refer to the rights described in the ‘Appeal Procedures’ section or the rights described in the entirety of the plan. Moreover, since the provision in question begins with ‘however,’ it could be interpreted that the parties intended to modify the preceding sentence, and therefore the anti-assignment provision only deals with BCBS’s policy to ‘afford Insureds a full and fair review.’ The plan also defines ‘Appeal’ to mean a review of an adverse decision submitted to BCBS, not a court of law. None of the stated definitions implicate the assignability of the right to sue for benefits, which is the right at issue here. Therefore, the Court finds that the plan language before the Court is ambiguous and declines to enforce it on a motion for judgment on the pleadings.” As a result, the court denied BCBS’ motion.

Retaliation Claims

Third Circuit

Fernandez v. Famiglio, No. 26-CV-0105, 2026 WL 1529246 (E.D. Pa. May 29, 2026) (Judge Chad F. Kenney). Sacha Fernandez alleges in this action that she was employed by Peter Famiglio from 2014 to 2020 and was a participant in a 401(k) plan established by Famiglio. Fernandez contends she discovered illegal billing practices, including misleading patients about insurance coverage. Fernandez reported these practices after the end of her employment, at which time Famiglio’s brother, an attorney, allegedly threatened to sue her and withhold her 401(k) funds if she spoke out. She further alleged that Famiglio “retaliated against her by withholding her 401(k) contributions and/or vested benefits, refusing to provide her with required plan documents, and concealing information Plaintiff needed to understand her rights relating to the 401(k) plan.” Fernandez brought this pro se action asserting three claims for relief: (1) violation of ERISA’s anti-retaliation provision, 29 U.S.C. § 1140, (2) failure to provide plan documents under ERISA, 29 U.S.C. §§ 1024, 1132(c), and (3) whistleblower retaliation under 31 U.S.C. § 3730(h). Famiglio filed a motion to dismiss all three claims. On the first claim, the court found that Fernandez failed to allege any “prohibited employer conduct” under ERISA § 510. The alleged retaliatory actions occurred after Fernandez’s employment ended, and “the Third Circuit has held that the term ‘discriminate’ in ERISA § 510 is ‘limited to actions affecting the employer-employee relationship.’” Because Fernandez was not employed by Famiglio at the time of the alleged retaliation, she could not show that the relationship was affected. As for Fernandez’s second claim for failure to provide plan documents, the court ruled that it was time-barred. Because ERISA does not specify a statute of limitations for § 502(c) actions, the court applied Pennsylvania’s two-year statute of limitations for civil penalty or forfeiture actions.   Fernandez’s claim accrued by 2020 at the latest, but she did not file this action until 2026, well beyond the limitations period. The court rejected Fernandez’s arguments for extending the deadline due to the continuing violations and equitable tolling doctrines, finding no ongoing policy or extraordinary circumstances that prevented timely filing. Finally, the court dismissed Fernandez’s third claim for whistleblower retaliation because she was not employed by Famiglio at the time of the alleged protected conduct, which occurred after her employment ended.   Therefore, she could not show that she was “discriminated against in the terms and conditions of employment” as required by 31 U.S.C. § 3730(h). Furthermore, Fernandez failed to provide sufficient details about her protected conduct, such as to whom she reported the practices or whether it was in furtherance of a False Claims Act suit. Famiglio also argued that this third claim was preempted by ERISA, but the court chose not to reach that issue because Fernandez had not stated a viable claim. The court thus granted Famiglio’s motion and dismissed Fernandez’s action without prejudice.

Withdrawal Liability & Unpaid Contributions

Seventh Circuit

Penske Truck Leasing, LP v. Central States Se. & Sw. Areas Pension Plan, No. 25-1738, __ F.4th __, 2026 WL 1502200 (7th Cir. May 29, 2026) (Before Circuit Judges Hamilton, St. Eve, and Pryor). Penske Truck Leasing, L.P. was a participating employer in the Central States, Southeast and Southwest Areas Pension Plan, a multiemployer pension plan serving union members of the International Brotherhood of Teamsters. Penske made contributions to the plan under ten separate collective-bargaining agreements, including one with Local 745 in Dallas, Texas. The collective-bargaining agreement with Local 745 was set to expire on March 1, 2021, but was extended to March 1, 2022, contingent upon Central States’ approval. Central States rejected this extension, prompting Penske and Local 745 to renegotiate. Central States was concerned that Penske was aligning the expiration dates of all its agreements to effect a complete withdrawal in 2022, which would minimize its withdrawal liability. Central States proposed that any withdrawal of Local 745 in 2022 be treated as a 2021 withdrawal, which Penske did not accept. Consequently, Central States decided to terminate Local 745’s participation effective December 25, 2021, unless Penske agreed to the proposal. Penske responded with this lawsuit, seeking a declaratory judgment that Central States had no authority under the Trust Agreement to expel Local 745. The district court granted summary judgment to Central States, concluding that it had the authority to expel Local 745 and that the decision was not arbitrary or capricious. The court also dismissed Central States’ counterclaim regarding Local 745’s effective withdrawal date, ruling that this claim had to be arbitrated under 29 U.S.C. § 1401. In this published decision, the Seventh Circuit affirmed. At the outset, the court determined the appropriate standard of review, ruling that deferential review was appropriate because the Central States Trust Agreement gave the trustees the discretion to interpret disputed terms in the agreement and other plan documents. The court noted that “[w]e have exercised Firestone deference most often in disputes over benefit denials,” but saw no reason why the same approach would not apply in this dispute: “Though our dispute in this case arises from the LMRA’s breach-of-contract provision, that difference provides no reason to change tack.” Under this deferential standard, “We see no reason to disturb the Trustees’ reasonable interpretation finding that they had authority to expel Local 745 without expelling all other Penske’s bargaining units.” The court admitted that “the Expulsion Provision is not a model of clarity on this point,” but under deferential review, the court found the trustees’ decision reasonable because “The Trust Agreement contemplates the expulsion of a single bargaining unit and suggests that Central States need not formally terminate an entire agreement to expel just one bargaining unit.” The court further ruled that the expulsion of Local 745 was not arbitrary and capricious. The court characterized Penske’s complaints about the Trustees’ investigation and decision-making process as “minor quibbles” that did not meet the high bar required for reversal on deferential review. The court noted that Central States had no fiduciary duty to Penske and was not obligated to let Penske minimize its withdrawal liability. Finally, the court addressed Central States’ counterclaim regarding the effective withdrawal date. It agreed with the district court that disputes over withdrawal liability, including the date of withdrawal, must be arbitrated before proceeding in federal court. The court rejected Central States’ argument that the absence of a finalized determination of withdrawal liability exempted it from arbitration, stating that “[t]his reading of the statute’s text would threaten to hollow out the arbitration requirement altogether.” As a result, the entire judgment was affirmed, and any further disputes must be handled in arbitration.

Eighth Circuit

General Elec. Co. v. Boilermaker-Blacksmith Nat’l Pension Trust, No. 25-1442, __ F.4th __, 2026 WL 1466654 (8th Cir. May 26, 2026) (Before Circuit Judges Gruender, Kelly, and Erickson). In this action the Boilermaker-Blacksmith National Pension Trust (the Fund) seeks to impose withdrawal liability on General Electric Company (GE) pursuant to the Multiemployer Pension Plan Amendments Act of 1980 (MPPAA). The Fund asserted two withdrawal claims against GE. The first “was based on the Fund’s assertion that GE experienced a 70% decline in contribution base units (CBUs) in three consecutive years when compared to the average of the two highest years in the preceding five-year period.” The Fund asserted that this resulted in a partial withdrawal which meant GE owed $205 million in withdrawal liability. The second assessment, totaling $22 million, “was a ‘bargaining-out’ partial withdrawal based on GE’s closure of a manufacturing facility in Chattanooga, Tennessee[.]” GE contested these decisions, arguing that it was not liable because it qualified under the MPPAA’s “building and construction industry” (BCI) exemption. (This exemption applies if “substantially all the employees with respect to whom the employer has an obligation to contribute under the plan perform work in the building and construction industry[.]” 29 U.S.C. § 1383(b)(1)(A).) The parties proceeded to arbitration, where GE prevailed on its BCI exemption argument. The district court upheld this ruling, and the Fund appealed to the Eighth Circuit, which issued this published decision. The court noted that the entire case turned on how to interpret the term “substantially all” as it is used in the BCI exemption definition: “More specifically, is ‘substantially all’ determined by using a monthly headcount [as argued by the Fund] or a cumulative headcount [favored by GE]? The parties agree that the answer to this question resolves both the 70% Decline Claim and the Chattanooga Claim.” The court found that the statute was ambiguous, and thus “we must ‘independently interpret the statute.’” It concluded, “Neither the monthly headcount method nor the cumulative headcount method is a precise fit for determining eligibility for the BCI. Nevertheless, we conclude that, of the two options, the cumulative headcount method is more consistent with the purpose of the statute and hews more closely to congressional intent.” The court found that this method “is better able to accommodate natural fluctuations inherent in building and construction employment,” as it considers the total number of employees over the entire lookback period rather than a month-by-month snapshot. The court stressed that the MPPAA aims to protect the solvency of multiemployer plans, and that interpreting the BCI exemption over a longer time period better accounts for the “mobility of both employers and employe[e]s and the intermittent nature of employment” in the BCI. The court noted that “[a] different set of facts may warrant a different result,” but in this case, “of the two options presented, GE’s preferred method is less arbitrary and more faithful to the statute and the congressional intent behind it.” The Eighth Circuit thus ruled in GE’s favor and affirmed.