Duke v. Luxottica U.S. Holdings Corp., No. 24-3207, __ F.4th __, 2026 WL 303549 (2d Cir. Feb. 5, 2026) (Before Circuit Judges Robinson, Nathan, and Kahn)

This week’s notable decision, a published opinion from the Second Circuit, addresses a number of issues that often pop up in challenges to the administration of employee benefit plans, so rather than list them all up front, let’s just dive into the facts and see if you can spot them, law-school style.

The plaintiff was Janet Duke, a retired regional manager for Luxottica U.S. Holdings Corporation. Duke worked for Luxottica for nearly 21 years and was a participant in the Luxottica Group Pension Plan, a defined benefit plan.

On retirement, Duke had a choice of benefits. She selected the default option for married participants, a joint and survivor annuity (JSA) that would pay a percentage of her monthly benefit to her surviving spouse.

Under ERISA, a JSA has to be “actuarially equivalent” to a hypothetical single life annuity (SLA) that a participant would otherwise receive. In order to calculate Duke’s JSA, the plan’s benefits committee used a 7% annual interest rate and life expectancy values published in 1971. Duke contends that these assumptions were outdated, resulted in a benefit that was not actuarially equivalent to an SLA, and decreased her monthly benefit by about $54.

Duke filed this putative class action against her employer and related defendants, asserting four claims: violation of ERISA’s JSA equivalence requirement, violation of ERISA’s equivalence requirement for accrued benefits, violation of ERISA’s rules prohibiting forfeiture of retirement benefits, and breach of ERISA’s fiduciary duty obligations.

As for remedies, Duke sought “both reformation of the Plan to update its actuarial assumptions used to convert SLAs into JSAs, as well as monetary restitution to the Plan in the form of loss restoration and disgorgement of profits.”

Defendants moved to compel arbitration pursuant to Duke’s employment agreement, or, in the alternative, for lack of standing and failure to state a claim. The district court agreed with defendants that Duke lacked standing to pursue relief on behalf of the plan under ERISA Section 502(a)(2), and ruled that she must arbitrate her individual claims under Section 502(a)(3). (Your ERISA Watch covered this ruling in our October 11, 2023 edition.)

This decision was short-lived, however. The case was transferred, and the new judge granted plaintiffs’ motion for reconsideration. The court concluded that Duke had standing to assert a claim under Section 502(a)(2) on behalf of the plan for both reformation and monetary payments, and further ruled that the “effective vindication” doctrine precluded mandatory individual arbitration of that claim. The district court also denied defendants’ request to stay litigation of the claims under Section 502(a)(2) pending arbitration of the claims under Section 502(a)(3). (Your ERISA Watch covered this decision in our December 4, 2024 edition.)

Defendants filed interlocutory appeals from both the motion to compel arbitration and the motion to stay.

The Second Circuit began by discussing its own appellate jurisdiction. The court noted that it has the power to review certain interlocutory orders, including a district court’s denial of motions to compel arbitration and to stay litigation under the Federal Arbitration Act (FAA). However, here defendants were asking the court to review whether Duke had standing under Section 502(a)(2), which was “a determination of the district court’s subject matter jurisdiction that is not ordinarily immediately appealable.”

The court was not concerned, however. It ruled that the scope of an appealable order under the FAA “includes a district court’s determination that it has subject matter jurisdiction over the controversy to be litigated rather than stayed or arbitrated – including a plaintiff’s Article III standing.” Even if the scope was not this expansive, the Second Circuit ruled that it would consider the issue regardless as a matter of its pendent jurisdiction because standing and jurisdiction were “inextricably intertwined” with appealable issues.

The Second Circuit then turned to Duke’s Article III standing under Section 502(a)(2). The court divided this issue into two parts: whether Duke had standing to seek plan reformation, and whether Duke had standing to seek monetary payments to the plan.

On the first issue, defendants agreed that Duke’s receipt of decreased benefits was a “classic pocketbook injury” cognizable under Article III. However, they contended that plan reformation was a remedy “categorically unavailable under Section 502(a)(2) – which authorizes relief only to a plan – and thus Duke’s injury is not redressable under that provision.”

The Second Circuit was unconvinced, noting that defendants’ argument “targets the merits of Duke’s claims, not her standing to pursue them.” Furthermore, Duke was careful to argue that the harm to the plan was not her “receipt of reduced benefits,” but instead “its use of allegedly outdated actuarial assumptions,” which “renders the Plan in constant noncompliance with ERISA and jeopardizes its favorable tax status as a result.” Thus, while correcting that noncompliance would benefit Duke, that was not her point: “the Plan’s alleged noncompliance is its own injury that Duke seeks to remedy with Section 502(a)(2), rather than her receipt of decreased benefits, which is sufficient for standing[.]”

The court stressed that it was not reaching the issue of “whether ERISA noncompliance and attendant tax consequences really do constitute ‘plan injuries’ within Section 502(a)(2)’s remedial scope[.]” This was “an undecided question properly reserved for the merits.” Instead, the court merely held that Duke had standing to advance her arguments on the issue.

The Second Circuit reached a different conclusion as to Duke’s standing regarding monetary payments. Duke sought repayment of losses and disgorgement of profits to the plan, but defendants contended that only the plan would benefit from those remedies, not Duke, and thus she had no standing. Relying on the Supreme Court’s decision in Thole v. U.S. Bank, N.A., the court agreed with defendants.

Duke attempted to distinguish Thole with two arguments. First, she pointed out that the plaintiffs in Thole, unlike her, had received all their benefits. However, the Second Circuit responded that this did not matter because both plans were defined benefit plans. Thus, the plaintiffs in both cases “possessed ‘no equitable or property interest’ in the plan’s assets, and so monetary repayment to the plan would not benefit the plaintiffs personally.” Furthermore, Duke’s benefits were not reduced because of “a lack of Plan funds, but because of the Plan’s use of outdated actuarial assumptions.”

Duke’s second argument was that “the forms of relief she seeks will ‘work in tandem’ by increasing Plan funding commensurate with the reformation she hopes to obtain.” However, the court found that this argument was “foreclosed by Thole.” The court explained that the employer was the backstop for the plan, and thus was both “on the hook for plan shortfalls” and the recipient of any surplus after benefit payments. Thus, “nothing suggests monetary payments to the Plan will be necessary to effectuate any eventual reformation.” Either way, Duke “will be made whole regardless of whether the Plan receives additional funds; and if Duke is unsuccessful in seeking reformation, she will not be made whole regardless of whether the Plan receives those funds.” As a result, this claim “fails Article III’s redressability requirement.”

Next, the court considered arbitration. Duke contended that the effective vindication doctrine “precludes mandatory individual arbitration of her Section 502(a)(2) claim,” and the Second Circuit agreed. The court noted that it had already recognized the doctrine in the ERISA context in Cedeno v. Sassoon, and saw no reason not to apply it here.

Defendants offered three arguments against this conclusion, but the court rejected them, ruling that (1) Duke had properly alleged standing to bring her claim, as explained above, (2) it made no difference that this case involved a defined benefit plan, rather than a defined contribution plan as in Cedeno, because either way “only a representative action can resolve the allegedly detrimental effects of widespread violations of federal law,” and (3) defendants’ authorities regarding the scope of the FAA did not apply because Duke was not pursuing a “representative procedure” seeking “a personal remedy under Section 502(a)(2),” but was instead seeking relief on behalf of the plan for “a single absent principal.”

Finally, the Second Circuit addressed the district court’s denial of defendants’ motion to stay the litigation of Duke’s Section 502(a)(2) claim while the arbitration of her Section 502(a)(3) claim progressed. Defendants contended that a stay was mandatory under Section 3 of the FAA, but the court noted that “Section 3 does not extend to claims not subject to arbitration; whether a district court stays those is ‘a matter of its discretion to control its docket.’” The court observed that “Duke’s requested relief under Section 502(a)(2) is much broader than, and therefore not derivative of, her request under Section 502(a)(3).” Thus, the district court was within its discretion to allow the Section 502(a)(2) claim to continue.

As a result, Duke’s claims will proceed on two tracks: her Section 502(a)(3) claims in arbitration, and her Section 502(a)(2) claims in federal court. Of course, we’ll keep you updated on any further developments.

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

Breach of Fiduciary Duty

First Circuit

Heet v. National Medical Care, Inc., No. CV 25-11644-WGY, __ F. Supp. 3d __, 2026 WL 353317 (D. Mass. Feb. 9, 2026) (Judge William G. Young). Plaintiffs Michelle Heet, Mike Bickle, Frank Luketich, and David Kitchell, participants in the Fresenius Medical Care North America 401(k) Savings Plan, brought this putative class action against National Medical Care, Inc. (d/b/a Fresenius Medical Care North America) and related defendants. Plaintiffs allege that defendants breached their fiduciary duties under ERISA by improperly applying forfeited matching contributions. According to the plan, these forfeited contributions should be used to reduce company contributions and offset administrative expenses. However, plaintiffs allege that from 2019 through 2024, the defendants applied these forfeitures only to reduce matching contributions and not to administrative expenses. Defendants moved to dismiss. The court noted, and readers of Your ERISA Watch are well aware, that this is a hot topic in ERISA litigation. The court explained, “There are two schools of thought here. On the one hand, fiduciaries typically argue that they are not required to maximize benefits, only to ensure that the benefits due plan participants are appropriately disbursed. Accordingly, the reallocation of forfeited benefits to other matching contributions due as opposed to paying off administrative expenses is appropriate. On the other hand, plan participants typically argue that fiduciaries are conflicted when presented with a choice about using forfeited contributions to pay down matching contributions due from the company and thereby benefit the coffers of the company, as opposed to paying down administrative expenses to plan beneficiaries.” The court characterized this as “a zero-sum game: using chargeable forfeited matching contributions to defray other contributions due from the company obviously benefits the company, while administrative expense defrayment benefits the plan participants.” The court noted there was no controlling ruling from the First Circuit on the issue, or a ruling by any Circuit for that matter. It observed that the majority of courts have ruled against plaintiffs, but “[h]ere, this Court follows persuasive authority adopting the minority position.” Addressing plaintiffs’ specific claims, the court ruled against plaintiffs on their first count for failure to follow plan terms. The court ruled that the plan was “unambiguous” in that it “requires forfeited matching contributions to be used to offset other matching contributions…and, once those are paid, the only other permissible, albeit discretionary, use under the Fresenius Plan expands to defrayment of administrative expenses[.]” However, this ruling did not compel the court to find for defendants on plaintiffs’ other claims because “ERISA’s statutorily imposed fiduciary duty of prudence ‘trumps the instructions of a plan document.’” On plaintiffs’ claims for breach of the duties of loyalty and prudence the court found that plaintiffs did not allege overbroadly that forfeitures must always be used to pay expenses. Instead, they alleged, sufficiently for the court, that defendants failed to act solely in the interest of plan participants in making their decisions and did not adequately investigate the best use of forfeited contributions. In this way the court distinguished its ruling from others, such as Hutchins v. HP, which had granted motions to dismiss. As for plaintiffs’ prohibited transactions claim, the court granted defendants’ motion, ruling that the reallocation of forfeitures did not qualify under the statute. Finally, the court denied defendants’ motion as to plaintiffs’ failure to monitor claim to the extent it was dependent on plaintiffs’ other claims that survived. As a result, the split deepens among the district courts on this issue.

Sixth Circuit

Sweeney v. Nationwide Mut. Ins. Co., No. 2:20-CV-1569, 2026 WL 352845 (S.D. Ohio Feb. 9, 2026) (Judge Sarah D. Morrison). This is a certified class action by former employees of Nationwide Mutual Insurance Company who were participants in the company’s 401(k) plan, the Nationwide Savings Plan. They claim that Nationwide Mutual, Nationwide Life Insurance Company, and members of the Plan’s Benefits Investment Committee (BIC) violated ERISA by maintaining the Guaranteed Fund (“a stable value investment vehicle backed by a Nationwide Life annuity contract”) as an investment option for plan participants. The Guaranteed Fund “is a heavily utilized investment option for Plan Participants. As of 2020, 86% of Plan Participants had some portion of their account invested in the Guaranteed Fund, accounting for $1.75 billion.” The plan also had several features that encouraged investment in the Fund, including a target date fund which included the Fund as a portfolio component, and an “easy enroll” option for new participants which automatically invested them in the Fund. Plaintiffs contend that the BIC’s mismanagement led to the plan overpaying for the Fund, benefiting Nationwide at the expense of plan participants. They alleged several claims under ERISA, including breach of fiduciary duty, prohibited transactions, self-dealing, and anti-inurement. Before the court here were several pre-trial matters, including cross-motions for summary judgment and expert-related motions. The court addressed the expert motions first, denying defendants’ motion to exclude because plaintiffs’ two experts were qualified and their opinions were helpful and relevant. The court granted plaintiffs’ motion to exclude in small part, ruling that defendants’ financial analyst could not testify as to legal conclusions (such as “whether the Annuity Contract is a prohibited transaction”). The court then turned to the summary judgment motions. Defendants asserted two “safe harbors” in its motion: ERISA Section 408(b)(5)’s exemption and the “transition policy” safe harbor. The court ruled that summary judgment was not appropriate on this issue because genuine disputes of material fact existed. Under Section 408(b)(5), there were questions as to whether the plan paid “no more than adequate consideration” and whether the process that led to the annuity contract price complied with defendants’ fiduciary duties. For similar reasons, the court found that defendants failed to establish that the annuity contract qualified as a transition policy. Turning to the merits of plaintiffs’ claims, the court found that there was a genuine dispute of material fact as to whether the BIC fulfilled its fiduciary duties in overseeing Fund expenses. The court also found that there were factual questions regarding whether the plan, investment policy statement, and annuity contract were monitored and followed. As for plaintiffs’ claims for prohibited transactions and self-dealing, the court ruled that genuine disputes of material fact prevented a finding that Section 408(b)(5) applied as a defense to these counts. The court also found that the statute of repose does not bar these claims to the extent they are based on rate setting within the six-year period before Plaintiffs filed suit. Under plaintiffs’ claim for self-inurement, the court granted defendants’ motion to the extent the claim was based on conduct outside the six-year period before plaintiffs filed suit. Finally, the court considered named plaintiff Bryan Marshall, whom defendants contend released any ERISA claims he had. However, the court found that Marshall’s release did not affect his ability to bring a claim on behalf of the plan, as such claims belong to the plan. As a result, most of the relief sought by both sides was denied, and this case will proceed to a bench trial.

Seventh Circuit

Russell v. Illinois Tool Works, Inc., No. 22 CV 02492, 2026 WL 332662 (N.D. Ill. Feb. 9, 2026) (Judge Sunil R. Harjani). Employees of Illinois Tool Works, Inc. (ITW) brought this action in 2022 alleging that ITW and related defendants violated ERISA by breaching their duties of prudence and monitoring in mismanaging the company’s retirement plan. Defendants filed a motion to dismiss which the court denied in 2024, ruling that plaintiffs’ allegations were similar enough to the allegations in Hughes v. Northwestern University, which the Seventh Circuit had deemed sufficient. In 2025, plaintiffs filed a motion to amend their complaint to add allegations regarding defendants’ use of plan forfeitures. In their new allegations plaintiffs contend that defendants allocated unvested benefits, which had been forfeited back to the plan, to reduce ITW’s contributions rather than plan expenses borne by participants. Defendants moved to dismiss. The court first addressed defendants’ statute of limitations argument. The court determined that plaintiffs’ new claims did not relate back to the original 2022 complaint because they were based on new factual allegations regarding the use of forfeitures, which were not included in the original complaint. As a result, any claims related to conduct before February 21, 2019, were barred by ERISA’s six-year statute of limitations. On the breach of fiduciary duty claim, the court ruled that plaintiffs sufficiently alleged that defendants acted as fiduciaries, and not as plan settlors, with regard to their use of the forfeitures. The court noted two potentially conflicting plan provisions and held that “[a] reasonable reading that gives effect to both provisions is that some forfeitures in a given year must be used to reduce employer contributions, but not necessarily all. Under this interpretation, Defendants would retain discretion to allocate the remainder to further reduce employer contributions or reduce Plan expenses.” As a result, it was “reasonable” for plaintiffs to allege that the plan granted defendants discretion, and thus reasonable to allege that defendants were acting in a fiduciary capacity. The court further held that plaintiffs’ claim survived because they did not allege a “per se ban on the use of forfeitures for reducing employer contributions.” Instead, “Plaintiffs assert that Defendants breached their duties by not considering whether specific forfeiture allocations benefited the Plan participants rather than just themselves and choosing the option that only benefited themselves.” For similar reasons, the court ruled that plaintiffs could pursue their duty of loyalty claim. The court reiterated that plaintiffs were not seeking a per se rule and “only allege liability for certain forfeiture use under the circumstances presented here.” Defendants argued that the plan and government regulations authorized them to allocate the forfeitures as they did, but “[t]he mere fact that Defendants can make these allocations under the Plan is not mutually exclusive with the allegation that they were motivated by selfish purposes that breached their duty of loyalty. Further, the Court cannot create a presumption of loyalty based on a plan’s allowance of an action because ERISA’s duties ‘trump[] the instructions of a plan document.’” The court further ruled that there was harm to the plan, because expenses paid by plaintiffs left the plan, and that plaintiffs plausibly pled an anti-inurement violation because the benefit to defendants was not “incidental,” but instead “a direct benefit that motivated their actions.” The court also upheld its earlier ruling that plaintiffs had adequately pled a breach of the duty of monitoring against ITW and its board. However, the court dismissed plaintiffs’ co-fiduciary liability claim against the plan’s investment committee because “Plaintiffs do not allege how a breach by the Committee enabled a breach by ITW or the Board.” As a result, defendants’ motion was granted in part, but denied on the issues that mattered most: “Plaintiffs have sufficiently alleged that Defendants acted as fiduciaries, used forfeitures to reduce employer contributions instead of Plan expenses in violation of ERISA’s fiduciary duty of loyalty and anti-inurement provision, and harmed Plaintiffs through a loss of benefits.”

Eighth Circuit

Plesha v. Ascension Health Alliance, No. 4:24-CV-01459-CMS, 2026 WL 279321 (E.D. Mo. Feb. 3, 2026) (Judge Cristian M. Stevens). In this putative class action Jennifer L. Plesha challenges the tobacco surcharge provision in the ERISA-governed health benefit plan administered by her employer, Ascension Health Alliance. Under the plan, “any member who used tobacco products in the past three years was required to identify himself as a tobacco user during enrollment for the next year… Tobacco users were surcharged an additional $750 per year, or about $30 per paycheck.” However, tobacco users could avoid this surcharge by participating in a wellness program, which qualifies as a “reasonable alternative standard” under ERISA. Plesha paid the surcharge, and now brings three claims for relief. First, she claims that the plan violates ERISA, specifically 29 U.S.C. § 1182(b), because it does not provide the “full reward” for participating in the wellness program. Specifically, she contends that the plan does not provide a refund for the entire year if a participant completes the program. Second, she claims that Ascension “failed to provide the required notice of a reasonable alternative standard that would allow participants to avoid paying the tobacco surcharge for the entire plan year, as required by applicable regulations.” Third, she contends that Ascension breached its fiduciary duty by assessing the surcharge. Ascension filed a motion to dismiss. On Plesha’s first count, Ascension contended that “full reward” in the statute meant only that it had to remove the surcharge prospectively, not retroactively, and the court agreed. “Nothing in the text…suggests that that particular reward must be given retroactively, and Congress knew how to mandate retroactive reimbursement when it enacted the PHSA.” The court also stated that Plesha’s interpretation would “frustrate Congress’ stated purpose in creating the wellness program scheme” because withholding retroactive reimbursement would incentivize insureds to participate in the plan sooner. Plesha asked the court to “defer to the regulatory definition of ‘full reward’ found in the 2013 preamble” to the Department of Labor’s interpreting regulations, but the court declined because the statute was unambiguous, could not be overridden by regulation, and the court was not obligated to show the preamble or the regulations any special deference. (For a contrary view, see last week’s edition in which we summarized the court’s decision in Wilson v. Whole Food Market, Inc. that “to make available the ‘full reward’ to ‘all similarly situated individuals,’ a wellness program must provide retroactive reimbursements of all tobacco surcharges paid that Plan year.”) As for Plesha’s second claim, the court ruled that Plesha lacked Article III standing. The court determined that Plesha’s alleged injuries – not receiving proper notification – were “purely informational” and did not satisfy the concreteness requirement for standing. Plesha also did not allege how her behavior would have changed if she had received proper notice: “Put another way, Plaintiff would be in the exact same place with or without the purported defects in the notice.” Plesha’s third count met the same fate as the first two. The court agreed with Ascension that it did not breach any fiduciary duty because the plan complied with ERISA. The court also found that Ascension acted as a settlor, not a fiduciary, in creating and administering the plan. As a result, the court granted Ascension’s motion to dismiss in its entirety and dismissed the case with prejudice.

Ninth Circuit

Wit v. United Behavioral Health, No. 14-CV-02346-JCS, 2026 WL 290352 (N.D. Cal. Feb. 3, 2026) (Magistrate Judge Joseph C. Spero). This class action, originally filed in 2014, has a long and tortured history, including numerous Ninth Circuit rulings. (We covered the Circuit’s published 2023 decision as our case of the week in our August 30, 2023 edition.) The Westlaw history map says it all:

The decisions above the dotted line are from the Ninth Circuit. In the course of issuing those decisions, the Ninth Circuit significantly scaled back the district court’s extensive rulings against United Behavioral Health in which the district court found that UBH breached its fiduciary duty to health plan participants in its misuse of mental health guidelines to deny patient claims. The Ninth Circuit’s rulings left several issues open, however, and the district court tried to sort it all out in an August 5, 2025 order, as we explained in our August 13, 2025 edition. In that order the court acknowledged that the Ninth Circuit had eliminated parts of the plaintiffs’ breach of fiduciary duty claim, but ruled that other parts survived: “the Court’s findings as to the breach of the duty of care and the duty of loyalty are not intertwined with the erroneous interpretation of the Plans identified by the [Ninth Circuit] Panel and therefore, the Court’s judgment on the breach of fiduciary duty claim survives to the extent that it is based on those theories.” The district court further ruled that the fiduciary duty claim was not subject to exhaustion requirements, and even if it were, exhaustion would be excused as futile because of UBH’s uniform application of its guidelines. The court ordered the parties to meet and confer, and after further submissions, it issued this judgment. The court declared that UBH acted as a fiduciary under ERISA when it developed level of care guidelines and coverage determination guidelines for making coverage determinations, which were not terms of the class members’ plans. Those plans required services to be consistent with generally accepted standards of care (GASC), and UBH’s guidelines were used to interpret this requirement. However, although the class members “had a right, under ERISA and their plans, to have UBH adopt Guidelines that were developed solely in the interests of the class members and with care, skill, prudence, and diligence,” they “were deprived of this right” because the guidelines were “tainted by UBH’s financial interests and its lack of due care.” Furthermore, “UBH’s misconduct in developing and adopting its Guidelines was willful and systematic,” “affected the class members across-the-board,” and violated ERISA’s statutorily imposed duties of loyalty and care. The court noted that UBH’s guidelines “purport to be based on generally accepted standards of care.” However, the court compared the guidelines to the standards that “are generally accepted in the field of mental health and substance use disorder treatment and patient placement,” and concluded that UBH’s guidelines in fact “do not accurately reflect generally accepted standards of care. They are instead significantly and pervasively more restrictive than those standards. This defect is a direct result of UBH’s self-interest and lack of due care[.]” Among other failures, the court noted that UBH’s guidelines inappropriately emphasized acuity and crisis stabilization over effective treatment of underlying conditions, failed to address co-occurring conditions, did not address the unique needs of children and adolescents, and did not err on the side of caution for higher levels of care. The court further found that “UBH affirmatively misled regulators about its Guidelines” and violated the laws of Connecticut, Illinois, Rhode Island, and Texas in applying its too-strict guidelines. As a result, the court ruled that UBH “breached its fiduciary duties to the class members, including its obligations under 29 U.S.C. §§ 1104(a)(1)(A), and (a)(1)(B), when it developed, revised, and adopted the Guidelines.” The court imposed injunctive relief, (1) permanently enjoining UBH from using the invalidated guidelines to implement the GASC requirement in ERISA-governed plans, and (2) ordering UBH, in adopting criteria to interpret ERISA-related plans, to ensure that its criteria “accurately reflect GASC” and comply with state law. The second requirement will be in effect for the next five years, during which the court will maintain jurisdiction. Will UBH once again appeal to the Ninth Circuit? Given the history of this case, it would be astonishing if it did not. Either way, we will let you know of any further developments.

Class Actions

Sixth Circuit

Best v. James, No. 3:20-CV-299-RGJ, 2026 WL 357964 (W.D. Ky. Feb. 9, 2026) (Judge Rebecca Grady Jennings). In a case with one of the shortest names we have had the pleasure of covering here at Your ERISA Watch, plaintiffs Nathan Best, Matthew Chmielewski, and Jay Hicks have sued defendants ISCO Industries, Inc., James Kirchdorfer, and Mark Kirchdorfer. Plaintiffs have alleged various ERISA claims against defendants, including fiduciary breach and engaging in a prohibited transaction in connection with ISCO’s Employee Stock Ownership Plan (“ESOP”). In 2022, the court granted defendants’ motion to compel arbitration, and in 2023 it denied plaintiffs’ motion for reconsideration, in which plaintiffs argued that the effective vindication doctrine invalidated the operative arbitration provision. However, in 2024 the Sixth Circuit decided Parker v. Tenneco, in which it applied the effective vindication doctrine to strike down an arbitration provision similar to the one in this case. Based on Parker, plaintiffs filed another motion for reconsideration, and in 2025 the court granted it, agreeing that Parker was a change in controlling law that required it to vacate its prior order. Plaintiffs then filed a motion for class certification, seeking to certify a class of all persons who were participants in the ISCO ESOP when it sold its shares in 2018. The motion was unopposed and granted by the court in this order. The court marched through the Federal Rule of Civil Procedure 23(a) requirements: numerosity, commonality, typicality, and adequacy of representation. The proposed class consisted of over 400 participants, satisfying the numerosity requirement. Commonality was met as the case involved common questions of law and fact, such as whether the defendants breached fiduciary duties under ERISA. Typicality was satisfied because the plaintiffs’ claims arose from the same conduct affecting all class members. Adequacy of representation was confirmed as the plaintiffs had common interests with the class and were represented by qualified counsel. The court also considered Rule 23(b) requirements, determining that certification was appropriate under Rule 23(b)(1)(B) because the case involved ERISA fiduciary duty claims, which typically require plan-wide relief. This subsection was deemed suitable because adjudications for individual class members could affect the interests of others not party to the adjudications. Finally, under Rule 23(g), the court appointed Kaplan Johnson Abate & Bird LLP as class counsel, finding them qualified based on their experience and the work done in the case.

Disability Benefit Claims

Eighth Circuit

Jackson v. The Hartford Financial Servs. Grp., Inc., No. 4:25-CV-01329-JAR, 2026 WL 352912 (E.D. Mo. Feb. 9, 2026) (Judge John A. Ross). Lynette Jackson, a former employee of American Water, asserts that she filed a claim for disability benefits with The Hartford Financial Services Group in 2019 due to unspecified health conditions. She brought this pro se complaint against Hartford accusing it of bad faith and fraudulent practices, including underpaying her short-term disability benefits and incorrectly asserting that she lacked long-term disability coverage. Jackson alleged that these actions led to her termination from American Water in 2020, resulting in severe financial hardship and emotional distress. She seeks $300 million(!) in compensatory and punitive damages. Jackson brought claims under several state and federal laws, including ERISA, the Americans with Disabilities Act (ADA), the Rehabilitation Act, and the Family and Medical Leave Act (FMLA). Jackson filed a motion for leave to proceed in forma pauperis, the appointment of counsel, leave to amend, and to compel a ruling. The court quickly dismissed Jackson’s state law claims, ruling that because they “arise directly from the administration of her employee health plan, they are preempted” by ERISA. As for Jackson’s ERISA claims, the court ruled that “Jackson does not identify a particular disability, impairment, or medical condition, nor does she allege any facts describing functional limitations that would bring her condition within the plan’s definition of disability… Jackson’s allegation that she became ‘medically unable to work’…is a ‘naked assertion’ devoid of ‘further factual enhancement.’” This was insufficient under federal pleading standards and thus the court dismissed her ERISA claims. The court also dismissed Jackson’s other claims, ruling that (1) under the ADA and Rehabilitation Act she did not sue her former employer, American Water, but rather Hartford, and did not allege that Hartford discriminated against her based on her disability, and (2) under the FMLA she again did not allege that Hartford was her employer, which was necessary to establish a violation under the FMLA. As for Jackson’s motion to amend, the court determined that her proposed amendment would be futile because it did not address the deficiencies in her original claims or establish a new cause of action against Hartford. As a result, the court granted Jackson’s motion to proceed in forma pauperis but dismissed the action without prejudice for failing to state a plausible claim for relief.

Medical Benefit Claims

Second Circuit

Savage v. Rabobank Med. Plan, No. 24-2759-CV, __ F. App’x __, 2026 WL 303600 (2d Cir. Feb. 5, 2026) (Before Circuit Judges Calabresi, Raggi, and Lee). The plaintiff in this case is Sheri Savage, who is the executor of the estate of Cindy Sieden. The case revolves around Sieden’s daughter, J.S., who suffered from a severe eating disorder and mental health conditions. J.S. had been receiving treatment for her eating disorder since she was eight years old, including residential treatment and partial hospitalization. In 2016 J.S. was admitted to Avalon Hills Adolescent Treatment Facility. Sieden submitted claims for J.S.’ treatment at Avalon to United Behavioral Health (UBH), the mental health claims administrator for the Rabobank Medical Plan, under which J.S. was a covered dependent. Initially, UBH approved her claims, but as of February 2017, UBH determined that J.S. no longer met the criteria for partial hospitalization or residential care and denied further coverage. Appeals were unsuccessful, and UBH did not respond to post-service claims from Avalon, so Savage brought this action. On cross-motions for summary judgment, the district court applied an arbitrary and capricious standard of review because the plan conferred discretion on UBH. The court affirmed UBH’s use of its level of care guidelines and held that Avalon’s post-service submission functioned as an additional appeal rather than a new claim requiring a merits determination, thus not altering the standard of review. The court ultimately ruled that UBH’s denials were not an abuse of discretion. (Your ERISA Watch covered this ruling in our October 9, 2024 edition.) Savage appealed to the Second Circuit, which issued this unpublished opinion. On appeal, Savage argued that (1) the district court was bound by findings made in Wit v. United Behavioral Health regarding UBH’s level of care guidelines (see above for the latest installment in the Wit case), (2) UBH’s denials were arbitrary and capricious, and (3) Avalon’s post-service claims were subject to de novo review and were supported by unrebutted medical evidence. The Second Circuit rejected all three arguments. First, the court ruled that the collateral estoppel argument regarding Wit was forfeited because it was not raised in the district court; instead, Savage had used the Wit ruling “more generally as persuasive authority.” Furthermore, the Second Circuit noted that the Ninth Circuit in Wit did not require UBH’s level of care guidelines to be coextensive with generally accepted standards of care. As for the denial of benefits, the court acknowledged there was evidence in support of both sides as to the medical necessity of J.S.’ treatment. However, “[g]iven the substantial deference afforded to ERISA administrators, the record here does not overcome the requisite standard to warrant overturning the denial of benefits.” Finally, the Second Circuit rejected Savage’s arguments regarding the post-service claim, noting that “voluntary appeals” are not subject to “ERISA safeguards” and thus the claim did not require de novo review. The court further stated that the “post-service submission appears to largely repackage claims for services that had already been denied with overlapping dates.” As a result, the court upheld the district court’s rulings on the post-service submission as well, and affirmed the judgment below. (Disclosure: Kantor & Kantor represented Ms. Savage in this action.)

Seventh Circuit

R.S. v. Quartz Health Benefit Plans Corp., No. 22-CV-418-WMC, 2026 WL 309629 (W.D. Wis. Feb. 5, 2026) (Judge William M. Conley). Plaintiff R.S. was a participant in an employee health benefit plan insured and administered by Quartz Health Benefit Plans, and his son, A.S., was a covered dependent under the same plan. A.S. has a history of behavioral and mental health difficulties from an early age, including diagnoses of attention deficit hyperactivity disorder and “extreme” oppositional defiant disorder. A.S. was failing his school classes, had suicidal thoughts, used drugs, and stole from his parents. “When confronted, A.S. also attacked his father, destroyed parts of his car, and threatened to have his friends kill him.” A.S.’ therapist recommended inpatient treatment, so A.S. was admitted to Triumph Youth Services, a residential mental health facility in Utah. Quartz initially covered A.S.’ treatment at Triumph for 34 days but later denied further coverage, stating that continued residential treatment was not medically necessary. Appeals were unsuccessful, so R.S. filed this action, alleging that Quartz violated ERISA by denying coverage for A.S.’ treatment, and violated the Mental Health Parity and Addiction Equity Act. The parties filed cross-motions for summary judgment. R.S. acknowledged that the benefit plan gave Quartz discretionary authority to make benefit determinations, but argued that because of Quartz’s procedural violations, it had forfeited any deference. The court decided it “need not resolve this dispute because, as discussed below, defendant’s decision denying benefits was arbitrary and capricious under even the more deferential standard.” The court found that Quartz did not provide a full and fair review because it did not give its medical review report to R.S. until litigation, even though ERISA’s claim procedure regulation required it to do so before denying the appeal. The court further ruled that Quartz erred by failing to consider A.S.’ severe substance abuse disorder. Quartz never addressed his substance abuse in any of its reports or denials, and “[g]iven its length and comorbidity, defendant’s failure to address plaintiff’s substance abuse disorder as powerful evidence supporting his need for ongoing, residential treatment was arbitrary and capricious.” The court rejected Quartz’s contentions that (1) A.S.’s substance abuse was not a focus of his treatment, finding that this was belied by the record, and (2) Quartz considered the substance abuse by implication even if it never directly discussed it. “[A] vague reference that all records were reviewed is not sufficient under the circumstances here, in which plaintiff asked specifically and repeatedly that defendant consider his substance abuse treatment needs on appeal, just as his primary care providers did at Triumph.” The court thus granted R.S.’ motion, and remanded the case to Quartz for further findings and explanations. R.S. had less luck with his Parity Act claim. R.S. contended that the plan violated the Parity Act because it required “acute” symptomatology for mental health coverage while the analogous skilled nursing plan provisions did not. The court seemed sympathetic to the argument; a comparison “appears to support plaintiff’s assertion.” However, the court ruled that the claim, as presented, was “poorly developed” and that R.S. did not address several of Quartz’s arguments in opposition. As a result, the court denied R.S.’ motion as to his Parity Act claim. However, the court stated that on remand Quartz “should consider whether its review of plaintiff’s claim satisfies the concerns raised by the court and plaintiff under the Parity Act, as the court’s decision is not intended to foreclose plaintiffs from raising a new as-applied challenge under the Parity Act to a new decision by defendant.”

Pension Benefit Claims

Second Circuit

Dimps-Hall v. Employee Benefit Plan Administration Committee HSBC-North America, No. 25-CV-00421 (LJL), 2026 WL 305485 (S.D.N.Y. Feb. 5, 2026) (Judge Lewis J. Liman). In this action Shirley A. Dimps-Hall seeks benefits under the Manhattan Savings Bank (MSB) pension plan. She alleges that a temporary agency placed her at MSB in 1982, but she was hired as a full-time employee by MSB in 1983, and was a permanent employee of MSB from that year until April of 1991, when she retired as Senior Bookkeeper. Before she retired, MSB was taken over by Republic National Bank of New York. Republic was, in turn, acquired by HSBC in 1999. In 2023, Dimps-Hall submitted a claim contending she was entitled to pension benefits beginning in 2019, when she turned 65, pursuant to her employment at MSB and Republic. HSBC denied her claim. HSBC stated that under the Republic pension plan, which was in effect at the time of Dimps-Hall’s retirement, participants were eligible for benefits if they had “completed at least 5 RNB Years of Service.” Active participants in the MSB plan when MSB was taken over by Republic were given credit for their employment at MSB. However, “HSBC’s records, including IRS Employee Census Reports for the Retirement Plan of the Manhattan Savings Bank…from 1988, 1989 and 1990, reflect that you were first hired by MSB on July 20, 1987.” As a result, HSBC told Dimps-Hall that she did not have five years of vesting service when she retired in 1991, and was not eligible for benefits. Dimps-Hall unsuccessfully appealed this decision and then filed this pro se action against HSBC. HSBC moved to dismiss. The court noted that the plan gave HSBC discretionary authority to determine eligibility for benefits, and thus the arbitrary and capricious standard of review applied. The court agreed with HSBC that it was appropriate for HSBC to rely on its records in denying Dimps-Hall’s claim because such reliance “promotes uniformity, predictability, and efficiency. Those features, in turn, protect all participants as a group. They help ensure that benefits are calculated according to the same rules for everyone, that the Plan can be funded and administered at a reasonable cost, and that assets are reserved for the benefits promised under the Plan rather than spent on repeated reconstruction of decades-old employment histories whenever a dispute arises.” Thus, “It is not enough to allege that other records might exist somewhere, or that further searching might yield a different picture.” As a result, the court ruled that Dimps-Hall had not plausibly pled that HSBC abused its discretion. HSBC had relied on its records in making the decision, and “[t]he fact that Plaintiff believes those records to be incomplete, or believes that other documents might exist that would support her view of her employment history, does not by itself render the Committee’s decision arbitrary and capricious, particularly where the Plan expressly permits the Committee to ‘conclusively rely’ on those records.” The court further rejected Dimps-Hall’s contention that she should be allowed to conduct discovery to find supporting evidence of her employment, noting that discovery beyond the administrative record is typically not allowed. Furthermore, because the plan allowed HSBC to “conclusively rely” on its records, “even if there existed documents in the bowels of the bank that would tend to show that Plaintiff was a full-time, salaried employee prior to 1987, that would not make the Committee’s decision arbitrary and capricious.” The court then quickly disposed of Dimps-Hall’s remaining claims, ruling that (1) she was not a plan participant and thus could not sue for statutory penalties, and in any event HSBC responded appropriately to her inquiries, (2) her breach of fiduciary duty claim was duplicative of her claim for benefits, and (3) she did not have a private right of action to sue for violations of Department of Labor regulations. The court further struck her jury demand as there is no right to a jury trial in ERISA benefit actions. The court thus granted HSBC’s motion in full, and dismissed Dimps-Hall’s complaint with prejudice, ruling that it would be futile to allow her to amend.

Sixth Circuit

Alliance Coal, LLC v. Smith, No. 0:26-CV-10-REW-EBA, 2026 WL 353029 (E.D. Ky. Feb. 9, 2026) (Judge Robert E. Wier). This is an interpleader action initiated by Alliance Coal, LLC, concerning the distribution of retirement plan benefits following the death of Constance Smith, a long-time employee of Excel Mining, LLC, a subsidiary of Alliance Coal. In 2007 Constance designated Dusty L. McCoy, her second cousin, as the primary beneficiary of her account in Alliance Coal’s 401(k) retirement plan, which was managed by INTRUST Bank. After Constance’s death in December 2024, her brother, Larry Smith, contested this designation, presenting a beneficiary form dated February 21, 2024, which allegedly named him as the sole beneficiary. Larry claimed that Constance did not file this form due to misrepresentations by INTRUST Bank representatives, who allegedly told her that she did not need to update her beneficiary designation. Alliance Coal thus filed this action to allow the court to determine who was the proper beneficiary. Larry responded by filing counterclaims against Alliance Coal and McCoy, alleging breach of fiduciary duty, equitable estoppel, reformation of plan documents, and breach of plan requirements under ERISA. McCoy and Alliance Coal filed motions to dismiss. Addressing the Alliance Coal motion first, the court held that Larry could not obtain individual relief under ERISA § 502(a)(2) because his claims did not benefit the plan as a whole. Additionally, his claims under ERISA § 502(a)(3) failed because he did not adequately allege that Alliance Coal made any misrepresentations, or that INTRUST Bank’s actions could be attributed to Alliance Coal. (The court noted that INTRUST Bank, although named by Larry as a counter-defendant, had not appeared in the case and Larry conceded that INTRUST Bank was not a target of his claims.) Furthermore, Larry could not bring a breach of plan requirements claim under ERISA § 502(a)(1)(B) because he “does not identify a plan provision entitling him to the disputed benefits… Rather, he argues that he should be entitled to the disputed benefits on account of Ms. Smith’s intent and the communications history… He fails to highlight any plan provision that Alliance Coal itself has broken[.]” The court further ruled that Larry could not pursue a surcharge remedy because of Sixth Circuit precedent, and was not entitled to a jury trial. Thus, the court granted Alliance Coal’s motion in its entirety, with prejudice. This ruling rendered McCoy’s motion to dismiss moot, so the court did not discuss it in any detail, other than to note that Larry’s counterclaims did not allege any facts supporting a claim against her, and were primarily directed at Alliance Coal. The dismissal was with prejudice.

Pleading Issues & Procedure

Second Circuit

Sacerdote v. Cammack Larhette Advisors, LLC, No. 17-CV-8834 (AT) (VF), 2026 WL 350842 (S.D.N.Y. Feb. 9, 2026) (Magistrate Judge Valerie Figueredo). This is a long-running action in which employees of New York University allege that Cammack Larhette Advisors, LLC, the investment advisor to the plans, breached its fiduciary duty by providing imprudent advice, resulting in substantial losses to the plans. (The Second Circuit’s ruling reviving this case was the notable decision in our October 8, 2019 edition.) Before the court here was plaintiffs’ motion to join CapFinancial Group, LLC as a party under Federal Rule of Civil Procedure 25(c). “Plaintiffs contend that Cammack transferred its assets, operations, and personnel to CapTrust following an acquisition that occurred in February 2021… More specifically, Plaintiffs argue that CapTrust is the successor-in-interest to Cammack because it substantially continued Cammack’s business operations, personnel, and client relationships, and CapTrust had actual or constructive notice of Plaintiffs’ claims against Cammack at the time of the acquisition.” CapTrust opposed plaintiffs’ motion, arguing it was untimely under the court’s scheduling order, and thus plaintiffs had to show “good cause” to amend under Federal Rule of Civil Procedure 16. CapTrust also argued that ERISA forecloses successor liability for breaches of fiduciary duty. The court concluded that plaintiffs did not have to show good cause under Rule 16 because that requirement did not apply to Rule 25(c) motions. The court noted that substitution under Rule 25(c), unlike under Rule 16, “does not alter the claims and ‘[t]he merits of the case and the disposition of the property are still determined with respect to the original parties.’” In short, “Imposing a good-cause requirement on Rule 25(c) motions is nonsensical given the purpose served by the rule. Substitution is not mandatory and, even if a party does not seek substitution, the judgment will be binding on a successor-in-interest. The Rule simply serves as a mechanism to simplify the action and expedite the ultimate resolution.” The court further ruled that even if Rule 16 applied, it would not bar plaintiffs’ motion because CapTrust did not demonstrate that it would be prejudiced by the substitution (although the court noted that plaintiffs “unduly delayed” filing their motion to add CapTrust as a party). Finally, the court addressed whether ERISA bars successor liability for claims of breach of fiduciary duty. CapTrust argued that Section 409(b) of ERISA precludes successor liability, but the court noted that courts have applied successor liability in the ERISA context, particularly for withdrawal liability and delinquent contributions. The court found that ERISA’s purpose supports applying successor liability to breaches of fiduciary duty, as it aligns with the statute’s goals of protecting employee interests. The court directed CapTrust to submit a letter identifying specific factual allegations that it contends are disputed, and for which an evidentiary hearing regarding successor liability might be necessary, by March 2, 2026.

Eighth Circuit

Meilstrup v. Standing Rock Sioux Tribe, No. 1:25-CV-162, 2026 WL 352690 (D.N.D. Feb. 9, 2026) (Judge Daniel L. Hovland). Daniel Meilstrup worked at Prairie Knights Casino in North Dakota as the Chief Executive Officer and General Manager. The casino is owned and operated by the Standing Rock Sioux Tribe. Meilstrup initiated this action to challenge the casino’s actions in mishandling his termination, which caused delays and disruptions to his wife’s medical care. He has alleged claims under ERISA and common law against the Standing Rock Sioux Tribe and related defendants. In our October 15, 2025 edition, we covered the court’s order denying defendants’ motion to dismiss as to Meilstrup’s ERISA claim, which ruled that (1) Meilstrup’s claim was properly pled, (2) defendants’ operation of a non-governmental plan waived their sovereign immunity as to the claim, and (3) the tribal court did not have jurisdiction over the claim. Now the Tribe has brought a motion to stay the proceedings while the tribal court handles non-ERISA issues relating to Meilstrup’s termination, contending that a stay is warranted under federal abstention doctrine. “Abstention is a judge-made doctrine that allows a federal court to abstain from exercising its jurisdiction when parallel state court proceedings are pending and doing so would result in the conservation of judicial resources.” The court made short work of the motion. The court noted that “a federal district court must exercise its jurisdiction over claims unless there are ‘exceptional circumstances’ for not doing so,” and “[w]here jurisdiction to hear a case exists, a federal court’s ‘obligation’ to hear and decide a case is ‘virtually unflagging.’” The court ruled that defendants could not overcome this high bar: “no exceptional circumstances in this case that warrant a stay.” The court acknowledged that defendants disagreed with its prior ruling on their motion to dismiss, but “[t]he Defendants cannot evade the Court’s prior order finding that tribal courts lack jurisdiction over ERISA claims. Any ERISA claim purportedly raised in the Tribal Court litigation does not deprive this Court of its jurisdiction, nor does it provide reason for this Court to abstain from exercising its jurisdiction while a court that lacks jurisdiction rules on the issue. A stay would be futile because the Tribal Court plainly lacks jurisdiction over Meilstrup’s ERISA claim. Any rulings from the Tribal Court pertaining to Meilstrup’s ERISA claim have no effect on this case.” Furthermore, staying the case “would cause unnecessary delay and would prejudice the Plaintiff.” As a result, the court denied defendants’ motion to stay.

Provider Claims

First Circuit

Abira Medical Laboratories, LLC v. Blue Cross Blue Shield of R.I., No. 24-CV-475-MRD-PAS, 2026 WL 353339 (D.R.I. Feb. 9, 2026) (Judge Melissa R. DuBose). As Your ERISA Watch readers know, Abira Medical Laboratories, d/b/a Genesis Diagnostics, is a medical testing business that has filed dozens of actions across the country in the last few years alleging underpayment by health insurers. In this action Genesis has alleged that it performed various testing services for patients who were insured by Blue Cross Blue Shield of Rhode Island (BCBSRI). Genesis claims that these patients assigned their insurance benefits to it, creating a contractual obligation for BCBSRI to reimburse Genesis for the services rendered. However, BCBSRI allegedly failed to respond to claims, fabricated reasons to refuse payment, and underpaid other claims, resulting in a claimed debt approaching $1.8 million. Genesis filed a complaint against BCBSRI asserting claims under ERISA and state law. BCBSRI moved to dismiss, arguing that Genesis failed to identify any specific insurance contract or provision entitling it to reimbursement. BCBSRI also contended that Genesis’ claims were barred by anti-assignment provisions in the health plans and were time-barred. Addressing Genesis’ ERISA claim first, the court ruled that it was insufficiently pleaded because Genesis did not identify any specific ERISA plan or provisions entitling it to benefits. The court acknowledged that “some courts have been sympathetic to the concern raised by [Genesis], specifically its claim that they have no access to any health plans prior to filing their Complaint.” However, the court still found Genesis’ allegations far too vague. The court noted that the complaint lacked details about the ERISA plans, such as the intended benefits, class of beneficiaries, and procedures for receiving benefits. Furthermore, the court was unconvinced by Genesis’ argument that discovery was necessary in order to obtain more detailed plan information. The court noted that Genesis received assignments of benefits “which presumably includes the right to access the patients’ plan.” Furthermore, “this Court views [Genesis’] predicament as self-inflicted because it never sought to secure the Plans from their patients upon receiving the requisitions of laboratory testing, failed to plead any attempts to retrieve Plan documents directly from BCBSRI, and refused to engage in the process outlined by this Court – designed to have the Plans produced – after BCBSRI filed its initial motion to dismiss.” As a result, the court granted BCBSRI’s motion to dismiss Genesis’ ERISA claim. The court ruled against Genesis on its state law claims as well for various reasons, and thus granted BCBSRI’s motion to dismiss in its entirety and entered judgment in its favor.

Fourth Circuit

Abira Medical Laboratories, LLC v. Anthem Health Plans of Virginia, Inc., No. 3:25CV108 (RCY), 2026 WL 281172 (E.D. Va. Feb. 3, 2026) (Judge Roderick C. Young). In our second case involving Genesis this week, it sued Anthem Health Plans of Virginia, Inc. for services it provided based on requisitions that included an assignment of benefits provision. Genesis claims that Anthem failed to pay for these services, resulting in damages approaching $3 million. In its complaint Genesis alleged four counts: (1) violation of ERISA, (2) breach of contract, (3) breach of the implied covenant of good faith and fair dealing, and (4) actual and constructive fraud. Anthem filed a motion to dismiss, which the court ruled on in this order. The court denied the motion as to Genesis’ ERISA claim, ruling that Genesis sufficiently alleged standing through valid assignments of benefits from Anthem’s insureds. The court observed, “The Fourth Circuit has not defined what constitutes a ‘valid’ assignment for purposes of assessing derivative standing; the last time it appears to have even considered the concept was in 2008.” However, the court noted that “courts within the Fourth Circuit have held that Plaintiffs generally need not plead specific language of assignment for purposes of showing derivative standing.” Based on those cases, and decisions from other circuits, the court found that the following allegations by Genesis were sufficient: “medical service providers submitted requisitions for lab services to Plaintiff,” “those requisitions contained an assignment of benefits from Defendant’s insureds to Plaintiff,” “Defendant’s insureds executed the assignment(s),” and “the assignments… specifically assigned the right of payment and the right to pursue and collect such payments to Plaintiff.” The court noted that the alternative was a “tidal wave of piecemeal litigation which would bog down courts across this country and in no way benefit the ERISA plan participants.” The court also rejected Anthem’s arguments that Genesis’ claim was too thinly pled and that it failed to plead exhaustion. The court cited the Fourth Circuit’s “high-level” approach to pleading, which “recognize[s] plaintiffs’ difficulty obtaining plan documents at the early stages of litigation,” thus justifying some level of vagueness in referring to operative plan provisions. As for exhaustion, the court noted that the Fourth Circuit “has not ruled on whether administrative exhaustion is something that must be pleaded in the first instance, as Defendant argues, or an affirmative defense with the onus of proof on the Defendant, as Plaintiff argues.” However, the court sided with the latter, “in line with the positions of the Second, Third, and Fifth Circuits,” thus ruling that Genesis did not have to plead around the exhaustion defense, and leaving the issue for another day. The court then turned to Genesis’ state law claims. It denied Anthem’s motion as to the claims for breach of contract and breach of the implied covenant of good faith and fair dealing, ruling that Genesis plausibly alleged a legally enforceable obligation, a breach of that obligation, and resulting damages. (However, the court indicated that Genesis might not be able to pursue both claims if they were factually duplicative by the summary judgment stage.) The court granted Anthem’s motion as to Genesis’ fraud claim, finding that Genesis’ “general, conclusory, and anonymous allegations regarding its course of dealing with Defendant and/or Defendant’s ‘representatives’ are insufficient to state a claim for fraud under either Virginia law or [Federal Rule of Civil Procedure 9(b)].” Finally, Anthem argued in its motion that Genesis had improperly combined 2,170 claims for services rendered to over 1,000 patients into one action. The court “appreciate[d] Defendant’s concern for its case management capabilities,” but ruled that Genesis’ claims were proper under Federal Rule of Civil Procedure 18, which gives a plaintiff the “freedom to assert as many claims as the plaintiff chooses.” The court admitted that the number of claims was “certainly a large number,” but they were still “related” and thus Genesis, as “the master of the complaint,” could combine them. Plus, “Defendant does not acknowledge the alternative to permitting Plaintiff to bring all its claims together, i.e., that the Court would be inundated with duplicative, claim-by-claim litigation.” Thus, “the Court will not sever and dismiss the claims underlying Plaintiff’s Complaint simply because Defendant is daunted by the discovery process.” As a result, Anthem’s motion was largely unsuccessful, as it was only able to eliminate one of Genesis’ claims and failed to break up the lawsuit.

Retaliation Claims

Sixth Circuit

Tascarella v. Aptiv US General Services Partnership, No. 4:26-CV-0024, 2026 WL 294962 (N.D. Ohio Feb. 4, 2026) (Judge Benita Y. Pearson). In September of 2025 defendant Aptiv US General Services Partnership (the American subdivision of a Swiss automotive technology supplier), offered Daniel Tascarella a job as the plant manager of its Ohio facility. He began work on September 29, but only worked two days before stopping due to health issues and taking a medical leave of absence. From its conversations with Tascarella, which included Tascarella informing Aptiv that he was on a liver transplant recipient list, Aptiv concluded that his absence would be lengthy and chose to terminate him as of December 31, offering him a severance agreement. On the date of his termination, Tascarella filed this action in state court alleging six claims: ERISA interference, promissory estoppel, fraud in the inducement, unilateral contract, disability discrimination, and unlawful retaliation. Tascarella also sought a temporary restraining order (TRO) and a preliminary injunction seeking the continuance of his healthcare and employment benefits. The state court initially granted an ex parte TRO, after which Aptiv removed the case to federal court. In this order the court considered Tascarella’s motion for a preliminary injunction, addressing the four required elements: “(1) the movant has a strong likelihood of success on the merits; (2) the movant would suffer irreparable injury without injunctive relief; (3) granting injunctive relief would cause substantial harm to others; and (4) the public interest would be served by granting injunctive relief.” First, the court found that Tascarella was unlikely to succeed on the merits of his ERISA retaliation claim. At the outset, it was unclear whether ERISA governed his short-term disability benefits; Aptiv contended that these benefits were a “payroll practice” exempt from ERISA. Furthermore, the court found that Tascarella was only able to show “at best, an inference of retaliation or improper termination.” The court was more persuaded by Aptiv, which contended that its decision to terminate Tascarella’s employment was based on business needs – i.e., keeping its Ohio factory operational – and not on any intent to interfere with ERISA benefits. On the “irreparable injury” prong, the court determined that Tascarella had not met his burden because he remained insured under COBRA and was eligible for Social Security and Medicare. The court noted that the benefits at risk were monetary in nature, and thus victory at trial would remedy any harms Tascarella might suffer. The court ruled that the remaining two factors also did not favor Tascarella. “Granting injunctive relief under these circumstances – absent a showing of Aptiv’s specific intent to avoid ERISA liability – would mean that ‘every employee discharged by a company with an ERISA plan would have a claim under § 510.’” Furthermore, “there are…reasons justifying employer decisions – however difficult or emotionally fraught they may be – to terminate an employee unable to perform the duties for which they were hired.” Thus, the public interest was not served by issuing an injunction. As a result, the court denied Tascarella’s motion for a preliminary injunction and the case will proceed as usual.

Statute of Limitations

Third Circuit

Hamrick v. E.I. du Pont De Nemours & Co., No. CV 23-238-JLH-LDH, 2026 WL 353624 (D. Del. Feb. 9, 2026) (Magistrate Judge Laura D. Hatcher). This case involves two class action complaints filed under ERISA against E.I. du Pont de Nemours and Company and related defendants. In one complaint plaintiffs Mary J. Hamrick, David B. Beckley, and Valentin Rodriguez contend that defendants “improperly reduced [Income-Leveling Option (“ILO”)] benefits for participants and beneficiaries below the amounts that they would receive if those benefits had been calculated using the Treasury Assumptions in violation of ERISA § 205(g).” They claim defendants used an outdated formula with a higher interest rate and an antiquated mortality table. In the second, James M. Manning contends that defendants “improperly reduced [Spouse Benefit Options (“SBOs”)] for participants and beneficiaries of the Plan below the amounts that they would receive if those benefits were actuarially equivalent to a [single life annuity (“SLA”)] in violation of ERISA § 205(d).” Again, outdated mortality tables were the alleged culprit. Defendants initially filed a motion to dismiss, contending, among other arguments, that plaintiffs’ claims were time-barred. The court denied this motion because defendants did not establish when plaintiffs’ claims accrued. According to the court, defendants did not meet their burden of demonstrating when the plaintiffs were on notice that their benefit calculations were wrong. (Your ERISA Watch covered this decision in our February 7, 2024 edition.) Defendants filed a motion for summary judgment in which they took a second swing at the timeliness argument. They argued that plaintiffs’ claims were subject to a one-year statute of limitations under 10 Del. C. § 8111; plaintiffs responded that laches, rather than a statute of limitations, should govern the timeliness of their claims. Relying on Third Circuit precedent, the court agreed that § 8111 (which governs claims for wages or salary) applied because it was the state law most analogous to plaintiffs’ claims regarding their benefits. Plaintiffs argued that they sought equitable relief, not the recovery of benefits, and that laches should apply. However, the court found that plaintiffs’ claims for increased benefits were legal in nature because they sought monetary relief. Even if the claims were equitable, laches would not exclude the statute of limitations as an affirmative defense. This left the question of when plaintiffs’ claims accrued. Defendants contended that “Plaintiffs’ claims accrued in 2019 when they made their pension elections, received documents from Defendants ‘making them aware of the material facts underlying their claims’ and, thereafter were not diligent in ensuring the accuracy of their benefit awards.” Meanwhile, plaintiffs contended that “documents they received did not amount to a ‘clear repudiation’ of their benefits and accordingly, they could not have reasonably discovered any actionable harm.” The court found this issue “a close call” and concluded that summary judgment was not warranted because there was a “genuine dispute of material fact regarding Plaintiffs’ diligence.” The court agreed with defendants that plaintiffs’ claims were repudiated when they were informed of their benefit amounts, but was not convinced the repudiations were “clear and made known” to plaintiffs because correspondence was ambiguous as to which assumptions defendants were using in calculating benefits. The magistrate judge thus recommended denying defendants’ motion for summary judgment without prejudice, allowing them to raise timeliness for a third time at trial.

Seventh Circuit

Garippo v. Skokie Valley Air Control Inc., No. 24-CV-03346, 2026 WL 296391 (N.D. Ill. Feb. 4, 2026) (Judge John Robert Blakey). Robert Garippo and Michael Garippo are former employees of Skokie Valley Air Control Inc. (SVAC) who filed this action against SVAC and their father (William Garippo) and uncle (Tony Garippo), who were executives at the company. Plaintiffs raised two disputes in their complaint. First, they contended that in 2011 Tony told them they could no longer contribute to SVAC’s retirement plan due to insufficient participants, which was untrue, as other employees continued to contribute. “No one told Plaintiffs that Tony’s statement was false or otherwise corrected this information about Plaintiffs’ eligibility to contribute to the Plan.” Second, plaintiffs contend that around 2005, Tony and William entered into a shareholders’ agreement that gave plaintiffs a right of first refusal to purchase the company if it ever went up for sale. In 2023 SVAC was purchased by another company, but plaintiffs allegedly were never informed of the offer or given an opportunity to match it. Plaintiffs alleged three claims for relief. The first was for breach of fiduciary duty under ERISA, and the other two claims relating to the sale of the company were brought under state law. Defendants moved to dismiss all three claims, contending first that plaintiffs’ ERISA claim was time-barred. The court agreed. The court explained that an ERISA claim for breach of fiduciary duty expires “six years after (A) the date of the last action which constituted a part of the breach or violation, or (B) in the case of an omission the latest date on which the fiduciary could have cured the breach or violation.” There is an exception for “fraud or concealment,” which delays the clock from starting until “the date of discovery of such breach or violation.” Here, because plaintiffs brought suit 13 years after they were allegedly told in 2011 that they could not contribute to the plan, they needed to satisfy the fraud or concealment exception. However, the court noted that this exception requires a plaintiff to show “actual concealment” or “‘steps taken by wrongdoing fiduciaries to cover their tracks.” Here, “Plaintiffs merely state that no one at SVAC told them the truth; the Complaint does not plead any fact reflecting actions of actual concealment. Without more, Plaintiffs’ allegations remain insufficient to trigger the fraud or concealment exception.” As a result, plaintiffs’ clock expired in 2017, and their ERISA claim was too late. As for plaintiffs’ state law claims, the court ruled that it did not have subject matter jurisdiction over them, and dismissed them without prejudice. Thus, defendants’ motion to dismiss was granted in its entirety and the case was terminated.

Packaging Corp. of Am. Thrift Plan for Hourly Emps. v. Langdon, No. 25-1859, __ F.4th __, 2026 WL 262954 (7th Cir. Feb. 2, 2026) (Before Circuit Judges Brennan, Lee, and Kolar)

ERISA, like many statutory schemes, is one that attempts to balance competing interests. It is designed to protect plan participants, which means honoring their desires in managing their benefits. However, ERISA is also designed to simplify and streamline plan management by giving administrators uncomplicated rules to follow.

So, what happens when these principles collide? What happens, for example, if a participant makes a decision – such as a benefit election or a beneficiary designation – that does not fully comply with the plan’s procedures? Do we honor that participant’s intent, to the extent it can be discerned, or do we strictly apply the plan’s rules to negate the choice?

Federal courts have tried to strike their own balance on this issue by applying the “substantial compliance” doctrine. Under this doctrine, a participant’s decision will be upheld, even if it does not fully comply with plan procedures, if the participant “substantially complied” with those procedures.

Of course, the devil is in the details. How much compliance is “substantial” compliance? And is this doctrine even consistent with Supreme Court jurisprudence in the first place? The Seventh Circuit confronted these issues in this week’s notable decision.

The case revolves around Carl Kleinfeldt, who was an employee of the Packaging Corporation of America (PCA) and a participant in the company’s Thrift Plan for Hourly Employees, a retirement plan governed by ERISA. The plan stated, “You should keep your beneficiary designation and your beneficiary’s address up to date. To do so, contact the PCA Benefits Center at [a designated phone number] or you can update your beneficiaries online.”

Initially, Kleinfeldt designated his wife, Dená Langdon, as the primary beneficiary of his retirement account. However, after their divorce in September 2022, Kleinfeldt attempted to remove Langdon as the beneficiary by sending a fax to PCA’s benefits center requesting that the plan “remove [his] former spouse” from his “health, vision[,] and dental insurance and as a beneficiary from [his] 401k, pension[,] and life insurance accounts.” PCA complied with regard to Kleinfeldt’s health, vision, and dental insurance, and changed Langdon’s status from “spouse” to “ex-spouse.” However, it did not remove Langdon as the primary beneficiary under the plan.

Kleinfeldt died on January 16, 2023, and the plan indicated that it intended to pay Langdon as the designated beneficiary. However, Kleinfeldt’s estate intervened, contending this was improper, and the funds were frozen. The plan subsequently filed this interpleader action, naming Langdon and the estate as the competing claimant defendants. The district court subsequently added Kleinfeldt’s sister, Terry Scholz, as a defendant because she was a potential contingent beneficiary. (Scholz passed away before the case was decided, so her estate stepped in to represent her interest.)

After the plan deposited the funds at issue with the court, the court dismissed it. Langdon and the Kleinfeldt estate then filed cross-motions for summary judgment, but the district court denied them both. Instead, the district court granted summary judgment sua sponte in favor of Scholz’s estate. The court ruled that Kleinfeldt had substantially complied with the plan’s requirements to remove Langdon as the beneficiary, which meant that Scholz was the proper beneficiary under the plan’s contingent beneficiary rules. (Your ERISA Watch covered this decision in our May 7, 2025 edition.)

Langdon appealed, and the Seventh Circuit issued this published opinion. The court addressed the standard of review first, noting “there is some question as to whether the Plan’s initial decision to distribute the retirement funds to Langdon means we should apply the arbitrary and capricious standard when deciding the merits.”

The court chose to apply the de novo standard of review, however, noting that the plan never made a final decision (“the Plan threw its arms in the air and filed this interpleader action”), and, more importantly, the case involved the application of the substantial compliance doctrine, which was an issue of law that the court was required to review de novo.

Next, the court addressed Langdon’s argument that the substantial doctrine test had been weakened by the Supreme Court’s 2009 decision in Kennedy v. Plan Administrator for DuPont Savings & Investment Plan. The court stated, “we have long recognized the doctrine of substantial compliance in ERISA cases” as a matter of federal common law, and it doubted that it should change course because of Kennedy.

The court acknowledged that Kennedy emphasized the importance of acting in accordance with plan documents, but here the plan administrator did not exercise its discretion, and instead filed an interpleader action which “[left] it up to the court.” As a result, “the need for the straightforward administration of plans and the avoidance of potential double liability – while central to the Supreme Court’s decision in Kennedy, are not implicated.” However, giving away the game, the court stated, “we think Langdon prevails either way,” and thus “we will assume without deciding the continued viability of the substantial compliance doctrine here.”

Turning to the merits, the Seventh Circuit observed that the substantial compliance test requires that “the insured (1) evidenced his intent to make the change and (2) attempted to effectuate the change by undertaking positive action which is for all practical purposes similar to the action required by the change of beneficiary provisions of the policy.”

The court found that the first element was “undeniably met here: Kleinfeldt’s fax unequivocally evidences his intent to make a change of beneficiary.” The fax was “a clear expression that he wanted Langdon removed from all of his benefit plans, including his retirement plan.”

However, the question of whether the fax was a satisfactory “positive action” was “a closer question and requires a deeper dive into our prior application of the doctrine.” The court examined several cases applying the doctrine and noted that in the cases finding substantial compliance “the plan participants took pains to follow the procedures the plan required, including obtaining the appropriate forms and even completing them to the extent they were able.”

Kleinfeldt’s estate argued that his fax was “for all practical purposes similar to” the procedures set forth in the plan documents. The court was unconvinced: “Kleinfeldt did not even attempt to utilize the proper procedures. Nowhere in the plan documents is the participant allowed to request a beneficiary change via fax.” The court found that the fax was “a method that deviates materially from the Plan’s terms” and therefore it “falls short of being ‘for all practical purposes similar to’ the procedures required by the plan documents[.]”

The court further noted that in his fax Kleinfeldt requested that the plan “fax [him] any necessary paperwork…that [he] may need to complete” to effectuate his beneficiary change, which suggested that “he himself understood that further steps may have been required to do so. Rather than following up with PCA, however, Kleinfeldt did nothing more.”

In short, the Seventh Circuit ruled that “Kleinfeldt did not substantially comply with the plan’s beneficiary-change requirements.” It reversed and remanded with instructions to enter judgment for Langdon, serving as a warning to all plan participants: follow the rules in designating your beneficiaries.

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

Breach of Fiduciary Duty

Second Circuit

DeDyn v. Gintzler Graphics, Inc., No. 1:23-CV-1291-GWC, 2026 WL 221434 (W.D.N.Y. Jan. 28, 2026) (Judge Geoffrey W. Crawford). J. Patrick DeDyn, Jeffrey Erny, and Jeffrey Kasprzyk are current or former employees of Gintzler Graphics, Inc. who filed this putative class action against Gintzler and its parent company, Resource Label Group, challenging Gintzler’s pay practices and benefit plan administration. Plaintiffs alleged three causes of action, asserting violations of the Fair Labor Standards Act (FLSA), New York Labor Law § 191(1)(a), and ERISA. Plaintiffs moved for conditional certification of a FLSA collective action, defendants filed a motion to dismiss, and the assigned magistrate judge issued a report and recommendation (R&R) on both motions. The magistrate recommended that defendants’ motion be granted in full and plaintiffs’ motion be denied. Plaintiffs filed objections on which the court ruled in this order. The court adopted the R&R’s ruling that defendants’ changing of its pay schedule for manual workers from weekly to biweekly did not constitute a violation of the FLSA, and dismissed that claim with prejudice. However, it rejected the R&R’s ruling that plaintiffs improperly alleged a violation of Labor Law § 191(1)(a). That law requires employers to pay “manual workers” on a weekly basis. Defendants admitted that plaintiffs properly alleged they were “manual workers,” but contended there was no private right of action under the law. However, the court noted that after the R&R was issued, the New York legislature amended the law to add “new language [which] explicitly provides a private right of action for violations of § 191(1)(a)” and “explicitly applies to cases pending at the time of its enactment.” As a result, the court denied defendants’ motion to dismiss this claim. As for plaintiffs’ ERISA claim, they contended that defendants “violated §§ 404 and 406 of ERISA by failing to timely remit employees’ 401(k) contributions and improperly using those unremitted contributions to operate the business.” Defendants contended that this count was thinly pled and “cursory.” The court agreed with the R&R that plaintiffs “failed to allege sufficient factual matter to support their claims,” and upheld the dismissal of the ERISA count, but without prejudice, allowing plaintiffs to amend their complaint to plead their claim more specifically. The court also addressed defendants’ argument that the court should sever the ERISA claim from the other claims. Because the court was allowing the § 191(1)(a) claim to proceed, “it is not appropriate to sever the [ERISA] claim at this time.” However, the court ruled that defendants could “renew their request to sever the claims in a future motion.” Thus, the court granted defendants’ motion to dismiss in part, denied it in part, and denied plaintiffs’ motion for conditional certification as moot because of the dismissal of the FLSA claim.

Fourth Circuit

Carter v. Sentara Healthcare Fiduciary Committee, No. 2:25-CV-16, 2026 WL 252616 (E.D. Va. Jan. 30, 2026) (Judge Jamar K. Walker). Plaintiffs Tracey Carter and Bonny Davis are participants in the Sentara Health 403(b) Savings Plan, an ERISA-governed defined contribution retirement plan. In this action they allege that the Sentara Healthcare Fiduciary Committee and Sentara Health breached their fiduciary duties by imprudently managing a stable value option, the Guaranteed Interest Balance Contract (GIBC), in the plan. Defendants filed a motion for summary judgment and a motion seeking the exclusion of expert witness testimony. In its summary judgment motion, defendants argued that their conduct was prudent as a matter of law because they enlisted the services of an investment consultant, adopted the consultant’s recommendations, and held quarterly meetings. The court agreed that this “suggests that Sentara engaged in a generally prudent process” regarding the plan’s investments as a whole, but did not answer the question of whether the GIBC in particular was prudently managed. On the GIBC, plaintiffs contended that defendants did not regularly review its status, did not obtain requests for information or proposals from competitors, and “exclusively relied on a benchmark and peer group that fundamentally differed from the GIBC and were thus ‘ill-suited for meaningful evaluation[.]’” The court concluded that “genuine disputes remain regarding what a reasonably prudent monitoring process looks like for a stable value investment option like the GIBC,” “whether the conduct of the defendants satisfies that standard,” and “whether the defendants prudently followed [their monitoring] process for the GIBC.” As for defendants’ motion regarding plaintiffs’ experts, they challenged the qualifications of Matthew Eickman, arguing that he was not qualified to opine on appropriate benchmarks and peer groups for the GIBC. The court found that Eickman’s experience as a retirement plan investment advisor provided a sufficient basis for his opinions, and that any challenges to his credibility could be addressed through cross-examination. Defendants’ motion regarding Christian Toft, however, was partly successful. The court found that Toft was not qualified to render opinions on proper benchmarks and peer groups for the GIBC, as he lacked relevant experience and relied on Eickman’s opinions rather than his own analysis. The court thus limited Toft’s testimony to quantifying losses based on comparing the GIBC’s performance to competing products. Having ruled on defendants’ motions, the court then referred the parties to the assigned magistrate judge for a settlement conference, and ordered them to meet and confer to propose a trial schedule.

Peeler v. Bayada Home Health Care, Inc., No. 1:24-CV-00231-MR, 2026 WL 208630 (W.D.N.C. Jan. 27, 2026) (Judge Martin Reidinger). Donna Peeler and Kathleen Hanline are participants in Bayada Home Health Care, Inc.’s 401(k) plan. They filed this putative class action, individually and on behalf of the plan, alleging that Bayada and related defendants mismanaged the plan, resulting in financial losses due to excessive fees and investment underperformance. Plaintiffs asserted six causes of action: breach of fiduciary duty of prudence, breach of duty of loyalty, co-fiduciary liability, breach of duty to monitor, and two counts of engaging in prohibited transactions. Defendants filed a motion to dismiss. In this order the court granted the motion based on plaintiffs’ lack of standing and the implausibility of their claims. The court found that plaintiffs lacked standing to challenge the selection and monitoring of certain funds because they did not invest in those funds and failed to allege a non-speculative financial loss. Plaintiffs contended that they were not required to personally invest in each fund because suits brought under 29 U.S.C. § 1132(a)(2) are representative actions on behalf of the plan to recover losses suffered by the plan. However, the court, quoting the Supreme Court’s ruling in Thole v. U.S. Bank N.A., emphasized, “[t]here is no ERISA exception to Article III.” The court admitted that this case was different because it involved a defined contribution plan, not a defined benefit plan as in Thole, but cited the Second Circuit’s decision in Collins v. Northeast Grocery, Inc. (Your ERISA Watch’s case of the week in our August 27, 2025 edition), for the proposition that plaintiffs “must allege a non-speculative financial loss actually affecting, or imminently threatening to affect, their individual retirement accounts.” Plaintiffs could not do so here and thus they had no standing to assert breach of the fiduciary duty of prudence for “selection and monitoring.” The court also found that plaintiffs could not obtain equitable relief under this claim in any event because it was unclear how defendants had been “unjustly enriched” by their alleged conduct. As for plaintiffs’ recordkeeping fees claim, the court ruled that plaintiffs failed to state a plausible claim because the comparator plans they offered were not “meaningful” and their alleged similarity was belied by Form 5500s. The court also ruled that plaintiffs’ allegation that defendants “failed to solicit bids from other recordkeepers” was insufficient, by itself, to support a claim for imprudence. Plaintiffs’ claim based on advisory fees was rejected for the same reasons: “The Plaintiffs have failed to adequately allege that comparator plans offered similar services for less,” and thus could not “‘advance the [advisory fees] claim across the line from conceivable to plausible.’” The court further dismissed the claims for breach of fiduciary duty of loyalty and co-fiduciary liability, as they were not supported by independent facts beyond those alleged for imprudence. The breach of duty to monitor claim was dismissed because it was derivative of the dismissed imprudence claim. Finally, the court dismissed the prohibited transactions claims for lack of standing and failure to state a claim. The court found that “Plaintiffs’ allegations fail to draw a meaningful comparison between the advisory fees incurred by the Plan and the advisory fees incurred by the alleged comparator plans,” and furthermore, “the Plaintiffs nowhere allege that the value of their individual accounts declined because of these advisory fees.” The court also ruled that plaintiffs’ prohibited transactions allegations were “conclusory” because they “provided no factual basis to distinguish between ordinary compensation for services in the form of revenue-sharing payments and illicit kickbacks.” Thus, the court granted defendants’ motion to dismiss in full.

Fifth Circuit

Wilson v. Whole Food Market, Inc., No. 1:25-CV-00085-DAE, 2026 WL 196517 (W.D. Tex. Jan. 20, 2026) (Judge David Alan Ezra). The plaintiffs – Paul Wilson, Tyler Houston, and James Besterfield – are current and former Whole Foods employees who brought this class action against Whole Foods Market, Inc. and the Whole Foods Market, Inc. Benefits Administrative Committee, contending that Whole Foods’ imposition of a tobacco surcharge in its employee health plan violates ERISA. To avoid the surcharge, participants were allowed to enroll in a tobacco cessation program, but the surcharge was only removed prospectively, not retroactively. Plaintiffs allege that the wellness program is non-compliant with ERISA because it does not provide retroactive reimbursement and fails to provide proper notice to participants. They seek declaratory and injunctive relief, as well as other forms of equitable relief. Defendants filed a motion to dismiss, arguing that plaintiffs lacked standing and failed to state a claim. On the standing issue, defendants argued that the “alleged statutory violation underlying the Complaint is not the imposition of the tobacco surcharge, but rather that [Whole Foods] did not offer a retroactive refund of the surcharge once a participant completed the cessation program.” Thus, because plaintiffs did not actually participate in the program, they had not suffered an injury. The court disagreed, ruling that plaintiffs had standing because they alleged the surcharge is unlawful on its face due to non-compliance with regulatory requirements. It did not matter if they participated in the program; plaintiffs had “the right to not to be charged an illegal surcharge in the first instance.” The court rejected defendants’ standing argument regarding plaintiffs’ claim that they received insufficient notice on the same grounds: “Plaintiffs assert not that the failure to notify injured them but that the failure to notify in accordance with the statutory and regulatory requirements rendered the surcharge they paid unlawful. As already explained, Plaintiffs have standing to raise that challenge.” The court then turned to the merits. The court found that plaintiffs plausibly pled that the imposition of the tobacco surcharge violated ERISA because the plan did not provide a “full reward” for completing the wellness program. Instead, it only provided prospective relief in the form of lower future premiums. “The Court finds that to make available the ‘full reward’ to ‘all similarly situated individuals,’ a wellness program must provide retroactive reimbursements of all tobacco surcharges paid that Plan year.” This interpretation, the court ruled, was consistent with statutory and regulatory language. As for plaintiffs’ second claim, for breach of fiduciary duty, defendants contended that they were not acting as ERISA fiduciaries when they performed the challenged actions, and that plaintiffs did not allege a loss to the plan. Again, the court disagreed. The court noted that while decisions regarding the form or structure of a plan do not amount to fiduciary acts, plaintiffs’ allegations went beyond mere plan design by alleging that defendants engaged in discretionary decisions, such as depositing surcharge amounts into Whole Foods’ general account instead of in a plan trust account, failing to disclose information about the wellness program, and failing to supervise and monitor the plan to ensure compliance with ERISA. The court further ruled that plaintiffs alleged a cognizable loss to the plan by contending that defendants withheld surcharge amounts and deposited them into Whole Foods’ general accounts, earning interest and reducing their financial contributions to the plan. As a result, the court was satisfied that plaintiffs had properly alleged “at this stage of the case” that defendants’ conduct constituted a breach of fiduciary duty and prohibited transactions in violation of ERISA, and denied defendants’ motion in its entirety.

Seventh Circuit

Gardner-Keegan v. W.W. Grainger, Inc., No. 1:25-CV-5233, 2026 WL 194772 (N.D. Ill. Jan. 26, 2026) (Judge Mary M. Rowland). Plaintiffs Adrianne Gardner-Keegan, Scott A. Norman, and Alison Dela Riva, participants and beneficiaries of the W.W. Grainger, Inc. Retirement Savings Plan, filed this six-count action against Grainger and related defendants contending that they violated ERISA in their use of plan forfeitures. Like other similar plans, the Grainger plan is funded by wage withholding contributions from participants and employer profit-sharing contributions from Grainger, which vest over time. If a participant’s employment ends before vesting, Grainger’s contributions are forfeited. This plan differed from many others, however, because it specified that “Forfeiture Account amounts shall be utilized to pay reasonable administrative expenses of the Plan and to restore Accounts for a Plan Year, as directed by the Committee, and then (i) for Plan Years prior to the 2016 Plan Year, to increase the amount allocated as Company Profit Sharing Contributions for that Plan Year, (ii) beginning with the 2016 Plan Year, to offset Company Profit Sharing Contributions, and (iii) beginning with the 2021 Plan Year, to offset Company Contributions[.]” Plaintiffs alleged that from 2019 to 2023, “the Plan Committee did not utilize forfeitures to pay reasonable administrative expenses for the Plan but instead utilized forfeitures to offset Grainger’s profit-sharing contributions to the Plan,” thus violating the plan and breaching fiduciary duties to participants. Defendants filed a motion to dismiss in which it first argued that plaintiffs lacked standing because, under the plan, participants are responsible for administrative expenses. The court rejected this argument, agreeing with plaintiffs that the plan was unambiguous, and that the provision directing defendants to use forfeitures to pay reasonable administrative expenses governed over any other plan language suggesting the contrary. “By alleging that the Plan Committee disregarded this language – resulting in the Plan and its participants being stuck with the bill – Plaintiffs have sufficiently alleged an Article III injury.” On the merits, the court ruled that plaintiffs plausibly pled that the committee breached its fiduciary duty of loyalty by failing to abide by plan terms. The court acknowledged that many courts had ruled against plaintiffs on similar forfeiture claims, but stressed that this case was different because the operative plan language “does not give discretion as to how the Plan Committee can allocate forfeitures. It instead mandates the Plan Committee to utilize forfeitures to pay reasonable administrative expenses (Step 1) before offsetting employer contributions (Step 2).” The court noted that defendants’ interpretation might be “in some situations…in the best interests of Plan participants (and thus not a breach of loyalty),” but “[w]hether this situation occurred in the present case, however, is unfit for resolution at this stage in the proceedings.” The court further ruled that plaintiffs plausibly pled a breach of the duty of prudence by alleging that the committee used “an imprudent and flawed process in determining how forfeitures would be allocated,” and that plaintiffs had plausibly alleged that the committee’s breach harmed the plan because it “reduce[d] the funds available to participants for distribution and/or investing[.]” Plaintiffs’ winning streak ended with their prohibited transactions claims, however. The court agreed with defendants that plaintiffs “have not identified any ‘transaction’ within the meaning of 29 U.S.C. § 1106.” Instead, “forfeitures remained in the Plan and were simply shifted to other employees in the form of contributions… Movement of funds within a plan ‘does not fit neatly within the plain meaning of ‘transaction.’’” Indeed, the court stated that “Plaintiffs’ prohibited transaction theory yields absurd implications” because it “seems to classify any intra-plan transfer of funds to offset employer contributions – even if expressly permitted in a plan – as a violation of 29 U.S.C. § 1106. The broad reach of Plaintiffs’ theory is untenable.” As a result, the court granted defendants’ motion to dismiss the prohibited transaction claims. The remainder of plaintiffs’ claims survived, however, and the court set a status conference for February 4 to discuss next steps in the case.

Ninth Circuit

Moran v. ESOP Committee of the Aluminum Precision Products, Inc. Employee Stock Ownership Plan, No. SACV 24-00642-MWF (ADSx), 2026 WL 235573 (C.D. Cal. Jan. 28, 2026) (Judge Michael W. Fitzgerald). The Aluminum Precision Products, Inc. (APP) Employee Stock Ownership Plan (ESOP) was established in 2009 to provide retirement benefits to employees. The ESOP holds primarily APP stock but also maintains an “Other Investments Account” (OIA) consisting of non-APP stock assets. The plan purchased APP stock via a loan in 2011 and 2012, which was paid off by 2017 using dividends and cash contributions. Since then, these contributions have accumulated in the OIA, which now represents about 20-25% of the plan’s total assets. In this action plaintiff Gustavo Moran alleges that from 2018 to 2021 the plan committee invested the OIA assets in a money market fund and a short-term U.S. Treasury bond fund, significantly reducing investment returns for the participants. Moran further contends that the committee intentionally kept the OIA balance liquid for self-serving reasons, as the company wanted to “use the OIA has a backup reserve to satisfy its long-term liability to repurchase shares from departing participants.” Moran brought two claims under ERISA: breach of the fiduciary duty of prudence in violation of 29 U.S.C. § 1104(a)(1), and a prohibited transaction in violation of 29 U.S.C. § 1106(a). The committee filed a motion for judgment on the pleadings, which the court ruled on in this order. The committee argued first that ERISA’s statutory exemption from diversification for ESOPs created a complete bar to the duty of prudence claim. However, the court noted that Moran was challenging the investment of the OIA assets within the ESOP, not the ESOP as a whole. The court observed that the issue of whether the statutory exemption applied to non-employer assets within an ESOP was one that the Ninth Circuit had not addressed, “and district courts appear to have reached divergent conclusions.” Ultimately, the court concluded that the “plain language of the statute” was “relatively clear” and held that ERISA “does not purport to exempt the management of other assets from prudence review simply because those assets are held within an ESOP.” As a result, the court turned to the merits of Moran’s claim, and ruled that his allegations were sufficiently specific: “Here, Plaintiff has done more than allege that Defendant should have pursued ‘higher returns’ or ‘riskier assets.’ Plaintiff alleges an objective ‘mismatch’ between the Plan’s assets and its purpose as a retirement plan.” Moran also “points to relevant comparators, alleging that the APP ESOP holds 100 times more cash equivalents than the median cash holdings of comparator ESOP plans[.]” The court ruled that this “vast disparity [between plans] supports a reasonable inference of a lack of prudence.” The committee argued that plan language gave it the authority to invest OIA assets as it saw fit, but the court ruled that this did not foreclose a prudence claim, and in any event “the duty of prudence trumps the instructions of a plan document.” As for Moran’s prohibited transaction claim, the committee argued that its investment strategy was not a “transaction,” and furthermore it was “not for an improper purpose.” The court ruled that Moran had sufficiently specified investment activity by the OIA, including “an alleged 2021 reallocation in which Defendant moved approximately half of the OIA from a money market fund into a short-term treasury fund…such affirmative purchases suffice to satisfy the ‘transaction’ component of a § 1106(a) claim[.]” Furthermore, Moran had identified an improper purpose, i.e., the “reallocation was for Defendant’s ‘use’ of the OIA for the benefit of APP and APP’s repurchase obligations.” The committee argued that repurchasing shares was not “prohibited” because, through repurchasing, the OIA funds would be used to pay benefits. However, the court ruled that this was not enough: “Plaintiff here has plausibly alleged that the primary purpose of the 2021 transaction was to serve APP’s interest in liquidity rather than the participants’ interest in long-term growth.” Thus, the problem was not that the plan had a liquid reserve or cash buffer, but that the committee “engage[d] in affirmative investment transactions to create an allegedly excessive buffer for the employer’s benefit. At this stage, those allegations are sufficient to state a claim under § 1106(a)(1)(D).” With that, the court denied the committee’s motion for judgment on the pleadings in its entirety.

Class Actions

Third Circuit

Bennett v. Schnader Harrison Segal & Lewis LLP, No. 2:24-CV-00592-JMY, 2026 WL 202548 (E.D. Pa. Jan. 22, 2026) (Judge John M. Younge). In this case Jo Bennett, an attorney, sued her defunct law firm on behalf of a class of employees, alleging numerous violations of ERISA in the firm’s administration of its 401(k) benefit plan. In Your ERISA Watch’s July 31, 2024 edition, we detailed the judge’s order in the case denying defendants’ motion to dismiss, and since then the parties have negotiated and reached a settlement which was presented to the court. Here, the court granted final approval of the class action settlement, which included certifying the class for settlement purposes, approving attorney’s fees and expenses, and granting a class representative service award. The court determined that the settlement, which included a monetary component of $675,000, representing approximately 68% of the maximum potential recovery, and non-monetary benefits, such as tax-favored treatment of distributions through a “Special SubTrust,” was fair, reasonable, and adequate. The court also considered the Third Circuit’s Girsh and Prudential factors, which include the complexity and duration of the litigation, the reaction of the class to the settlement, and the risks of establishing liability and damages. The court found that the settlement was reasonable given the complexity of ERISA litigation and the potential risks and costs of continued litigation. The plan of allocation was approved, providing for a pro rata distribution of the net settlement fund based on the losses in class members’ accounts. The court also approved the requested attorney’s fees, which were one-third of the settlement fund, and reimbursement of expenses totaling $7,650.11. A service award of $10,000 was granted to Bennett as class representative. The court thus entered judgment, ordered the case dismissed, and retained jurisdiction over the implementation and enforcement of the settlement agreement.

Tamburrino v. United Healthcare Ins. Co., No. 21-12766 (SDW) (LDW), 2026 WL 234155 (D.N.J. Jan. 28, 2026) (Judge Susan D. Wigenton). In 2018 plaintiff Barbara Williams underwent post-mastectomy delayed bilateral breast reconstruction with deep inferior epigastric perforator (“DIEP”) flap microsurgery. In this action Williams alleges that defendant United Healthcare Insurance Company denied her claim “because of its application of a denial policy that relies on inapplicable Medicare billing and coding guidelines. Specifically, Plaintiff contends that Defendant relied on Medicare billing and coding guidelines, rather than using HCPCS S2068, the billing code created for DIEP flap microsurgery.” Williams’ operative complaint alleges three claims under ERISA: one for wrongful denial of benefits under 29 U.S.C. § 1132(a)(1)(B), and two for equitable relief under 29 U.S.C. § 1132(a)(3). Williams filed a motion for class certification on which the court ruled in this order. The court evaluated the motion under Federal Rule of Civil Procedure 23, which imposes numerosity, commonality, typicality, and adequacy requirements. The court ruled that the numerosity requirement was met because United did not dispute that the potential number of plaintiffs exceeded 40. However, the court found that the commonality requirement was not satisfied because of variation in benefit plan language among the members of the proposed class. The court noted that some plan language required an abuse of discretion standard of review while some language would result in de novo review. As a result, “individualized, fact-specific” inquiries would be required, thus defeating her proposed class. “[T]he question of which standard of review applies to the members’ plan cannot be resolved on a class-wide basis and as such, Plaintiff fails to satisfy the commonality requirement.” As for typicality, the court noted that the variety of limitation periods in members’ plans could render some claims untimely. “Based on the sample claims and thousands of putative class members, it is likely that the numerous class members with untimely claims could render Plaintiff’s timely claims atypical.” Regarding adequacy, the court noted “significant concerns” about Williams’ ability to serve as a class representative, citing “sworn deposition testimony where Plaintiff expressed doubts or an unwillingness to serve as a class representative.” Furthermore, the remedy she sought, reprocessing of claims, “may be harmful to some class members as they could be worse off financially while providers may be better off financially.” The court did not make definitive rulings on these other elements, however, and relied on Williams’ failure to satisfy the commonality requirement to deny her motion for class certification.

Fourth Circuit

Alford v. The NFL Player Disability & Survivor Benefit Plan, No. 1:23-CV-00358-JRR, 2026 WL 216349 (D. Md. Jan. 28, 2026) (Judge Julie R. Rubin). In this closely watched case, former players of the National Football League have brought numerous claims under ERISA against the league’s disability benefit plan and its review board alleging wrongful denial of benefits, failure to provide adequate notice of denial, denial of the right to a full and fair review, and breaches of fiduciary duties. The players argue that defendants “have rigged the claims process against those in whose best interests they are supposed to be administering the Plan” by engaging in practices that unfairly disadvantage applicants for disability benefits, including failing to consider all evidence, misinforming applicants, and employing financially conflicted physicians. (The players’ claims are supported in large part by the findings made by the district court in Cloud v. Bert Bell/Pete Rozelle NFL Player Ret. Plan. In that case the plan eventually prevailed at the Fifth Circuit, although that court “commend[ed]” the district court for “expos[ing] the disturbing lack of safeguards to ensure fair and meaningful review of disability claims brought by former players who suffered incapacitating on-the-field injuries, including severe head trauma,” and for “chronicling a lopsided system aggressively stacked against disabled players.”) The players survived defendants’ motion to dismiss in March of 2024 (as we detailed in our March 27, 2024 edition), and in September of 2024 the players filed a motion for class certification. The players sought to certify a class of all plan participants who filed applications for disability benefits between August 1, 1970, and the date of class certification, and proposed five subclasses based on different types of disability benefits and adverse determinations. In this ruling the court denied the players’ motion. As in every class action, the court focused on whether plaintiffs met Federal Rule of Civil Procedure 23’s requirements of numerosity, commonality, typicality, and adequacy of representation, and concluded that plaintiffs could not satisfy the Rule’s commonality and typicality requirements. On commonality, the court noted that in the Fourth Circuit, “[a]llegations of generalized policies are not usually sufficient for the purposes of class certification,” and thus courts “are skeptical” when plaintiffs “rely on nebulous references to ‘systemic failures’ or ‘systemic deficiencies’ to satisfy commonality.” The players admitted that any particular plaintiff might be “unaffected by one or more of the policies and practices at issue,” but contended that “Defendants’ panoply of practices and policies steeply tilted the playing field against benefits applicants and amounted, in their totality, to objectively unreasonable conduct.” This was not enough for the court, which agreed with defendants that the players had not alleged “a uniformly-applied or well-defined common practice that affected (or affects) each member of the proposed class[.]” The court stated that each player’s claim would ordinarily involve “a highly individualized assessment,” and thus the class could not proceed without “some common thread or ‘glue’ (such as a uniform or common application of a policy) to tie ‘those decisions together in a way that suggests that they can productively be litigated all at once.’” The court also noted that the proposed class reached back to 1970 and thus raised questions about how common the players’ claims could be given the various plan changes and legal precedents that occurred during that lengthy time period. As for Rule 23’s typicality requirement, the court held that the players “fail to show that their claims are typical of putative class members’ claims” because “Plaintiffs have not persuaded the court that their claims arising from this overarching policy are typical of the claims of class members from decades ago, asserting their own unique medical conditions and applications, under different Plan terms.” The court was further unconvinced that the players’ claims “‘arise from the same factual nexus and are based on the same legal theories as’ those of the proposed class members.” As a result, the court denied the players’ motion for class certification.

Franklin v. Duke Univ., No. 1:23-CV-833, 2026 WL 191142 (M.D.N.C. Jan. 26, 2026) (Judge Catherine C. Eagles). This is a class action brought by Joy G. Franklin alleging that Duke University and related defendants violated ERISA by using outdated and unreasonable actuarial equivalency formulas which resulted in reduced benefits for participants in Duke’s pension plan. Specifically, Franklin claimed that this conduct violated ERISA’s actuarial equivalence requirement and anti-forfeiture rules, and breached fiduciary duties. Defendants responded with a motion in which it sought to dismiss Franklin’s Section 1132(a)(3) claim and/or compel arbitration of both her individual and class claims. As Your ERISA Watch detailed in our March 13, 2024 edition, the district court denied defendants’ motion, ruling that Franklin had standing to bring her claim and that the unilaterally added arbitration provision in the plan was unenforceable. (The district court subsequently denied defendants’ motion to dismiss Franklin’s Section 1132(a)(2) claim as well.) Defendants appealed to the Fourth Circuit on the arbitration issue, and in September of 2025, while that appeal was pending, the parties reached a settlement. The Fourth Circuit agreed to remand the case back to the district court for settlement approval proceedings. Notice was given to the class, and no objections were raised. A final fairness hearing was held on January 21, 2026, and in this order the court granted final approval of the settlement. The settlement class was defined as participants and beneficiaries of Duke’s retirement plan who began receiving benefits between September 29, 2017, and July 1, 2023, and were receiving certain types of annuities. The proposed settlement awarded the class roughly 17% of the calculated class-wide damages, which the court admitted was “marginally lower than similar ERISA cases[.]” However, the court also acknowledged that “the plaintiff here faces unusually strong headwinds if litigation continues” because recent precedent “may have altered the analysis of the arbitration provision at issue in the defendants’ pending appeal.” Furthermore, plaintiff could not be certain of success on the merits, given the complex and expert-dependent nature of ERISA cases in general and actuarial equivalence cases in particular.” The court noted that an independent fiduciary had reviewed and approved the settlement terms. The court marched throughout the requirements of Federal Rule of Civil Procedure 23, including numerosity, commonality, typicality, and adequacy of representation, and found all were satisfied. The court found the settlement fair and reasonable, and noted that it was reached through arm’s length negotiations with the assistance of an experienced ERISA mediator. The court thus granted final certification of the class and approval of the class action settlement, finding it in the best interests of the class members. The court retained jurisdiction over the settlement and dismissed the operative complaint with prejudice.

Disability Benefit Claims

Sixth Circuit

Robinette v. Appalachian Regional Healthcare, Inc., No. 6:26-CV-22-REW-EBA, 2026 WL 252992 (E.D. Ky. Jan. 30, 2026) (Judge Robert E. Wier). Dayna Suzanne Robinette stopped working as a ward clerk for Appalachian Regional Healthcare, Inc. (ARH) in 2023 due to chronic pain from congenital left hip dysplasia and degenerative lumbar spine disease. She applied for disability retirement benefits under ARH’s pension plan, supported by a letter from her treating provider. The provider stated that Robinette “was born with congenital hip dysplasia, was born without a hip, and had surgery when she was eight years old to try to help build a hip.” The provider further attested that Robinette had “progressive left hip joint pain and lower back pain due to a marked lower extremity deformity,” and “faces ‘ongoing pain’ that is ‘progressively worse.’” The plan’s first medical reviewer “acknowledged Robinette’s severe hip deformity and osteoarthritis but concluded that she was not ‘Totally Disabled’ under the Plan, suggesting she could work with restrictions.” On appeal, the plan arranged an independent medical examination (IME) which concluded that Robinette “could work in a sedentary position with adequate pain control.” As a result, the plan denied Robinette’s claim and she initiated this action for unlawful denial of benefits under ERISA. Robinette filed a motion for judgment which was the subject of this order. The court began with the standard of review; both parties agreed that the plan granted discretionary authority to the review committee, so the court employed the arbitrary and capricious standard. Robinette advanced three arguments in support of her motion: “First, she argues that the Committee applied an incorrect standard of disability in making the disability determination… Second, she claims the Committee’s reliance on [the IME] opinion in reaching its decision to deny benefits was arbitrary and capricious… Third, she contends that the medical evidence provides compelling support that she is ‘Totally Disabled’ as provided in the Plan.” Addressing the first argument, the court ruled that the committee reasonably interpreted the plan definition of disability, and that Robinette’s contention that the definition was ambiguous was defeated by the standard of review, which gave the committee discretion to interpret the provision. On her second and third arguments, the court agreed, however. The court found that the IME reviewer “plainly did not review or have access to the full record,” conditioned his conclusion on “adequate pain management,” which was not reflected in the record, and his report “has glaring internal inconsistence and a stark logic deficit.” The court faulted the reviewer’s reference to potential hip replacement because “that prospective possibility hardly speaks to Robinette’s condition at the time of the claim or denial,” and furthermore he “denies any reference to such surgery in any of the medical records ‘available.’” These contradictions, according to the court, “will not do, even in the forgiving arbitrary and capricious world.” The court also criticized the medical reviewer supporting the committee’s initial decision, which was a “documents-only review” that “ultimately lands on a work ability unsupported by the record and cites only a job that plainly involves duties (e.g., bending) that exceed Robinette’s capacities[.]” As a result, the court granted Robinette’s motion, and chose to award her benefits rather than remand because she was “clearly entitled to benefits.” The court further authorized Robinette to seek “reasonable attorney’s fees and costs under 29 U.S.C. § 1132(g) by timely post-judgment motion[.]”

ERISA Preemption

Second Circuit

Doolittle v. Hartford Fin. Servs. Grp., Inc., No. 1:25-CV-00148 (BKS/TWD), 2026 WL 266009 (N.D.N.Y. Feb. 2, 2026) (Judge Brenda K. Sannes). Micky R. Doolittle brought this pro se action against Hartford Life and Accident Insurance Company alleging that Hartford unlawfully underpaid his long-term disability benefits. The dispute stems from Doolittle’s Social Security disability benefit award. Before he received that award, Doolittle agreed to receive unreduced benefits from Hartford with the understanding that the award was an offset under Hartford’s policy and he would have to pay Hartford back if he received the award. Doolittle subsequently received a retroactive Social Security disability check for $31,000, and Hartford requested reimbursement. Doolittle contends that he entered into a verbal agreement with a Hartford representative in which he would pay $10,000 to settle the overpayment, and subsequently sent a check for $10,000, which Hartford cashed. However, Hartford allegedly stopped paying benefits anyway, presumably to recover the remainder of the overpayment. Doolittle filed a complaint in state court alleging two state law causes of action, and last year Hartford moved to dismiss. As we chronicled in our September 17, 2025 issue, the court granted Hartford’s motion, ruling that Doolittle’s two claims were preempted by ERISA. Doolittle amended his complaint, and Hartford moved to dismiss again. In this order, the court granted Hartford’s motion again for the very same reasons. Doolittle asserted the same two state law causes of action in his new complaint – breach of contract and bad faith – and thus the court again ruled that these claims were preempted. However, the court ruled that due to the limited facts before it, it “cannot conclude as a matter of law that Plaintiff does not have a cause of action under Section 502(a)(1)(B) of ERISA, 29 U.S.C. § 1132(a)(1)(B).” As a result, the court granted Hartford’s motion to dismiss Doolittle’s state law claims, but allowed him to pursue a federal claim under Section 502(a)(1)(B).

Third Circuit

Kirmser v. Unity Bancorp, Inc., No. 24-10663 (MAS) (TJB), 2026 WL 265476 (D.N.J. Feb. 2, 2026) (Judge Michael A. Shipp). Michelle S. Kirmser was employed by Unity Bank and was a participant in the Bank’s Executive Life Insurance Plan. The plan stated that a participant’s rights would cease if terminated for cause, if employment ended before early retirement age for reasons other than disability, or if the participant became gainfully employed elsewhere after terminating due to disability. Kirmser alleges she became disabled in 2023 and that her employment was terminated after reaching early retirement age due to disability, not for cause, and thus she was entitled to continued coverage under the life insurance plan. Kirmser also challenges her payments under the Bank’s executive long-term disability (LTD) benefit plan. Kirmser contends the Bank informed her that her premiums were paid in a manner that would not subject her benefits to taxation. However, after becoming disabled and receiving LTD benefits, Kirmser discovered the income was reported as taxable. Kirmser thus filed this action against three related Bank defendants, alleging (1) declaratory judgment under ERISA, (2) breach of contract, (3) breach of the covenant of good faith and fair dealing, (4) promissory estoppel, and (5) misrepresentation. Defendants moved to dismiss. First, defendants argued that the Bank’s holding company was an improper defendant because it did not play any role in controlling the plan or its administration. The court agreed and dismissed the holding company. The court then addressed the merits of Kirmser’s claims. In her first claim, Kirmser sought a declaratory judgment that she was a participant in the life insurance plan, but the court dismissed this claim sua sponte for lack of subject matter jurisdiction because Kirmser did not demonstrate a “real and immediate” threat of future harm. The court acknowledged that although Kirmser “alleges a theoretical future harm – that her beneficiaries would not recover any money upon a claim made after her death – Plaintiff has not otherwise alleged that she or her beneficiaries face an immediate threat of this occurring absent a declaration from this Court or that any purported limitations period is set to expire.” The court allowed Kirmser an opportunity to amend her complaint “to bolster allegations related to the threat of imminent harm she may face.” As for Kirmser’s state law claims, which all addressed the taxability of her benefits under the LTD plan, the court ruled that they were preempted by ERISA. Kirmser contended that these claims “do not seek benefits under any ERISA plan,” but instead “ask only that the Court require [Unity] to make good on various representations that were made to [P]laintiff[.]” However, the court ruled that her claims “clearly require an analysis of the EX LTD Plan itself, and its administration, to discern the responsibility for paying premiums for coverage, and thus, whether Plaintiff should be taxed on the EX LTD Benefits as she receives them.” Thus, these claims were preempted and dismissed. As a result, the court granted defendants’ motion to dismiss in its entirety.

Exhaustion of Administrative Remedies

Eleventh Circuit

Bolton v. Inland Fresh Seafood Corp. of Am., Inc., No. 24-10084, __ F.4th __, 2026 WL 205635 (11th Cir. Jan. 27, 2026). In our October 22, 2025 edition we reported on the Eleventh Circuit’s published opinion in this case in which that court once again adhered to its 40-year-old rule that plaintiffs must “exhaust,” i.e., fully appeal, all their ERISA claims – even statutory claims, such as breach of fiduciary duty or prohibited transactions – before they can file a civil action in federal court. As the court admitted, its rule is at odds with seven other circuits, which have all held there is no exhaustion requirement under ERISA for statutory claims. (Only the Seventh Circuit agrees, and its rule is more forgiving.) The judges on the panel were clearly not thrilled with Circuit precedent, so two of them (Adalberto Jordan and Jill Pryor) issued a concurrence in which they “propose[d] that we convene en banc to consider overruling” the Circuit’s outlier rule. Lo and behold, three months later the full court issued this order granting their wish and vacating the panel’s October decision. The Circuit will now reconsider the case and decide whether to jettison its idiosyncratic exhaustion rule.

Medical Benefit Claims

Ninth Circuit

R.R. v. California Physicians’ Service, No. 24-6337, __ F. App’x __, 2026 WL 207507 (9th Cir. Jan. 27, 2026) (Before Circuit Judges Paez, Bea, and Forrest). Plaintiffs R.R. and his minor son E.R. brought this action challenging defendant Blue Shield of California’s denials of their claims for reimbursement for E.R.’s treatment at a mental health residential treatment center. Although the ERISA-governed plan insured and administered by Blue Shield covered residential treatment, Blue Shield denied plaintiffs’ claims because it concluded that E.R.’s residential treatment was not medically necessary under its clinical guidelines. Plaintiffs thus filed this action under 29 U.S.C. § 1132(a)(1)(B) seeking recovery of benefits, and the case was decided on summary judgment proceedings. The district court acknowledged that there “is no doubt that E.R. has a serious psychiatric condition and has suffered substantially from it, as has his family,” but in the end granted summary judgment to Blue Shield, ruling that its decision was not an abuse of discretion. (Your ERISA Watch covered this ruling in our August 21, 2024 edition.) Plaintiffs appealed, and in this unpublished decision the Ninth Circuit affirmed. The court agreed with the district court that the proper standard of review was abuse of discretion because the plan authorized Blue Shield to interpret its provisions and determine eligibility for benefits. The court nominally tempered this deference with skepticism because Blue Shield “acts as both the administrator that decides claims and the insurer that pays benefits” and thus “has a conflict of interest.” However, plaintiffs did not offer evidence that this conflict of interest affected the benefits decision. Thus, Blue Shield’s use of an independent physician reviewer, “combined with Plaintiffs’ failure to meet their burden of production, makes Blue Shield’s conflict ‘less important’ to our analysis, ‘perhaps to the vanishing point.’” The court then turned to the merits, determining that Blue Shield did not abuse its discretion in determining that E.R.’s residential treatment was not “medically necessary” under the terms of the plan. The court ruled that Blue Shield properly used its Magellan Care Guidelines in interpreting medical necessity because they are “nationally recognized” and “widely used.” The court further ruled that Blue Shield did not abuse its discretion in determining that E.R. did not meet specific criteria under these guidelines. Plaintiffs argued against Blue Shield’s reliance on the treatment center’s records, claiming they were based on E.R.’s self-reports, which were not credible. However, the court found it was not an abuse of discretion for Blue Shield to consider these records, as “they were the most contemporaneous reports of E.R.’s mental state” and “reflect the judgment of independent clinicians.” Plaintiffs also contended that Blue Shield failed to explain why it reached a different conclusion from E.R.’s treating physicians and parents, but the court noted that administrators are not required to accord special weight to the opinions of a claimant’s physician, and furthermore those entreaties post-dated E.R.’s admission and did not address the guidelines at issue. The court further found that Blue Shield complied with ERISA’s procedural rules and that it did not “present a new rationale to the district court that was not presented to the claimant…during the administrative process.” Instead, the court stated, “There is a difference between offering a new rationale,” which is forbidden, and “offering new evidence to bolster an existing rationale,” which is what Blue Shield did: “[A]n administrator may cite evidence in litigation that it had not cited during the administrative process, so long as that evidence supports the same underlying legal theory.” As a result, the Ninth Circuit affirmed the decision below in its entirety. Judge Richard A. Paez dissented, arguing that the majority misapplied the standard of review because Blue Shield’s conflict of interest required more skepticism. Judge Paez further argued that Blue Shield failed to credit plaintiffs’ reliable evidence and did not engage in a meaningful dialogue with plaintiffs. Specifically, Blue Shield did not engage with the arguments or evidence presented by plaintiffs; “Indeed, the final denial letter either misstated or ignored the contents of Plaintiffs’ internal appeal.” In short, Judge Paez concluded that Blue Shield was entitled to less deference because of its conduct, and thus he “would hold that Blue Shield abused its discretion. At minimum, I would remand to the district court to reconsider Plaintiffs’ claim for benefits under a less-deferential standard of review.”

Pension Benefit Claims

Ninth Circuit

Woo v. Kaiser Foundation Health Plan Inc., No. 23-CV-05063-RFL, 2026 WL 194578 (N.D. Cal. Jan. 26, 2026) (Judge Rita F. Lin). Plaintiff Sarah Woo has been employed by Kaiser Foundation Hospitals since 2002. In 2009, Woo transferred from Kaiser’s Southern Region to its Northern Region. Upon transfer, she received confirmation of her eligibility to participate in Kaiser’s Supplemental Retirement Plan, an after-tax component of the Kaiser Permanente Employees Pension Plan Supplement. Woo enrolled, and over the next decade made voluntary contributions from her paychecks. During this time Kaiser confirmed her eligibility multiple times in both phone calls and letters. However, in December 2020, Kaiser informed Woo that it had made a mistake. Woo was in fact ineligible to participate in the plan because “her transfer to Northern California had brought her outside the Plan’s definition of Eligible Employee.” Woo’s internal appeals were unsuccessful, and thus she brought this action, seeking equitable relief pursuant to ERISA Section 1132(a)(3) under an estoppel theory. The parties filed cross-motions for judgment which were decided in this order. The court noted that estoppel claims under ERISA require “(1) a material misrepresentation; (2) reasonable and detrimental reliance on the representation; (3) extraordinary circumstances; (4) the provisions of the plan at issue are ambiguous, such that reasonable persons could disagree as to their meaning or effect; and (5) the representations must have been made to the beneficiary involving a spoken or written interpretation of the plan.” The court ruled that Woo satisfied all five elements. The court found that Kaiser “materially misrepresented Woo’s eligibility to participate in the SRIP and the KPEPP for over a decade,” either directly to her or through its agents. The court acknowledged that some of these communications included disclaimers, but others, such as the initial eligibility letter, did not, and thus the multiple misrepresentations over several years were sufficiently misleading. The court further found that Woo reasonably relied on Kaiser’s representations because continuing participation in the plan was “a high priority” for her when deciding to transfer to the Northern Region. Woo “engaged in years of financial planning – as reflected by her numerous calls to KPRC regarding her retirement benefits – under the assumption she would be able to count on receiving retirement benefits through the SRIP and the KPEPP.” The court further ruled that “extraordinary circumstances” existed due to Kaiser’s repeated misrepresentations over time: “This pattern of repeated misrepresentation is a prototypical example of extraordinary circumstances that support an equitable estoppel claim under ERISA.” The court also found that the plan provisions were ambiguous because, while it was clear that Woo was not an “Eligible Employee,” “[t]he Plan is ambiguous as to what happens when KFH, the Participating Company, makes an error in the eligibility determination.” The court concluded that “[o]ne could reasonably read the Plan as treating KFH’s eligibility determination as conclusive and binding…even if it was an erroneous application of the eligibility criteria[.]” Finally, the court found that the fifth element was met because the representations made to Woo involved interpretations of the plan, and thus “Woo has established all the elements of her equitable estoppel claim under ERISA.” The court granted her motion for judgment, denied Kaiser’s, and ordered the parties to meet and confer to prepare a proposed judgment.

Provider Claims

Third Circuit

Samra Plastic & Reconstructive Surgery v. UnitedHealthcare Ins. Co., No. CV 25-6001 (MAS) (JTQ), 2026 WL 266754 (D.N.J. Feb. 2, 2026) (Judge Michael A. Shipp). Samra Plastic and Reconstructive Surgery, a healthcare services provider, performed surgical services on a patient insured by UnitedHealthcare Insurance Company. Samra alleges that it obtained prior authorization from United, which “explained to Plaintiffs that the out-of-network benefit to be paid by Defendant was the FAIRHealth Benchmark at the 75th percentile.” However, Samra alleges that United only paid a fraction of the billed amount, leaving a significant outstanding balance. Samra and the patient filed this suit in state court alleging six causes of action: breach of contract, promissory estoppel, account stated, failure to pay benefits under ERISA, breach of fiduciary duty and co-fiduciary duty under ERISA, and failure to provide a summary plan description in accordance with ERISA. The state law claims were asserted by Samra, while the ERISA claims were asserted by the patient. United moved to dismiss Samra’s claims on preemption grounds, and all claims for failure to state a claim. The court first addressed United’s preemption argument, ruling that Samra’s claims were not preempted by ERISA because they did not require an “impermissible reference” to the patient’s ERISA-governed plan and were based on a separate agreement between Samra and United. The court acknowledged that some reference to the plan might be necessary, but such a reference would be nothing more than “a cursory examination,” which “is ‘not the sort of exacting, tedious, or duplicative inquiry that the preemption doctrine is intended to bar.’” The court then examined Samra’s state law claims and found they were all properly pleaded. The court ruled that Samra had alleged claims for (1) breach of contract based on United’s “multiple representations” that it would pay the patient’s claim at a certain rate, (2) promissory estoppel based on those same representations, as well as Samra’s detrimental reliance, and (3) account stated because Samra had sent a bill to United for a precise amount which United had accepted and did not dispute. However, the patient had less luck with her ERISA claims. The court found that the patient’s allegations supporting her claim for benefits were too vague and that she did not identify a specific plan provision that entitled her to benefits. The court also dismissed the patient’s claim for breach of fiduciary duty under ERISA, concluding that the relief sought was legal rather than equitable, and that she had merely relabeled her claim for benefits. As for the alleged failure to produce plan documents, it was dismissed as well because the patient did not allege that United was a plan administrator, a necessary element under Section 1132(c)(1)(B). As a result, the court denied United’s motion as to Samra’s state law claims but granted it as to the patient’s ERISA claims.

Fifth Circuit

Abira Med. Laboratories LLC v. Blue Cross Blue Shield of Texas, No. 3:24-CV-2001-B, 2026 WL 252097 (N.D. Tex. Jan. 30, 2026) (Judge Jane J. Boyle). Abira Medical Laboratories LLC, d/b/a Genesis Diagnostics, brought this action against Blue Cross Blue Shield of Texas seeking $7.1 million in reimbursement for laboratory testing Genesis provided to BCBS’ insureds. Genesis initiated arbitration proceedings against BCBS in 2022, contending that BCBS failed to pay both in-network and out-of-network claims. In 2023, the out-of-network claims were severed from the arbitration, leading Genesis to file this separate lawsuit in state court. In its complaint Genesis asserted claims for account stated, breach of contract, and quantum meruit. BCBS removed the case to federal court and moved to dismiss. The court granted the motion, dismissing Genesis’ quantum meruit claim with prejudice, and the breach of contract and account stated claims without prejudice. Genesis then filed an amended complaint asserting ERISA, breach of contract, and account stated claims. BCBS again moved to dismiss the amended complaint, and the court issued this decision. BCBS first argued that “Genesis failed to sufficiently allege it has standing to bring an ERISA claim because the requisition excerpts it relies upon only contain an authorization for direct payment, not an assignment.” The court agreed, ruling that the requisition excerpts did not contain an assignment: “For starters, the word ‘assign’ is absent. Moreover, the requisition excerpts contain no manifestation of an intent to vest in Genesis the right to enforce the members’ insurance plans against BCBSTX… Instead, the requisition excerpts merely authorize Genesis to receive payment and, in some instances, release the members’ medical information.” As for Genesis’ state law claims, the court ruled that (1) Genesis’ breach of contract claim failed for the same reason as its ERISA claims, i.e., lack of assignment; and (2) Genesis failed to state a claim for account stated because it did not “sufficiently allege an express or implied agreement between it and BCBSTX that fixed the amount due.” The court thus granted BCBS’ motion in its entirety. The court granted leave to amend the ERISA and breach of contract claims, but dismissed the account stated claim with prejudice because Genesis had already had two chances to plead that claim.

Withdrawal Liability & Unpaid Contributions

Fourth Circuit

International Painters & Allied Trades Indus. Pension Fund v. Florida Glass of Tampa Bay, Inc., No. 25-1312, __ F.4th __, 2026 WL 191344 (4th Cir. Jan. 26, 2026) (Before Circuit Judges Wilkinson, Wynn, and Keenan). Florida Glass of Tampa Bay stopped paying into the International Painters & Allied Trades Industry Pension Fund in 2015, and subsequently filed for bankruptcy in 2016. During the bankruptcy proceedings, International Painters submitted a proof of claim for withdrawal liability, requesting $1,577,168. However, International Painters was uncertain as to whether Florida Glass had in fact withdrawn, due to the inconsistent start-and-stop nature of the building and construction industry (BCI), and thus labeled the proof of claim “contingent.” Ultimately, the claim was not objected to and was deemed allowed, resulting in a distribution of $48,349 to International Painters. In 2021, during one of its annual reviews, International Painters identified Florida Glass as one of its participating employers that had not contributed to the plan for five years and began investigating. It determined that Florida Glass and its control group satisfied the plan conditions for withdrawal in 2015, and in 2022 it assessed withdrawal liability of $1,577,168, sending a notice and demand letter. Defendants contested the notice but did not seek arbitration within the statutory 180-day window, and thus International Painters brought this action to collect the withdrawal liability. On summary judgment, defendants contended that International Painters’ statute of limitations had expired because the 2016 bankruptcy claim constituted a notice and demand and request for acceleration under ERISA, as amended by the Multiemployer Pension Plan Amendments Act of 1980 (MPPAA), which started a six-year limitations clock. The district court disagreed, ruling that the claim was not a notice and demand, and alternatively ruled that defendants waived their statute of limitations defense by failing to initiate arbitration. Defendants appealed, and the Fourth Circuit issued this published opinion. The court noted that the case “presents two important questions for our circuit, both of which concern what happens when a multiemployer pension plan submits a proof of claim for withdrawal liability in the bankruptcy of a contributing employer. First, does the proof of claim operate as a notice and demand under 29 U.S.C. § 1399(b)(1)? Second, does it operate as an acceleration under 29 U.S.C. § 1399(c)(5)?” The court held that the answer to both questions “may in some cases be ‘yes’,” but in this case, the answer was “no.” The court explained that the MPPAA and the bankruptcy laws are “an imperfect fit,” and thus rejected defendants’ contention that “every proof of claim operates as a notice and demand as a matter of law.” Indeed, the court noted that defendants’ argument “would seriously undermine the optionality the MPPAA was designed to provide pension plans,” observing that the MPPAA “bespeaks a deliberate legislative choice to afford some flexibility” to plans and “purposely ‘place[s] the running of the statute of limitations in the control of the fund’” by giving them discretion as to when to start the collection process. “Forcing a pension plan’s protective, contingent filing against a BCI employer to operate as a notice and demand would turn this concept on its head by handing the stopwatch to the bankrupt employer.” Furthermore, defendants’ argument “would also constrain the ability of pension plans to recover withdrawal liability from BCI employers at all” because it, in combination with the MPPAA’s industry-specific rules for identifying BCI withdrawals, which provide a five-year window, would place plans on an unfairly shortened clock. As a result, the Fourth Circuit concluded that “the better rule – the rule that leaves the stopwatch in the hands of the pension plan and provides it the flexibility to protect its assets, as Congress directed – is that a proof of claim operates as a notice and demand only when it clearly satisfies the MPPAA’s requirements… Ambiguity should be resolved by concluding that the proof of claim is not a notice and demand.” Here, International Painters’ notice and demand letter clearly satisfied the MPPAA’s requirements, but its bankruptcy claim, which did not even use the word “demand” and was labeled as “contingent,” did not. The Fourth Circuit acknowledged that International Painters accepted some money from its bankruptcy claim, but ruled that defendants could not “transform the filing into a clear notice and demand” simply by not objecting to it. Instead, the district court appropriately treated the distribution as a set-off from the plan’s award in this action. Finally, the Fourth Circuit declined to rule on the alternative waiver holding by the district court, stating that it was unnecessary to do so because the appellate court had “fully resolved the case on the basis of the notice and demand question.” Thus, the Fourth Circuit affirmed the ruling in International Painters’ favor, concluding that defendants could not “use a quirk of bankruptcy law to avoid paying what it owes[.]” The court ordered defendants to pay the withdrawal liability, minus the amount already recovered through bankruptcy, along with interest, liquidated damages, attorney’s fees, and costs.

T.E. v. Anthem Blue Cross & Blue Shield, No. 25-5407, __ F.4th __, 2026 WL 172050 (6th Cir. Jan. 22, 2026) (Before Circuit Judges Griffin, Thapar, and Hermandorfer)

The tide appears to be turning in medical benefit cases. For years consumers have grown accustomed to receiving opaque and uninformative denial letters from their health insurers. These letters were often tolerated by the courts, which found the denials acceptable partly due to the deferential standard of review they were typically required to apply under ERISA.

However, it appears the courts have become increasingly frustrated with such denial letters and are beginning to scrutinize them more closely, regardless of the operative standard of review. The Tenth Circuit has led the way on this issue (see, e.g., Ian C. v. UnitedHealthcare Ins. Co. and D.K. v. United Behavioral Health), but other courts have weighed in as well (such as the Fifth Circuit in Dwyer v. UnitedHealthcare Ins. Co.; see below for this week’s attorney’s fees ruling in that case). Most of these cases have involved health insurance giant UnitedHealthcare.

This week it was the Sixth Circuit’s turn to express its displeasure, but this time with a different insurer: Anthem Blue Cross & Blue Shield. As a bonus, the court also discussed the 2008 Mental Health Parity and Addiction Equity Act (the “Parity Act”).

The plaintiff in the case was T.E., who sued individually and on behalf of his son, C.E. (initials were used for both because C.E. was a minor). Unfortunately, C.E. has a history of behavioral and mental health issues, including ADHD, anxiety, and autism. He received therapy and medication throughout his childhood, but in January of 2020 his condition worsened. C.E. exhibited aggressive behavior and suicidal ideation and was placed in a partial hospitalization program. C.E. did not improve, and thus he was moved to acute inpatient hospitalization for a few days.

C.E. returned to partial hospitalization, but he was discharged in February of 2020 with a recommendation that he “needed intensive in-patient treatment to address his symptoms.” T.E. then enrolled C.E. at Elevations, a residential treatment center.

Anthem, the administrator of the benefit plan covering C.E., initially approved coverage for two weeks at Elevations. It then approved another week of treatment based on Elevations’ comments that C.E. had “severe executive functioning” issues and “struggle[d] to self-regulate.”

C.E. did not improve, however; Elevations “noted that C.E was again confined to his dorm for safety reasons and would not follow staff instructions. C.E. also continued to be disruptive and argumentative, on top of reporting continued anger and feelings of aggression towards others.”

Despite this, Anthem denied coverage for further treatment at Elevations, stating it was no longer “medically necessary” under the plan’s guidelines. T.E. appealed, but to no avail. As a result, T.E. filed this action alleging that Anthem (1) arbitrarily and capriciously denied his claim for benefits, and (2) violated the Parity Act. The district court granted summary judgment to Anthem (Your ERISA Watch covered this ruling in our April 9, 2025 edition), and T.E. appealed to the Sixth Circuit.

The appellate court began with the standard of review, which both parties agreed was the arbitrary and capricious standard because the benefit plan at issue gave Anthem discretionary authority to make benefit decisions. The court reviewed the district court’s application of this standard de novo.

The Sixth Circuit explained that “ERISA’s arbitrary-and-capricious standard has both a procedural and substantive component.” However, the court never even reached the substantive component because “Anthem’s coverage decision was procedurally arbitrary and capricious.” The court ruled that this was so because “Anthem failed to ‘engage in reasoned decisionmaking’” in three different ways.

First, Anthem “inadequately assessed C.E.’s treating-clinician evidence.” The Sixth Circuit observed that three of C.E.’s treating clinicians had supported his continued treatment, but Anthem “never addressed the[ir] opinions,” did not “provide a reason for rejecting” those opinions, and “‘never explained’ their ‘disagreement with the opinions.’”

Instead, Anthem “decided, without explanation, to adopt the contrary opinions of its physician reviewers…based only on cursory ‘[f]ile reviews’ – rendering Anthem’s decision even more ‘questionable,’ particularly given that T.E.’s claim ‘involves a mental illness component.’” This “total failure to address the opinions of C.E.’s treating clinicians falls short of the meaningful review ERISA requires.”

Anthem argued that it did consider the clinicians’ opinions. However, the Sixth Circuit explained that Anthem only mentioned some of the opinions, “did not address the crux” of their evidence, contradicted some of the clinicians’ evidence, ignored evidence that cut against its decision, and offered conclusory statements about the scope of its review. In short, Anthem failed “the bare minimum required by our caselaw,” which is to “‘give’ some ‘reasons’ for rejecting the opinions of the participant’s treating doctors… Anthem failed to do so. All told, Anthem shut its eyes to the medical opinions of C.E.’s treating clinicians, which suggests that its coverage denial was arbitrary and capricious.”

Second, the Sixth Circuit accused Anthem of evidentiary cherry-picking, which is “a hallmark of arbitrary-and-capricious decisionmaking.” The court found that one of Anthem’s physician reviewers quoted parts of C.E.’s medical records while ignoring others, and “never explained why he privileged one portion of the notes over the other or how he reconciled the conflicting evidence.” Another reviewing physician incorrectly interpreted C.E.’s milieu notes, which actually indicated ongoing struggles rather than improvement.

Third, the Sixth Circuit found that Anthem “failed to ‘adequately explain[] any change from an earlier benefits ruling.’” The court noted that Anthem covered the first 21 days of C.E.’s treatment, but then denied further coverage without identifying “a rational reason” for doing so.

The court examined the appeal denial letters, the initial denial letter, and the physician reviewer reports to find such a reason, but none satisfied ERISA’s requirements. The appeal denial letters misrepresented C.E.’s condition and contradicted its clinical guidelines. The initial denial letter misrepresented the medical records, nebulously referred to “improvement” without explaining how that changed coverage, and cited facts which were irrelevant to Anthem’s coverage determination. The physician reviewers either “offered only bottom-line conclusions, devoid of any explanation,” or “misstated the record and never addressed why treatment was no longer needed to address C.E.’s ‘mood disorder’ and ‘severe executive functioning’ issues.”

In sum, “Anthem justified its coverage denial by citing considerations that were unrelated to C.E.’s initial admission and contradicted its prior assessment. Anthem’s justification for its coverage-decision change was, in short, irrational.”

As for a remedy, the Sixth Circuit ruled that remand was appropriate. The court stated that while “T.E. has put forth evidence that C.E.’s treatment is medically necessary under Anthem’s coverage guideline,” the court was not a “medical specialist” and thus it would not make a coverage determination in the first instance. “The ‘proper remedy’ in such a case is to vacate the district court’s decision and remand with instructions that the district court remand to the plan administrator for ‘a full and fair inquiry.’”

The decision was not a total victory for T.E., however, as the Sixth Circuit turned next to his Parity Act claim. The court acknowledged that to date it had “neither interpreted nor applied the Parity Act,” and in fact, “we have not even accepted that there is a private cause of action to enforce the Parity Act[.]”

However, the court found it unnecessary to “resolve here exactly how to evaluate Parity Act claims because T.E.’s claim fails in any event.” The court noted that, “[a]t a minimum, the statutory text directs that Parity Act claims require a comparison between an insurer’s treatment limitations for mental-health care and the treatment limitations for medical or surgical care.” Such an analysis requires plaintiffs to “demonstrate what those medical or surgical treatment limitations are and how they apply in practice.”

Here, however, the Sixth Circuit ruled that T.E. did not identify the comparable medical/surgical guidelines or how they applied. The court stated that T.E. also “failed to identify evidence of how those limitations are ‘separate’ from or less ‘restrictive’ than Anthem’s ‘treatment limitations’ on mental-health care.” As a result, even if T.E. could bring a private right of action under the Parity Act, he did not satisfy his burden of proof, and thus the court affirmed the judgment in Anthem’s favor on this claim.

Despite the court’s Parity Act ruling, the decision can only be considered a huge success for T.E., and will certainly assist plan beneficiaries looking to challenge future health insurance denials.

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

Arbitration

Second Circuit

Moody v. Starbucks Corp., No. 25-CV-8739 (PAE) (BCM), 2026 WL 146404 (S.D.N.Y. Jan. 20, 2026) (Judge Barbara Moses). Amari J. Moody, proceeding pro se, brought this action “alleging claims under the Americans with Disabilities Act (ADA)…the Family Medical Leave Act (FMLA)…and the Employee Retirement Income Security Act of 1974 (ERISA)…all arising out of the termination of his employment in August 2025, ‘while Plaintiff’s approved medical leave…remained active.’” Starbucks filed a motion (1) to dismiss the ADA claim, (2) for failure to exhaust required administrative remedies, and (3) to compel arbitration of all of plaintiff’s claims. The court granted Starbucks’ motion to compel arbitration, noting that Moody had signed an arbitration agreement as a condition of his employment, which required arbitration for employment-related claims. The court found that the agreement was valid and that all of Moody’s claims fell within its scope. The court acknowledged that “[i]n some cases, the court must also consider whether the plaintiff’s federal statutory claims are exempt from the reach” of the Federal Arbitration Act, but “[t]hat is not an issue here. It is well-settled that individual claims under the ADA, the FMLA, and ERISA are arbitrable… Shafer v. Stanley, 2023 WL 8100717, at *20 (S.D.N.Y. Nov. 21, 2023) (‘Second Circuit law makes clear that compulsory arbitration of ERISA claims is lawful.’).” Moody contended that Starbucks waived its right to compel arbitration by “engaging in litigation-stage conduct fundamentally inconsistent with that right, including merits briefing, submission of fact-disputed declarations, and continued post-notice retaliation following formal litigation notice,” but the court found this argument “borders on the frivolous.” The court observed that Starbucks had timely and repeatedly informed the court that the case belonged in arbitration, and had not participated in any discovery or other litigation activities that would suggest a waiver. As a result, the court sent the case to arbitration and stayed all matters pending its completion.

Attorneys’ Fees

Fifth Circuit

Dwyer v. UnitedHealthcare Ins. Co., No. A-17-CV-439-RP, 2026 WL 184247 (W.D. Tex. Jan. 21, 2026) (Magistrate Judge Mark Lane). In 2017, Kelly Dwyer sued UnitedHealthcare Insurance Company, the administrator of his ERISA-governed medical benefit plan, for wrongfully terminating mental health benefits for his daughter and for failing to process claims under the correct rates in the plan. After a 2019 bench trial, the district court ruled against Dwyer almost four years later, in March of 2023, on both arguments. Dwyer appealed, and in 2024 the Fifth Circuit reversed in a published decision that was highly critical of United. (That ruling was Your ERISA Watch’s case of the week in our September 25, 2024 edition.) The Fifth Circuit ruled that United’s denial letters were unhelpful and unsupported by medical evidence, and that United failed to conduct a meaningful dialogue with Dwyer when handling his claims. The Fifth Circuit further ruled that United had forfeited the right to contest the issue of the correct rates because it never responded to Dwyer’s internal appeal. The Fifth Circuit remanded, and in this report and recommendation the assigned magistrate judge addressed the issues of attorney’s fees, costs, and interest. First, the court applied the Fifth Circuit’s five-factor test to determine whether fees should be awarded at all. The court ruled that all five factors favored an award. The court stated that the Fifth Circuit “made clear that United was entirely culpable for Dwyer’s damages,” “[t]he court has no doubt that United can satisfy an award of attorneys’ fees,” “the court can only hope that such an award may cause United to pause before acting again under similar circumstances,” “Dwyer…sought to make clear to United that it could not treat other plan beneficiaries the way it treated him,” and “as made clear by the Fifth Circuit, United had little to no merit in its position. Accordingly, Dwyer has shown that a fee award is appropriate.” The court then applied the lodestar method – multiplying a reasonable hourly rate by the hours reasonably spent on the case – to determine an appropriate fee. The court acknowledged that “[g]enerally, the ‘relevant market for purposes of determining the prevailing rate to be paid in a fee award is the community in which the district court sits.’” However, based on the declarations of Dwyer and his counsel, the court was “satisfied that Dwyer has shown the necessity of turning to out-of-district counsel for representation in this matter.” As a result, it awarded the prevailing market rates in the Central District of California, where Dwyer’s counsel was located, ranging from $800-900 per hour. The court also found that using the attorneys’ current rates was reasonable to compensate them for the fact that they took the case on contingency and had not been paid “for the nearly decade of time that has gone by.” The court dismissed United’s concerns about the rates, stating, “United did not illustrate its point by sharing how much it spent in fighting to deny $109,063.50 in benefits of life-saving treatment for a child.” Next, the court examined the hours spent on the case by Dwyer’s counsel and ruled that they were mostly reasonable as well. Again, the court noted that Dwyer’s attorneys worked on contingency and thus “had no incentive to spend unnecessary time on this case.” The court examined United’s individual arguments regarding certain tasks, and reduced minor time for travel and clerical tasks, but largely dismissed its objections. In the end, the court “recognize[d] that the amount of attorneys’ fees far outpaces the amount recovered. United makes much of this. However, there is no indication that Dwyer could have recovered his benefits without the expenditure. Reducing the fee award would only make it harder for future plaintiffs to find vindication in the courts.” The court then turned to costs and interest. Dwyer sought litigation costs of $6,517.27 and prejudgment interest of $87,596.77 (8% compounded annually) beginning on the date of the Fifth Circuit’s ruling. The court found both justified, noting that Dwyer “was forced to drain his savings and refinance his home to pay for his daughter’s care.” Thus, in the end, the magistrate judge recommended granting Dwyer’s motion for attorneys’ fees, costs, and interest, with minimal reductions, and ordered Dwyer to submit a notice reflecting its reductions. (Disclosure: Kantor & Kantor LLP is counsel of record for Mr. Dwyer in this action.)

Breach of Fiduciary Duty

Fourth Circuit

Jacob v. RTX Corp., No. 1:25-CV-1389 (LMB/WBP), __ F. Supp. 3d __, 2026 WL 173228 (E.D. Va. Jan. 22, 2026) (Judge Leonie M. Brinkema). This is yet another case challenging an employer’s use of forfeited contributions to a retirement plan, and it ended in the same manner as the vast majority of similar cases preceding it. The plaintiffs, Melissa Jacob and Thomas Miller, were employees of aerospace and defense conglomerate RTX Corporation and participants in the RTX Savings Plan, an ERISA-governed 401(k) plan. Like many such plans, it is funded by participants and company matching contributions. Participants are immediately vested in their contributions, but matching contributions vest after two years of service. If a participant leaves before full vesting, unvested contributions are forfeited. Plaintiffs filed this putative class action alleging eight counts under ERISA against RTX and related defendants, including breaches of fiduciary duties and prohibited transactions. They contended that defendants improperly used forfeitures to offset future employer contributions instead of covering administrative expenses, reducing funds available for participants and depriving the plan of potential earnings. Defendants filed a motion to dismiss, which the court adjudicated in this published decision. First the court found that defendants acted in accordance with plan documents because the parties agreed that defendants did use forfeitures to pay some plan expenses, and because there was no plan provision requiring forfeitures to be used by the end of the year, as plaintiffs contended. Second, the court dismissed the claims for breach of ERISA’s duties of loyalty and prudence for similar reasons. The court stated that “Plaintiffs’ interpretation, which reads as a prioritization of using forfeitures to pay for administrative expenses instead of for reducing employer contributions into the Plan, is both unsupported by the language of the Plan, and the principles of ERISA.” Third, the court ruled against plaintiffs on their anti-inurement claim because “Plaintiffs’ Complaint does not allege any facts showing that defendants have removed any of the forfeited funds from the Plan.” On the contrary, the forfeitures remained within the plan and were used for permissible purposes. Defendants may have benefited from using forfeitures to reduce employer contributions, but such a benefit was only “indirect” and thus “insufficient to state a claim under the anti-inurement provision.” Fourth, the court found no prohibited transactions because the forfeitures remained within the plan, and the transactions at issue did not “present a special risk of plan underfunding” or otherwise harm the plan. Fifth, the court dismissed plaintiffs’ duty to monitor claim because it was derivative of plaintiffs’ other claims, which the court had already found failed to state a claim. In short, the court concluded that none of plaintiffs’ claims were supported by the plan’s language or ERISA principles, and thus it granted defendants’ motion to dismiss.

Eighth Circuit

Adams v. U.S. Bancorp, No. 22-CV-509 (NEB/LIB), 2026 WL 151825 (D. Minn. Jan. 16, 2026) (Judge Nancy E. Brasel). The plaintiffs in this putative class action are former employees of U.S. Bank who sued the bank and related defendants, alleging that they violated ERISA by underpaying early retirement benefits under the bank’s pension plan. Specifically, plaintiffs argued that defendants used unreasonable mortality tables and discount rates, which resulted in benefits that were not actuarially equivalent to those they would have received had they retired at the normal age of 65. Plaintiffs sought declaratory and equitable relief under 29 U.S.C. § 1132(a)(3), alleging breach of fiduciary duty and violations of 29 U.S.C. § 1054(c)(3) and 29 U.S.C. § 1053(a). In 2022, the court denied defendants’ motion to dismiss, but the court “left open whether actuarial equivalence, in practice, requires reasonable assumptions.” (Your ERISA Watch covered this ruling in our October 26, 2022 edition.) The parties conducted expert discovery, after which defendants filed a motion to exclude plaintiffs’ expert and a motion for summary judgment, both of which were granted in this order. The court ruled that the testimony of plaintiffs’ expert, Ian Altman, was inadmissible because his “methodology (a) uses an inapposite interest-rate assumption (b) as a brightline point of comparison, rather than measuring the Plan’s [early commencement factors (ECFs)] against a range of possible values.” The court noted that Altman used interest-rate assumptions from 26 U.S.C. § 417(e), which “is not in line with actuarial science or the practices of other actuaries.” Furthermore, his methodology “would require annually updating the underlying interest-rate assumption to reflect current market conditions,” which “would be ‘impractical and unprecedented’” and “would generate considerable administrative burdens for plan sponsors.” Also, “Altman’s approach, which assesses the Plan’s ECFs against a single data point rather than a range of values, is so unconventional as to be unreliable.” Thus, the court excluded Altman’s testimony as “untested, unsupported, and ultimately unreliable.” The court then moved on to defendants’ summary judgment motion and answered the question it had left open on their motion to dismiss: “[T]he Court concludes that actuarial equivalence does not require reasonable underlying assumptions.” The court explained that actuarial equivalence “is an exercise in relative comparison of value under consistent assumptions, not absolute value.” As a result, “a plan’s actuarial equivalence is properly assessed in reference to those assumptions and conversion factors stated in the plan document.” Under this lenient standard, the court concluded that the plan’s ECFs were “within a range of reduction factors that generate actuarially equivalent early retirement benefits.” The court noted that even if ERISA required “reasonable assumptions,” plaintiffs could not meet their burden on this issue because their expert had been excluded, and in any event defendants had presented evidence supporting the reasonableness of their ECFs. Furthermore, even if Altman’s evidence had been admitted, he failed to rebut defendants’ expert’s argument that the plan’s assumptions were reasonable, and conceded that “other assumptions, beyond those he used in his framework, could be reasonable and generate actuarially equivalent ECFs.” As a result, the court concluded that the plan did not violate ERISA and there was no breach of fiduciary duty. Defendants’ motions were granted, plaintiffs’ class certification motion was denied as moot, and judgment was entered for defendants.

Disability Benefit Claims

First Circuit

Butter v. Hartford Life & Accident Ins. Co., No. 24-11499-MJJ, __ F. Supp. 3d __, 2026 WL 172049 (D. Mass. Jan. 22, 2026) (Judge Myong J. Joun). Alison Butter was employed by Metrowest Jewish Day School and covered by the school’s employee long-term disability benefit plan, which was insured by Hartford Life and Accident Insurance Company. She stopped working in March of 2021 due to various health issues, including leg pain, neck pain, overall body pain, and fatigue. She was diagnosed with conditions including mild bilateral osteoarthritis, complex ovarian cyst, bilateral leg paresthesia/pain, cervical radiculopathy, fibromyalgia, chronic pelvic congestion, and Raynaud’s anemia of chronic disease. Hartford initially approved her claim for benefits, but in 2022 it conducted surveillance of Butter and requested that she undergo an independent medical examination (IME). Based on the IME findings, which concluded that Butter could perform various physical activities, such as sitting for up to 8 hours per day and walking for up to 60 minutes at a time, Hartford terminated Butter’s benefits in March of 2023, determining that she did not meet the plan’s definition of disability under the “Any Occupation” standard. Butter appealed, submitting her own IME report and the results of a functional capacity evaluation, but Hartford upheld its decision on appeal and this action followed. The parties filed cross-motions for summary judgment, which were decided in this published order. The court ruled that the abuse of discretion standard of review applied because the plan granted Hartford discretionary authority to determine benefit eligibility. Butter argued that this standard should be weakened because of Hartford’s structural conflict of interest as “both the adjudicator and payor of claims.” However, the court “agree[d] with Hartford” that this conflict “is not entitled to any weight” because there were no procedural errors in Hartford’s review. Turning to the merits, the court found that Hartford gave “undue weight” to the surveillance footage of Butter because its assessment “fails to consider her slow gait, the obvious struggle in her movements, and the short length of observation.” The court also criticized Hartford’s IME, noting that it contradicted the findings of Butter’s personal physicians and “provides no explanation” as to why those findings were less persuasive. The court further criticized Hartford for not adequately addressing the “years of documentation” of Butter’s chronic pain. The court noted that Hartford did a better job on appeal because it “grapple[d] more with the medical evidence submitted by Ms. Butter,” but it still “fails to explain why Ms. Butter would be capable of full-time functioning[.]” The court also cited Hartford’s finding that “there is no documentation of clinical findings to suggest total inability of activity, such as functional loss of strength/sensation and mobility/gait,” and stated that “[t]his misses the point” because it did not address Butter’s chronic pain symptoms. The court also critiqued Hartford’s assessment of Butter’s award of Social Security Disability Insurance benefits. Hartford only “provided a vague explanation for why an award of SSDI did not entitle her to long-term disability benefits,” and did “not sufficiently explain that the actual medical evidence it relied upon was different than that which was in the SSA’s possession, how it was different, and how it relied on vocational and behavioral evidence that differed from the SSA.” Because of all this, the court was “inclined to rule in Ms. Butter’s favor,” but “it would be unwise to take this step without first giving [Hartford] the chance to address the deficiencies in its approach.” Thus, the court remanded to Hartford “for further review in accordance with this decision.”

Sixth Circuit

Potthoff v. Unum Life Ins. Co. of Am., No. 1:24-CV-991, 2026 WL 177603 (W.D. Mich. Jan. 22, 2026) (Judge Paul L. Maloney). William Potthoff was a general and vascular surgeon who worked in Traverse City, Michigan, for more than 25 years. Throughout his career, Potthoff suffered from back pain, which led to the closure of his clinic in 2018. He began looking for new work, and at the same time Unum Life Insurance Company of America approved his claim for residual long-term disability benefits, which allowed him to work on a reduced schedule as recommended by his doctors. Seven months into his job search, Potthoff’s back pain worsened to the point he felt he could no longer return to work at all, so he applied for total disability benefits. Unum approved Potthoff’s claim, but classified his disability as arising from “sickness,” not “injury,” which was important because the policy insuring the plan limited benefits to 42 months for sickness, whereas benefits due to injury are payable for life. Potthoff appealed, contending that his back pain was due to a slip-and-fall accident in 1996, and from “repetitive stress injuries through decades of performing surgery as part of his high-volume practice.” However, Unum’s reviewing physicians concluded Potthoff’s back pain had started in 1995 and was due to degenerative disc disease, and thus upheld its determination that his disability was due to “sickness.” Potthoff then sued Unum under ERISA § 502(a)(1)(B), contending that he was entitled to benefits under the injury provision of the policy, and filed a motion for judgment on the administrative record, which the court reviewed in this order. The court applied a de novo standard of review because the plan did not give Unum discretionary authority to determine benefit eligibility. The court asked two questions: (1) “Did Potthoff’s slip-and-fall cause his total disability?”; and (2) “Did Potthoff’s repetitive stress injuries cause his total disability?” The court, noting the 20-year gap between the slip-and-fall and the disability, found “there is not enough evidence in the record to prove, more likely than not, that the slip-and-fall caused his total disability.” As for the repetitive stress argument, Unum’s policy defined “injury” as an “accidental bodily injury.” Unum argued that the court should apply Michigan law to interpret this term, but the court explained that because this was an ERISA case, federal common law applied. As a result, it applied the First Circuit’s Wickman test, borrowed by the Sixth Circuit, to determine whether Potthoff had suffered an “accident.” The court noted that “[c]ourts in the Sixth Circuit have so far only applied this test to accidental death policies,” but “[t]here is no…reason that the Sixth Circuit would limit its use of the First Circuit’s test only to accidental death policies,” and thus it adopted the test in the disability context as well. The Wickman test involves a subjective/objective inquiry, but “the record here does not reflect Potthoff’s subjective expectations about his injury.” As a result, the court evaluated “whether a reasonable person in the insured’s position (here, a reasonable general and vascular surgeon) with the insured’s same knowledge and experience might know or reasonably believe about whether developing their condition (like degenerative disc disease) is ‘highly likely.’” The court concluded that the answer was no. The medical studies in the record showing the connection between back pain and performing surgery did not appear until after 2018, and “although some of these risks could have been known to Potthoff during his working years, there is nothing in the record to reflect that a reasonable surgeon would have been aware of how his or her work affected his or her wellbeing in this way.” As a result, “it is…reasonable that Potthoff would not have known about the risk of repetitive stress injuries. Potthoff’s repetitive stress injuries are therefore ‘accidental.’” The court further determined that Potthoff’s work as a surgeon, which involved standing in contorted positions for long hours while wearing uncomfortable equipment, “more likely than not” led to his repetitive stress injuries and total disability. As a result, the court agreed with Potthoff that his total disability was due to “injury” and not “sickness.” As for a remedy, the court determined that the record “clearly establishes that Potthoff is totally disabled,” and thus remand was unnecessary; Unum was “not entitled to a ‘second bite at the apple’ during remand.” The court thus granted Potthoff’s motion for judgment and declaratory relief, and ordered the parties to meet and confer regarding the issues of interest, attorney’s fees, and costs.

Eleventh Circuit

Tunkle v. ReliaStar Life Ins. Co., No. 24-12563, __ F. App’x __, 2026 WL 144606 (11th Cir. Jan. 20, 2026) (Before Circuit Judges Newson and Brasher, and District Court Judge Paul C. Huck). Dr. Alyosha S. Tunkle was a general surgeon for 21st Century Oncology, Inc., which funded its employee long-term disability benefit plan with a group insurance policy issued by ReliaStar Life Insurance Company. The policy covered employees who worked at least 30 hours per week and excluded coverage for preexisting conditions. Due to complications from shoulder surgery, Dr. Tunkle developed a disabling tremor, which eventually forced him to stop working on July 30, 2020. His 2020 pay summaries showed he worked 40 hours per week until March 15, after which his hours and pay decreased significantly until May 23. His full-time work and salary resumed on May 24 and continued through mid-July. Dr. Tunkle submitted a claim for benefits to ReliaStar, but ReliaStar denied it, contending that Dr. Tunkle’s disability was caused by a preexisting condition. ReliaStar explained that it had obtained Dr. Tunkle’s pay summary and productivity reports, which showed that he did not work at least 30 hours per week between March 15 and late May 2020. As a result, Dr. Tunkle was not “actively at work” during this period as required by the policy and his coverage lapsed. According to ReliaStar, Dr. Tunkle regained his coverage in May, but because he received treatment for his tremor in the three months prior to the date of his restarted coverage, his tremor was a preexisting condition under the policy and thus ReliaStar refused to pay his claim. Dr. Tunkle appealed, arguing that he had voluntarily reduced his salary during the pandemic to keep the practice afloat, and that he had in fact worked more hours than the reports showed. ReliaStar denied Dr. Tunkle’s appeal, contending that he did not produce sufficient documentation to support his claims. Dr. Tunkle then filed this action, and the case proceeded to cross-motions for summary judgment, which were decided in ReliaStar’s favor. (Your ERISA Watch covered this decision in our August 14, 2024 edition.) Dr. Tunkle appealed to the Eleventh Circuit, which issued this per curiam decision. The court reviewed the district court’s grant of summary judgment de novo, but, like the district court, applied the arbitrary and capricious standard to ReliaStar’s decision because the policy gave ReliaStar discretion to review claims. Dr. Tunkle contended that “ReliaStar’s decision was arbitrary and capricious because his productivity report, payroll records, and letters prove that ReliaStar had no reasonable basis to conclude that he worked for fewer than thirty hours per week.” However, the Eleventh Circuit agreed with ReliaStar for two reasons. First, “Dr. Tunkle’s productivity report and payroll records reasonably support that he lost coverage because neither reflects thirty or more hours of weekly work between March 15 and May 23, 2020.” Second, “21st Century Oncology told ReliaStar that Dr. Tunkle’s payroll records and productivity report were its only records of his hours and that all his hours were recorded. 21st Century Oncology also asserted that it lacked ‘any information to support Dr. Tunkle working full time’ between mid-March and mid-May.” The court acknowledged that “[s]ome record evidence supports a contrary conclusion,” such as Dr. Tunkle’s explanation for his salary reduction and assertions of undocumented work. However, this was insufficient to overcome the deferential standard of review because “the record reasonably supported” ReliaStar’s decision, “regardless of whether the record also supported a different conclusion.” As a result, the court concluded that ReliaStar had a reasonable basis to determine that Dr. Tunkle lost his coverage in March 2020 when his weekly hours decreased, and his coverage did not restart until May 24, 2020. This meant that the preexisting condition provision applied and ReliaStar correctly denied Dr. Tunkle’s claim. Finally, the court considered whether ReliaStar operated under a conflict of interest, but because Dr. Tunkle “‘does not dispute’ that ReliaStar ‘was not operating under a conflict of interest,’” the court’s analysis ended there and the judgment below was affirmed.

Discovery

Eighth Circuit

Gibson v. Unum Life Ins. Co. of Am., No. 25-CV-2711 (JWB/JFD), 2026 WL 172541 (D. Minn. Jan. 22, 2026) (Magistrate Judge John F. Docherty). This action arises from defendant Unum Life Insurance Company of America’s denial of plaintiff Tyrone Gibson’s claim for long-term disability benefits. Gibson alleged two claims for relief under ERISA: one for plan benefits and another for equitable relief under the theory of surcharge for harm caused by Unum’s breaches of fiduciary duty. Before the court was Gibson’s motion for discovery. Gibson sought information to support his second claim for breach of fiduciary duty, claiming that Unum lied about the opinions of his treating physicians. Gibson acknowledged that plaintiffs are typically not entitled to discovery beyond the administrative record in ERISA benefit cases, but contended that “because he alleges misrepresentations by Unum the administrative record alone cannot provide the information he needs to fully litigate his claim for breach of fiduciary duty.” Gibson specifically requested to conduct discovery regarding “1) a correct and full record of the conversation between his treating physician and the Unum physician; 2) whether the Unum physician lied about that conversation; 3) why Unum relied on the Unum physician after Mr. Gibson raised his concerns about the alleged lie; 4) a full understanding of the qualifications of the nurse who opined on Mr. Gibson’s condition; and 5) whether Unum ‘compl[ied] with its obligations under the Regulator Settlement Agreement.’” Unum responded that “Mr. Gibson’s claim for breach of fiduciary duty is duplicative of his claim for benefits owed and is not a legitimate claim but an impermissible end-run around ‘ERISA’s goal of inexpensive and expeditious resolution of claims.’” Relying on recent decisions from within the district, the court ruled for Gibson, concluding that “a Plaintiff asserting a breach of fiduciary duty claim, alongside a separate claim for payment of benefits under ERISA, is entitled to discovery beyond the administrative record.” (The court noted that Unum failed to cite these decisions to the court, even though it was a party in one of those cases, had the same defense counsel, and made “indistinguishable” arguments in both.) The court “agrees with Mr. Gibson and other courts in this District that such misrepresentations would not have been recorded by Unum in the administrative record.” The court noted that it “of course expresses no view on the merits of the breach of fiduciary duty claim as this case goes forward. In fact, the Court has hesitations about the viability of a breach of fiduciary duty claim where such a claim alleges the denial of the claim itself as its sole basis.” However, “a court can find a claim well-pleaded and still entertain skepticism about the likelihood of success on that claim at trial.” As a result, “discovery beyond the administrative record is appropriate here.” Thus, the court granted Gibson’s motion and directed the parties to meet and confer and submit a proposed amended pretrial scheduling order.

Medical Benefit Claims

Ninth Circuit

Clove v. Teamsters Local 631 Security Fund for S. Nev., No. 2:24-CV-02348-APG-DJA, 2026 WL 146490 (D. Nev. Jan. 18, 2026) (Judge Andrew P. Gordon). Craig L. Clove is a retired former member of Teamsters Local 631 who argues in this action that the Teamsters’ Security Fund failed to notify him that he could retain health insurance benefits under the Fund’s benefit plan at a reduced rate after retiring. Clove’s last day of work for a contributing employer was in 2018, and he retired in April of 2021, after which the Teamsters’ pension plan approved him for a pension. In January of 2024, Clove applied to the Fund to participate in the retiree program for health care coverage, but his application was denied by the Fund on timeliness grounds. Clove appealed, and the Fund denied his application again, this time adding that he was ineligible for the benefit he sought because he did not work sufficient hours for contributing employers. Clove then filed this action. The Fund moved to dismiss, and both parties filed motions for summary judgment. The court reviewed the Fund’s decision for abuse of discretion because the plan gave the trustees discretionary authority to determine benefit eligibility. The court found there was no conflict of interest affecting this review because the Fund was administered by a joint labor-management board and funded by employer contributions that could not revert to the employers. However, the court noted a procedural irregularity because the Fund introduced a new reason for denial (Clove’s ineligibility) in its final decision, so the court weighed this in its abuse of discretion analysis. This irregularity was insufficient, however, as the court concluded that the Fund did not abuse its discretion in denying Clove’s claim. The court found that the plan “clearly and unambiguously” stated that a retiree was only eligible if the “Contributing Employer for whom the Retiree worked has contributed to the Plan (minimum 500 hours per year or equivalent) on behalf of the Retiree as an Employee for at least five (5) of the last seven (7) years immediately preceding retirement.” However, “[t]he evidence shows that Clove has not met this requirement because he has only four years of 500 contribution hours in the seven years preceding his retirement.” As a result, “Even considering the procedural irregularity, the Fund did not abuse its discretion in determining that Clove is ineligible.” Clove complained about inadequate notice from the Fund, but the court found this argument irrelevant, because the Fund clearly told him why he was ineligible, and “[e]ven if the Fund was required to give Clove notice of the eligibility requirements and did not do so, he would not meet those requirements.” As a result, the court granted the Fund’s motion for summary judgment, denied Clove’s motion, and denied the Fund’s motion to dismiss as moot.

Delgado v. ILWU-PMA Welfare Plan, No. 24-1845, __ F. App’x __, 2026 WL 161403 (9th Cir. Jan. 21, 2026) (Before Circuit Judges Wardlaw, N.R. Smith, and Miller). This case involves multiple plaintiffs who are participants in the ILWU-PMA Welfare Benefit Plan, a multiemployer health plan governed by ERISA. The plaintiffs all received treatment at Advanced Pain Treatment Medical Center (APTMC), a physician-owned surgery facility in San Pedro, California. Prior to January 1, 2013, the plan consistently paid facility fees for surgical procedures at APTMC, but after that date the plan stopped paying such fees, determining that APTMC was not a “hospital” as that term was defined by the plan. Plaintiffs brought this action under 29 U.S.C. § 1132(a)(1)(B), alleging that this decision was incorrect. The case proceeded to a bench trial, after which the district court ruled in favor of the plan, concluding that the plan’s trustees and the reviewing arbitrator did not abuse their discretion in determining that APTMC was not a “hospital.” Plaintiffs appealed, and in this memorandum disposition the Ninth Circuit reversed. The court first addressed the standard of review, and found that the district court correctly applied an abuse of discretion standard, as the plan conferred discretionary authority to the trustees. The court further found that plaintiffs did not demonstrate any procedural irregularities or conflicts of interest that would necessitate altering this standard of review. The court then addressed the merits and ruled that the district court erred in concluding that APTMC was not a “hospital.” The plan defined “hospital” to include a “licensed non-Medicare approved ambulatory surgical facility” that met specific criteria. However, the plan did not define “ambulatory surgical facility” or specify the type of license a facility must have. The court noted that the State of California no longer issues licenses for physician-owned surgical clinics and instead requires accreditation by an approved agency. APTMC was accredited to perform outpatient surgery. The court stated, “We do not understand the Plan to argue that APTMC fails to qualify as a ‘licensed’ facility solely because it lacks a license that California no longer issues.” The district court ruled that APTMC was not a licensed ambulatory surgical facility because its accreditor classified it as an “office-based surgery/procedure center,” but the Ninth Circuit agreed with plaintiffs that “this distinction has no significance in California law and does not affect the applicable accreditation standards. Neither category mirrors the exact term used in the Plan. Even under the abuse-of-discretion standard, it was error to define the term ‘ambulatory surgical facility’ solely by reference to a seemingly arbitrary distinction in the accreditor’s classification system.” As for a remedy, the Ninth Circuit noted that the district court did not make findings regarding other criteria defining the plan’s definition of “hospital,” and thus it declined to do so in the first instance. The court noted that these findings “will require close review of the extensive record, a task that we generally entrust in the first instance to the district court.” Thus, the Ninth Circuit remanded for further proceedings. Judge N. Randy Smith dissented, however. He argued that the majority failed to properly apply the standard of review and that the Trustees did not abuse their discretion in determining that APTMC was not a “hospital.” Judge Smith argued that three of the four criteria of the Plan definition of “hospital” were not met by APTMC, and that “the Plan provides no definition as to what an ‘ambulatory surgical facility’ is, thus leaving it to the Trustees’ discretion to determine its meaning.” Because of “the Plan’s complete lack of instruction as to what constitutes an ‘ambulatory surgical facility,’ and an abuse of discretion standard for making this determination on appeal, the majority cannot show how the Trustee’s determination ‘clearly conflicts with the plain language’ of the Plan.” As a result, Judge Smith would have affirmed the decision below. (Disclosure: Kantor & Kantor LLP is counsel of record for plaintiffs in this action.)

Eleventh Circuit

Vickie B. v. Anthem Blue Cross & Blue Shield, No. 1:25-CV-3054-MLB, 2026 WL 146545 (N.D. Ga. Jan. 20, 2026) (Judge Michael L. Brown). Plaintiff Vickie B. is a participant in the self-funded Bank of America Group Benefits Program, and her son, D.B., is also insured under the plan. Anthem Blue Cross and Blue Shield is the third-party claims administrator for the plan. D.B. has a history of anxiety, ADHD, and drug and alcohol abuse, which led to his admission to Wingate Wilderness Therapy in February 2022. Wingate is a treatment facility in Utah that provides sub-acute treatment to adolescents with mental health, behavioral, and substance abuse problems. Anthem denied payment for D.B.’s treatment at Wingate, claiming it was not a covered service under the plan. In May 2022, D.B. was admitted to Crossroads Academy, another treatment facility in Utah, where he received mental health, behavioral, and substance abuse treatment. Anthem initially denied payment for this treatment because Vickie did not seek preapproval for the benefit, and later stated D.B.’s treatment at Crossroads did not meet the plan’s medical necessity requirements for residential mental health treatment. Vickie then brought this action against Blue Cross and the plan alleging two claims for relief under ERISA: one for plan benefits under Section 1132(a)(1)(B), and one under Section 1132(a)(3) for violation of the Mental Health Parity and Addiction Act of 2008 (Parity Act). Defendants moved to partially dismiss the complaint, seeking dismissal of all claims except Count I regarding D.B.’s Crossroads treatment. First, defendants contended that Wingate was an “alternative residential program” not covered by the plan. Plaintiffs responded that Wingate’s services were covered because the language defining covered mental health and chemical dependency services is “inclusive rather than exclusive.” The court found this argument “puzzling” because it ignored the definition of an approved treatment facility. Plaintiffs also argued that the plan defines a treatment facility as one that only deals with substance abuse issues, and because D.B. received both substance abuse and mental health treatment, the facility requirements did not apply. However, the court found that the plaintiffs cited the wrong definition of “treatment facility,” and regardless, “even without a specific definition in that section of the Plan, Wingate fits comfortably within the ‘plain and ordinary meaning’ of a treatment facility.” Plaintiffs further alleged that Wingate was an “outdoor behavioral health program” rather than a “wilderness camp,” but the court found that this was a distinction without a difference for the purposes of the plan. Finally, plaintiffs argued that the plan’s requirement of 24-hour nursing and an onsite psychiatrist was “not consistent with generally accepted [sic] at outdoor behavioral health providers,” However, the court stated that this “seems more like an argument that the terms of the Plan are unfair rather than an argument that Defendant misapplied or misinterpreted the plan.” Thus, the court concluded that Wingate fell within the plan’s exclusion and did not meet the plan’s requirements for coverage. Plaintiffs had more luck with their Parity Act claim, however. Defendants contended that this claim was duplicative of plaintiffs’ claim for benefits, but the court disagreed, ruling that plaintiffs’ two claims were not based on the same underlying conduct and did not rely on similar allegations. “Plaintiffs’ allegations in [the first] count concern Defendants’ application of the Plan’s requirements for coverage of D.B.’s treatment at Wingate and Crossroads… In Count II, however, they shift their allegations and focus to the substance of the Plan’s coverage requirements themselves[.]” As a result, “Plaintiffs’ Section 1132(a)(1)(B) and Section 1132(a)(3) claims can comfortably coexist.” The court further found that plaintiffs’ Parity Act claim properly sought equitable relief and was not merely “cloaking the relief sought in equitable language.” As for the merits of the Parity Act claims, the court rejected plaintiffs’ claim against Wingate, (1) ruling that plaintiffs irrelevantly cited to billing codes, (2) noting that “the Plan does not categorically exclude outdoor behavioral health and wilderness programs,” and (3) finding that plaintiffs’ allegations regarding analogous medical/surgical facilities were conclusory and belied by plan language. As for Crossroads, the court found that plaintiffs failed to identify the specific medical necessity criteria used for analogous medical or surgical treatment, rendering their allegations of disparity conclusory. The court allowed plaintiffs to replead this claim, however, because they did not have the criteria at the time they filed their complaint. Finally, plaintiffs alleged that defendants violated the Parity Act by failing to provide a comparable degree of in-network residential treatment facilities compared to in-network skilled nursing and inpatient rehabilitation facilities. However, the court found that plaintiffs lacked standing to assert this claim, as they did not “explain the causal connection between Defendants’ alleged network inadequacy and the denial of benefits at Wingate or Crossroads.” In the end, the court granted in part and denied in part defendants’ motion, allowing plaintiffs to amend Count II of their complaint to reallege their Parity Act claim against Crossroads, while dismissing Counts I and II as to Wingate.

Provider Claims

Second Circuit

Long Island Plastic Surgical Grp., PC v. UnitedHealthcare Ins. Co. of N.Y., No. 21-CV-5825(JS)(ST), 2026 WL 161152 (E.D.N.Y. Jan. 21, 2026) (Judge Joanna Seybert). In this action Long Island Plastic Surgical Group, P.C. asserted seven claims against UnitedHealthcare Insurance Company of New York arising from non-payment for plaintiff’s treatment of patients insured by United. Before the court was plaintiff’s motion for leave to amend its complaint. In August of 2025 a magistrate judge issued a report and recommendation (R&R) suggesting the court grant in part and deny in part plaintiff’s motion. Specifically, the magistrate ruled that plaintiff’s ERISA benefits claim was valid for plans without anti-assignment provisions, but not for those with such provisions, and that plaintiff’s unjust enrichment claim was preempted by ERISA. Both parties objected, and in this order the district court mostly overruled the objections. On its claim for ERISA plan benefits, plaintiff objected to the dismissal of claims with anti-assignment provisions, contending that it is “plausible that the health plans’ actions waived the anti-assignment clauses or estopped the plans from asserting them.” The court noted that plaintiff’s counsel had “lodged an objection in another case before this Court just two months ago that is identical to the above objection, save for changes to the names of the parties and citations[.]” The court overruled the plaintiff’s objection in that case, and did the same here, ruling that there was no “clear intent” by United to waive its rights under the anti-assignment clause; simply participating in the claims administration process was insufficient. The court also overruled plaintiff’s objection regarding its unjust enrichment claim, ruling that it was preempted by ERISA. As for defendants’ lone objection, the court overruled it, upholding the R&R’s determination that plaintiff had properly alleged that it had assignments from its patients to assert their ERISA claims because the assignments “conveyed ownership.” In doing so, the court distinguished a Second Circuit case relied on by defendants (Cortlandt St. Recovery Corp. v. Hellas Telecomm., S.a.r.l., 790 F.3d 411 (2d Cir. 2015)), noting that it was not an ERISA case and was inconsistent with other Second Circuit precedent regarding the assignment of benefits in the ERISA context. In the end, the court overruled all of the objections by the parties except for plaintiffs’ objection regarding its state law claim for unjust enrichment claim relating to emergency services, which was sustained. The court ordered plaintiff to file a second amended complaint consistent with this order by February 4.

Rowe Plastic Surgery of N.J., LLC v. Aetna Life Ins. Co., No. 23CV7049 (DLC), 2026 WL 158610 (S.D.N.Y. Jan. 20, 2026) (Judge Denise Cote). Regular readers of Your ERISA Watch are familiar with Rowe Plastic Surgery of New Jersey, which has filed numerous actions against insurers asserting breach of contract and other claims relating to non-payment or underpayment for treatment it provided to patients. As the court noted, “The complaint filed in this lawsuit is identical in all material respects to a score of such complaints filed by Rowe in this district and in the Eastern District of New York.” In this case, defendant Aetna Life Insurance Company originally filed a motion to dismiss in 2023, but the action was stayed pending a decision by the Second Circuit in one of Rowe’s other cases. After the ruling in that case, Rowe moved to amend its complaint and the magistrate judge recommended that the motion be denied. Rowe objected, and the court considered both Aetna’s motion to dismiss and Rowe’s objections in this order. The court was not pleased with Rowe: “As several judges have warned Rowe and its counsel, their continued litigation – in a raft of lawsuits of virtually identical claims which have been repeatedly dismissed – risks the imposition of sanctions. That remains true.” (Your ERISA Watch detailed Judge Colleen McMahon’s irritation with Rowe in another case – in which she called Rowe’s arguments “frivolous” and “ridiculous” and threatened sanctions – in our March 12, 2025 edition.) The court ruled that Rowe’s amended complaint was essentially identical to its previous versions: “All of these claims rely on a May 14, 2021 call and the statement by an Aetna employee that Aetna’s payment for the procedure would be calculated using the ‘80th percentile of reasonable and customary.’ As courts have repeatedly held, this conversation did not create a contract and did not constitute a promise to pay a particular sum. It was a benefits verification call.” The court then quickly rejected Rowe’s other state law claims on various grounds. Finally, the court noted that “Rowe in essence seeks to stand in the shoes of its surgical patients and to challenge the ERISA benefits that are provided to those patients. Its state law claims allege an ‘improper processing of a claim for benefits,’ and ‘undoubtedly meet the criteria for pre-emption’ under ERISA’s express preemption clause… On this separate ground, Rowe’s claims are preempted and must be dismissed.” As a result, the court granted Aetna’s motion to dismiss, denied Rowe’s motion to amend, overruled Rowe’s objections, and entered judgment in Aetna’s favor.