Nevada Resort Ass’n-Int’l Alliance of Theatrical Stage Emps. & Moving Picture Mach. Operators of the US & Canada Loc. 720 Pension Tr. v. JB Viva Vegas, LP, No. 24-2791, __ F.4th __, 2026 WL 32577 (9th Cir. Jan. 6, 2026) (Before Circuit Judges Rawlinson, Miller, and Desai)

In a first for Your ERISA Watch, we are covering a withdrawal liability case as our notable decision for the second week in a row. Last week, the Ninth Circuit tackled the issue of what constitutes the “building and construction industry” under ERISA, as amended by the Multiemployer Pension Plan Amendments Act (MPPAA). In this week’s edition, the very same court – indeed, the very same panel of judges – focused its attention on the MPPAA’s use of the term “employees in the entertainment industry.”

As we explained last week, Congress enacted the MPPAA in 1980 to strengthen pension protections in multiemployer plans. Before the MPPAA, ERISA “did not adequately protect multiemployer pension plans from the adverse consequences that resulted when individual employers terminated their participation in, or withdrew from, multiemployer plans.” Thus, under the MPPAA, an employer that withdraws from a multiemployer pension plan is liable for its share of the plan’s unfunded vested benefits in order to help keep the plan afloat.

However, employers do not always have to pay withdrawal liability because the MPPAA includes several exceptions. Last week we discussed one of them: work in the “building and construction industry.” In that case the court ruled that asbestos abatement fell within that exception because Congress intended the term “to include not only the erection of new buildings, but also maintenance, repair, and alterations that are essential to the buildings’ usability.” This case involved a different exception revolving around “employees in the entertainment industry.” Would the court interpret this term expansively as well?

The plaintiff in this case was – deep breath – the Nevada Resort Association-International Alliance of Theatrical Stage Employees and Moving Picture Machine Operators of the United States and Canada Local 720 Pension Trust. In the past, employees covered by the Trust’s pension plan primarily performed entertainment work. However, as time passed, Las Vegas hotels and other venues began hosting more conventions and trade shows. The Trust recognized this trend, and in 2013 it amended its plan restatement to state that it “is not an Entertainment Plan under ERISA.”

Meanwhile, from 2008 to 2016 the defendant, JB Viva Vegas LP, contributed to the plan on behalf of the stagehands for its production of “Jersey Boys.” When the musical closed, JB stopped contributing to the plan. The Trust demanded $913,315 in withdrawal liability.

In arbitration proceedings JB disputed its liability, contending that it qualified for the MPPAA’s entertainment exception. The arbitrator agreed, but when the case moved to federal court the assigned district court judge invalidated the award. The court ruled that the arbitrator “improperly shifted the burden of proof to the Trust and should have determined the plan’s status as an entertainment plan based on the year that JB withdrew from the plan, rather than the year it joined.” As a result, the court vacated the award and remanded to the arbitrator.

On remand, the arbitrator reversed itself and granted summary judgment to the Trust. The arbitrator concluded that the MPPAA was ambiguous because “it does not specify the amount of entertainment work an employee must perform to qualify as an entertainment employee.” Furthermore, the arbitrator held that the Trust reasonably concluded that the plan does not “primarily cover employees in the entertainment industry” because “less than half of its employees earned more than half of their wages from entertainment work.”

JB was understandably displeased with its reversal of fortune and filed this action to challenge the arbitrator’s decision. The parties filed cross-motions for summary judgment but JB went bust again; the court granted the Trust’s motion while denying JB’s. The district court ruled that “the plan does not primarily cover entertainment employees because fewer than half of its employees earned the majority of their wages from entertainment work.” JB appealed, and the Ninth Circuit issued this published opinion.

The Ninth Circuit noted that the MPPAA’s entertainment exception applies if “(1) the employer contributes to the plan ‘for work performed in the entertainment industry, primarily on a temporary or project-by-project basis,’ (2) ‘the plan primarily covers employees in the entertainment industry,’ and (3) the employer ends its entertainment work in the jurisdiction and does not resume the work within five years.”

The crux of the dispute was the second element. The parties agreed that a pension plan “primarily” covers entertainment employees if more than half of the covered individuals are employees in the entertainment industry. However, they disagreed about what constituted an “employee in the entertainment industry.” The Trust argued that “over 50 percent of an individual’s work must be in the entertainment industry for the individual to be an ‘employee[ ] in the entertainment industry,’” while JB argued that “the statute imposes no minimum entertainment-work requirement.”

The court observed that this was a question of first impression, and as expected looked first to the text of the statute. The court ruled that “the plain text of the entertainment exception unambiguously covers individuals performing any amount of entertainment work.” The court stated, “Under a plain reading of the text, an individual who performs work in the entertainment industry is an ‘employee in the entertainment industry.’ That is all that is required.” The statute did not state that a person’s work had to be “substantially” or “primarily” in the entertainment industry to qualify; “any amount of entertainment work suffices.”

The Trust argued that the provision was ambiguous because it gives “no instruction on how to determine if an employee should qualify as in the entertainment industry.” However, the court stated, “instructions are unnecessary…the text is plain on its face: an individual qualifies if they work in the entertainment industry.”

The Trust also argued that even if the statute was unambiguous, the court should still recognize a minimum entertainment-work requirement because ruling otherwise would lead to “absurd results.” The Trust argued that “it makes little sense to classify someone as an ‘employee[ ] in the entertainment industry’ when the person performs a minimal amount of entertainment work.”

However, the court responded that it could not take such liberties when the plain meaning of the statute indicated otherwise. Furthermore, the court observed, “Given the part-time nature of most entertainment work, it is possible that Congress intended ‘employees in the entertainment industry’ to include individuals who work multiple jobs or projects, some of which involve entertainment work and some of which do not.” In short, “Because the entertainment exception is unambiguous, we must enforce its clear meaning and refrain from writing in limitations that do not exist.”

The court further ruled that even if the text were ambiguous, as the Trust argued, it would still rule the same way because “the best reading of the exception is that ‘employees in the entertainment industry’ are individuals performing any amount of entertainment work.” The court noted that Congress “knew how to impose quantitative limits” when drafting the MPPAA because it had done so in other parts of the legislation. “Congress inserted language like ‘insubstantial portion,’ ‘substantially all,’ or ‘primarily’ to limit the applicability of withdrawal exceptions to employers and plans conducting a certain amount of work” when discussing other industries, such as construction and trucking. However, Congress did not do so with respect to the “entertainment industry”; the phrase “does not include any limiting language.”

As a result, the Ninth Circuit held that the Trust’s plan “‘primarily covers employees in the entertainment industry’ because there is no minimum entertainment-work requirement and the majority of employees covered by the plan perform some entertainment work.” The case was thus reversed and remanded, giving employers two victories in two days over how to interpret the MPPAA’s withdrawal liability exceptions.

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

Breach of Fiduciary Duty

Second Circuit

Dempsey v. Verizon Communications, Inc., No. 24 CIV. 10004 (AKH), 2026 WL 72197 (S.D.N.Y. Jan. 8, 2026) (Judge Alvin K. Hellerstein). The plaintiffs in this action are former participants in defendant Verizon Communications Inc.’s defined benefit pension plans. They filed this action against Verizon and related entities alleging that the defendants breached their fiduciary duties and engaged in prohibited transactions by purchasing annuities from Prudential Insurance Company of America (PICA) and RGA Reinsurance Company in terminating the plans through what is commonly known as a “pension risk transfer,” or PRT. Plaintiffs allege that PICA and RGA were unsuitable providers because they posed a high risk of default due to their use of captive reinsurance and modified co-insurance practices. They further argued that the annuity providers’ financial practices reduced transparency and increased liabilities, creating a substantial risk of future harm to plaintiffs’ benefits. Plaintiffs also alleged that the annuity transaction resulted in a $200 million shortfall between the plan assets transferred and the liabilities, violating ERISA. Defendants filed motions to dismiss, which the court ruled on in this order. First, defendants contended that plaintiffs lacked standing because they failed to allege a substantial risk of future harm or any present injury. They contended that the plaintiffs’ claims were speculative and that the annuity providers were reputable companies with strong financials, making the risk of default implausible. The court agreed, ruling that plaintiffs’ allegations were “conclusory and speculative.” The court stated that financial records showed “adequate assets and strong credit ratings for each of the Annuity Providers,” which were “substantial companies.” Furthermore, “reinsurance and modified coinsurance are common industry practices,” and “the use of such common industry practices does not create a substantial risk of default.” The court also rejected plaintiffs’ argument that their equitable remedies could create standing, because the diminution in value plaintiffs identified represented “an accounting value difference, not actual cash or profits realized by Verizon.” In any event, “Seeking an equitable remedy is insufficient to create standing without a concrete injury.” The court then addressed the merits of plaintiffs’ claims for breach of fiduciary duty and loyalty. The court agreed with plaintiffs that Verizon exercised fiduciary duties in selecting the annuity providers. However, plaintiffs failed to plausibly allege that a prudent fiduciary would not have selected those providers. Again, the court stated that the providers were “reputable insurance companies,” and plaintiffs “are unable to allege that the actual investments made by the Annuity Providers are suspect or point to other markers that would imply a high risk of default.” The court also rejected plaintiffs’ duty of loyalty claim based on allegations of conflict of interest. The court ruled that the financial connections between the defendants were “common business relationships” and thus did “not support a plausible inference of liability absent other allegations to support disloyalty.” Finally, the court addressed plaintiffs’ prohibited transaction claims. The court dismissed these as well, ruling that the sale of annuity contracts did not constitute the provision of services, and thus, the annuity providers were not parties in interest under ERISA. The court also found no prohibited transaction in Verizon’s balance sheet benefit from the annuity transaction, as there was no actual transfer of plan assets to Verizon. Thus, in the end, the court granted defendants’ motions to dismiss the case in their entirety. The dismissal was with prejudice because “Plaintiffs have not asked to replead and, it would seem, a repleading would be futile.”

Third Circuit

Cho v. The Prudential Ins. Co. of Am., No. 25-1134, __ F. App’x __, 2026 WL 74499 (3d Cir. Jan. 9, 2026) (Before Circuit Judges Krause, Phipps, and Fisher). Plaintiff Young Cho, a former employee and participant in The Prudential Insurance Company of America’s employer-sponsored defined contribution retirement plan, brought this putative class action against Prudential and its investment oversight committee (IOC). Cho contends that Prudential breached its fiduciary duty and failed to monitor its fiduciaries under ERISA due to deficiencies in its investment monitoring process, leading to imprudent investment decisions. Cho did not convince the district court, which granted summary judgment in favor of Prudential, concluding that Cho failed to raise a triable issue of fact regarding Prudential’s prudence in its investment decisions. Cho appealed to the Third Circuit, which issued this unpublished ruling. On appeal, Cho argued that Prudential’s fiduciary process was not sufficiently independent or grounded in objective data. Cho contended that Prudential’s external professional investment consultant, Bellwether Consulting LLC, “was not truly independent from the IOC” because it was founded by former Prudential employees and was “engaged without a competitive bidding process.” Cho also argued that the IOC’s quarterly meetings were too brief, briefing materials were not received sufficiently in advance, Prudential appointed unqualified members to the IOC, and it preferred its own affiliated investment products. The Third Circuit was not impressed. The court emphasized that the duty of prudence is a process-driven obligation, focusing on the fiduciary’s conduct in making investment decisions. The Third Circuit agreed with the district court that Prudential employed appropriate methods to investigate and determine the merits of investments. The court noted that the IOC’s process, which included engaging an independent consultant, holding regular meetings, and receiving regular updates, was adequate to satisfy ERISA’s duty of prudence. The IOC actively engaged with not just Bellwether, but also an internal group of investment professionals at Prudential, and there was no indication of passive acceptance of recommendations without independent investigation. The court also found that the IOC evaluated and monitored both affiliated and non-affiliated funds using the same criteria and process, receiving independent advice throughout. The court further concluded that the IOC engaged in a robust process for selecting and monitoring investments, and the record evidence confirmed generally positive performance for the challenged funds compared to benchmarks. As a result, the court affirmed the lower court’s issuance of summary judgment in Prudential’s favor.

Disability Benefit Claims

Fifth Circuit

Portier v. Hartford Life & Accident Ins. Co., No. CV 24-1717, 2026 WL 45078 (E.D. La. Jan. 7, 2026) (Judge Ivan L.R. Lemelle). From 2021 to 2023 Jody Portier received benefits from Hartford Life & Accident Insurance Company under an ERISA-governed group long-term disability benefit policy. During this period the policy had an “Own Occupation” standard, which required him to be unable to perform his specific job. After 24 months, the standard changed to “Any Occupation,” requiring Portier to be unable to perform the duties of any job to continue receiving benefits. Hartford conducted an Employability Analysis Report (EAR) to identify suitable occupations for Portier, considering his limitations. The EAR suggested that Portier could work as a “Superintendent, Maintenance,” a sedentary job with flexibility for breaks. As a result, Hartford terminated Portier’s benefits, informing him that he did not meet the policy’s “Any Occupation” definition of disability. Portier appealed this decision, providing additional medical opinions and personal statements about his conditions, including coronary artery disease, Crohn’s disease, knee osteoarthritis, and others. In response, Hartford obtained a report from an independent physician, who acknowledged Portier’s impairments but concluded that he could work full-time with certain limitations. Hartford upheld its decision based on this report. In doing so, Hartford acknowledged that Portier had been awarded Social Security disability benefits, but distinguished them on the ground that “the standards governing the award of social security benefits differs from those that apply to the award of LTD benefits.” Portier then filed this action. The parties filed cross-motions for judgment, which were adjudicated in this order. The court applied the abuse of discretion standard of review and ruled that Hartford’s decision was supported by substantial evidence, including medical records and opinions from both treating and independent physicians. Portier argued that Hartford failed to consider his self-reported complaints and the EAR was flawed. However, the court found that the administrative record contained numerous references to Portier’s complaints and Hartford had considered them. The court also found no procedural unreasonableness in Hartford’s actions, distinguishing this case from others where procedural issues affected the decision. Ultimately, the court granted Hartford’s motion for judgment on the administrative record and denied Portier’s motion, concluding that Hartford’s decision was not arbitrary or capricious.

Sixth Circuit

Elliott v. Unum Life Ins. Co. of Am., No. 3:25 CV 2303, 2026 WL 35851 (N.D. Ohio Jan. 6, 2026) (Judge James R. Knepp II). Eric J. Elliott, proceeding pro se, filed this action against Unum Life Insurance Company of America and Vontier Employment Services, LLC seeking injunctive, declaratory, and monetary relief under ERISA. Two months after filing the complaint, Elliott filed a one-page motion for a temporary restraining order seeking to “enjoin[] the termination of Long-Term Disability (LTD) benefits by the administrator, and preserving Plaintiff’s eligibility for the 60% LTD Buy-Up pending final adjudication of this matter.” (Your ERISA Watch can only assume that this action is related to a previous dispute we reported on between Elliott and Unum in our September 3, 2025 issue, although that action had a different case number and seemed to involve a different issue. His TRO requests in both cases met the same fate, however.) The court denied Elliott’s motion. The court noted that while pro se pleadings are given liberal construction, litigants must still adhere to the Federal Rules of Civil Procedure. Furthermore, a TRO is “an extraordinary and drastic remedy” and requires a “clear showing” of entitlement. Elliott could not clear this bar. The court could not conclude that he was likely to succeed on the merits of his ERISA claims based solely on his allegations.  Additionally, Elliott did not adequately demonstrate irreparable harm, as the harm described was economic and could potentially be remedied with monetary damages: “The Motion’s only cited support for irreparable injury is Plaintiff’s own conclusory statement of such… And the Complaint describes only economic harm, which Plaintiff has not persuasively demonstrated cannot be cured with monetary damages should he prove Defendants violated ERISA and that is he is entitled to greater long-term disability benefits than he has been provided.” The court concluded by indicating that it would schedule a case management conference once defendant Vontier had been served and answered the complaint.

Eighth Circuit

Hardy v. Unum Life Ins. Co. of Am., No. 23-563 (JRT/JFD), 2026 WL 36063 (D. Minn. Jan. 6, 2026) (Judge John R. Tunheim). In our September 11, 2024 edition we reported on plaintiff Mark W. Hardy’s victory in this action, in which the court concluded that defendant Unum Life Insurance Company of America wrongfully terminated his claim for long-term disability benefits. The parties could not agree on the amount of benefits due pursuant to the judgment, so the court requested additional briefing, which it assessed in this order. The court’s September 2024 order required Unum to pay Hardy retroactive benefits from the date of termination through the date of the order. Unum had responded by paying Hardy $90,445.98 on November 3, 2025 for the time period of December 11, 2020 through September 1, 2024, which the court found satisfied its obligations for that time period. The court also approved an interest rate of 4.37 percent for retroactive benefits because the parties had agreed upon that rate. As for the time period of September 2, 2024 to the present, Unum argued that the court’s judgment “does not award prospective benefits because (1) it does not expressly do so, and (2) the Policy requires ongoing proof of disability, and there is no evidence for Unum or the Court to evaluate on or after September 1, 2024, to determine whether Hardy is entitled to further benefits.” The court rejected both arguments, ruling that Unum was required “to pay Hardy benefits from September 2, 2024, to the present and continuing thereafter. Hardy is entitled to disability benefits until Unum determines that Hardy is no longer disabled under the terms of the Policy.” The court then addressed how those benefits should be calculated. Unum contended that Hardy’s 2025 benefits should be reduced by the amount of his anticipated December 2025 bonus, but the court vetoed this approach: “Under the Policy, Hardy is required to submit proof of earnings on a quarterly basis, after which Unum may adjust the benefit amount. The Policy does not permit Unum to estimate the amount of Hardy’s bonus and adjust his benefits.” The court ended its order with a warning: “The Court notes that the parties have likely expended more in attorneys’ fees litigating these issues than the amount separating their respective positions. Accordingly, the Court strongly encourages the parties to try resolve any remaining issues before seeking further relief from the Court.”

Discovery

Fourth Circuit

Ross v. International Brotherhood of Elec. Workers Pension Benefit Fund, No. 2:25-CV-00449, 2026 WL 74290 (S.D.W. Va. Jan. 9, 2026) (Judge Irene C. Berger). Plaintiff George A. Ross contends that the two defendants in this case, the International Brotherhood of Electrical Workers Pension Benefit Fund and the National Electrical Benefit Fund, improperly suspended his benefits. The core issue revolves around whether any benefit plan provision permitted the suspension and clawback of Ross’ pension based on his work as an estimator. Ross sought to conduct discovery into defendants’ decision-making processes and potential conflicts of interest, arguing that “‘the same decision makers orchestrated the suspension of Plaintiff’s benefits under both funds’ and the denial of benefits reflected an interest in keeping proceeds within the funds.” Ross further contended the administrative record as it currently sits “would not permit the court to evaluate the impact of the conflict of interest.” The assigned magistrate judge disagreed and denied Ross’ motion to conduct discovery. Ross objected, and in this ruling the district court judge agreed with the magistrate and overruled his objections. The court explained that “[w]hile any conflict of interest will be considered in evaluating whether the suspension of the Plaintiff’s benefits was an abuse of discretion or otherwise violated ERISA, additional discovery is not necessary to facilitate the Court’s consideration.” The court stated that the central issue was “relatively straightforward,” and “[d]iscovery into matters outside the administrative record will not likely assist in resolving that issue.” As a result, the magistrate judge’s “order denying discovery was not clearly erroneous or contrary to law.”

Life Insurance & AD&D Benefit Claims

Fifth Circuit

Guidry v. Metropolitan Life Ins. Co., No. CV 25-18-SDD-RLB, 2026 WL 49720 (M.D. La. Jan. 7, 2026) (Judge Shelly D. Dick). In this action plaintiff Katherine Crow Albert Guidry seeks to recover $504,000 in life insurance proceeds after the death of her husband, Jason Guidry. Jason worked for defendant Waste Management and received his coverage through its employee life insurance plan. In her complaint Katherine alleged that defendants created “a confusing chain of events to disqualify the decedent from the rights he secured prior to his cancer diagnosis to prohibit [Katherine’s] ability to collect on the policy of insurance.” Katherine brought suit under ERISA and three Louisiana statutes against Waste Management, Metropolitan Life Insurance Company, and Life Insurance Company of North America. (MetLife was the insurer and claim administrator of the life insurance plan, while LINA provided administrative services under Waste Management’s disability leave policies.) In this order the court ruled on four motions for either summary judgment or judgment on the administrative record brought by the three defendants, as well as motions to dismiss brought by Waste Management and MetLife. First, the court addressed Waste Management’s and MetLife’s motion for summary judgment, which was directed solely at the standard of review. The court found that the Waste Management benefit plan vested MetLife with discretionary authority to determine eligibility for benefits and to construe the terms of the plan, and thus the abuse of discretion standard of review applied. Next, the court considered LINA’s motion for summary judgment, which was based on ERISA preemption. The court found that ERISA preempted all of Katherine’s state law claims related to the employee benefit plan at issue, and thus dismissed them. The court then addressed the merits of Katherine’s claims. Katherine alleged that Jason “was not accorded all of his vacation time and Family Medical Leave Extended Time that allowed him to be classified, according to the Plan Administrators, as ‘actively at work’ as required under the Plan for entitlement to Optional Life Insurance coverage.” The court concluded that these allegations could not create liability for any of the three defendants. Taking Waste Management first, “the record shows that MetLife, not Waste Management, denied Plaintiff’s claim[.]” As a result, Katherine had no claim against Waste Management. As for MetLife, the court ruled that its denial of Katherine’s claim was not an abuse of discretion. According to the court, MetLife reasonably denied coverage because Jason was on a leave of absence, and not “actively at work,” on the date the optional coverage took effect. The court acknowledged Katherine’s argument regarding vacation time and medical leave, but stated there was “no evidence to support this assertion,” and “[t]here is also no evidence supporting Plaintiff’s theory that MetLife (or any of the Defendants) ‘manipulated the process to place him outside of his employment prematurely’ in an intentional effort to eliminate the Optional Life Insurance coverage.” As for LINA, Katherine argued “it is ‘suspicious’ that LINA did not give notice as to the status of Jason Guidry’s leave request until the date of his death.” However, the court ruled that there was no evidentiary support for her claims. “LINA approved the requests for leave and short-term disability coverage and was not involved in the denial of Optional Life Insurance. Further, there is no evidence supporting the argument that LINA (or any of the Defendants) convinced Jason Guidry or Plaintiff ‘that they would be better off’ if Jason Guidry sought leave status and short-term disability, thereby depriving them of Optional Life Insurance coverage.” As a result, the court granted the motions for summary judgment and judgment on the administrative record, resulting in the dismissal of Katherine’s claims against all defendants. The motions to dismiss were terminated as moot.

Medical Benefit Claims

Sixth Circuit

Patterson v. Swagelok Co., No. 1:20-CV-566, 2026 WL 74074 (N.D. Ohio Jan. 9, 2026) (Judge J. Philip Calabrese). Readers of Your ERISA Watch are familiar with the long-running dispute between husband and wife Eric and Laura Patterson on one side, and Eric’s employer, Swagelok Company, and the administrator of Swagelok’s employee health insurance plan, United Healthcare, on the other. (Just last month, we reported on the most recent installment, a published decision from the Sixth Circuit.) Both of the Pattersons were involved in separate motor vehicle accidents and received medical treatment paid for by United. They sought compensation from the insurers of the other drivers involved in their accidents and obtained settlements. United then pursued reimbursement of the medical costs it paid, based on a subrogation and reimbursement provision in a summary plan description of the healthcare policy. The Pattersons challenged the existence of such rights in the plan, leading to extensive litigation in both state and federal courts. Currently the Pattersons have two actions pending in federal court and one action pending in state court. The Pattersons consolidated their federal allegations into a single complaint, and the defendants moved to dismiss this combined complaint. First, the court addressed defendants’ standing arguments. The court found that Laura could not pursue any claims under ERISA because she was “not suffering a past, present, or future harm”; the court noted that the reimbursement action against her was “perpetually stayed” and “is expected to be voluntarily dismissed.” However, the court ruled that she had standing to allege claims under the Fair Debt Collection Practices Act (FDCPA) and under state law because she had alleged concrete injuries such as attorneys’ fees, costs, and loss of use of settlement funds due to multiple lawsuits. As for Eric, there was no dispute that he had standing under ERISA to pursue individual relief for the $25,000 he paid to defendants. However, the court ruled that under the law-of-the-case doctrine, Eric was limited to seeking recovery of that amount only pursuant to the Sixth Circuit’s rulings, and he could not pursue any claims on behalf of the plan. Furthermore, Eric conceded he could no longer pursue any of his state law claims, as they were preempted. The court noted that the Sixth Circuit did not address whether Eric could represent a class, leaving open the possibility of class action proceedings down the road. Next, the court addressed the issue of collateral estoppel, determining that it could not be applied at this stage due to unresolved questions about the applicability of plan documents and privity between defendants and the plan. The court then addressed Laura’s claims, ruling first that she could not maintain a FDCPA claim because defendants did not treat the subrogation or reimbursement rights as a debt in default. As for her remaining state law claims, the court ruled that ERISA completely preempted her civil conspiracy claim but not her claims for malicious prosecution, abuse of process, or tortious interference, as these claims were based on defendants’ non-fiduciary conduct. In short, the court granted in part and denied in part the motion to dismiss, allowing Eric to proceed with ERISA claims and Laura to proceed with her state law claims, except for civil conspiracy.

Pension Benefit Claims

Second Circuit

Williams v. Metro North Railroad Human Resources Dep’t, No. 25-CV-7473 (LTS), 2026 WL 72156 (S.D.N.Y. Jan. 7, 2026) (Judge Laura Taylor Swain). Derick Williams was employed by Metro-North Railroad as a coach cleaner and was terminated in 2018. A few months later he attempted to obtain a “retirement ID pass” from Metro-North Railroad’s human resources department but was told he was not eligible due to his termination. Williams believes that he is eligible for the pass because his right to it vested before his termination. As a result, he filed this pro se action claiming that Metro-North violated ERISA by denying him access to a vested benefit and failing to provide a plan document. The court previously granted Williams’ request to proceed in forma pauperis, i.e., without paying fees, but in this order it dismissed his complaint. The court explained that “[t]o state a claim under ERISA, a plaintiff must allege: (1) that the benefit plan is governed by ERISA, (2) that the plaintiff is a participant in the plan, and (3) that the defendant breached its duty to pay the plaintiff under the terms of the plan.” However, Williams “offers no details concerning the ‘retirement ID pass’ that is the subject of this lawsuit. He neither describes the nature of the ‘retirement ID pass’ nor explains what, if anything, he would be able to obtain with the pass. Plaintiff does not allege any facts that would allow the Court to conclude that the ‘retirement ID pass’ confers benefits consistent with an employee welfare benefit plan or an employee welfare pension plan under ERISA.” As a result, the court ruled that he had failed to state a claim under ERISA. Furthermore, the court noted that Williams had not brought his suit against the proper defendant. Williams “names Metro-North Railroad Human Resources Department as the sole defendant, but he does not allege any facts suggesting that Metro-North Human Resources Department is the ‘administrator’ or the ‘plan sponsor’ of Metro-North Railroad’s retirement plan. He has therefore failed to state an ERISA claim against Defendant Metro-North Human Resources Department.” The court thus dismissed Williams’ action, but gave him 30 days to amend his complaint to allege a proper claim for relief under ERISA against the correct party.

Provider Claims

Fifth Circuit

Columbia Hosp. at Medical City Dallas Subsidiary, LP v. Anthem Health Plans of Virginia, Inc., No. 3:25-CV-0689-X, 2026 WL 36075 (N.D. Tex. Jan. 6, 2026) (Judge Brantley Starr). This is a reimbursement dispute between a group of acute care facilities in North Texas, collectively referred to by the court as “Medical City,” and Anthem Health Plans of Virginia over medical care provided in 2021-22 to three patients who were insured by Anthem. Medical City contends that the treatment it provided was medically necessary and that it communicated with Anthem through Blue Cross Blue Shield of Texas according to the procedures of the Blue Card Program, of which Anthem is an affiliate. Anthem partially paid for one patient’s treatment but ultimately denied reimbursement for the remaining claims, citing lack of medical necessity or failure to obtain preauthorization. Medical City seeks $342,007.83 in unpaid reimbursement pursuant to four claims: “breach of contract (Count I), breach of an implied-in-fact contract (Count II), breach of the health plans (Count III), and breach of contract for non-ERISA plans (Count IV).” Anthem moved to dismiss Count III for lack of derivative standing, moved to dismiss the remaining counts for failure to state a claim, and alternatively moved to compel arbitration. The court ruled that Medical City plausibly pled derivative standing based on the patients’ assignments of benefits, which were effected through a “Conditions of Admission” form. The court also found that Medical City plausibly alleged breach of contract, asserting that Anthem, though a non-signatory, was bound by the hospital agreement Medical City signed with Blue Cross Texas, with which Anthem was affiliated through the Blue Card Program. The court noted that “Anthem denied the claims based on alleged lack of medical necessity and failure to obtain preauthorization – not because it was not bound by the Agreement.” Thus, Medical City had properly alleged that Anthem impliedly assumed the Agreement’s obligations. Finally, the court noted that the parties agreed that the hospital agreement at issue “contains a valid arbitration clause, including a delegation clause governing the arbitrability of claims.” Thus, because “Medical City’s claims arise out of and relate directly to the Agreement, the Court must enforce the arbitration agreement under the Federal Arbitration Act.” As a result, the court granted Anthem’s motion to compel arbitration and denied without prejudice the remainder of Anthem’s Rule 12(b)(6) motion because “the valid arbitration agreement and delegation clause deprive the Court of jurisdiction to decide the merits of the remaining claims.” The court ordered the parties to update the court every three months on the status of the arbitration proceedings.

Walker Specialty Constr., Inc. v. Board of Trs. of Constr. Indus. & Laborers Joint Pension Tr. for S. Nevada, No. 24-1560, __ F.4th __, 2026 WL 21743 (9th Cir. Jan. 5, 2026) (Before Circuit Judges Rawlinson, Miller, and Desai)

Here at Your ERISA Watch we generally leave the withdrawal liability and unpaid contributions cases alone, as they tend to be very similar and not particularly engaging. (The vast majority are default judgments against deadbeat employers.) However, on rare occasions – when the federal court output is slow and an interesting issue pops up in an appellate decision – we are happy to take a swing. This week’s notable decision fits the bill.

The plaintiff was Walker Specialty Construction, Inc., a company that performed asbestos abatement and demolition in Nevada. Asbestos abatement is directed at insulation, roofing, and flooring, and “involves removing or covering asbestos-containing materials to prevent the release of asbestos fibers, which can facilitate the refurbishment and renovation of existing buildings and the construction of new ones.”

For several years Walker contributed as a participating employer to the Board of Trustees of the Construction Industry and Laborers Joint Pension Trust, a pension plan governed by ERISA, as amended by the Multiemployer Pension Plan Amendments Act (MPPAA). However, in 2019 Walker ceased operations and stopped contributing.

In 2021, the Trust informed Walker that it owed the Trust $2,837,953 in withdrawal liability. Walker refused to pay, claiming that it was not required to pay under the MPPAA. Specifically, Walker cited a provision in the MPPAA stating that employers are excepted from withdrawal liability rules if they are operating in the “building and construction industry.” 29 U.S.C. § 1383(b). The Trust countered that asbestos abatement did not qualify as “building and construction” because it involved tearing down structures rather than building them.

The parties could not reach an agreement, and the dispute went to arbitration. Meanwhile, Walker continued to contribute, as required by the MPPAA, while it disputed the Trust’s claim. The arbitrator ruled in favor of the Trust, “holding that ‘work in the construction industry’ is ‘the provision of labor whereby materials and constituent parts may be combined on the building site to form, make or build a structure’ and that Walker’s work ‘does not fit within that definition.’”

Walker then sued the Trust in district court to contest the arbitration award. On cross-motions for summary judgment, Walker found a more receptive ear with District Court Judge Andrew P. Gordon. The district court “adopted a more expansive understanding of ‘building and construction industry,’ which includes the erection, maintenance, repair, and alteration of buildings and structures.” As a result, the court granted Walker’s summary judgment motion and ordered the Trust to return Walker’s payments with interest. (Your ERISA Watch reported on this decision in our February 28, 2024 edition.) The Trust appealed to the Ninth Circuit, which issued this published decision.

The Ninth Circuit reviewed the district court’s grant of summary judgment de novo, as well as the statutory interpretation of the term “building and construction industry.” The court noted that when ERISA was first enacted, it did not adequately protect multiemployer pension plans from the financial consequences of individual employer withdrawals. The MPPAA was designed to address this issue, imposing liability on employers that withdraw from such plans.

However, Congress created a “building and construction industry” exception due to “the transitory nature of contracts and employment” in the industry, which does not necessarily shrink when a contractor leaves, as employees are often dispatched to other contractors contributing to the plan.

The sole issue on appeal was “whether asbestos abatement qualifies as work in the ‘building and construction industry.’” The Trust argued for a narrow interpretation that the term “only relates to the building of structures,” while Walker argued that the term is broader and “includes alterations and repairs.”

The court acknowledged that the MPPAA did not define the term “building and construction industry,” and thus the court was forced to interpret it as a matter of first impression. The court began by looking to the National Labor Relations Board’s (NLRB) definition of the term under the Taft-Hartley Act because, at the time Congress enacted the MPPAA, that was the only other time Congress had used the term.

The court explained that the NLRB had given this term “a comprehensive definition,” and because it had done so, “we must infer that Congress incorporated the NLRB’s definition of ‘building and construction industry’ into the MPPAA.”

This decision doomed the Trust. As the court explained, over a series of years and decisions the NLRB had settled a meaning for the term under the Taft-Hartley Act “to include not only the erection of new buildings, but also maintenance, repair, and alterations that are essential to the buildings’ usability.” The court noted that two other circuit courts – the Second and Eighth – had also similarly relied on the NLRB’s “expansive interpretation of ‘building and construction industry’ to include repairs and alterations under the MPPAA exception.”

The court rejected the Trust’s arguments to the contrary. The Trust argued that the court should not use the NLRB interpretation because “Taft-Hartley is a different law covering a different subject area than the MPPAA.” However, the court found that the laws were in fact quite similar as they addressed the same issues: “Although Taft-Hartley addresses labor practices and the MPPAA addresses pension plans, it is appropriate to use the same definition of ‘building and construction industry’ under both statutes because Congress enacted the exceptions based on the transient nature of the construction industry in both contexts.”

The Trust also argued that the MPPAA “expressly references and incorporates several other terms from Taft-Hartley,” but did not do so with the “building and construction industry” exception. However, the court ruled that “a cross-reference is not required, and its absence does not defeat the presumption that Congress intended to incorporate the NLRB’s definition…into the MPPAA.”

The Trust further argued that the Supreme Court’s decision in Loper Bright v. Raimondo reduced any deference the court owed to the NLRB. However, the court explained that it was not deferring to the NLRB; instead, it was interpreting statutory language based on Congressional intent, which “is plain from its use of the same language in both statutes.”

Because the court ruled that the NLRB’s definition of “building and construction industry” applied equally to the MPPAA, the only remaining question was whether Walker’s activities fell within that definition. The court quickly found that they did because they involved “maintenance and repair…of immobile structures…which become integral parts of structures and are essential to their use for any general purpose.” Indeed, “Walker’s abatement work requires substantial alterations to buildings – it is not merely scraping surfaces, as the Trust argues.”

As a result, the Ninth Circuit concluded that “Walker’s asbestos abatement is part of the ‘building and construction industry’ under the MPPAA.” It thus affirmed the district court’s ruling in Walker’s favor.

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

Class Actions

Ninth Circuit

Imber v. Lackey, No. 1:22-CV-00004-HBK, 2025 WL 3761593 (E.D. Cal. Dec. 23, 2025) (Magistrate Judge Helena M. Barch-Kuchta). Brandon Imber brought this class action against multiple defendants associated with “the December 31, 2018 sale of 2,000,000 shares of common stock of Ritchie Trucking Service Holdings, Inc….to the People Business Employee Stock Ownership Plan (‘ESOP’) for $19,543,000[.]” Imber contended that “the ESOP fiduciaries failed to provide or provided incomplete information to the ESOP’s advisors,” that the ESOP’s trustee “failed to conduct a prudent investigation as to the purchase price,” and as a result “the ESOP paid more than fair market value for Ritchie Holdings stock[.]” Plaintiffs’ complaint asserted eight claims for relief under ERISA against defendants, including breach of fiduciary duty, prohibited transactions, and co-fiduciary liability. After more than three years of litigation, including motions to dismiss, limited discovery, and mediation, the parties reached a settlement agreement in March 2025. The settlement includes a cash settlement fund of $485,000 and a stock settlement involving a $1.4 million reduction in the principal balance of ESOP-related debt, resulting in the release and allocation of 115,000 shares of Ritchie Trucking Employer Stock to the ESOP accounts of class members. In our October 1, 2025 edition we reported that the court granted plaintiffs’ unopposed motion for class certification and preliminary settlement approval, and a fairness hearing was held on December 19. There were no objections to the settlement from any class members, and thus in this order the court granted final approval, finding it fair, reasonable, and adequate. The court also approved attorneys’ fees in the amount of $442,624, expenses in the amount of $33,009.53, a service award of $5,000 for class representative Imber, and $5,449 in settlement administration costs and expenses. Pursuant to the parties’ agreement, the court dismissed all claims alleged in the action with the exception of Count V, which was an individual claim not covered by the settlement.

Discovery

Second Circuit

Long Island Neuroscience Specialists LLP v. Oscar Health, Inc., No. 25-CV-05813 (GRB) (JMW), 2026 WL 17142 (E.D.N.Y. Jan. 2, 2026) (Magistrate Judge James M. Wicks). Plaintiff Long Island Neuroscience Specialists LLP treated a patient with health plans issued or administered by defendant Oscar Health. Plaintiff contends that it submitted claims to Oscar that Oscar refused to pay in full, despite an arbitration award in plaintiff’s favor. Plaintiff filed this action and in its amended complaint it alleges improper denial of benefits under ERISA and unjust enrichment. Oscar intends to file a motion to dismiss, but while it is preparing that motion it has filed a motion to stay discovery. Plaintiff has not opposed the motion. The court cited the standard for deciding such motions: “In evaluating whether a stay of discovery pending resolution of a motion to dismiss is appropriate, courts typically consider: ‘(1) whether the defendant has made a strong showing that the plaintiff’s claim is unmeritorious; (2) the breadth of discovery and the burden of responding to it; and (3) the risk of unfair prejudice to the party opposing the stay.’” The court found all three factors weighed in Oscar’s favor. The court credited Oscar’s arguments that it is not a proper party in the action and that plaintiff’s claim for unjust enrichment is likely preempted by ERISA. Furthermore, the court noted that “Plaintiff has already changed its legal theories once since the inception of this matter,” making it unclear what discovery would be required, which “may result in burdensome efforts that could be unnecessary if the action is dismissed or narrowed by the Court’s ruling.” Finally, regarding the risk of unfair prejudice, the court noted that the case is in its early stages, and a short stay is unlikely to cause undue prejudice. Furthermore, plaintiff did not object to a stay, which resulted in “little to no prejudice.” As a result, the court granted Oscar’s motion to stay discovery pending the resolution of the anticipated motion to dismiss.

Medical Benefit Claims

Fifth Circuit

Townley v. Aetna Life Ins. Co., No. 4:24-CV-3513, 2025 WL 3771448 (S.D. Tex. Dec. 31, 2025) (Magistrate Judge Dena Hanovice Palermo). Erin Townley was a beneficiary of an ERISA-governed health insurance plan administered by Aetna Life Insurance Company when she gave birth by cesarean section in May 2023. Her newborn required medically necessary care which cost about $7,000, but when Townley filed a claim under her plan to cover these costs, Aetna denied it. Townley initially sued in Texas state court, alleging breach of contract, promissory estoppel, and violation of the Texas Deceptive Trade Practices Act. Aetna removed the case to federal court, where Townley filed an amended complaint alleging that Aetna’s denial violated ERISA. Aetna filed a motion to dismiss. The court began with the standard of review, determining that the abuse of discretion standard applied because the plan granted Aetna the discretion to determine benefit eligibility and interpret plan terms. Under this standard the court ruled that Aetna’s interpretation of the plan was legally correct and consistent with a fair reading of the plan. Townley argued that the plan provided “automatic coverage for the newborn for 31 days following birth.” However, the court stated that the plan language required that a newborn be enrolled within 31 days following birth in order to receive retroactive coverage, and Townley did not allege that she enrolled her child within this deadline. Townley alternatively argued that the Newborns’ and Mothers’ Health Protection Act (NMHPA) entitled her to coverage, but the court explained that the NMHPA only provides that benefits cannot be restricted in certain ways for persons that are already covered. “By the plain terms of the statute, the NMHPA does not require coverage of benefits to a person who is not otherwise covered under the plan. As Aetna states, enrollment is required for benefit coverage eligibility… Nothing in the NMHPA requires automatic coverage for non-beneficiaries.” The court concluded that Townley’s ERISA and NMHPA claims “cannot be saved by any amendment” because “no new factual allegations could change the analysis[.]” The court thus granted Aetna’s motion to dismiss with prejudice.

Plan Status

Eighth Circuit

Thompson v. Pioneer Bank & Trust, No. 5:24-CV-05067-RAL, 2025 WL 3771472 (D.S.D. Dec. 31, 2025) (Judge Roberto A. Lange). Andrew Taylor Thompson was employed by Pioneer Bank & Trust as a financial advisor from 2006 to 2024, when he alleges he was compelled to resign. Following his resignation, Thompson sued Pioneer, asserting three counts: (1) an ERISA claim alleging that a salary continuation agreement (SCA) between him and Pioneer was an ERISA-governed employee benefits plan breached by Pioneer, (2) a declaratory judgment seeking various declarations related to his employment agreement and resignation, and (3) breach of the employment agreement. Thompson attached the SCA to his complaint, but it was unsigned. Pioneer moved to dismiss the case, arguing that the SCA was never executed and thus was not an ERISA-governed plan, which meant the court did not have subject matter jurisdiction. The court initially denied this motion, relying on the Eighth Circuit’s decision in Sanzone v. Mercy Health (discussed in Your ERISA Watch’s April 8, 2020 edition), which determined that whether a plan is governed by ERISA “is an element of the plaintiff’s case and not a jurisdictional inquiry.” In that decision, the court found that “Thompson raised a colorable ERISA-governed claim based on his allegations of entering into the SCA.” Thompson moved for partial summary judgment on issues related to the employment agreement, while Pioneer sought summary judgment on Thompson’s ERISA claim, arguing once again that the SCA was never executed and thus did not create an ERISA plan. Pioneer contended that the parties executed a long term retention agreement in 2018 in lieu of the SCA, and thus the parties never signed the SCA. This time the court agreed with Pioneer, concluding that the unexecuted draft SCA did not create an ERISA plan binding on the parties, and therefore Thompson had not pleaded a viable claim arising under federal law. The court noted that ERISA preempts state law causes of action related to employee benefit plans and creates a federal cause of action for participants or beneficiaries to recover benefits due under an employee benefit plan. However, because the SCA was never executed, it was not an ERISA-governed plan, and Thompson could not bring an ERISA claim based on it. Thompson argued that while his complaint was focused on the SCA, his ERISA claim “includes a broader claim of relief that is not limited to the SCA,” including benefits from a profit-sharing and 401(k) plan. However, the court ruled that “Thompson’s Complaint plainly pleads that the SCA is an ERISA-governed plan, that Pioneer breached the SCA, and that he has an ERISA remedy based on the SCA… This Court need not consider whether some ERISA claim might spring from elsewhere in Thompson’s employment because Thompson’s Complaint pleads no such claim.” As a result, the court granted Pioneer’s motion for summary judgment and ruled that it lacked federal subject matter jurisdiction over Thompson’s first claim for relief. The court noted that it did not have diversity jurisdiction over the remaining two state law claims, and thus it dismissed the entire case without prejudice. Thompson’s motion for partial summary judgment on his state law claims was denied as moot.

Ninth Circuit

Furst v. Mayne, No. CV-20-01651-PHX-DLR, 2026 WL 21269 (D. Ariz. Jan. 5, 2026) (Judge Douglas L. Rayes). This is a case originally filed in 2020 that we have reported on three times. It is a family dispute between siblings (plaintiff brother and defendant sister) over the management of the DHF Corporation Profit Sharing Plan. All along the parties have litigated the case as if it were governed by ERISA. Indeed, they litigated the case vigorously, taking the case to a motion for summary judgment by defendant, which the court mostly denied, upholding its decision on reconsideration. Now, bafflingly, plaintiff has filed a “motion under Federal Rule of Civil Procedure 12(b)(1) to dismiss his own case without prejudice for lack of subject-matter jurisdiction.” As the court put it, “Plaintiff contends that now, after five years of litigation and ‘[u]pon further review,’ he ‘had determined that the [P]lan is not an ERISA-covered plan as a matter of law,’ and therefore the Court lacks subject-matter jurisdiction because his complaint invoked only this Court’s federal question jurisdiction.” Defendant’s response was equally strange. She “conspicuously avoids stating whether she agrees with Plaintiff’s jurisdictional analysis.” Even though she had conducted herself during the case as if ERISA governed it, now she “does not say whether [she] agrees the Plan is not governed by ERISA, or whether…this issue is jurisdictional in nature.” Instead, she merely asked that the court dismiss the case with prejudice instead of without prejudice. The court denied plaintiff’s motion, noting that “the issue of whether a plan is governed by ERISA” is a merits issue, not a jurisdictional issue. As a result, the court ordered plaintiff to show cause why the action should not be dismissed with prejudice given that “Plaintiff now admits that he will be unable to prove that the Plan is subject to ERISA.” The court allowed defendant a response, which “should address whether Defendant agrees that the Plan is not subject to ERISA, notwithstanding Defendant’s contrary position earlier in this litigation.” Will the court get to the bottom of this mysterious turn of events? If so, we will of course give you an update.

Pleading Issues & Procedure

Second Circuit

Meka v. Deloitte LLP, No. 25 CIV. 3547 (AKH), 2025 WL 3761874 (S.D.N.Y. Dec. 30, 2025) (Judge Alvin K. Hellerstein). Anudeep Meka is a Texas resident and citizen of India. He alleges that he resigned from his employment at IBM in June of 2024 and returned to India. He then received a conditional offer of employment from Deloitte Consulting to work in their Dallas office. Meka signed the offer letter and submitted a background check questionnaire to Deloitte. Deloitte also agreed to sponsor his H-1B visa, and he reentered the United States in December of 2024 under this sponsorship. However, in January of 2025 Deloitte withdrew its offer of employment. Annoyed at Deloitte’s reversal, Meka subsequently filed this action alleging sixteen claims against Deloitte under state and federal law. Deloitte filed a motion to dismiss, which the court granted in this order. Three of the claims were alleged under ERISA, “pursuant to 29 U.S.C. § 1132(a)(1)(B) and (a)(3), to recover benefits, enforce rights under alleged benefit plans, and obtain equitable relief.” The court made short work of these claims, noting that civil actions under ERISA “may be brought by participants,” and ERISA defines “participant” as “any employee or former employee…who is or may become eligible to receive a benefit of any type from an employee benefit plan… The Supreme Court has construed this definition to mean ‘either employees in, or reasonably expected to be in, currently covered employment, or former employees who have a reasonable expectation of returning to covered employment or who have a colorable claim to vested benefits.’” However, the court observed that Meka’s employment with Deloitte “never commenced,” and thus “he was not a participant in any ERISA-governed plan and lacks statutory standing to assert ERISA claims.” As a result, the court dismissed those claims. The court gave Meka the opportunity to file an amended complaint to correct the deficiencies identified in its order.

Sixth Circuit

Mason v. Head, No. 3:25-CV-01362, 2026 WL 18759 (M.D. Tenn. Jan. 2, 2026) (Judge Waverly D. Crenshaw, Jr.). Plaintiffs Andy Mason and Clay Head filed this action in state court, both individually and derivatively on behalf of A&W Southern Sod Farms, LLC, against defendants William Head, Julie Head, and Tennessee Elite Sod Farm, LLC. In a second amended verified complaint filed November 12, 2025, plaintiffs contended that William Head breached fiduciary duties related to an ERISA-governed retirement plan in connection with “more than $500,000 of unauthorized transfers by William to his company that eventually went to him.” Defendants removed the case to federal court on November 21, 2025, citing ERISA as creating federal jurisdiction. Plaintiffs filed a motion to remand the case back to state court, arguing that defendants’ removal was untimely. In a short no-nonsense order the court agreed with plaintiffs. Under 28 U.S.C. § 1446, a notice of removal must be filed within 30 days after the defendant receives a copy of an amended pleading or other paper indicating that the case is removable. With their motion, plaintiffs provided emails from defense counsel from as early as September 2, 2025 showing that “Defendants knew that Plaintiffs developed evidence of William Head’s possible unauthorized contributions in the A & W Southern Sod Farms, LLC retirement plan… Defendants had actual knowledge that ERISA was implicated because Defendants specifically cited 26 U.S.C. § 408 (Individual Retirement Account) after receipt of Plaintiffs’ counsel email.” As a result, the removal “was more than 30 days after Defendants had actual knowledge that Plaintiffs’ fiduciary duty allegations implicated the IRA plan governed by ERISA. Accordingly, Plaintiffs motion for remand is GRANTED.” However, the court denied plaintiffs’ motion for attorney’s fees under 28 U.S.C. § 1447(c), determining that “Defendants had an objectively reasonable basis for removal.”

Ninth Circuit

Dalton v. Freeman, No. 2:22-CV-00847-DJC-DMC, 2025 WL 3771345 (E.D. Cal. Dec. 31, 2025) (Judge Daniel J. Calabretta). Last year, in Cunningham v. Cornell, the Supreme Court took a look at ERISA’s prohibited transactions provision, found in Section 406. Section 406 generally prohibits transactions between a plan and a person in interest where the transaction transfers plan assets. However, Section 408 creates exceptions to this rule; the most commonly invoked one is Section 408(b)(2)(A), which allows “Contracting or making reasonable arrangements with a party in interest for…services necessary for the establishment or operation of the plan, if no more than reasonable compensation is paid therefor.” The question in Cunningham was whether plaintiffs were required to plead that no Section 408 exceptions applied in order to establish a claim under Section 406. The court ruled that plaintiffs were not required to negate defenses under Section 408 in their complaints. Instead, as the court in this case explained, “section 406 sets out the basis and three necessary elements for prohibited transactions claims, while section 408 provides affirmative defenses to such claims… Thus, in bringing a prohibited transactions claim, a plaintiff needs only to satisfy the elements of section 406… Plaintiffs are not required to attempt to anticipate and proactively plead facts establishing that potential affirmative defenses under section 408 do not apply.” While this approach was a straightforward interpretation of the statutory language, “the Supreme Court recognized that this structure creates a procedural issue. In short, by only requiring a plaintiff to plead the basic elements under section 406 and not necessitating that they address the exceptions under section 408 in their complaint, meritless cases could make their way past the motion to dismiss stage and into discovery.” Thus, the Supreme Court suggested that district courts could use “an uncommonly used tool” to help weed out potentially meritless cases: the “reply to an answer,” authorized by Federal Rule of Civil Procedure 7(a)(7). Here, plaintiffs have alleged that Alerus Financial, N.A. engaged in prohibited transactions in its dealings with the O.C. Communications Employee Partnership Program Plan and Trust. Alerus did not challenge the adequacy of those allegations, but asserted an affirmative defense under Section 408, contending that the transactions were services for reasonable compensation. The court stated that the case was “in the exact procedural posture discussed in Cunningham.” As a result, the court concluded that a reply was warranted and ordered plaintiffs to file one pursuant to the Supreme Court’s discussion in Cunningham. The court observed that its order “should not be read as a comment regarding the viability of Plaintiffs’ prohibited transactions claim or Defendant’s affirmative defense,” but was simply “grounded in considerations of factual clarity and procedural efficiency.” The court “expects that if Plaintiffs can put forward specific, nonconclusory factual allegations that arguably show the asserted exemption does not apply, the parties will promptly proceed forward with discovery.”

Starboard Attitude Trust v. FirstFleet Inc., No. CV-25-03701-PHX-MTL, 2025 WL 3763927 (D. Ariz. Dec. 30, 2025) (Judge Michael T. Liburdi). Gary L. Wagoner is a health care provider in Arizona who treated a patient named Jeffrey Cagle, who assigned his claim for benefits to Wagoner. In this pro se action Wagoner, through Starboard Attitude Trust, contends that FirstFleet, Inc., the sponsor and administrator of Cagle’s ERISA-governed self-insured health plan, underpaid his claim because it “misadjudicated” Wagoner as being in-network under the plan when he was actually an out-of-network provider. If these facts seem familiar to you, they should, because “[t]his is the fifth time Plaintiff has asserted his claims against FirstFleet for the Cagle assignment.” (Your ERISA Watch has reported on Wagoner’s crusade on several occasions.) Wagoner’s first lawsuit was dismissed by Judge James A. Teilborg, Wagoner voluntarily dismissed his second and third actions, and his fourth lawsuit was dismissed as being res judicata by Judge Diane J. Humetewa, “who invited the defendant to file a motion for attorneys’ fees.” FirstFleet filed a motion to dismiss this fifth action, and the court wasted no time granting it, adopting Judge Humetewa’s “thoroughly reasoned res judicata analysis in which Plaintiff’s claims were dismissed in Wagoner IV.” The judge ruled that the claims were the same, they all arose from Wagoner’s “billing dispute with FirstFleet over the Cagle claim,” there was a final judgment on the merits in FirstFleet’s favor, the parties were identical, and Wagoner “has had a full and fair opportunity to litigate his claims.” Wagoner attempted to avoid res judicata by bringing his claims on behalf of a trust, but the court rejected this maneuver: “as a non-lawyer, Plaintiff cannot assert claims on behalf of his trust… Additionally, the Court finds that Plaintiff is the real party in interest with respect to his trust and both will be considered functionally the same party under res judicata.” As a result, the court dismissed the action, entered judgment in FirstFleet’s favor, and invited FirstFleet to move for attorneys’ fees and related expenses.

Wagoner v. State Industrial Products Corp., No. CV-25-01763-PHX-JJT, 2025 WL 3771269 (D. Ariz. Dec. 31, 2025) (Judge John J. Tuchi). In our second case of the week featuring Gary L. Wagoner, he and the Catalina Seaward Trust filed this action asserting similar claims for failure to pay benefits for medical services he provided to a different patient, Vavrix D. Owens, in 2018. Wagoner alleged that “Mr. Owens was insured by Cigna, an insurance provider owned by Defendant, that pre-authorized the services but denied the claim after the services were performed.” In 2022, Wagoner initially sued defendant in the wonderfully named Dreamy Draw Justice Court, and defendant removed the case on ERISA preemption grounds. Wagoner’s claims were dismissed after he failed to respond to a motion to dismiss. Plaintiffs alleged that in 2025 Wagoner received letters from defendant stating it could not verify Owens’ eligibility or locate his account. Plaintiffs subsequently filed this new action in Dreamy Draw Justice Court, alleging five state law claims based on the same facts as in the 2022 litigation, but adding allegations regarding the 2025 letters. Defendant once again removed the case to federal court because of ERISA preemption. It then filed a motion for judgment on the pleadings, arguing that plaintiffs’ claims were barred due to claim preclusion. Plaintiffs “do not dispute that the 2022 Judgment was final on the merits, or that the two actions involve identical parties. Rather, Plaintiffs only dispute that the claims are the same in light of the 2025 Letters, which “post-date[] the 2022 dismissal and create[] new, independent causes of action for misrepresentation and consumer fraud.” Plaintiffs also contended that their state law claims “rest on duties independent of any plan benefits.” The court rejected these arguments, noting that it had already ruled that plaintiffs’ state law claims were completely preempted by ERISA and were thus extinguished. Furthermore, “The only factual difference between the two lawsuits is that Plaintiffs received the 2025 Letters after the 2022 Judgment. The operative question, then, is whether the 2025 Letters give rise to a claim that did not exist in the 2022 Litigation.” The court concluded, “They do not.” The court ruled that “Plaintiffs’ current ERISA claim existed in 2022, and he had the opportunity to pursue that claim then. Plaintiffs’ current ERISA claim also turns on substantially the same evidence as the former ERISA claim, involves the same purported infringement of Plaintiffs’ right to benefits underlying the former ERISA claim, and arise out of the same nucleus of facts as the former litigation.” As a result, “Plaintiffs’ ERISA claim in this action is precluded by the 2022 Judgment.” The court thus granted defendant’s motion and dismissed the action with prejudice.

As expected, the last week of 2025 was a slow one in the federal courts, but there were some interesting ERISA cases nonetheless. Read on to learn about (1) yet another dismissal of a putative class action alleging fiduciary breaches over the use of forfeited plan contributions (Donelson v. Meijer), (2) an employer and an insurer unsuccessfully attempting to dismiss claims against them in a disability dispute (Hamilton v. Logic20/20), (3) a win for plaintiffs in a medical benefit case involving residential mental health treatment (Michelle Z. v. California Physicians’ Service), and (4) a case in which an employee claims skullduggery in the administration of an employee stock ownership plan, but confusingly refuses to allege any claims under ERISA (Botterio v. Tessel). We hope you have an enjoyable New Year’s Eve, and we’ll see you in 2026.

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

Breach of Fiduciary Duty

Sixth Circuit

Donelson v. Meijer, Inc., No. 1:25-CV-1156, 2025 WL 3754241 (W.D. Mich. Dec. 29, 2025) (Judge Hala Y. Jarbou). The plaintiffs in this putative class action are participants in the 401(k) retirement plan of midwestern supercenter chain Meijer, Inc. The plan’s assets are held in a trust fund administered by Meijer, which makes base contributions and matches 50% of employee contributions up to a limit. Employees must work for five years to receive full matching contributions; otherwise, the funds are forfeited to the general trust. The plan allowed Meijer to use forfeitures to pay administrative expenses or reduce employer contributions. From August 2019 to January 2025, Meijer used forfeitures solely to reduce employer contributions. In January 2025, the plan was amended to prioritize reducing employer contributions with forfeitures. Plaintiffs brought this action under ERISA, alleging that Meijer’s use of forfeited funds to reduce its contribution obligations breached its duties of loyalty and prudence, and that it engaged in prohibited transactions. Meijer moved to dismiss. If you are a loyal reader of Your ERISA Watch, the court’s ruling will not surprise you; it granted the motion in full. On the duty of loyalty, plaintiffs contended that Meijer should have used forfeitures to aid beneficiaries or defray administrative costs. Meijer responded that its duty was to provide promised benefits, and using forfeitures for administrative expenses was not promised. The court agreed with Meijer, ruling that “a fiduciary’s duties are only to provide beneficiaries the specific benefits promised in the plan.” The court stated, “Just as fiduciaries managing a defined benefit plan need only provide beneficiaries the monetary payment they were promised, fiduciaries managing a defined contributions plan need only provide beneficiaries the money in their individual accounts. And § 1002(34) recognizes that employees may be entitled to funds forfeited by others, but only if those forfeitures are allocated to their individual accounts. Before that happens, employees are not entitled to others’ forfeited funds.” In the end, “Meijer promised nothing regarding forfeitures, leaving that decision entirely to the discretion of the fiduciary. And because Meijer made no promises regarding forfeitures, it did not violate its fiduciary duties.” The court noted that “[t]his holding aligns with the significant majority of courts across the country that have considered similar claims,” as well as “with the long-held position of the United States Department of Treasury that forfeitures in defined contribution plans may be used to reduce employer contributions.” The court next considered plaintiffs’ prohibited transactions claim. Meijer argued that using forfeitures to reduce contributions was not a “transaction,” but the court did not even reach this issue, concluding that “the provisions of ERISA that limit an employer’s ability to benefit from a fiduciary’s actions are inapplicable when the employer could achieve the same benefit via plan amendment. Thus, because Meijer could have implemented an amendment requiring forfeitures to go toward employer contributions, it could also achieve that same outcome by acting as a fiduciary without violating ERISA.” Finally, the court addressed plaintiffs’ argument that “Meijer violated its fiduciary duty of prudence by failing to use the forfeitures within the calendar year that they accumulated.” The plan allowed allocation by the following year, and IRS guidance required allocation, rather than use, by year’s end. The court found no violation of the plan or IRS guidance because the delay at issue was not unreasonable, and thus Meijer was not imprudent. As a result, the court granted Meijer’s motion and dismissed the action.

Disability Benefit Claims

Ninth Circuit

Hamilton v. Logic20/20, Inc., No. C24-916RSL, 2025 WL 3754023 (W.D. Wash. Dec. 29, 2025); Hamilton v. Logic20/20, Inc., No. C24-916RSL, 2025 WL 3754065 (W.D. Wash. Dec. 29, 2025) (Judge Robert S. Lasnik). Alexis Hamilton began working as a customer success consultant for Logic20/20 in 2019 when she was 25 years old. She alleges she was advised by Logic20/20 not to sign up for benefits until her 26th birthday because she was covered under her parents’ insurance plans until then. However, this delay triggered a requirement for her to complete an evidence of insurability (EOI) form under Logic20/20’s employee disability coverage, as more than 31 days had elapsed since her initial eligibility for enrollment. Hamilton contends that she would not have knowingly forgone automatic enrollment in disability benefits because of her history of ankylosing spondylitis. Eight months after beginning work, Hamilton received and completed her enrollment paperwork. She alleged she signed up for all available insurance, including short-term disability (STD) insurance. She believed she had also signed up for long-term disability (LTD) insurance, but Logic20/20 allegedly failed to provide her with an EOI form. She was not enrolled in LTD coverage in 2019 or 2020 and was not charged premiums for it during that period. In March 2020, after attempting to enroll in LTD benefits, she was informed by Logic20/20 to send an EOI form to Prudential, which she did not submit. In late 2020, Logic20/20 moved to online benefits enrollment, and Hamilton checked the box for LTD insurance, believing it was a continuation of her prior insurance. Logic20/20 and Prudential accepted her enrollment and began charging her premiums for LTD coverage, which it accepted until she stopped working at Logic20/20 in 2023 due to symptoms of long COVID which aggravated her preexisting conditions. She received the maximum amount of STD benefits from Prudential, but when she submitted a claim for LTD benefits, Prudential denied it due to the lack of an EOI form. Appeals were unsuccessful so she brought this action naming both Logic20/20 and Prudential as defendants. Against Logic20/20 Hamilton asserted a claim for breach of fiduciary duty and a claim for failure to provide plan documents, and against Prudential Hamilton asserted a claim for plan benefits and a claim for breach of fiduciary duty. Both defendants filed motions to dismiss, which were decided in the two orders cited above.

In its motion, Logic20/20 argued: (1) Hamilton had no standing; (2) Hamilton’s claims were time-barred; (3) Hamilton could not seek attorney’s fees; (4) Hamilton sought improper remedies; (5) Hamilton engaged in duplicative pleading; (6) Logic20/20 was not a fiduciary and did not breach any duty; and (7) Hamilton sought inappropriate equitable relief. The court rejected all of these arguments. It ruled that (1) plan participants have standing to sue, and ERISA includes in the definition of “participant” a former employee like Hamilton who has a colorable claim for benefits; (2) Hamilton’s claim was not time-barred because she plausibly alleged she did not have actual knowledge of Logic20/20’s breach of fiduciary duty until 2022; (3) ERISA authorizes awards of attorney’s fees for breach of fiduciary duty; (4) Hamilton sought relief through waiver, estoppel, reformation, and surcharge, which are all authorized equitable remedies under ERISA; (5) plaintiffs are allowed to plead simultaneous claims for plan benefits and equitable relief under ERISA; (6) Logic20/20 was plausibly a fiduciary because it was the plan sponsor and administrator, engaged in recordkeeping and enrollment, and collected premiums, and arguably breached its duty by misleading Hamilton as to the plan’s EOI requirements; and (7) Hamilton adequately pleaded facts supporting her equitable relief based on the alleged misrepresentations and deductions of premiums by Logic20/20. The court also allowed Hamilton’s claim for failure to produce plan documents to proceed because she alleged she had requested them from Logic20/20 in 2022 and never received them. Thus, the court denied Logic20/20’s motion to dismiss in its entirety.

As for Prudential, in its motion it argued that Hamilton could not bring a claim for plan benefits because she “admits that she did not meet the terms for LTD coverage under the plan,” i.e., she did not submit the required EOI form. The court agreed with Hamilton, however, comparing her situation favorably to that of the plaintiff in Salyers v. Metropolitan Life Ins. Co., in which the Ninth Circuit concluded that the defendants’ actions “were collectively ‘so inconsistent with an intent to enforce’ the evidence of insurability requirement as to ‘induce a reasonable belief that [it] ha[d] been relinquished.’” As a result, the court concluded that Hamilton had plausibly stated a claim for plan benefits. The court also concluded that she had pled a claim for breach of fiduciary duty against Prudential by alleging it failed to notify her of her lack of eligibility, misleading her as to her coverage by accepting premiums, and “using a compartmentalized system to escape responsibility.” Finally, the court denied Prudential’s motion to strike certain allegations in Hamilton’s complaint about Prudential’s 2023 settlement with the Department of Labor (DOL) over its denials of coverage for lack of EOI. The court found these allegations “both material and pertinent, in that the matter both relates and pertains to the type of practice alleged here.” The court also granted Hamilton’s request for judicial notice of documents relating to the DOL settlement and two court orders in a case with similar issues. As a result, both Logic20/20 and Prudential left the court empty-handed and all of Hamilton’s claims for relief against them will proceed.

Discovery

Third Circuit

Stallman v. First Unum Life Ins. Co., No. CV 23-20975 (JXN)(LDW), 2025 WL 3749611 (D.N.J. Dec. 29, 2025) (Judge Julien Xavier Neals). Jeremy Stallman was an attorney at Kasowitz, Benson & Torres LLP and covered under its various ERISA-governed employee benefit plans. He fractured his hip in September of 2019 and applied for and received short-term disability (STD) benefits. He was cleared to return to work in November of 2019 but filed a new claim for long-term disability (LTD) benefits based on symptoms from depression shortly thereafter, in January of 2020. The insurer and administrator of the LTD plan, First Unum Life Insurance Company, denied his claim, stating that the medical evidence did not support a disability and that Stallman was not covered under the policy as of November 2019. After exhausting administrative appeals, Stallman initiated this lawsuit. He moved to compel discovery, seeking (1) to include his STD claim file in the administrative record, (2) limited discovery on the completeness of the record, (3) extra-record discovery into First Unum’s alleged conflict of interest, and (4) discovery related to First Unum’s affirmative defenses. The assigned magistrate judge granted in part and denied in part Stallman’s motion, excluding the STD claim file from the administrative record for the LTD claim but allowing limited discovery regarding the completeness of the administrative record and the structural conflict of interest by First Unum. Stallman appealed parts of that decision to the district judge, who upheld it in this order. The district judge found that the arbitrary and capricious standard of review applied because First Unum was granted discretionary authority to determine benefit eligibility under the plan. Therefore, review was limited to the administrative record before First Unum at the time of the benefits determination. The court ruled that “while Plaintiff’s STD benefits were known to Defendant, the record does not reflect that the STD claim file was relied upon, submitted, considered, or generated in the course of making the LTD benefits determination at issue here.” The court pointed out that the medical basis for Stallman’s STD claim was different from the basis for his LTD claim. Furthermore, “Plaintiff fails to point to anything determinative in the administrative record produced by First Unum to indicate that the LTD claim administrator considered the STD file.” Instead, the LTD file merely “acknowledges the STD claim’s existence, which is insufficient to render it part of the administrative record.” As for Stallman’s request for conflict-of-interest discovery, the court noted that “[w]hile the Third Circuit has not adopted a standard for determining whether conflict of interest discovery may be pursued,” the magistrate judge “correctly noted that courts in this District have consistently required plaintiffs to identify a reasonable basis to suspect that a conflict influenced the benefits determination.” The court agreed with the magistrate judge that Stallman failed to demonstrate procedural irregularities or evidence of misconduct beyond the structural conflict inherent in First Unum’s dual role as claim payor and adjudicator. The magistrate judge did allow limited discovery on this issue, permitting one interrogatory to address whether the compensation or performance evaluations of First Unum’s claims and medical personnel involved in Stallman’s LTD claim decision were based on the outcome of their claims determinations. The district judge ruled that this was not an abuse of discretion. As a result, the court denied Stallman’s appeal in its entirety.

ERISA Preemption

Second Circuit

Botterio v. Tessel, No. 24-CV-4401-SJB-ST, 2025 WL 3718713 (E.D.N.Y. Dec. 23, 2025) (Judge Sanket J. Bulsara). Denise Botterio worked for Lambro Industries, Inc. for about 30 years and owned shares in the company. She filed this action in state court on behalf of herself and derivatively on behalf of the Lambro employee stock ownership plan (ESOP) against Lambro CEO David Tessel, asserting three state law causes of action: accounting, breach of fiduciary duty, and abuse of control. In her complaint, Botterio alleged that Tessel engaged in misconduct in his management of the ESOP. She claimed this misconduct led to the liquidation of the ESOP at an artificially depressed value. She alleged Tessel engaged in self-dealing, conflicts of interest, and a breach of fiduciary duty, asserting that Tessel favored the majority shareholder’s interests over those of the ESOP. Tessel removed Botterio’s action to federal court on ERISA preemption grounds. After discussions with Tessel and the court, Botterio amended her complaint twice, but continued to allege only state law claims for relief and did not add any claims under ERISA. Tessel filed a motion to dismiss, which was decided in this order. The court observed that even though Botterio’s claims were centered on an employee benefit plan, she had alleged no claims under ERISA. Botterio argued that her breach of fiduciary duty claim was sufficient to invoke ERISA: “Her position is that if a complaint intentionally pleads common law claims, so long as the factual allegations are sufficient, the Court can and should interpret the claims as ERISA claims.” The court found this “unpersuasive.” It explained that Botterio’s second amended complaint did not indicate an intent to bring an ERISA claim, did not give notice to Tessel that she was bringing such a claim, and Botterio’s conduct throughout the litigation demonstrated that she did not intend to pursue an ERISA claim. “Ultimately, there are limits on the ability to construe a complaint as alleging causes of action not actually pled. Here, Botterio filed three separate federal court complaints after being told that Tessel viewed her claims as preempted by ERISA. And at each turn, she refused to allege an ERISA claim, and as noted above, resisted – and did not accede to – any attempt to reframe her claim as a federal one.” As a result, the court refused to recharacterize Botterio’s claims as ERISA claims. The court then applied the Supreme Court’s two-pronged Davila test to determine if her state law claims were preempted. It ruled that they were. It found “the first prong is satisfied because Botterio could have brought this claim under ERISA, which empowers a plan participant to sue, on behalf of the plan, for a breach of fiduciary duty.” As for the second prong, “the breach of fiduciary duties owed to ESOP participants is not ‘completely independent’ from the ‘ERISA-related basis for legal action’…since ERISA creates the very fiduciary duties that Botterio alleges were breached. In other words, Botterio is seeking to vindicate a duty protected by ERISA, not one independent of the statute.” Thus, both prongs were satisfied and the court ruled that Botterio’s state law claims were completely preempted by ERISA. Additionally, Tessel requested to seal the unredacted filing of his motion to dismiss, which included a valuation report conducted by an external firm for Lambro. The court granted the motion to seal, finding that the commercial interests in keeping sensitive financial information confidential outweighed the public’s interest in disclosure. Finally, the court denied Botterio further leave to amend because she had already “had three chances to plead an ERISA claim that survives dismissal” and failed to do so.

Medical Benefit Claims

Ninth Circuit

Michelle Z. v. California Physicians’ Service, No. 23-CV-05784-AMO, 2025 WL 3731841 (N.D. Cal. Dec. 26, 2025) (Judge Araceli Martínez-Olguín). Plaintiffs Michelle Z. and Bo Z. are parents of A.Z., and all three are beneficiaries of health benefit plans administered by defendant California Physicians’ Service, d/b/a Blue Shield. Unfortunately, A.Z. has a history of mental health issues, including suicide attempts, and has required significant mental health treatment. In 2019, A.Z. received treatment at Evolve Growth Initiatives in California and later at Elevations Residential Treatment Center in Utah. Under plaintiffs’ original plan, which was an individual and family plan not governed by ERISA, Blue Shield initially approved coverage for A.Z.’s treatment at Evolve but denied coverage for treatment at Elevations, stating that out-of-state benefits were not included under the plan. In 2020, A.Z. was admitted to New Haven Residential Treatment Center in Utah. Claims for this treatment were also administered by Blue Shield, although many of them were adjudicated under a different ERISA-governed plan. Blue Shield denied coverage for this treatment as well, this time citing a lack of medical necessity, contending that A.Z.’s treatment at New Haven could have been provided in a less restrictive outpatient setting. Plaintiffs originally filed their complaint in state court, asserting claims for breach of contract and breach of the covenant of good faith and fair dealing. Blue Shield removed the case to federal court, after which plaintiffs added a cause of action for plan benefits under ERISA. The parties then filed cross-motions for judgment on the ERISA-governed benefits, and cross-motions for summary judgment on the state-law-governed benefits.

Addressing the state law claims first, the court at the outset denied plaintiffs’ request for additional discovery under Federal Rule of Civil Procedure 56(d) due to procedural deficiencies and a lack of diligence in pursuing discovery. As for the merits, “The principal dispute relevant to Plaintiffs’ breach of contract claim is about whether Plaintiffs obtained prior authorization.” Plaintiffs contended that they were prevented from obtaining prior authorization and argued that even without it, they would still be entitled to coverage if the services were a covered benefit and medically necessary. The court examined the plan, which it interpreted as providing that prior authorization was required for all non-emergency mental health admissions, but failure to obtain it would not automatically result in denial of coverage unless the services were not a benefit of the plan or were not medically necessary. Under this interpretation, neither side was entitled to summary judgment because there were issues of fact to be determined. On plaintiffs’ side, the court concluded that a reasonable jury could find that A.Z.’s services should have been prior authorized or covered as medically necessary, while on Blue Shield’s side, the jury could conclude that the services were not medically necessary even if Blue Shield had determined that initial coverage existed. As for plaintiffs’ claim for breach of the covenant of good faith and fair dealing, the court found that the same factual disputes precluded summary judgment on this cause of action as well. The reasonableness of Blue Shield’s decision to withhold benefits was a question for the jury.

On plaintiffs’ ERISA claim, the court conducted a de novo review of the administrative record and found that plaintiffs were entitled to judgment. The court determined that the care A.Z. received at New Haven under the ERISA-governed plan was medically necessary. The court examined treatment records from New Haven which showed A.Z.’s ongoing struggles, including anxiety, depression, panic attacks, aggressive thoughts and urges, impaired social relationships, and thoughts of self-harm. The court concluded that this treatment was consistent with A.Z.’s presentation, and any lower level of care would not have safely managed A.Z.’s symptoms. The court thus granted plaintiffs’ cross-motion for judgment on their ERISA claim and denied Blue Shield’s motion. The court directed the parties to meet and confer on the appropriate amount of benefits due, attorney’s fees, and prejudgment interest, and to file a further case management statement addressing a trial date for the state law claims and the possibility of further settlement discussions.

Pension Benefit Claims

Ninth Circuit

Upchurch v. International Union of Painters and Allied Trades Indus. Pension Plan, No. 2:25-CV-1918 DC AC PS, 2025 WL 3718847 (E.D. Cal. Dec. 23, 2025) (Magistrate Judge Allison Claire). Joseph J. Upchurch contends that he has accrued over 29 years of credited service and more than 24 benefit units under the Northern California Glaziers, Architectural Metal and Glassworkers Pension Trust Fund. The Glaziers Plan has a reciprocal agreement with the International Union of Painters and Allied Trades Industry Pension Plan (IUPAT). This agreement requires the first qualifying plan, in this case, Glaziers, to initiate coordination of benefits with other signatory plans. Upchurch submitted pension plan applications to both plans. Upchurch alleges that while Glaziers eventually began paying benefits after a delay, IUPAT denied benefits, citing a lack of covered employment. Upchurch contends that IUPAT erroneously applied a “rehabilitation plan” adopted in January 2022 to deny him early retirement benefits, which he claims violates the reciprocal agreement. Upchurch brought this action pro se alleging three claims for relief: denial of benefits under ERISA § 502(a)(1)(B) against IUPAT, breach of fiduciary duty under ERISA § 404(a)(1) against Glaziers, and violation of the reciprocal agreement by both Glaziers and IUPAT. Upchurch sought an order compelling the defendants to pay all benefits owed and a declaration of his eligibility for benefits under the reciprocal agreement. Both defendants moved to dismiss. Glaziers argued that Upchurch did not have standing to sue it, and that he failed to state a claim, while IUPAT argued that Upchurch “fails to allege what benefits he is entitled to, because the Plan was correct to deny plaintiff benefits, and because the Reciprocal Agreement does not bar changes made by the Rehabilitation Plan.”

Addressing Glaziers’ motion first, the court ruled that Upchurch’s complaint did not establish standing for his breach of fiduciary duty claim “because he has not identified how, even if he were to prevail, the Glaziers Plan caused an injury that is redressable by a favorable decision from this court. The complaint does not plainly seek any benefits directly from Glaziers.” Furthermore, calculating benefits is not a fiduciary function, and thus “[i]t appears clear to the court that the crux of plaintiff’s claim is one for denial of benefits, not breach of fiduciary duty.” Upchurch contended at oral argument that “he does contend that Glaziers wrongfully denied him benefits for a finite period of time between his application date and Glaziers’ delayed approval date,” and the court allowed him to amend his complaint to reflect this allegation. As for the reciprocal agreement with IUPAT, the court found no breach of fiduciary duty because that agreement was not part of any plan. Also, Upchurch did “not explain how Glaziers violated the Reciprocal Agreement, which only requires that the signatory plans provide the information to one another, not to individual enrollees.”

As for IUPAT, the court denied its motion to dismiss Upchurch’s wrongful denial of benefits claim. IUPAT contended that Upchurch was not entitled to benefits because he was not an “Active Employee,” i.e., he had not earned 450 hours of service in covered employment in the three years before he filed his application. Upchurch acknowledged that he did not contribute to the plan during the relevant time period, but contended that he was operating a self-employed contracting business, and, under the terms of the IUPAT plan, he was not required to make contributions in order to receive service hours. The court examined the relevant definitions and provisions of the IUPAT plan and was “unconvinced by IUPAT’s argument.” It concluded that “it is not at all clear that plaintiff failed to qualify” for benefits pursuant to the terms of the IUPAT plan and therefore recommended denial of IUPAT’s motion on this ground. However, the court recommended dismissal of Upchurch’s breach of fiduciary claim against IUPAT regarding the reciprocal agreement for two reasons. First, this claim “ultimately makes the same claim (that he was wrongfully denied benefits by IUPAT) and seeks the same remedy as his wrongful denial of benefits claim (provision of benefits),” and thus his claim was duplicative. Second, although Upchurch claimed that the rehabilitation plan violated the reciprocal agreement, the court found that “the Rehabilitation Plan does not change how certain hours are recognized” and thus “it does not violate the Reciprocal Agreement. The court agrees that the Rehabilitation Plan does not obviously impact the Reciprocal Agreement. Accordingly, this portion of the complaint should be dismissed.” As a result, the magistrate judge recommended denial of Upchurch’s claims against both parties for violation of the reciprocal agreement, allowed his claim for benefits against IUPAT to proceed, and allowed him to amend his complaint to assert a denial of benefits claim against Glaziers.

Pleading Issues & Procedure

Sixth Circuit

Kosla v. Flex Technologies, Inc., No. 5:25-CV-00070, 2025 WL 3754029 (N.D. Ohio Dec. 29, 2025) (Judge John R. Adams). Stephen Kosla worked for Flex Technologies from May 2005 to September 2024. Kosla developed cancer in 2019, which went into remission but returned in 2023, necessitating work absences for treatment. He filed this action against Flex, alleging that after informing his employer of his advanced cancer in September 2024, he was demoted and subsequently terminated after requesting accommodations. When Kosla initially filed this case, he alleged claims of disability discrimination under the Americans with Disabilities Act (ADA) and Ohio law, failure to accommodate under the ADA and Ohio law, aiding and abetting discrimination, retaliation, Family and Medical Leave Act (FMLA) interference, and FMLA retaliation. However, at the end of the discovery period Kosla took the deposition of one of Flex’s sales managers and contended that he learned information during that deposition that supported additional claims against Flex. He filed a motion for leave to amend his complaint to add causes of action for retaliation and interference with benefits under ERISA. In this order, the court denied his motion. The court stated that Kosla had enough information to form the belief that his termination was due to medical costs as soon as he was terminated in 2024, based on a conversation with Flex’s former president in 2022 or 2023. Kosla testified during his deposition that during this conversation the president asked about Kosla’s wife and specifically “how many more surgeries Plaintiff’s wife was expected to undergo.” Kosla further testified that “this call was the only reason he believes Defendant Flex Technologies terminated him due to the costs of his cancer treatment.” Thus, the court ruled that the additional information obtained during the deposition was not necessary in order for Kosla to assert claims of ERISA retaliation and interference at the outset of the case. The court concluded, “The facts as presented here indicate Plaintiff was not diligent in his attempt to meet the requirements of the Court’s Case Management Conference Plan. He had enough information prior to filing this case to plead the ERISA claims of retaliation and interference. Accordingly, the Court finds he has not shown good cause for bringing additional claims or altering the scheduling order.”