Healthcare Ally Mgmt. of Cal., LLC v. WSP USA, Inc., No. 24-3479, __ F.4th __, 2026 WL 2319896 (9th Cir. Aug. 11, 2026) (Before Circuit Judges Berzon, Higginson (sitting by designation), and Sung)

It was difficult to choose the notable decision this week, as the federal appellate courts presented three good options, all of them published opinions. In Kaiser v. Alcoa, the Seventh Circuit affirmed class certification, but reversed a summary judgment ruling in favor of plan participants seeking reinstatement of their lifetime retiree healthcare benefits. In Johnson v. Royal Caribbean Cruises Ltd., the Eleventh Circuit ruled that plaintiffs asserting retirement fund mismanagement do not always have to identify comparable investments to establish loss causation.

However, as Californians we here at Your ERISA Watch will stick close to home and discuss the Ninth Circuit’s decision in the above-cited case, which tackles the evergreen issue of ERISA preemption. As practitioners know, 29 U.S.C. § 1144(a) provides that ERISA preempts all state laws that “relate to” ERISA, and those two pesky words have generated an avalanche of case law over the last 50 years that is unlikely to cease anytime soon.

This week we’re discussing preemption in the context of medical billing disputes. Out-of-network healthcare providers often call insurance companies before providing services to determine whether the services will be covered and at what rate. But what if the insurer makes a misrepresentation during that call? Can the provider sue the insurer for negligent misrepresentation under state law, or does that claim “relate to” ERISA, thus eliminating such a claim? Read on to find out.

The provider in this case was La Peer Surgery Center, which performed surgery on a patient covered by an ERISA-governed health plan sponsored by WSP USA, Inc., an engineering and design firm. The plan was administered by Aetna Life Insurance Company.

Because La Peer had no preexisting contract with Aetna, it placed a verification call to Aetna before the surgery to confirm coverage and pricing. On that call, Aetna allegedly told La Peer that the patient would owe a portion out-of-pocket and the plan would pay the remainder at the “Usual, Customary, and Reasonable” (UCR) rate. Aetna specifically assured La Peer that “payment would not be based on the Medicare Fee Schedule,” which generally pays a much lower rate than the UCR rate. Neither Aetna nor WSP informed La Peer of any plan provision that might reduce that promised rate, and neither provided La Peer a copy of the plan.

After the surgery, WSP paid La Peer at – you guessed it – the Medicare rate, which was only five percent of La Peer’s bill. This action by Healthcare Ally Management of California (HAMOC), acting as La Peer’s successor-in-interest, followed. HAMOC sued WSP and Aetna in California state court, asserting only state law claims.

When defendants removed the case to federal court based on ERISA preemption, HAMOC amended its complaint. Its new complaint attempted to eliminate any state law claims that might run afoul of ERISA preemption; HAMOC thus ditched a breach of contract claim and a claim under California’s Unfair Competition Law. Instead, its complaint asserted only two state law claims: one for negligent misrepresentation and one for promissory estoppel. (HAMOC also included a third cause of action for failure to pay ERISA plan benefits under 29 U.S.C. § 1132(a)(1)(B). The district court dismissed this claim for lack of derivative standing, and HAMOC did not appeal that ruling.)

HAMOC’s preemption-dodging gambit did not work with the district court. That court granted defendants’ motion to dismiss, holding that both of HAMOC’s state law claims “necessarily depend on the existence of an ERISA-covered plan” and were therefore preempted by ERISA. HAMOC appealed this ruling to the Ninth Circuit.

In this published opinion, the Ninth Circuit affirmed in part and reversed in part, arriving at different conclusions on HAMOC’s two claims. The court began with a concise summary of the difficulties out-of-network providers face when trying to obtain payment for services. The court noted that providers do not have network agreements with insurers, often cannot file derivative actions because of anti-assignment provisions, and must make judgment calls about whether to provide service based on how much they trust patients and their insurers to pay at the end of the day. Finally, when they end up in court they must overcome ERISA preemption.

The Ninth Circuit reiterated the age-old Supreme Court test for preemption, which asks whether a state law claim has a “reference to” or “an impermissible connection with” an ERISA plan. The court admitted that these two prongs have not “resulted in clarity in applying ERISA’s express preemption provision,” and thus in applying the prongs the court pledged to “‘go beyond’ the text of the statute and also beyond the short-form tests meant to cabin statutory overreach, and look ‘to the objectives of the ERISA statute as a guide to the scope of the state law that Congress understood would survive[.]’”

With these lofty preliminaries out of the way, the court addressed HAMOC’s negligent misrepresentation claim first. The court found the “connection with” prong “more straightforward and easier to apply.” The court used its “relationship test,” which asks whether a claim “bears on an ERISA-regulated relationship, e.g., the relationship between plan and plan member, between plan and employer, between employer and employee.”

The Ninth Circuit acknowledged that HAMOC’s claim touched three ERISA-regulated actors, and thus an ERISA-regulated relationship was “involved.” However, the court stated that “the pertinent question is not whether an ERISA-regulated relationship exists but whether the claim itself bears upon that relationship.”

Here, “It does not.” The court explained that ERISA authorizes only participants, beneficiaries, and fiduciaries to sue, and “the relationship between La Peer, a medical service provider, and Aetna, a plan administrator, falls outside ERISA’s regulatory scope.” As alleged, HAMOC’s tort “runs from a non-ERISA entity (La Peer) to ERISA entities (WSP and Aetna)… Further, the claim does not encroach upon an ERISA relationship, like that between Aetna and the patient beneficiary. HAMOC’s claim concerns only representations that Aetna made as a plan provider to a third-party physician.” As a result, “the claim is not preempted under the ‘connection with’ test.”

The court’s analysis of the “reference to” prong also did not support preemption. The court boiled this prong down to an analysis of “whether the claim at issue is the sort that a participant, beneficiary, or their assignee could have asserted as a § 502(a) benefits claim or is otherwise dependent on an ERISA-covered plan. If not, then the state law claim can stand alone without ‘reference to’ an ERISA plan and is not preempted, because it seeks to remedy an injury to a third-party, not to a beneficiary or the covered plan.”

The court answered this question by examining three prior cases. Two of them (The Meadows v. Employers Health Ins. and Cedars-Sinai Medical Center v. National League of Postmasters) were Ninth Circuit cases, while the third (Access Mediquip LLC v. UnitedHealthcare Insurance Co.) was a Fifth Circuit case.

The court noted that “in almost every case, a literal or strict application of the words ‘reference to’ would have supported preemption.” However, all three cases went the other way. Those cases held that misrepresentation claims by providers regarding verification-call promises survived preemption, and the Ninth Circuit arrived at the same conclusion regarding HAMOC’s claim.

The court emphasized that HAMOC’s claim “does not hinge on the denial of benefits to the patient from an ERISA plan. In fact, the patient here received the covered treatment.” Instead, the claim arose from Aetna’s promise “that it would reimburse La Peer at the UCR rate – without any reasonable ground to believe the veracity of that promise.” This injury “is not rooted in a plan term,” the claim was “not one that the patient could have assigned to a third-party under § 502(a),” and thus HAMOC “does not have a remedy under the statute[.]” Thus, there was no impermissible “reference to” a plan.

The court supported its preemption ruling by engaging in a thought experiment: “How might this case be different if the patient here did not receive insurance through an employer?” Obviously, ERISA would not apply and HAMOC would be able to bring any relevant state law cause of action. “So the question is: Did Congress intend to limit an out-of-network provider like La Peer’s ability to recover under a negligent misrepresentation claim to situations where the patient’s insurance was employer-sponsored, rather than privately acquired?”

The court stated, “Nothing in ERISA or its history suggests that result.” Insulating plan administrators from the consequences of misrepresentations to providers “does not further any of ERISA’s objectives,” and could perversely make out-of-network care more expensive and less accessible by forcing providers to demand up-front payment or decline treatment for ERISA-covered patients specifically. This outcome “would afford less protection to employees and their beneficiaries than they enjoyed before ERISA was enacted.”

Next, the court turned to HAMOC’s promissory estoppel claim and arrived at a different result. This was because of the Ninth Circuit’s 2024 decision in Bristol SL Holdings, Inc. v. Cigna Health & Life Insurance Co. (the case of the week in our June 5, 2024 edition.)

In Bristol, the Ninth Circuit held that ERISA preempted a rehabilitation facility’s state law contract and promissory estoppel claims arising from similar verification calls, because Cigna’s alleged oral promises to pay directly conflicted with an actual, disputed plan provision permitting Cigna to deny claims for “fee-forgiving.” The Ninth Circuit held that Bristol “controls the promissory estoppel preemption question in this case” because the causes of action were “analogous in all legally meaningful respects,” and affirmed dismissal of that count.

Despite the similarities, however, the court held that Bristol did not control HAMOC’s negligent misrepresentation claim. This was because Bristol expressly reserved that question, distinguishing cases (including Access Mediquip) where an insurer misrepresented coverage. In Bristol there was no misrepresentation; Cigna’s denial rested on an undisputed plan term the provider was attempting to circumvent. Here, by contrast, “the negligent misrepresentation claim…arises from an injury distinct from compliance or noncompliance with the ERISA plan[.]”

As a result, the case will return to the district court and proceed, but only on HAMOC’s negligent misrepresentation claim. The Ninth Circuit expressed no opinion as to how the case should turn out, but noted in a footnote “that it is far from obvious that HAMOC’s claim can succeed on the merits.”

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

Attorneys’ Fees

Sixth Circuit

McEachin v. Reliance Standard Life Ins. Co., No. 2:21-CV-12819-TGB-EAS, 2026 WL 2391210 (E.D. Mich. Aug. 17, 2026) (Judge Terrence G. Berg). Annette McEachin stopped working after two car accidents which were followed by severe mental health struggles after her son’s death by suicide. Her claim for ERISA-governed long-term disability benefits was initially approved by Reliance Standard Life Insurance Company, but the insurer terminated her claim after three years of benefits. This action ensued. In a March 2023 order, the district court partly adopted and partly rejected a magistrate judge’s report and recommendation. The court agreed that McEachin was not disabled by a physical condition as of April 2021 but rejected the conclusion that she had exhausted the policy’s 24-month cap on benefits caused or contributed to by mental illness. The court ordered Reliance to pay benefits from April 2021 up to the 24-month maximum so long as McEachin remained totally disabled. (Your ERISA Watch covered this decision in our March 29, 2023 edition.) Reliance appealed the 24-month award, while McEachin cross-appealed the physical disability ruling. The Sixth Circuit affirmed the district court on the benefits award. As for McEachin’s cross-appeal, the appellate court affirmed the ruling that McEachin was no longer disabled due to physical issues in April of 2021. However, it reversed and remanded for the district court to consider whether she was allowed to toll the 24-month limitation in order to extend her benefit period. (This published opinion was our notable decision for the week of November 20, 2024.) The parties reached an agreement on remand, which left only the issue of attorney’s fees. The court had already granted McEachin’s first fee motion, awarding $24,530 for pre-appeal district court work (as we discussed in our February 7, 2024 edition). McEachin filed a new motion seeking fees for both the appellate litigation and the post-remand district court work. In this order the court denied her appellate fee request as untimely. Under the court’s local rules, a fee motion must be filed within 28 days of judgment, and for appellate work that clock runs from the Sixth Circuit’s judgment or mandate. Here, those dates were November 13, 2024 and December 30, 2024 respectively. However, McEachin’s motion was not filed until November 17, 2025, nearly a year later, so the court denied the appellate-fee request as untimely. As for McEachin’s post-remand fee request, the court found that this was timely because it followed within 28 days of the stipulated order resolving the case. The court thus moved on to the Sixth Circuit’s five-factor King test, which addresses culpability/bad faith, ability to pay, deterrent effect, common benefit, and relative merits. The court tackled the appellate and post-remand work separately. The court found that the factors favored no award for the appellate work, even if the request had been timely, and that the factors also favored no award for the post-remand work. On culpability, the court found McEachin offered no argument that Reliance’s appeal or its post-remand advocacy was pursued in bad faith. Ability to pay favored McEachin because Reliance was able to satisfy any award. Deterrence favored Reliance; the court, quoting the Sixth Circuit, worried that a fee award would have a deterrent effect on parties “‘contemplating appeal of a unanswered legal question regarding ERISA with general applicability’… Such parties ‘ought not to be deterred for fear of an attorney’s fees award.’” The court similarly found no deterrence rationale favored a fee award for the post-remand proceedings. The common-benefit factor favored Reliance because McEachin sought no relief for other plan participants and did not resolve any significant, generally applicable ERISA legal question. Finally, the relative-merits factor was neutral: the Sixth Circuit had rejected every argument actually presented to it, remanding only an unraised issue for initial consideration. Furthermore, the post-remand proceedings ended in settlement before the court had any occasion to assess the parties’ relative positions. As a result, with three of the five King factors favoring Reliance, only one favoring McEachin, and one neutral, the court declined to award McEachin fees.

Ninth Circuit

Rushing v. Life Ins. Co. of N. Am., No. CV 24-10088-JFW(RAOx), 2026 WL 2353337 (C.D. Cal. Aug. 13, 2026) (Judge John F. Walter). Candace Rushing sued Life Insurance Company of North America to challenge the calculation of her ERISA-governed long-term disability benefits. The dispute centered on whether LINA correctly calculated her “Covered Earnings,” the figure used to set her benefit amount. Rushing raised several theories relating to that calculation, which included how her overtime, commissions, date of disability, and various offsets should apply, along with the applicable standard of review. However, Rushing only prevailed on one theory; the court found that LINA abused its discretion by calculating her overtime hours at her base hourly rate rather than a proper overtime rate. Based on that partial victory, the court entered judgment in Rushing’s favor in the amount of $31,016.65. This award was comprised of $17,534.10 in benefits and $13,482.55 in prejudgment interest, which was calculated at 10% because Rushing “endured enormous hardships” from LINA’s miscalculation. (Your ERISA Watch covered this decision in our May 6, 2026 edition.) Rushing has now filed a motion under 29 U.S.C. § 1132(g)(1) for $222,570 in attorneys’ fees, $4,373.40 in non-statutory costs, and $405 in costs. Rushing’s counsel (McKennon Law) represented that it had already voluntarily reduced its request by roughly half. This was done first by reducing the firm’s initial 525.2 “raw” hours (amounting to $391,890) down to 383.9 compensable hours, by trimming “excessive time and for non-recoverable administrative work.” Counsel then cut the remaining figure by a further one-third to account for Rushing’s partial success. LINA opposed Rushing’s motion, principally arguing the fee request was “grossly disproportionate” to the modest recovery and should be slashed by 90%. The court granted the motion in full. It first held Rushing eligible for fees because she had achieved “some degree of success on the merits” under the Supreme Court’s test in Hardt v. Reliance Standard. Next, the court turned to the Ninth Circuit’s five-factor Hummell test. The court found the first factor (culpability or bad faith) neutral, since LINA had engaged in a good-faith, if ultimately incorrect, claims process. The second factor (ability to pay) and third factor (deterrent effect) both favored a fee award. The court reasoned that a fee award would discourage LINA and other administrators from continuing to apply unreasonable interpretations of overtime compensation in calculating covered earnings. The fourth factor favored Rushing only marginally: although she sought relief solely for herself rather than the plan as a whole, the ruling would functionally prevent LINA from repeating the same miscalculation against other claimants under the same or similar plans going forward. The fifth factor, the relative merits of the parties’ positions, favored Rushing because she prevailed on the central, dispositive issue in the case (i.e., whether her benefits had been correctly calculated) even though not all of her arguments were successful. As for the proper amount, the court applied a lodestar approach of multiplying reasonable time expended by a reasonable hourly rate. The court rejected LINA’s claim that billing records “reveal a pervasive pattern of duplicate billing among three attorneys,” finding that only two attorneys ever worked the file at any given time (a departing associate was replaced mid-case by another due to a health-related departure) and that the supervising attorney’s overlapping entries reflected legitimate supervision rather than duplication. The court further stated that contingency fee lawyers have little incentive to pad hours due to the uncertainty of the outcome, and highlighted counsel’s own unprompted 27% reduction in time and roughly 50% in amount. The court also found counsel’s hourly rates to be reasonable, which included $875-$925 for founding shareholder Robert McKennon, $750 for departed senior counsel, and $675 for the attorney who took over. Finally, the court declined to further discount the fee award for Rushing’s partial success, as the firm had already done so, and her various theories all arose from the single underlying dispute over how to calculate her benefits and were not discrete claims that could be billed separately. The court thus awarded all of Rushing’s requested fees and costs.

Breach of Fiduciary Duty

Third Circuit

Aramark Services, Inc. v. QCC Ins. Co., No. 26-1664, 2026 WL 2350130 (E.D. Pa. Aug. 13, 2026) (Judge Gerald J. Pappert). The food services giant Aramark Services, Inc. self-funds two ERISA welfare benefit plans holding more than $600 million in combined assets, covering medical benefits for its employees. Aramark hired QCC Insurance Company, a subsidiary of Independence Blue Cross (IBC), in turn owned by Independence Health Group (IHG), to act as the third-party administrator for its plans. Over three successive agreements spanning from 2018 to 2024, the parties characterized QCC’s role in several ways. The 2018 agreement called QCC the “Named Claims Fiduciary” with “final discretionary authority” over benefit determinations, while the 2022 renewal stated that Aramark, “and not Independence Administrators,” was the claims fiduciary, even though an incorporated exhibit again called QCC the “named claims fiduciary.” Aramark grew disenchanted with QCC’s services over time. Aramark alleges that it discovered QCC paid plan assets toward thousands of duplicate, excluded, fraudulent, or medically unnecessary claims, and also contends that QCC engaged in undisclosed “cross-plan offsetting” that credited recovered overpayments to Independence’s own fully-insured plans rather than Aramark’s, netting defendants “tens of millions” of dollars at the plans’ expense. Aramark and its benefits committee sued QCC, IBC, and IHG, asserting breach of fiduciary duty and prohibited-transaction claims under ERISA §§ 502(a)(2) and (a)(3) (Counts I through IV), as well as a claim for declaratory relief (Count V). Defendants moved to dismiss and to strike plaintiffs’ jury demand. The court first ruled that the plans could not be plaintiffs, holding that being the victim of a fiduciary breach does not make an ERISA plan a fiduciary with standing to sue. “None of the agreements between the parties name either plan as a fiduciary, nor were they named fiduciaries pursuant to a procedure specified in those agreements.” Aramark, by contrast, plausibly qualified as a functional fiduciary. It exercised discretionary authority by selecting, retaining, and monitoring QCC over an eight-year relationship, which gave it an independent fiduciary duty to monitor QCC and allowed it to seek relief under ERISA. The court then flipped the analysis and determined which defendants were fiduciaries. The court ruled that QCC was plausibly a fiduciary but IBC and IHG were not. The court held that the conflicting language across the three agreements between Aramark and QCC created a factual dispute on this issue that was inappropriate to resolve on a motion to dismiss. Furthermore, QCC qualified as a functional fiduciary because each agreement gave it discretionary leeway in adjudicating and paying claims. The court rejected defendants’ argument that final, unreviewable decision-making authority was required: “a functional fiduciary only needs ‘any discretionary authority or discretionary responsibility’ – not final decision-making authority.” Moreover, QCC also qualified as a beneficiary because of its ability to manage the plan’s assets. (It held sole signing authority over the checking account used to pay claims.) Plaintiffs did not allege such specifics regarding IBC and IHG, so they were dismissed. On the merits of Count I, the court quickly held that Aramark plausibly alleged QCC breached its duty of prudence. Aramark’s allegations regarding paying claims too quickly for adequate documentation review, with invalid billing codes, for expressly excluded services, and at rates exceeding Medicare and in-network pricing, not to mention cross-plan offsetting, were sufficient to plead a breach. The court also rejected defendants’ argument that surcharge, disgorgement, and accounting are unavailable equitable remedies under ERISA § 502(a)(3). The court held that the Supreme Court (in CIGNA Corp. v. Amara) recognized surcharge as a traditional equitable remedy for a fiduciary’s breach of trust, and that disgorgement and accounting were properly pled because plaintiffs identified specific sums that defendants had wrongfully retained. However, the court dismissed Count V. That count sought a declaratory judgment regarding access to electronic remittance data, but the court ruled that it had no statutory basis. Finally, the court struck plaintiffs’ jury demand because Aramark sought only equitable relief and the Seventh Amendment’s jury trial guarantee does not extend to equitable ERISA claims.

Eighth Circuit

Batt v. 3M Co., No. 25-CV-3149 (ECT/DTS), 2026 WL 2322559 (D. Minn. Aug. 11, 2026) (Judge Eric C. Tostrud). The plaintiffs in this putative class action are current or former 3M employees who participated in the 3M Voluntary Investment Plan and the 3M Savings Plan, two defined contribution plans holding a combined $12.4 billion in assets with 58,000 participants. Almost 40% of plan assets (about $4.1 billion) were invested in the 3M TDF Series, a family of nine target-date funds modeled on BlackRock’s LifePath funds. This was the default fund for new hires and was the plans’ only target-date option. Plaintiffs contend that these TDFs persistently underperformed comparable target-date funds, that 3M’s disclosures about the funds’ holdings and risk metrics were sparse and contained obvious errors, and that the funds’ asset allocation deviated from the advertised “to retirement” glide path. Separately, plaintiffs allege that 3M Investment Management Corporation (IMCO), a wholly owned 3M subsidiary, served as co-investment manager of the TDFs and was paid at least $1.83 million in fees between 2019 and 2024 out of plan assets, even though the same 3M entities responsible for selecting and monitoring the TDFs were also the ones setting IMCO’s compensation. Plaintiffs’ operative complaint asserts (1) breach of the duty of prudence (Count I, resting on three theories: underperformance, inadequate disclosure, and glide-path deviation), (2) prohibited transactions and self-dealing under ERISA §§ 406(a) and (b), 29 U.S.C. § 1106(a)-(b) (Count II), and (3) failure to monitor fiduciaries (Count III, derivative of Count I). Plaintiffs have already suffered one setback; the court previously dismissed the prudence claim for failure to identify a “meaningful benchmark.” (We covered this ruling in our March 18, 2026 edition.) Plaintiffs amended their complaint, and defendants responded with another motion to dismiss, which the court ruled on in this order. Defendants moved to dismiss Count II under Rule 12(b)(1) for lack of standing and moved to dismiss the entire amended complaint for failure to state a claim. On standing, the court began with Count I, even though defendants had not challenged that count on standing grounds. The court ruled that plaintiffs’ disclosure-based theory failed Article III’s concreteness requirement. The court found that their alleged injury was “purely informational” and did not identify “downstream consequences.” Specifically, plaintiffs did not connect the erroneous fact sheets or opaque disclosures to any actual reliance or resulting harm. The glide-path-deviation theory failed for the same reason: plaintiffs alleged the funds’ risk profile diverged from what was promised but never alleged this produced lower returns. Indeed, “it’s entirely consistent with the Amended Complaint that Plaintiffs earned more money than they otherwise would have because of Defendants’ ‘structural divergences.’” Both theories were dismissed without prejudice for lack of subject-matter jurisdiction. Moving on to Count II, the court changed its tune and found that plaintiffs’ prohibited transaction theory adequately pled a concrete, traceable economic injury. The fees at issue were allegedly paid to IMCO out of assets in which plaintiffs were invested, which “caused the Plaintiffs to suffer economic losses.” On the merits of the surviving Count I underperformance theory, the court conducted an extensive comparator-by-comparator analysis for each of plaintiffs’ six proposed benchmarks. It found that four were sufficiently similar to serve as meaningful benchmarks, but rejected two others. As for performance, only the comparison with the Fidelity Freedom TDFs showed underperformance substantial and sustained enough to plausibly suggest imprudence. The court accordingly dismissed Count I with prejudice as to every comparator except the Fidelity Freedom TDFs. As for the prohibited transaction claims in Count II, the court denied dismissal. The court held that plaintiffs adequately alleged that IMCO was a fiduciary and party in interest, that it received compensation traceable to plan assets for managing the TDFs’ underlying bond fund, and that 3M effectively “hire[d] itself to perform work and then set[] its own fees.” The court rejected defendants’ arguments for dismissal, ruling that plaintiffs did “not need to identify specific transactions from Plan assets to 3M IMCO,” and recognizing that while defendants may have affirmative defenses under 29 U.S.C. § 1108, those defenses cannot be adjudicated on a motion to dismiss pursuant to the Supreme Court’s recent ruling in Cunningham v. Cornell University. Finally, because the duty-to-monitor claim in Count III was derivative of the prudence claim in Count I, it survived “to the same extent.”

Ninth Circuit

Klawonn v. Board of Directors for the Motion Picture Industry Pension Plans, Nos. 25-2874, 25-3230, __ F. App’x __, 2026 WL 2364541 (9th Cir. Aug. 14, 2026) (Before Circuit Judges Rawlinson and Sanchez, and District Judge Sidney A. Fitzwater). Patricia Klawonn is a participant in the Motion Picture Industry Pension Plans who brought this putative class action against the plans’ board of directors, alleging that the board breached its duty of prudence under ERISA in managing plan investments. Klawonn’s standing to pursue prospective injunctive relief was complicated by her employment status; at the time the district court certified her as class representative, the motion picture industry was engaged in industry-wide strikes, which had caused widespread work shortages. Klawonn testified she “absolutely [would] be returning to work as soon as the strike is over,” but by the time summary judgment proceedings rolled around, she remained unemployed, had not worked the 870 hours needed to reenter the plan, and had cashed out of the plan altogether. The district court granted summary judgment to the board on Klawonn’s prudence claim, and separately entered a class certification order that the board challenged on a conditional cross-appeal. On the merits, the district court applied a standard requiring that any alleged investment underperformance be “both substantial and consistent” to support a claim of imprudence, and found Klawonn’s evidence insufficient under that test. In this memorandum disposition the Ninth Circuit vacated and remanded on the prudence claim, explaining that the district court’s ruling predated the appellate court’s intervening decision in Anderson v. Intel Corp. Investment Policy Committee. (We discussed that ruling in our May 28, 2025 edition; the case is now in the Supreme Court and is currently scheduled to be argued on October 6.) As the court explained, Anderson clarified that fiduciary prudence must be evaluated “prospectively, based on the methods the fiduciaries employed,” meaning a plaintiff can establish a breach through direct evidence “that the fiduciaries employed unsound methods in making their investment decisions.” The court also directed the district court to “revisit its definition of loss in light of the statutory language referencing ‘any loss,’ rather than ‘substantial loss,’ as implied by the district court’s ruling.” This was a reference to 29 U.S.C. § 1109(a), which makes a breaching fiduciary liable for “any loss to the plan.” As for class issues, the Ninth Circuit held that the district court did not abuse its discretion in initially certifying the class with Klawonn as representative, since her sworn intent to return to work once the strikes ended was sufficient at that stage. However, the panel agreed with the board that subsequent events rendered any return to covered work too speculative to sustain a live controversy: “The confluence of Klawonn’s choice to ‘cash[] out of the [Retirement] Plan,’ and her continued unemployment render her claim for prospective relief moot.” However, the court noted that the class was properly certified before Klawonn’s claim became moot, and thus “the current mootness of Klawonn’s ‘claim [does] not moot the class action.’” The court thus instructed the district court to consider on remand whether a substitute class representative was available to step in Klawonn’s shoes.

Northcutt v. Gen Digital Inc., No. CV-25-02768-PHX-DWL, 2026 WL 2389356 (D. Ariz. Aug. 17, 2026) (Judge Dominic W. Lanza). Plaintiffs are current and former participants in the Gen Digital Inc. 401(k) Plan, an ERISA-governed defined contribution plan. (Gen Digital is the successor to several computer security companies, including NortonLifeLock, Avast, and Symantec.) The plan includes employer matching contributions. When a participant terminates employment before becoming fully vested in matching contributions, the unvested amount is forfeited and becomes a plan asset. The plan provides that Gen Digital has the “sole discretion” to determine whether forfeitures should be used to either reduce its own future matching contributions or to pay plan administrative expenses. Plaintiffs allege that throughout the class period Gen Digital never allocated forfeitures to administrative expenses, instead choosing to reduce its own out-of-pocket contribution costs, despite having a financial conflict of interest. Plaintiffs also contend that their pre-suit document request revealed no evidence of any deliberative process behind Gen Digital’s allocation. Plaintiffs’ complaint asserted four counts, and defendants responded with a motion to dismiss. Defendants did not challenge (yet) plaintiffs’ first two counts, which were prohibited transaction claims involving plan consultants Great-West and Fidelity. Instead, they moved to dismiss Count Three (breach of the fiduciary duty of prudence, against Gen Digital) and Count Four (failure to monitor, against Gen Digital and the board of directors). The court first addressed a threshold question: whether a plan sponsor’s decision to allocate forfeitures is a fiduciary act, or a non-fiduciary “settlor” design choice immune from scrutiny. The court agreed with the majority of courts on this issue and held that while designing the plan to permit either use of forfeitures was a settlor decision, the company’s actual selection between the two choices was an exercise of discretion over plan assets. Thus, it was a fiduciary decision subject to attack under ERISA’s civil enforcement scheme. The court thus turned to whether plaintiffs adequately pleaded a breach, noting that it “does not operate on a blank slate when assessing the viability of this theory.” The court noted that more than 30 class actions had been filed asserting forfeiture theories, but the vast majority did not make it past the pleadings. This one would not either. The court held that a bare allegation of financial conflict of interest, standing alone, does not plausibly establish a breach of the duty of prudence. Instead, a plaintiff must plead specific facts about what was flawed in the fiduciary’s decision-making process. Here, plaintiffs contended there was no prudent process because Gen Digital did not investigate whether it could absorb administrative expenses, failed to evaluate how the forfeitures should be used, and failed to consult an independent decision-maker. However, for the court, these were “general allegations” unsupported by “specific facts as to what was actually imprudent in Gen Digital’s process. The majority of courts faced with such allegations have dismissed them.” Because Count Four’s monitoring claim was derivative of the prudence claim, it fell along with Count Three. The court gave plaintiffs leave to amend.

Eleventh Circuit

Johnson v. Royal Caribbean Cruises Ltd., No. 25-10692, __ F.4th __, 2026 WL 2387006 (11th Cir. Aug. 17, 2026) (Before Circuit Judges Jill Pryor, Luck, and Brasher). Ann Johnson, a participant in the Royal Caribbean Cruises Ltd. Retirement Savings Plan, sued on behalf of a class of plan participants after Royal Caribbean’s Investment Committee replaced the Vanguard Target Date Funds in the Plan’s investment menu with Russell Target Date Funds in 2015. The new Russell TDFs employed a “to retirement” glidepath rather than a “through retirement” glidepath and “a bias towards investing in emerging markets and real assets relative to its competitors, which tended to be more heavily invested in U.S. equities.” From 2015 to 2019, the Russell funds underperformed both the legacy Vanguard TDFs and the American Funds TDFs that eventually replaced them by an annualized average of 1.51% and 2.12% respectively, and even slightly lagged their own custom benchmark at times. One Russell executive internally worried that Royal Caribbean might “think they have made a bad fiduciary decision,” and another noted that other clients were leaving because “as a fiduciary it is hard to go with worse numbers and higher fees.” In her suit Johnson alleged that Royal Caribbean breached ERISA’s fiduciary duty of prudence by imprudently selecting Russell as investment manager, failing to monitor the Russell TDFs’ performance, and failing to monitor its investment committee. Johnson argued that funds’ underperformance, glidepath selection, and comparatively high fees demonstrated the funds were objectively imprudent investments. On summary judgment, the district court ruled for defendants. The court held that Johnson was required to identify an “apples-to-apples” comparator fund that was consistent with the Russell TDFs’ investment strategy and risk profile in order to prove objective imprudence. The court also ruled that Johnson’s comparisons to the Vanguard and American Funds TDFs were improper and that Russell’s own custom benchmark, which its funds had only slightly underperformed, was the only proper comparator. (Your ERISA Watch covered this ruling in our February 5, 2025 edition.) Johnson appealed. (Meanwhile, Russell settled and was dismissed from the appeal.) In this published decision, the Eleventh Circuit reversed. Applying its recent decision in Pizarro v. Home Depot, Inc. (the case of the week in our August 14, 2024 edition), the court reiterated that ERISA fiduciary liability requires both procedural imprudence and loss causation, with loss causation turning on whether the challenged investment was “objectively prudent,” i.e., falling “outside the ‘range of reasonable judgments a fiduciary may make based on her experience and expertise,’ such that a hypothetical prudent fiduciary in the same circumstances as the defendant…would not (or could not) have made the same choice.” The court held the district court erred by requiring comparator evidence as a mandatory element of that showing. The Eleventh Circuit stated that “we cannot say it is always necessary,” because a prudence inquiry “will necessarily be context specific.” The court found that different cases require different combinations of qualitative evidence (such as a fund’s popularity among comparable plans and its ratings from industry analysts) and quantitative evidence (such as a fund’s fees and performance against contemporaneous peers and benchmarks). “In some circumstances, a context-specific inquiry may favor either qualitative or quantitative evidence, and a plaintiff does not need both.” After all, “some of the most objectively imprudent investments will lack an apples-to-apples comparison precisely because they are such objectively bad fiduciary decisions.” The court found this approach consistent with the Sixth Circuit’s 2022 decision in Smith v. CommonSpirit Health and the Third Circuit’s decision from earlier this year in In re Quest Diagnostics ERISA Litig. (covered in our June 24, 2026 edition), both of which declined to impose a “mechanical checklist” for proving imprudence. Turning to the record, the court found that the district court did not satisfactorily address Johnson’s theory of liability: “[T]he mere fact that the Russell funds were within striking distance of their own custom benchmark does not answer Johnson’s theory of objective imprudence – that the Russell TDFs’ unique features, which were also baked into the custom benchmark, are what made them an objectively imprudent investment to begin with.” The court thus reversed and remanded for further proceedings, “mak[ing] no determination about whether the record warrants summary judgment under the appropriate standard.”

Class Actions

Seventh Circuit

Kaiser v. Alcoa USA Corp., No. 25-1627, __ F.4th __, 2026 WL 2364300 (7th Cir. Aug. 14, 2026) (Before Circuit Judges Lee, Pryor, and Kolar). Plaintiff Lynnette Kaiser’s late husband worked for aluminum giant Alcoa for fifteen years and, under the collective bargaining agreement (CBA) in place at his retirement, he and his wife were entitled to lifetime healthcare benefits when he retired. However, on January 1, 2021, Alcoa terminated the retiree healthcare benefits of Kaiser and more than 3,000 other pre-1993 retirees and their dependents, transitioning them instead to a health reimbursement arrangement that Alcoa claimed it could terminate “at any time.” None of the CBAs Alcoa had negotiated with unions expressly stated how long retiree healthcare benefits would last, but all barred Alcoa from unilaterally reducing them; all had also expired. Kaiser sued on behalf of a putative class, asserting claims under ERISA §§ 502(a)(1)(B) and (a)(3) against Alcoa and three of its benefit plans, seeking a declaration that pre-1993 retirees’ healthcare benefits had vested for life and an injunction restoring the pre-2021 plan. The district court certified a Rule 23(b)(2) class of all pre-1993 retirees and dependents whose uncapped benefits were terminated effective January 1, 2021, and later granted plaintiffs summary judgment on liability. Crucially, however, the court’s liability ruling was not based on a finding that the benefits had actually vested, but by judicially estopping Alcoa from disputing vesting at all. The district court concluded that Alcoa’s position was “diametrically opposed” to statements it had made in an earlier suit, Curtis v. Alcoa, Inc. That suit was also brought by Alcoa retirees, but over a different, capped tier of benefits, in which Alcoa allegedly conceded that pre-1993 retirees had lifetime, uncapped benefits. Based on its estoppel finding, the court granted plaintiffs declaratory and injunctive relief, while also establishing a claims process for reimbursement of expenses. (We covered this ruling in our April 3, 2024 edition.) Alcoa appealed both the class certification order and the summary judgment order. In this published decision, the Seventh Circuit affirmed the class certification order. The court rejected Alcoa’s argument that differing CBAs across facilities defeated commonality, noting Alcoa itself conceded that “[t]here is no language in the CBAs providing for a specific duration for retiree healthcare benefits” in any of them. The court was satisfied that plaintiffs had demonstrated a “latent ambiguity” which supported a finding of vesting across the class. This included sworn testimony from Alcoa’s lead negotiator that Alcoa “couldn’t touch” or “unilaterally” change the benefits of already-retired employees, and Alcoa’s decades-long practice of leaving the benefits untouched. On typicality, the court likewise found no error, since Kaiser’s claim shared “the same essential characteristics” as the class’, all arising from Alcoa’s single, uniform decision to terminate the pre-2021 plan. The court further found that the district court’s choice of Rule 23(b)(2) over (b)(3) was not an abuse of discretion. The court concluded that plaintiffs’ requested monetary relief (reimbursement calculated by comparing what a class member incurred against what they would have incurred under the reinstated plan) was merely “incidental” to the injunctive and declaratory relief. The Eleventh Circuit changed course on the judicial estoppel issue, however. Applying the Supreme Court’s framework from New Hampshire v. Maine, the court walked through each Alcoa statement from the Curtis litigation on which the district court relied and found none “clearly inconsistent” with Alcoa’s position in this case. For example, one statement was merely Alcoa’s paraphrase of the opposing party’s argument, not an admission. Another addressed how the cap would affect post-1993 retirees, and did not affirmatively concede that pre-1993 retirees’ benefits were vested and uncapped. A promise to pay benefits “for the rest of [the plaintiffs’] lives” likewise referred only to the post-1993 Curtis class. As a result, the Eleventh Circuit concluded that “the doctrine of judicial estoppel does not bar Alcoa from contesting the merits in this case.” The court thus reversed the grant of summary judgment as to liability, leaving it “to the district court’s sound discretion whether to consider motions for summary judgment anew or press forward to trial.”

Ninth Circuit

Andrews v. Wilson Electric Services Corp., No. CV-24-00995-PHX-DJH, 2026 WL 2368105 (D. Ariz. Aug. 14, 2026) (Judge Diane J. Humetewa). Wilson Electric Services Corporation (WESC) established an employee stock ownership plan (ESOP) in 2005 to provide retirement benefits. The ESOP held two categories of assets: WESC stock and an “Other Investments Account” (OIA), which averaged $11.2 million between 2018 and 2022. Plaintiffs Daniel Andrews and Matthew Baker allege that WESC and related defendants kept the entire OIA invested exclusively in bank deposit and money market accounts throughout most of that period, generating negligible returns and causing the OIA’s real value (and plan participants’ retirement savings) to shrink, in violation of ERISA’s duty of prudence under 29 U.S.C. § 1104(a)(1). In August of last year the court certified, without opposition, a class of all ESOP participants and beneficiaries since six years before the suit was filed, although defendants reserved the right to later seek decertification if discovery revealed grounds for it. Sure enough, the parties have conducted discovery and defendants have now moved to decertify the class, arguing it no longer satisfies Rule 23(a)’s commonality and adequacy requirements. (Defendants also moved to dismiss for failure to state a claim, but that motion was denied, as we discussed in last week’s edition.) The court ruled at the outset that WESC had the burden of proving changed circumstance of fact or law in order to support decertification, which would shift the burden back to plaintiffs to reestablish that Rule 23 remained satisfied. On commonality, defendants argued that determining whether individual participants had “actual knowledge” sufficient to trigger ERISA’s three-year statute of limitations would require an individualized inquiry defeating class treatment. The court rejected this, noting that defendants’ argument relied entirely on documents that were in their possession throughout the litigation and thus could have been raised when the original class certification motion was filed. The court also found the argument would fail on the merits regardless because courts do not typically let a speculative, individualized statute-of-limitations defense defeat commonality. “The existence of a statute of limitations issue does not compel a finding that individual issues predominate over common ones.” As for adequacy, the court reviewed the deposition testimony of the class representatives but ultimately rejected defendants’ arguments. Addressing the statute of limitations first, the court cited the Supreme Court’s 2020 Intel v. Sulyma decision for the proposition that “actual knowledge” requires more than access to disclosed information. A plaintiff must have actually become aware of, and appreciated the significance of, the facts constituting the breach. For plaintiff Andrews, the court found that a 2021 email exchange with WESC’s CFO did not qualify because it was primarily about distributions, not investment strategy. For plaintiff Baker, the court found neither his review of account statements nor his forwarding of a Form 5500 to the CFO sufficient, crediting his testimony that he did not understand the significance of either document. The court likewise rejected defendants’ argument that the named plaintiffs’ preference for an equity-heavy OIA investment strategy made them atypical of the class. The court stated, “Defendants’ arguments on this subject venture into arguments concerning the merits of Plaintiffs’ breach of fiduciary duty claim…but a motion for class decertification is not the appropriate point at which to resolve the merits of a plaintiff’s claim.” Finally, the court dismissed defendants’ attacks on the plaintiffs’ credibility and candor. The court was “perplexed by Defendants’ argument that Plaintiffs’ minor legal infractions make them unsuitable class representatives. Infractions relating to a traffic citation and racing dirt bikes that occurred ten or forty years ago do not show examples of dishonesty, do not directly relate to this litigation, and warrant no further discussion.” The court also dismissed defendants’ other credibility attacks because they were not “so sharp as to jeopardize the interests of absent class members.” The court found no evidence of dishonesty directly relevant to the litigation and no indication the named plaintiffs had ceded control of the case to counsel. As a result, defendants’ motion to decertify was denied. Next up: summary judgment proceedings.

Carr v. SSP America Inc., No. CV-25-00911-PHX-JJT, 2026 WL 2363508 (D. Ariz. Aug. 14, 2026) (Judge John J. Tuchi). SSP America, Inc. owns and operates airport restaurants nationwide and sponsors a 401(k) plan for its employees. Plaintiff Natasha Carr works as a server at an SSP restaurant in Phoenix Sky Harbor International Airport under a collective bargaining agreement between SSP and Unite Here Local 11, a hospitality workers’ union, and has participated in the plan since 2021. In January 2024, SSP stopped remitting both employer and employee contributions to the plan. During subsequent negotiations with the union, SSP committed to auditing the shortfall and repaying union-affiliated participants the missed contributions plus lost earnings. This agreement was memorialized in an October 2024 “Side Letter” that also incorporated the collective bargaining agreement’s (CBA) grievance procedure, which included arbitration. However, at this point SSP’s audit has not been completed and no repayment has been made to anyone. Carr thus brought this suit, asserting failure to make required participant and matching contributions, breach of fiduciary duties in administering the plan and providing accurate plan materials, and failure to furnish summary plan descriptions. Carr moved to certify two classes: a broader Class 1 covering all plan participants as of October 2022 for the summary-plan-description claim (which SSP did not oppose), and a narrower Class 2 for her other claims, which covered all active participants who, on or after January 1, 2024, had at least one payroll period in which their contributions were not timely deducted and transmitted. SSP opposed this second class, arguing that Carr could not satisfy Rule 23(a)’s typicality and adequacy requirements. SSP’s central argument was that because Carr was a union member, she was in a materially different position than non-union class members. Specifically, Carr’s claims were potentially subject to the CBA’s grievance procedure, which “could culminate in mandatory arbitration.” The court ruled in Carr’s favor, however, agreeing with her that SSP had waived any right to compel arbitration of her claims. Applying the Ninth Circuit’s two-part waiver test from Hill v. Xerox Business Services – which requires knowledge of an existing right to compel arbitration plus intentional acts inconsistent with that right – the court found SSP had long known of the CBA’s arbitration mechanism (having signed both the CBA and the Side Letter) but never invoked it. Indeed, SSP did not plead arbitration as an affirmative defense in its answer, never moved to compel arbitration, and never gave the notice the CBA requires. Because the CBA makes arbitration discretionary rather than automatic, and SSP had taken no steps toward invoking it, the court concluded the arbitration risk was “merely hypothetical,” leaving Carr “in a position no different than that of non-Union class members.” SSP had a fallback argument, which was that Carr’s claims were atypical because SSP had already promised repayment to union participants but made no comparable commitment to non-union participants. The court did not like this argument either, noting that “‘[t]he requirement of typicality is not primarily concerned with whether each person in a proposed class suffers the same type of damages’… Instead, typicality examines whether the injury and the conduct giving rise to the injury is the same or similar across the class.” Here, “Plaintiff contends that the injury and preceding conduct causing the injury are the same across Class 2, and Defendants do not argue otherwise.” The court then briefly addressed the other requirements of Rule 23. Finding no conflict of interest, adequate counsel experience in ERISA and class litigation, and no other contested Rule 23 element, the court granted Carr’s motion for class certification as to both classes, and, in an ancillary ruling, granted SSP’s unopposed motion to file certain business-sensitive exhibits under seal.

Schuster v. Swinerton Inc., No. 3:24-cv-04970-JSC, 2026 WL 2323537 (N.D. Cal. Aug. 11, 2026) (Judge Jacqueline Scott Corley). The plaintiffs in this action are participants in a retirement savings plan sponsored by the commercial construction company Swinerton Inc. They allege that Swinerton and related defendants breached their ERISA fiduciary duties in administering the plan by incurring excessive recordkeeping and administrative fees. Plaintiffs were able to fend off a motion to dismiss in April of last year (as we covered in our April 16, 2025 edition), and after negotiations the parties were able to reach a settlement. Plaintiffs have represented that the settlement is for $497,500 and constitutes 22.1% of the class’ total estimated losses of $2.25 million. In March of this year the parties notified the court of the settlement, and plaintiffs subsequently moved for preliminary approval, supported by a proposed plan of allocation, a settlement administrator’s declaration describing the notice plan and estimated administration costs, and a postcard-form class notice. The court was dissatisfied with plaintiffs’ motion, identifying four deficiencies. First, the court found the motion failed to explain what individual class members would actually recover: “While the motion indicates the gross settlement amount of $497,500 represents 22.1% of the total estimated losses of $2.25 million, there is no discussion – beyond reference to the Plan of Allocation – of the range of class member recovery under the settlement.” Second, the court flagged the settlement’s reversion provision, which would send unclaimed funds back to the plan “to defray administrative expenses and benefit class member Plan participants, along with the Plan as a whole.” The court was concerned that plaintiffs “do not discuss whether this is common practice in ERISA settlements or cite any authority supporting the reasonableness of this approach.” Third, the court sought more information about the proposed settlement administrator, Analytics. Plaintiffs asserted that class counsel had used Analytics for “a dozen other ERISA class settlements” and had been “highly satisfied,” but did not specify the actual frequency of that relationship or whether counsel had used other administrators during the same period. The court also noted that while Analytics estimated notice costs at $40-50,000, the settlement agreement “does not include a cap on the amount of settlement administration costs and appears to leave it to the Settlement Administrator’s discretion how much to withhold.” Finally, the court held that it could not assess notice adequacy because the motion attached only the postcard notice, not the long-form notice that will be sent to class members: “To approve the settlement, the Court must determine whether the notice affords adequate notice to the class.” The court reminded counsel that the notice “must advise class members they can object to both the settlement itself and the request for attorneys’ fees and costs, and advise Settlement Class Members about how they can review Class Counsel’s motion for attorneys’ fees and costs prior to the final approval hearing.” The court thus ordered supplemental briefing to address these issues and continued the hearing on plaintiffs’ motion for preliminary approval.

Disability Benefit Claims

Eighth Circuit

Huynh v. Schwan’s Shared Services, LLC, Civ. No. 25-3988 (JRT/LIB), 2026 WL 2363632 (D. Minn. Aug. 14, 2026) (Judge John R. Tunheim). Chinh Huynh worked as Director of Enterprise Architecture for food company Schwan’s from 2019 until his termination in 2022. Following motor vehicle accidents in 2018 and 2020, Huynh was diagnosed with persistent postural-perceptual dizziness and related cognitive symptoms, requiring workplace accommodations from 2020 onward. Days before a Mayo Clinic neuropsychologist recommended a six-month leave of absence, and before Huynh submitted any leave request, Schwan’s terminated him for “unsatisfactory performance.” Two days later, Huynh filed a claim for short-term disability (STD) benefits under Schwan’s self-insured STD plan, administered by Sedgwick Claims Management Services. Sedgwick denied the claim, and later denied Huynh’s first-level appeal, both times stating the denial rested on the plan’s “General Eligibility Provisions” found in a separate “Wrap Document.” When Huynh’s counsel requested the underlying third-party administrative (TPA) services agreement between Schwan’s and Sedgwick and a complete copy of the Wrap Document, Schwan’s refused to provide the TPA agreement and only months later produced an incomplete excerpt of the Wrap Document. Then it informed Huynh that no second-level appeal was available and that Sedgwick’s denial was final. Huynh sued Schwan’s and Sedgwick, asserting a claim for STD benefits due (Count One), a claim that Schwan’s failed to produce the TPA Agreement and complete Wrap Document as ERISA requires (Count Two), and a claim for equitable relief (surcharge) based on breach of fiduciary duty by both Schwan’s and Sedgwick (Count Four). (Count Three was a claim against Prudential for long-term disability benefits which was not at issue in this order.) Schwan’s and Sedgwick moved to dismiss Counts One, Two, and Four for failure to state a claim. Addressing Count One first, the court noted that the STD plan’s “Coverage Termination” provision appeared to bar Hynh’s claim because he was terminated on the same day he claimed disability. However, the Eighth Circuit requires that courts review only the plan administrator’s final denial rationale rather than post-hoc justifications, and thus the court held it was bound to the reasoning Sedgwick actually gave, which invoked the “General Eligibility Provisions.” Thus, the court declined to dismiss Count One. Next, the court found it was “premature” to determine the issue of whether defendants’ eligibility determination was reasonable as a matter of law because “it is unclear who the relevant decisionmaker was or on what basis the STD benefits were denied[.]” The court also declined to dismiss Sedgwick as an improper defendant, finding the factual record on control “undeveloped” at the pleading stage, as both Schwan’s and Sedgwick had sent Huynh information regarding his claim eligibility. Moving on to Count Two, the court held that the TPA Agreement plausibly should have been produced as a “contract, or other instrument under which the plan is established or operated” under 29 U.S.C. § 1024(b)(4). In so ruling the court relied on the Tenth Circuit’s 2024 decision in M.S. v. Premera Blue Cross (the case of the week in our October 9, 2024 edition) and the Seventh Circuit’s 2009 decision in Mondry v. American Family Mutual Insurance Co. (The Fourth Circuit just agreed with both of these decisions in Kelly v. Altria Client Servs., the case of the week from last week’s edition.) As for the Wrap Document, the court found Schwan’s own admission that it sent only “the relevant portion” fatal, holding that ERISA affords no basis for a plan administrator to unilaterally decide which portions of a governing document a participant may see. On Count Four, the court held Huynh plausibly alleged Sedgwick acted as a functional fiduciary rather than a purely ministerial claims processor, again because the record did not yet establish who held discretionary authority over eligibility. Finally, relying on the Supreme Court’s decision in CIGNA Corp. v. Amara and interpreting Eighth Circuit precedent, the court rejected the argument that Huynh’s equitable relief claim was impermissibly duplicative of the benefits claim. The court held that the two claims were distinct legal theories that may be pleaded in the alternative, with any duplicate-recovery problems better resolved at a later date. Defendants’ motion to dismiss was thus denied.

Eleventh Circuit

Kendall v. Metropolitan Life Insurance Co., No. 2:26-CV-950-KCH-KRH, 2026 WL 2299338 (M.D. Fla. Aug. 11, 2026) (Judge Kyle C. Dudek). In 2009 June Yvonne Kendall became disabled, and since 2011 she has been receiving ERISA-governed long-term disability benefits under a plan sponsored by Bank of America, N.A. and administered by Metropolitan Life Insurance Company. Kendall contends in this pro se action that although she elected coverage that paid sixty percent of her annual salary, her monthly checks reflected only forty percent of her pay, and that this shortfall continued for “over fifteen…years,” resulting in what she calculated as a nearly quarter-million-dollar underpayment. In her complaint against both Bank of America and MetLife she asserted two claims for relief: one to recover the allegedly underpaid benefits under 29 U.S.C. § 1132(a)(1)(B), and a second for breach of fiduciary duty under § 1132(a)(3). Defendants moved to dismiss both counts, arguing that the recovery of benefits claim was time-barred and that the fiduciary duty claim failed as a matter of law because it duplicated the benefits claim. Defendants attached the governing plan document to their motion, and Kendall did not dispute its authenticity. The court granted the motion as to the recovery of benefits claim and dismissed it with prejudice. The court first held it could consider the plan document itself under the incorporation-by-reference doctrine. The plan contained a contractual limitations provision requiring suit to “be brought…during a certain period,” which “begins 60 days after the date Proof is filed and ends 3 years after the date such Proof is required.” Proof was due “not later than 90 days after the date of loss.” Under these provisions, the court calculated that Kendall’s window to sue closed by the end of 2012, more than a decade before she filed this action. Kendall argued that a different plan provision excused late-filed proof if it was “given as soon as is reasonably possible,” which extended her deadline. However, the court noted that because Kendall alleged that she had been receiving benefit checks since 2011, she necessarily must have submitted her proof by then: “[i]t’s hard to imagine how she could receive benefits otherwise.” Even using 2011 as the accrual date, Kendall’s limitations deadline expired well before this suit was filed, in 2015. The court also rejected Kendall’s argument that her claim could not have accrued until she discovered the underpayment through a 2026 administrative appeal. The court stated that this argument was improperly raised for the first time in Kendall’s response brief, and furthermore ran afoul of the Eleventh Circuit’s “clear repudiation rule,” which asks when a claimant had reason to know her benefits had been adversely affected. “[A]fter a year or more of under- or non-payment, claimants should understand their rights to have been rejected.” The court found that “[t]he twenty percent she claims to have been shorted was stark enough to make her aware she was being shorted,” and thus “her cause of action accrued long before this action was filed.” As for Kendall’s breach of fiduciary duty claim, the court explained that a plaintiff with an adequate remedy under § 1132(a)(1)(B) cannot simultaneously proceed on an equitable-relief theory under § 1132(a)(3), since the latter functions only as a “safety net” for injuries ERISA does not otherwise remedy, relying on the Supreme Court’s decision in Varity Corp. v. Howe. Kendall’s fiduciary duty claim incorporated the same factual allegations underlying her benefits claim without adding any independent factual predicate, making it impermissibly duplicative. However, the court noted that Kendall’s response brief hinted at new allegations concerning defendants’ alleged withholding of benefit-calculation information that might support a valid fiduciary duty claim if properly pled. The court therefore dismissed Kendall’s second claim without prejudice and gave her leave to amend.

Life Insurance & AD&D Benefit Claims

Ninth Circuit

Aloff v. Prudential Ins. Co. of America, No. 3:25-cv-05834-DGE, 2026 WL 2389181 (W.D. Wash. Aug. 17, 2026) (Judge David G. Estudillo). The two plaintiffs in this case are widows of pilots employed by Clay Lacy Aviation who died in a February 2024 airplane crash. Clay Lacy provided its pilots basic term life insurance and basic accidental death and dismemberment (AD&D) coverage under a group policy purchased from Prudential Insurance Company of America. The AD&D coverage, unlike the term life benefit, excluded losses resulting from “travel or flight in any vehicle used for aerial navigation” where the decedent was performing as a pilot or crew member. Plaintiffs submitted AD&D claims, which Prudential denied, relying on the aviation exclusion. Plaintiffs allege that “a Prudential employee ‘forecasted the decision’ in a telephone call, stating, ‘[d]on’t blame us [Prudential]. This is Clay Lacy, they were the ones to put the [aviation] exclusion in [the life insurance policy].’” Plaintiffs originally asserted claims against both Clay Lacy and Prudential for recovery of benefits, breach of fiduciary duty, equitable relief, and violations of California and Washington consumer protection statutes, but the court granted defendants’ motion to dismiss in February of this year (as we explained in our February 25, 2026 edition). The court found that plaintiffs failed to identify plan language entitling them to AD&D benefits, that the derivative fiduciary duty claim failed for the same reason, and the state consumer protection claims were preempted by ERISA. The court granted plaintiffs leave to amend, which they did, narrowing their new complaint to two counts: recovery of benefits under 29 U.S.C. § 1132(a)(1)(B) and breach of fiduciary duty. The new complaint is based on allegations that Clay Lacy publicly represented it offered “fully paid” benefits including “life insurance” while knowing the aviation exclusion would bar any AD&D claims for pilots killed while flying for Clay Lacy, and that Prudential kept collecting premiums despite that knowledge. Defendants moved to dismiss again, and prevailed in this order. On the benefits claim, plaintiffs acknowledged the aviation exclusion, but argued that it should not be enforced because doing so would render AD&D coverage “illusory, unconscionable, and objectionable” as a matter of contract and public policy. Plaintiffs cited state law in support of this argument, but the court found that this did not advance the ball because of ERISA, which preempts state law unconscionability theories. Furthermore, federal common law provided no relief either: “ERISA mandates no minimum substantive content for employee welfare benefit plans,” and “we are not free to amend the Plan to our liking.” As for plaintiffs’ “illusory” theory, the court found that plaintiffs “merely state a general principle for federal common law contract interpretation; they do not otherwise state how the aviation exclusion is illusory.” Furthermore, plaintiffs had received life insurance benefits, which undercut their argument regarding illusory benefits. The court thus dismissed plaintiffs’ benefits claim, which doomed their fiduciary duty claim as well. Because plaintiffs’ theory of breach rested on the underlying premise that they were wrongly denied AD&D benefits, the claim failed for the same reason as the benefits claim, without the court needing to resolve any issues of who was a fiduciary. Because plaintiffs did not request further leave to amend, the court dismissed both counts with prejudice. Finally, the court declined Clay Lacy’s request for attorneys’ fees. The court found that its one-paragraph fee argument, which did not address the Ninth Circuit’s Hummell factors, was inadequate to justify fee-shifting against plaintiffs, which is generally disfavored in the Ninth Circuit.

Provider Claims

Second Circuit

Rowe Plastic Surgery of N.J., L.L.C. v. Aetna Life Ins. Co., No. 23-CV-3632-SJB-LKE, 2026 WL 2349750 (E.D.N.Y. Aug. 13, 2026); Rowe Plastic Surgery of N.J., L.L.C. v. Aetna Life Ins. Co., No. 23-CV-3636-SJB-LKE, 2026 WL 2349790 (E.D.N.Y. Aug. 13, 2026) (Judge Sanket J. Bulsara). Rowe Plastic Surgery of New Jersey and East Coast Plastic Surgery are out-of-network providers who, as the court noted at the outset of both of these decisions, have filed “dozens” of nearly identical reimbursement suits against health insurers in New York federal courts over the last few years. Plaintiffs have not succeeded in any of them. These two companion decisions, issued the same day by the same judge, arrived at a similar result. In the first case, before performing surgery on patient R.S., plaintiffs called Aetna to “check the benefits,” and an Aetna representative stated the out-of-network reimbursement rate would be “80 percent reasonable and customary.” Plaintiffs eventually billed $300,000 but received only $39,467.88. In the second case, involving patient E.M., a nearly identical phone call occurred. Again, plaintiffs billed $300,000 but this time they were reimbursed just $8,319.54. In both cases, plaintiffs allege the telephone representations were binding offers that Aetna breached by later applying a different reimbursement methodology. Both complaints asserted the same four claims: (1) breach of contract, (2) unjust enrichment, (3) promissory estoppel, and (4) violation of New York’s Prompt Pay Law. Both cases were filed in state court, removed to federal court, then stayed in early 2024 pending the Second Circuit’s decisions in Park Avenue Podiatric Care v. Cigna Health & Life Ins. Co. and a prior Rowe appeal against Aetna. The decisions in both cases affirmed dismissal of virtually identical claims. The court thus directed the parties to file summary judgment briefing, which were adjudicated in these two decisions. The court’s reasoning, essentially identical in both, rested first on evidentiary threshold rulings and then on the merits. As a preliminary matter, the court rejected plaintiffs’ challenges to Aetna’s evidence, which was offered to authenticate the plans and document the conversations between plaintiffs and Aetna. Aetna’s evidence was admissible because it was either non-hearsay or satisfied the business records hearsay exception. On the merits, the court held that all four state law claims in both cases were expressly preempted by ERISA because, “[n]o matter how much this is dressed up in state law garb,” the claims “grow out of what was (not) paid under an ERISA plan.” Plaintiffs’ “only argument to the contrary” was that Aetna “has not ‘introduced a controlling plan instrument’ to prove the existence of an ERISA-governed plan.” For the court, however, this was unnecessary; it had already held that the plan was governed by ERISA, and this conclusion was bolstered by a summary plan description in the record. The court further ruled that plaintiffs did not have a plausible claim regardless of preemption. The court ruled that Aetna’s “80 percent reasonable and customary” statements lacked “the definiteness typically required to create an offer,” thus foreclosing breach of contract. The unjust enrichment claims failed because the benefit of the surgeries ran to the patients, not to Aetna, which neither requested nor benefited from the services. Plaintiffs’ promissory estoppel claim failed because an indefinite statement cannot constitute the “clear and unambiguous promise” required by the doctrine. The Prompt Pay Law claims were deemed abandoned because plaintiffs failed to defend them in their oppositions. In the end, the court granted summary judgment to Aetna in both cases and dismissed all claims with prejudice. This was not enough for Aetna, which also asked for sanctions in both cases. The court declined, however: “Though the Court appreciates Aetna’s frustration at having to brief the same issues, Plaintiffs were entitled to proceed to summary judgment, since the denial of the motion to amend did not dispose of the claims in the original Complaint. Notwithstanding the waste of time, money, and judicial resources the decision to continue this litigation has incurred, Aetna’s request for sanctions is denied.”

Third Circuit

Abira Medical Laboratories, LLC v. United HealthCare Services, Inc., No. 24-7375 (MAS)(TJB), 2026 WL 2334104 (D.N.J. Aug. 12, 2026) (Judge Michael A. Shipp). Plaintiff Abira Medical Laboratories, also known as Genesis Diagnostics, is a recurring cast member of this newsletter. It is an out-of-network clinical laboratory that has alleged in numerous actions that it was underpaid for the testing services it provided. This particular case alleges that patients insured through health plans administered by United HealthCare Services received services from Genesis and signed assignment-of-benefits forms directing that insurance payments be made directly to Genesis. Genesis contends that between 2016 and 2019 it submitted more than 15,000 claims to United for reimbursement, many of which were either unpaid or not paid at all. According to Genesis, roughly $23 million in unpaid claims is at issue. This was Genesis’ third attempt to plead a viable complaint. After removal from state court, the court dismissed the original amended complaint (with two counts dismissed with prejudice and nine without), then dismissed the second amended complaint in full, each time giving Genesis another chance to amend. (We discussed the dismissal of Genesis’ second amended complaint in our December 3, 2025 edition.) The operative third amended complaint contains five counts: an ERISA claim to recover benefits under 29 U.S.C. § 1132(a)(1)(B) (Count One), breach of contract (Count Two), breach of the implied covenant of good faith and fair dealing (Count Three), quantum meruit/unjust enrichment (Count Four), and promissory estoppel (Count Five). United moved to dismiss all five counts. On the ERISA claim, the court held (for the third time) that Genesis’ failure to identify any specific plan provision entitling it to payment was fatal, since “[a] claim for ERISA benefits ‘stands and falls by the terms of the plan.’” Genesis conceded that it lacked access to the plans, but “attempts to overcome its lack of specific plan language by including spreadsheets of instances where Defendant paid Plaintiff, in whole or in part, for services rendered to the same patients under the same plans as those for which Defendant now allegedly refuses to pay.” This was not good enough: “[E]ven with this additional information, Plaintiff still fails to allege facts regarding any plan language suggesting that it is entitled to payment under ERISA… Without more regarding the precise plan terms at issue, the Court finds that Plaintiff has failed to state an ERISA claim[.]” Genesis fared better with its state law claims. The court held that Genesis’ newly added exhibit (a list of services which included named patients, amounts, and assignment language, among other information) plausibly alleged an implied contract arising from United’s own “prior and concurrent payment practices,” even though Genesis did not quote a specific contractual provision. Because the existence and terms of that implied contract remained genuinely disputed, the derivative implied-covenant-of-good-faith claim survived as well. However, the quantum meruit/unjust enrichment and promissory estoppel counts did not survive. The court stated that when a healthcare provider sues an insurer for unjust enrichment, the benefit conferred is the discharge of the insurer’s obligation to the insured under a plan. However, Genesis failed to tie its claim to any specific plan or plan-based duty, so the count failed regardless of how much billing data it supplied. The promissory estoppel claim failed for a related reason: Genesis alleged only that United’s representatives generally said it “would pay” for services and that United’s history of paying similar claims implied a promise, but under New Jersey law a promissory estoppel claim requires a “clear and definite promise.” Neither a vague verbal assurance nor a pattern of prior claims payments was sufficient. As a result, the suit will continue, but without its ERISA claims.

Fifth Circuit

Columbia Hospital at Medical City of Dallas Subsidiary, L.P. v. California Physicians’ Service, No. 4:24-cv-924, 2026 WL 2365066 (E.D. Tex. Aug. 14, 2026) (Judge Amos L. Mazzant). Plaintiffs Medical City Dallas and Medical City Plano are Texas hospitals that treated two patients enrolled in health plans issued by California Physicians’ Service d/b/a Blue Shield of California, with claims administration handled by Keenan & Associates. Plaintiffs alleged that both patients assigned their plan benefits to the hospitals in exchange for treatment. After plaintiffs submitted claims, Blue Shield and Keenan denied payment, and this action ensued. Plaintiffs sued Blue Shield and Keenan under three counts: Count One, a claim for unpaid benefits under ERISA § 502(a)(1)(B), premised on the patients’ assignments of their plan rights; Count Two, breach of contract against Blue Shield; and Count Three, an alternative breach-of-contract claim against both defendants. Defendants filed a motion to dismiss, which was successful in August of last year because the court found that plaintiffs did not adequately allege that they had standing pursuant to the assignments. (We covered this order in our August 27, 2025 edition.) Plaintiffs amended their complaint, and defendants once again moved to dismiss. The court characterized defendants’ arguments regarding plaintiffs’ derivative standing as a factual attack on subject-matter jurisdiction, not a Rule 12(b)(6) merits or prudential-standing argument. This distinction mattered because “there is no presumptive truthfulness to the allegations in the complaint” in such disputes. Instead, plaintiffs are “‘required to submit facts through some evidentiary method’ to establish ‘by a preponderance of the evidence’ that the Court has subject matter jurisdiction.” The relevant plan documents contained an anti-assignment clause barring subscribers from assigning benefits without the plan’s consent, and plaintiffs did not dispute the clause’s validity or applicability. Instead, plaintiffs argued defendants had waived the clause or should be estopped from enforcing it. However, the court ruled that plaintiffs did not submit competent evidence supporting their waiver/estoppel arguments. The claims at issue were denied out of the gate, and there was no “duplicitous conduct” or “protracted process” that might support a finding that defendants had promised payment. The court dismissed Count One without prejudice but without further leave to amend, holding “a plaintiff who has already had one opportunity to plead facts sufficient to establish subject-matter jurisdiction is not entitled to endless additional chances.” The court thus turned to plaintiffs’ non-ERISA claims and determined there was no personal jurisdiction over defendants, both of which were domiciled in California. The court found Keenan’s contacts with Texas, which included claims processing and treatment-approval communications directed at Texas providers, were insufficient to establish purposeful availment of the jurisdiction. Blue Shield’s participation in the national BlueCard network also did not amount to purposeful availment of the Texas forum. The court thus dismissed all claims against all defendants without prejudice and without leave to amend.

Remedies

Fifth Circuit

Pedersen v. Kinder Morgan Inc., No. 4:21-CV-03590, 2026 WL 2297148 (S.D. Tex. Aug. 10, 2026) (Judge Keith P. Ellison). The plaintiffs in this complex certified class action are current and former employees of energy infrastructure company Kinder Morgan Inc.’s ANR pipeline subsidiary. In this suit they challenged two aspects of the company’s defined benefit pension plan. The Benefit Accrual subclass consists of participants hired before age 35 whose retirement benefits were calculated using a 2001 “Coastal Transition Benefit” formula containing an “uncapped” denominator that could reduce their promised 2% of final-pay accrual rate down to as little as 1.33%, a result that was not explained in the summary plan descriptions (SPDs). The Early Retirement subclass consists of participants who were affected by a plan amendment (the “Ninth Amendment”) that eliminated their ability to “grow into” unreduced early retirement benefits at age 62 rather than age 65, and whose benefits were further affected by a 2018 administrator interpretation of a related “ANR Legacy” provision. The court has already ruled in plaintiffs’ favor on three claims: that the SPDs’ failure to disclose the uncapped denominator violated ERISA § 102, 29 U.S.C. § 1022(a), which requires SPDs to be written in a manner calculated to be understood by the average participant; the Ninth Amendment violated ERISA § 204(g)’s anti-cutback protections; and the 2018 ANR Legacy interpretation was legally incorrect and an abuse of discretion. (Your ERISA Watch covered this ruling in our July 31, 2024 edition.) Plaintiffs then moved for equitable relief. They seek reformation of the Coastal Transition Benefit formula for the Benefit Accrual subclass and reformation plus injunctive relief and prejudgment interest for the Early Retirement subclass. The motion was assigned to Magistrate Judge Yvonne Y. Ho, who issued a memorandum and recommendations (M&R) recommending that reformation be denied for the Benefit Accrual subclass, that reformation and injunctive relief be granted for the Early Retirement subclass but with three carved-out groups of subclass members excluded from relief, and that plaintiffs’ request for a uniform 36-month award of unreduced benefits to the entire subclass be denied as overbroad. Plaintiffs objected on multiple grounds; defendants did not object but preserved their appellate rights as to the court’s earlier liability ruling. The court sustained plaintiffs’ objections as to the Benefit Accrual subclass and granted reformation. It held the M&R had effectively imposed an intentional misconduct requirement onto the “equitable fraud” standard for reformation. The court ruled that “intention to defraud or misrepresent is not a necessary element” of equitable fraud, which instead reaches any breach of a legal or equitable duty that yields an “undue and unconscientious advantage.” The court borrowed the Sixth Circuit’s “three relevant ‘guideposts’ for assessing equitable fraud,” and found that (1) Kinder Morgan’s § 102 violation was a breach of its statutory disclosure duty, (2) the company obtained an undue advantage by saving “in excess of $100 million” and “avoided ‘employee backlash’ by not adequately disclosing the formula’s effect,” and (3) participants suffered a real injury in losing the ability to plan for retirement with an accurate understanding of their benefits. The court thus found there was “clear and convincing evidence” that “Defendants’ violation of ERISA § 102 constituted fraud or inequitable conduct,” and ordered the Coastal Transition Benefit formula reformed to the 2% accrual rate participants reasonably understood from the SPDs. On the Early Retirement subclass, the court sustained in part and overruled in part plaintiffs’ objections. It agreed with plaintiffs that the M&R’s exclusion of three subclass groups improperly imported a “detrimental reliance” requirement rejected by the Supreme Court in CIGNA Corp. v. Amara. The court found that the record “supports a reasonable inference that all Early Retirement subclass members were harmed,” and thus “it is within this Court’s discretion to award them equitable relief.” However, the court agreed with the M&R that plaintiffs’ request for a blanket 36-month award of unreduced benefits to the entire subclass would function as damages rather than equitable relief and would give many members an unwarranted windfall. It instead ordered individualized “make whole” relief tailored to each participant’s actual circumstances.

Kelly v. Altria Client Services, LLC, Nos. 25-1350, 25-2080, __ F.4th __, 2026 WL 2293854 (4th Cir. Aug. 10, 2026) (Before Circuit Judges Quattlebaum, Benjamin, and Berner)

This week’s notable decision primarily addresses whether a delay in the timing of a transaction in a plan participant’s retirement account can give rise to ERISA liability. However, the lasting impact of this case likely has nothing to do with that issue. Instead, the case will likely be remembered for its handling of a collateral question also decided by the court: what types of documents are covered by ERISA’s disclosure provision located at 29 U.S.C. § 1024(b)(4)? Read on to learn the Fourth Circuit’s answer.

The plaintiff in the case was Richard Kelly, who worked for Philip Morris USA and its successor Altria Client Services for over two decades. He maintained a 401(k) account in Altria’s Deferred Profit-Sharing Plan for Salaried Employees even after his position was eliminated in 2010.

In 2020, anticipating a post-election stock market rally, Kelly decided to liquidate his account, transfer the proceeds to a Goldman Sachs account, and reinvest quickly, while also preserving favorable tax treatment for his non-Altria shares. On November 2, the day before the election, Kelly and his Goldman Sachs advisors called Fidelity Workplace Services, the plan’s corporate recordkeeper, to set the strategy in motion.

Fidelity told Kelly the stock sales would settle in two business days, and that the subsequent in-kind distribution of his non-Altria shares could take up to ten business days, with Fidelity holding the proceeds until the entire transfer was ready to move to Goldman Sachs. When Kelly was unhappy with this response, the representative added, “the liquid portion, you’re right, it would just take a day or two and then once it’s available, you can move that out.”

However, the full transfer was not complete until November 12. Kelly contended that Fidelity had misled him about how quickly he would have access to his money, and that had he understood the true timeline, he “would have made different decisions.”

Kelly pursued that complaint as a formal benefits claim, which Altria denied, concluding that Fidelity had acted in a timely fashion and did not give Kelly substantively incorrect information.

Kelly thus sued Altria, the plan, and Fidelity, eventually asserting three claims: (1) a denial-of-benefits claim against Altria and the plan under 29 U.S.C. § 1132(a)(1)(B); (2) a breach-of-fiduciary-duty claim against Fidelity under § 1132(a)(3), based on its allegedly misleading statements about transfer timing; and (3) a claim against Altria for refusing to produce, upon request, the Administrative Services Agreement (ASA) between Altria and Fidelity governing Fidelity’s recordkeeping role under § 1024(b)(4).

The district court proceedings went poorly for Kelly. The district court granted defendants summary judgment in a March 2025 order (as we discussed in our April 2, 2025 edition), and followed that up with an attorney’s fees award against him (covered in our August 20, 2025 edition). Kelly appealed to the Fourth Circuit, which issued this published decision.

Tackling the benefits claim first, the appellate court applied the abuse of discretion standard because the plan gave Altria “discretionary power to determine all questions that arise under the Plan,” including “the amount of any benefit to which any person is entitled to under the Plan.” Under this standard, the court found Altria’s process “reasoned” and “principled”: it gave Kelly a fair hearing, considered his claims in a deliberative meeting, reviewed the call transcripts, and considered a detailed presentation of the facts.

The court acknowledged Kelly’s frustration with Fidelity’s comment that his funds might be available earlier, but noted that Fidelity explicitly told Kelly “that the cash rollover to the Fidelity IRA would take approximately three to five business days, and that the in-kind distribution could take seven to ten business days.” Furthermore, Altria reasonably concluded that Fidelity completed its tasks “within the time frame quoted for the rollover of the cash and well before the time frame quoted for the rollover of the in-kind stock.”

Thus, the court moved on to Kelly’s breach of fiduciary duty claim. The Fourth Circuit agreed with the district court that Fidelity’s ministerial recordkeeping functions – answering participant calls, providing balances, processing distribution requests – did not make it a “functional fiduciary” under 29 U.S.C. § 1002(21)(A).

Kelly argued that “the way Fidelity performed those duties made it a functional fiduciary,” but the Fourth Circuit disagreed. The court noted that Kelly had already decided, before ever calling Fidelity, to exit the plan entirely and move his money to Goldman Sachs, and thus Fidelity did not offer him advice or guide his participation in the plan in any way.

Furthermore, the court concluded that even if Fidelity was a fiduciary, there was no breach. Fidelity’s estimates proved accurate and it completed the requested transactions within the estimated timeframes. The isolated comment Kelly seized on about “the liquid portion” was “sandwiched between several statements that the transaction would take seven to ten days,” an estimate that was repeated to Kelly in future conversations. “Less than perfect customer service? Perhaps. Breach of fiduciary duty? No.”

Kelly had better luck with his statutory penalty claim under § 1024(b)(4). Altria had argued, and the district court agreed, that the ASA merely “memorialize[d] Fidelity’s obligations to provide certain services to Altria” rather than “establishing or operating” the plan itself, and thus Altria was not required to produce the ASA.

The Fourth Circuit examined the text of the statute, focusing on the words “established or operated.” While the ASA obviously did not “establish” the plan, the court held it plainly helped the plan “operate,” because “operate” means to function, work, or produce an effect. The ASA directed Fidelity to field participant calls, process transactions, and report fund data. Because these duties “help the plan work or perform part of its process…the ASA was a document under which the plan operated.”

In so ruling, the Fourth Circuit distinguished its 1996 decision in Faircloth v. Lundy Packing Co., which had excluded appraisal reports and meeting minutes from § 1024(b)(4)’s ambit but included funding and investment policies. The court found that the ASA more closely resembled the latter, which was consistent with the Tenth Circuit’s 2024 decision in M.S. v. Premera Blue Cross (the case of the week in our October 9, 2024 edition) and the Seventh Circuit’s 2009 decision in Mondry v. American Family Mutual Insurance Co.

Finally, the court affirmed the award of attorney’s fees against Kelly in a footnote, finding no abuse of discretion in the district court’s balancing of the relevant factors.

As a result, Kelly’s appeal was mostly unsuccessful. However, the Fourth Circuit’s ruling in his favor on his document disclosure claim gives ERISA plaintiffs further ammunition in their efforts to expand the scope of documents that are subject to statutory penalty exposure.

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

Arbitration

Seventh Circuit

PHI Health, LLC v. Health Care Service Corp., No. 26 C 2954, 2026 WL 2254879 (N.D. Ill. Aug. 5, 2026) (Judge Matthew F. Kennelly). PHI Health provided out-of-network air ambulance services to patients covered by health plans administered by Health Care Service Corporation, which operates various Blue Cross Blue Shield entities. PHI alleges that HCSC issued underpayments for twelve of PHI’s air ambulance transports. PHI invoked the dispute resolution process under the federal No Surprises Act (NSA), culminating in independent dispute resolution (IDR) proceedings. PHI prevailed in those proceedings, but PHI alleges HCSC failed to pay within the NSA’s 30-day statutory deadline and did not seek vacatur, modification, or correction of the awards. (PHI contends that this reflects a broader HCSC pattern of underpaying and delaying claims, and then ignoring awards once they are obtained.) PHI thus filed this action asserting six claims. Three seek to enforce the IDR award under the NSA itself (Count 1), the Federal Arbitration Act (FAA) (Count 2), or the Illinois Uniform Arbitration Act (IUAA) (Count 3). The remaining claims seek declaratory and injunctive relief (Count 4), relief under ERISA §§ 502(a)(1)(B) and 502(a)(3) (Count 5), and relief under the Illinois Consumer Fraud and Deceptive Business Practices Act (Count 6). HCSC moved to dismiss the complaint for failure to state a claim. Addressing the NSA claim first, the court held that the NSA contains neither an express nor implied private right of action to enforce or confirm IDR awards. The court acknowledged that the statute has “shall be binding” language which is “rights-creating,” but that was insufficient; “Congress must intend to create a private remedy.” The NSA has an administrative enforcement scheme empowering HHS, the Department of Labor, and the Department of Treasury to assess penalties against noncompliant insurers, and this choice of remedy suggested that Congress did not intend a judicially implied private right of action. PHI contended that regulatory review was not “a true enforcement mechanism,” but the court responded that it was “not a court’s role…to step in and create a private right of action simply because private enforcement may provide a more effective remedy than the mechanism Congress chose.” In so ruling, the court agreed with the Fifth Circuit’s decision in Guardian Flight LLC v. HCSC (discussed in Your ERISA Watch’s June 18, 2025 edition) and the majority of district courts (including two other judges in the same district) over contrary decisions. As for the FAA and IUAA claims, the court ruled that both statutes require a written agreement to arbitrate before a court may confirm an award, and no such agreement existed here. PHI argued that HCSC’s participation in the IDR process constituted agreement to arbitrate, but the court rejected this, joining other courts that have held that the FAA cannot be used to enforce NSA awards absent an actual written arbitration agreement. On PHI’s ERISA claims, the court found PHI’s theory of standing conflated Article III standing with ERISA’s separate “zone of interests” requirement. Although the court agreed that patients had validly assigned their benefits to PHI, PHI’s claim in this action was not based on those benefits but on HCSC’s failure to pay IDR awards, which was a duty HCSC owed independently to PHI. “The patients could not bring a claim to enforce the awards, and thus the patients have no claim to assign to PHI. The Court thus concludes that PHI cannot bring a claim to enforce the NSA awards under ERISA because the claim does not fall within the Act’s zone of interests.” The court also ruled that PHI did not have any independent claim under ERISA because it never alleged it was a “participant,” “beneficiary,” or “fiduciary,” which is required in order to obtain relief under ERISA’s civil enforcement scheme. On PHI’s Illinois Consumer Fraud Act claim, PHI conceded it was not a “consumer” and thus had to satisfy the “consumer nexus” test, which required showing the disputed conduct occurred “primarily and substantially” in Illinois. The court ruled that PHI failed this test. PHI did not render services in Illinois, the affected patients were not Illinois residents, and PHI’s argument that HCSC’s Illinois headquarters directed claims-processing policy did not relate to conduct directed at the Illinois market or consumers. Finally, the court dismissed PHI’s claim for declaratory/injunctive relief. Because this claim was derivative of the other counts, and no viable underlying claim survived, it could not proceed independently. The court thus granted HCSC’s motion to dismiss in its entirety, but gave PHI leave to amend.

Attorneys’ Fees

Fifth Circuit

Krongold v. American Air Liquide Holdings, Inc., No. 4:24-CV-01971, 2026 WL 2230506 (S.D. Tex. July 27, 2026) (Magistrate Judge Christina A. Bryan). Plaintiff Martin Krongold worked as a mechanical engineer for Messer Griesheim Industries (MGI) from 1984 to 1991, and then at American Air Liquide Holdings, Inc. until 2016. Air Liquide assumed sponsorship of the MGI pension plan through a 2004 acquisition. In 2021, as Krongold approached retirement age, Air Liquide informed him that his MGI and Air Liquide pension benefits would be calculated separately, rather than combined. Krongold thus brought this action against Air Liquide, asserting a benefits claim (Count I), “for his car allowance,” and an equitable estoppel claim (Count II), arguing that his MGI and Air Liquide pension benefits should be combined. The court granted summary judgment to Krongold on Count I in 2024 (Air Liquide did not oppose his motion), and in 2025 the court held a bench trial on Count II. The court “concluded that while Defendant made material misrepresentations to Plaintiff, Plaintiff did not prove reasonable detrimental reliance or extraordinary circumstances.” Thus, judgment was entered in Air Liquide’s favor on Count II. At issue now is attorney’s fees. The court declined to award them to Air Liquide, and Krongold’s motion for fees was referred to the assigned magistrate judge, who issued this ruling. Krongold sought “almost one million dollars” in his motion. This relief consisted of three parts: (1) $238,431.50 in attorney’s fees; (2) $13,088.63 in expenses; and (3) “‘other remedies’ totally unrelated to fees and costs,” including prejudgment interest of $396,327.68, statutory penalties of $140,250, an accounting of benefits from August 2021, and “gross-ups” to account for tax liability ($172,998.15) and Medicare ($19,547.06). The court quickly disposed of the third category, finding it “easily rejected.” The court ruled that a post-judgment fee motion cannot be used to assert new claims for relief not awarded in the final judgment, and that tax consequences are not one of the factors to be considered in awarding fees. Next, the court rejected category two, holding that 28 U.S.C. § 1920 strictly limits recoverable costs to those enumerated in the statute and that any recoverable costs should have been included in Krongold’s previously filed bill of costs. “The Court finds no good cause to entertain a second request for additional costs, many of which are not taxable under § 1920.” Thus, the court turned to category one, “[t]he only appropriate relief Plaintiff seeks in his motion[.]” The court found that Krongold achieved “some degree of success on the merits” by prevailing on his car allowance claim, but achieved no success on his equitable estoppel claim. As a result, the court limited fee eligibility to work performed on Count I between the filing of the complaint and the 2024 summary judgment ruling in Krongold’s favor on that count. Because Krongold’s fee motion did not segregate fees attributable to the recoverable Count I from the unrecoverable Count II, the court applied a percentage-reduction approach. First, limiting the fee request to invoices predating October 17, 2024 reduced the lodestar to $110,350.80. The court then found, based on the billing entries (which included extensive discovery and legal research specific to the equitable estoppel theory), that the bulk of the time expended during this period was still attributable to the more complex and discovery-intensive Count II rather than the simpler Count I benefits claim. Thus, the court applied a further 70% reduction, yielding a final recommended fee award of $33,105.24. The court found this to be “consistent with the Fifth Circuit’s guidance that attorneys’ fees ‘must be reasonable under the particular circumstances of the case and must have some reasonable relationship to the amount in controversy or to the complexity of the issue to be determined.’” The court declined to award any additional fees for time spent preparing the fee motion itself because the motion “seeks excessive fees, overly broad relief, and is longer than necessary.” Finally, the court recommended denying prejudgment interest entirely, reasoning that such interest compensates for the “use of funds,” and Krongold “has never applied for distribution of his benefits. Thus, the car allowance issue did not delay or deprive Plaintiff of the use of his money.” The parties were given 14 days to appeal this ruling to the district court judge.

Ninth Circuit

Wagoner v. State Indus. Prods. Corp., No. CV-25-01763-PHX-JJT, 2026 WL 2247759 (D. Ariz. Aug. 4, 2026) (Judge John J. Tuchi). This is one of two cases this week involving plaintiff Gary L. Wagoner. Wagoner is a physician who has brought numerous unsuccessful cases in Arizona federal court, both in his name and in the name of trusts he controls, attempting to recover assigned benefit payments from insurers of ERISA-governed health plans. In this particular case, Wagoner sued State Industrial Products Corporation regarding underpaid medical claims relating to services he provided to a patient in 2018. The court has already dismissed all of Wagoner’s claims with prejudice (see our coverage in our January 7, 2026 edition for more details), and separately denied his motion for relief from that judgment. Wagoner then filed a motion for leave to amend and a motion for sanctions, both of which were quickly denied in this order. The court found that Wagoner’s motion to amend was procedurally improper, his claims were still defective, and that he inappropriately filed “several documents…on the public record that contain personal identifying information and medical records of his former patient, a non-party to this action,” which the court ordered sealed. The court also found no unreasonable or bad faith conduct by defendant that would support sanctions. On the other hand, the court noted that Wagoner sent defendant a demand letter threatening extensive discovery and reputational harm in which he stated, “[T]his process does not end quietly; it ends with headlines higher D&O premiums, and copycat litigation[.]” Wagoner declared that he “cannot be priced out, delayed, or worn down” unless defendant settled. He also filed complaints against defendant with the Arizona Attorney General and the FBI, using those filings as leverage to demand a large settlement and withdrawal of defendant’s fee motion. In short, “it is Plaintiff’s own conduct that is of great concern to this Court and will expound on this point further in the next section.” That section involved defendant’s motion for attorney’s fees. Applying the Ninth Circuit’s five-factor Hummell test for fee awards under ERISA, the court found the factors favored an award. On culpability/bad faith, the court found Wagoner acted in bad faith by initially pleading around ERISA to avoid preemption and by using the litigation as leverage for a settlement demand, evidenced by his threatening demand letter. On ability to pay, the court rejected Wagoner’s claimed financial hardship, noting he provided no supporting detail, had inflated his claimed damages from $6,945 in the original pleading to over $311,000 post-dismissal apparently to manufacture an appearance of hardship, and maintained an ongoing chiropractic practice. The remaining factors (deterrence, benefit to other plan participants, and relative merits) likewise favored defendant, particularly since Wagoner did not meaningfully contest them and his “new evidence” of bad faith (pre-authorization letters followed by a coverage denial) did not establish any unlawful conduct. Thus, the court turned to calculating a reasonable award. Applying the lodestar method, the court found defense counsel’s hourly rates ($360 and $305) reasonable and consistent with market rates, but reduced several billing entries by 40% as excessive (e.g., over 20 hours spent on a reply brief raising largely the same arguments as the original motion) or insufficiently itemized (block-billed entries mixing multiple tasks). The court also disallowed entirely certain unexplained or unverifiable entries, including communications with an unidentified individual not otherwise appearing in the record. After these reductions, the court approved $25,625.30 in fees and $954.06 in costs.

Breach of Fiduciary Duty

Sixth Circuit

Greenwood v. Cigna Health & Life Ins. Co., No. 4:25-CV-1759, 2026 WL 2263158 (N.D. Ohio Aug. 6, 2026) (Judge John R. Adams). Ross Greenwood was a beneficiary of a self-insured ERISA-governed health plan administered by Cigna Health and Life Insurance Company which covered medically necessary residential mental health treatment. Greenwood was admitted for residential treatment for major depression in 2024, but Cigna denied benefits for his stay. In this action Greenwood alleges that Cigna improperly relied on the MCG Behavioral Health Guidelines in finding his stay not medically necessary. Based on this theory he is pursuing class relief based on ERISA claims for breach of fiduciary duty, violation of plan terms, and breach of co-fiduciary duty. For remedies, he seeks declaratory and injunctive relief to prohibit Cigna’s ongoing use of the MCG Guidelines, and also reprocessing of his claims without application of those guidelines. Notably, Greenwood did not bring a claim for failure to pay plan benefits. Cigna moved to dismiss on several grounds, but argued principally that because Greenwood was no longer a plan beneficiary he did not have standing to seek equitable relief. The court agreed, resolving the motion entirely on that ground. It explained that Article III requires an “injury in fact” that is “concrete and particularized,” “actual or imminent, not conjectural or hypothetical,” is fairly traceable to the defendant’s conduct, and likely to be redressed by a favorable decision. According to the court, Greenwood’s allegations fell short regarding the “concrete stake” element: “Under the facts alleged here, to the extent that Greenwood seeks to prohibit the use of the MCG Guidelines in the future, his status as a former plan participant compels the conclusion that he does not have a concrete stake in the outcome. Any future processing of mental health claims under the existing plan will never impact Greenwood. Accordingly, regardless of any argument surrounding statutory standing, Greenwood cannot meet the requirement of Article III standing.” Greenwood argued that his request for reprocessing of his claim supported standing, but the court disagreed because “the complaint wholly fails to allege in his complaint that such a remedy would actually redress his injury.” The court ruled that in order to have standing, Greenwood “must, at a minimum, allege that reprocessing will remedy that injury. In other words, Greenwood must allege that absent use of the MCG Guidelines, he would be entitled to benefits.” However, Greenwood’s allegations did not support such a conclusion: “The denial of his benefits makes clear that the finding of medical necessity was not based solely on the MCG Guidelines. Rather, the denial letter detailed that Cigna relied on more than the Guidelines in denying the claim.” As a result, Greenwood’s reprocessing request failed for redressability reasons. The court thus ruled that Greenwood did not have standing, granted Cigna’s motion, and dismissed Greenwood’s complaint.

Eighth Circuit

Hodges v. Washington Regional Med. System, No. 5:26-CV-05070, 2026 WL 2296091 (W.D. Ark. Aug. 10, 2026) (Judge Timothy L. Brooks). Plaintiffs Donald Hodges and Joyce Kendrick are participants in the Washington Regional 401(k) Plan, a defined-contribution plan sponsored by their employer, Washington Regional Medical System (WRMS), to which employees contribute tax-deferred wages matched by WRMS. From 2016 to 2024, the plan’s most popular investment option was the American Century (AC) Target Date Fund, which held between 68% and 76% of plan assets. (Target date funds allocate assets based on a participant’s expected retirement date, shifting that mix as retirement approaches.) Plaintiffs contend in this putative class action that the AC fund underperformed comparable target date funds for years. To support their underperformance theory, plaintiffs compared the AC fund’s returns to four other target date fund families: the American Funds Retirement Series, Vanguard Target Retirement Series, T. Rowe Price Target Series, and BlackRock LifePath Index series. Plaintiffs contend that these funds “consistently outperformed most alternatives,” and, based on their large market share, were “the most often selected TDF options.” In Count I they contend that WRMS and its pension committee breached their ERISA fiduciary duties both by initially selecting the AC fund and by continuing to retain it despite its underperformance, and in Count II they allege that defendants derivatively breached their duty to monitor the plan’s fiduciaries. Defendants moved to dismiss for failure to state a claim. The court relied on Eighth Circuit precedent in stating that a fiduciary-breach claim requires more than an allegation that costs were too high or returns too low; a plaintiff must supply “a sound basis for comparison – a meaningful benchmark.” As a result, plaintiffs were required to present comparator funds that “hold similar securities, have similar investment strategies, and reflect a similar risk profile.” Plaintiffs contended that their four alternative funds were prominent, high-market-share TDF families, but this was insufficient for the court: “the fact that certain TDFs are ‘the top 5 largest’ and ‘account[ ] for 80% of all TDF-invested dollars’ does not make them comparable benchmarks to other TDFs.” The court stated that “fiduciaries select TDFs for any number of reasons” and plaintiffs cited no authority treating market prominence as a proxy for similar strategy or risk. Furthermore, the complaint “is silent about whether the comparators they have selected hold similar securities, have similar strategies, and reflect a similar risk profile as compared to AC TDF. The lack of such facts is fatal to the Complaint[.]” The court highlighted plaintiffs’ concession that they selected comparators sharing only “the same retirement-allocation purpose and the same glide-path [to retirement] structure” as the AC fund while acknowledging those comparators might carry “relatively more (or less) risk.” Plaintiffs argued they neutralized any such differences by applying their own “risk-adjusted performance metrics,” but the court concluded that risk-adjusted ratios “are not magic wands that equalize any two investments as meaningful benchmarks in the first place[.]” As a result, plaintiffs did not meet their burden of pleading meaningful benchmarks, and defendants’ motion to dismiss Count I was granted. The duty-to-monitor claim in Count II fell with it because it was derivative of Count I. The complaint was dismissed without prejudice.

Scholin v. Digi-Key Corp., No. 26-CV-1485 (JMB/LIB), 2026 WL 2234404 (D. Minn. Aug. 3, 2026) (Judge Jeffrey M. Bryan). In our second case involving American Century this week, plaintiff Paige Scholin is a former employee of Digi-Key Corporation and a participant in the company’s 401(k) Profit Sharing Plan. She alleges in this putative class action that from 2018 through at least the end of 2023, the plan retained target date funds (TDFs) managed by American Century. Scholin alleges these TDFs “consistently underperformed other prudent target date series options” across all metrics, including investment performance, risk-adjusted performance, and market acceptance of glide path and investment philosophy. Thus, she contends that the fiduciary defendants should have removed the TDFs from the plan’s menu by early 2020 at the latest. As in the Hodges case discussed above, Scholin presented as comparators four alternative TDF series that performed better: the Capital Group Target Retirement Series (American Funds), Vanguard Target Retirement Series, T. Rowe Price Target Series, and BlackRock LifePath Index series. She brought two claims under ERISA: (1) breach of the fiduciary duty of prudence under 29 U.S.C. § 1104(a)(1)(B), and (2) failure to adequately monitor plan fiduciaries. Defendants moved to dismiss both for failure to state a claim. On Scholin’s prudence claim, the court held that she failed to plead a “meaningful benchmark” for comparison as required by Eighth Circuit precedent. The court acknowledged that Scholin had presented four comparators, but the complaint contained no factual detail about their glide paths, specific investment holdings, objectives, or risk profiles, nor any explanation of how their structures were “sufficiently similar” to the plan’s TDFs. “Absent such allegations, the composition of these comparator TDFs ‘remains a mystery[.]’” The court also noted additional concerns that the complaint focused on poor fund performance rather than alleging a flawed decision-making process, and lacked detail on the “duration and magnitude” of the TDFs’ underperformance. However, the court’s ruling was not based on these concerns because the benchmark deficiency was sufficient to grant defendants’ motion. As for the failure to monitor claim, because it was derivative of Scholin’s underlying fiduciary breach claim, it necessarily failed as well. Defendants’ motion was thus granted, albeit without prejudice.

Ninth Circuit

Andrews v. Wilson Electric Services Corp., No. CV-24-00995-PHX-DJH, 2026 WL 2283444 (D. Ariz. Aug. 7, 2026) (Judge Diane J. Humetewa). Plaintiffs Daniel Andrews and Matthew Baker are employees of Wilson Electric Services Corporation (WESC) and participants in the company’s ERISA-governed Employee Stock Ownership Plan (ESOP). Naturally, the ESOP contains company stock, but it also has an “Other Investments Account” (OIA) containing more than $11 million. Plaintiffs allege that WESC, its plan committee, and six individual defendants who served on WESC’s board kept the OIA “invested exclusively in bank deposit and money market accounts during all or most of the subject period,” generating minimal returns. This meant that “the OIA funds depreciated in real value, and the retirement savings of ESOP participants effectively shrunk.” Plaintiffs’ operative third amended complaint asserts that defendants breached their fiduciary duty of prudence under 29 U.S.C. § 1104(a)(1) by failing to invest the OIA consistent with the ESOP’s retirement-savings objectives. The complaint also contains derivative claims for failure to monitor and co-fiduciary liability. Defendants moved to dismiss, arguing that (1) the Ninth Circuit’s 2025 decision in Anderson v. Intel (discussed in our May 28, 2025 edition and currently scheduled to be argued before the Supreme Court on October 6) foreclosed plaintiffs’ theory, (2) ERISA’s diversification exemption for ESOPs barred plaintiffs’ claims, (3) plaintiffs’ own allegations showed that the OIA was invested prudently, (4) the individual defendants were not adequately alleged as fiduciaries, and (5) the monitoring and co-fiduciary claims failed for being derivative of other failed claims. Regarding Anderson, the court found that defendants “overstate the import of the case and its impact on the present matter.” It stated that Anderson held only that a plaintiff relying on a purely circumstantial, underperformance-based theory must compare the challenged fund to a “meaningfully similar” benchmark. Defendants argued that under Anderson plaintiffs “cannot challenge a fiduciary’s risk-mitigation objective,” but the court noted that defendants “do not address whether there is a stated risk-mitigation objective here.” Instead, the ESOP’s stated purpose was to let participants “share in the growth and prosperity” of the company and “accumulate capital for their future economic security.” Defendants “do not identify any information establishing that a risk-minimization strategy was communicated to plan participants.” Furthermore, plaintiffs cleared Anderson’s requirement for a meaningful benchmark. The complaint identified specific comparator ESOPs that invested 60% to 95% of similar OIA balances in stocks, and cited a broader dataset showing that among comparable ESOPs, the median allocation to cash and short-term treasuries was just 17%, not 100% as here. The court found these allegations “sufficient to avoid dismissal.” The court added that, regardless of any comparators, plaintiffs had alleged a “mismatch” between the OIA’s all-cash allocation and the ESOP’s stated purpose of providing growth-oriented retirement benefits, which further supported a finding of a breach of the duty of prudence. The court relied on two 2026 district court decisions from the Ninth Circuit to support this argument, Moran v. ESOP Committee and Dawson-Roberts v. Norman S. Wright Mech. Equip. Moving on to defendants’ argument regarding ERISA’s diversification exception for ESOPs, the court again followed Moran and Dawson-Roberts, holding that the exception in 29 U.S.C. § 1104(a)(2) is limited in application to “qualifying employer securities,” and says nothing about the prudent management of non-employer-security assets like the OIA. The court also rejected defendants’ argument that the complaint actually pled prudent investment, clarifying that plaintiffs challenged only the OIA’s cash allocation, not the ESOP’s broader mix of WESC stock and other holdings. As for the individual defendants, the court found plaintiffs’ allegations “a bit thin,” but adequate, because plaintiffs alleged that each individual served on the board, which in turn directed the committee’s plan investment decisions. Finally, because plaintiffs’ prudence claim survived, the derivative failure to monitor and co-fiduciary claims survived as well. Thus, defendants’ motion to dismiss was denied in full.

Class Actions

Ninth Circuit

Bozzini v. Ferguson Enterprises LLC, No. 22-CV-05667-AMO, 2026 WL 2255455 (N.D. Cal. Aug. 5, 2026) (Judge Araceli Martínez-Olguín). This is a class action concerning alleged fiduciary breaches in the management of a retirement plan sponsored by Ferguson Enterprises LLC. Plaintiffs asserted four claims for relief under ERISA against Ferguson and related entities, contending that they breached their duty of prudence by allowing the plan to retain underperforming funds, not investing in lower cost shares, choosing actively managed funds instead of passively managed index funds, and declining to invest in better-performing funds. The court previously granted defendants’ motion to dismiss two of the four claims, leaving only the breach of prudence and failure to monitor claims, which centered on allegations of excessive recordkeeping fees. The parties subsequently negotiated a class settlement. Plaintiffs’ first motion for preliminary approval was denied in January of this year, as the court identified multiple deficiencies under the Northern District of California’s Procedural Guidance for Class Action Settlements (the “Guidelines”). Plaintiffs thus filed an amended motion attempting to cure the deficiencies identified. As the court explained in this order, they were unsuccessful. The court ruled that plaintiffs failed to correct several previously identified problems and identified additional new deficiencies. First, the court found unexplained discrepancies in the class definition as set forth in the operative complaint, the settlement agreement, and the long form notice to class members. Second, although plaintiffs represented that the settlement released only the surviving claim for excessive recordkeeping fees, the settlement agreement’s actual “Released Claims” definition swept more broadly, covering far more claims without adequate explanation for the discrepancy. Third, the proposed notice improperly directed objecting class members to send objections to both the parties’ counsel and the court, instead of just the court. It also imposed an objector disclosure requirement not authorized by the Guidelines, and failed to clearly state that the court cannot modify the settlement’s terms. The notice also contained outdated courthouse information. Fourth, the proposed schedule did not afford class members the Guidelines-required minimum of 35 days to opt out or object to the settlement and fee motion, nor did it give the court adequate time to review objections and responses before the final fairness hearing. Fifth, the court identified an unexplained discrepancy between the settlement agreement’s stated cap on settlement administration fees ($110,000) and the figure represented in the motion and notice ($120,000), as well as the motion’s omission of a separate recordkeeper fee (capped at $1,500) that was listed in the agreement. Sixth, plaintiffs cited two comparator cases to support their motion but failed to provide the specific comparative metrics the Guidelines require. The court also gave instructions regarding any amended motion, directing plaintiffs to provide specific case citations with pincites supporting comparable language, ideally summarized in easy-to-read comparison charts, and reminded plaintiffs to submit Word-format versions of proposed orders and notices as required by the Guidelines. As a result, plaintiffs’ motion was denied and they will have to try a third time.

Schuman v. Microchip Technology Inc., No. 16-CV-05544-HSG, 2026 WL 2227356 (N.D. Cal. Aug. 3, 2026) (Judge Haywood S. Gilliam, Jr.). When we last checked in on this case in our June 10, 2026 edition, it was scheduled to go to trial on July 13. As explained below, that did not happen. As a refresher, this is a long-running class action filed in 2016 alleging that Microchip Technology and related defendants failed to pay severance benefits owed under the Atmel Corporation U.S. Severance Guarantee Benefit Program. Crucial to the case was the allegation that defendants improperly solicited releases from class members in exchange for only partial benefits. Indeed, 215 of the 220 class members signed releases in exchange for partial severance. In 2023 the court granted partial summary judgment to defendants on this issue, ruling that the named plaintiffs’ releases were enforceable under a six-factor test. Plaintiffs appealed, and the Ninth Circuit reversed in a published opinion, articulating a new non-exhaustive nine-factor test for evaluating release enforceability. This test included consideration of whether the fiduciary engaged in improper conduct in obtaining the release, a factor the Ninth Circuit stated “may weigh particularly heavily” against enforceability. (This ruling was Your ERISA Watch’s case of the week in our June 11, 2025 edition.) After remand, the district court denied defendants’ motions to decertify the class and reopen discovery. Defendants apparently did not like which way the wind was blowing, and on the eve of trial the parties reached a $13 million settlement. In this order the court approved plaintiffs’ motion for preliminary approval of the settlement under Federal Rule of Civil Procedure 23(e). At the outset, because the settlement class definition mirrored the class already certified, and was recently examined in the court’s June order, the court found no need to revisit its prior Rule 23(a)/(b) analysis and thus provisionally certified the class. As for the settlement itself, it proposed that the five class members who never signed releases would receive 100% of their unpaid severance benefits plus interest, while the two named plaintiffs and the 213 class members who did sign releases would receive 80% of unpaid severance plus interest. The named plaintiffs would also receive $10,000 incentive awards, and class counsel would seek attorneys’ fees not exceeding $3.5 million. The court noted that the settlement contained a “clear sailing” provision by which defendants would not challenge plaintiffs’ fees, but the court was not concerned because the proposed fees were below the lodestar and were negotiated only after the substantive settlement terms were set. Furthermore, the fee award would not reduce class recovery and class members were receiving a substantial remedy; indeed, “[w]hen accounting for interest…Class Members’ recovery will exceed 100% of their unpaid severance amounts.” The court further found the settlement “within range of possible approval” given significant litigation risk. The court noted that the Ninth Circuit’s new multi-factor release-enforceability test would need to be litigated, and it was possible that predominance issues could undermine class certification. The court thus determined that “the settlement amount, given these risks, weighs strongly in favor of granting preliminary approval.” The court further approved the proposed notice plan, but directed counsel to include specific language stating the deadlines for filing and objecting to the attorneys’ fees and incentive award motions. The court also ordered the parties to meet and confer to set a schedule for finalizing approval of the settlement.

Disability Benefit Claims

Fourth Circuit

Wingfield v. United of Omaha Life Ins. Co., Civ. No. 3:25-11648-MGL, 2026 WL 2268478 (D.S.C. Aug. 6, 2026) (Judge Mary Geiger Lewis). Troy Wingfield was employed by Still Hopes Episcopal Retirement Community and was covered by his employer’s ERISA-governed long-term disability benefit plan, which was insured and administered by United of Omaha Life Insurance Company. Wingfield filed a claim for benefits under the plan, but United denied it. Wingfield alleges that he appealed, informed United that he was obtaining medical records, and asked United for an extension to submit those records, but United “completely ignored” the request and upheld its decision. Wingfield thus filed this action, asserting a single claim for plan benefits under 29 U.S.C. § 1132(a)(1)(B). However, rather than seeking a benefits award outright, the complaint asked only “that Plaintiff is entitled to a remand of his claim to Defendant for a full and fair review.” Wingfield contended that United “failed to allow a reasonable time period for Plaintiff to submit, and for Defendant to consider, important evidence Plaintiff intended to provide in support of his appeal.” Wingfield filed a motion to remand, which the court decided in this order. The court explained that remand to a plan administrator is a discretionary remedy, “most appropriate ‘where the plan itself commits the trustees to consider relevant information which they failed to consider.’” However, that remedy was inappropriate here because the medical records Wingfield wanted more time to gather were irrelevant to why his claim was actually denied. The plan required Wingfield to satisfy a 90-day waiting period, but United’s records showed that he was out of work for only 49 days. United’s denial letters repeatedly informed Wingfield that because he returned to work, with no loss in earnings, he did not satisfy the plan’s definition of disability. United’s final denial specifically noted that Wingfield’s appeal offered “no explanation” of how the additional records he sought “may be relevant to the denial of the claim given this was not a medical decision denial.” Because Wingfield’s only claim was a request for remand, and the court found remand “pointless,” it denied his motion and dismissed the case without prejudice. In doing so the court expressly declined to decide whether United “provided Wingfield with a sufficient opportunity in which to provide supporting documentation, as required by regulation.”

Ninth Circuit

Mendoza v. First Unum Life Ins. Co., No. 25-3080, __ F. App’x __, 2026 WL 2295887 (9th Cir. Aug. 10, 2026) (Before Circuit Judges Rawlinson, Sanchez, and Tung). Siam Mendoza submitted a claim for ERISA-governed long-term disability benefits after he was hospitalized for COVID-like symptoms in 2021. The plan’s insurer, First Unum Life Insurance Company, denied his claim, contending that Mendoza was not disabled throughout the plan’s elimination period. Mendoza thus brought this action seeking plan benefits under 29 U.S.C. § 1132(a)(1)(B). Under de novo review the district court concluded that Mendoza had not carried his burden to prove that he was disabled and entitled to benefits. (Your ERISA Watch covered this decision in our May 21, 2025 edition.) Mendoza appealed to the Ninth Circuit, which affirmed in this brief memorandum disposition, rejecting all four grounds Mendoza raised on appeal. First, it held the administrative record adequately supported the district court’s factual finding that Mendoza was not disabled under the plan: “After comparing the assessments from Plaintiff’s and Defendant’s set of experts, the district court found that Plaintiff had not met his burden to show he was disabled. That is enough to survive clear error review.” Second, Mendoza argued the district court erred by crediting First Unum’s non-examining, record-reviewing physicians over his own physicians. The court noted that courts are not required to give special deference to examining physicians, citing the Supreme Court’s 2003 decision in Black & Decker Disability Plan v. Nord. The Ninth Circuit added that the district court’s ruling was partly based on Mendoza’s own experts, who found that his “cognitive test performance was within normal limits.” Third, Mendoza contended that First Unum’s earlier payment of short-term disability benefits should have created a legal presumption that he was also disabled for long-term disability purposes. The court rejected this, stating that “no such presumption exists under our caselaw, and we have rejected similar propositions… Instead, our caselaw treats prior payment of benefits merely as relevant evidence of disability.” The district court was thus free to weigh, rather than defer to, the prior payments. Finally, Mendoza argued the district court improperly upheld the denial based on rationales First Unum never raised during the administrative claims process, contrary to the Ninth Circuit’s decision in Collier v. Lincoln Life that a court “clearly errs by adopting a newly presented rationale” not raised below. Mendoza asserted two examples: an inference that testing by one of his physicians showed signs of malingering, and a determination that witness statements submitted with his administrative appeal were not credible because they conflicted with the medical evidence. The panel disagreed that these were truly new rationales, and instead found that “those ‘new’ issues are merely subsidiary to a pre-litigation rationale that Defendant asserted in its denial of Plaintiff’s claim: that Plaintiff’s ‘self-reported symptoms are disproportionate’ to his ‘clinically unremarkable’ medical testing results.” In short, the court viewed the district court’s findings as simply elaborations on the original denial rationale rather than freestanding new grounds for denial. As a result, the court affirmed the judgment in First Unum’s favor.

ERISA Preemption

Third Circuit

Bowden v. Express Scripts, Inc., No. 3:25-cv-261, 2026 WL 2272715 (W.D. Pa. Aug. 6, 2026) (Judge Robert J. Colville). Garrett Bowden has health insurance through UPMC Health Plan (also known as Highmark) and is a longtime patient of Martella’s Pharmacies, “which Plaintiff describes as a critical healthcare provider in Cambria County and its surrounding areas that operates six community-based retail pharmacy locations and serves thousands of Cambria County and neighboring community residents.” Bowden is suing Express Scripts, Inc. (ESI) in its capacity as the pharmacy benefits manager for UPMC/Highmark members. ESI had a provider agreement with Martella’s, but in 2025 ESI announced it was dropping Martella’s from its network. Bowden alleges that this resulted in higher out-of-pocket costs, loss of home-delivery and adherence-packaging services, and increased health risks. He brought this putative class action in state court asserting state law causes of action. Defendants removed it to federal court based on ERISA and Class Action Fairness Act (CAFA) preemption and Bowden moved to remand. His motion was unsuccessful, as the court agreed with defendants that his claims were preempted by ERISA. (We covered this ruling in our September 24, 2025 edition). The court gave Bowden an opportunity to amend his complaint, which he took advantage of, asserting new state law claims in an effort to stay out of ERISA’s clutches. The amended complaint dropped any express reference to health benefits and instead pled a third-party-beneficiary breach of contract claim (based on the ESI-Martella’s provider agreement), a tortious interference with prospective economic relations claim, and once again a claim for violation of the Pennsylvania Unfair Trade Practices and Consumer Protection Law (UTPCPL). Bowden stressed in his new complaint that his class does “not seek to recover benefits or enforce plan terms[,]” but instead seeks “to enforce independent contractual and statutory duties owed to them as third-party beneficiaries and Pennsylvania consumers.” Bowden also renewed his motion to remand, while defendants moved to dismiss the new complaint. Bowden also moved for a preliminary injunction to reinstate Martella’s network status. The court denied Bowden’s renewed remand motion, holding that his new claims remained completely preempted by ERISA. The court’s analysis was the same as before “because, while Plaintiff has renamed his claims, the underlying facts and relief sought remain materially unchanged. As the Court previously noted, a plaintiff ‘cannot circumvent the preemptive reach of ERISA by artful pleading.’” Applying the two-part test from Aetna v. Davila, the court asked whether Bowden could have brought his claims under ERISA § 502(a) and whether any legal duty independent of the plan supported them. On the first question, the court found it “abundantly clear” that Bowden’s actual grievance was that Martella’s was no longer in-network, and “network scope” is a core aspect of plan benefit design. “Accordingly…Plaintiff’s claims implicate the administration of a health benefit plan,” and thus failed prong one of Davila. On the second question, the court found no independent duty could rescue Bowden’s claims. The breach of contract claim failed because Bowden cited no authority allowing him to sue as a third-party beneficiary of a PBM-pharmacy contract. The court reasoned that allowing such a remedy would mean “any health benefit plan participant would be able to circumvent the broad preemptive effect of ERISA.” Furthermore, if Bowden was correct, and ESI had breached its contract with Martella’s, “it is Martella’s, not Plaintiff,” who must pursue relief. The tortious interference claim also failed. That tort’s first element requires a relationship between the plaintiff and a third party which did not exist here; instead, Bowden was asserting interference with Martella’s relationships. This was misleading because Bowden’s real issue was “whether Defendants’ removal of Martella’s as an in-network provider complied with the requirements of the putative class members’ health benefit plans.” The same analysis applied to Bowden’s UTPCPL claim, as “Plaintiff provide[d] no basis to revisit” the court’s analysis of that claim from his first complaint. As an independent, alternative basis for jurisdiction, the court also found CAFA’s requirements met and rejected Bowden’s invocation of the local controversy exception as unsupported. Thus, the court granted defendants’ motion to dismiss and denied Bowden’s motions to remand and for a preliminary injunction. However, the court agreed to give Bowden one final opportunity to replead claims under ERISA.

Torsiello Plastic Surgery & Wound Care LLC v. K.B., No. 25-18323, 2026 WL 2295345 (D.N.J. Aug. 10, 2026) (Judge Julien Xavier Neals). Patient K.B. underwent five knee surgeries in 2019 while covered under an ERISA-governed health plan administered by Oxford Health Insurance (a subsidiary of UnitedHealthcare). Plaintiff Torsiello Plastic Surgery & Wound Care LLC performed four of the five procedures. Plaintiff alleges that K.B. and her husband agreed to pay for the services rendered and assigned plaintiff their right to seek reimbursement from Oxford. According to the complaint, Oxford reimbursed only a fraction of the billed charges, leaving K.B. with substantial unpaid balances. Plaintiff thus sued K.B., Oxford, and UnitedHealthcare. Count One “‘interpleads all of the Defendants – in an effort to have the appropriate party/parties pay the appropriate amounts to the Plaintiff’ for services rendered,” while Count Two alleges that “Plaintiff deserves to be compensated for the value of said medical services from those who benefited.” Defendants removed the case to federal court, asserting ERISA preemption. They then moved to dismiss on four grounds: (1) United was an improper defendant, (2) Count One failed as a matter of law because it did not state a true interpleader action, (3) any ERISA benefits claim embedded in the complaint failed as a matter of law, and (4) Count Two was preempted. Plaintiff did not oppose the motion, but the motion was denied regardless because the court found it did not have subject matter jurisdiction. The court explained that removal requires that a federal issue appear on the face of a well-pleaded complaint. Count One, though mislabeled as interpleader, “resembles an ordinary breach of contract claim,” and Count Two sounded in common-law unjust enrichment. “No element of Counts One or Two requires the Court to interpret federal law.” The court thus turned to defendants’ complete preemption argument, applying the Third Circuit’s two-prong Pascack Valley test, which asks (1) whether the plaintiff could have brought its claim under ERISA § 502(a)(1)(B), and (2) whether an independent legal duty is implicated. The court found no need to discuss prong two because prong one was not satisfied. A healthcare provider is not a “participant” or “beneficiary” authorized to sue under § 502(a), and can only obtain standing derivatively through a valid assignment of benefits from a plan participant. Here, however, the plan contained an anti-assignment clause, and thus plaintiff was not the “type of party” who could bring a § 502(a) claim. Complete preemption therefore did not apply, the court lacked subject matter jurisdiction, and it remanded the case to state court, denying defendants’ motion to dismiss as moot. In a footnote, the court noted that defendants had advanced substantially similar, unsuccessful ERISA-preemption removal arguments in other cases, and warned them that continuing to do so might expose them to attorney’s fees and sanctions.

Sixth Circuit

Turner v. Transamerica Investors Securities, LLC, No. 2:26-CV-117, 2026 WL 2240172 (S.D. Ohio Aug. 4, 2026) (Judge Algenon L. Marbley). Jessica Turner requested a hardship distribution from her retirement plan to buy a house. In this pro se action she alleges defendants Transamerica Investors Securities, LLC, Transamerica Retirement Advisors, LLC, and Pension Design Group, LLC denied her request and gave her inaccurate information, forcing her to secure real estate financing on worse terms when closing on her home. Turner originally sued, pro se, in state court, but the Transamerica defendants removed the case to federal court, asserting that ERISA governed her claims and that Pension Design Group, LLC was defunct. Turner then moved for leave to file an amended complaint, and then five days later filed a “Notice of Voluntary Dismissal of All Federal Claims and Motion to Remand,” which attached yet another amended complaint which dropped all ERISA references and instead asserted only state law claims. In this order the court considered the first motion to be moot given the new complaint presented in the second motion. It then denied the second motion. The court ruled that Turner could not simply attach a revised pleading to her remand motion and treat it as automatically superseding her prior complaint. Because she had already amended once, she needed either defendants’ written consent or leave of court, neither of which she had acquired. Even if Turner wanted to sever her federal claims while preserving her state law claims, she had to follow Federal Rule of Civil Procedure 21, not Rule 41, which only allowed her to dismiss an entire action. As for allowing Turner to amend, the court declined, holding that her proposed state law claims were merely her original ERISA claims recast to evade federal jurisdiction. Applying the artful pleading doctrine, the court explained that a plaintiff cannot circumvent removal by disguising claims that are “essentially federal” as state law claims, and that removal remains proper where there is federal preemption. Here that was the case. ERISA’s preemption provision supersedes state laws relating to employee benefit plans, and Turner’s proposed contract, negligence, and fiduciary duty claims all arose from the same denial of her hardship distribution request under her ERISA-governed retirement plan. As a result, Turner’s claims impermissibly attempted to create an end-run around ERISA’s civil enforcement scheme and were preempted. Turner tried to rely on the Supreme Court’s 2025 decision in Royal Canin v. Wullschleger, but the court ruled that it was distinguishable because it did not address the artful pleading doctrine or ERISA preemption, and did not require the court to treat her newly proposed pleading as the operative complaint. The court closed by noting that it would approve substitution of Capital Pension Group, LLC for the defunct Pension Design Group, LLC upon proper motion.

Exhaustion of Administrative Remedies

Seventh Circuit

Stempel v. Unum Life Ins. Co. of Am., No. 24 C 6077, 2026 WL 2241244 (N.D. Ill. Aug. 4, 2026) (Judge John F. Kness). James A. Stempel was an attorney for Kirkland & Ellis LLP and a participant in its ERISA-governed long-term disability benefit plan, which was insured and administered by Unum Life Insurance Company of America. Stempel filed a claim for benefits under the plan, but Unum denied the claim in August of 2021, sending a letter with appeal instructions. Stempel claims he submitted his appeal in January of 2022, followed by another letter in July of 2022. In 2023 Stempel sent an inquiry, to which Unum responded it had never received his prior letters and that his deadline to appeal had expired. Stempel thus filed this action, asserting a single claim for recovery of benefits under ERISA § 502(a)(1)(B), 29 U.S.C. § 1132(a)(1)(B). The parties agreed to submit the threshold issue of whether Stempel exhausted his administrative remedies to the court under Federal Rule of Civil Procedure 52. The court first ruled that exhaustion was required by the plan. Stempel contended that the requirement was in the summary plan description, not in the plan, and was thus unenforceable, but the court found that the summary plan description was incorporated into the plan and thus its exhaustion provisions applied. The court further ruled that no exception to the exhaustion requirement existed because Stempel “was given explicit instructions regarding the review process,” and “[n]othing in the record of this case suggests that Plaintiff’s appeal would certainly have been denied.” The court thus turned to whether Stempel had exhausted, declaring that the issue “boils down to the mailbox rule, a federal common law presumption that mail properly sent is received.” The court ruled that Stempel could not avail himself of the presumption because he could not show that his letters were “properly sent.” The court was skeptical of Stempel’s factual account, noting that he offered no witnesses, no electronic copies, and inconsistent testimony about which laptop the letters were drafted on and whether the laptop had been recycled. The copy of the envelope he produced for the January 2022 letter was unstamped, unpostmarked, and incorrectly addressed. The court highlighted that Stempel alleged he began drafting the January 2022 appeal letter in March of 2021, which was before his claim was denied in August of 2021, which the court found “an unlikely circumstance.” The court also used Stempel’s experience against him, noting that he was “a former partner in a highly successful corporate restructuring practice” and thus should have “exhibited a level of sophistication of execution beyond what he exhibited here” and should have been “aware of the importance of maintaining orderly records.” Furthermore, neither of Stempel’s first two alleged letters were sent by trackable methods, although his 2023 letter was, which hurt his credibility. Unum’s mail room supervisor offered testimony about the company’s mail-handling protocols and its retention of digital mail records for at least seven years, and asserted that Unum had conducted a thorough search of both digital records and its physical facility that found no trace of either 2022 letter. Even if Stempel could invoke the presumption, however, the court found that Unum had rebutted it with its detailed evidence of non-receipt. As a result, because Stempel could not establish that he timely mailed his appeal, he failed to exhaust administrative remedies. Judgment was issued in Unum’s favor.

Pleading Issues & Procedure

Second Circuit

Cunningham v. Cornell University, No. 16-cv-6525 (PKC), 2026 WL 2269035 (S.D.N.Y. Aug. 6, 2026) (Judge P. Kevin Castel). This decade-old case is familiar to ERISA practitioners for its ascent to the Supreme Court last year. In that appeal the high court ruled that plaintiffs alleging prohibited transaction claims under ERISA Section 406(a) do not also have to plead that their claims are not covered by the exemptions in Section 408. In short, the court held that the exemptions in Section 408 are affirmative defenses for defendants to prove, not for plaintiffs to negate in their complaints. (We covered this decision as our case of the week in our April 23, 2025 edition.) Now the case is back in the district court. As a reminder, plaintiffs are participants in the Cornell University Retirement Plan and the Cornell University Tax Deferred Annuity Plan who sued Cornell and other fiduciaries of the plans, alleging they engaged in prohibited transactions under ERISA when they allowed the plan to pay recordkeeping fees to third-party administrators TIAA-CREF and Fidelity. Plaintiffs seek to make defendants “personally liable to make good to the Plans all losses to the Plans resulting from each breach of fiduciary duty, and to otherwise restore the Plans to the position they would have occupied,” along with more conventional equitable relief such as removal of fiduciaries, an accounting, and plan reformation. In 2018, after the district court dismissed plaintiffs’ prohibited transactions claim, defendants moved to strike plaintiffs’ jury demand on the claims then remaining, and the court denied that motion in part, holding that the “make good” relief sought by plaintiffs was legal, not equitable, and therefore triable to a jury. Now that the case has returned to district court, defendants have renewed their motion to strike the jury demand, arguing that recent appellate decisions have undercut the district court’s previous ruling. The court applied the two-part test from Tull v. United States, which required the court to first compare the ERISA claim to its 18th-century common-law analogue, and second (and “more important”) examine whether the remedy sought is legal or equitable. On the first prong, the court agreed with defendants (and “plaintiffs now appear to concede”) that breach of fiduciary duty claims would historically have been brought in equity. On the second prong, the court also agreed with defendants that “the Complaint’s request for relief in the form of removal of fiduciaries, an accounting, reformation of the Plans and ‘other equitable or remedial relief as the Court deems appropriate’ are traditional equitable remedies for which the prohibited transaction claim need not be tried to a jury.” However, the court again arrived at a different conclusion regarding plaintiffs’ request for “make good” relief. The court relied on the Second Circuit’s 2005 decision in Pereira v. Farace for the proposition that restitution only lies in equity if it seeks to “to restore to the plaintiff particular funds or property in the defendant’s possession.” Here, however, defendants never possessed the recordkeeping fees at issue because they were paid to TIAA-CREF and Fidelity, not defendants. Thus, “make good” monetary relief demanded from defendants is “legal in nature,” not equitable restitution. The court rejected defendants’ argument that two intervening decisions had overtaken Pereira. It found that the Second Circuit’s 2020 decision in Sullivan-Mestecky v. Verizon Communications Inc. answered a different question regarding equitable remedies under ERISA and did not address jury issues, and thus could not have overruled Pereira “sub silentio.” As for the Supreme Court’s 2024 decision in SEC v. Jarkesy, the court found it cut against defendants because it reaffirmed that “money damages are the prototypical common law remedy,” and asked whether a monetary remedy “restore[s] the status quo.” Here, “the defendant fiduciaries never possessed the fees that are the subject of the prohibited transaction claim and recovery is sought from the personal assets of the defendants,” and thus ordering them to pay from their own assets was a personal, legal liability and not a restoration of the status quo. The court closed by noting that it was joining three sister courts in the Circuit (Vellali v. Yale University, Khan v. Board of Directors of Pentegra Defined Contribution Plan, and Garthwait v. Eversource Energy Co.), all of which had denied similar motions to strike jury demands. As a result, if this case is tried, part of it will go a jury.

Third Circuit

Birmelin v. Verizon Pension Plan for Assocs., No. 3:24-cv-1369, 2026 WL 2268378 (M.D. Pa. Aug. 6, 2026) (Judge Julia K. Munley). Kelly Birmelin is the widow of Michael Birmelin, a former Verizon employee who died in 2023. As his surviving spouse, Birmelin claims she is entitled to survivor pension benefits under the Mid-Atlantic Plan of the Verizon Pension Plan for Associates. The plan informed her that she qualified for only 65% of the available survivor annuity, but Birmelin contends that her husband’s accumulated vacation and sick time should have been credited toward his years of service, and that doing so would result in 100% of the available benefit. Birmelin filed this action in state court, asserting two counts: a declaratory judgment claim seeking recalculation of her husband’s employment time and a declaration that she is owed 100% of benefits, and a breach of contract claim alleging the plan violated the pension plan’s terms. What happened next is disputed. Birmelin says she served the complaint on the plan by certified mail to a post office box, that the plan never answered, and the state court entered a default judgment in her favor. The plan says it was never properly served, filed a state-court petition to open or strike the default, and removed the case to federal court before that petition was decided. The plan then filed a motion to dismiss for failure to state a claim based on ERISA preemption and failure to exhaust administrative remedies. Last year the court agreed that Birmelin’s claims were preempted, but ruled that it could not adjudicate the motion to dismiss until the state court default issue had been cleared up. (Your ERISA Watch covered this ruling in our September 24, 2025 edition.) The plan thus followed up with a motion to strike or vacate the default judgment, which placed two motions on the court’s plate. Addressing default first, the court first rejected the plan’s argument that the judgment was void for lack of service under Federal Rule of Civil Procedure 60(b)(4). The plan argued that Birmelin served it at the wrong address, but the court ruled that Birmelin had properly served the plan at the address listed in the summary plan description (SPD) for the plan administrator. The court was unimpressed by the plan’s attempt to recast the address as merely a “service center” distinct from the plan administrator: “Arguments caked in administrative sludge are not persuasive.” However, Birmelin’s victory on the service issue did not win the day. The court noted that the Third Circuit “does not favor entry of defaults or default judgments” and resolves doubtful cases in favor of deciding them on the merits. The court applied the Third Circuit’s four-factor test for excusable neglect under Rule 60(b)(1) – prejudice to the plaintiff, a meritorious defense, culpability, and the availability of alternative sanctions – and found in favor of the plan on each factor. First, Birmelin showed only delay, not lost evidence or impaired proof. Second, the plan’s preemption and exhaustion defenses were meritorious. Third, routing mail through a third-party vendor’s courier reflected carelessness rather than bad faith. Fourth, an “admonishment” to the plan for its confusing SPD language was an adequate alternative to default. Turning to the motion to dismiss, the court quickly reaffirmed that Birmelin’s state law claims were preempted by ERISA and therefore must be dismissed. It granted Birmelin leave to replead claims arising under ERISA. Furthermore, because the parties agreed Birmelin had not exhausted the plan’s claim and appeal procedures, the court stayed and administratively closed the case to allow for those procedures, ordering the parties to give periodic status reports.

Sixth Circuit

Tascarella v. Aptiv US Gen. Servs. Partnership, No. 26-3101, __ F. App’x __, 2026 WL 2243787 (6th Cir. Aug. 4, 2026) (Before Circuit Judges Batchelder, Moore, and Thapar). Aptiv Corporation offered Daniel Tascarella the position of plant manager of an Ohio manufacturing facility beginning in September of 2025. Tascarella “was particularly attracted to Aptiv’s ostensibly immediate vesting of employment benefits,” and began work. However, within a couple of days Tascarella began experiencing severe medical symptoms, including dizziness, temporary loss of consciousness, and drops in blood pressure. He was subsequently diagnosed with liver cirrhosis, portal hypertension, hepatic encephalopathy, and stage-four liver failure, with his doctor recommending a liver-transplant listing. Tascarella was approved for disability benefits and informed Aptiv he would need an indefinite leave extension. In response, Aptiv terminated Tascarella, citing “the ‘critical’ nature of the plant-manager position and the ‘undue burden’ of leaving that position vacant for an indefinite, months-long period.” Aptiv also offered a severance package that Tascarella considered insufficient. Tascarella thus sued Aptiv in state court asserting ERISA interference and various claims under state law, and moved for a temporary restraining order (TRO) and a preliminary injunction. The state court issued an ex parte TRO before Aptiv was able to remove the case to federal court. After a hearing, the district court denied Tascarella’s motion for a preliminary injunction, so Tascarella appealed. (Your ERISA Watch covered this ruling in our February 11, 2026 edition.) At the outset, the Sixth Circuit acknowledged that the district court erred by requiring Tascarella to prove his entitlement to an injunction by “clear and convincing evidence.” However, the appellate court noted that it could affirm on any ground supported by the record, and thus this legal error did not require reversal because Tascarella still failed to show irreparable harm under the correct standard. The court explained that “the irreparable-harm factor is ‘indispensable,’” and even a strong showing on the other relevant factors “will not overcome a lack of irreparable harm because ‘[i]f the plaintiff isn’t facing imminent and irreparable injury, there’s no need to grant relief now as opposed to at the end of the lawsuit.’” The court stated that losing employment, salary, disability benefits, life insurance, and retirement benefits are “quintessentially reparable by money damages,” and a delay in receiving compensation is not, by itself, irreparable harm. There was “no indication from the record that Aptiv would not be able to reinstate or compensate Tascarella should he prevail on the merits of his claims.” Tascarella argued that an injunction was required because he might lose the ability to reinstate his long-term disability and life insurance coverage, but the court found this speculative, and, in any event, these harms were fully compensable through money damages. Tascarella also argued that he “faces significant medical bills and an inability to obtain other income and benefits, both due to his liver condition,” thus warranting an injunction. However, the Sixth Circuit noted that the district court found that Tascarella was eligible for Medicare, Social Security benefits, and COBRA continuation coverage, and that he “‘has not pled a financial barrier to [his] obtaining [the] coverage’ or healthcare that he needs.” Tascarella could not rely on his wife’s needs either, because she too was eligible for COBRA continuation and had since become Medicare-eligible. Thus, “Tascarella’s assertion of ‘great undue hardship’ and a ‘great risk of being unable to obtain needed medical treatment’ is unavailing here, too.” As a result, the Sixth Circuit affirmed the ruling below, and Tascarella’s case will have to proceed without any interim relief.

Provider Claims

Ninth Circuit

Wagoner v. Local 428 Trustees of the Operating Engineers Health & Welfare Trust Fund, No. CV-26-03543-PHX-KML, 2026 WL 2247857 (D. Ariz. Aug. 4, 2026) (Judge Krissa M. Lanham). In our second Gary Wagoner case of the week (see above under “Attorneys’ Fees”) – curiously issued on the very same day as our first one – Wagoner provided medical services in 2019 and 2020 to a participant in the Local 428 Trustees of the Operating Engineers Health and Welfare Trust Fund, a self-funded multi-employer ERISA welfare benefit plan. Wagoner submitted claims to the Fund totaling $378,971.62 but the fund allegedly systematically denied or underpaid those claims. Wagoner filed suit in Arizona state court, asserting state law claims and, in the alternative, ERISA claims under § 502(a)(1)(B) (for plan benefits) and § 502(a)(3) (for equitable relief). Wagoner applied for entry of default in state court, but the Fund subsequently removed the case to federal court and then filed a motion to dismiss. The Fund argued that Wagoner’s state law claims were preempted by ERISA, that the governing plan’s anti-assignment clause barred Wagoner from pursuing any ERISA claims, and that the claims were untimely. Wagoner opposed, first arguing that the state court default entry barred the motion, and alternatively addressing the merits. The court addressed the default issue first, finding no evidence that default had actually been entered in state court before removal, and even if it had been entered, “any delay in appearing was brief, the Fund has now appeared, and the Fund has meritorious defenses.” Thus, the court ruled that any purported default was vacated. On the merits, the court noted that Wagoner had filed numerous similar suits in recent years, several of which had resulted in rulings that his state law claims were preempted by ERISA. “Despite this case raising the same type of claims, Wagoner does not address the governing law nor identify any way in which his state-law claims might avoid preemption.” Indeed, the court noted that Wagoner effectively conceded that both sets of his claims arose from the same underlying facts by alleging ERISA claims in the alternative. The court thus found Wagoner’s state law claims to be preempted. As for Wagoner’s claims under ERISA, the court noted that he was bringing them as an assignee and not on his own behalf. However, the plan at issue contained an anti-assignment clause. The court stated that anti-assignment clauses in ERISA plans are valid and enforceable, and considered the plan documents as incorporated by reference into the complaint. (The court rejected Wagoner’s attempt to dispute the authenticity of the plan because the document he submitted contained the same relevant language as the document offered by the Fund.) Examining that language, the court found that while the plan permitted a participant to “request” that benefit payments be directed to a provider, this did not constitute an assignment because the plan specifically stated that “coverage and your rights to receive any benefits under this Plan may not be assigned.” Furthermore, directing payment to a provider “is not an assignment of any right under this Plan or under ERISA…and is not an assignment of any legal or equitable right to institute any court proceeding.” As a result, the anti-assignment provision was enforceable and prevented Wagoner from bringing his ERISA claims. The court granted the Fund’s motion in full and directed judgment in the Fund’s favor.

Retaliation Claims

Sixth Circuit

Hoxworth v. Erard, No. 1:26-CV-626, 2026 WL 2274159 (W.D. Mich. Aug. 7, 2026) (Judge Hala Y. Jarbou). Jeffrey Hoxworth worked for SDI Consulting, LLC for more than 20 years, was a member of SDI, owned one-third interest in the company, and participated in the company’s 401(k) plan. Hoxworth alleges that SDI withheld money from his wages for his 401(k) contributions but failed to transfer those funds to the plan. In early 2026 he sent SDI a letter raising 401(k) and pay issues and informed SDI that he was resigning effective April 11, 2026. Hoxworth alleges SDI placed him on administrative leave the very next day and terminated him a week later, citing performance problems it had never previously raised. Hoxworth sued SDI, along with JAE Consulting LLC (a fellow member of SDI) and Jeremy Erard (JAE’s owner and SDI’s managing member), asserting ERISA claims for the unremitted 401(k) contributions and for retaliation, in addition to claims under the Fair Labor Standards Act and state law. Erard and JAE were parties to an Operating Agreement, which was executed alongside Hoxworth’s 2018 buyout of Hoxworth’s SDI ownership stake, that required arbitration of disputes among SDI’s members. Defendants jointly moved to compel arbitration of all of Hoxworth’s claims, and alternatively moved to dismiss the ERISA claims for lack of Article III standing and the ERISA retaliation claim for failure to state a claim. The court first addressed standing. Defendants argued that Hoxworth’s 401(k) claim had had already been resolved by a prior Department of Labor consent order against SDI and Erard covering the same conduct. The court disagreed, stating that the record did not indicate that the DOL settlement was coextensive with Hoxworth’s claimed damages or that his losses had been fully redressed. Any risk of a double recovery, the court held, was a merits issue to be addressed later, not a basis to find lack of standing. Turning to arbitrability, the court found that the Operating Agreement’s arbitration clause governed the ERISA claims against JAE and Erard, regardless of forum selections clauses in Hoxworth’s separate Employment and Redemption Agreements, because all three contracts were executed as one interrelated transaction and had to be read together. JAE, as an actual signatory, could compel arbitration outright. Erard, though not a signatory, could enforce the clause under Michigan agency-law principles because he had signed the Operating Agreement as JAE’s agent. However, the court changed course regarding SDI, ruling that it could not invoke the arbitration clause because the Operating Agreement expressly disclaimed third-party beneficiaries, and SDI was not JAE’s agent. The court also held that it was required to resolve the issue of whether non-signatories could enforce the arbitration agreement, instead of an arbitrator, under the Supreme Court’s 2024 decision in Coinbase, Inc. v. Suski. (The court even concluded that this decision “implicitly overruled” a Sixth Circuit decision to the contrary.) Thus, in the end Hoxworth will have to arbitrate his claims against JAE and Erard, but his claims against SDI remained in federal court. The court stayed the non-arbitrable claims pending arbitration, however, because they were “inherently inseparable” from the arbitrable claims. As for the merits of Hoxworth’s ERISA retaliation claim, the court held Hoxworth adequately alleged that SDI fired him because he complained about his 401(k) contributions. Termination two months before his planned resignation date was an adverse action, and the one-day gap between his complaint letter and his administrative leave, followed by termination a week later, was close enough in time to support an inference of retaliatory causation. The court found this reinforced by SDI’s reliance on performance problems it had never previously raised. Defendants’ motion to dismiss the retaliation claim was thus denied.

Seventh Circuit

Tallon v. United Airlines, Inc., No. 25 C 7529, 2026 WL 2294706 (N.D. Ill. Aug. 10, 2026) (Judge Jorge L. Alonso). Michael Tallon, a United Airlines pilot, alleges that in 2023 he suffered a head injury when he tripped during a layover in the Azores. Tallon further alleges that when he raised the issue with United and his union, the Air Line Pilots Association (ALPA), they directed him into the Human Intervention Motivation Study (HIMS) program, a substance-abuse treatment and monitoring track developed by the Federal Aviation Administration. They did not arrange for any care for his head injury. Instead, ALPA’s HIMS representative told Tallon that “if he did not confess to a drinking problem, he would never fly for United again.” Tallon denied having a drinking problem but enrolled in HIMS under “coercion and duress,” worried that he might suffer “loss of benefits…or termination.” Tallon alleges that over the following two years, he underwent repeated evaluations that increasingly indicated he did not have alcohol dependence, yet United continued to require additional testing which he ultimately refused. He was removed from HIMS, issued a noncompliance charge, and eventually terminated in 2025. He now brings this action against United, ALPA, and two examining physicians, alleging claims including disability discrimination and retaliation, Rehabilitation Act violations, civil RICO claims, and state-law fraud and tortious interference claims. Most relevant to us, Count IV alleges that United and ALPA violated ERISA § 510, 29 U.S.C. § 1140, which makes it unlawful to discharge or discriminate against a plan participant “for the purpose of interfering with the attainment of any right to which such participant may become entitled under the plan.” Tallon’s theory was that by pressuring him into the HIMS program, defendants interfered with his long-term disability (LTD) benefit rights under United’s collective bargaining agreement with ALPA. This was because participation in the HIMS program, which acts as a form of disability coverage, “puts this bargained-for LTD benefit at risk.” All four defendants moved to dismiss. On the ERISA count, United and ALPA argued that the claim was precluded by the Railway Labor Act (RLA), which governs airline-industry collective bargaining agreements, and, alternatively, that Tallon failed to plausibly allege the required causal connection between his benefits and his termination. The court agreed on both grounds and dismissed the ERISA claim. First, applying the RLA’s “minor dispute” doctrine, which gives the RLA precedence in “controversies over the meaning of an existing collective bargaining agreement in a particular fact situation,” the court explained that Tallon’s claim must be arbitrated under the RLA because it involved interference with a bargained-for benefit. Independent of preclusion, the court held the claim implausible on the merits. Tallon’s own allegations showed that he applied for and received full LTD benefits, including back pay, for his head injury, and was only terminated afterward when he failed to complete the HIMS program’s required testing. As a result, “it is not plausible that his termination was motivated by his receipt of ERISA benefits.” The court granted defendants’ motion to dismiss Tallon’s other federal claims as well for a variety of reasons. It also declined to exercise supplemental jurisdiction over his state law counts, although it identified several issues with them “in hopes of heading off issues that might recur if Plaintiff files a second amended complaint.” The dismissal was without prejudice.

Statute of Limitations

Third Circuit

Fernandez v. Famiglio, No. 26-CV-0105, 2026 WL 2227138 (E.D. Pa. July 31, 2026) (Judge Chad F. Kenney). Sacha Fernandez alleges in this pro se action that she was employed by Peter Famiglio from 2014 to 2020, during which time she participated in an ERISA-governed 401(k) retirement plan. She alleges that she discovered company misconduct, and after her employment ended, Famiglio’s brother, an attorney, threatened to sue her and withhold her 401(k) funds if she spoke up. Fernandez filed this action; one of her claims was for statutory penalties for failure to provide plan documents under ERISA, 29 U.S.C. §§ 1024, 1132(c). Famiglio filed a motion to dismiss, which was granted in May of this year. The court specifically ruled that Fernandez’s statutory penalty claim was time-barred because her claim accrued by 2020 at the latest, but she did not file this action until 2026. (See our June 3, 2026 edition for more details about this decision.) Now, Fernandez has moved for reconsideration of that order. She submitted fifteen exhibits and a proposed second amended complaint with more detailed factual allegations regarding her document requests. The court emphasized that “[a] motion for reconsideration is an ‘extremely limited’ remedy, which courts grant ‘only to correct manifest errors of law or fact or to present newly discovered evidence.’” Fernandez did not qualify for relief under this standard. The court stated that although ten of the fifteen exhibits attached to the SAC were new to the record, they were available to Fernandez when she filed her initial complaint and thus did not qualify as “newly discovered” evidence justifying reconsideration. Moreover, the court had already accepted Fernandez’s factual allegations as true, and thus the additional details “do not change the outcome.” Fernandez also identified no intervening change in controlling law. The court then revisited the legal issue and determined once again that Fernandez’s claim was time-barred. The court explained that her claim was governed by Pennsylvania’s analogous two-year statute of limitations for civil penalty and forfeiture actions. Because she submitted her request for plan documents on July 24, 2020, defendant’s response was due by the end of August 2020 and her claim accrued then. She thus had until August of 2022 to file suit, but she waited until 2026. Fernandez argued that her “inability to access the governing Plan documents impaired her ability to understand the procedures applicable to her retirement-plan claims, including where such claims should be brought.” However, the court stated, “This is not an extraordinary circumstance.” The court held that “Defendant’s failure to furnish the requested information within the thirty-day deadline should have been sufficient to alert Plaintiff that she had an actionable claim.” Fernandez also argued that her originally filed complaint in state court should have tolled her deadline, but this argument did not work either: “[E]ven if the state action did toll the statute of limitations, reconsideration must still be denied because Plaintiff’s initial state court action was itself untimely… Plaintiff did not file her state court action until December 15, 2023, over a year after the statute of limitations had run.” Fernandez’s motion for reconsideration was thus denied.

Withdrawal Liability & Unpaid Contributions

Ninth Circuit

City of Tacoma v. Western Metal Industry Pension Fund, No. 25-4055, __ F. App’x __, 2026 WL 2295813 (9th Cir. Aug. 10, 2026) (Before Circuit Judges McKeown, N.R. Smith, and Christen). Western Metal Industry Pension Fund is a multiemployer pension plan governed by ERISA. The City of Tacoma was a contributing employer to the plan under a series of collective-bargaining agreements, but it withdrew from the plan after its obligations under those agreements ended. The parties disagreed regarding how much withdrawal liability Tacoma owed, so the parties took the dispute to arbitration. The arbitrator ruled that the plan’s actuary erred by calculating Tacoma’s withdrawal liability using interest-rate assumptions published by the Pension Benefit Guaranty Corporation (PBGC) rather than a rate that reflected the “best estimate of anticipated experience under the plan,” as required by 29 U.S.C. § 1393(a)(1). The arbitrator ordered the plan to recalculate Tacoma’s liability using a 7% interest rate instead, the same rate the plan used to calculate minimum-funding contributions for participating employers. The district court confirmed the award and the plan appealed to the Ninth Circuit, which affirmed in this unpublished memorandum disposition, ruling that the district court “simply followed controlling precedent… Because the PBGC rates were not based on the Plan’s assets and did not account for any future experience of the Plan, the actuary’s use of those rates was improper.” The Ninth Circuit also rejected the plan’s challenge to the 7% interest rate. It emphasized the deference owed to the arbitrator’s factual findings under 29 U.S.C. § 1401(c), which directs courts to presume an arbitrator’s findings of fact are correct unless rebutted “by a clear preponderance of the evidence.” The plan’s actuary testified in her deposition that the 7% rate was “based on expected returns of the assets of the [P]lan,” and the arbitrator found that this rate “best reflect[ed] the anticipated experience under the [P]lan.” The plan did not sufficiently rebut the presumption that these conclusions were correct. The court noted that in a previous case (GCIU-Employer Retirement Fund v. MNG Enterprises, Inc.) it had similarly upheld an arbitral award ordering recalculation of withdrawal liability using a plan’s own minimum-funding interest rate, which supported the result here. Finally, the panel denied Tacoma’s request for appellate attorney’s fees and costs under 29 U.S.C. § 1451(e), which gives courts discretion to award fees to a prevailing party in multiemployer plan litigation. Applying the court’s five-factor test from Cuyamaca Meats, the panel found that two factors cut against an award: the plan’s ability to pay the fees, and the fact that an award would not particularly benefit the plan’s participants. The panel also concluded, “Our decision today will provide sufficient deterrent value.” Thus, the court affirmed the judgment in Tacoma’s favor, but exercised its discretion to deny the city’s fee request.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Breach of Fiduciary Duty

Sixth Circuit

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

Seventh Circuit

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

Class Actions

Ninth Circuit

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

Disability Benefit Claims

Ninth Circuit

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

Discovery

D.C. Circuit

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

Sixth Circuit

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

ERISA Preemption

Fifth Circuit

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

Medical Benefit Claims

Seventh Circuit

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

Tenth Circuit

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

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

Pension Benefit Claims

Ninth Circuit

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

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

Pleading Issues & Procedure

First Circuit

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

Fourth Circuit

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

Ninth Circuit

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

Provider Claims

Fourth Circuit

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

Eleventh Circuit

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

Statute of Limitations

Fourth Circuit

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

Venue

Ninth Circuit

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