We here at Your ERISA Watch hope all our readers had a relaxing Labor Day weekend, and that you were all able to take a moment to reflect on the massive contributions laborers have made to this country. This is also a good time to reflect on how we can best protect the benefits those laborers receive for their efforts, which of course are often governed by our favorite statutory scheme, ERISA.

The federal appellate courts perhaps did a bit too much reflecting last week, as they only issued one unpublished decision (Pankey v. Aetna Life Ins. Co.). As a result, we have no featured ruling to highlight. The most influential of the district court decisions was probably PCMA v. Gillespie, in which an Illinois district court granted a motion for a preliminary injunction filed by the Pharmaceutical Care Management Association (PCMA) – the national trade association for pharmacy benefit managers (PBMs) – in its dispute with the State of Illinois over the state’s new reporting requirements for PBMs. The court agreed with PCMA that it will likely be successful in its argument that the requirements run afoul of ERISA preemption.

Of course, there were more cases covering a number of ERISA-related issues, so read on for more detail about Gillespie, Pankey, and many other decisions.

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

Attorneys’ Fees

Ninth Circuit

Brian W. v. Premera Blue Cross of Washington, No. C24-0154-KKE, 2026 WL 2620024 (W.D. Wash. Sept. 4, 2026) (Judge Kymberly K. Evanson). Brian W. sued Premera Blue Cross of Washington under ERISA sections 502(a)(1)(B) and (a)(3) after Premera denied benefits for his son’s residential mental health treatment at two facilities, Cherry Gulch and the Heritage School. In March of 2026, following cross-motions for judgment, the court ruled in favor of Brian W. (Your ERISA Watch covered this ruling in our March 18, 2026 edition.) After further briefing on damages, the court entered judgment for Brian W. in the amount of $395,593.07 plus post-judgment interest. In doing so the court rejected Brian W.’s request to reimburse the Heritage School treatment at the in-network rate and applied the federal prejudgment interest rate rather than the higher rate he proposed. (We covered this ruling as well on June 10, 2026.) Before the court here was Brian W.’s motion for $223,495 in attorney’s fees and $7,351.17 in costs. Premera opposed the motion, arguing the fee request should be denied outright or, alternatively, reduced by at least 50 percent. The court walked through the Ninth Circuit’s five-factor Hummell test for awarding fees and found all but one favored Brian W. On the culpability factor, the court found no bad faith, but “Premera’s handling of Brian W.’s claim was deficient to the point of culpability.” Its responses on the Cherry Gulch claim shifted repeatedly among different denial rationales, and “[t]hroughout this flipflopping, Brian W. was made to wait years to have his claims reimbursed.” As for the Heritage School claim, Premera “lost the appeal and never responded,” and then submitted “an unresponsive letter” to the Washington Insurance Commissioner’s inquiry. The ability-to-pay factor, which the court described as “the greatest weight of all the factors,” tilted heavily in Brian W.’s favor given Premera’s undisputed capacity to satisfy an award. The deterrence and relative-merits factors likewise favored an award, as a fee award would discourage insurers from defending denials using undisclosed post hoc rationales, and Brian W. prevailed on every substantive claim, falling short only on two damages arguments. Only the fourth factor – whether the litigation sought to benefit other plan participants or resolve a significant ERISA question – was neutral or slightly against an award. Turning to the amount of fees, the court applied the Ninth Circuit’s lodestar approach, first finding the requested hourly rates of $850, $750, $510, and $250 (for David M. Lilienstein, Katie J. Spielman, McKean Evans, and paralegals Dani Mernick and Chelsea Giles respectively), reasonable and unopposed. As for the time spent on the case, the court declined to discount the hours spent on partially unsuccessful damages arguments because Brian W. prevailed on all his claims and obtained “excellent” results. The court nonetheless made several targeted reductions: it corrected an arithmetic error inflating lead counsel’s rate calculation, excluded a handful of billing entries postdating the fee motion that counsel conceded were mistaken, cut one-third of the hours billed on the fee application itself after counsel admitted that the motion recycled some language, and excluded certain clerical paralegal tasks. The court rejected Premera’s argument that the work of two senior attorneys on the case reflected unreasonable duplication, finding that the attorneys reasonably divided responsibility for different briefing sections. Because Premera’s request for an across-the-board 35 percent reduction rested on the same considerations the court had already weighed in calculating the lodestar, and because a lodestar adjustment is warranted only in “‘rare’ and ‘exceptional cases,’” the court declined to adjust the resulting lodestar further. Thus, the court granted Brian W.’s motion for attorney’s fees in part, awarding $198,231 in attorney’s fees and $7,351.17 in costs.

Breach of Fiduciary Duty

First Circuit

Halamek v. Philips North America LLC, No. 25-12003-FDS, 2026 WL 2620864 (D. Mass. Sept. 4, 2026) (Judge F. Dennis Saylor IV). James Halamek, Karl Tysl, and Kathy Woods, participants in the Philips North America LLC defined contribution retirement plan, brought this putative class action against Philips and the plan’s Investment Committee. Plaintiffs contend that the plan’s Prudential Stable Value Fund, a guaranteed investment contract in which more than $420 million of plan assets were invested by 2023, substantially underperformed comparable stable value funds by an average of more than 40 percent while exposing participants to Prudential’s solvency risk. Plaintiffs further allege that the Committee never sought competing proposals or negotiated a higher crediting rate. Plaintiffs separately alleged that Philips used forfeited, non-vested employer contributions to reduce its own future contribution obligations rather than pay plan administrative expenses, and that it did so without considering alternatives or consulting an independent decision-maker. Plaintiffs’ complaint asserts three counts: (1) against the Committee for breach of the duty of prudence for retaining the Prudential fund; (2) against Philips for breach of fiduciary duty for failing to monitor the Committee; and (3) against Philips for breach of the duty of loyalty for consistently using forfeitures for its own benefit. Defendants moved to dismiss all three counts. On the prudence claim, the court rejected defendants’ argument that First Circuit precedent, which held that “a fiduciary’s investments could not be imprudent by virtue of being ‘too conservative,’” barred plaintiffs’ claim. The court distinguished that precedent, noting that here plaintiffs identified specific corrective steps – soliciting competing proposals from Prudential and other stable value providers, or negotiating a higher crediting rate – that the Committee could have taken but did not. Defendants also argued that plaintiffs did not provide “meaningful comparator SVFs” and did not show “that the Prudential SVF consistently and substantially underperformed them.” However, the court ruled that this “dispute involves a question of fact that the Court cannot resolve at this stage.” The court thus denied defendants’ motion as to the fiduciary duty claim, and because the monitoring claim was derivative of it, denied dismissal of that claim as well. On the loyalty claim regarding forfeitures, the court acknowledged that a majority of courts have held that a fiduciary does not breach its duty of loyalty by exercising plan-authorized discretion to use forfeitures to reduce employer contributions rather than plan expenses. Those cases rest on the argument that ERISA does not impose a duty to maximize pecuniary benefits, and instead protects only the benefits a plan promises. However, the court found that in this case, “there may be reasons to decide this case differently.” The court noted that the plan was a defined contribution plan, in which participants’ ultimate benefits are not fixed and may be affected by the level of expenses charged against their accounts. Thus, “[i]f discretionary decisions to reduce expenses are always exercised in favor of the employer, and never in favor of the participants, and if that reduces participant benefits, that conceivably could constitute a breach of the fiduciary duty of loyalty.” Even if the plan “confers broad discretionary powers, it is at least plausible that defendants were motivated purely by self-interest and acted in a manner that was detrimental to participants.” The court held that it lacked a sufficient factual record to resolve these arguments, and denied defendants’ motion on this claim as well. As a result, defendants’ motion to dismiss was denied in its entirety.

Third Circuit

Muldoon v. Penn State Health, No. 1:25-CV-01181, 2026 WL 2594498 (M.D. Pa. Sept. 2, 2026) (Judge Karoline Mehalchick). James Muldoon, a former Penn State Health employee who participated in its 403(b) retirement plan, sued Penn State Health, its Board of Directors, and its Retirement Management Committee individually, on behalf of a putative class, and derivatively on behalf of both the 403(b) plan and the separate 401(k) savings plan. Muldoon alleges that defendants selected Great-West Life & Annuity’s Guaranteed Investment Contract (GIC) for the plans’ stable value option despite its comparatively low credit quality and significant underperformance compared to other GICs. Muldoon also alleges that defendants paid Great-West recordkeeping fees far above market rate, and improperly used its discretionary authority over forfeited employee contributions to offset Penn State Health’s required contributions rather than pay plan expenses. Muldoon brought five claims under ERISA: breach of the duty of prudence, breach of the duty of loyalty, violation of ERISA’s anti-inurement provision, failure to monitor, and engagement in prohibited transactions. Defendants moved to dismiss on the ground that Muldoon lacked standing because he had signed a severance agreement releasing claims against Penn State Health, and alternatively that the complaint failed to state a claim. The court held it could review the severance agreement despite the general rule against considering matters outside the pleadings, because a court can examine evidence bearing on subject matter jurisdiction, and Muldoon did not dispute the agreement’s authenticity. Applying the Third Circuit’s 2009 decision in In re Schering Plough Corp. ERISA Litig., the court explained ERISA only voids releases to the extent they purport to alter a fiduciary’s statutory obligations, not releases of an individual’s own direct claims. As a result, a release can bar an individual’s direct claims, including claims brought as a class representative based on those claims. However, a release cannot bar claims framed purely as derivative causes of action belonging to the plan itself. Because Muldoon’s complaint explicitly asserted individual and class claims under Rule 23, the court dismissed those claims as barred by the release. But because Muldoon also pleaded, in the alternative, that he brought his claims derivatively under ERISA § 502(a)(2), and because Schering Plough recognized that § 502(a)(2) claims are inherently derivative, the court allowed Muldoon’s derivative claims to proceed. On the duty of loyalty and anti-inurement counts, Muldoon acknowledged that the plan gave defendants discretion over how to use plan forfeitures, but alleged that “Defendants took no steps to consult with an independent decision maker or otherwise account for their conflict of interest and purposefully used their discretionary authority to save themselves millions of dollars.” For the court, this was sufficient. “While ERISA does not prohibit discretionary authority, it does prohibit defendants from using that authority for the purpose of serving their own interests and benefiting themselves.” The court found that this inquiry involved issues of fact that could not be resolved on a motion to dismiss. On the duty of prudence and prohibited transaction counts, the court first held Muldoon could challenge defendants’ management of the 401(k) plan even though he personally participated only in the 403(b) plan, since his challenge targeted the same general practices involving the Great-West GIC, which affected both plans. On the merits, the court found that Muldoon’s allegations that the Great-West GIC underperformed comparable GICs by more than 56%, and that Great-West was paid 224% above average recordkeeping costs, were sufficient. Muldoon’s comparators were not “perfect,” but they were good enough under the Third Circuit’s guidance in Mator v. Wesco Distribution, Inc. (covered in our May 22, 2024 edition). On the prohibited transaction count, the court applied the Supreme Court’s recent decision in Cunningham v. Cornell University (covered in our April 23, 2025 edition), which held that a plaintiff need only allege a fiduciary caused the plan to transact with a party in interest, leaving the reasonable compensation exemption under 29 U.S.C. § 1108(b)(2)(A) to be raised as an affirmative defense rather than resolved at the pleading stage. Muldoon’s complaint met this low bar, so the court denied dismissal of the prohibited transaction count. Because the court had earlier found properly alleged breaches, it denied dismissal of the derivative failure to monitor count as well. As a result, the court granted defendants’ motion to dismiss Muldoon’s individual claims but denied it as to Muldoon’s derivative claims.

Sixth Circuit

Irmen v. Benchmark Restaurant Grp., LLC, No. 3:25 CV 1275, 2026 WL 2581864 (N.D. Ohio Sept. 1, 2026) (Judge James R. Knepp II). Sue Irmen worked as a server at Claude’s, a restaurant owned by Benchmark Restaurant Group, LLC, and accepted the position in part because it promised health insurance benefits under the Spartan Warehouse and Distribution Company Incorp Group Health Plan, for which Industrial Developers, Ltd. was the named plan sponsor and administrator. After being told she needed to average 30 hours per week to keep her coverage, Irmen repeatedly confirmed with management that she met the threshold, and C. Edward Harmon, who became sole owner of Benchmark in December 2023, personally told her the company would not take away her benefits. Management nonetheless reclassified her as part-time in April 2024 for allegedly falling below 30 hours, and when Irmen later needed care for a back injury in the fall of 2024, she discovered her coverage had been terminated without any notice or COBRA election paperwork. She was ultimately terminated from her position in January 2025. Irmen sued Benchmark, Harmon, Spartan Logistics, Ltd., and Developers, asserting age and disability discrimination claims, ERISA breach of fiduciary duty, retaliation, and documents claims, a COBRA notice claim, and Ohio state law claims including promissory estoppel. Harmon, Spartan, and Developers (but not Benchmark) moved to dismiss the ERISA and promissory estoppel counts. On the breach of fiduciary duty claim, the court dismissed the claim against Spartan, finding Irmen’s allegations that Spartan “handles human resources including benefits administration” and that an employee there told her she had lost coverage described only ministerial functions, not discretionary control. Irmen’s claim against Developers survived because she adequately alleged that Developers was the plan’s named sponsor and administrator. Harmon presented “the closest call,” but the court found his sole ownership of Benchmark, combined with his personal assurance that “no one would be taking away her benefits under the Plan,” followed by a manager’s comment that “Harmon was ‘the big guy’ and that ‘[i]f he said’ Plaintiff could keep her benefits, she could,” plausibly suggested Harmon exercised a discretionary role in benefits-related decisions. The court rejected defendants’ argument that the entire claim was barred because Irmen could obtain adequate relief under § 1132(a)(1)(B). The court ruled that Irmen’s theory of harm (i.e., that “Defendants violated their fiduciary duties by misrepresenting the status of Plaintiff’s health coverage, specifically by claiming her benefits would not be taken away”) alleged an injury separate from any wrongful benefits denial. However, the court dismissed Irmen’s ERISA retaliation claim under 29 U.S.C. § 1140 against all three defendants, holding that Irmen did not show that Harmon, Spartan, or Developers had the “authority to make hiring and firing decisions or otherwise participated in the decision to terminate her employment with Benchmark.” The court likewise dismissed the § 1132(c) documents claim against Harmon, as Irmen identified Developers, not Harmon, as the Plan’s named administrator, and only a plan administrator can be liable for withholding documents. (The COBRA notice claim against Harmon was dismissed on the same ground.) The court further held that Irmen’s document request letter, addressed only to “‘Benchmark Restaurant Group, LLC,’ to the attention of Defendant Harmon” did not give “clear notice” to Spartan or Developers of her request. Irmen’s “de facto administrator” theory linking the three entities was not sufficiently supported by the complaint. Finally, the court denied dismissal of Irmen’s Ohio law promissory estoppel claim, rejecting defendants’ ERISA preemption argument. The court held the claim was not completely preempted because it rested on Harmon’s independent oral promise rather than any right conferred by the plan’s actual terms. Nor was the claim expressly preempted; defendants offered no developed argument that the claim would mandate particular benefit structures, provide an alternative enforcement mechanism for plan benefits, or otherwise regulate the plan. As for the merits, the court found Irmen’s allegations sufficient. Defendants argued that Irmen failed to allege ambiguity in the plan, but the court noted that her claim was governed by Ohio law, not ERISA, and Ohio’s promissory estoppel standard does not require pleading ambiguity as an element. Furthermore, Irmen’s allegation that she did not know the plan’s terms made it plausible she reasonably relied on Harmon’s oral assurances, regardless of what the plan said. Thus, in the end, the court granted defendants’ motion to dismiss only in part: as to Spartan on the fiduciary duty count, as to all three defendants on the retaliation and plan documents counts, and as to Harmon on the COBRA notice claim.

Trout v. Meijer, Inc., No. 1:25-cv-1378, 2026 WL 2581855 (W.D. Mich. Sept. 1, 2026) (Judge Hala Y. Jarbou). Justin Trout, an employee participating in Meijer, Inc.’s self-funded health care plan, brought this putative class action challenging the plan’s $20 monthly tobacco surcharge which was a part of the plan’s “wellness program.” Trout made two arguments: (1) Meijer failed to properly disclose the availability of individual medical accommodations to the surcharge as required by the Public Health Service Act (PHSA) and its implementing regulations, and (2) Meijer breached its fiduciary duties under ERISA, and engaged in a prohibited transaction, by using the surcharges it collected to directly offset its own contributions to the plan. In April of this year, the court granted in part and denied in part Meijer’s first motion to dismiss, dismissing the offset-based fiduciary duty theory but allowing the PHSA notice claim to proceed. (Your ERISA Watch covered this ruling in our April 29, 2026 edition.) Trout filed an amended complaint and Meijer moved to dismiss again. In this order, the court once again dismissed the fiduciary duty claim, and this time reversed course and dismissed the PHSA notice claim as well. The PHSA requires an employer offering a wellness program such as a tobacco surcharge to provide a “reasonable alternative standard” accommodating employees for whom the program is medically inadvisable, and to disclose the availability of that alternative. A Department of Labor regulation further requires the disclosure to include a statement that recommendations of an employee’s personal physician will be accommodated; the Meijer plan did not include this statement. Meijer contended that the regulation exceeded the agency’s authority as applied to its tobacco cessation program, and the court agreed. Because the regulation identifies a tobacco cessation program as the type of wellness program that does not require any accommodation for a health status factor, and because Meijer’s cessation program does not implicate any medical condition, there was no individual medical need for Meijer to accommodate and thus notification was not required. The court held that its prior decision did not bar this new ruling because Meijer’s argument had changed to an “as-applied” challenge. On the fiduciary duty theory, the court again rejected Trout’s claim that Meijer’s practice of using surcharge revenue to offset its own plan contributions harmed the plan or its participants. The court reiterated its earlier holding that Trout failed to allege any obligation in the plan documents requiring Meijer to make a fixed contribution or to add surcharges on top of whatever it otherwise contributed, so reducing its own contribution by the surcharge amount was permissible. Furthermore, Trout continued to fail to allege any monetary loss to the plan itself, as opposed to a possible indirect increase in what individual employees pay in premiums, which the court held was not a cognizable injury to the plan under ERISA Section 502(a)(2). (The court relied on its own December 2025 decision in Donelson v. Meijer, which involved forfeited pension funds, in making this ruling.) The court explained that a fiduciary’s duties extend only to delivering the specific benefits promised under the plan, not to maximizing plan assets whenever an employer could theoretically contribute more. Under Section 502(a)(3), the court likewise found no claim because Trout identified no plan provision that Meijer’s premium-setting practice violated. The court also dismissed Trout’s derivative failure-to-monitor claim for lack of any predicate breach, and dismissed his prohibited transaction claim because it was foreclosed by the Sixth Circuit’s 1984 decision in Holliday v. Xerox Corp. (holding that a transfer benefiting the employer does not violate ERISA if the employer could have achieved the identical result by amending the plan outright). The court thus granted Meijer’s motion to dismiss in full.

Ninth Circuit

Scentsy, Inc. v. Blue Cross of Idaho Health Service, Inc., No. 1:23-cv-00552-AKB, 2026 WL 2607193 (D. Idaho Sept. 3, 2026) (Judge Amanda K. Brailsford). Scentsy, Inc. is an Idaho employer that sponsors a self-funded health plan for its employees and their dependents. Scentsy contracted with Blue Cross of Idaho Health Service, Inc. (BCI) under an administrative services agreement (ASA), pursuant to which BCI would process and pay claims, and act as the plan’s claims administrator and “ERISA Claim Fiduciary.” The two companies separately entered into an excess loss contract (ELC), under which BCI provided stop-loss coverage for claims that exceeded $200,000, subject to a coverage window tied to the contract period running from May 2021 through April 2022. The dispute in this case centers on a plan participant’s infant daughter, born in February of 2022 with a complex set of birth defects requiring extended treatment at a California children’s hospital under contract with Blue Shield of California, a “Host Blue” under BCI’s “Inter-Plan Arrangements” with the Blue Cross Blue Shield Association. BCI paid the infant’s first excess claim, for care rendered in February and March 2022, under the ELC, but it refused to cover a second excess claim, for roughly $1.4 million in care rendered from March through April 22, 2022. BCI contended that it did not receive that claim from the Host Blue until September 2022, after the ELC’s coverage period had lapsed. Scentsy ultimately paid the second excess claim itself and brought this action, asserting breach of fiduciary duty under ERISA sections 502(a)(2) and (a)(3), along with several state law claims pleaded in the alternative to the ERISA counts. The parties filed cross-motions for summary judgment on all claims, which were decided in this order. As a threshold matter, the court found BCI conceded it was an ERISA fiduciary under the ASA by failing to respond to Scentsy’s briefing on that point, while Scentsy in turn conceded BCI was not a fiduciary under the separate ELC. The court further held that BCI operated under a conflict of interest because it served simultaneously as the entity investigating and determining the validity of claims under the ASA, and as the entity that would have to pay those claims under the ELC. The court rejected BCI’s argument that its reliance on the Host Blue’s claims-handling process absolved it of fiduciary responsibility, explaining that ERISA’s anti-exculpation provision, 29 U.S.C. § 1110(a), voids any agreement purporting to relieve a fiduciary of its duties. Furthermore, the ASA itself stated BCI “remains responsible for fulfilling its contractual obligations” regardless of any Inter-Plan Arrangement. The court likewise rejected BCI’s claim that it could not have breached any duty because it did not learn of the second excess claim until after the ELC lapsed. The court found it undisputed that BCI’s account director had emailed Scentsy months earlier identifying the infant as a “high cost claimant” with a serious, ongoing diagnosis, which was sufficient to place BCI on notice that an excess claim was in the works before the coverage window closed. Because BCI took no steps to address its conflict, such as expediting the claim or retroactively honoring it as it had done for other claimants in the past, the court held BCI breached its fiduciary duty of loyalty and granted Scentsy summary judgment on both ERISA counts. As for the proper remedy, the court held Scentsy could pursue equitable surcharge under ERISA section 502(a)(3), as recognized by the Supreme Court in CIGNA Corp. v. Amara. The appropriate amount was what Scentsy was forced to pay to cover the infant’s second excess claim. Having granted summary judgment to Scentsy on its ERISA claims, the court did not reach Scentsy’s state law claims, which BCI contended were preempted by ERISA and had been pleaded only in the alternative. The court granted BCI summary judgment on those remaining counts, and further granted the parties’ unopposed motions to seal.

Ventura v. Lithia Motors, Inc., No. 2:26-cv-01786-HDV-RAO, 2026 WL 2601871 (C.D. Cal. Sept. 2, 2026) (Judge Hernán D. Vera). David Ventura, a former Lithia Motors, Inc. employee and participant in its ERISA-governed 401(k) retirement plan, brought this putative class action challenging three aspects of the plan’s administration: (1) the recordkeeping fees Lithia paid to Merrill Lynch and its affiliate Bank of America; (2) Lithia’s practice of using forfeited, non-vested employer contributions to reduce its own future contribution obligations rather than pay plan expenses; and (3) Lithia’s decision to transition the plan’s target-date fund lineup from JPMorgan mutual funds to JPMorgan collective investment trusts. Ventura asserted five ERISA counts arising from this conduct: prohibited transactions, breach of fiduciary duty, breach of ERISA’s anti-inurement provision, a second breach of the duty of prudence specific to the collective investment trust transition, and failure to monitor. Lithia moved to dismiss all five counts for failure to state a claim. On the prohibited transaction count, the court applied the Ninth Circuit’s broad reading of ERISA section 406(a) in Bugielski v. AT&T, which treats a plan’s contract with a service provider like a recordkeeper as falling within the statute’s bar on furnishing services between a plan and a party in interest. The court rejected Lithia’s argument that Merrill Lynch and Bank of America were not parties in interest when first engaged, as this argument was foreclosed by Bugielski, and rejected Lithia’s statute-of-repose defense because the plan’s 2023-24 transition into the collective investment trusts fell well within ERISA’s six-year window. However, the court held that Lithia’s use of forfeitures to offset its own contributions could not independently support a prohibited transaction claim because the forfeited funds never left the plan. On the breach of fiduciary duty count, the court found Ventura’s excessive-fee theory adequately pleaded, crediting allegations that the plan paid roughly $61 per participant for recordkeeping services while three comparably sized plans paid between $3 and $31 for similar services. The court rejected Lithia’s argument that the comparator plans were inadequate because “an ‘apples to apples’ comparison need not be exquisitely granular at this early pleading stage.” But the court dismissed the forfeiture-based breach of fiduciary duty theory, following the majority of courts which have held that using forfeitures to reduce an employer’s future contributions, where the plan document expressly authorizes that choice, does not violate the duties of loyalty or prudence. The court likewise dismissed Ventura’s separate duty of prudence count aimed at the collective investment trust transition, holding both that the allegations describing reduced fee transparency were too conclusory to plausibly allege imprudence, and that Ventura lacked standing to pursue the theory at all, having failed to allege any concrete injury flowing from the switch. On the anti-inurement count, the court held that because the forfeited amounts were, by Ventura’s own allegations, merely reallocated within the plan to offset future employer contributions and never left the plan, there was no inurement to Lithia. The court dismissed both the anti-inurement count and the forfeiture-based fiduciary duty theory without leave to amend, observing that Ventura’s counsel “has filed a number of complaints with similar or identical allegations claiming that the plan-compliant use of forfeitures to pay future employer obligations violates ERISA,” and that these claims were based on “a novel legal theory that is unsupported by present law.” The failure to monitor count survived, however, because it derived from the excessive-fee breach of fiduciary duty theory that the court allowed to proceed. As a result, Lithia’s motion was granted in part and denied in part.

Tenth Circuit

Dow v. Lumen Technologies, Inc., No. 24-cv-02434-LTB-TPO, 2026 WL 2582196 (D. Colo. Sept. 1, 2026) (Judge Lewis T. Babcock). Dolly Dow and Virginia Sakal brought this putative class action against Lumen Technologies, Inc., its Employee Benefits Committee, CenturyLink Investment Management Company, Kathleen M. Lutito, and State Street Global Advisors Trust Co. The lawsuit challenges Lumen’s 2021 pension risk transfer (PRT) of roughly $1.4 billion in obligations under the Lumen Combined Pension Plan, covering 22,600 participants, to the private-equity-controlled insurer Athene. Plaintiffs contend that State Street, which was selected as an independent fiduciary to select the annuity provider, and Lumen, which made the ultimate selection on State Street’s advice, breached their fiduciary duties by choosing Athene despite its comparatively low credit rating, its exploitation of “lax Bermuda regulatory standards,” its “high concentration of risky assets,” and its use of a riskier separate account structure for funding annuity liabilities. Plaintiffs contend defendants selected Athene because the transaction was cheaper for Lumen than purchasing from a more conventional insurer, and because it eliminated Lumen’s ongoing premium payments to the federal Pension Benefit Guaranty Corporation (PBGC). Following the transfer, plaintiffs’ benefits are no longer backstopped by the PBGC and are instead backed by state guaranty associations, whose funding and coverage are allegedly not as reliable. The Lumen-related defendants moved to dismiss for lack of Article III standing and failure to state a claim. The court did not reach the merits and decided the motion on standing grounds. The court began with the Supreme Court’s 2020 decision in Thole v. U.S. Bank N.A., which held that participants in a defined benefit plan who have received and remain entitled to their full fixed monthly payments lack Article III standing to sue over alleged plan mismanagement. The court acknowledged Thole was not directly on point because it did not involve a PRT. However, it noted that other cases had applied Thole in the PRT context. The results of those decisions were not uniform, and there was “no controlling authority to guide the Court’s analysis” from the Tenth Circuit. With this prologue, the court turned to each of plaintiffs’ four standing theories. First, plaintiffs argued that the PRT itself caused a cognizable injury by reducing the value of their benefits and removing ERISA’s protections. The court disagreed, ruling that participants in a defined benefit plan have no equitable or property interest in the plan under Thole, their monthly benefit does not change regardless of who pays it, and they have no vested right to remain within ERISA’s protections because PRTs are expressly authorized by 29 U.S.C. § 1341(b)(3)(A)(i). Second, the court rejected plaintiffs’ theory of a “substantially increased risk of future default and non-payment of benefits” by Athene, stating that plaintiffs’ allegations, even if true, showed at most that Athene was “more likely to fail than other annuity providers,” which did not rise to the required level of “actual or imminent” harm. Such failure might not even lead to non-payment of benefits because state guaranty associations provided a backstop. Third, the court rejected plaintiffs’ argument that trust law entitled them to seek disgorgement without any showing of economic harm. The court held that Thole forecloses treating defined benefit plan participants as analogous to private trust beneficiaries. Fourth, the court held that plaintiffs could not rely on the statutory cause of action in 29 U.S.C. § 1132(a)(9), which covers violations related to the purchase of annuity contracts upon plan termination, because “the cause of action does not affect the Article III standing analysis.” Having rejected all of plaintiffs’ arguments, the court found that they lacked standing and granted the Lumen defendants’ motion to dismiss.

Class Actions

Seventh Circuit

Paszkiet v. The Animal Doctor, Ltd., No. 1:24-cv-8403, 2026 WL 2620412 (N.D. Ill. Aug. 27, 2026) (Judge Mary M. Rowland). Cathy Paszkiet, a participant in The Animal Doctor, Ltd. Profit Sharing Plan, brought this putative class action against The Animal Doctor, Ltd., Lori W. Wyatt, the plan’s fiduciary, and the plan itself. Paszkiet alleged in three counts that defendants breached their fiduciary duties of prudence and loyalty by causing the plan to make imprudent investments in high-cost, poorly performing pharmaceutical-industry securities and by failing to monitor those investments. As a result, a class of roughly 70 participants and beneficiaries who held accounts in the plan between 2021 and 2025 suffered losses. Following arm’s-length negotiations facilitated by a court-appointed neutral mediator, the parties reached a proposed settlement under which defendants would pay $500,000 into a settlement fund for distribution to the class. This amount represented about 50 percent of the losses Paszkiet’s expert estimated, or more than $7,000 in gross recovery per class member before deductions. Defendants also promised to adopt a written investment policy statement governing the plan’s future investment decisions. Paszkiet filed an unopposed motion to certify the settlement class and grant preliminary approval of the settlement and the accompanying plan of allocation. Addressing certification first, the court found the proposed class satisfied Rule 23(a)’s numerosity requirement, that common questions concerning defendants’ investment and monitoring conduct predominated and were capable of classwide resolution, that Paszkiet’s claims were typical of the class because she was subject to the same allegedly imprudent investment decisions as every other member, and that she and class counsel would adequately represent the class’ interests. The court certified the class under both Rule 23(b)(1)(A), because ERISA breach of fiduciary duty actions are paradigmatic examples of claims for which inconsistent adjudications would establish incompatible standards of conduct, and Rule 23(b)(1)(B), because any recovery would flow to the plan itself and thereby affect the interests of all participants. The court found certification under Rule 23(b)(2) appropriate as well, as defendants’ conduct applied uniformly to the class and the requested monetary relief would follow from a formula rather than requiring individualized proof. As for fairness, the court found the negotiations were conducted at arm’s length through an experienced mediator, that the relief was adequate in light of the costs, risks, and delay inherent in continued ERISA litigation, particularly given the litigation risk plaintiff faced on both liability and damages: “ERISA cases are ‘enormously complex’ involving ‘exceedingly complicated’ law and facts.” The court noted that no claims form would be required for class members because the plan could identify all eligible participants from its own records. Class counsel’s anticipated request for attorney’s fees of up to one-third of the settlement fund fell within the range regularly awarded in common-fund ERISA settlements and would be evaluated at the final approval stage. As a result, the court certified the settlement class under Rules 23(b)(1) and (b)(2), preliminarily approved the settlement and plan of allocation, approved the proposed notice program, and appointed SureClaim as settlement administrator. A final fairness hearing will be held in December.

Tenth Circuit

Schissler v. Janus Henderson US (Holdings) Inc., No. 22-cv-02326-RM-SBP, 2026 WL 2619883 (D. Colo. Sept. 4, 2026) (Judge Raymond P. Moore). Sandra Schissler, Karly Sissel, and Derrick Hittson, participants in the Janus 401(k) and Employee Stock Ownership Plan, brought this putative class action against Janus Henderson US (Holdings) Inc., the Janus Henderson Advisory Committee, and unnamed committee members, alleging the defendants breached their fiduciary duties by including proprietary Janus Funds in the plan. They claim the funds underperformed and that defendants failed to employ a reasonable process for selecting and monitoring the plan’s investment lineup. The case survived a motion to dismiss in early 2024, with the court finding the fund-selection and monitoring claims stated a viable breach of fiduciary duty. (We covered this ruling in our January 31, 2024 edition.) After discovery and briefing of dispositive motions, the parties reached a $6.5 million settlement with the assistance of a mediator. Plaintiffs filed an unopposed motion for final approval, which was granted in this order. The court certified a class under Federal Rule of Civil Procedure 23(b)(1) consisting of all plan participants and beneficiaries invested in any Janus Fund between 2016 at 2026, finding the class satisfied all of Rule 23(a)’s requirements as well as Rule 23(b)(1). The court found the notice program, which succeeded in delivering settlement notices to 98.26% of identified class members, satisfied Rule 23(c)(2) and 23(e) as well as due process, and that the parties complied with notice to the government under the Class Action Fairness Act. The court further found the settlement fair, reasonable, and adequate based on the following factors: (1) the settlement resulted from arm’s-length negotiations by experienced ERISA counsel at an advanced stage of the proceedings; (2) the recovery fell within the range of reasonable outcomes given the nature of the claims and comparable ERISA settlements; (3) the named plaintiffs actively participated in developing the case; (4) class members had a full opportunity to object but none did so; and (5) the settlement was reviewed and approved by an independent fiduciary, Fiduciary Counselors, Inc. The court thus granted final approval and dismissed the amended complaint and all released claims with prejudice. The court retained jurisdiction to enforce the Final Approval Order and the Settlement Agreement, including any allocation of the settlement.

Disability Benefit Claims

Ninth Circuit

Camp v. Lincoln National Life Insurance Co., No. 25-cv-06199-AMO, 2026 WL 2608200 (N.D. Cal. Sept. 3, 2026) (Judge Araceli Martínez-Olguín). Christopher Camp, an Elite Account Director at Yelp, Inc., stopped working in January 2024 after developing sudden-onset tinnitus in his left ear, which he contended caused insomnia, anxiety, and depression. Lincoln National Life Insurance Company, which insured Yelp’s ERISA-governed long-term disability benefit plan, paid Camp short-term disability benefits through the maximum benefit period but denied his subsequent claim for long-term benefits, finding that the medical record, which included evaluations from Camp’s own treating physicians, two ENT specialists, a licensed clinical counselor, and several physicians who reviewed the file for Lincoln, did not establish restrictions or limitations severe enough to prevent him from performing the duties of his own occupation. Camp appealed, submitting functional assessments from his primary care physician and his therapist, but Lincoln upheld the denial. Lincoln concluded that the objective clinical findings throughout the record did not support functional impairment from either his hearing-related condition or his mental health complaints. Camp thus brought this action under ERISA section 502(a)(1)(B), and the case proceeded to a bench trial on the administrative record under Federal Rule of Civil Procedure 52. The court applied de novo review because the policy did not confer discretionary authority on Lincoln. Under that standard, the court found Camp failed to carry his burden on any of his theories of impairment. On the physical side, the court noted that Lincoln’s reviewing otolaryngologists, as well as one of Camp’s own treating ENT physicians, agreed Camp could work subject to modest restrictions and limitations, such as avoiding unprotected heights, heavy machinery, and high-decibel environments. Lincoln’s vocational expert confirmed none of those restrictions were incompatible with Camp’s sedentary desk-based occupation. On the cognitive side, the court pointed to Camp’s own Activities Questionnaire responses describing his ability to manage his finances and communicate independently, and to a functional assessment from his treating physician reflecting no more than mild limitations in concentration, attendance, and workplace interaction. On the psychiatric side, the court found no mental status examination in the record that documented findings of the kind associated with disabling depression or anxiety. Camp’s claim of psychiatric impairment rested almost entirely on his own self-reports to providers rather than on clinical findings. The court also rejected Camp’s broader challenges to Lincoln’s claims process. It held that Lincoln did not impermissibly impose an objective-evidence requirement, and declined to discount the opinions of Lincoln’s file-reviewing physicians. The court stated that Camp did not offer any extrinsic evidence of bias, and that any general preference for examining physicians’ opinions over paper reviews carried little weight in this case because the medical diagnoses were never in dispute. Instead, the issue was impairment, on which Lincoln’s reviewers and Camp’s own treating providers’ objective findings substantially agreed. Finally, the court ruled that Camp’s earlier receipt of short-term disability benefits was irrelevant to his long-term claim. The short-term plan was a separate contract, was not part of the administrative record, and “[e]ven under the same ERISA plan, different policies require different analyses.” The court thus granted Lincoln’s motion for judgment, denied Camp’s, and directed Lincoln to submit a proposed judgment.

Tenth Circuit

Pickering v. Equitable Financial Life Ins. Co. of Am., No. 1:25-cv-00046, 2026 WL 2606603 (D. Utah Sept. 3, 2026) (Judge Tena Campbell). Michael Pickering worked in a warehouse for North Atlantic Imports and was a participant in North Atlantic’s ERISA-governed long-term disability benefit plan, which was insured. by Equitable Financial Life Insurance Company of America. In 2022 he submitted a claim for benefits under the plan based on congestive heart failure, chronic obstructive pulmonary disease, and hypertension. The policy required Pickering to show he could not perform his “Own Occupation” for the first 24 months of disability and, after that, could not perform “Any Occupation” for which he was “qualified by education, training or experience” and that met a minimum earnings threshold. Equitable initially approved benefits under the Own Occupation standard, but when the Any Occupation standard rolled around, Equitable terminated Pickering’s claim. Equitable relied on an Employability Analysis Report generated through a computerized job-matching system that identified several occupations as “fair” or “potential” matches given Pickering’s work history. Around the same time, Pickering’s treating physician, Dr. Carr, told Equitable that Pickering could not perform sedentary work because of “ongoing problems with mental health,” including anxiety and impaired social skills. Equitable discounted that opinion on the stated ground that “no cognitive testing has been completed and there was no mention of mental health treatment or care within the medical records.” Pickering appealed, primarily challenging the vocational analysis, but Equitable upheld the denial and thus Pickering filed this action. The parties cross-moved for summary judgment, agreeing that de novo review applied because the grant of discretionary authority in the Equitable policy was invalid under Utah law, which bars discretionary clauses. Addressing vocational issues first, the court rejected Pickering’s challenges to the Any Occupation analysis performed by Equitable. It read the disjunctive “or” in “qualified by education, training or experience” to mean a claimant qualified through education or experience alone need not also possess prior training. Pickering “urge[d] the court to find that he cannot be qualified for any job that requires additional training,” but the court disagreed: “such a holding would contradict the common sense understanding of what it means to be qualified for an occupation. Indeed, many individuals who are hired for positions because they are qualified still must complete on-the-job training before they can begin their work.” The court found the Employability Analysis Report’s limitation to occupations requiring only thirty days to three months of on-the-job training to be reasonable. The court further found Equitable had adequately tailored Pickering’s occupational profile to his actual past duties rather than relying on generic job titles. It also rejected Pickering’s argument that Equitable should have accounted for his age, since Social Security’s age-based transferability regulations do not govern ERISA claims. Pickering had more success with his arguments based on his mental health. Although the Medical Case Manager review that formed the basis of the Employability Analysis Report asserted the record contained no mention of mental health treatment, this was incorrect. The record actually referenced Pickering’s anxiety disorder and related treatment on multiple occasions. As a result, the court held Equitable failed to satisfy its obligation to meaningfully engage with reliable evidence from a treating physician. The court rejected Equitable’s argument that Pickering forfeited this argument by not raising it during his administrative appeal, explaining that a claimant is allowed to raise new arguments in litigation supporting a claim so long as the claim was administratively exhausted. The court also addressed Equitable’s argument that because the Policy caps benefits for disability based on mental illness at 24 months, and Pickering had already received 24 months of benefits, he could not receive more. The court found Pickering’s original claim rested solely on his cardiac and pulmonary conditions, with no mental illness identified, and held the mental health limitation is triggered only when a mental illness plays a causal role in a claimant’s disability. Because that had not yet occurred, the entire 24 months of mental illness benefits were available to Pickering. As for a remedy, the court ruled that remand was the correct course of action because Equitable had not yet properly considered Pickering’s mental health evidence. Because remand, rather than an award of benefits, was the proper remedy, the court declined at this stage to award prejudgment interest or to decide the availability of attorneys’ fees. The case was thus administratively closed pending Equitable’s decision on remand.

Eleventh Circuit

Pankey v. Aetna Life Insurance Co., No. 25-11338, __ F. App’x __, 2026 WL 2606845 (11th Cir. Sept. 3, 2026) (Before Circuit Judges Grant, Lagoa, and Abudu). Judson Pankey received long-term disability benefits under an ERISA-governed plan issued by Aetna Life Insurance Company after suffering severe hearing loss that ended his career as a Senior Vice President at CPH Engineers, Inc. Pankey received “own occupation” benefits under the plan’s initial 24-month disability benefit period, and then transitioned to the benefit period in which he was required to show that he could not work at “any reasonable occupation” earning more than 60% of his predisability earnings. Beginning in July of 2021, Aetna made a series of requests for updated proof of Pankey’s continuing eligibility, including an attending physician’s statement, a claimant questionnaire, and personal tax returns or Schedule K-1 forms related to Pankey’s involvement with an entity called Brown Little Development. Pankey did not respond, so Aetna terminated his benefits in July of 2022 for insufficient proof of loss. Pankey appealed but failed to furnish an updated claimant questionnaire or recent Schedule K-1 forms despite further requests. Aetna upheld its decision in March of 2023 and this action under 29 U.S.C. § 1132(a)(1)(B) followed. The parties cross-moved for summary judgment. A magistrate judge recommended finding Aetna’s termination arbitrary and capricious and granting judgment to Pankey, but the district court judge disagreed. It sustained Aetna’s objections and rejected the recommendation, holding that the plan gave Aetna discretionary authority not only to define the disability definition but also to evaluate the sufficiency of proof submitted toward it. The district court further held that Aetna’s termination for insufficient proof was reasonable, and that Pankey did not show the decision was tainted by a conflict of interest. (Your ERISA Watch covered this decision in our April 2, 2025 edition.) Pankey appealed. In this unpublished decision the Eleventh Circuit applied its six-step Blankenship framework, and, as is common, exercised its option to skip the initial de novo “wrongness” inquiry. Instead, it proceeded directly to whether Aetna was vested with discretion and found that the plan’s discretionary clause plainly conferred it. Pankey did not argue on appeal that a conflict of interest affected Aetna’s decision, and thus the court treated that issue as abandoned. As a result, the court examined whether reasonable grounds supported the termination under arbitrary and capricious review. The parties agreed that Pankey was physically disabled, so the issue on appeal was the disability definition’s “earning more than 60%” requirement. The court found that Aetna’s specific requests for updated financial documentation were reasonable in light of Pankey’s continuing burden to prove disability. The court noted that Aetna had previously accommodated Pankey by accepting Schedule K-1 forms in lieu of personal tax returns, which undercut any inference of bad faith, and that Aetna’s need to verify whether Pankey’s income or relationship with Brown Little Development had changed over time justified periodic re-verification. The court rejected Pankey’s argument that Aetna administered the plan inconsistently, observing that Pankey’s refusal to provide an updated Schedule K-1 form and claimant questionnaire was a change from his prior position, and furthermore, “the record establishes that Pankey regularly refused to cooperate with Aetna’s reasonable requests.” Because Pankey did not dispute that he failed to provide the requested documentation, despite multiple opportunities, the court concluded that Aetna’s decision was rational and made in good faith. The Eleventh Circuit thus affirmed the district court’s grant of summary judgment to Aetna.

ERISA Preemption

Seventh Circuit

Pharmaceutical Care Mgmt. Ass’n v. Gillespie, No. 26-cv-3200, 2026 WL 2569468 (C.D. Ill. Aug. 31, 2026) (Judge Colleen R. Lawless). The Pharmaceutical Care Management Association (PCMA) is the national trade association for pharmacy benefit managers (PBMs), which administer prescription drug benefits for almost 300 million Americans. PCMA brought this action and sought a preliminary injunction against Ann Gillespie, Director of the Illinois Department of Insurance, and the Department itself, to block enforcement of reporting requirements in the Illinois Prescription Drug Affordability Act (PDAA) as applied to ERISA-governed plans. (The law was signed last year and began to go into effect on January 1, 2026.) The PDAA requires PBMs to submit extensive annual reports to the Department, plan sponsors, and insurers by September 1 of each year. These reports include “various ‘data on the health benefit plan,’ including for each plan ‘a list of drugs including corresponding information on therapeutic class, brand name, generic name, or specialty drug name;’ ‘number of covered individuals;’ ‘number of drug-related claims;’ ‘dosage units;’ ‘dispensing channel used;’ and ‘average wholesale acquisition cost per drug.’” PBMs are required not only to “disclose total gross spending on drugs by each plan and total net spending on drugs by each plan customer,” but also disclose certain items on a “claim-by-claim basis.” Fines for incomplete filings add up to $10,000 per day. PCMA contends that the reporting requirements are preempted by ERISA, while defendants contend that the requirements “are ancillary to the PDAA’s prohibition against PBM practices that conceal the availability of more affordable prescription drug alternatives and the true cost of prescription drugs.” Applying the Seventh Circuit’s four-factor preliminary injunction standard, the court focused on the likelihood-of-success inquiry and centered its discussion of that inquiry on the Supreme Court’s 2016 decision in Gobeille v. Liberty Mutual Ins. Co. In that case the Supreme Court held that ERISA preempted a Vermont all-payer claims database law because reporting, disclosure, and recordkeeping are “central to, and an essential part of, the uniform system of plan administration contemplated by ERISA.” The court found that the PDAA’s reporting requirements were “substantially the same” as those found preempted in Gobeille. Both compelled third-party administrators to submit detailed data to a state agency for the same broad purpose of reviewing health care costs and utilization. The court discussed the Seventh Circuit’s hot-off-the-presses decision in Central States, Southeast and Southwest Areas Health & Welfare Fund v. McClain (recapped in last week’s edition), which upheld an Arkansas reporting requirement because it was not ERISA-preempted, and found that it supported PCMA, not defendants. Unlike the Arkansas regulation, the PDAA requirements were not needed to enforce any fee or tax provision, and even if they were, their scope was, in the court’s view, “much broader than necessary” to serve that purpose. As a result, the PDAA “does not merely require incidental reporting,” as was the case in McClain, and thus infringed on ERISA. As for irreparable harm, the court held that exposure to fines of up to $10,000 per day for noncompliance was sufficient. The court rejected defendants’ argument that PCMA’s motion came too late, noting that PCMA filed suit and moved for a preliminary injunction two months before the September 1 reporting deadline after attempting to resolve the dispute before litigation. The court also rejected defendants’ request to limit any injunction to the five PCMA member companies that submitted supporting declarations, holding that association-wide relief was appropriate. Finally, weighing the balance of harms and the public interest, the court acknowledged Illinois’ “strong interest in protecting consumers from predatory practices,” agreeing that “[t]he increased cost of prescription drugs in recent years is a significant problem that Illinois and other states have sought to address.” However, “[t]he State’s strong interest in enforcing its own laws must yield to Congress’s decision more than 50 years ago to expressly preempt ‘any and all State laws as they may now or hereafter relate to any employee benefit plan.’” The court thus granted PCMA’s motion for a preliminary injunction.

Eleventh Circuit

Debt Collections, LLC v. Alabama Dental Ass’n, No. 2:26-cv-00398-NAD, 2026 WL 2572826 (N.D. Ala. Aug. 31, 2026) (Magistrate Judge Nicholas A. Danella). Defendant Alabama Dental Association (ALDA), a professional membership organization for dentists, sponsored a self-funded medical benefits plan administered by the now-bankrupt Arsenal Health, LLC. ALDA contracted with Iron Reinsurance Company, which issued a stop-loss insurance policy to ALDA in which “Iron agreed to reimburse ALDA for all eligible claims incurred by a participant in a particular year once that participant’s claims exceeded the Specific Deductible of $10,000.” Iron also agreed to temporarily fund certain plan claims incurred before the Specific Deductible was met if ALDA had not set aside sufficient funds, with ALDA contractually obligated to repay Iron for such advances. Plaintiff Debt Collections, LLC is the assignee of Iron, and brought this action against ALDA in Alabama state court, alleging state law counts for breach of contract, open account, account stated, money had and received, and unjust enrichment. Debt contends that ALDA refused to honor the policy’s terms by not repaying advances. ALDA removed the case to federal court based on ERISA preemption; Debt responded by moving to remand. The parties agreed the controlling test for ERISA preemption was the Eleventh Circuit’s four-part test from Butero v. Royal Maccabees Life Insurance Co., under which removal is proper if (1) there is a relevant ERISA plan, (2) the plaintiff has standing to sue under that plan, (3) the defendant is an ERISA entity, and (4) the complaint seeks relief similar to that available under ERISA’s civil enforcement provision, 29 U.S.C. § 1132(a). The parties “also agree that the dispositive issue is whether Debt, as assignee of Iron, has standing to sue under ERISA – that is, specifically, whether Iron was an ERISA fiduciary.” The court began by noting that “there is no caselaw concluding that an alleged stop-loss reinsurer – like Iron here – is an ERISA fiduciary… Indeed, ‘[a]n apparently unbroken line of decisions concludes that excess loss or reinsurance proceeds that are not payable to persons covered by a plan are outside the scope of ERISA.’” ALDA argued Iron nonetheless qualified as a fiduciary on three theories: (1) the policy gave Iron discretion over the plan or its assets by allowing it to advance funds; (2) Iron’s alleged discretionary decisions about whether to fund accommodation payments constituted fiduciary control; and (3) Iron possessed information about those payments that it had a fiduciary duty to disclose to ALDA or plan participants. The court found none of these convincing. The policy expressly disclaimed that Iron was “a fiduciary or a party in interest to the Employee Benefit Plan,” and repeatedly stated that ALDA and Arsenal, not Iron, were responsible for administering the plan and its benefit determinations. The court further stated that ALDA was ultimately responsible for any payments, despite Iron’s advances, and thus Iron’s payments were, at most, a “ministerial insurance-policy-related service” and not an exercise of discretionary authority over the plan. The court also noted that Iron never managed claims, made plan payments, or invested plan assets, and that any discretion Iron exercised concerned only whether to advance funds under a financing arrangement, not administration of the plan itself. As a result, the court found that ALDA could not establish that Iron was an ERISA fiduciary, and thus Debt did not have standing to sue under § 1132(a)(3) as Iron’s assignee. The case was thus improperly removed because ERISA preemption did not apply. The court granted Debt’s motion to remand.

Exhaustion of Administrative Remedies

Fourth Circuit

Childress v. Jewell Smokeless Coal Corp., No. 26-CV-00006, 2026 WL 2628945 (W.D. Va. Sept. 4, 2026) (Judge James P. Jones). The plaintiffs in this case are 22 retirees and dependent spouses of Jewell Smokeless Coal Corporation, each of whom qualifies for coverage under Jewell’s ERISA-governed retiree medical benefit plan. In this action they contend that Jewell significantly reduced the subsidy it provided to plan beneficiaries in December of 2024, which “made it impossible to obtain coverage equivalent to what was promised at retirement.” Jewell moved to dismiss, contending that plaintiffs failed to timely exhaust their administrative remedies under the plan, attaching a copy of the plan as an exhibit in support. Because exhaustion is an affirmative defense, the defense was not apparent on the face of the complaint, and the court would need to consider extra-pleading material to resolve the issue, the court held that Federal Rule of Civil Procedure 12(d) required converting the motion into one for summary judgment under Rule 56. The court cited the Fourth Circuit’s guidance that “all parties must be given ‘some indication by the court…that it is treating the 12(b)(6) motion as a motion for summary judgment,’” and thus the court chose to delay ruling on Jewell’s motion. Instead, it gave both parties 60 days “to file affidavits and pursue reasonable discovery” regarding the exhaustion issue.

Life Insurance & AD&D Benefit Claims

Eleventh Circuit

Metropolitan Life Ins. Co. v. Williams, No. 4:24-cv-00357-CLM, 2026 WL 2569485 (N.D. Ala. Aug. 31, 2026) (Judge Corey L. Maze). This interpleader action arose from a dispute over the proceeds of life insurance benefits under the ERISA-governed General Motors Life and Disability Benefits Program, which was insured by Metropolitan Life Insurance Company. When GM employee Jan Ehemann died in 2023, his purported wife, Roslyn Smith, was listed as the sole beneficiary on the policy. However, MetLife refused to pay benefits to her because Ehemann’s three daughters from a prior marriage made a competing claim for the benefits. MetLife filed this interpleader action so the court could resolve the competing claims, after which Roslyn and the daughters cross-moved for summary judgment. The central question in the case was whether Ehemann had validly changed his beneficiary in a March 2020 phone call with MetLife. The policy’s beneficiary provision required a change to be made “in writing on a form approved by us” and to “take effect as of the date YOU signed it,” while a separate provision defined “ENROLLMENT FORM” to include “an election made through a telephone.” Interpreting the plan according to its “ordinary meaning,” the court held that the enrollment form definition did not apply because it only governed enrollment in coverage, not beneficiary designations. Furthermore, the beneficiary provision never invoked the capitalized, defined term “ENROLLMENT FORM.” The March 2020 phone call thus did not satisfy the requirement that a beneficiary be named “in writing on a form.” The court also rejected Roslyn’s estoppel argument because that doctrine addresses oral representations between an insurer and its insured, not competing claims among third-party interpleader claimants. The court also declined to apply the federal common law substantial compliance doctrine (discussed by the Ninth Circuit just last week in Liu v. Kaiser), noting the Eleventh Circuit “has never adopted it.” The court further questioned the doctrine’s viability in the wake of the Supreme Court’s 2009 decision in Kennedy v. Plan Administrator for DuPont Savings & Investment Plan, “which emphasized strict adherence to ERISA plan documents.” Because Ehemann never validly designated Roslyn, the most recent written beneficiary designation controlled, which was Ehemann’s prior wife, Sharon DeVarona. However, DeVarona had predeceased Ehemann. (In fact, Roslyn herself is no longer with us; her estate was proceeding in this action on her behalf.) As a result, the plan provision titled “No Beneficiary at Your Death” was triggered. That provision gave MetLife discretion to pay the proceeds, in order, to a surviving spouse, then children, then parents. Thus, the court evaluated whether Roslyn qualified as Ehemann’s “spouse.” Applying Georgia law, where Ehemann and Roslyn were married in 2014, the court found that Roslyn’s marriage to Ehemann was void because she remained married to a prior husband, Willie Smith, who did not die until 2021. No record of divorce between Roslyn and Willie existed, her son testified he knew of none, Willie’s 2021 obituary listed her as his wife, a 2017 mortgage she signed with Willie identified them as “Husband and Wife,” and she referred to Willie as her husband in Facebook posts after marrying Ehemann. Thus, because Roslyn was never Ehemann’s valid spouse, the next class in the plan’s order of distribution applied, which was Ehemann’s surviving daughters. The court thus granted the Ehemann daughters’ motion for summary judgment and denied Roslyn’s cross-motion.

Provider Claims

Second Circuit

Norman Maurice Rowe, M.D. MHA LLC v. Oxford Health Ins., Inc., No. 23-CV-10344 (MMG), 2026 WL 2583106 (S.D.N.Y. Sept. 1, 2026) (Judge Margaret M. Garnett). Norman Maurice Rowe, M.D. and three affiliated provider entities are the plaintiffs in this case (and in many cases we have covered in recent years). They performed breast reduction surgeries on 21 patients insured under plans administered by Oxford Health Insurance, Inc. Plaintiffs are out of network with Oxford. They allege that Oxford promised, by words and course of conduct, to reimburse them as if they were in-network providers, but instead paid out-of-network rates, causing plaintiffs to bill the patients for the difference as “surprise bills” under provisions in the patients’ plans that held patients harmless for such bills and permitted them to assign their benefits to the provider for that purpose. Plaintiffs asserted claims for breach of contract, unjust enrichment, and promissory estoppel under state law, plus two ERISA counts. One of the ERISA counts is for benefits due under the patients’ plans and the other is for failure to comply with ERISA’s claims procedure regulations. Oxford moved to dismiss, which was accompanied by a request for judicial notice of 30 state court actions plaintiffs have filed against Oxford alleging similar claims. “Except where Plaintiffs voluntarily dropped the lawsuits, the State courts uniformly dismissed them.” Plaintiffs filed a 60-page opposition. The court began with preemption, applying the Supreme Court’s two-prong test from Aetna Health Inc. v. Davila and finding that ERISA completely preempted all three of plaintiffs’ state law claims. On prong one, the court found that plaintiffs, as the assignees of their patients, satisfied ERISA’s standing requirement because the patients were beneficiaries whose plans expressly permitted assignment of surprise-bill benefits to non-participating providers. The court also found that plaintiffs’ claims qualified as claims for benefits under § 1132(a)(1)(B) because their complaint tied their entitlement to indemnification directly to the plans’ terms. On prong two, the court held no independent legal duty supported the state law claims because each depended entirely on the plans’ surprise-bill and hold-harmless provisions. The court separately rejected plaintiffs’ argument that ERISA did not apply because only self-funded plans are ERISA plans, calling this both “flatly wrong” and contrary to plaintiffs’ own complaint, which asserted ERISA claims. The court turned to those two claims next, and dismissed them for failure to exhaust. Plaintiffs contended that they “exhausted any internal or administrative remedy required by the Relevant Plan by submitting a level 1 appeal and a level 2 appeal,” without any supporting detail. The court stated, “It is anyone’s guess what this means.” Plaintiffs did “not allege what steps any of the Patients’ plans required Plaintiffs to take to exhaust,” and did “not explain if or how Plaintiffs diligently completed those steps.” The court rejected plaintiffs’ argument that Oxford’s claims procedures were unreasonable, as well as their futility argument, holding that Oxford’s mere disagreement that additional reimbursement was owed did not constitute a “clear and positive showing” that “seeking review by the carrier would be futile.” Thus, the court granted Oxford’s motion to dismiss in full. The court did not grant plaintiffs leave to amend, citing the 30 cases plaintiffs had filed against Oxford: “Put simply, it is not fair to require Oxford to litigate these same claims forever, in multiple iterations that do not present any advances on the merits.” Furthermore, “Plaintiffs have already twice been granted leave to amend their complaint. There is little reason to believe that the third time will be the charm.”

Statute of Limitations

Ninth Circuit

Brand Tarzana Surgical Institute Inc. v. Aetna Life Ins. Co., No. 2:25-cv-04146-CV (PVCx), 2026 WL 2622050 (C.D. Cal. Sept. 4, 2026) (Judge Cynthia Valenzuela). Brand Tarzana Surgical Institute is an ambulatory surgery center located in Tarzana, California. As an out-of-network provider, it performed surgical services on a patient enrolled in an Aetna-administered ERISA-governed self-funded medical benefit plan sponsored by the patient’s employer. Before the surgery, a Brand Tarzana representative called Aetna three times to verify the patient’s out-of-network benefits. Aetna gave inconsistent answers, quoting 80 percent of usual, customary, and reasonable rates on the first and third calls, but 140 percent of a different benchmark rate on the second. The patient assigned all plan rights and benefits to Brand Tarzana on the day of surgery, and Brand Tarzana proceeded with the procedure in reliance on the 80 percent representation. After billing $56,558.50 for the facility services, Brand Tarzana received an explanation of benefits denying the claim in full on the ground that Aetna had deemed the surgery cosmetic rather than medically necessary. Brand Tarzana’s appeal was denied on February 24, 2022. Brand Tarzana filed suit against Aetna and the employer on May 8, 2025, asserting a claim for ERISA benefits under 29 U.S.C. § 1132(a)(1)(B) and a claim for breach of fiduciary duty under 29 U.S.C. § 1132(a)(3). Defendants moved to dismiss both claims as untimely, relying on a three-year contractual limitations period contained in a benefit plan booklet. At the outset, the court rejected defendants’ argument that the booklet was incorporated into the plan: “there is scant evidence that the Booklet constitutes a formal plan document.” The court noted that the booklet described itself as merely “one of two documents” outlining the plan’s benefits and repeatedly directed participants elsewhere for basic plan identifying information. The court also held that the booklet itself explained that it was not a plan document because in its listing of plan documents it was not syntactically included as one of them. As a result, the court did not adopt the booklet’s three-year period as the governing limitations provision. The court thus turned to the general rules of limitation. For the benefits claim, because ERISA supplies no federal statute of limitations, the court borrowed California’s four-year period for actions on written contracts as the most analogous state law rule. The claim accrued when Brand Tarzana had reason to know of a “clear and continuing repudiation” of its rights, which the court found occurred no later than the February 24, 2022 denial of the appeal. Because Brand Tarzana filed suit on May 8, 2025, the benefits claim was within four years and thus timely. For the breach of fiduciary duty claim, the court applied 29 U.S.C. § 1113’s three-year limitation period, which runs from the date the plaintiff had actual knowledge of the breach. The court found dismissal of the claim premature for two reasons. First, resolving a disputed factual question about “actual knowledge” is generally improper on a motion to dismiss. Second, under the complaint “all that is clear is that the benefits were denied and that further reimbursement was denied after a third-party appeal… Defendants fail to provide any evidence that the explanation of benefits or the completion of the third-party appeal made the Plaintiff actually aware of anything beyond denial of their claim. Knowledge that the underlying action occurred is insufficient, on its own, to show actual knowledge of a breach of fiduciary duties.” The court thus denied defendants’ motion to dismiss in its entirety.

Venue

Eighth Circuit

Clear v. Amazon.com Services LLC Group Health & Welfare Benefit Plan, No. 4:26-cv-430-JM, 2026 WL 2581797 (E.D. Ark. Sept. 1, 2026) (Judge James M. Moody Jr.). Demetrice Clear, a Tennessee resident, alleges in this action that Amazon.com Services LLC and its Group Health & Welfare Benefit Plan wrongfully denied her claim for ERISA-governed short-term disability benefits. Defendants moved to dismiss for improper venue under 28 U.S.C. § 1406(a) or, alternatively, to transfer the case pursuant to 28 U.S.C. § 1404(a) to the Western District of Washington, where the plan is administered. Defendants acknowledged that the Western District of Tennessee, where Clear resides and received her adverse benefits determination, would also be a permissible forum. Clear opposed dismissal, arguing Amazon “may be found” in the Eastern District of Arkansas under ERISA’s expansive venue provision, 29 U.S.C. § 1132(e)(2), relying on supplemental evidence outside of her complaint detailing Amazon’s fulfillment centers and delivery stations within the district. Clear further argued that this presence satisfied federal personal jurisdiction requirements. If the court disagreed, Clear asked it to transfer the case to the Western District of Tennessee rather than dismiss. The court held that the Supreme Court’s 2014 decision in Daimler AG v. Bauman controlled and ruled that a corporation is “at home,” and thus subject to general jurisdiction, only in its state of incorporation and principal place of business: “Accepting the supplemental information provided by Plaintiff for purposes of this motion, the fact that Amazon may be served here and has substantial contact with Arkansas does not make it ‘found’ here pursuant to ERISA’s venue provision.” The court thus “determines that venue in the Eastern District of Arkansas is improper as to Defendants and that transfer is appropriate under § 1406(a). Even if venue were proper in the Eastern District of Arkansas, the Court determines that transfer is appropriate under § 1404(a). The Court directs the Clerk to transfer this case immediately to the Western District of Tennessee.”

Ninth Circuit

Andersen v. Medical Solutions, L.L.C., No. 26-cv-3123-RSH-MSB, 2026 WL 2574368 (S.D. Cal. Aug. 31, 2026) (Judge Robert S. Huie). Natalie Andersen, an Iowa resident who worked for Medical Solutions from 2020 to 2026, brought a putative class action alleging that Medical Solutions and its Employee Benefits Committee breached the fiduciary duty of prudence and failed to adequately monitor fiduciaries in administering the company’s ERISA-governed 401(k) plan. Medical Solutions is a nationwide healthcare staffing agency, is headquartered in Omaha, Nebraska, and maintains offices in six other states, including California. The Committee that administers the plan is made up of four to six senior employees, most of whom are based in Omaha, and during the relevant period the Committee was advised by two financial advisory firms which were also located in Omaha. Andersen filed suit in the Southern District of California based on the presence of Medical Solutions’ San Diego office in the district. Defendants moved to transfer venue to the District of Nebraska under 28 U.S.C. § 1404(a), which allows transfer when it would serve “the convenience of the parties and witnesses” and “the interest[s] of justice.” Andersen conceded Nebraska was a permissible venue, so the court proceeded to apply the Ninth Circuit’s multifactor test from Jones v. GNC Franchising, Inc. The court began with Andersen’s choice of forum, which is ordinarily entitled to “great weight,” but found that weight substantially reduced here for two reasons. First, this is a class action, and thus Andersen’s choice was entitled to diminished deference, and second, “there are various indicia of forum shopping, including that Plaintiff does not reside in the district or have any discernible ties to the district, and none of the operative facts occurred in the district.” Andersen contended that Medical Solutions “employs a substantial number of California residents who are Plan participants,” but this did not establish that California’s interest in the case rivaled Nebraska’s, particularly given the plan’s roughly 24,000 nationwide participants and the absence of any allegations about how many were Californians. As for the remaining factors, “Every other relevant factor weighs in favor of transferring venue to the District of Nebraska.” Both the named plaintiff and virtually all of the key witnesses and evidence were located in or near Omaha. Andersen herself lives near Omaha, a majority of the Committee’s members are based there (and none are based in California), and both outside financial advisors who counseled the Committee are Omaha-based. The court also noted that compulsory process rules under Federal Rule of Civil Procedure 45 would assist the parties far more in Omaha. Andersen complained that defendants failed to name specific inconvenienced witnesses, but the court ruled that defendants had sufficiently identified the expected witnesses’ roles and the relevance of their expected testimony. The court was similarly unpersuaded by Andersen’s argument that Medical Solutions’ size and resources made any inconvenience “overstated”: “[T]he fact that a party can afford to litigate in a particular district does not mean it is convenient to do so. Based on all of the evidence before the Court, it seems that it would be more convenient to both Parties to litigate this case in Nebraska.” Finally, the court found that Nebraska had “at least somewhat of a greater interest in this case given that the plan was administered in Nebraska and Medical Solutions is headquartered in the state… Plaintiff has failed to bring forth any evidence or allegation establishing that California’s interest in this case is equivalent to or outweighs Nebraska’s.” Thus, the court granted the motion to transfer, and the action will continue in District of Nebraska.