Third Circuit Rules That Life Insurance Beneficiary Cannot Target Employer

By Peter Sessions on June 24, 2026

Posted in Life Insurance and AD&D Benefit Claims

Justman v. Accenture LLP, No. 25-2084, __ F.4th __, 2026 WL 1742110 (3d Cir. June 17, 2026) (Before Circuit Judges Hardiman, Bove, and Fisher)

Newcomers to ERISA are sometimes bewildered by the extensive cast of characters, which can include plan sponsors, plan administrators, benefit committees, claim administrators, insurers, advisors, and others. Some entities can perform more than one of these functions, and some may be fiduciaries, while others are not. Furthermore, an entity might be a fiduciary for one purpose but not for another, and its duties might be limited depending on its role.

As a result, it is important when asserting claims under ERISA to identify who performs what role, how that entity is legally responsible, and buttress those allegations with specific facts. Otherwise, you may find yourself on the wrong end of a motion to dismiss, as explained in this published opinion from the Third Circuit.

The case revolved around Karen Justman, who was an employee of the technology consulting company Accenture LLP. Ms. Justman died suddenly in August of 2021 from septic shock when she suffered a bacterial infection from eating raw oysters.

At the time of her death, Ms. Justman was enrolled in an ERISA-governed life insurance plan offered by Accenture, which included basic accidental life insurance coverage equal to her salary and additional optional accidental death and dismemberment (AD&D) coverage of three times her salary. She had designated her husband, Mark Justman, as her beneficiary.

The summary plan description (SPD) identified Accenture as the plan administrator and Prudential Insurance Company of America as the claims administrator. The SPD stated that “[b]enefits under the Plans will be paid only if the Plan Administrator and/or Claims Administrator decide in its discretion that the claimant is entitled to them.” The SPD further stated that Accenture had delegated to Prudential the discretionary authority “to provide claim processing, claim investigation, claim control, and the daily administration of the plan.”

Mr. Justman submitted a claim for benefits to Prudential, but Prudential denied it. Prudential stated that Ms. Justman died of a “medical illness and/or sickness,” and thus her death did not constitute an accident under the plan, which was circuitously defined as “Accidental Injury…as the direct result of an Accident.” Mr. Justman’s appeal was unsuccessful, so he filed this action naming both Prudential and Accenture as defendants.

Mr. Justman settled with Prudential, leaving only his claims against Accenture. He alleged that Accenture wrongly denied his claim for benefits under ERISA § 502(a)(1)(b) and breached its fiduciary duties by failing to furnish his wife with all relevant SPDs.

Accenture moved to dismiss, and the district court granted its motion. The district court ruled that Mr. Justman did not allege facts demonstrating that “Accenture controlled the claims administration of benefits,” and that he failed to state a plausible claim for breach of fiduciary duty because he did not explain how the alleged failure to provide the SPDs constituted a breach of fiduciary duty. (Your ERISA Watch covered this ruling in our November 6, 2024 edition.)

Mr. Justman amended his complaint, but the district court dismissed the amended complaint on similar grounds, and then denied him leave to file a second amended complaint. As a result, Mr. Justman appealed to the Third Circuit, which issued this decision.

The appellate court divided Mr. Justman’s claims into two categories: the benefit denial claim and the SPD claim. Addressing the benefit claim first, the court noted that ERISA authorizes a plan beneficiary to assert a claim to recover benefits, “but it does not specify who may be sued.” Mr. Justman contended that Accenture was a proper defendant because the SPD gave it the authority to make benefit determinations.

The court disagreed: “a plausible suit for ‘benefits due’ must be brought against a party with an obligation to pay… Sometimes that will be the plan, and sometimes that will be the insurance company that adjudicates claims. The latter is the case here[.]” The court emphasized that the plan required that all proof of claim be routed through Prudential: “‘Prudential must be given written proof of the loss including any requested documentation,’ and benefits will be paid ‘when Prudential receives written proof of the loss.’”

In contrast, the plan “does not confer Accenture any authority over claims administration, and Justman does not provide evidence plausibly suggesting otherwise.” The court noted that in so ruling it was “align[ing] ourselves with five other circuits.” (The court cited cases from the Fifth, Sixth, Seventh, Eighth, and Eleventh Circuits as being directly on point, and cases from the Second and Ninth Circuits as supportive.)

The court further held that Mr. Justman’s attempts to amend his complaint did not solve this problem. Instead, his further allegations “confirmed that Prudential, not Accenture, called the shots: Prudential made the benefits determination, and Accenture could follow up if it had questions.”

Nor did the SPD language help Mr. Justman. The court noted that the SPDs were “not the terms of the plan,” and in any event “the SPD language Justman highlights shows only that, depending on the issue at hand, either Accenture or Prudential may have a particular plan responsibility.” Accenture had the authority to address issues such as enrollment and eligibility, while Prudential was in charge of processing and deciding claims. “Because Accenture delegated claims administration duties to Prudential, Prudential was the proper defendant for Justman’s denial of benefits claim.”

The Third Circuit thus turned to Mr. Justman’s SPD claim, which “fares no better.” Mr. Justman “does not indicate whether his wife received an SPD when she started employment at Accenture, when the five-year deadline arose for Accenture to provide her another SPD, or if a material modification occurred in either 2020 or 2021” which would trigger the requirement to provide a new SPD. As a result, “Justman did not plead facts that would support a claim against Accenture under ERISA § 104(b)(1)[.]”

Mr. Justman’s SPD allegations did not support a breach of fiduciary duty either. He “did not allege that Accenture’s failure to provide his late wife with the relevant SPDs deprived her of any information, or even if it had, how that deprivation was material. Nor did Justman show that he relied on the 2020 or 2021 SPDs: he did not allege the SPDs helped or harmed his claim with Prudential, or that either he or Prudential relied on them in their AD&D claim dispute.”

Mr. Justman contended that his breach of fiduciary duty claim should proceed because ERISA did not require him to prove detrimental reliance, only actual harm. However, “Even so, Justman’s claim still fails; he does not satisfy the other elements. In any case, Justman did not allege any harm, let alone actual harm stemming from Accenture’s alleged failure to provide Ms. Justman with the 2020 or 2021 SPD.”

Finally, the court disposed of Mr. Justman’s remaining arguments, including his contention that the district court abused its discretion by dismissing his claims with prejudice. The court found no error because his claims were not plausibly pleaded and further amendment would have been futile. As a result, the judgment in Accenture’s favor was affirmed.

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

Breach of Fiduciary Duty

Third Circuit

In re Quest Diagnostics ERISA Litig., No. 24-2866, __ F.3d __, 2026 WL 1783204 (3d Cir. June 22, 2026) (Before Circuit Judges Bibas, Porter, and Bove). The plaintiffs in this putative class action are participants in Quest Diagnostics’ ERISA-governed 401(k) retirement plan. They contend that two investment options offered by the plan – the Fidelity Freedom Funds and the Invesco Global Real Estate Fund – underperformed, and thus Quest breached its fiduciary duty to plaintiffs by maintaining the funds in the plan’s portfolio. Plaintiffs argued that these funds performed poorly compared to benchmarks and that the plan’s managers should have removed them from the investment options. Plaintiffs were able to get past the pleadings before one judge, but when the case was transferred to a new judge, defendants were able to successfully move for summary judgment. The district court found no triable fact as to whether Quest breached its fiduciary duty because Quest “had hired an investment advisor, actively monitored its investment menu, gotten annual training on its fiduciary duties, and taken follow-up steps about the Freedom and Invesco Funds.” Plaintiffs appealed, and this published Third Circuit decision was the result. The opening line left no doubt as to the outcome: “Sometimes, even a good process produces disappointing results.” The appellate court agreed with the district court that Quest’s fiduciaries followed a prudent process by collaborating with an outside investment advisor, meeting with fund managers, and critically examining the plan’s investment options. Regarding the Freedom Funds, plaintiffs contended that defendants were “too slow to react,” but the court stated, “A fund’s poor performance alone does not mandate drastic or sudden action.” Furthermore, “short-term underperformance does not prove long-term imprudence… So long as a plan fiduciary analyzes that underperformance and evaluates the fund’s underlying strategy, there may be sound reasons to hold on to the fund during a period of weaker returns.” In any event, the court noted that the Freedom Funds’ performance “was hardly egregious,” and sometimes out-performed benchmarks. Quest was also prudent in managing the Invesco fund by placing it on a watch list when it began underperforming, and by discussing its future in the plan’s portfolio with its advisors. The court noted that the Invesco fund was conservative in nature and thus would tend to underperform in bull markets. The court also rejected plaintiffs’ argument that Quest breached its fiduciary duty by not adhering to its investment policy statement (IPS), which they contended was “binding” under the terms of the plan. The Third Circuit characterized this argument as “novel” but concluded that it “need not decide the question.” The court found that Quest did not violate the IPS in any event because the IPS was “full of permissive language” that gave Quest “discretion to deviate” from the statements within. The court further stated that “background principles of trust law favor deferring to trustees’ judgment calls.” In conclusion, “ERISA, like trust law, does not hold trustees liable for poor performance alone. Courts review process first. A fiduciary is prudent if it hires an advisor, critically examines its recommendations and data, and follows up when needed. Quest did just that. Even if the Funds kept on its menu were not the best, they were not the worst either, and the Committee’s process was sensible. Because ERISA mandates prudence, not perfection, we will AFFIRM.”

Seventh Circuit

Apex Mgmt. Grp. I, Inc. v. Verdegard Administrators, LLC, No. 24 C 7746, 2026 WL 1785159 (N.D. Ill. June 22, 2026) (Judge Robert W. Gettleman). The plaintiffs – Apex Management Group I, Inc. and its principal, Jeffrey Bemoras – develop and market self-funded health benefit plans to employers. The defendants – Verdegard Administrators, LLC, Regional Care, Inc., and DWS Holdings, LLC (d/b/a Pinnacle Peak Administrators) – entered into agreements with Apex to serve as third-party administrators for some of Apex’s plans. Enter the Department of Labor (DOL), which has charged plaintiffs with breaches of fiduciary duties under ERISA, contending that between 2018 and 2020 they directed third-party administrators such as Pinnacle and Regional to improperly transfer more than $2.7 million between unrelated participating plans to cover underfunded claims. Plaintiffs in turn brought this action against defendants, seeking equitable indemnification and contribution under Section 502(a)(3) of ERISA. (Pinnacle is also a defendant in another action brought by the Oregon Potato Company.) Regional and Pinnacle filed motions to dismiss, arguing that the claims against them should be dismissed based on arbitration agreements, the doctrine of unclean hands, and failure to state a claim. The court ruled that the arbitration clauses in the agreements between Apex and defendants did not apply to the claims at issue because the agreements did not encompass pre-2023 conduct. Furthermore, Bemoras was not bound by the arbitration clauses in the agreements because he was not a signatory to those agreements. As for unclean hands, the court rejected Regional’s argument that plaintiffs’ claims should be dismissed based on this defense. “Regional has not shown that the face of the complaint shows beyond a doubt that this affirmative defense is dispositive.” The court noted that Regional relied heavily on the DOL’s allegations, but those “are not established facts.” The court further found that plaintiffs’ claims were sufficiently pleaded to survive a motion to dismiss. Pinnacle contended that it was not a fiduciary, but the court found that plaintiffs plausibly alleged that Pinnacle was a “functional fiduciary” that “exercised discretionary control over the management and administration of the plans, and…exercised authority and control over plan assets.” Pinnacle contended that it lacked access to plan funding, but plaintiffs’ allegations that payments were remitted to Pinnacle and that it deposited them in a pooled account were sufficient to defeat its argument. The court also rejected Pinnacle’s argument that it was simply performing “ministerial” tasks because plaintiffs alleged that Pinnacle acted contrary to plan requirements, was transferring funds, and was “using the assets of one plan to pay the claims of another plan.” Finally, Pinnacle argued that plaintiffs’ claims should be dismissed because Pinnacle was not a co-defendant in the underlying DOL case, and thus plaintiffs could not seek indemnification or contribution against it. However, the court found this argument “inadequately developed and supported,” and in any event “Pinnacle concedes that the Seventh Circuit recognizes that ERISA allows indemnification among fiduciaries,” and to the extent Pinnacle had any objections, “it can contest fiduciary status and responsibility for any losses in this case – and has started doing just that with its motion here.” Thus, Pinnacle’s and Regional’s motions to dismiss were denied in full.

Eighth Circuit

In re: UnitedHealth ERISA 401(k) Litig., No. 25-CV-1751 (ECT/ECW), 2026 WL 1786167 (D. Minn. June 22, 2026) (Judge Eric C. Tostrud). This case (which began as two separate cases) involves the UnitedHealth Group 401(k) Savings Plan and the treatment of “forfeited funds” in the plan from 2019 to 2023. During this period, plan participants who left United before completing two years of service forfeited the matching and profit-sharing contributions made by United to their 401(k) accounts. The plan allowed the committee overseeing the plan to use these forfeited funds to either reduce United’s contributions or pay administrative expenses. During the relevant time period the committee chose to use the forfeited funds to reduce contributions every year. Plaintiffs, who are plan participants, have challenged that decision in this case. They have alleged five claims for relief: (1) breach of the fiduciary duty of prudence under 29 U.S.C. § 1104(a); (2) breach of the fiduciary duty of loyalty under 29 U.S.C. § 1104(a); (3) breach of the anti-inurement provision under 29 U.S.C. § 1103(c)(1); (4) breach of fiduciary duty by failing to monitor the committee and its members; and (5) violation of the prohibited-transaction rules under 29 U.S.C. § 1106(a)(1)(D) and (b). Defendants moved to dismiss for lack of subject matter jurisdiction and for failure to state a claim. Their jurisdictional argument was that plaintiffs did not allege that the plan suffered a redressable injury because using the forfeited funds for contributions did not harm the plan. The court disagreed, finding plausible plaintiffs’ argument that United’s “robust financial performance” from 2019 through 2023 “positioned the company to comfortably satisfy its matching-contribution requirements and make the same amount of discretionary profit-sharing contributions without the forfeited amounts the Committee elected to use to reduce UnitedHealth’s contributions.” As for the merits of plaintiffs’ claims, the court found that they plausibly alleged a breach of the duty of prudence. Plaintiffs alleged that from 2019 to 2023 “UnitedHealth would have made matching and profit-sharing contributions in the same amounts without the reductions resulting from the Committee’s elections,” which left the plan with “roughly $25.6 million less in cumulative assets by the end of 2023 than had the Committee chosen to use forfeitures to reduce the Plan’s administrative expenses.” Defendants raised a number of arguments, including that its decisions were made pursuant to guidance from the DOL, IRS, and Congress, but this was insufficient. “The fact that the Committee might lawfully have used forfeitures to reduce UnitedHealth’s contributions does not answer whether the Committee’s decision to do that complied with its duty of prudence.” The court further ruled that plaintiffs plausibly alleged a breach of the duty of loyalty because it was plausible that self-interest motivated the committee’s decisions. The court emphasized the subjective standard of the duty of loyalty, focusing on the fiduciary’s intent rather than on what the plan authorized defendants to do. Because plaintiffs’ duty of loyalty claim survived, their derivative claim for breach of the duty to monitor also survived. Plaintiffs’ winning streak ended with their anti-inurement claim. The court dismissed this claim because “[a]ny benefit to UnitedHealth was incidental” and there was no “reversion or diversion of plan assets to the sponsor.” For similar reasons, the court also dismissed plaintiffs’ prohibited transaction claim, ruling, “The decision to use forfeitures to reduce UnitedHealth’s contributions did not risk the Plan’s ability to pay promised benefits. It served that purpose.” Finally, the court noted (and cited) 51 recent decisions addressing the issue of ERISA plan forfeitures. The court explained that each case was premised on its own facts and claims, and that it “identified no clear trend or consensus in these decisions that might justify a particular outcome on this motion.”

Ninth Circuit

Meyer v. UnitedHealthcare Ins. Co., No. 25-3070, __ F. App’x __, 2026 WL 1734988 (9th Cir. June 16, 2026) (Before Circuit Judges Murguia, W. Fletcher, and Koh). In December of 2015 John Philip Meyer was in a skiing accident and received treatment at Billings Clinic and Community Medical Center in Missoula, Montana. Meyer was unhappy with his insurance billing for this treatment, which included charges for out-of-network rates, so he filed this action against his insurance provider, UnitedHealthcare Insurance Company. United originally asserted that Meyer’s claim was not governed by ERISA and threatened him with attorney’s fees (the court characterized United’s conduct in this regard as “troubling”), but eventually United realized its error and filed a motion to dismiss on ERISA preemption grounds. The court granted the motion, and in 2021 the Ninth Circuit affirmed. On remand, Meyer amended his complaint and restyled it as a class action alleging that United failed to pay benefits and breached its fiduciary duties under ERISA. Specifically, Meyer alleged that United failed to maintain correct billing records, failed to pay service providers for in-network services, allowed out-of-network charges at in-network facilities, and improperly reset his deductible. These allegations were centered around violations of the federal No Surprises Act. United moved to dismiss once again, and again its motion was granted. The district court ruled that Meyer failed to state a claim and that his claims exceeded ERISA’s three-year statute of limitations for breach of fiduciary duty. (Your ERISA Watch covered this ruling in our April 16, 2025 edition.) Meyer appealed to the Ninth Circuit once again, and this very brief memorandum decision left him empty-handed for a second time. The appellate court agreed with the district court that Meyer failed to plead a cognizable claim for relief under ERISA, as he did not allege sufficient facts to support his theory that United’s actions breached any fiduciary duty owed to him. The No Surprises Act did not apply to Meyer’s case because the challenged conduct took place in 2015 and 2016, well before the Act went into effect on January 1, 2022. Because the Ninth Circuit affirmed on this basis, it declined to reach the other arguments United advanced in favor of dismissal, including the issues of whether United was a fiduciary at all and whether Meyer’s claims were time-barred.

Platt v. Sodexo S.A., No. 8:22-CV-02211-DOC-ADS, 2026 WL 1782287 (C.D. Cal. June 18, 2026) (Judge David O. Carter). Robert Platt is an employee of Sodexo, S.A., the food services company. He contends that the company and related defendants imposed a $1,200 annual “nicotine surcharge” on employees who used nicotine and were participants in Sodexo’s ERISA-governed health care plan. ERISA allows discounts or surcharges in company wellness programs, provided they offer a “reasonable alternative standard” for participants “for whom participation may be unreasonably difficult or medically inadvisable due to a medical condition.” However, Platt contends that Sodexo’s program did not meet this requirement because it did not provide the “full reward” by retroactively reimbursing participants for surcharges paid before enrolling in a nicotine cessation class. He also contends that Sodexo failed to provide notice of the availability of a reasonable alternative standard. Platt’s complaint contains four claims for relief; (1) the surcharge violates ERISA by not providing a reasonable alternative standard to avoid the surcharge for the entire plan year; (2) Sodexo failed to give employees the required notice of any reasonable alternative standard; (3) Sodexo breached its fiduciary duty by assessing and collecting the surcharge, allegedly discriminating against plan participants based on health status-related factors, and (4) the surcharge violates the terms of the plan. This case has already been up to the Ninth Circuit, where that court ruled that Platt was not required to arbitrate his § 502(a)(1)(B) and § 502(a)(3) claims, and had viable defenses to arbitration on his § 502(a)(2) claim. On remand, defendants moved to dismiss, arguing that Platt’s claims were untimely and that he failed to state a claim upon which relief could be granted. Addressing timeliness first, the court ruled in Platt’s favor. For Counts I and II, the court applied the federal catchall limitations period of four years, as the claims were based on post-1990 amendments to ERISA. For Count IV, the court determined that the claim was timely because even under defendants’ proposed Maryland-based limitation period Platt plausibly did not have “actual knowledge” of the surcharge. The court then examined the merits of each of Platt’s claims. On Count I, the court found that Platt sufficiently alleged that Sodexo’s wellness program did not meet the “full reward” requirement, as participants were not reimbursed for surcharges paid before enrolling in a cessation program. The court acknowledged that the term “full reward” was open to interpretation and concluded, “There is enough legal uncertainty that the Court cannot conclude Defendants will prevail on its defense as a matter of law in its entirety[.]” On Count II, the court found it plausible that Sodexo failed to disclose the availability of a reasonable alternative standard in plan materials and thus denied defendants’ motion to dismiss this claim. On Count III, the court determined that Platt sufficiently alleged harm to the plan because he pled that Sodexo allegedly used surcharge funds to offset its contributions rather than depositing them in the plan. The court also found that defendants’ implementation and assessment of the surcharge involved fiduciary conduct. Finally, under Count IV, defendants argued that Platt did not exhaust his administrative appeals before filing suit. However, the court noted that “Plaintiff’s suit before the Court does not revolve around typical claims for benefits, but rather Sodexo’s policies in relation to ERISA jurisprudence.” As a result, it was ambiguous whether the plan’s exhaustion requirement applied to Platt’s claim. Thus, the court would not “automatically dismiss” it. As for the claim itself, the court found there were enough potential inconsistencies between plan documents to allow it to proceed. As a result, defendants’ motion was denied in its entirety.

Class Actions

First Circuit

Turner v. Liberty Mut. Ret. Benefit Plan, No. CV 20-11530-FDS, __ F. Supp. 3d __, 2026 WL 1734859 (D. Mass. June 16, 2026) (Judge F. Dennis Saylor IV). In this long-running putative class action Thomas Turner has sued various Liberty Mutual defendants, asserting that defendants incorrectly calculated cost-share obligations for post-retirement medical benefits by failing to account for employees’ years of service with Safeco Insurance Company, which was acquired by Liberty Mutual in 2008. In 2022, the court granted defendants summary judgment as to whether Turner was entitled to benefits under his Section 502(a)(1)(B) claim, ruling that the post-retirement medical benefit Mr. Turner sought was not vested. Defendants then moved for summary judgment on Turner’s remaining claims, but the court denied that motion in part, ruling in defendants’ favor on Turner’s full and fair review claim and his claim for failure to disclose plan limitations, but ruling against defendants on Turner’s claim for equitable relief. (The court found triable issues of fact as to whether defendants misled Turner and whether he reasonably relied on those misrepresentations to his detriment.) Turner then filed a motion for class certification, but the court denied it in 2024 because Turner defined his class in a way that expanded his theory of liability. Previously Turner had argued that Safeco employees were improperly denied benefits under the Liberty Mutual plan, whereas the class definition contended that they were also improperly denied benefits earned under the Safeco plan prior to the Liberty Mutual acquisition. The court denied the motion without prejudice, noting that a class more narrowly focused on the Liberty Mutual plan might be allowed. Turner responded by filing a motion for leave to amend his complaint to assert his “combined-benefits theory” that he was improperly denied both his grandfathered Safeco benefits and his earned Liberty Mutual benefits. In July of 2025 the court denied Turner’s motion, ruling that his motion was unduly and unjustifiably delayed and would impose substantial and unfair prejudice on defendants. Turner filed a renewed motion for class certification which the court adjudicated in this order. The court found that Turner’s proposed class did not meet the commonality requirement of Rule 23(a)(2). The court noted that the summary plan description was “unambiguous as to whether class members were entitled to cost-sharing credit for all their years of service at Safeco” (they were not), and the plan documents were consistent with the SPD. As a result, the only theoretically common evidence would be misrepresentations to class members, which required individualized evidence and separate findings as to whether those misrepresentations constituted a breach of fiduciary duty. The court also found that the proposed class did not satisfy any subsections of Rule 23(b). Under Rule 23(b)(1), the court again stated that Turner’s claim was based on individual misrepresentations, not plan administration, and separate proceedings would not risk inconsistent adjudications. Similarly, under Rule 23(b)(2), individualized remedies would be necessary, making class certification inappropriate. Finally, under Rule 23(b)(3), the court found that common questions did not predominate over individual ones because, again, the claim relied on individual representations rather than common evidence. Thus, the court denied class certification.

Exhaustion of Administrative Remedies

Second Circuit

Lucas v. Hartford Life & Accident Ins. Co., No. 24-CV-7561 (VEC), 2026 WL 1759034 (S.D.N.Y. June 18, 2026) (Judge Valerie Caproni). In 2021 Suzanne Lucas submitted a claim for benefits under an ERISA-governed long-term disability benefit plan insured and administered by Hartford Life and Accident Insurance Company. Hartford approved Lucas’ claim, and in 2024, as part of its ongoing claim administration, it required her to undergo an independent medical examination. Lucas attended the exam but left before it was completed, “refus[ing] to provide photo identification or sign paperwork.” Hartford then terminated Lucas’ claim and informed her of the appeal process. Lucas’ counsel engaged in email exchanges with two of Hartford’s claim adjusters, and eventually emailed an appeal to one of them, attaching a letter to the email. The letter was not subsequently physically mailed to the P.O. Box identified by Hartford in its denial letter. Hartford did not respond to the email within the 45-day period set forth in ERISA’s claim regulations and thus Lucas filed this action. Hartford responded by moving for summary judgment, arguing that Lucas failed to exhaust her administrative remedies as required by ERISA before filing suit. Lucas argued first that the appeal was optional because the plan stated that she “may appeal…for a full and fair review,” but the court rejected this, holding that “exhaustion was mandatory.” Thus, the court turned to whether Lucas was required to send her appeal to the P.O. Box specified in Hartford’s denial letter or whether emailing it to one of Hartford’s claim adjusters was sufficient. Lucas argued that the P.O. Box instructions were not binding because they were not present in the plan and the letter was “ineffective to amend the terms of the underlying plan.” The court did not like this argument either, stating, “the Denial Letter did not alter any portion of the Plan but, rather, instructed Plaintiff about how to file an appeal. That is consistent with the Plan’s provision that, upon rendering a decision on a claim, Hartford will provide a ‘written notification of the decision’ that ‘will…provide an explanation of the review procedure.’” However, the court concluded that it “need not resolve whether Plaintiff was strictly obligated to send her appeal to the P.O. Box” because her decision to email her appeal letter to Hartford’s claims personnel “was not unreasonable, as a matter of law,” given the communications which “may have created some ambiguity as to whether it was necessary for Plaintiff to send her appeal to the P.O. Box for the Appeals Department, as outlined in the Denial Letter, or whether sending it to one of them would suffice.” The court noted that Hartford’s communications implied that Lucas could send her appeal to the personnel, who would then forward it to the appropriate department. Thus, a reasonable factfinder could determine that Hartford’s communications created enough ambiguity about the appeals process for her to believe that her email was sufficient. In such a scenario, Lucas exhausted her administrative remedies within the required timeframe, and Hartford failed to render a decision on her appeal within the applicable 45-day period. As a result, summary judgment in Hartford’s favor on the exhaustion issue was inappropriate and its motion was denied.

Pension Benefit Claims

Second Circuit

Garan v. 1199SEIU Benefit & Pension Funds, No. 25-2086, __ F. App’x __, 2026 WL 1728129 (2d Cir. June 12, 2026) (Before Circuit Judges Livingston, Sack, and Carney). Jozef Garan, proceeding pro se throughout this action, contends that his former union’s ERISA-governed pension fund, 1199SEIU Benefit and Pension Funds, miscalculated his pension benefits because it did not credit him for service prior to 2020. The district court granted the fund’s motion for summary judgment, finding that the plan gave the fund discretionary authority to determine benefits and that the fund’s decision not to credit Garan for pre-2020 service was not arbitrary and capricious. Garan appealed. The Second Circuit agreed with the district court that the operative collective bargaining agreement indicated that Garan’s employer was not obligated to contribute to the Fund until January 1, 2020, and “only service after that point is generally credited toward benefits calculations.” As a result, Garan could not plausibly allege that the Fund’s denial of his appeal was “without reason, unsupported by substantial evidence, or erroneous as a matter of law.” The court attempted to throw Garan a bone, noting that before 2020 his employer was paying into a different pension plan (the Retirement Plan of New York-Presbyterian Lawrence Hospital). The court suggested “without opining on the merits of such a claim” that this other plan might owe Garan pension benefits for contributions made before 2020. However, “those benefits are not managed by the Fund, which is the only pension-plan Defendant in this case.” As a result, the judgment below was affirmed.

Ninth Circuit

Munger v. Cloud, No. 23-3107, __ F. App’x __, 2026 WL 1734889 (9th Cir. June 16, 2026) (Before Circuit Judges Lee, Sanchez, and H.A. Thomas). Ruth Ann Munger brought this action as the representative of the Estate of Philip Cloud. She sought payment of benefits under five ERISA-governed plans offered by Mr. Cloud’s former employer, the Intel Corporation, after his death. Mr. Cloud’s named beneficiary, his wife, Tracy Cloud, was accused of killing him. In 2023, she was convicted by a Washington jury of second-degree murder. (That conviction was upheld on appeal in 2025). Based on this conclusion, the district court granted Munger summary judgment and awarded her the benefits at issue, ruling that as Mr. Cloud’s “slayer” Ms. Cloud was not entitled to recover any benefits under the plans. (Your ERISA Watch covered this decision in our October 18, 2023 edition. We also reported in our December 13, 2023 edition on the court’s subsequent order awarding the Intel defendants $20,297.79 in attorney’s fees.) Ms. Cloud appealed and this memorandum decision from the Ninth Circuit was the result. The court found that it “need not resolve whether Oregon or California law applies, or whether their state slayer statutes are preempted by ERISA, because there is no triable factual dispute that Ms. Cloud is Mr. Cloud’s slayer and is therefore not entitled to his ERISA benefits.” The court ruled that both Oregon and California law forbid a person’s killer from benefiting from the decedent’s pension, and furthermore, “[e]ven if the state slayer statutes were preempted, federal common law refuses to allow a person to benefit financially from a murder she has committed.” The court further ruled that the district court correctly prohibited Ms. Cloud from “relitigating whether she murdered Mr. Cloud” because “[u]nder the Full Faith and Credit Act…the preclusive effect of a state court judgment…is determined by the preclusion law of the state in which the judgment was issued.” Here, “all criteria are met because Ms. Cloud was convicted for the intentional murder of Mr. Cloud which is a serious offense, and her guilt was established in the criminal case where she had a full and fair opportunity to litigate.” The court then quickly dispensed with Ms. Cloud’s remaining arguments on appeal, ruling that (1) “[w]hether Plaintiff-Appellees violated Ms. Cloud’s Fifth and Sixth Amendment rights was not pleaded or adjudicated in the district court and therefore is not properly before us on appeal,” (2) “[t]he district court did not abuse its discretion in denying Ms. Cloud’s request to appoint counsel because Ms. Cloud failed to make the requisite showing of exceptional circumstances,” and (3) “[t]he district court did not abuse its discretion in denying Ms. Cloud leave to amend to assert a counterclaim based on a rescinded state settlement agreement” because the proposed claim “was both futile and unduly delayed.” As a result, the judgment below was affirmed and Mr. Cloud’s estate will receive the benefits in dispute.

D.C. Circuit

Anderson v. BDO USA, P.C., No. 25-CV-1002 (CRC), 2026 WL 1758224 (D.D.C. June 18, 2026) (Judge Christopher R. Cooper). Kevin Anderson was a partner at the accounting, tax, and consulting firm BDO USA, and under the firm’s Partnership Agreement was entitled to an “annual retirement benefit” as a partner, which would begin after a “separation of service.” Anderson retired from the partnership in 2019 as required by company policy and signed a Retirement Agreement. However, he continued working for BDO as a salaried full-time managing director until 2023, at which point BDO began paying him retirement benefits. In this action Anderson claims that BDO underpaid him by not providing retirement benefits for his service between 2019 and 2023, arguing that these benefits had accumulated during that time period, were deferred, and should have been made in a lump sum immediately after his separation from BDO. The case proceeded to cross-motions for judgment under Federal Rule of Civil Procedure 52. The court focused on Section 7.9(a) of the Partnership Agreement, which explained when retirement benefits would be paid. The court agreed with BDO that the agreement “makes no mention of a ‘lump sum’ or ‘accrual’ of retirement benefits prior to a partner’s separation from service.” The court interpreted the Section as addressing timing only, meaning that benefits would start after Anderson’s separation from BDO. This interpretation aligned with the Retirement Agreement, which only provided that benefits would commence after separation and also did not mention any “accrual” of benefits during his employment, or any lump sum payment. Anderson attempted to rely on other parts of the Partnership Agreement to support his argument, but they were unconvincing to the court, which ruled that they did not create a right to continued accrual of retirement benefits. As a result, the court concluded that Anderson was not entitled to a lump sum of retirement benefit payments for the period between 2019 and 2023, and BDO did not improperly deny his claim. Judgment was entered for BDO.

Pleading Issues & Procedure

Third Circuit

Schertle v. Weis Markets Inc., No. 4:25-CV-02080, 2026 WL 1749547 (M.D. Pa. June 17, 2026) (Judge Matthew W. Brann). Kurt Schertle was employed by Weis Markets, Inc. starting in 2009 as Senior Vice President of Sales and Merchandising and later promoted to Chief Operating Officer in 2014. He participated in the company’s supplemental executive retirement plan (SERP), a “top hat” plan, which is an unfunded deferred compensation arrangement for executives. In 2024, Schertle disclosed a consensual romantic relationship with another employee which resulted in a meeting with the company’s human resources department and its CEO in which Schertle was informed that “leadership had lost trust in him and that the parties should separate.” Schertle alleges that “he was never formally terminated and was never informed that his separation was for cause.” He also alleges that he was terminated because of “personal animus against him” by the CEO. Schertle contended that the company “initially proposed a severance package that included payment of his full SERP benefits but later withdrew that proposal and denied payment of those benefits.” This lawsuit followed in which Schertle asserted six claims for relief against the company and its retirement committee arising from the company’s denial of “more than four million dollars” in SERP benefits. Count I asserts a claim for benefits under ERISA § 502(a)(1)(B), Counts II and VII assert breach of contract claims, Count III alleges unjust enrichment, Count IV claims breach of fiduciary duty, and Counts V and VI assert promissory estoppel claims. Defendants filed a motion to dismiss all of Schertle’s claims except for Count I, arguing that they did not state an independent claim separate from his claim for benefits. Beginning with Counts III and IV, the court found that these claims were abandoned because Schertle did not respond to the arguments for their dismissal. Regardless, the court ruled that Count III (unjust enrichment) failed because “[t]o recover under unjust enrichment, there must be an absence of written agreement between parties,” and here the SERP controlled. Furthermore, Count IV (breach of fiduciary duty) failed because top hat plans are exempt from ERISA’s fiduciary duty provisions. As for Counts II and VII, these breach of contract claims were dismissed as duplicative of Count I because they sought the same benefits and “rely upon the same operative facts and seek the same relief.” Schertle argued that “the alleged breach arises from Defendants’ purported misinterpretation and inconsistent application of the SERP’s cause provisions,” but the court ruled that this was a distinction without a difference: “Those allegations are fully encompassed within Count I.” Finally, Counts V and VI (promissory estoppel) were dismissed because the alleged material representations were either part of the contractual obligations in Count I or did not establish the “extraordinary circumstances” required by Third Circuit precedent. In essence, these claims “serve to repackage Plaintiff’s central contention that Defendants wrongly denied him benefits under the SERP plan,” which was already covered by Count I. As a result, the court granted defendants’ motion. Counts II, III, IV, and VII were dismissed with prejudice because the court found amendment would be futile, but the court granted Schertle leave to amend his promissory estoppel claims under Counts V and VI if he can “plausibl[y] allege viable facts in support of those claims.”

Tenth Circuit

Long v. Blue Shield of Cal., No. 24-CV-03352-PAB-CYC, 2026 WL 1732989 (D. Colo. June 16, 2026) (Judge Philip A. Brimmer). Jacob Long submitted medical claims for reimbursement to his insurer, Blue Shield of California, but was dissatisfied with what Blue Shield paid, so he brought this pro se action in which he alleged three state law claims for relief: breach of contract, breach of the implied covenant of good faith and fair dealing, and bad faith denial of insurance claim. Blue Shield moved to dismiss, contending that Long’s claims were preempted by ERISA. In May of 2025 Magistrate Judge Cyrus Y. Chung issued a report and recommendation recommending the court dismiss the claims as preempted, but without prejudice so that Long could replead his claims under ERISA. (Your ERISA Watch reported on this ruling in our May 21, 2025 edition.) Long did not object to the recommendation, the district court judge accepted it, the court entered judgment, and that was that for more than five months. In November of 2025 Long filed a motion to reopen the case and amend his complaint under Federal Rules of Civil Procedure 60(b) and 15(a)(2), seeking to amend his complaint to bring claims under ERISA pursuant to the court’s earlier order. Blue Shield opposed the motion, arguing that Long did not meet the standard for relief under Rule 60(b) and that the proposed amendments were futile. The court sided with Blue Shield. “Here, plaintiff made the deliberate decision not to bring his claims under ERISA. Moreover, when defendant moved to dismiss plaintiff’s claims as being preempted by ERISA, plaintiff made the deliberate decision not to amend his complaint at that time. Plaintiff could have protected against this error by bringing his claims under ERISA in the first place, or by amending his complaint to bring claims under ERISA after defendant pointed out the preemption problem in its motion to dismiss. Plaintiff’s failure to predict the legal consequence of his decision to bring preempted claims does not warrant relief under Rule 60(b)(1).” The court further denied relief under Rule 60(b)(2)’s “catch-all provision” because “there is nothing extraordinary about plaintiff’s desire to amend his complaint after it was dismissed without prejudice.” The court further pointed out that Long could have moved to alter the judgment under Rule 59(e), “where he would have faced a much more lenient standard,” and that he was free to refile his claims in a separate action because the dismissal was without prejudice. Thus, denying Long’s motion “would not offend justice.”

Eleventh Circuit

Isoviv v. Hartford Life & Accident Ins. Co., No. 1:25-CV-5865-TWT, 2026 WL 1760334 (N.D. Ga. June 18, 2026) (Judge Thomas W. Thrash, Jr.). This case is a dispute over ERISA-governed long-term disability (LTD) benefits. Hata Isoviv was a houseware coordinator for Cort Business Services Corp. and was a participant in Cort’s LTD plan, which was insured and administered by Hartford Life and Accident Insurance Company. Since 2022, Isoviv has been disabled due to a back condition, and was paid LTD benefits by Hartford. With the assistance of Allsup, LLC, she applied for Social Security disability benefits and was approved for those benefits as well. Subsequently, Hartford reduced its LTD benefit to account for the Social Security offset, Allsup allegedly collected an overpayment from Isoviv’s bank account “without informing her of Hartford’s legal options for collection,” and Hartford terminated her LTD benefits. Isoviv brought this suit against Hartford and Allsup alleging four state law and ERISA counts arising from the termination of her benefits; three were against Hartford and the fourth was against Allsup for breach of fiduciary duty. Allsup filed a motion to dismiss on several grounds but the court focused on only one: the legibility of the complaint. “Because addressing the Motion to Dismiss would require the Court to expend substantial judicial resources in order to attempt to comprehend the pleadings within the Plaintiff’s Complaint, the Court sua sponte dismisses the Plaintiff’s Complaint as a shotgun pleading.” The court explained that the complaint violated Federal Rule of Civil Procedure 8 because it failed to provide a clear and concise statement of Isoviv’s claims. The complaint realleged almost every paragraph in each count, was “replete with conclusory, vague, and immaterial facts that are not connected to any cause of action,” and failed to specify which defendants were responsible for which acts or omissions. “In other words, the Plaintiff has presented the Court with a box of parts and expects the Court to build the claim without providing an instruction manual.” The court noted that such pleadings are prohibited as they confuse the court and the defendants, making it difficult to understand what claims are being alleged and the grounds upon which they rest. The court thus granted Allsup’s motion and dismissed the complaint without prejudice, allowing Isoviv to amend.

Your ERISA Watch – Week of June 17, 2026

By Peter Sessions on June 17, 2026

Posted in ERISA

There was no notable decision this week in ERISAland, as the federal judiciary was undoubtedly too busy watching the NBA Finals (congrats Knicks), the NHL Stanley Cup Final (congrats Hurricanes), and the beginning of the FIFA World Cup (congrats…Cape Verde?).

However, while all four of Monday’s World Cup matches ended in a tie, the first time in 68 years, there are no ties in federal court! Read on to learn about this week’s winners and losers, which include (1) a health plan participant’s unsuccessful effort to get his insurer to pay for his GLP-1 medication (Hamburger v. CareFirst); (2) two life insurance cases discussing the “substantial compliance” doctrine (Adams v. MetLife, Unum v. Crane), with the latter featuring the memorable line, “And tomorrow I’m fixing my life insurance policies I’m going to erase this mistake in my past. Enjoy destroying another man”; (3) a serial litigator getting her comeuppance (Clark v. DaVita); and last, but not least, (4) a cautionary tale from Puerto Rico in which a defendant successfully removed a case to federal court but unwittingly gained a jury at the same time (Morales-Álvarez v. Intelvox).

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

Attorneys’ Fees

Tenth Circuit

C.J. v. United Healthcare Ins. Co., No. 2:22-CV-00092-DBB-CMR, 2026 WL 1678251 (D. Utah June 10, 2026) (Judge David Barlow). C.J. is a participant in an employee medical benefit plan and her teenage daughter, F.R., is a plan beneficiary. F.R. was admitted to New Haven, a residential mental health treatment center in Utah. C.J. began submitting claims for her treatment to the plan’s claim administrator, United Healthcare, which approved them. However, defendant Cigna Health and Life Insurance Company took over the plan’s administration on July 1, 2019, and immediately denied coverage after that date, contending that F.R.’s residential treatment was not medically necessary. Plaintiffs unsuccessfully appealed and then filed this action, ultimately dismissing the two United defendants and pursuing claims only against the remaining Cigna defendants. In September of 2024 plaintiffs prevailed on their claim for plan benefits, but not on their claim under the Mental Health Parity and Addiction Equity Act because the court deemed the latter claim moot. The court determined that defendants’ denial was arbitrary and capricious: “Defendants’ denial letters did not meet ERISA’s minimum standards because they were conclusory, failed to state what clinical information was used to make the denial decision, did not cite to medical records, and failed to grapple with facts that could have justified awarding benefits.” Furthermore, “Defendants did not consider relevant medical necessity opinion letters and failed to engage in a meaningful dialogue with Plaintiffs.” On remand, defendants again denied coverage, and plaintiffs “chose not to pursue further review.” However, plaintiffs did file a motion for attorney’s fees, which the court adjudicated in this order. At the outset, the court determined that plaintiffs were eligible for fees because they achieved “some degree of success on the merits.” The court acknowledged that “[a] remand order by itself may not always constitute some success on the merits,” but here the court’s finding that defendants’ denial was arbitrary and capricious “was not merely a procedural victory for Plaintiffs; it was based on a finding that Defendants failed provide a full and fair review as required by ERISA.” Next, the court applied the Tenth Circuit’s five-factor test to decide whether fees should be awarded. The court found that (1) defendants were culpable because “it was Defendants’ failure to comply with ERISA requirements and engage in meaningful dialogue and full and fair review in the first instance that made the current proceedings necessary,” (2) defendants did not dispute their ability to satisfy an award of fees, (3) awarding fees would deter similar misconduct by ERISA plan administrators, (4) plaintiffs were not primarily seeking to benefit all plan participants or resolve an important legal question, which weighed against awarding fees, and (5) plaintiffs’ position was meritorious regarding the sufficiency of defendants’ review, as the denial was arbitrary and capricious. The fact that plaintiffs did not challenge the renewed denial on remand was relevant, but “[e]ven if Cigna’s denial of coverage was ultimately upheld on remand, the initial denial that made this lawsuit necessary was arbitrary and capricious and failed to follow ERISA’s minimum requirements.” The court then turned to the reasonableness of plaintiffs’ fee request. The court applied the lodestar method of reasonable hours expended multiplied by a reasonable rate to determine the amount. Plaintiffs requested $58,660 in fees, which included 40 hours worked by Brian King at $600 per hour and 84 hours worked by Brent Newton at rates between $325 and $425 per hour. Defendants argued that Mr. King’s $600 hourly rate was excessive and should be reduced to $500, but the court disagreed, noting that although Mr. King’s rate had been reduced in past cases, more recent cases supported a $600 rate due to his “tremendous experience and specialization in the field of ERISA litigation,” and the “increasing hourly rates for ERISA litigation in Salt Lake City.” The court reduced the total fee by $1,645 related to discovery on the Parity Act claim, which plaintiffs did not contest, and further reduced fees by $1,180 for work solely related to the dismissed defendants. Defendants’ other requested reductions were rejected. As a result, the court granted plaintiffs’ motion in part, awarding $55,835 in attorney’s fees and $400 in costs.

Breach of Fiduciary Duty

Ninth Circuit

Alas v. AT&T Inc., No. 2:17-CV-08I06-SPG-RAO, 2026 WL 1671492 (C.D. Cal. June 4, 2026) (Judge Sherilyn Peace Garnett). This is a nine-year-old case that has been up to the Ninth Circuit and back. (The Ninth Circuit’s decision, which was Your ERISA Watch’s case of the week in our August 9, 2023 edition, held in part that ERISA’s prohibited transactions provision included “arm’s-length service transactions.” This holding was vindicated by the Supreme Court in 2025 in Cunningham v. Cornell). The case involves the AT&T Retirement Savings Plan, a defined-contribution 401(k) plan. The plaintiffs, Robert J. Bugielski and Chad S. Simecek, allege that AT&T and the plan’s investment committee violated ERISA by failing to account for indirect compensation paid to the plan’s recordkeeper, Fidelity Workplace Services LLC, in connection with two transactions: the “BrokerageLink Transaction” and the “Financial Engines Transaction.” The plan’s contracts with Fidelity included a “most favored customer” clause, and plaintiffs contend that through these contracts indirect compensation was paid to Fidelity through revenue sharing fees from mutual funds available through BrokerageLink and through fees paid by Financial Engines to Fidelity for access to its platform and user data. The plaintiffs brought the following claims under ERISA: (1) violation of the fiduciary duty of prudence by failing to adequately monitor recordkeeping expenses and forms of indirect compensation; (2) prohibited transactions by failing to obtain required disclosures of indirect compensation; and (3) violation of the fiduciary duty of candor by erroneously reporting in Form 5500s that Fidelity’s indirect compensation was ‘eligible indirect compensation.” The case was originally assigned to a different judge, who granted summary judgment in defendants’ favor. As mentioned above, the Ninth Circuit reversed, and the parties renewed their summary judgment motions. In this order the court granted in part and denied in part both parties’ motions. The court started with the prohibited transaction claims, addressing the BrokerageLink Transaction first. The court granted plaintiffs summary judgment on the issue of liability, finding that defendants failed to comply with 29 U.S.C. § 1108(b)(2), rendering the arrangement “unreasonable.” Specifically, the disclosure provided by Fidelity was untimely and lacked sufficient information to evaluate the reasonableness of the compensation. Defendants conceded that they “never ‘directly’ got information about Fidelity’s indirect compensation through BrokerageLink” and instead had to estimate it. Because defendants did not meet their burden to prove that Fidelity made the statutorily required disclosures, “the arrangement cannot be considered reasonable.” As for the Financial Engines Transaction, the court granted summary judgment to defendants on the issue of whether they entered into a “reasonable arrangement” within the meaning of 29 U.S.C. § 1108(b)(2), which plaintiffs “do not appear to dispute.” However, the court found a triable issue of fact regarding whether “no more than reasonable compensation” was paid to Fidelity, precluding summary judgment for either party on this issue. Fidelity presented sufficient evidence to avoid summary judgment for plaintiffs, but that evidence hinged largely on the deposition testimony of one AT&T vice president whose credibility was at issue. Furthermore, plaintiffs pointed to other evidence which “suggest[ed]that Defendants gave little consideration to Fidelity’s indirect compensation and could support a factual finding that Defendants paid more than reasonable compensation.” Because the issue of reasonable compensation is a “heavily factual inquiry,” the court determined that summary judgment was inappropriate. The court then turned to damages and ruled that there was a genuine dispute of material fact on this issue as well. The court noted that plaintiffs had made a prima facie showing of the total cost of the prohibited transactions, shifting the burden to the defendants to show any offsets due to benefits conferred upon the plan. Defendants offered evidence, but again it was subject to credibility challenges, which created a triable issue of fact. Finally, the court addressed plaintiffs’ duty of prudence claim, resolving it similarly to the prohibited transactions claim. For the BrokerageLink Transaction, the court found a breach of the duty of prudence due to the lack of required disclosures, which prevented defendants from acting prudently. For the Financial Engines transaction, there was a triable issue of fact regarding whether defendants acted prudently, as a reasonable jury could find that more than reasonable compensation was paid. As a result, while the court resolved some issues, this case is still heading for trial.

Life Insurance & AD&D Benefit Claims

Fifth Circuit

Adams v. Metropolitan Life Ins. Co., Civ. No. 24-668-SDD-RLB, 2026 WL 1662073 (M.D. La. June 9, 2026) (Judge Shelly D. Dick). Audrey Adams was a long-time participant in an ERISA-governed life insurance employee benefit plan sponsored by General Motors and insured by Metropolitan Life Insurance Company. In 1976, Adams designated her parents as beneficiaries. However, in 2022, while experiencing health issues and receiving assistance from her caregiver, Sefera Givens, Adams called the GM Benefits and Services Center and, in a recorded telephone conversation, changed her beneficiary designation to Givens. When Adams died, her daughters, the plaintiffs in this case, contended the change was improper and that benefits should instead be paid to them as the default beneficiaries because Adams’ parents were both deceased. MetLife disagreed and paid the benefits to Givens. This action followed in which plaintiffs argued that the Givens beneficiary designation was invalid because (1) the plan required beneficiary changes to be made in writing, making the telephonic change ineffective, and (2) the change should be set aside due to fraud/undue influence by Givens. The parties filed cross-motions for judgment which were reviewed de novo by the court because the plan did not contain language granting MetLife discretionary authority. The court rejected both of plaintiffs’ arguments. First, the court acknowledged that the certificate of insurance required beneficiary changes to be in writing. Thus, Adams “did not technically comply with the terms of the Plan.” However, the summary plan description allowed changes to be made on the internet and by telephone. The court applied the doctrine of substantial compliance to resolve the issue. Under that doctrine, a beneficiary change is effective if the insured “(1) evidences his or her intent to make the change and (2) attempts 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 recorded call showed that Adams repeatedly and clearly expressed her intent to name Givens as the sole beneficiary and “undertook positive action by verbally affirming her desire for Givens to receive the benefits.” As a result, “the Insured substantially complied with the terms of the Plan in designating Givens as beneficiary. The purpose of the doctrine is to give effect to an insured’s intention to name a beneficiary despite technical noncompliance with the required procedures.” Turning to plaintiffs’ undue influence argument, the court stated that it was “not especially inclined to create federal common law on an issue not addressed by the Fifth Circuit in the context of ERISA, and based on a theory that Plaintiff recognizes is not supported by Louisiana law in the context of life insurance.” Furthermore, the court held that even if such an argument were viable, the facts in the administrative record did not support a finding of undue influence. The court found that the recording reflected that Adams could answer key questions and affirm her choice, and did not demonstrate coercion or incapacity sufficient to invalidate her designation. “The Insured was clear in giving the representative permission to speak to Givens during the call, and the Insured personally verified that she wanted Givens to be the beneficiary. Without more, the audio recording cannot provide sufficient factual support for a claim of undue influence.” Finally, the court addressed evidence plaintiffs sought to introduce from outside the administrative record. Plaintiffs’ evidence was intended to show that, if Givens were removed, they would be next in line as default beneficiaries. (MetLife had conducted a public records search that suggested one of Adams’ parents was still alive.) The court refused, relying on Fifth Circuit authority which limits courts to the administrative record in deciding ERISA benefits cases. As a result, the court held that even if plaintiffs could undermine Givens’ designation, the record still did not establish that they were entitled to the benefits. As a result, MetLife’s motion for judgment was granted, and plaintiffs’ was denied.

Sixth Circuit

Unum Life Ins. Co. of Am. v. Crane, No. 5:24-CV-00230-MAS, 2026 WL 1706791 (E.D. Ky. June 12, 2026) (Magistrate Judge Matthew A. Stinnett). John D. Crane was covered under an ERISA-governed group life insurance policy insured by Unum Life Insurance Company of America. He made a beneficiary designation in favor of Sarah Carta, with whom he began a romantic relationship in 2019-20. At that time Carta was embroiled in litigation over her previous romantic relationship, with William Brent Bundy. According to court records Carta logged into Bundy’s work-related benefits portal and changed Bundy’s life insurance beneficiary designation to herself. Bundy killed himself shortly thereafter and in litigation the court “ruled that Carta had lied about the events and granted the benefits to Bundy’s default beneficiaries, his parents.” According to Carta, Crane knew all about these events. In 2022 Crane and Carta began splitting up, and in late 2022 Crane sent texts to Carta indicating that he wanted to remove her as his beneficiary. However, although Crane accessed his employer benefits portal, there was no record that he initiated or submitted a beneficiary-change transaction. Unpleasant texts between the two continued. Crane told Carta that she “won’t get a dime. Bundy’s was your last death insurance check you will ever get.” Crane also told Carta, “[Y]ou been gone for over two weeks because you thought you could keep your shit here and not pay a storage bill and strong [sic] old dumb John on. Well you fucked up. This dogs done with you kicking me. Its not worth it. So again stay away from my house.” He reiterated that he was going to remove Carta as his life insurance beneficiary: “And tomorrow I’m fixing my life insurance policies I’m going to erase this mistake in my past. Enjoy destroying another man.” However, Crane never followed through and died in August of 2023. Unum received competing claims from Carta and Crane’s children, filed this interpleader action, and deposited the funds at issue with the court. Before the court here were competing motions for summary judgment from the potential beneficiaries. The court explained, “All parties agree that the express beneficiary of Crane’s life insurance policies was Carta… The sole issue before the Court is not Crane’s intent but whether Crane’s actions demonstrate that he substantially complied with removing Carta as the beneficiary.” The court stated that “substantial compliance is deemed sufficient ‘when the insured had done all he could do under the circumstances; all he believed necessary to effect the change or what the ordinary layman would believe was all that was necessary to accomplish the change.’” Under this standard, the court ruled in Carta’s favor. The court acknowledged that “cases considering substantial compliance are always difficult,” and emphasized that its role was not to answer the question of “does the named beneficiary deserve to receive the proceeds of this policy?” Indeed, “it is axiomatic that the court will not decide whom the insured should have named as beneficiary.” Thus, Crane’s intent was insufficient; substantial compliance required action. The court found there was no evidence that Crane did all he reasonably could under the circumstances to effect a beneficiary designation change. Crane’s children “want to assume that Crane removed Carta as his beneficiary in November 2022 but for some procedural snafu,” but although there was evidence that Crane accessed his employer’s benefits portal there was no evidence that he actually made any changes. Indeed, testimony indicated that any changes Crane might have intended were left pending in the portal and never submitted. The court also rejected the Crane children’s reliance on the Bundy case, explaining that (1) “the facts at issue in [the] Bundy Case stand in stark contrast to those in this litigation” because here there was no “clear evidence that Carta had accessed and unilaterally changed the beneficiary,” and (2) Carta’s credibility was not at issue in this case because “[n]one of the critical facts listed above come from Carta.” Thus, “In the end, Crane certainly expressed an intent to remove Carta as a beneficiary. However, there is no evidence that he took any actions to reflect that intent, much less substantially complied with fulfilling that intent.” As a result, the court granted Carta’s summary judgment motion, denied the Crane children’s cross-motion, and directed the clerk to pay the interpleaded funds to Carta.

Medical Benefit Claims

Eighth Circuit

Paul P. v. Anthem Blue Cross & Blue Shield, No. 4:25-CV-00991-SRC, 2026 WL 1723665 (E.D. Mo. June 15, 2026) (Judge Stephen R. Clark). B.P., a minor, suffers from mental health and substance abuse issues. After he underwent unsuccessful outpatient treatment, his father, Paul P., admitted him to blueFire, an outdoor behavioral health treatment center in Idaho. B.P. received treatment there for over three months, which improved his condition. The treatment cost $70,485, but Anthem, the administrator of Paul’s ERISA-governed health benefit plan, denied his claims for reimbursement, labeling the services as investigational and not medically necessary. Paul’s appeals were unsuccessful, so he and B.P. brought this action alleging two claims for relief under ERISA against Anthem, his employer, and the plan, asserting: (1) a wrongful denial of benefits claim under 29 U.S.C. § 1132(a)(1)(B), and (2) a Mental Health Parity and Addiction Equity Act claim under 29 U.S.C. § 1185a for appropriate equitable relief. Defendants responded by moving to dismiss the Parity Act claim. The court noted that “[t]he parties do not cite, and the Court has not found, binding precedent interpreting the Parity Act.” The court concluded that, “To establish a violation, [Plaintiffs] must [plausibly] show that the ‘treatment limitations’ on mental-health care are ‘more restrictive’ than or ‘separate’ from the treatment limitations…‘applied to substantially all medical and surgical benefits covered by the plan.’” Under this framework defendants argued that the Parity Act failed “for two independent reasons… One, Plaintiffs failed to plausibly plead a Parity Act claim… And two, Plaintiffs cannot seek ‘equitable relief’ under the Parity Act for ‘a purported wrongful denial of benefits.’” The court addressed each argument. First it ruled that plaintiffs plausibly pled a Parity Act claim by alleging that Anthem’s denial of coverage was an as-applied violation, even though they conceded their facial challenge. The court noted that plaintiffs had alleged that “Anthem/the Plan declined to produce the requested documents and materials requested by Plaintiffs.” As a result, pleading on information and belief was permissible; “the unique posture of this case presents an instance where certain facts necessary to state a plausible claim ‘tend systemically to be in the sole possession of defendants.’” As for defendants’ second argument, that plaintiffs improperly asserted duplicative claims under 29 U.S.C. §§ 1132(a)(1)(B) and 1132(a)(3), the court rejected it. The court held that plaintiffs were permitted to plead both claims because “they assert different theories of liability.” Thus, it was premature to determine at the motion to dismiss stage “whether the relief available under section 1132(a)(1)(B) would adequately remedy Plaintiffs’ alleged injuries if they were to prevail.” The court thus denied defendants’ motion to dismiss.

D.C. Circuit

Hamburger v. CareFirst BlueCross BlueShield, No. 1:25-CV-03000 (TNM), 2026 WL 1678249 (D.D.C. June 10, 2026) (Judge Trevor N. McFadden). “Recent years have seen the meteoric rise of GLP-1 drugs,” noted the court, and plaintiff Martin Hamburger would like his insurance company to pay for his prescription for one of those drugs, Zepbound. Hamburger is a participant in an ERISA-governed health plan sponsored by Destination DC, a tourism non-profit, and was prescribed Zepbound by his doctor to treat obstructive sleep apnea. Zepbound has been approved by the Food and Drug Administration for treating obstructive sleep apnea in adults with obesity, to be used alongside a reduced-calorie diet and increased physical activity. However, when Hamburger sought coverage for Zepbound from his plan’s insurer, CareFirst BlueCross BlueShield, its pharmacy benefit manager, Caremark, denied it on the ground that his plan did not cover the medication. Hamburger’s appeal was unsuccessful, so he brought this putative class action against CareFirst and Caremark, asserting two claims under ERISA: one for denial of benefits under 29 U.S.C. § 1132(a)(1)(B) and another for breach of fiduciary duty under 29 U.S.C. § 1132(a)(3). Defendants filed a motion to dismiss for failure to state a claim. Addressing Hamburger’s denial of benefits claim first, the court found that it was based on a “false premise” because the plan excluded coverage for Zepbound, citing Exclusion 13, which stated that “[b]enefits will not be provided” for “Prescription Drugs for weight loss.” Hamburger “trie[d] to recast Zepbound as something other than a weight-loss drug” by arguing that it was also prescribed for obstructive sleep apnea and citing the FDA’s approval for that purpose. However, “the FDA’s authorization hurts him more than it helps” because “the FDA approved Zepbound for obstructive sleep apnea only in adults with obesity, to be used in combination with a reduced-calorie diet and increased physical activity… In other words, Zepbound helps with sleep apnea because it promotes weight loss, not as a separate, unrelated benefit. If anything, then, the FDA’s approval confirms that Zepbound is a weight-loss drug.” As for Hamburger’s second claim, the court ruled that he could not pursue a breach of fiduciary duty claim under § 1132(a)(3) because he had an adequate remedy under § 1132(a)(1)(B) for the denial of benefits. The court admitted that the D.C. Circuit “has not weighed in” on this issue, but declared that “judges in this district have ‘followed the view of the majority of circuits that a breach of fiduciary [duty] claim under § 1132(a)(3) cannot stand when a plaintiff has an adequate remedy for her injuries under § 1132(a)(1)(B).’” In any event, the court found that Hamburger could not state a claim even if it were allowed, as the denial of coverage adhered to the plan’s terms, and defendants had no obligation to consider Hamburger’s request for a non-formulary exception when Zepbound was already on the formulary. The court also found that defendants gave Hamburger adequate notice and explanation for why his claim had been denied. Finally, the court dismissed the putative class action because Hamburger, having failed to state a viable individual claim, could not serve as a class representative. Thus, defendants’ motion to dismiss was granted: “Hamburger can pay for Zepbound himself or lobby his employer to renegotiate the terms of the Group Contract, but he cannot use ERISA to force CareFirst to pay for a drug it specifically excluded in its agreement with his employer.”

Pleading Issues & Procedure

First Circuit

Morales-Álvarez v. Intelvox LLC, No. CV 26-1256 (FAB), __ F. Supp. 3d __, 2026 WL 1693838 (D.P.R. June 11, 2026) (Judge Francisco A. Besosa). Erick Iván Morales-Álvarez was the Chief Financial Officer of Intelvox LLC from 2019 through February of 2026, when he was terminated at the age of 68. Morales contends that his termination was “performed irregularly” because he did not receive a termination letter, Intelvox refused to return his belongings, and he was replaced by a 27-year-old employee. Morales filed suit in Puerto Rico court, asserting various claims under Puerto Rico law and one under ERISA for failure to pay 401(k) plan benefits. Intelvox removed the complaint to federal court. Morales did not contest the removal but made a demand for a jury trial, which Intelvox moved to strike. Intelvox contended that Puerto Rico, as a civil law jurisdiction, does not provide for civil jury trials, and removal to federal court does not create a jury trial right where none existed before. Intelvox also argued that none of Morales’ claims contained a statutory jury trial provision. The court disagreed, stating that because the case had been removed to federal court, federal law applied and thus “[t]he Seventh Amendment guarantees a right to trial by jury in federal courts ‘[i]n Suits at common law, where the value in controversy shall exceed twenty dollars.’” The court noted that this right extends to statutory claims that are legal in nature. Thus, because Morales’ claims under Puerto Rico Law 80 (severance for unjust dismissal), Law 100 (age discrimination), and Law 180 (vacation and sick leave) sought monetary relief and were legal in nature he was entitled to a jury trial on those claims. As for Morales’ ERISA claim, the parties did not dispute, and the court acknowledged, that “Morales lacks the right to a jury trial on his ERISA claim. Remedies available under ERISA are widely acknowledged to be equitable rather than legal, and consequently, actions under ERISA generally do not trigger the Seventh Amendment right to a jury trial… Accordingly, Morales is not entitled to trial by jury on his ERISA claim.” As a result, Morales’ ERISA claim will be tried by the court, but a jury will decide his remaining claims arising under Puerto Rico law. Intelvox might be rethinking that removal decision.

Third Circuit

Clark v. DaVita Inc., No. CV 26-23, 2026 WL 1723469 (E.D. Pa. June 15, 2026) (Judge Karen S. Marston). Joy Lucretia Clark was employed by DaVita Inc. and participated in its ERISA-governed employee benefits plan. She alleges that while she was on approved leave from her job, she lost access to DaVita’s employee and benefits online portal. She missed open enrollment periods, affecting her long-term disability coverage, and was provided “inconsistent information” about her benefits status. She thus filed this pro se action in which she asserted claims that included failure to disclose requested documents, breach of fiduciary duty, interference with her right to access the benefits portal, and failure to provide a full and fair review of her benefits denial. She sought injunctive and declaratory relief, as well as monetary damages. The court granted Clark’s application to proceed in forma pauperis and screened the complaint under 28 U.S.C. § 1915(e)(2)(B)(ii) to determine if it failed to state a claim. The court expressed frustration with Clark’s complaint because she “provides no information whatsoever about the benefits plan, its term provisions or requirements, or her enrollment. No information is provided about the benefits she was purportedly entitled to during her medical leave or even those she participated in before she purportedly took leave in November 2024.” Nonetheless, the court addressed each of Clark’s claims in order. On her first two counts for failure to disclose plan documents, the court found that Clark’s “threadbare” allegations were insufficient to state a plausible claim because she did not clearly allege she was a plan participant or beneficiary, did not specify the documents requested, or to whom the request was directed. As for Clark’s next two claims regarding portal access and benefits, the court determined that these claims “involve the interpretation of the plan itself and Clark must exhaust administrative remedies first before seeking relief here.” Her allegations of breach of fiduciary duty were deemed conclusory and lacking specific facts about the fiduciary’s duty, breach, and any loss to the plan: “she has simply made wholly conclusory and vague allegations of liability, which will not do to state a claim.” On Clark’s fifth count for failure to provide a full and fair review, the court dismissed this claim because “she does not affirmatively allege that she submitted a claim for benefits that Defendants denied. In any event, courts have held that Section 503 does not confer a private right of action.” Finally, the court noted that “Clark has now filed a total of eleven civil actions in this Court since October 2024,” and that it had warned Clark after her seventh filing “against abusing the judicial process and the consequences for doing so.” This warning “failed to deter Clark,” as she filed yet more actions, and “[a]s of the date of this Memorandum, she has yet to state a claim in any case filed, and three of the four recent cases have been dismissed with prejudice.” As a result, the court issued an order to show cause “why her ability to file future lawsuits pro se in this Court without paying the filing fee should not be enjoined unless she includes with her complaint and in forma pauperis application (1) a certification indicating that the claims she seeks to present have arguable merit, (2) that is signed by a licensed attorney, and (3) includes that attorney’s bar number and contact information.” The complaint was thus dismissed, although Clark was given leave to amend.

Eighth Circuit

Benotti v. Lockton, Inc., No. 4:26-CV-00188-DGK, 2026 WL 1701049 (W.D. Mo. June 11, 2026); Benotti v. Lockton, Inc., No. 4:26-CV-00188-DGK, 2026 WL 1701050 (W.D. Mo. June 11, 2026) (Judge Greg Kays). These two procedural orders are the result of two motions filed by plaintiff Elizabeth Benotti, a participant in Lockton, Inc.’s ERISA-governed 401(k) plan. In this putative class action Benotti contends, among other things, that Lockton and other plan fiduciaries “failed to remove the America Century Target Date Fund series as an investment option in the Plan,” which constituted a breach of fiduciary duty. Benotti’s first motion sought to consolidate this case with a related case, Fritts v. Lockton, Inc., which was pending in the same judicial district. In connection with this motion Benotti sought appointment of class counsel and an extension of pleading and motion deadlines. The plaintiffs in Fritts did not oppose the motion, and neither did the Lockton defendants. The court approved the motion pursuant to Fed. R. Civ. P. 42(a), stating that “[t]he cases involve the same defendants and have overlapping legal and factual issues. The cases involve identical ERISA claims against Defendants… Because the legal claims are the same in each case, the cases will have near-identical discovery, evidence, and witnesses. Given this significant factual, legal, and evidentiary overlap, consolidating the cases will reduce costs for the parties and save the parties, the Court, and the jury an immense amount of time.” The court ordered all future filings to be submitted under the Fritts docket, approved Alexandr Rudenco of Milberg PLLC and Mark Gyandoh of Capozzi Adler, P.C., as interim co-lead class counsel, and Maureen Brady of McShane Brady Law as interim liaison counsel. The court also set a new schedule, which included a deadline for plaintiffs to file a consolidated class complaint. In Benotti’s second motion, she sought to transfer the case to Judge Stephen R. Bough in the same judicial district. Defendants opposed this motion, and the court denied it. Benotti contended that her case was related to Doll v. Evergy Inc., which was pending in front of Judge Bough, arguing that the facts, allegations, and legal issues were similar in both cases. The court noted that the local rules required transfer when a case is “related to another case filed in the District.” However, “In general, a case is ‘related’ to another case for purposes of transfer when the cases involve ‘the same principal defendant, the same cause of action, and similar factual allegations.’” Benotti admitted that the cases involved different parties. As a result, “the cases are not related for purposes of transfer.” Thus, the new consolidated case will proceed in front of Judge Kays.

Venue

Third Circuit

Byers v. Sunrise Senior Living, LLC, No. CV 26-448, 2026 WL 1679067 (E.D. Pa. June 10, 2026) (Judge Gerald J. Pappert). The plaintiffs in this putative class action are employees of Sunrise Senior Living LLC, which is headquartered in McLean, Virginia, and participants in Sunrise’s ERISA-governed 401(k) retirement plan. Plaintiffs allege that the plan fiduciaries violated ERISA by (1) selecting or retaining an imprudent investment option (a Prudential guaranteed income fund), (2) failing to adequately monitor the plan committee’s investment decisions, and (3) violating ERISA’s prohibited-transaction provision by allowing Prudential to earn excessive fees for managing the guaranteed income fund. Defendants responded with a motion to transfer the case to the Eastern District of Virginia under 28 U.S.C. § 1404(a), which allows for the transfer of a civil action for the convenience of parties and witnesses and in the interest of justice. The court evaluated six private-interest factors and six public-interest factors to determine whether the transfer was appropriate. First, the court found that the private-interest factors favored transfer. Although the plaintiffs’ choice of forum is usually given “paramount consideration,” the court noted that less deference is given in class actions, especially when the class is large and “scattered all over the Nation,” as in this case. The court also found that the core allegations and operative facts of the lawsuit had a more significant connection to Virginia than Pennsylvania, as the committee’s decision-making process occurred primarily in Virginia. The convenience of the parties and witnesses was neutral. Sunrise is located in Virginia and administered the plan there, but defendants failed to show that litigating in the Eastern District of Pennsylvania would be inconvenient. Books and records were not a factor: “Though the defendants argue the books and records are in Virginia, they do not explain why those materials could not be produced in Pennsylvania.” Turning to the public interest factors, the court found that the Eastern District of Virginia was less congested than the Eastern District of Pennsylvania, supporting transfer. Furthermore, the Virginia court would have subpoena power over a key non-party witness. The court also emphasized the “public interest in having cases adjudicated where their operative facts occurred.” Because the fiduciary conduct was most connected to Virginia, Virginia had the stronger local interest. As a result, “On balance, the private and public interests favor transferring this case to the Eastern District of Virginia.” Defendants’ motion was thus granted.

Your ERISA Watch – Week of June 10, 2026

By Peter Sessions on June 10, 2026

Posted in ERISA

You will no doubt be relieved to learn that this week, unlike the last two weeks, we are not featuring a case of the week about actuarial calculations. In fact, it was a relatively light week in the federal courts for ERISA cases, with no decision standing out as meriting individual attention.

Still, there was plenty of action. Read on to learn about (1) two preliminary approvals of class action settlements – one arising from allegedly illegal tobacco surcharges in welfare plans (Bailey v. Sedgwick), and one arising from the alleged misuse of retirement plan forfeitures (Halter v. Providence); (2) a denial of a motion to decertify a class in a ten-year-old case, with trial scheduled for next month (Schuman v. Microchip); (3) the latest battle in the war between Envision Healthcare and United Healthcare (Envision v. United Healthcare); (4) an appellate court reversal finding that Cigna erred in denying a claim for artificial disc replacement surgery (Roggenkamp v. Morgan Stanley); and (5) three more cases concluding that the independent dispute resolution process established by the No Surprises Act does not give providers a private right of action in federal court (SpecialtyCare Inc. v. HCSC (IL, NM, TX)).

We’ll be back next week!

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

Class Actions

Sixth Circuit

Bailey v. Sedgwick Claims Mgmt. Servs., Inc., No. 2:24-CV-02749-TLP-TMP, 2026 WL 1649991 (W.D. Tenn. June 8, 2026) (Judge Thomas L. Parker). Plaintiff Korine Bailey filed this class action against Sedgwick Claims Management Services, Inc., alleging that the tobacco surcharge in Sedgwick’s welfare benefits plan violated ERISA’s anti-discrimination provisions, fiduciary duty provisions, and prohibited transaction provisions. Bailey further contended that Sedgwick impermissibly imposed higher premiums for life insurance benefits based on tobacco use, which violated ERISA’s anti-discrimination provisions. In September of 2025 the court allowed the case to proceed past the pleading stage, and the parties subsequently reached a settlement. Bailey filed an unopposed motion for preliminary approval of the settlement agreement, which the court granted in this brief order. The court confirmed it had jurisdiction over the matter and preliminarily found that the settlement class met the requirements of Federal Rule of Civil Procedure 23(a) because the class was ascertainable, with common questions of fact or law, and the claims of Bailey, who would adequately protect the interests of the class, were typical of the class. The court also found that the settlement class met the requirements of Federal Rule of Civil Procedure 23(b)(1), certifying a non-opt-out class which was defined to include plan participants or beneficiaries who paid a tobacco or nicotine surcharge without full reimbursement during the specified period. The court approved the terms of the settlement, finding that “(a) the proposed Settlement resulted from arm’s-length negotiations; (b) the Agreement was executed only after Class Counsel had researched and investigated multiple legal and factual issues pertaining to Plaintiff’s claims; (c) there is a genuine controversy between the Parties involving Defendant’s compliance with the requirements of ERISA; (d) the Settlement appears on its face to be fair, reasonable, and adequate; and (e) the Settlement is sufficiently fair, reasonable, and adequate to warrant sending notice to the Settlement Class.” The court further found the proposed plan of allocation to be “fair, reasonable, and adequate.” (The details were not set forth in the order, but the total settlement is $3 million). The court also approved the form and content of the settlement notice and outlined the process for class members to object to the settlement. The final approval hearing was scheduled for October 9, 2026.

Ninth Circuit

Halter v. Providence Health & Servs., No. 2:25-CV-00210-JNW, 2026 WL 1601689 (W.D. Wash. June 4, 2026) (Judge Jamal N. Whitehead). This is a class action in which participants of the Providence Health & Services 401(k) Savings Plan contend that Providence Health & Services and the Providence Health & Services Total Rewards Management Committee breached their fiduciary duties under ERISA by mismanaging the plan. Specifically, plaintiffs contended that defendants used forfeited employer contributions to reduce Providence’s contributions to the plan instead of using them to pay plan expenses in accordance with plan documents. In this brief order the court granted plaintiffs’ unopposed motion for preliminary approval of a class action settlement. The court found that the settlement was reached after plaintiffs received sufficient information from defendants to ensure that plaintiffs were informed and had a thorough understanding of the case, followed by arm’s-length negotiations overseen by a neutral mediator. The court emphasized that if the settlement had not been achieved, the class “faced the expense, risk, and uncertainty of protracted litigation,” and that the settlement amount – which was not mentioned in the order but apparently totals $42,724,532 – was “fair, reasonable, and adequate, taking into account the costs, risks, and delay of litigation, trial, and appeal.” The method of distributing the settlement funds was deemed efficient, as it relied on existing records and required no filing of claims. The court also preliminarily certified the class, finding that the class was sufficiently numerous that joinder of all members was impracticable, there were common issues of law and/or fact, the claims of the class representative were typical of the claims of the class, the class representative would fairly and adequately protect the interests of the class, and the prosecution of separate actions by individual members of the class would create a risk of inconsistent or varying adjudications. The court set a fairness hearing for October 20, 2026, to determine whether to grant final approval of the settlement and to address any motions for attorneys’ fees, costs, and service awards. Additionally, the court approved Analytics Consulting LLC as the settlement administrator to manage the settlement process.

Schuman v. Microchip Technology Inc., No. 16-CV-05544-HSG, 2026 WL 1603305 (N.D. Cal. June 4, 2026); Schuman v. Microchip Technology Inc., No. 16-CV-05544-HSG, 2026 WL 1613729 (N.D. Cal. June 4, 2026) (Judge Haywood S. Gilliam, Jr.). These are the latest two orders in a ten-year-old class action against Microchip Technology Inc., Atmel Corporation, and the ERISA-governed Atmel Corporation U.S. Severance Guarantee Benefit Program in which plaintiffs contend that that they were entitled to benefits from the plan when Atmel was acquired by Microchip. The plan was set to terminate on November 1, 2015, unless an “Initial Triggering Event” occurred, which would extend the plan for 18 months. An agreement with Dialog Semiconductor in September 2015 was considered an Initial Triggering Event, but the merger with Dialog did not close because Microchip made a better offer, which led to an Atmel-Microchip merger in April 2016. The central dispute in the case is whether the Initial Triggering Event with Dialog extended the plan if Atmel never closed its merger deal with Dialog. Plaintiffs alleged that Atmel executives assured employees that the plan remained in place, but after the merger, Microchip’s CEO stated that the plan had expired and offered reduced severance benefits if employees signed a release. Most plaintiffs signed the release in exchange for partial benefits. The district court originally certified the class, but on summary judgment it agreed with defendants that the named plaintiffs (Peter Schuman and William Coplin) were precluded by the releases from suing and representing others who had signed releases. (Your ERISA Watch covered this ruling in our August 30, 2023 edition.) Plaintiffs appealed, and in June of 2025 the Ninth Circuit reversed, announcing a new nine-factor test for determining when releases of rights under ERISA should be enforced. (This decision was the case of the week in our June 11, 2025 edition.) On remand, defendants filed a motion to decertify the class, which the district court evaluated in the first order listed above. The court found that the requirements of Federal Rule of Civil Procedure 23(a) were still met, including numerosity, commonality, typicality, and adequacy of representation. Numerosity and adequacy were not disputed. On commonality, the court emphasized that common questions, such as whether Microchip violated its fiduciary duty by claiming the plan had expired, remained central to the case and could “generate common answers” for the class. The court rejected defendants’ argument that “the validity of the releases is a threshold, individual question that will ‘swamp[]’ any common question,” noting that the Ninth Circuit’s decision highlighted the importance of considering alleged improper conduct by the fiduciary in obtaining the releases. For similar reasons, the court also found typicality, noting that it had already rejected defendants’ similar arguments at the class certification stage, “and the Ninth Circuit’s recent decision simply underscores that the Court must consider a fiduciary’s alleged improper conduct when considering whether a waiver is knowing and voluntary.” The court also found Rule 23(b)(2) satisfied because the primary relief sought was injunctive, and the court had broad authority to invalidate claims releases that were not knowing and voluntary or violated public policy. The court disagreed with defendants’ assertion that the injunctive relief sought was merely a disguised request for monetary relief: “That an injunction may ultimately clear the way for the class to receive a monetary payment does not render the injunction a nullity or somehow transform Plaintiffs’ requested injunctive relief into one for monetary damages.” As for Rule 23(b)(3), the court found that common issues predominated over individual ones, particularly the central issue of whether defendants engaged in improper conduct in obtaining the releases. The court rejected defendants’ “attempt to leverage the tension in the Court’s prior class certification order and order granting summary judgment,” noting that the court did not have the benefit of the Ninth Circuit’s test on summary judgment, and thus “did not consider the class-wide communications allegedly misrepresenting the terms of the Plan as part of its evaluation of whether the releases were entered into knowingly and voluntarily.” The court also minimized defendants’ argument that individualized inquiries would need to be made as to the enforceability of each release, stating that “[t]he heart of Plaintiffs’ case is – and has always been – whether Defendants mischaracterized the Atmel Plan and thus misled employees about their rights under the Plan.” This central issue of “fiduciary misconduct could predominate over the other factors.” Finally, the court found that class treatment was superior to other methods of adjudicating the controversy, as “it would be spectacularly inefficient to have over 200 trials here when the most critical facts that the Ninth Circuit has indicated ‘warrant serious consideration’ and ‘may weigh particularly heavily’…overlap as to all of the class members.” As a result, defendants’ motion to decertify the class was denied. In the court’s second order, it considered defendants’ motion to amend the scheduling order to reopen discovery. Defendants contended that discovery was necessary because the Ninth Circuit’s opinion “transforms the nature of this case.” However, “As the Court already explained in denying the motion for decertification, the Court disagrees that the opinion has such sweeping implications.” The court noted that trial was set to begin on July 13, less than six weeks from the ruling, and thus “the breadth and burdensome nature of the discovery now sought by Defendants ensures that it could not possibly be completed or digested before trial.” Furthermore, the court “has some concern that Defendants’ request is a strategic choice to further delay this decade-old case.” The court noted that defendants could have sought their proposed discovery earlier but chose not to do so. Moreover, “even after the case was reopened following the Ninth Circuit appeal, Defendants still waited six months to file this motion… Defendants offer no real explanation for this delay.” As a result, the court ruled that defendants had not shown good cause to reopen discovery and denied their motion. However, the court left open the possibility of revisiting the issue if necessary, after “the common factual record regarding Defendants’ conduct in interpreting the Atmel Plan and communicating with class members” has been developed.

ERISA Preemption

Sixth Circuit

Envision Healthcare Operating, Inc. v. United Healthcare Servs., Inc., No. 3:22-CV-00693, 2026 WL 1623108 (M.D. Tenn. June 4, 2026) (Judge Eli Richardson). This case is part of a long-running dispute between plaintiff Envision Healthcare Operating, Inc., a provider of emergency medical services, and defendants United Healthcare Services, Inc. and United Healthcare Insurance Company. (In 2023 Envision obtained a $91 million arbitration award against UnitedHealthcare.) Envision alleges that after its network agreements with defendants expired in 2020, defendants denied or reduce payments for services Envision provided to defendants’ insureds. Envision contends that this was done fraudulently and was “part of a coercive campaign to force Envision to accept unfavorable contract terms and to suppress Plaintiff’s business in favor of Defendants’ subsidiary, Optum, Inc. (‘Optum’), a non-party in this case.” As part of their scheme, defendants allegedly “implemented several specific strategies to achieve their goals, including pre-payment review practices, claim denials and adjustments, and extended delays in claim processing.” Envision’s complaint contained eight counts: two under the Racketeer Influenced and Corrupt Organizations Act (RICO), one under a Tennessee Prompt Pay statute, and several state-law causes of action including fraud, civil conspiracy, unjust enrichment, breach of implied-in-fact contract, and quantum meruit. Defendants filed a motion to dismiss for failure to state a claim. Because this is Your ERISA Watch, we will start at the end of the order and discuss the court’s ruling on defendants’ argument that all of Envision’s state law claims were preempted by ERISA. Crucially, the court noted that defendants conceded that preemption only applied “[t]o the extent [that] these claims are based on an assignment of benefits by an individual covered under an ERISA-governed plan.” The court explained that complete preemption was “inapplicable here because the propriety of removal has never been at issue in this case (which was originally filed in this Court), and Defendants have made no challenge to subject-matter jurisdiction.” Thus, the only question was whether express preemption applied to Envision’s state law claims. The court agreed with Envision that “none of its claims are based at all on an assignment of benefits by an individual covered under an ERISA-governed plan, and that therefore Defendants’ argument for preemption… is simply inapplicable.” As for the merits of Envision’s claims, the court (1) dismissed the RICO claims, finding that Envision failed to adequately plead the existence of a distinct RICO enterprise; (2) dismissed the fraud claim for failing to allege specific details regarding the alleged misrepresentations, such as the speaker, time, place, and reliance; (3) dismissed the Prompt Pay claim, ruling that the statute does not provide a private right of action for healthcare providers; (4) dismissed the civil conspiracy claim, noting that it is not a standalone cause of action but a theory to extend tort liability; (5) dismissed the unjust enrichment and quantum meruit claims because Envision did not adequately allege that defendants received a benefit from the services provided; and (6) allowed the breach of implied-in-fact contract claim to proceed, finding that the complaint contained sufficient factual matter to plausibly suggest the existence of an implied contract. As a result, only Envision’s implied contract claim passed muster; the court granted defendants’ motion to dismiss the remaining claims.

Ninth Circuit

Providence Mission Hosp. v. UFCW Unions & Food Employers Benefit Fund, No. 8:26-CV-00495-DOC-ADS, 2026 WL 1603910 (C.D. Cal. June 3, 2026) (Judge David O. Carter). The plaintiffs in this case are four related medical facilities which allege that they have a written healthcare services contract with Anthem Blue Cross which requires them to provide medical services to enrollees of Anthem and other payors, such as defendant UFCW Unions and Food Employers Benefit Fund, in exchange for reimbursement at rates specified in the contract. Although the fund is not a signatory to the contract, it is part of the Anthem network. Plaintiffs provided medical services to the fund’s participants and allege that they were not fully reimbursed by the fund for those services, resulting in an outstanding balance of $538,111.31. Plaintiffs filed this action in California state court asserting state law claims of breach of implied contract and quantum meruit. The fund removed the case to federal court, asserting ERISA preemption, and plaintiffs responded by filing a motion to remand, arguing that their claims were not preempted and arose independently from their contract with Anthem. The court applied the Supreme Court’s two-prong test from Aetna Health Inc. v. Davila to determine who should prevail. Under the first prong, the court found that plaintiffs could not have brought their claims under ERISA § 502(a)(1)(B) because the claims did not seek to recover benefits owed under an ERISA plan. Instead, the claims were based on an implied contract with the fund, independent of any ERISA plan. The fund contended that plaintiffs could bring suit as assignees of the plan participants, but the court was unimpressed with this hypothetical claim: “[T]he matter of assignment is irrelevant here since Plaintiffs’ claims to recover further payment from Defendant arise under Plaintiffs’ separate rate agreement contract with Anthem (which Defendant is contracted with).” The court also found that the second prong of the Davila test was not met because “the obligations arising from Defendant’s contract with Anthem Blue Cross would have existed regardless of the existence of the patients’ ERISA plans and arise from an independent legal duty.” The court ruled that “the claims brought by Plaintiffs…rely on an implied contract between a provider (themselves) and insurer (Defendant) and flow from this legal relationship rather than an ERISA plan… Therefore, their claims are based on legal duties independent of ERISA and the second prong of the Davila test is also not satisfied.” Because neither prong was satisfied, the court concluded that plaintiffs’ claims were not preempted by ERISA. The court thus determined that it lacked subject matter jurisdiction and granted plaintiffs’ motion to remand the case back to state court.

Medical Benefit Claims

Ninth Circuit

Roggenkamp v. Morgan Stanley Med. Plan, No. 24-7864, __ F. App’x __, 2026 WL 1625357 (9th Cir. June 5, 2026) (Before Circuit Judges Lee, Bumatay, and Sung). Marc Roggenkamp brought this action against the Morgan Stanley Medical Plan to recover ERISA-governed medical benefits. Cigna, the administrator of the plan, denied Roggenkamp’s pre-authorization request for a two-level artificial disc replacement (ADR) surgery. Cigna’s denial was based on its internal guidance, Medical Coverage Policy No. 0104 (MCP), which “categorically excludes two-level ADR as ‘experimental.’” The district court ruled in the plan’s favor, and Roggenkamp appealed to the Ninth Circuit. First, the appellate court affirmed the district court’s conclusion that Cigna did not operate under a conflict of interest. The parties agreed that the plan granted discretionary authority to Cigna, but “Roggenkamp has provided no evidence of a financial conflict, as he cannot show that Cigna both determines eligibility and pays for benefits.” Furthermore, the court found no conflict in Roggenkamp’s “allegations that Cigna delayed during the administrative and legal process, repeated the same conclusory language in its denial letters, and interrupted Roggenkamp’s physician in a peer-to-peer phone call[.]” The court rejected the idea that Cigna’s actions were attributable to the plan, noting its conclusion in Salyers v. Metropolitan Life Ins. Co. that “[o]ur holding in this case does not mean that a policy-holder employer is always an agent of the insurer in every aspect of plan administration in which it participates.” However, the court agreed with Roggenkamp that the district court erred in upholding the denial of his claim. ERISA regulations require a notice of claim denial to contain specific reasons and references to plan provisions, but Cigna’s denial letters cited only the MCP, not the governing summary plan description (SPD), which “does not categorically exclude two-level ADR.” The district court’s reliance on the SPD’s definition of “experimental, investigational or unproven” services was a “‘post-hoc rationalization[] that [was] not presented to the claimant…during the administrative process,’ and thus, an improper basis for affirming the denial of benefits.” Cigna only relied on the MCP, and thus “the district court could not construe Cigna’s denial as impliedly relying on the SPD because the plan administrator must ‘specific[ally] reference [] the plan provisions that form the basis of the denial,’ and the MCP and SPD are meaningfully different.” Finally, the court ruled that the district court erred in concluding that Cigna did not abuse its discretion in denying Roggenkamp’s claim. The court agreed with Roggenkamp that he did not receive a “full and fair review” as required by ERISA because Cigna’s denial letters did not reference the SPD’s definition of “experimental, investigational or unproven” services or explain how two-level ADR qualified under that definition. “Thus, Cigna did not ‘interpret’ the SPD at all, much less interpret it reasonably.” Furthermore, the court ruled that “Cigna abused its discretion by failing to meaningfully address the information Roggenkamp provided in his appeals.” As a result, “we reverse and remand with directions to remand to Cigna for reevaluation of the merits of Roggenkamp’s claim under the SPD definition, not the MCP definition.”

Pleading Issues & Procedure

Fourth Circuit

Vickers v. Cigna, No. 25-CV-17425 (MEF)(LDW), 2026 WL 1590595 (D.N.J. June 1, 2026) (Judge Michael E. Farbiarz). Stanley Vickers was enrolled in the multi-employer MILA National Health Plan, which is self-funded by the MILA Managed Case Health Care Trust Fund. Vickers’ specific benefits were administered by Cigna. Vickers brought this action against multiple Cigna entities, which responded by filing a motion to dismiss, contending that they are not proper parties to the action. In support of their argument they provided a declaration and a copy of the benefit plan. However, the court ruled that “from the get-go, there is a threshold problem with the Defendants’ argument – it relies on materials that are outside of the pleadings… The complaint here does not mention MILA. Let alone its funding structure. Or its relationship with any of the Defendants. Indeed, for their factual account of all of this (MILA, etc.), the Defendants rely on a declaration… But the declaration is an outside-of-the-pleadings item. It is plainly out of bounds for now. It cannot be considered here, at the motion-to-dismiss stage.” Defendants argued that the court could at least consider the plan because it was integral to Vickers’ allegations, but the court stated that “the fact that a plan document can be considered does not mean that this plan document can be considered. And without the Defendants’ outside-of-the-pleadings assertions as to MILA, there is no way to know whether the operative ERISA plan here is the MILA plan document or some other plan document.” The court thus determined that it could not rule on defendants’ motion as presented, and instead converted it into a motion for summary judgment. The court also ruled that “the parties will be permitted to now conduct rapid and highly targeted discovery, as to: MILA; MILA’s relationship to the Plaintiff; MILA’s relationship to the Defendants; and any closely related subject, all in the discretion of the United States Magistrate Judge.” The court stated that it would revisit defendants’ proper-party arguments after the completion of this discovery. The court also allowed Vickers to amend his complaint to add claims against two MILA defendants.

Provider Claims

Seventh Circuit

SpecialtyCare Inc. v. Health Care Serv. Corp. d/b/a Blue Cross Blue Shield of Illinois, No. 25 CV 12935, 2026 WL 1556442 (N.D. Ill. June 2, 2026); SpecialtyCare Inc. v. Health Care Serv. Corp. d/b/a Blue Cross Blue Shield of New Mexico, No. 25 CV 12902, 2026 WL 1556244 (N.D. Ill. June 2, 2026); SpecialtyCare Inc. v. Health Care Serv. Corp. d/b/a Blue Cross Blue Shield of Texas, No. 25 CV 12945, 2026 WL 1556346 (N.D. Ill. June 2, 2026) (Judge Manish S. Shah). These three cases were brought by medical providers SpecialtyCare Inc., Remote Neuromonitoring Physicians, and Sentient Physicians against three different Blue Cross Blue Shield entities. Plaintiffs contend that they treated certain patients who assigned their entitlement to ERISA-governed benefits to plaintiffs, but those benefits were underpaid by defendants. The parties engaged in the independent dispute resolution (IDR) process established by the No Surprises Act, 42 U.S.C. § 300gg-111 et seq., in which plaintiffs prevailed. However, they allege that all three defendants failed to comply with the IDR award (which involved paying $274,434 (BCBS Illinois), $42,312 (BCBS New Mexico), and $1,864,562 (BCBS Texas)). Plaintiffs thus brought this action; defendants responded by moving to dismiss for lack of subject-matter jurisdiction and failure to state a claim. Addressing plaintiffs’ ERISA claims first, the court agreed that plaintiffs, as assignees of plan participants, were considered “beneficiaries” under the statute. However, “plaintiffs do not allege that payment was denied, rather, they allege that they were underpaid for their services… There is a difference between a claim that implicates the rate of payment, and one that implicates the right to payment.” The court ruled that “[t]he ‘right to payment’ falls within ERISA’s ‘zone of interests’ because an outright denial of payment is a denial of benefits, but the ‘rate of payment’ does not, because the rate depends on terms outside the plans themselves (here, the [IDR] process).” The patients were not and could not have been parties to the IDR process, so there was no assigned right the providers could assert as an ERISA plan beneficiary: “While the ultimate effect on [plaintiffs] may be the same (i.e., nonpayment), [plaintiffs’] grievance with Blue Cross is uniquely its own; it is not derivative of [plaintiffs’] patients.” Turning to plaintiffs’ claims under the Federal Arbitration Act (FAA), the court dismissed them, reasoning that the FAA requires an arbitration agreement between the parties, which was absent in this case. The IDR process was statutory, not contractual, and thus Section 9 of the FAA did not apply. Furthermore, the No Surprises Act did not incorporate Section 9. The court also found no implied private right of action under the No Surprises Act. It noted that private rights of action must be created by Congress, and there was no express right of action detailed in the Act. The Act’s enforcement mechanism, which allows the Department of Health and Human Services to assess penalties against non-compliant insurers, suggested that Congress did not intend to create a private remedy for providers. Finally, the court dismissed plaintiffs’ state law claims without prejudice, declining to exercise supplemental jurisdiction because “there are no federal claims remaining and there is no complete diversity between the parties.” Defendants’ motions were thus granted and all three cases were terminated.

Remedies

Seventh Circuit

Appvion, Inc. Retirement Savings & Employee Stock Ownership Plan v. State St. Bank & Trust Co., No. 18-C-1861, 2026 WL 1623068 (E.D. Wis. June 5, 2026) (Judge William C. Griesbach). Appvion, Inc. was a Wisconsin-based paper company that established an employee stock ownership plan (ESOP) in 2001, fell on hard times, and went bankrupt in 2017. The bankruptcy court appointed Grant Lyon to act on behalf of the plan and help the ESOP participants recover some of their losses. As a result, he brought this wide-ranging action in which the ESOP asserted 37 causes of action against seven entities and 19 individuals. The claims included breach of fiduciary duty under 29 U.S.C. § 1104, co-fiduciary liability under 29 U.S.C. § 1105, and prohibited transactions under 29 U.S.C. § 1106. (For more details, check out our summary of the Seventh Circuit’s 2024 opinion, which revived the case after most of it was dismissed by the district court.) Lyon eventually settled with former Appvion directors and officers, and also settled a related state law case against one of Appvion’s pre-bankruptcy accounting firms. As a result, Lyon has at this point obtained almost $16 million in settlement proceeds. He has already distributed $10 million of these proceeds to himself, his lawyers, and his expert witnesses, and intends to distribute the remaining $6 million to ESOP participants. Before the court here was a motion by defendants State Street Bank & Trust Company and Argent Trust Company “to Establish Due Process and Fairness Protections Related to Settlement Funds.” These defendants wanted the court to enter an order “either (1) directing Lyon to submit to the court a detailed procedure to protect the due process interests of the ESOP and its participants or (2) establishing a constructive trust with terms acceptable to the court over the settlement proceeds pending final judgment or other resolution of the case.” In the event this request is denied, defendants requested in the alternative that “disbursement be preceded by procedural safeguards of due process and fairness, such as giving notice to ESOP participants and other stakeholders of the settlement terms and proposed allocation of the settlement proceeds, an opportunity for ESOP participants or other stakeholders to file objections to the planned allocation of settlement proceeds, and a fairness hearing before the court.” At the outset, the court partially granted related motions from both sides to restrict public access to certain documents. The court concluded that “the public does not have to know which parties settled and how much was paid by them or on their behalf. It is enough that the total amount of the settlement proceeds and how it is to be disbursed are disclosed.” As for defendants’ “due process” motion, the court denied it. The court reasoned that no statute or rule required or allowed it to impose such protections, as this was not a class action or derivative claim, and Federal Rules of Civil Procedure 23 and 23.1 did not apply. Additionally, the court found that Lyon’s and his counsel’s fees were consistent with the bankruptcy court’s confirmation order and similar contingency fees approved in other cases. The court emphasized that Lyon, as a fiduciary, had an exclusive duty of loyalty to act solely in the interest of the ESOP beneficiaries, and participants had remedies against him if he failed to do so, “[b]ut that would be a separate case.” The court further noted that “neither State Street nor Argent have been found liable in this case. Should they be found liable at trial and seek an offset against any damages or attorneys’ fees they are ordered to pay for any amounts already paid by settling co-defendants, they are free to raise the issue at that time.” With that, the court denied defendants’ motion.

Ninth Circuit

Brian W. v. Premera Blue Cross of Wash., No. C24-0154-KKE, 2026 WL 1552524 (W.D. Wash. June 2, 2026) (Judge Kymberly K. Evanson). Brian W. brought this action arising from residential mental health treatment his son, A.W., received at two facilities: Cherry Gulch and Heritage School. Brian W. paid for A.W.’s treatment out of pocket and then submitted claims under his ERISA-governed health benefit plan. However, the plan’s administrator, Premera Blue Cross of Washington, denied his claims. Brian W. then brought this action and prevailed in March of this year on cross-motions for judgment. (Your ERISA Watch covered this decision in our March 18, 2026 edition.) In this order the court addressed several post-judgment issues. First, Brian W. argued he was entitled to reimbursement for the Heritage School charges at the higher in-network rate (90%) under a plan provision allowing in-network reimbursement for out-of-network care when a covered service is “not available from an in-network provider.” The court disagreed, noting that that the plan stated that “[i]f a covered service is not available from an in-network provider…you must request this before you get the care.” Brian W. did not do so and thus he was only entitled to “the out-of-network rate: 50% of billed costs after any annual deductibles.” Next, the court addressed Premera’s motion to seal its list of in-network residential treatment providers, which it submitted in support of its argument that in-network alternatives were available to A.W. Because the court had just ruled that the out-of-network rate applied, the court denied Premera’s motion as moot and struck the list from the docket. The court then moved on to Brian W.’s motion to strike documents offered by Premera suggesting that it had made partial payments on some of A.W.’s claims. He contended that Premera did not disclose these documents during litigation, and furthermore, these documents would have undermined Premera’s earlier position that the claims were not payable at all. The court acknowledged that “Brian W.’s point is well taken,” but noted that Premera had not requested any offsets for prior payments in its proposed judgment and thus denied Brian W.’s motion as moot. Finally, the judge addressed the appropriate prejudgment interest rate. The court stated that under Ninth Circuit precedent, the default prejudgment interest rate in ERISA cases is “the weekly average 1-year constant maturity Treasury yield, as published by the Board of Governors of the Federal Reserve System, for the calendar week preceding,” pursuant to 28 U.S.C. § 1961, and “substantial evidence” is required to deviate from this rate, which the parties agreed was 3.66%. The parties originally agreed on this rate but Brian W. changed course and argued for Washington’s 12% statutory interest rate instead, submitting a declaration stating he had made “early withdrawals from [his] retirement and brokerage accounts” to fund treatment, and that his “investments have generally tracked the S&P 500 index,” which since 2016 “has averaged approximately 11.3%” according to a “very basic web search[.]” This was not good enough for the court, which found that his “generic statement” “does not specify how much he withdrew from his retirement or brokerage accounts; nor does he present evidence supporting the rates of return for either account.” As a result, the court ruled that 3.66% was the appropriate interest rate. As for the accrual date, the parties had originally agreed to a “‘midpoint accrual approach’ based on the midpoint of the relevant period when Brian W. was paying for A.W.’s care.” However, this time it was Premera which changed its mind; it argued interest should only begin accruing from the dates it actually received Brian W.’s claims. The court rejected this proposal because it was “unworkable and unfair in this case.” Premera’s administrative failures, which included losing submissions, forcing resubmission, and making contradictory determinations about when claims were received, made it impractical to reliably identify submission dates. Furthermore, the court reasoned that “the purpose of prejudgment interest in the ERISA context…is to fully compensate the plaintiff for ‘losses incurred as a result of [the defendant’s] nonpayment of benefits,’” and thus it was disinclined to reward Premera for its deficient claim administration. The court thus adopted the originally agreed-upon midpoint date. The parties were ordered to submit a proposed judgment conforming with this ruling.

Venue

Ninth Circuit

Ventura v. Lithia Motors, Inc., No. 2:26-CV-01786-HDV-RAO, 2026 WL 1625362 (C.D. Cal. June 2, 2026) (Judge Hernán D. Vera). David Ventura is a California resident who was employed at the California automobile dealership Lexus of Valencia, which was owned by Lithia Motors, Inc., from May 2023 to May 2025. Lithia Motors is headquartered in Medford, Oregon, and operates more than 450 dealerships, including several in California. While employed by Lithia, Ventura participated in the company’s ERISA-governed 401(k) plan, which is administered by a committee of seven senior Lithia employees, four of whom are based in Oregon. The committee meets quarterly at Lithia’s headquarters in Oregon where it receives investment advice from Deschutes Investment Consulting, LLC, which is also based in Oregon. Ventura contends in this action that Lithia breached its fiduciary duties under ERISA by, “among other things, using forfeited Plan assets to offset employer contributions rather than to reduce administrative fees, charging excessive administrative fees, and offering imprudent collective investment trust options… He seeks relief on behalf of a putative nationwide class of Plan participants.” Lithia filed a motion to transfer venue from the Central District of California to the District of Oregon pursuant to 28 U.S.C. § 1404(a). The court conducted a two-step process, determining first if the action could have been brought in the transferee district, and second, whether convenience, fairness, and justice considerations militated in favor of transfer. The court agreed that the action could have been brought in Oregon because Lithia is headquartered there and the plan was administered there. However, venue was also proper in California because “the breach occurs where the Plan participant expects to receive benefits.” The court then addressed plaintiff’s choice of forum, which the court found was “entitled to reduced – but not minimal – deference” because he was bringing a nationwide class action in which he “purports to represent class members located across multiple districts.” As for the convenience of witnesses, Lithia argued that most of the key witnesses were in Oregon, but the court found this factor “insufficient to tip the balance decisively toward transfer” because Lithia identified only one non-party witness, Deschutes, and did not provide evidence that witnesses from Deschutes were unwilling to testify in California. The court highlighted “the modern litigation environment where remote and video testimony are widely available and accepted.” The court also stated that Lithia’s witnesses in Oregon could be compelled to testify due to their employment relationship with Lithia, and that “Ventura and his California-based witnesses, including his former supervisors, are relevant to establishing the circumstances of his Plan participation and the claims as they relate to California-based employees.” As a result, “the witness convenience factor is, at best, neutral.” Finally, the court considered the interests of justice, noting that Lithia did not establish that litigation costs would be significantly cheaper in Oregon or that the Central District of California’s caseloads, even if higher than Oregon’s, would impede efficient case management. “In sum, transfer under § 1404(a) is not designed to shift inconvenience from one party to the other. Lithia has not demonstrated that Ventura’s choice of forum and California’s connections to the case are outweighed substantially by the convenience of adjudicating this case in Oregon.” Defendants’ motion to transfer venue was thus denied.