Ah, the dog days are upon us. This week there is no case of the week, but there is plenty of good summer reading, whether you like digging into the complexity of mortality tables, are drawn into the human drama of disability cases, or excited by healthcare claims asserted by medical providers. Stay cool and enjoy!

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

Breach of Fiduciary Duty

Seventh Circuit

Nessi v. Honeywell Ret. Earnings Plan, No. 24 C 6093, 2025 WL 1826100 (N.D. Ill. Jul. 2, 2025) (Judge Matthew F. Kennelly). When plaintiff Antoinette Nessi notified her employer Honeywell International Inc. of her plans to retire, the company presented her with benefit amounts available under the Honeywell Retirement Earnings Plan’s pension benefit forms. Presented with this information, Ms. Nessi elected a 50% joint and survivor annuity benefit, with a commencement date of March 1, 2023. The amounts Honeywell promised were not what Ms. Nessi received, and the amounts she received upon retirement kept changing, although they were never the amount she was presented with before her retirement. Recognizing this disparity, Honeywell issued Ms. Nessi a retroactive payment, but that payment was not for the full amount Ms. Nessi believed she was entitled to, nor did it include interest. Ms. Nessi also made requests to Honeywell for, among other documents, a copy of her pension file, a detailed calculation of her retirement benefits, complete copies of all plan documents and their amendments, a copy of the trust agreement governing the plan, and copies of the mortality assumptions used to calculate her benefits. Honeywell has not provided this information. In July 2024, Ms. Nessi filed the present action on behalf of herself and a putative class alleging various violations of ERISA. Broadly, Ms. Nessi contends that the plan’s actuarial factors are outdated and unreasonable and the benefits the plan is paying to retirees and their spouses are significantly less than the actuarial equivalent of the single life annuity and significantly less than if the benefits had been calculated under reasonable factors. Honeywell International, the Honeywell Plan, and 11 Doe defendants, moved to dismiss Ms. Nessi’s three class-wide claims (they did not seek dismissal of her two individual claims). The court granted the motion to the extent the claims are brought on behalf of the beneficiaries receiving a pre-retirement survivor annuity, but otherwise denied defendants’ motion to dismiss. The pre-retirement survivor annuity is available to spouses of employees that die before they commence retirement. This situation did not apply to Ms. Nessi. As such, the court dismissed the claims on behalf of beneficiaries who receive pre-retirement survivor annuity claims as it agreed with defendants that Ms. Nessi lacks standing to pursue these claims given the undisputed fact that Ms. Nessi does not receive this type of annuity and is thus not affected in any personal way if the pre-retirement survivor annuities paid by the plan are less than the actuarial equivalent of the single life annuities. However, unlike their standing argument, none of defendants’ Rule 12(b)(6) arguments were persuasive to the court. In the first of the three class-wide claims, Ms. Nessi alleges that defendants are violating Section 205 of ERISA by failing to ensure that the plan’s calculation of the joint and survivor annuities results in the actuarial equivalent of the single life annuities as required. The court held that, “[g]iven that her current monthly payment is still less than the figure originally presented to her, it is plausible that Honeywell is using an unreasonable conversion factor.” despite the fact that Honeywell has refused to divulge what mortality table it does rely upon for the tabular factors. Accordingly, the court concluded that Ms. Nessi has asserted specific facts that plausibly support a claim that she and the putative class members are receiving less than the actuarial equitable of a single life annuity. In the next class-wide claim Ms. Nessi alleges that Honeywell is violating ERISA Sections 203(a) and 204(c)(3), ERISA’s nonforfeiture provision and benefit accrual requirement, respectively. The court determined that the complaint sufficiently alleges that defendants have failed to pay the total amount of a given month’s benefit, and failed to include interest on the retroactive payments. Thus, the court agreed with Ms. Nessi that she may pursue this claim individually and on behalf of the class to seek to restore all benefits wrongfully not paid and/or withheld together with make-whole relief to put her and the putative class members in the position they would be in had Honeywell not incorrectly calculated their benefits. In the third and final challenged claim Ms. Nessi asserts that Honeywell breached its fiduciary duties when calculating the joint and survivor annuity benefits. At this stage of the proceedings, the court accepted the allegations that Honeywell had discretionary authority to select the plan’s joint and survivor conversion methods and to calculate benefits using the tabular factors. Moreover, the court also found it plausible that Honeywell breached its duties of prudence and loyalty by failing to have an adequate claims procedure as required under ERISA. Accordingly, for the reasons set forth above, the court denied the motion to dismiss, except to the extent the claims were brought on behalf of putative class members receiving a pre-retirement survivor annuity.

Class Actions

Ninth Circuit

Berkeley v. Intel Corp., No. 3:22-CV-01509 (KAD), 2025 WL 1785320 (N.D. Cal. Jun. 27, 2025) (Judge Edward J. Davila). Plaintiff Gregg Berkeley brings this ERISA action against the Intel Corporation and the Administrative Committee of the Intel Minimum Pension Plan on behalf of a proposed class of approximately 1,847 Intel retirees or their surviving spouses alleging that defendants are violating ERISA and their fiduciary duties by converting their single life annuity (“SLA”) to a joint and survivor annuity (“JSA”) using unreasonable actuarial assumptions and interest rates in the plan. Before the court here was Mr. Berkeley’s motion for class certification. The court granted the motion in this decision. First, the court found that Mr. Berkeley carried his burden to prove his proposed class satisfies the requirements of Rule 23(a). Although it was not contested, the court unsurprisingly noted that the 1,847 member class satisfies the numerosity requirement. The court then found the commonality requirement was also satisfied. “The overarching questions relevant to all claims include (1) whether ERISA requires “reasonable” actuarial assumptions for SLA to JSA conversions, and (2) whether the actuarial assumptions Intel used in the conversion calculation failed to provide actuarial equivalence between the two forms of benefit.” To prove these claims and measure losses, Mr. Berkeley presents evidence comparing the JSA benefits the class members received to those they would have received if the plan had used his proposed actuarial assumptions. The court found that these questions of law and fact are common to the class and can be resolved on a class wide basis. Next, the court determined that typicality is satisfied as Mr. Berkeley’s claims arise from the same course of conduct and events as each of the absent class members receiving a JSA using the same challenged actuarial assumptions. The court was also confident that the adequacy requirement under Rule 23(a) has been met as Mr. Berkeley and his counsel have no conflicts of interest with other class members and because they have demonstrated they will vigorously prosecute this action on behalf of the class. Finally, the court found certification proper under Rule 23(b)(1), given the fact that separate actions could result in conflicting decisions as to how to calculate the JSA benefits. Moreover, the court agreed with Mr. Berkeley that any adjudication by one class member will necessarily impact them all due to the nature of the modifications in the plan that he seeks. Based on the foregoing, the court granted Mr. Berkeley’s motion and certified the class.

Disability Benefit Claims

Second Circuit

Nabi v. Provident Life & Casualty Ins. Co., No. 1:23-CV-00844-HKS, 2025 WL 1798356 (W.D.N.Y. Jun. 30, 2025) (Magistrate Judge Kenneth Schroeder Jr.). In 2003, plaintiff Angelika Nabi was diagnosed with a fast-growing and aggressive form of brain cancer. Even with aggressive and immediate treatment, most patients with this type of brain tumor die within two years. Immediately upon her diagnosis Ms. Nabi began an intense treatment regime which consisted of brain surgeries, chemotherapy, and high-dose radiation. Ms. Nabi and her family were focused on her survival. Remarkably, Ms. Nabi beat the odds of her diagnosis, and even continued working in her position as an office administrator for a healthcare provider part time until 2009. But the treatment Ms. Nabi received not only killed off the cancerous brain cells, but the healthy cells too, and the high doses of radiation, over time, resulted in “radiation necrosis” of her brain, leaving her with severely diminished executive functioning. By the time she stopped working in 2009, Ms. Nabi had undergone four brain surgeries and three facial surgeries. Her treating neurosurgeon testified that Ms. Nabi’s mental processing problems became pronounced in 2008-2009, which was the reason she had to stop working. Ms. Nabi did not apply for disability benefits when she stopped working. At the time Ms. Nabi did not remember she had a long-term disability plan through her employment. She only applied for benefits twelve years later, in 2021, when her husband discovered the policy. Under the terms of the plan insured by defendant Provident Life and Casualty Insurance Company, Ms. Nabi was required to give written notice of her claim and apply for benefits “as soon as reasonably possible.” In response to Ms. Nabi’s claim, Provident approved disability benefits, but only beginning September 8, 2021, the date of her notice. In this ERISA action, Ms. Nabi alleges that Provident wrongly denied her benefits between 2009 and 2021 and challenges its decision under Section 502(a)(1)(B). Ms. Nabi broadly maintains that by December 2009, she had become totally disabled and unable to work, and that due to the effects of her cancer and treatments, she was too cognitively impaired to recognize, remember, and submit an insurance claim under the policy. Before the court here were Provident’s motion for judgment on the administrative record and Ms. Nabi’s motion for summary judgment. Although Provident filed a motion for judgment on the administrative record, the court held that “the Federal Rules of Civil Procedure make no provision for such a mechanism.” Instead, the court treated the pending motions as cross-motions for summary judgment and accordingly proceeded to inquire whether disputed questions of material fact exist. The court also held that the de novo standard of review applies. To begin, the court considered whether it would permit a declaration outside of the administrative record from Ms. Nabi’s neurosurgeon testifying to the central issue of the case – namely whether Ms. Nabi was mentally fit to have filed her claim any sooner. In the Second Circuit, courts have the discretion to consider evidence outside of the administrative record where good cause exists to do so. Here, the court found that good cause exists to admit the doctor’s declaration given Provident’s financial conflict of interest and the procedural irregularities in the way it handled Ms. Nabi’s claim, both of which call into question the fairness and clarity of its decision-making process. Moreover, the court disagreed with Provident that the declaration should be excluded because the doctor’s opinion constitutes expert testimony. The court considered the declaration, as well as the doctor’s overarching conclusion that Ms. Nabi lacked the mental capability to file an insurance claim following her treatment in 2009. Although the court found this testimony instructive, especially when coupled with the other evidence in the record provided by Ms. Nabi, the court still concluded that genuine issues of material fact exist as to whether Ms. Nabi filed her claim as soon as reasonably possible, especially given the significant twelve-year delay between the disability onset date and filing of her claim. Therefore, the court denied both motions for summary judgment and instead set the case for a bench trial.

Coley v. Hartford Life & Accident Ins. Co., No. 3:22-CV-01509 (KAD), 2025 WL 1786082 (D. Conn. Jun. 27, 2025) (Judge Kari A. Dooley). In early 2018, plaintiff Joseph Coley began experiencing severe pain in his neck and shoulder from rheumatoid arthritis and underwent the first of three spinal surgeries. Because of his pain and the need to recover from surgery, Mr. Coley stopped working and submitted a claim for disability benefits under his employer’s policy insured by The Hartford Life and Accident Insurance Company. Hartford approved Mr. Coley’s disability claim and Mr. Coley began receiving long-term disability benefits under the “your occupation” disability definition of the policy. Twenty-four months later Hartford terminated Mr. Coley’s benefits under the definition of disabled under the “any occupation” category. This was in the summer of 2020, during the height of the COVID-19 pandemic. Because of this, Hartford tolled its appeal deadline until 60 days after the lifting of the national emergency declaration. During the tolled appeal period, Mr. Coley underwent his third surgery on November 18, 2020, and began taking oxycodone for pain. Mr. Coley timely appealed Hartford’s long-term disability decision on July 6, 2021, asserting several objections to Hartford’s adverse decision including its failure to consider his award of Social Security disability benefits and its reliance on cherry-picked portions of the record. After Hartford issued its final determination upholding its initial termination decision, Mr. Coley filed this lawsuit under ERISA. Each party filed its own motion for summary judgment on the administrative record. The court applied the arbitrary and capricious standard of review to Hartford’s decision as the plan unanimously grants the insurance company with full discretion and authority to determine eligibility of benefits. Under this deferential review, the court concluded that Hartford’s decision was reasonable and supported by substantial evidence, expressing that it agreed “with the Defendant: although this may be a case where a contrary determination would also be supported by substantial evidence, viewing the record in its totality, there was substantial evidence to support Hartford Life’s determination that Plaintiff was not disabled under the ‘Any Occupation’ definition.” The court noted that Hartford conducted an in-person independent medical examination of Mr. Coley and relied on opinions of appropriately qualified doctors to reach its ultimate determination “that although Plaintiff’s condition was serious, it was being managed well by his doctors and treatment plan, and with certain functional restrictions, Plaintiff could sustain a 40-hour workweek.” Although this conclusion diverged from Mr. Coley’s treating physician’s and from the decision of the Social Security Administration, the court nevertheless agreed with Hartford that it was not arbitrary and capricious. In sum, the court held that Hartford’s decision was substantively and procedurally fair and therefore not an abuse of discretion. Accordingly, the court granted Hartford’s motion for summary judgment in its entirety and denied Mr. Coley’s summary judgment motion.

Sixth Circuit

Wilkinson v. Unum Life Ins. Co. of Am., No. 1:24-cv-205, 2025 WL 1791139 (E.D. Tenn. Jun. 27, 2025) (Judge Curtis L. Collier). On April 12, 2023, plaintiff Carrie Wilkinson underwent neck surgery. Just three months later, Unum Life Insurance Company of America, the insurer of Ms. Wilkinson’s long-term disability plan, terminated her benefits. In this ERISA action, Ms. Wilkinson challenges that decision. Before the court here was Ms. Wilkinson’s motion for judgment on the record. Because the plan does not grant discretion to Unum, the parties agreed that the appropriate standard of review was de novo. Affording “no deference or presumption of correctness,” to Unum’s decision, the court entered judgment in favor of Ms. Wilkinson and reinstated her benefits in this decision. As an initial matter, the parties disputed what the material and substantial duties of Ms. Wilkinson’s usual occupation were. Before she became unable to work due to her medical conditions, Ms. Wilkinson was employed by a hospital as the Chief Clinical Officer. Unum characterized this role as most consistent with a Chief Nursing Officer position, whose primary duty was to oversee and coordinate the daily activities of the hospital’s nursing department. It categorized this role as a sedentary occupation. Ms. Wilkinson challenged Unum’s assessment of her role as sedentary and administrative, and argued that her position regularly required her to perform general nursing duties, such that her own occupation had a medium exertion level. The court sided with Unum. “Here, Unum appropriately used the Dictionary of Occupational Titles (‘DOT’) and identified ‘the most closely analogous DOT-recognized occupation’—namely, the job of chief nursing officer. Because nursing duties are not customarily required of other individuals engaged in her usual occupation, they are not material and substantial duties within Plaintiff’s usual occupation. Given the plain reading of the Plan,  Unum did properly consider Plaintiff’s job duties and correctly determined her usual occupation as one of sedentary capacity.” Although the court found that Unum properly considered Ms. Wilkinson’s job duties and appropriately assessed her usual work as sedentary, it nevertheless concluded that Unum incorrectly terminated her long-term disability benefits. Based on the objective medical evidence and test results in the record, the results of Ms. Wilkinson’s functional capacity evaluation, and the opinions of her treating neurosurgeon and primary care doctor, the court held that Ms. Wilkinson met her burden of proving by a preponderance of the evidence that she was unable to perform her sedentary occupation and therefore disabled under the plan. The court therefore granted Ms. Wilkinson’s motion for judgment on the administrative record and ordered that her long-term disability benefits be reinstated retroactive to the date of termination through the date of the judgment order.

Eighth Circuit

Halloran v. Unum Life Ins. Co. of Am., No. 24-cv-199 (ECT/ECW), 2025 WL 1833176 (D. Minn. Jul. 3, 2025) (Judge Eric C. Tostrud). Before he injured his left shoulder in the fall of 2019, plaintiff Andrew Halloran worked as a sheet metal fabricator, a position which required nearly constant standing and heavy lifting. The injury occurred when Mr. Halloran was caring for his wheelchair-bound wife. He was helping his wife transfer from her wheelchair to the bathroom, she slipped, and he caught her with his arms, causing his left shoulder to dislocate. Mr. Halloran underwent left shoulder surgery a few weeks later and stopped working. He then submitted claims for disability benefits under first a short-term, and later a long-term disability policy insured and administered by defendant Unum Life Insurance Company of America. This litigation stems from Unum’s decision to terminate Mr. Halloran’s benefits in 2022, after paying long-term disability benefits for two years. Unum determined that Mr. Halloran did not qualify for continuing benefits when the policy’s definition of disability changed from “own occupation” to “any gainful occupation.” Mr. Halloran and Unum filed competing motions for judgment on the administrative record. The court determined under de novo standard of review that Mr. Halloran failed to establish by a preponderance of the evidence that he was unable to perform sedentary occupations in April 2022. Accordingly, the court held that Unum properly terminated Mr. Halloran’s benefits. The court based its decision in large part on the fact that Mr. Halloran’s treating physician consistently opined that, as early as June, 2020, that Mr. Halloran could perform sedentary work. The court stressed, “[n]o medical provider opined that as of April 13, 2022, Halloran was unable to work in a sedentary capacity. Unum’s denial of Halloran’s benefits under the ‘any gainful occupation’ standard was in lockstep with Halloran’s restrictions.” The court thus agreed with Unum’s conclusion that Mr. Halloran’s condition precluded him from performing the physically demanding occupational requirements of the position he held before, but that he could nevertheless work fulltime in a role that was not so physically tasking. Therefore, the court denied Mr. Halloran’s motion for judgment, and granted Unum’s motion for judgment on the administrative record.

Ninth Circuit

Sarruf v. Lilly Long Term Disability Plan, No. C24-0461-JCC, 2025 WL 1837744 (W.D. Wash. Jul. 3, 2025) (Judge John C. Coughenour). Plaintiff David Sarruf filed this action against the Lilly Long Term Disability Plan seeking a determination that he is entitled to long-term disability and life insurance waiver of premium benefits under the plan pursuant to Section 502(a)(1)(B) of ERISA. Mr. Sarruf ceased working for Eli Lilly and Company in March of 2020 after developing post-COVID viral syndrome. The plan administrator denied Mr. Sarruf’s claim for benefits citing insufficient medical support and finding that Mr. Sarruf failed to follow a prescribed course of treatment, as required by the policy. Mr. Sarruf retained counsel (he is represented by attorneys at Kantor & Kantor), and attempted to appeal the adverse decision. During the height of the COVID pandemic, a national emergency was declared, and ERISA appeal deadlines were suspended. This tolling period caused significant confusion in this case. The administrator’s denial letter informed Mr. Sarruf that he had “240 days after the declared end of the current national emergency to appeal the determination.” However, a few months later, the plan paused the appeal deadline “until the earlier of (a) one year from the date the individual was first eligible for relief, or (b) 60 days after the announced end of the national emergency.” Based on this, defendant maintained that Plaintiff’s appeal deadline was April 26, 2022. Just prior to that date, Mr. Sarruf’s counsel sent a letter to the plan administrator notifying it of his intent to appeal the denial of benefits and requesting confirmation of the appeal deadline and copies of Mr. Sarruf’s claim files. Defendant’s representative responded by email and identified the appeal deadline as February 4, 2024. “Based on this advice, Plaintiff’s counsel submitted the appeal two days prior—on February 2, 2024. The LTD Plan administrator denied the appeal shortly thereafter, citing as its sole basis untimeliness (without any explanation as to why it was untimely or what the deadline was).” The parties cross-moved for summary judgment. In this decision the court held that the Lilly Long Term Disability Plan is estopped from arguing untimeliness and that Mr. Sarruf’s “appeal was inappropriately denied as untimely, despite an appeal submission compliant with the deadline provided by the LTD Plan administrator.” The court found that defendants’ conduct reasonably led Mr. Sarruf to believe that the appeal deadline was February 4, 2024, given their written statement to that effect and in light of varying deadlines resulting from the evolving COVID-19 national emergency. “Thus, Defendants are estopped from invoking the LTD Plan’s contractual limitations period because their own misrepresentations caused Plaintiff to reasonably and detrimentally rely on a later deadline. This reliance led to what Plaintiff believed to be the timely submission of his appeal, and equitable estoppel applies to prevent this type of injustice.” However, rather than engage in its own de novo fact-finding in the first instance, the court determined that the proper remedy for defendant’s procedural error is a remand to the plan administrator for a full and fair review of the post-denial administrative record. For this reason, the court found that remand was warranted in this instance, particularly as long COVID was not well understood at the time of the denial. The court then ended the decision finding that Mr. Sarruf is entitled to reasonable attorneys’ fees as he achieved some degree of success on the merits in challenging defendant’s denial. Thus, the court granted in part and denied in part each party’s motion for judgment, remanded Mr. Sarruf’s long-term disability and life insurance waiver of premium claims to the plan administrator for reevaluation, and awarded Mr. Sarruf attorney’s fees.

Discovery

Sixth Circuit

Trump v. Anthem Life Ins. Co., No. 5:24-cv-02109, 2025 WL 1827808 (N.D. Ohio Jul. 2, 2025) (Judge John R. Adams). Plaintiffs Kristin Trump and Amanda Trump Nevells filed this action against Anthem Life Insurance company and Enviroscience Incorporated Group Life Plan seeking to recover accidental death and college benefits pursuant to their late husband/father’s employee benefit plan. Plaintiffs filed a motion seeking limited discovery and requesting authorization to depose a representative from Anthem on four issues: (1) what constitutes the administrative record; (2) structural bias and steps taken by defendants to minimize bias; (3) Anthem’s policy of obtaining independent review of external medical reports; and (4) the plan administrator’s claims procedures. The court granted plaintiffs’ motion in this decision. It found that discovery was appropriate as to all of these topics. First, the court agreed with plaintiffs that there are genuine questions as to whether the administrative record is sufficiently complete to provide a full and fair review at the time the final benefits determination was made, given inconsistencies between the administrative record at the time when the decision was made and the administrative record now. The court was therefore persuaded the discovery regarding the completeness of the administrative record was warranted. Next, the court was persuaded that plaintiffs presented evidence that Anthem’s bias played a role in how their claim was handled which amounted to more than mere allegations that a structural conflict of interest exists. Therefore, the court held that discovery on how defendants minimize bias is allowable here. The court further permitted discovery into Anthem’s internal policies and the plan’s claim procedures stating, “additional discovery as to internal policy is necessary because there is a structural conflict of interest, and an explanation of internal procedures is not included in the administrative record. Plaintiffs have sufficiently laid a factual foundation to support a claim for lack of due process as to these issues.” For these reasons, the court granted plaintiffs’ discovery motion and permitted them to conduct a deposition limited to the topics addressed in this order.

Pleading Issues & Procedure

Sixth Circuit

Muhammad v. Gap Inc., No. 2:24-cv-3676, 2025 WL 1836657 (S.D. Ohio Jul. 3, 2025) (Judge Douglas R. Cole). Pro se plaintiff Haneef Muhammad filed this lawsuit in state court against his former employer, Gap Inc. and GPS Apparel, the insurer of his ERISA-governed disability policy, Hartford Life and Accident Insurance Company, two disability occupational consultants, and Verisk Analytics. Mr. Muhammad’s complaint asserts wide-ranging allegations and includes claims of defamation, retaliation, discrimination, wrongful termination, hostile work environment, wrongful denial of disability benefits, bad faith, and emotional distress, all of which seem to stem from a shoulder injury Mr. Muhammad says he incurred while working for Gap. Defendants responded to the lawsuit by removing it to federal court. The district judge previously assigned to the case then denied Mr. Muhammad’s motion to remand, finding that ERISA completely preempted his long-term disability benefit-related claims. Defendants, except for Hartford, subsequently filed motions to dismiss, while Mr. Muhammad filed a series of motions that remain pending. Hartford, meanwhile, moved for judgment on the pleadings. The court issued this decision granting the motions to dismiss, without prejudice, and granting Hartford’s motion for judgment on the pleadings, while deferring ruling on Mr. Muhammad’s pending motions. For various reasons, the court agreed with defendants that the complaint falls short against all defendants and fails to allege plausible causes of action or meet the pleading standards to state claims upon which relief may be granted. With regard to the ERISA-related disability claims asserted against Hartford, the court held that because Mr. Muhammad’s long-term disability benefits have been reinstated and he has received all of the benefits to which he’s entitled, he does not have standing to pursue a claim under ERISA, and the non-ERISA claims are completely preempted. As for the compensatory and putative damages Mr. Muhammad seeks, the court held that ERISA does not provide for these types of remedies. The court therefore agreed with Hartford that it is entitled to judgment as a matter of law on Mr. Muhammad’s wrongful denial of long-term disability benefits, bad faith, and emotional distress claims. Finally, although the court was not convinced that ERISA preempts Mr. Muhammad’s discrimination claim against Hartford, it nevertheless found that the complaint offers nothing from which it can infer that Hartford denied his benefits on account of his race. The decision ended with the court expressing its concern that Mr. Muhammad had cited nonexistent cases and ordered him to show cause in writing why it should not impose sanctions on him. The court then deferred ruling on Mr. Muhammad’s motions until after a scheduled hearing on the order to show cause.

Ninth Circuit

Williams v. Lawrence Livermore Nat. Sec., LLC Benefits & Investment Committee, No. 24-cv-07593-VC, 2025 WL 1829034 (N.D. Cal. Jul. 2, 2025) (Judge Vince Chhabria). Plaintiff Dean Williams brings this fiduciary breach action under ERISA against the Lawrence Livermore National Securities (“LLNS”), LLC Benefits & Investment Committee alleging that members of LLNS’s HR department made misrepresentations and omitted key details when they advised him about his options for enrolling in disability benefits and how those enrollments would affect his pension. Defendant moved to dismiss the complaint. In this brief order the court denied the motion. First, the court held that the plan’s limitations period only covers denial of benefit claims, not breach of fiduciary duty claims, and therefore does not bar Mr. William’s action. Next, the court concluded that Mr. Williams stated actionable misrepresentations by a fiduciary as the LLNS HR employees “were performing a fiduciary function because they were advising Williams about plan benefits.” Finally, the court determined that Mr. Williams alleged reasonable reliance on the HR employees’ representations as he sufficiently alleged that the plan’s terms are ambiguous and confusing on the issue of how election of disability benefits affects pension benefits.

Provider Claims

Second Circuit

Abira Med. Laboratories, LLC v. Anthem Blue Cross Blue Shield of Conn., No. 3:24-CV-00872 (SVN), 2025 WL 1825425 (D. Conn. Jul. 2, 2025) (Judge Sarala V. Nagala). Plaintiff Abira Medical Laboratories, LLC alleges that it performed lab testing services for patients insured by defendant Anthem Blue Cross Blue Shield of Connection for which it has not been compensated at all, or not been fully compensated. At issue in this lawsuit are thousands of claims, allegedly worth $3,793,084. Abira brings claims for breach of contract, breach of implied covenant of good faith and fair dealing, fraudulent misrepresentation, negligent misrepresentation, promissory estoppel, equitable estoppel, quantum meruit/unjust enrichment, and violations of the Families First Coronavirus Response Act (“FFCRA”) and the Coronavirus Aid, Relief, and Economic Security (“CARES”) Act. Abira does not assert a claim under ERISA in its complaint, but does state that to the extent the underlying claims are governed by ERISA, it wishes to pursue claims to recover benefits under Section 502(a)(1)(B) and for equitable relief under Section 502(a)(3). Anthem, along with hundreds of unnamed defendants, ABC Companies 1-00 John Does 1-100, moved to dismiss the complaint in its entirety under Federal Rules of Civil Procedure 8 and 12(b)(6). In this decision the court granted the motion to dismiss, and dismissed the action with leave to amend, “except as to the equitable estoppel, quantum meruit/unjust enrichment, and FFCRA and CARES Act claims, as well as claims barred by anti-assignment and time limitations provisions, and any state law claims preempted by ERISA and the Federal Employee Health Benefits Act (‘FEHBA’)—all of which are dismissed without leave to amend.” To begin, the court concluded that the unnamed defendants must be dismissed pursuant to Rule 8, as the amended complaint is so vague as to the unnamed defendants as to make it impossible to identify them or understand the claims against them. The court however rejected Anthem’s request for dismissal on Rule 8 grounds, holding that the complaint otherwise meets the requirements of notice pleading. Nevertheless, the court agreed with Anthem that the amended complaint does not state claims upon which relief may be granted, and that dismissal is appropriate under Rule 12(b)(6). First, the court concluded that the state law causes of action are all preempted by ERISA as to the 333 claims made pursuant to ERISA-governed healthcare plans. The court stated that these 333 claims necessarily relate to the ERISA plans as they seek to recover benefits denied under them and because they cannot be resolved without some analysis of the language of the plans. Additionally, the court concluded that the complaint does not plausibly allege sufficient derivative standing to state a claim under ERISA. “Plaintiff must plausibly allege that it received an assignment from a participant or beneficiary and has failed to do so.” Moreover, the court dismissed 1,197 of the claims because they are governed by healthcare plans that contain anti-assignment provisions which bar Abira from seeking recovery on behalf of insureds. “Accordingly, Plaintiff’s claims, whether brought pursuant to ERISA or state law, are barred as to the 1,197 Disputed Claims with anti-assignment provisions.” The court then dismissed a further 125 claims as time-barred by the express language of the governing health plans. An additional basis for dismissal of two claims was preemption under FEHBA, as the state law claims related to the two claims governed by the statute implicate matters of coverage and benefits, seeking payment for services rendered pursuant to the terms of those health benefit plans. The court then turned to the state law causes of action. It determined that all of them must be dismissed for failure to state a claim. The court found that the complaint (1) fails to plausibly allege that Anthem breached a contract; (2) that it does not state a claim for fraudulent or negligent misrepresentation; (3) fails to plausibly allege a clear and definite promise to state a claim for promissory and equitable estoppel; and (4) that a provider cannot bring an unjust enrichment or quantum meruit claim against an insurance company based on the services it provides to the insureds. Finally, the court dismissed the claims for violations of the FFCRA and the CARES Act as neither act creates a private right of action.

Third Circuit

Samra Plastic & Reconstructive Surgery v. Aetna Life Ins. Co., No. 23-23424 (MAS) (JTQ), 2025 WL 1792879 (D.N.J. Jun. 30, 2025) (Judge Michael A. Shipp). A breast cancer survivor, K.T., who received health insurance through an ERISA-plan administered by Aetna Life Insurance Company required post-mastectomy reconstructive surgery. Plaintiff Samra Plastic and Reconstructive Surgery was an out-of-network provider with Aetna. Before performing K.T.’s surgery, Samra contacted Aetna to request its authorization for the procedure and to obtain assurance of reimbursement rates. Aetna approved the surgery and Samra performed the operation on K.T. It then submitted a bill for $300,000 to Aetna. Aetna reimbursed the provider less than $15,000. Samra imitated this lawsuit to recoup the outstanding balance. On September 10, 2024, the court issued an order granting Aetna’s motion to dismiss Samra’s complaint. (Your ERISA Watch summarized the decision in our September 18, 2024 issue). Relevant here, the court held that Samra did not have standing through the assignment of benefits because of an unambiguous anti-assignment clause in the plan. It further held that the provider lacked standing under its designated authorized representative form, which it had allegedly conferred limited power of attorney status, because the form did not comply with the procedural requirements under New Jersey law. On October 24, 2024, Samra filed an amended complaint asserting three causes of action under ERISA on behalf of the patient. It maintains that it has standing to sue on K.T.’s behalf through a power of attorney document appointing its office manager as the patient’s attorney-in-fact, and through an assignment of benefits. Aetna once again moved for dismissal. In this order the court granted the motion to dismiss without prejudice. As a preliminary matter, the court declined to revisit plaintiff’s argument that it has standing to seek relief under ERISA based on the assignment of benefits. The court noted that it had already rejected this argument in its September 2024 opinion. The decision instead focused on whether Samra has standing to sue on K.T.’s behalf through a valid power of attorney. Once again, the court found that it did not. For one thing, the court agreed with Aetna that the patient needs to be the named plaintiff in the caption, not Samra Plastic & Reconstructive Surgery. But even putting aside the caption, the court held that the allegations in the amended complaint reveal that the focus of the alleged injury and damages is centered around the provider, and not on the harms incurred by the patient. The court stated, “the substance of the SAC reveals that it is seeking to enforce Plaintiff’s rights, rather than the rights of Patient. In fact, there are no allegations that Patient has suffered any harm. For the above reasons, the Court finds that Plaintiff does not have standing to pursue the claims at issue.” On top of these issues, the court further held that the complaint still fails to provide sufficient evidence that the patient’s power of attorney meets the procedural requirements of the state of New Jersey. The court pointed out that the amended complaint provides no details concerning the document, its execution, or any subscribing witnesses, and therefore does not demonstrate that the power of attorney is sufficient to confer standing under New Jersey law. For these reasons, the court dismissed all three counts. However, “[o]ut of an abundance of caution,” the court decided to dismiss without prejudice and granted Samra a final opportunity to amend its complaint and address the deficiencies identified in this decision.

Fifth Circuit

Lone Star 24 HR ER Facility, LLC v. Blue Cross & Blue Shield of Tex., No. SA-22-CV-01090-JKP, 2025 WL 1840733 (W.D. Tex. Jul. 2, 2025) (Judge Jason Pulliam). Plaintiff Lone Star 24 HR Facility, LLC is a privately held company that operates a freestanding emergency care facility. Lone Star brings this action on behalf of itself and its patients under ERISA and state law alleging that defendants Anthem Health Plans, Inc., Blue Cross Blue Shield Healthcare Plan of Georgia, Inc., Anthem Insurance Companies, Inc., Anthem Health Plans of Kentucky, Inc., Healthy Alliance Life Insurance Company, Anthem Health Plans of New Hampshire, Inc., Community Insurance Company, Anthem Health Plans of Virginia, Inc., Blue Cross Blue Shield of Wisconsin, Rocky Mountain Hospital and Medical Service, Inc., Blue Cross of California, and Anthem Blue Cross Life and Health Insurance Company (collectively, the “Anthem defendants” or “Anthem”) have underpaid claims for emergency services it provided to insureds. Defendants moved to dismiss the action for lack of jurisdiction pursuant to Federal Rule of Civil Procedure 12(b)(2). In this order the court granted the motion to dismiss the state law breach of contract claim for lack of jurisdiction, but denied the motion to dismiss the ERISA claims. With regard to the ERISA causes of action the court wrote, “to clarify the arguments and this Court’s focus, Anthem admits ERISA provides for nationwide personal jurisdiction over any defendant. Therefore, to the extent Lone Star asserts an ERISA cause of action on all or any of the underlying medical claims upon which this action rests, this Court holds personal jurisdiction over Anthem on the ERISA cause of action. This Court will not ‘dismiss the case’ against Anthem because this Court does hold jurisdiction to adjudicate any ERISA cause of action asserted on the underlying medical claims arising from plans governed by ERISA. To the extent Anthem argues this Court must dismiss this case for lack of personal jurisdiction because Lone Star does not differentiate the medical claims arising under a plan governed by ERISA from those arising from a plan exempt from ERISA, this argument fails in the context of this jurisdictional challenge.” However, it was a different matter with regard to the breach of contract cause of action. There, the court agreed with the Anthem defendants that Lone Star fails to establish either general or specific personal jurisdiction. In fact, the Fifth Circuit has addressed arguments nearly identical to those made by Lone Star here and has rejected them, holding that “authorizing out-of-state health care treatment and partially paying a bill for that treatment gives rise to specific jurisdiction.” Moreover, the court declined to exercise pendent jurisdiction over the breach of contract action, as it disagreed with Lone Star that the non-ERISA claims shared a common nucleus of facts such that resolution of the entire action would promote judicial economy and avoid piecemeal litigation. Therefore, the court granted the motion to dismiss the state law claim. Accordingly, Lone Star’s action against Anthem will proceed as a strictly ERISA case.