
Healthcare Ally Mgmt. of Cal., LLC v. WSP USA, Inc., No. 24-3479, __ F.4th __, 2026 WL 2319896 (9th Cir. Aug. 11, 2026) (Before Circuit Judges Berzon, Higginson (sitting by designation), and Sung)
It was difficult to choose the notable decision this week, as the federal appellate courts presented three good options, all of them published opinions. In Kaiser v. Alcoa, the Seventh Circuit affirmed class certification, but reversed a summary judgment ruling in favor of plan participants seeking reinstatement of their lifetime retiree healthcare benefits. In Johnson v. Royal Caribbean Cruises Ltd., the Eleventh Circuit ruled that plaintiffs asserting retirement fund mismanagement do not always have to identify comparable investments to establish loss causation.
However, as Californians we here at Your ERISA Watch will stick close to home and discuss the Ninth Circuit’s decision in the above-cited case, which tackles the evergreen issue of ERISA preemption. As practitioners know, 29 U.S.C. § 1144(a) provides that ERISA preempts all state laws that “relate to” ERISA, and those two pesky words have generated an avalanche of case law over the last 50 years that is unlikely to cease anytime soon.
This week we’re discussing preemption in the context of medical billing disputes. Out-of-network healthcare providers often call insurance companies before providing services to determine whether the services will be covered and at what rate. But what if the insurer makes a misrepresentation during that call? Can the provider sue the insurer for negligent misrepresentation under state law, or does that claim “relate to” ERISA, thus eliminating such a claim? Read on to find out.
The provider in this case was La Peer Surgery Center, which performed surgery on a patient covered by an ERISA-governed health plan sponsored by WSP USA, Inc., an engineering and design firm. The plan was administered by Aetna Life Insurance Company.
Because La Peer had no preexisting contract with Aetna, it placed a verification call to Aetna before the surgery to confirm coverage and pricing. On that call, Aetna allegedly told La Peer that the patient would owe a portion out-of-pocket and the plan would pay the remainder at the “Usual, Customary, and Reasonable” (UCR) rate. Aetna specifically assured La Peer that “payment would not be based on the Medicare Fee Schedule,” which generally pays a much lower rate than the UCR rate. Neither Aetna nor WSP informed La Peer of any plan provision that might reduce that promised rate, and neither provided La Peer a copy of the plan.
After the surgery, WSP paid La Peer at – you guessed it – the Medicare rate, which was only five percent of La Peer’s bill. This action by Healthcare Ally Management of California (HAMOC), acting as La Peer’s successor-in-interest, followed. HAMOC sued WSP and Aetna in California state court, asserting only state law claims.
When defendants removed the case to federal court based on ERISA preemption, HAMOC amended its complaint. Its new complaint attempted to eliminate any state law claims that might run afoul of ERISA preemption; HAMOC thus ditched a breach of contract claim and a claim under California’s Unfair Competition Law. Instead, its complaint asserted only two state law claims: one for negligent misrepresentation and one for promissory estoppel. (HAMOC also included a third cause of action for failure to pay ERISA plan benefits under 29 U.S.C. § 1132(a)(1)(B). The district court dismissed this claim for lack of derivative standing, and HAMOC did not appeal that ruling.)
HAMOC’s preemption-dodging gambit did not work with the district court. That court granted defendants’ motion to dismiss, holding that both of HAMOC’s state law claims “necessarily depend on the existence of an ERISA-covered plan” and were therefore preempted by ERISA. HAMOC appealed this ruling to the Ninth Circuit.
In this published opinion, the Ninth Circuit affirmed in part and reversed in part, arriving at different conclusions on HAMOC’s two claims. The court began with a concise summary of the difficulties out-of-network providers face when trying to obtain payment for services. The court noted that providers do not have network agreements with insurers, often cannot file derivative actions because of anti-assignment provisions, and must make judgment calls about whether to provide service based on how much they trust patients and their insurers to pay at the end of the day. Finally, when they end up in court they must overcome ERISA preemption.
The Ninth Circuit reiterated the age-old Supreme Court test for preemption, which asks whether a state law claim has a “reference to” or “an impermissible connection with” an ERISA plan. The court admitted that these two prongs have not “resulted in clarity in applying ERISA’s express preemption provision,” and thus in applying the prongs the court pledged to “‘go beyond’ the text of the statute and also beyond the short-form tests meant to cabin statutory overreach, and look ‘to the objectives of the ERISA statute as a guide to the scope of the state law that Congress understood would survive[.]’”
With these lofty preliminaries out of the way, the court addressed HAMOC’s negligent misrepresentation claim first. The court found the “connection with” prong “more straightforward and easier to apply.” The court used its “relationship test,” which asks whether a claim “bears on an ERISA-regulated relationship, e.g., the relationship between plan and plan member, between plan and employer, between employer and employee.”
The Ninth Circuit acknowledged that HAMOC’s claim touched three ERISA-regulated actors, and thus an ERISA-regulated relationship was “involved.” However, the court stated that “the pertinent question is not whether an ERISA-regulated relationship exists but whether the claim itself bears upon that relationship.”
Here, “It does not.” The court explained that ERISA authorizes only participants, beneficiaries, and fiduciaries to sue, and “the relationship between La Peer, a medical service provider, and Aetna, a plan administrator, falls outside ERISA’s regulatory scope.” As alleged, HAMOC’s tort “runs from a non-ERISA entity (La Peer) to ERISA entities (WSP and Aetna)… Further, the claim does not encroach upon an ERISA relationship, like that between Aetna and the patient beneficiary. HAMOC’s claim concerns only representations that Aetna made as a plan provider to a third-party physician.” As a result, “the claim is not preempted under the ‘connection with’ test.”
The court’s analysis of the “reference to” prong also did not support preemption. The court boiled this prong down to an analysis of “whether the claim at issue is the sort that a participant, beneficiary, or their assignee could have asserted as a § 502(a) benefits claim or is otherwise dependent on an ERISA-covered plan. If not, then the state law claim can stand alone without ‘reference to’ an ERISA plan and is not preempted, because it seeks to remedy an injury to a third-party, not to a beneficiary or the covered plan.”
The court answered this question by examining three prior cases. Two of them (The Meadows v. Employers Health Ins. and Cedars-Sinai Medical Center v. National League of Postmasters) were Ninth Circuit cases, while the third (Access Mediquip LLC v. UnitedHealthcare Insurance Co.) was a Fifth Circuit case.
The court noted that “in almost every case, a literal or strict application of the words ‘reference to’ would have supported preemption.” However, all three cases went the other way. Those cases held that misrepresentation claims by providers regarding verification-call promises survived preemption, and the Ninth Circuit arrived at the same conclusion regarding HAMOC’s claim.
The court emphasized that HAMOC’s claim “does not hinge on the denial of benefits to the patient from an ERISA plan. In fact, the patient here received the covered treatment.” Instead, the claim arose from Aetna’s promise “that it would reimburse La Peer at the UCR rate – without any reasonable ground to believe the veracity of that promise.” This injury “is not rooted in a plan term,” the claim was “not one that the patient could have assigned to a third-party under § 502(a),” and thus HAMOC “does not have a remedy under the statute[.]” Thus, there was no impermissible “reference to” a plan.
The court supported its preemption ruling by engaging in a thought experiment: “How might this case be different if the patient here did not receive insurance through an employer?” Obviously, ERISA would not apply and HAMOC would be able to bring any relevant state law cause of action. “So the question is: Did Congress intend to limit an out-of-network provider like La Peer’s ability to recover under a negligent misrepresentation claim to situations where the patient’s insurance was employer-sponsored, rather than privately acquired?”
The court stated, “Nothing in ERISA or its history suggests that result.” Insulating plan administrators from the consequences of misrepresentations to providers “does not further any of ERISA’s objectives,” and could perversely make out-of-network care more expensive and less accessible by forcing providers to demand up-front payment or decline treatment for ERISA-covered patients specifically. This outcome “would afford less protection to employees and their beneficiaries than they enjoyed before ERISA was enacted.”
Next, the court turned to HAMOC’s promissory estoppel claim and arrived at a different result. This was because of the Ninth Circuit’s 2024 decision in Bristol SL Holdings, Inc. v. Cigna Health & Life Insurance Co. (the case of the week in our June 5, 2024 edition.)
In Bristol, the Ninth Circuit held that ERISA preempted a rehabilitation facility’s state law contract and promissory estoppel claims arising from similar verification calls, because Cigna’s alleged oral promises to pay directly conflicted with an actual, disputed plan provision permitting Cigna to deny claims for “fee-forgiving.” The Ninth Circuit held that Bristol “controls the promissory estoppel preemption question in this case” because the causes of action were “analogous in all legally meaningful respects,” and affirmed dismissal of that count.
Despite the similarities, however, the court held that Bristol did not control HAMOC’s negligent misrepresentation claim. This was because Bristol expressly reserved that question, distinguishing cases (including Access Mediquip) where an insurer misrepresented coverage. In Bristol there was no misrepresentation; Cigna’s denial rested on an undisputed plan term the provider was attempting to circumvent. Here, by contrast, “the negligent misrepresentation claim…arises from an injury distinct from compliance or noncompliance with the ERISA plan[.]”
As a result, the case will return to the district court and proceed, but only on HAMOC’s negligent misrepresentation claim. The Ninth Circuit expressed no opinion as to how the case should turn out, but noted in a footnote “that it is far from obvious that HAMOC’s claim can succeed on the merits.”
Below is a summary of this past week’s notable ERISA decisions by subject matter and jurisdiction.
Attorneys’ Fees
Sixth Circuit
McEachin v. Reliance Standard Life Ins. Co., No. 2:21-CV-12819-TGB-EAS, 2026 WL 2391210 (E.D. Mich. Aug. 17, 2026) (Judge Terrence G. Berg). Annette McEachin stopped working after two car accidents which were followed by severe mental health struggles after her son’s death by suicide. Her claim for ERISA-governed long-term disability benefits was initially approved by Reliance Standard Life Insurance Company, but the insurer terminated her claim after three years of benefits. This action ensued. In a March 2023 order, the district court partly adopted and partly rejected a magistrate judge’s report and recommendation. The court agreed that McEachin was not disabled by a physical condition as of April 2021 but rejected the conclusion that she had exhausted the policy’s 24-month cap on benefits caused or contributed to by mental illness. The court ordered Reliance to pay benefits from April 2021 up to the 24-month maximum so long as McEachin remained totally disabled. (Your ERISA Watch covered this decision in our March 29, 2023 edition.) Reliance appealed the 24-month award, while McEachin cross-appealed the physical disability ruling. The Sixth Circuit affirmed the district court on the benefits award. As for McEachin’s cross-appeal, the appellate court affirmed the ruling that McEachin was no longer disabled due to physical issues in April of 2021. However, it reversed and remanded for the district court to consider whether she was allowed to toll the 24-month limitation in order to extend her benefit period. (This published opinion was our notable decision for the week of November 20, 2024.) The parties reached an agreement on remand, which left only the issue of attorney’s fees. The court had already granted McEachin’s first fee motion, awarding $24,530 for pre-appeal district court work (as we discussed in our February 7, 2024 edition). McEachin filed a new motion seeking fees for both the appellate litigation and the post-remand district court work. In this order the court denied her appellate fee request as untimely. Under the court’s local rules, a fee motion must be filed within 28 days of judgment, and for appellate work that clock runs from the Sixth Circuit’s judgment or mandate. Here, those dates were November 13, 2024 and December 30, 2024 respectively. However, McEachin’s motion was not filed until November 17, 2025, nearly a year later, so the court denied the appellate-fee request as untimely. As for McEachin’s post-remand fee request, the court found that this was timely because it followed within 28 days of the stipulated order resolving the case. The court thus moved on to the Sixth Circuit’s five-factor King test, which addresses culpability/bad faith, ability to pay, deterrent effect, common benefit, and relative merits. The court tackled the appellate and post-remand work separately. The court found that the factors favored no award for the appellate work, even if the request had been timely, and that the factors also favored no award for the post-remand work. On culpability, the court found McEachin offered no argument that Reliance’s appeal or its post-remand advocacy was pursued in bad faith. Ability to pay favored McEachin because Reliance was able to satisfy any award. Deterrence favored Reliance; the court, quoting the Sixth Circuit, worried that a fee award would have a deterrent effect on parties “‘contemplating appeal of a unanswered legal question regarding ERISA with general applicability’… Such parties ‘ought not to be deterred for fear of an attorney’s fees award.’” The court similarly found no deterrence rationale favored a fee award for the post-remand proceedings. The common-benefit factor favored Reliance because McEachin sought no relief for other plan participants and did not resolve any significant, generally applicable ERISA legal question. Finally, the relative-merits factor was neutral: the Sixth Circuit had rejected every argument actually presented to it, remanding only an unraised issue for initial consideration. Furthermore, the post-remand proceedings ended in settlement before the court had any occasion to assess the parties’ relative positions. As a result, with three of the five King factors favoring Reliance, only one favoring McEachin, and one neutral, the court declined to award McEachin fees.
Ninth Circuit
Rushing v. Life Ins. Co. of N. Am., No. CV 24-10088-JFW(RAOx), 2026 WL 2353337 (C.D. Cal. Aug. 13, 2026) (Judge John F. Walter). Candace Rushing sued Life Insurance Company of North America to challenge the calculation of her ERISA-governed long-term disability benefits. The dispute centered on whether LINA correctly calculated her “Covered Earnings,” the figure used to set her benefit amount. Rushing raised several theories relating to that calculation, which included how her overtime, commissions, date of disability, and various offsets should apply, along with the applicable standard of review. However, Rushing only prevailed on one theory; the court found that LINA abused its discretion by calculating her overtime hours at her base hourly rate rather than a proper overtime rate. Based on that partial victory, the court entered judgment in Rushing’s favor in the amount of $31,016.65. This award was comprised of $17,534.10 in benefits and $13,482.55 in prejudgment interest, which was calculated at 10% because Rushing “endured enormous hardships” from LINA’s miscalculation. (Your ERISA Watch covered this decision in our May 6, 2026 edition.) Rushing has now filed a motion under 29 U.S.C. § 1132(g)(1) for $222,570 in attorneys’ fees, $4,373.40 in non-statutory costs, and $405 in costs. Rushing’s counsel (McKennon Law) represented that it had already voluntarily reduced its request by roughly half. This was done first by reducing the firm’s initial 525.2 “raw” hours (amounting to $391,890) down to 383.9 compensable hours, by trimming “excessive time and for non-recoverable administrative work.” Counsel then cut the remaining figure by a further one-third to account for Rushing’s partial success. LINA opposed Rushing’s motion, principally arguing the fee request was “grossly disproportionate” to the modest recovery and should be slashed by 90%. The court granted the motion in full. It first held Rushing eligible for fees because she had achieved “some degree of success on the merits” under the Supreme Court’s test in Hardt v. Reliance Standard. Next, the court turned to the Ninth Circuit’s five-factor Hummell test. The court found the first factor (culpability or bad faith) neutral, since LINA had engaged in a good-faith, if ultimately incorrect, claims process. The second factor (ability to pay) and third factor (deterrent effect) both favored a fee award. The court reasoned that a fee award would discourage LINA and other administrators from continuing to apply unreasonable interpretations of overtime compensation in calculating covered earnings. The fourth factor favored Rushing only marginally: although she sought relief solely for herself rather than the plan as a whole, the ruling would functionally prevent LINA from repeating the same miscalculation against other claimants under the same or similar plans going forward. The fifth factor, the relative merits of the parties’ positions, favored Rushing because she prevailed on the central, dispositive issue in the case (i.e., whether her benefits had been correctly calculated) even though not all of her arguments were successful. As for the proper amount, the court applied a lodestar approach of multiplying reasonable time expended by a reasonable hourly rate. The court rejected LINA’s claim that billing records “reveal a pervasive pattern of duplicate billing among three attorneys,” finding that only two attorneys ever worked the file at any given time (a departing associate was replaced mid-case by another due to a health-related departure) and that the supervising attorney’s overlapping entries reflected legitimate supervision rather than duplication. The court further stated that contingency fee lawyers have little incentive to pad hours due to the uncertainty of the outcome, and highlighted counsel’s own unprompted 27% reduction in time and roughly 50% in amount. The court also found counsel’s hourly rates to be reasonable, which included $875-$925 for founding shareholder Robert McKennon, $750 for departed senior counsel, and $675 for the attorney who took over. Finally, the court declined to further discount the fee award for Rushing’s partial success, as the firm had already done so, and her various theories all arose from the single underlying dispute over how to calculate her benefits and were not discrete claims that could be billed separately. The court thus awarded all of Rushing’s requested fees and costs.
Breach of Fiduciary Duty
Third Circuit
Aramark Services, Inc. v. QCC Ins. Co., No. 26-1664, 2026 WL 2350130 (E.D. Pa. Aug. 13, 2026) (Judge Gerald J. Pappert). The food services giant Aramark Services, Inc. self-funds two ERISA welfare benefit plans holding more than $600 million in combined assets, covering medical benefits for its employees. Aramark hired QCC Insurance Company, a subsidiary of Independence Blue Cross (IBC), in turn owned by Independence Health Group (IHG), to act as the third-party administrator for its plans. Over three successive agreements spanning from 2018 to 2024, the parties characterized QCC’s role in several ways. The 2018 agreement called QCC the “Named Claims Fiduciary” with “final discretionary authority” over benefit determinations, while the 2022 renewal stated that Aramark, “and not Independence Administrators,” was the claims fiduciary, even though an incorporated exhibit again called QCC the “named claims fiduciary.” Aramark grew disenchanted with QCC’s services over time. Aramark alleges that it discovered QCC paid plan assets toward thousands of duplicate, excluded, fraudulent, or medically unnecessary claims, and also contends that QCC engaged in undisclosed “cross-plan offsetting” that credited recovered overpayments to Independence’s own fully-insured plans rather than Aramark’s, netting defendants “tens of millions” of dollars at the plans’ expense. Aramark and its benefits committee sued QCC, IBC, and IHG, asserting breach of fiduciary duty and prohibited-transaction claims under ERISA §§ 502(a)(2) and (a)(3) (Counts I through IV), as well as a claim for declaratory relief (Count V). Defendants moved to dismiss and to strike plaintiffs’ jury demand. The court first ruled that the plans could not be plaintiffs, holding that being the victim of a fiduciary breach does not make an ERISA plan a fiduciary with standing to sue. “None of the agreements between the parties name either plan as a fiduciary, nor were they named fiduciaries pursuant to a procedure specified in those agreements.” Aramark, by contrast, plausibly qualified as a functional fiduciary. It exercised discretionary authority by selecting, retaining, and monitoring QCC over an eight-year relationship, which gave it an independent fiduciary duty to monitor QCC and allowed it to seek relief under ERISA. The court then flipped the analysis and determined which defendants were fiduciaries. The court ruled that QCC was plausibly a fiduciary but IBC and IHG were not. The court held that the conflicting language across the three agreements between Aramark and QCC created a factual dispute on this issue that was inappropriate to resolve on a motion to dismiss. Furthermore, QCC qualified as a functional fiduciary because each agreement gave it discretionary leeway in adjudicating and paying claims. The court rejected defendants’ argument that final, unreviewable decision-making authority was required: “a functional fiduciary only needs ‘any discretionary authority or discretionary responsibility’ – not final decision-making authority.” Moreover, QCC also qualified as a beneficiary because of its ability to manage the plan’s assets. (It held sole signing authority over the checking account used to pay claims.) Plaintiffs did not allege such specifics regarding IBC and IHG, so they were dismissed. On the merits of Count I, the court quickly held that Aramark plausibly alleged QCC breached its duty of prudence. Aramark’s allegations regarding paying claims too quickly for adequate documentation review, with invalid billing codes, for expressly excluded services, and at rates exceeding Medicare and in-network pricing, not to mention cross-plan offsetting, were sufficient to plead a breach. The court also rejected defendants’ argument that surcharge, disgorgement, and accounting are unavailable equitable remedies under ERISA § 502(a)(3). The court held that the Supreme Court (in CIGNA Corp. v. Amara) recognized surcharge as a traditional equitable remedy for a fiduciary’s breach of trust, and that disgorgement and accounting were properly pled because plaintiffs identified specific sums that defendants had wrongfully retained. However, the court dismissed Count V. That count sought a declaratory judgment regarding access to electronic remittance data, but the court ruled that it had no statutory basis. Finally, the court struck plaintiffs’ jury demand because Aramark sought only equitable relief and the Seventh Amendment’s jury trial guarantee does not extend to equitable ERISA claims.
Eighth Circuit
Batt v. 3M Co., No. 25-CV-3149 (ECT/DTS), 2026 WL 2322559 (D. Minn. Aug. 11, 2026) (Judge Eric C. Tostrud). The plaintiffs in this putative class action are current or former 3M employees who participated in the 3M Voluntary Investment Plan and the 3M Savings Plan, two defined contribution plans holding a combined $12.4 billion in assets with 58,000 participants. Almost 40% of plan assets (about $4.1 billion) were invested in the 3M TDF Series, a family of nine target-date funds modeled on BlackRock’s LifePath funds. This was the default fund for new hires and was the plans’ only target-date option. Plaintiffs contend that these TDFs persistently underperformed comparable target-date funds, that 3M’s disclosures about the funds’ holdings and risk metrics were sparse and contained obvious errors, and that the funds’ asset allocation deviated from the advertised “to retirement” glide path. Separately, plaintiffs allege that 3M Investment Management Corporation (IMCO), a wholly owned 3M subsidiary, served as co-investment manager of the TDFs and was paid at least $1.83 million in fees between 2019 and 2024 out of plan assets, even though the same 3M entities responsible for selecting and monitoring the TDFs were also the ones setting IMCO’s compensation. Plaintiffs’ operative complaint asserts (1) breach of the duty of prudence (Count I, resting on three theories: underperformance, inadequate disclosure, and glide-path deviation), (2) prohibited transactions and self-dealing under ERISA §§ 406(a) and (b), 29 U.S.C. § 1106(a)-(b) (Count II), and (3) failure to monitor fiduciaries (Count III, derivative of Count I). Plaintiffs have already suffered one setback; the court previously dismissed the prudence claim for failure to identify a “meaningful benchmark.” (We covered this ruling in our March 18, 2026 edition.) Plaintiffs amended their complaint, and defendants responded with another motion to dismiss, which the court ruled on in this order. Defendants moved to dismiss Count II under Rule 12(b)(1) for lack of standing and moved to dismiss the entire amended complaint for failure to state a claim. On standing, the court began with Count I, even though defendants had not challenged that count on standing grounds. The court ruled that plaintiffs’ disclosure-based theory failed Article III’s concreteness requirement. The court found that their alleged injury was “purely informational” and did not identify “downstream consequences.” Specifically, plaintiffs did not connect the erroneous fact sheets or opaque disclosures to any actual reliance or resulting harm. The glide-path-deviation theory failed for the same reason: plaintiffs alleged the funds’ risk profile diverged from what was promised but never alleged this produced lower returns. Indeed, “it’s entirely consistent with the Amended Complaint that Plaintiffs earned more money than they otherwise would have because of Defendants’ ‘structural divergences.’” Both theories were dismissed without prejudice for lack of subject-matter jurisdiction. Moving on to Count II, the court changed its tune and found that plaintiffs’ prohibited transaction theory adequately pled a concrete, traceable economic injury. The fees at issue were allegedly paid to IMCO out of assets in which plaintiffs were invested, which “caused the Plaintiffs to suffer economic losses.” On the merits of the surviving Count I underperformance theory, the court conducted an extensive comparator-by-comparator analysis for each of plaintiffs’ six proposed benchmarks. It found that four were sufficiently similar to serve as meaningful benchmarks, but rejected two others. As for performance, only the comparison with the Fidelity Freedom TDFs showed underperformance substantial and sustained enough to plausibly suggest imprudence. The court accordingly dismissed Count I with prejudice as to every comparator except the Fidelity Freedom TDFs. As for the prohibited transaction claims in Count II, the court denied dismissal. The court held that plaintiffs adequately alleged that IMCO was a fiduciary and party in interest, that it received compensation traceable to plan assets for managing the TDFs’ underlying bond fund, and that 3M effectively “hire[d] itself to perform work and then set[] its own fees.” The court rejected defendants’ arguments for dismissal, ruling that plaintiffs did “not need to identify specific transactions from Plan assets to 3M IMCO,” and recognizing that while defendants may have affirmative defenses under 29 U.S.C. § 1108, those defenses cannot be adjudicated on a motion to dismiss pursuant to the Supreme Court’s recent ruling in Cunningham v. Cornell University. Finally, because the duty-to-monitor claim in Count III was derivative of the prudence claim in Count I, it survived “to the same extent.”
Ninth Circuit
Klawonn v. Board of Directors for the Motion Picture Industry Pension Plans, Nos. 25-2874, 25-3230, __ F. App’x __, 2026 WL 2364541 (9th Cir. Aug. 14, 2026) (Before Circuit Judges Rawlinson and Sanchez, and District Judge Sidney A. Fitzwater). Patricia Klawonn is a participant in the Motion Picture Industry Pension Plans who brought this putative class action against the plans’ board of directors, alleging that the board breached its duty of prudence under ERISA in managing plan investments. Klawonn’s standing to pursue prospective injunctive relief was complicated by her employment status; at the time the district court certified her as class representative, the motion picture industry was engaged in industry-wide strikes, which had caused widespread work shortages. Klawonn testified she “absolutely [would] be returning to work as soon as the strike is over,” but by the time summary judgment proceedings rolled around, she remained unemployed, had not worked the 870 hours needed to reenter the plan, and had cashed out of the plan altogether. The district court granted summary judgment to the board on Klawonn’s prudence claim, and separately entered a class certification order that the board challenged on a conditional cross-appeal. On the merits, the district court applied a standard requiring that any alleged investment underperformance be “both substantial and consistent” to support a claim of imprudence, and found Klawonn’s evidence insufficient under that test. In this memorandum disposition the Ninth Circuit vacated and remanded on the prudence claim, explaining that the district court’s ruling predated the appellate court’s intervening decision in Anderson v. Intel Corp. Investment Policy Committee. (We discussed that ruling in our May 28, 2025 edition; the case is now in the Supreme Court and is currently scheduled to be argued on October 6.) As the court explained, Anderson clarified that fiduciary prudence must be evaluated “prospectively, based on the methods the fiduciaries employed,” meaning a plaintiff can establish a breach through direct evidence “that the fiduciaries employed unsound methods in making their investment decisions.” The court also directed the district court to “revisit its definition of loss in light of the statutory language referencing ‘any loss,’ rather than ‘substantial loss,’ as implied by the district court’s ruling.” This was a reference to 29 U.S.C. § 1109(a), which makes a breaching fiduciary liable for “any loss to the plan.” As for class issues, the Ninth Circuit held that the district court did not abuse its discretion in initially certifying the class with Klawonn as representative, since her sworn intent to return to work once the strikes ended was sufficient at that stage. However, the panel agreed with the board that subsequent events rendered any return to covered work too speculative to sustain a live controversy: “The confluence of Klawonn’s choice to ‘cash[] out of the [Retirement] Plan,’ and her continued unemployment render her claim for prospective relief moot.” However, the court noted that the class was properly certified before Klawonn’s claim became moot, and thus “the current mootness of Klawonn’s ‘claim [does] not moot the class action.’” The court thus instructed the district court to consider on remand whether a substitute class representative was available to step in Klawonn’s shoes.
Northcutt v. Gen Digital Inc., No. CV-25-02768-PHX-DWL, 2026 WL 2389356 (D. Ariz. Aug. 17, 2026) (Judge Dominic W. Lanza). Plaintiffs are current and former participants in the Gen Digital Inc. 401(k) Plan, an ERISA-governed defined contribution plan. (Gen Digital is the successor to several computer security companies, including NortonLifeLock, Avast, and Symantec.) The plan includes employer matching contributions. When a participant terminates employment before becoming fully vested in matching contributions, the unvested amount is forfeited and becomes a plan asset. The plan provides that Gen Digital has the “sole discretion” to determine whether forfeitures should be used to either reduce its own future matching contributions or to pay plan administrative expenses. Plaintiffs allege that throughout the class period Gen Digital never allocated forfeitures to administrative expenses, instead choosing to reduce its own out-of-pocket contribution costs, despite having a financial conflict of interest. Plaintiffs also contend that their pre-suit document request revealed no evidence of any deliberative process behind Gen Digital’s allocation. Plaintiffs’ complaint asserted four counts, and defendants responded with a motion to dismiss. Defendants did not challenge (yet) plaintiffs’ first two counts, which were prohibited transaction claims involving plan consultants Great-West and Fidelity. Instead, they moved to dismiss Count Three (breach of the fiduciary duty of prudence, against Gen Digital) and Count Four (failure to monitor, against Gen Digital and the board of directors). The court first addressed a threshold question: whether a plan sponsor’s decision to allocate forfeitures is a fiduciary act, or a non-fiduciary “settlor” design choice immune from scrutiny. The court agreed with the majority of courts on this issue and held that while designing the plan to permit either use of forfeitures was a settlor decision, the company’s actual selection between the two choices was an exercise of discretion over plan assets. Thus, it was a fiduciary decision subject to attack under ERISA’s civil enforcement scheme. The court thus turned to whether plaintiffs adequately pleaded a breach, noting that it “does not operate on a blank slate when assessing the viability of this theory.” The court noted that more than 30 class actions had been filed asserting forfeiture theories, but the vast majority did not make it past the pleadings. This one would not either. The court held that a bare allegation of financial conflict of interest, standing alone, does not plausibly establish a breach of the duty of prudence. Instead, a plaintiff must plead specific facts about what was flawed in the fiduciary’s decision-making process. Here, plaintiffs contended there was no prudent process because Gen Digital did not investigate whether it could absorb administrative expenses, failed to evaluate how the forfeitures should be used, and failed to consult an independent decision-maker. However, for the court, these were “general allegations” unsupported by “specific facts as to what was actually imprudent in Gen Digital’s process. The majority of courts faced with such allegations have dismissed them.” Because Count Four’s monitoring claim was derivative of the prudence claim, it fell along with Count Three. The court gave plaintiffs leave to amend.
Eleventh Circuit
Johnson v. Royal Caribbean Cruises Ltd., No. 25-10692, __ F.4th __, 2026 WL 2387006 (11th Cir. Aug. 17, 2026) (Before Circuit Judges Jill Pryor, Luck, and Brasher). Ann Johnson, a participant in the Royal Caribbean Cruises Ltd. Retirement Savings Plan, sued on behalf of a class of plan participants after Royal Caribbean’s Investment Committee replaced the Vanguard Target Date Funds in the Plan’s investment menu with Russell Target Date Funds in 2015. The new Russell TDFs employed a “to retirement” glidepath rather than a “through retirement” glidepath and “a bias towards investing in emerging markets and real assets relative to its competitors, which tended to be more heavily invested in U.S. equities.” From 2015 to 2019, the Russell funds underperformed both the legacy Vanguard TDFs and the American Funds TDFs that eventually replaced them by an annualized average of 1.51% and 2.12% respectively, and even slightly lagged their own custom benchmark at times. One Russell executive internally worried that Royal Caribbean might “think they have made a bad fiduciary decision,” and another noted that other clients were leaving because “as a fiduciary it is hard to go with worse numbers and higher fees.” In her suit Johnson alleged that Royal Caribbean breached ERISA’s fiduciary duty of prudence by imprudently selecting Russell as investment manager, failing to monitor the Russell TDFs’ performance, and failing to monitor its investment committee. Johnson argued that funds’ underperformance, glidepath selection, and comparatively high fees demonstrated the funds were objectively imprudent investments. On summary judgment, the district court ruled for defendants. The court held that Johnson was required to identify an “apples-to-apples” comparator fund that was consistent with the Russell TDFs’ investment strategy and risk profile in order to prove objective imprudence. The court also ruled that Johnson’s comparisons to the Vanguard and American Funds TDFs were improper and that Russell’s own custom benchmark, which its funds had only slightly underperformed, was the only proper comparator. (Your ERISA Watch covered this ruling in our February 5, 2025 edition.) Johnson appealed. (Meanwhile, Russell settled and was dismissed from the appeal.) In this published decision, the Eleventh Circuit reversed. Applying its recent decision in Pizarro v. Home Depot, Inc. (the case of the week in our August 14, 2024 edition), the court reiterated that ERISA fiduciary liability requires both procedural imprudence and loss causation, with loss causation turning on whether the challenged investment was “objectively prudent,” i.e., falling “outside the ‘range of reasonable judgments a fiduciary may make based on her experience and expertise,’ such that a hypothetical prudent fiduciary in the same circumstances as the defendant…would not (or could not) have made the same choice.” The court held the district court erred by requiring comparator evidence as a mandatory element of that showing. The Eleventh Circuit stated that “we cannot say it is always necessary,” because a prudence inquiry “will necessarily be context specific.” The court found that different cases require different combinations of qualitative evidence (such as a fund’s popularity among comparable plans and its ratings from industry analysts) and quantitative evidence (such as a fund’s fees and performance against contemporaneous peers and benchmarks). “In some circumstances, a context-specific inquiry may favor either qualitative or quantitative evidence, and a plaintiff does not need both.” After all, “some of the most objectively imprudent investments will lack an apples-to-apples comparison precisely because they are such objectively bad fiduciary decisions.” The court found this approach consistent with the Sixth Circuit’s 2022 decision in Smith v. CommonSpirit Health and the Third Circuit’s decision from earlier this year in In re Quest Diagnostics ERISA Litig. (covered in our June 24, 2026 edition), both of which declined to impose a “mechanical checklist” for proving imprudence. Turning to the record, the court found that the district court did not satisfactorily address Johnson’s theory of liability: “[T]he mere fact that the Russell funds were within striking distance of their own custom benchmark does not answer Johnson’s theory of objective imprudence – that the Russell TDFs’ unique features, which were also baked into the custom benchmark, are what made them an objectively imprudent investment to begin with.” The court thus reversed and remanded for further proceedings, “mak[ing] no determination about whether the record warrants summary judgment under the appropriate standard.”
Class Actions
Seventh Circuit
Kaiser v. Alcoa USA Corp., No. 25-1627, __ F.4th __, 2026 WL 2364300 (7th Cir. Aug. 14, 2026) (Before Circuit Judges Lee, Pryor, and Kolar). Plaintiff Lynnette Kaiser’s late husband worked for aluminum giant Alcoa for fifteen years and, under the collective bargaining agreement (CBA) in place at his retirement, he and his wife were entitled to lifetime healthcare benefits when he retired. However, on January 1, 2021, Alcoa terminated the retiree healthcare benefits of Kaiser and more than 3,000 other pre-1993 retirees and their dependents, transitioning them instead to a health reimbursement arrangement that Alcoa claimed it could terminate “at any time.” None of the CBAs Alcoa had negotiated with unions expressly stated how long retiree healthcare benefits would last, but all barred Alcoa from unilaterally reducing them; all had also expired. Kaiser sued on behalf of a putative class, asserting claims under ERISA §§ 502(a)(1)(B) and (a)(3) against Alcoa and three of its benefit plans, seeking a declaration that pre-1993 retirees’ healthcare benefits had vested for life and an injunction restoring the pre-2021 plan. The district court certified a Rule 23(b)(2) class of all pre-1993 retirees and dependents whose uncapped benefits were terminated effective January 1, 2021, and later granted plaintiffs summary judgment on liability. Crucially, however, the court’s liability ruling was not based on a finding that the benefits had actually vested, but by judicially estopping Alcoa from disputing vesting at all. The district court concluded that Alcoa’s position was “diametrically opposed” to statements it had made in an earlier suit, Curtis v. Alcoa, Inc. That suit was also brought by Alcoa retirees, but over a different, capped tier of benefits, in which Alcoa allegedly conceded that pre-1993 retirees had lifetime, uncapped benefits. Based on its estoppel finding, the court granted plaintiffs declaratory and injunctive relief, while also establishing a claims process for reimbursement of expenses. (We covered this ruling in our April 3, 2024 edition.) Alcoa appealed both the class certification order and the summary judgment order. In this published decision, the Seventh Circuit affirmed the class certification order. The court rejected Alcoa’s argument that differing CBAs across facilities defeated commonality, noting Alcoa itself conceded that “[t]here is no language in the CBAs providing for a specific duration for retiree healthcare benefits” in any of them. The court was satisfied that plaintiffs had demonstrated a “latent ambiguity” which supported a finding of vesting across the class. This included sworn testimony from Alcoa’s lead negotiator that Alcoa “couldn’t touch” or “unilaterally” change the benefits of already-retired employees, and Alcoa’s decades-long practice of leaving the benefits untouched. On typicality, the court likewise found no error, since Kaiser’s claim shared “the same essential characteristics” as the class’, all arising from Alcoa’s single, uniform decision to terminate the pre-2021 plan. The court further found that the district court’s choice of Rule 23(b)(2) over (b)(3) was not an abuse of discretion. The court concluded that plaintiffs’ requested monetary relief (reimbursement calculated by comparing what a class member incurred against what they would have incurred under the reinstated plan) was merely “incidental” to the injunctive and declaratory relief. The Eleventh Circuit changed course on the judicial estoppel issue, however. Applying the Supreme Court’s framework from New Hampshire v. Maine, the court walked through each Alcoa statement from the Curtis litigation on which the district court relied and found none “clearly inconsistent” with Alcoa’s position in this case. For example, one statement was merely Alcoa’s paraphrase of the opposing party’s argument, not an admission. Another addressed how the cap would affect post-1993 retirees, and did not affirmatively concede that pre-1993 retirees’ benefits were vested and uncapped. A promise to pay benefits “for the rest of [the plaintiffs’] lives” likewise referred only to the post-1993 Curtis class. As a result, the Eleventh Circuit concluded that “the doctrine of judicial estoppel does not bar Alcoa from contesting the merits in this case.” The court thus reversed the grant of summary judgment as to liability, leaving it “to the district court’s sound discretion whether to consider motions for summary judgment anew or press forward to trial.”
Ninth Circuit
Andrews v. Wilson Electric Services Corp., No. CV-24-00995-PHX-DJH, 2026 WL 2368105 (D. Ariz. Aug. 14, 2026) (Judge Diane J. Humetewa). Wilson Electric Services Corporation (WESC) established an employee stock ownership plan (ESOP) in 2005 to provide retirement benefits. The ESOP held two categories of assets: WESC stock and an “Other Investments Account” (OIA), which averaged $11.2 million between 2018 and 2022. Plaintiffs Daniel Andrews and Matthew Baker allege that WESC and related defendants kept the entire OIA invested exclusively in bank deposit and money market accounts throughout most of that period, generating negligible returns and causing the OIA’s real value (and plan participants’ retirement savings) to shrink, in violation of ERISA’s duty of prudence under 29 U.S.C. § 1104(a)(1). In August of last year the court certified, without opposition, a class of all ESOP participants and beneficiaries since six years before the suit was filed, although defendants reserved the right to later seek decertification if discovery revealed grounds for it. Sure enough, the parties have conducted discovery and defendants have now moved to decertify the class, arguing it no longer satisfies Rule 23(a)’s commonality and adequacy requirements. (Defendants also moved to dismiss for failure to state a claim, but that motion was denied, as we discussed in last week’s edition.) The court ruled at the outset that WESC had the burden of proving changed circumstance of fact or law in order to support decertification, which would shift the burden back to plaintiffs to reestablish that Rule 23 remained satisfied. On commonality, defendants argued that determining whether individual participants had “actual knowledge” sufficient to trigger ERISA’s three-year statute of limitations would require an individualized inquiry defeating class treatment. The court rejected this, noting that defendants’ argument relied entirely on documents that were in their possession throughout the litigation and thus could have been raised when the original class certification motion was filed. The court also found the argument would fail on the merits regardless because courts do not typically let a speculative, individualized statute-of-limitations defense defeat commonality. “The existence of a statute of limitations issue does not compel a finding that individual issues predominate over common ones.” As for adequacy, the court reviewed the deposition testimony of the class representatives but ultimately rejected defendants’ arguments. Addressing the statute of limitations first, the court cited the Supreme Court’s 2020 Intel v. Sulyma decision for the proposition that “actual knowledge” requires more than access to disclosed information. A plaintiff must have actually become aware of, and appreciated the significance of, the facts constituting the breach. For plaintiff Andrews, the court found that a 2021 email exchange with WESC’s CFO did not qualify because it was primarily about distributions, not investment strategy. For plaintiff Baker, the court found neither his review of account statements nor his forwarding of a Form 5500 to the CFO sufficient, crediting his testimony that he did not understand the significance of either document. The court likewise rejected defendants’ argument that the named plaintiffs’ preference for an equity-heavy OIA investment strategy made them atypical of the class. The court stated, “Defendants’ arguments on this subject venture into arguments concerning the merits of Plaintiffs’ breach of fiduciary duty claim…but a motion for class decertification is not the appropriate point at which to resolve the merits of a plaintiff’s claim.” Finally, the court dismissed defendants’ attacks on the plaintiffs’ credibility and candor. The court was “perplexed by Defendants’ argument that Plaintiffs’ minor legal infractions make them unsuitable class representatives. Infractions relating to a traffic citation and racing dirt bikes that occurred ten or forty years ago do not show examples of dishonesty, do not directly relate to this litigation, and warrant no further discussion.” The court also dismissed defendants’ other credibility attacks because they were not “so sharp as to jeopardize the interests of absent class members.” The court found no evidence of dishonesty directly relevant to the litigation and no indication the named plaintiffs had ceded control of the case to counsel. As a result, defendants’ motion to decertify was denied. Next up: summary judgment proceedings.
Carr v. SSP America Inc., No. CV-25-00911-PHX-JJT, 2026 WL 2363508 (D. Ariz. Aug. 14, 2026) (Judge John J. Tuchi). SSP America, Inc. owns and operates airport restaurants nationwide and sponsors a 401(k) plan for its employees. Plaintiff Natasha Carr works as a server at an SSP restaurant in Phoenix Sky Harbor International Airport under a collective bargaining agreement between SSP and Unite Here Local 11, a hospitality workers’ union, and has participated in the plan since 2021. In January 2024, SSP stopped remitting both employer and employee contributions to the plan. During subsequent negotiations with the union, SSP committed to auditing the shortfall and repaying union-affiliated participants the missed contributions plus lost earnings. This agreement was memorialized in an October 2024 “Side Letter” that also incorporated the collective bargaining agreement’s (CBA) grievance procedure, which included arbitration. However, at this point SSP’s audit has not been completed and no repayment has been made to anyone. Carr thus brought this suit, asserting failure to make required participant and matching contributions, breach of fiduciary duties in administering the plan and providing accurate plan materials, and failure to furnish summary plan descriptions. Carr moved to certify two classes: a broader Class 1 covering all plan participants as of October 2022 for the summary-plan-description claim (which SSP did not oppose), and a narrower Class 2 for her other claims, which covered all active participants who, on or after January 1, 2024, had at least one payroll period in which their contributions were not timely deducted and transmitted. SSP opposed this second class, arguing that Carr could not satisfy Rule 23(a)’s typicality and adequacy requirements. SSP’s central argument was that because Carr was a union member, she was in a materially different position than non-union class members. Specifically, Carr’s claims were potentially subject to the CBA’s grievance procedure, which “could culminate in mandatory arbitration.” The court ruled in Carr’s favor, however, agreeing with her that SSP had waived any right to compel arbitration of her claims. Applying the Ninth Circuit’s two-part waiver test from Hill v. Xerox Business Services – which requires knowledge of an existing right to compel arbitration plus intentional acts inconsistent with that right – the court found SSP had long known of the CBA’s arbitration mechanism (having signed both the CBA and the Side Letter) but never invoked it. Indeed, SSP did not plead arbitration as an affirmative defense in its answer, never moved to compel arbitration, and never gave the notice the CBA requires. Because the CBA makes arbitration discretionary rather than automatic, and SSP had taken no steps toward invoking it, the court concluded the arbitration risk was “merely hypothetical,” leaving Carr “in a position no different than that of non-Union class members.” SSP had a fallback argument, which was that Carr’s claims were atypical because SSP had already promised repayment to union participants but made no comparable commitment to non-union participants. The court did not like this argument either, noting that “‘[t]he requirement of typicality is not primarily concerned with whether each person in a proposed class suffers the same type of damages’… Instead, typicality examines whether the injury and the conduct giving rise to the injury is the same or similar across the class.” Here, “Plaintiff contends that the injury and preceding conduct causing the injury are the same across Class 2, and Defendants do not argue otherwise.” The court then briefly addressed the other requirements of Rule 23. Finding no conflict of interest, adequate counsel experience in ERISA and class litigation, and no other contested Rule 23 element, the court granted Carr’s motion for class certification as to both classes, and, in an ancillary ruling, granted SSP’s unopposed motion to file certain business-sensitive exhibits under seal.
Schuster v. Swinerton Inc., No. 3:24-cv-04970-JSC, 2026 WL 2323537 (N.D. Cal. Aug. 11, 2026) (Judge Jacqueline Scott Corley). The plaintiffs in this action are participants in a retirement savings plan sponsored by the commercial construction company Swinerton Inc. They allege that Swinerton and related defendants breached their ERISA fiduciary duties in administering the plan by incurring excessive recordkeeping and administrative fees. Plaintiffs were able to fend off a motion to dismiss in April of last year (as we covered in our April 16, 2025 edition), and after negotiations the parties were able to reach a settlement. Plaintiffs have represented that the settlement is for $497,500 and constitutes 22.1% of the class’ total estimated losses of $2.25 million. In March of this year the parties notified the court of the settlement, and plaintiffs subsequently moved for preliminary approval, supported by a proposed plan of allocation, a settlement administrator’s declaration describing the notice plan and estimated administration costs, and a postcard-form class notice. The court was dissatisfied with plaintiffs’ motion, identifying four deficiencies. First, the court found the motion failed to explain what individual class members would actually recover: “While the motion indicates the gross settlement amount of $497,500 represents 22.1% of the total estimated losses of $2.25 million, there is no discussion – beyond reference to the Plan of Allocation – of the range of class member recovery under the settlement.” Second, the court flagged the settlement’s reversion provision, which would send unclaimed funds back to the plan “to defray administrative expenses and benefit class member Plan participants, along with the Plan as a whole.” The court was concerned that plaintiffs “do not discuss whether this is common practice in ERISA settlements or cite any authority supporting the reasonableness of this approach.” Third, the court sought more information about the proposed settlement administrator, Analytics. Plaintiffs asserted that class counsel had used Analytics for “a dozen other ERISA class settlements” and had been “highly satisfied,” but did not specify the actual frequency of that relationship or whether counsel had used other administrators during the same period. The court also noted that while Analytics estimated notice costs at $40-50,000, the settlement agreement “does not include a cap on the amount of settlement administration costs and appears to leave it to the Settlement Administrator’s discretion how much to withhold.” Finally, the court held that it could not assess notice adequacy because the motion attached only the postcard notice, not the long-form notice that will be sent to class members: “To approve the settlement, the Court must determine whether the notice affords adequate notice to the class.” The court reminded counsel that the notice “must advise class members they can object to both the settlement itself and the request for attorneys’ fees and costs, and advise Settlement Class Members about how they can review Class Counsel’s motion for attorneys’ fees and costs prior to the final approval hearing.” The court thus ordered supplemental briefing to address these issues and continued the hearing on plaintiffs’ motion for preliminary approval.
Disability Benefit Claims
Eighth Circuit
Huynh v. Schwan’s Shared Services, LLC, Civ. No. 25-3988 (JRT/LIB), 2026 WL 2363632 (D. Minn. Aug. 14, 2026) (Judge John R. Tunheim). Chinh Huynh worked as Director of Enterprise Architecture for food company Schwan’s from 2019 until his termination in 2022. Following motor vehicle accidents in 2018 and 2020, Huynh was diagnosed with persistent postural-perceptual dizziness and related cognitive symptoms, requiring workplace accommodations from 2020 onward. Days before a Mayo Clinic neuropsychologist recommended a six-month leave of absence, and before Huynh submitted any leave request, Schwan’s terminated him for “unsatisfactory performance.” Two days later, Huynh filed a claim for short-term disability (STD) benefits under Schwan’s self-insured STD plan, administered by Sedgwick Claims Management Services. Sedgwick denied the claim, and later denied Huynh’s first-level appeal, both times stating the denial rested on the plan’s “General Eligibility Provisions” found in a separate “Wrap Document.” When Huynh’s counsel requested the underlying third-party administrative (TPA) services agreement between Schwan’s and Sedgwick and a complete copy of the Wrap Document, Schwan’s refused to provide the TPA agreement and only months later produced an incomplete excerpt of the Wrap Document. Then it informed Huynh that no second-level appeal was available and that Sedgwick’s denial was final. Huynh sued Schwan’s and Sedgwick, asserting a claim for STD benefits due (Count One), a claim that Schwan’s failed to produce the TPA Agreement and complete Wrap Document as ERISA requires (Count Two), and a claim for equitable relief (surcharge) based on breach of fiduciary duty by both Schwan’s and Sedgwick (Count Four). (Count Three was a claim against Prudential for long-term disability benefits which was not at issue in this order.) Schwan’s and Sedgwick moved to dismiss Counts One, Two, and Four for failure to state a claim. Addressing Count One first, the court noted that the STD plan’s “Coverage Termination” provision appeared to bar Hynh’s claim because he was terminated on the same day he claimed disability. However, the Eighth Circuit requires that courts review only the plan administrator’s final denial rationale rather than post-hoc justifications, and thus the court held it was bound to the reasoning Sedgwick actually gave, which invoked the “General Eligibility Provisions.” Thus, the court declined to dismiss Count One. Next, the court found it was “premature” to determine the issue of whether defendants’ eligibility determination was reasonable as a matter of law because “it is unclear who the relevant decisionmaker was or on what basis the STD benefits were denied[.]” The court also declined to dismiss Sedgwick as an improper defendant, finding the factual record on control “undeveloped” at the pleading stage, as both Schwan’s and Sedgwick had sent Huynh information regarding his claim eligibility. Moving on to Count Two, the court held that the TPA Agreement plausibly should have been produced as a “contract, or other instrument under which the plan is established or operated” under 29 U.S.C. § 1024(b)(4). In so ruling the court relied on the Tenth Circuit’s 2024 decision in M.S. v. Premera Blue Cross (the case of the week in our October 9, 2024 edition) and the Seventh Circuit’s 2009 decision in Mondry v. American Family Mutual Insurance Co. (The Fourth Circuit just agreed with both of these decisions in Kelly v. Altria Client Servs., the case of the week from last week’s edition.) As for the Wrap Document, the court found Schwan’s own admission that it sent only “the relevant portion” fatal, holding that ERISA affords no basis for a plan administrator to unilaterally decide which portions of a governing document a participant may see. On Count Four, the court held Huynh plausibly alleged Sedgwick acted as a functional fiduciary rather than a purely ministerial claims processor, again because the record did not yet establish who held discretionary authority over eligibility. Finally, relying on the Supreme Court’s decision in CIGNA Corp. v. Amara and interpreting Eighth Circuit precedent, the court rejected the argument that Huynh’s equitable relief claim was impermissibly duplicative of the benefits claim. The court held that the two claims were distinct legal theories that may be pleaded in the alternative, with any duplicate-recovery problems better resolved at a later date. Defendants’ motion to dismiss was thus denied.
Eleventh Circuit
Kendall v. Metropolitan Life Insurance Co., No. 2:26-CV-950-KCH-KRH, 2026 WL 2299338 (M.D. Fla. Aug. 11, 2026) (Judge Kyle C. Dudek). In 2009 June Yvonne Kendall became disabled, and since 2011 she has been receiving ERISA-governed long-term disability benefits under a plan sponsored by Bank of America, N.A. and administered by Metropolitan Life Insurance Company. Kendall contends in this pro se action that although she elected coverage that paid sixty percent of her annual salary, her monthly checks reflected only forty percent of her pay, and that this shortfall continued for “over fifteen…years,” resulting in what she calculated as a nearly quarter-million-dollar underpayment. In her complaint against both Bank of America and MetLife she asserted two claims for relief: one to recover the allegedly underpaid benefits under 29 U.S.C. § 1132(a)(1)(B), and a second for breach of fiduciary duty under § 1132(a)(3). Defendants moved to dismiss both counts, arguing that the recovery of benefits claim was time-barred and that the fiduciary duty claim failed as a matter of law because it duplicated the benefits claim. Defendants attached the governing plan document to their motion, and Kendall did not dispute its authenticity. The court granted the motion as to the recovery of benefits claim and dismissed it with prejudice. The court first held it could consider the plan document itself under the incorporation-by-reference doctrine. The plan contained a contractual limitations provision requiring suit to “be brought…during a certain period,” which “begins 60 days after the date Proof is filed and ends 3 years after the date such Proof is required.” Proof was due “not later than 90 days after the date of loss.” Under these provisions, the court calculated that Kendall’s window to sue closed by the end of 2012, more than a decade before she filed this action. Kendall argued that a different plan provision excused late-filed proof if it was “given as soon as is reasonably possible,” which extended her deadline. However, the court noted that because Kendall alleged that she had been receiving benefit checks since 2011, she necessarily must have submitted her proof by then: “[i]t’s hard to imagine how she could receive benefits otherwise.” Even using 2011 as the accrual date, Kendall’s limitations deadline expired well before this suit was filed, in 2015. The court also rejected Kendall’s argument that her claim could not have accrued until she discovered the underpayment through a 2026 administrative appeal. The court stated that this argument was improperly raised for the first time in Kendall’s response brief, and furthermore ran afoul of the Eleventh Circuit’s “clear repudiation rule,” which asks when a claimant had reason to know her benefits had been adversely affected. “[A]fter a year or more of under- or non-payment, claimants should understand their rights to have been rejected.” The court found that “[t]he twenty percent she claims to have been shorted was stark enough to make her aware she was being shorted,” and thus “her cause of action accrued long before this action was filed.” As for Kendall’s breach of fiduciary duty claim, the court explained that a plaintiff with an adequate remedy under § 1132(a)(1)(B) cannot simultaneously proceed on an equitable-relief theory under § 1132(a)(3), since the latter functions only as a “safety net” for injuries ERISA does not otherwise remedy, relying on the Supreme Court’s decision in Varity Corp. v. Howe. Kendall’s fiduciary duty claim incorporated the same factual allegations underlying her benefits claim without adding any independent factual predicate, making it impermissibly duplicative. However, the court noted that Kendall’s response brief hinted at new allegations concerning defendants’ alleged withholding of benefit-calculation information that might support a valid fiduciary duty claim if properly pled. The court therefore dismissed Kendall’s second claim without prejudice and gave her leave to amend.
Life Insurance & AD&D Benefit Claims
Ninth Circuit
Aloff v. Prudential Ins. Co. of America, No. 3:25-cv-05834-DGE, 2026 WL 2389181 (W.D. Wash. Aug. 17, 2026) (Judge David G. Estudillo). The two plaintiffs in this case are widows of pilots employed by Clay Lacy Aviation who died in a February 2024 airplane crash. Clay Lacy provided its pilots basic term life insurance and basic accidental death and dismemberment (AD&D) coverage under a group policy purchased from Prudential Insurance Company of America. The AD&D coverage, unlike the term life benefit, excluded losses resulting from “travel or flight in any vehicle used for aerial navigation” where the decedent was performing as a pilot or crew member. Plaintiffs submitted AD&D claims, which Prudential denied, relying on the aviation exclusion. Plaintiffs allege that “a Prudential employee ‘forecasted the decision’ in a telephone call, stating, ‘[d]on’t blame us [Prudential]. This is Clay Lacy, they were the ones to put the [aviation] exclusion in [the life insurance policy].’” Plaintiffs originally asserted claims against both Clay Lacy and Prudential for recovery of benefits, breach of fiduciary duty, equitable relief, and violations of California and Washington consumer protection statutes, but the court granted defendants’ motion to dismiss in February of this year (as we explained in our February 25, 2026 edition). The court found that plaintiffs failed to identify plan language entitling them to AD&D benefits, that the derivative fiduciary duty claim failed for the same reason, and the state consumer protection claims were preempted by ERISA. The court granted plaintiffs leave to amend, which they did, narrowing their new complaint to two counts: recovery of benefits under 29 U.S.C. § 1132(a)(1)(B) and breach of fiduciary duty. The new complaint is based on allegations that Clay Lacy publicly represented it offered “fully paid” benefits including “life insurance” while knowing the aviation exclusion would bar any AD&D claims for pilots killed while flying for Clay Lacy, and that Prudential kept collecting premiums despite that knowledge. Defendants moved to dismiss again, and prevailed in this order. On the benefits claim, plaintiffs acknowledged the aviation exclusion, but argued that it should not be enforced because doing so would render AD&D coverage “illusory, unconscionable, and objectionable” as a matter of contract and public policy. Plaintiffs cited state law in support of this argument, but the court found that this did not advance the ball because of ERISA, which preempts state law unconscionability theories. Furthermore, federal common law provided no relief either: “ERISA mandates no minimum substantive content for employee welfare benefit plans,” and “we are not free to amend the Plan to our liking.” As for plaintiffs’ “illusory” theory, the court found that plaintiffs “merely state a general principle for federal common law contract interpretation; they do not otherwise state how the aviation exclusion is illusory.” Furthermore, plaintiffs had received life insurance benefits, which undercut their argument regarding illusory benefits. The court thus dismissed plaintiffs’ benefits claim, which doomed their fiduciary duty claim as well. Because plaintiffs’ theory of breach rested on the underlying premise that they were wrongly denied AD&D benefits, the claim failed for the same reason as the benefits claim, without the court needing to resolve any issues of who was a fiduciary. Because plaintiffs did not request further leave to amend, the court dismissed both counts with prejudice. Finally, the court declined Clay Lacy’s request for attorneys’ fees. The court found that its one-paragraph fee argument, which did not address the Ninth Circuit’s Hummell factors, was inadequate to justify fee-shifting against plaintiffs, which is generally disfavored in the Ninth Circuit.
Provider Claims
Second Circuit
Rowe Plastic Surgery of N.J., L.L.C. v. Aetna Life Ins. Co., No. 23-CV-3632-SJB-LKE, 2026 WL 2349750 (E.D.N.Y. Aug. 13, 2026); Rowe Plastic Surgery of N.J., L.L.C. v. Aetna Life Ins. Co., No. 23-CV-3636-SJB-LKE, 2026 WL 2349790 (E.D.N.Y. Aug. 13, 2026) (Judge Sanket J. Bulsara). Rowe Plastic Surgery of New Jersey and East Coast Plastic Surgery are out-of-network providers who, as the court noted at the outset of both of these decisions, have filed “dozens” of nearly identical reimbursement suits against health insurers in New York federal courts over the last few years. Plaintiffs have not succeeded in any of them. These two companion decisions, issued the same day by the same judge, arrived at a similar result. In the first case, before performing surgery on patient R.S., plaintiffs called Aetna to “check the benefits,” and an Aetna representative stated the out-of-network reimbursement rate would be “80 percent reasonable and customary.” Plaintiffs eventually billed $300,000 but received only $39,467.88. In the second case, involving patient E.M., a nearly identical phone call occurred. Again, plaintiffs billed $300,000 but this time they were reimbursed just $8,319.54. In both cases, plaintiffs allege the telephone representations were binding offers that Aetna breached by later applying a different reimbursement methodology. Both complaints asserted the same four claims: (1) breach of contract, (2) unjust enrichment, (3) promissory estoppel, and (4) violation of New York’s Prompt Pay Law. Both cases were filed in state court, removed to federal court, then stayed in early 2024 pending the Second Circuit’s decisions in Park Avenue Podiatric Care v. Cigna Health & Life Ins. Co. and a prior Rowe appeal against Aetna. The decisions in both cases affirmed dismissal of virtually identical claims. The court thus directed the parties to file summary judgment briefing, which were adjudicated in these two decisions. The court’s reasoning, essentially identical in both, rested first on evidentiary threshold rulings and then on the merits. As a preliminary matter, the court rejected plaintiffs’ challenges to Aetna’s evidence, which was offered to authenticate the plans and document the conversations between plaintiffs and Aetna. Aetna’s evidence was admissible because it was either non-hearsay or satisfied the business records hearsay exception. On the merits, the court held that all four state law claims in both cases were expressly preempted by ERISA because, “[n]o matter how much this is dressed up in state law garb,” the claims “grow out of what was (not) paid under an ERISA plan.” Plaintiffs’ “only argument to the contrary” was that Aetna “has not ‘introduced a controlling plan instrument’ to prove the existence of an ERISA-governed plan.” For the court, however, this was unnecessary; it had already held that the plan was governed by ERISA, and this conclusion was bolstered by a summary plan description in the record. The court further ruled that plaintiffs did not have a plausible claim regardless of preemption. The court ruled that Aetna’s “80 percent reasonable and customary” statements lacked “the definiteness typically required to create an offer,” thus foreclosing breach of contract. The unjust enrichment claims failed because the benefit of the surgeries ran to the patients, not to Aetna, which neither requested nor benefited from the services. Plaintiffs’ promissory estoppel claim failed because an indefinite statement cannot constitute the “clear and unambiguous promise” required by the doctrine. The Prompt Pay Law claims were deemed abandoned because plaintiffs failed to defend them in their oppositions. In the end, the court granted summary judgment to Aetna in both cases and dismissed all claims with prejudice. This was not enough for Aetna, which also asked for sanctions in both cases. The court declined, however: “Though the Court appreciates Aetna’s frustration at having to brief the same issues, Plaintiffs were entitled to proceed to summary judgment, since the denial of the motion to amend did not dispose of the claims in the original Complaint. Notwithstanding the waste of time, money, and judicial resources the decision to continue this litigation has incurred, Aetna’s request for sanctions is denied.”
Third Circuit
Abira Medical Laboratories, LLC v. United HealthCare Services, Inc., No. 24-7375 (MAS)(TJB), 2026 WL 2334104 (D.N.J. Aug. 12, 2026) (Judge Michael A. Shipp). Plaintiff Abira Medical Laboratories, also known as Genesis Diagnostics, is a recurring cast member of this newsletter. It is an out-of-network clinical laboratory that has alleged in numerous actions that it was underpaid for the testing services it provided. This particular case alleges that patients insured through health plans administered by United HealthCare Services received services from Genesis and signed assignment-of-benefits forms directing that insurance payments be made directly to Genesis. Genesis contends that between 2016 and 2019 it submitted more than 15,000 claims to United for reimbursement, many of which were either unpaid or not paid at all. According to Genesis, roughly $23 million in unpaid claims is at issue. This was Genesis’ third attempt to plead a viable complaint. After removal from state court, the court dismissed the original amended complaint (with two counts dismissed with prejudice and nine without), then dismissed the second amended complaint in full, each time giving Genesis another chance to amend. (We discussed the dismissal of Genesis’ second amended complaint in our December 3, 2025 edition.) The operative third amended complaint contains five counts: an ERISA claim to recover benefits under 29 U.S.C. § 1132(a)(1)(B) (Count One), breach of contract (Count Two), breach of the implied covenant of good faith and fair dealing (Count Three), quantum meruit/unjust enrichment (Count Four), and promissory estoppel (Count Five). United moved to dismiss all five counts. On the ERISA claim, the court held (for the third time) that Genesis’ failure to identify any specific plan provision entitling it to payment was fatal, since “[a] claim for ERISA benefits ‘stands and falls by the terms of the plan.’” Genesis conceded that it lacked access to the plans, but “attempts to overcome its lack of specific plan language by including spreadsheets of instances where Defendant paid Plaintiff, in whole or in part, for services rendered to the same patients under the same plans as those for which Defendant now allegedly refuses to pay.” This was not good enough: “[E]ven with this additional information, Plaintiff still fails to allege facts regarding any plan language suggesting that it is entitled to payment under ERISA… Without more regarding the precise plan terms at issue, the Court finds that Plaintiff has failed to state an ERISA claim[.]” Genesis fared better with its state law claims. The court held that Genesis’ newly added exhibit (a list of services which included named patients, amounts, and assignment language, among other information) plausibly alleged an implied contract arising from United’s own “prior and concurrent payment practices,” even though Genesis did not quote a specific contractual provision. Because the existence and terms of that implied contract remained genuinely disputed, the derivative implied-covenant-of-good-faith claim survived as well. However, the quantum meruit/unjust enrichment and promissory estoppel counts did not survive. The court stated that when a healthcare provider sues an insurer for unjust enrichment, the benefit conferred is the discharge of the insurer’s obligation to the insured under a plan. However, Genesis failed to tie its claim to any specific plan or plan-based duty, so the count failed regardless of how much billing data it supplied. The promissory estoppel claim failed for a related reason: Genesis alleged only that United’s representatives generally said it “would pay” for services and that United’s history of paying similar claims implied a promise, but under New Jersey law a promissory estoppel claim requires a “clear and definite promise.” Neither a vague verbal assurance nor a pattern of prior claims payments was sufficient. As a result, the suit will continue, but without its ERISA claims.
Fifth Circuit
Columbia Hospital at Medical City of Dallas Subsidiary, L.P. v. California Physicians’ Service, No. 4:24-cv-924, 2026 WL 2365066 (E.D. Tex. Aug. 14, 2026) (Judge Amos L. Mazzant). Plaintiffs Medical City Dallas and Medical City Plano are Texas hospitals that treated two patients enrolled in health plans issued by California Physicians’ Service d/b/a Blue Shield of California, with claims administration handled by Keenan & Associates. Plaintiffs alleged that both patients assigned their plan benefits to the hospitals in exchange for treatment. After plaintiffs submitted claims, Blue Shield and Keenan denied payment, and this action ensued. Plaintiffs sued Blue Shield and Keenan under three counts: Count One, a claim for unpaid benefits under ERISA § 502(a)(1)(B), premised on the patients’ assignments of their plan rights; Count Two, breach of contract against Blue Shield; and Count Three, an alternative breach-of-contract claim against both defendants. Defendants filed a motion to dismiss, which was successful in August of last year because the court found that plaintiffs did not adequately allege that they had standing pursuant to the assignments. (We covered this order in our August 27, 2025 edition.) Plaintiffs amended their complaint, and defendants once again moved to dismiss. The court characterized defendants’ arguments regarding plaintiffs’ derivative standing as a factual attack on subject-matter jurisdiction, not a Rule 12(b)(6) merits or prudential-standing argument. This distinction mattered because “there is no presumptive truthfulness to the allegations in the complaint” in such disputes. Instead, plaintiffs are “‘required to submit facts through some evidentiary method’ to establish ‘by a preponderance of the evidence’ that the Court has subject matter jurisdiction.” The relevant plan documents contained an anti-assignment clause barring subscribers from assigning benefits without the plan’s consent, and plaintiffs did not dispute the clause’s validity or applicability. Instead, plaintiffs argued defendants had waived the clause or should be estopped from enforcing it. However, the court ruled that plaintiffs did not submit competent evidence supporting their waiver/estoppel arguments. The claims at issue were denied out of the gate, and there was no “duplicitous conduct” or “protracted process” that might support a finding that defendants had promised payment. The court dismissed Count One without prejudice but without further leave to amend, holding “a plaintiff who has already had one opportunity to plead facts sufficient to establish subject-matter jurisdiction is not entitled to endless additional chances.” The court thus turned to plaintiffs’ non-ERISA claims and determined there was no personal jurisdiction over defendants, both of which were domiciled in California. The court found Keenan’s contacts with Texas, which included claims processing and treatment-approval communications directed at Texas providers, were insufficient to establish purposeful availment of the jurisdiction. Blue Shield’s participation in the national BlueCard network also did not amount to purposeful availment of the Texas forum. The court thus dismissed all claims against all defendants without prejudice and without leave to amend.
Remedies
Fifth Circuit
Pedersen v. Kinder Morgan Inc., No. 4:21-CV-03590, 2026 WL 2297148 (S.D. Tex. Aug. 10, 2026) (Judge Keith P. Ellison). The plaintiffs in this complex certified class action are current and former employees of energy infrastructure company Kinder Morgan Inc.’s ANR pipeline subsidiary. In this suit they challenged two aspects of the company’s defined benefit pension plan. The Benefit Accrual subclass consists of participants hired before age 35 whose retirement benefits were calculated using a 2001 “Coastal Transition Benefit” formula containing an “uncapped” denominator that could reduce their promised 2% of final-pay accrual rate down to as little as 1.33%, a result that was not explained in the summary plan descriptions (SPDs). The Early Retirement subclass consists of participants who were affected by a plan amendment (the “Ninth Amendment”) that eliminated their ability to “grow into” unreduced early retirement benefits at age 62 rather than age 65, and whose benefits were further affected by a 2018 administrator interpretation of a related “ANR Legacy” provision. The court has already ruled in plaintiffs’ favor on three claims: that the SPDs’ failure to disclose the uncapped denominator violated ERISA § 102, 29 U.S.C. § 1022(a), which requires SPDs to be written in a manner calculated to be understood by the average participant; the Ninth Amendment violated ERISA § 204(g)’s anti-cutback protections; and the 2018 ANR Legacy interpretation was legally incorrect and an abuse of discretion. (Your ERISA Watch covered this ruling in our July 31, 2024 edition.) Plaintiffs then moved for equitable relief. They seek reformation of the Coastal Transition Benefit formula for the Benefit Accrual subclass and reformation plus injunctive relief and prejudgment interest for the Early Retirement subclass. The motion was assigned to Magistrate Judge Yvonne Y. Ho, who issued a memorandum and recommendations (M&R) recommending that reformation be denied for the Benefit Accrual subclass, that reformation and injunctive relief be granted for the Early Retirement subclass but with three carved-out groups of subclass members excluded from relief, and that plaintiffs’ request for a uniform 36-month award of unreduced benefits to the entire subclass be denied as overbroad. Plaintiffs objected on multiple grounds; defendants did not object but preserved their appellate rights as to the court’s earlier liability ruling. The court sustained plaintiffs’ objections as to the Benefit Accrual subclass and granted reformation. It held the M&R had effectively imposed an intentional misconduct requirement onto the “equitable fraud” standard for reformation. The court ruled that “intention to defraud or misrepresent is not a necessary element” of equitable fraud, which instead reaches any breach of a legal or equitable duty that yields an “undue and unconscientious advantage.” The court borrowed the Sixth Circuit’s “three relevant ‘guideposts’ for assessing equitable fraud,” and found that (1) Kinder Morgan’s § 102 violation was a breach of its statutory disclosure duty, (2) the company obtained an undue advantage by saving “in excess of $100 million” and “avoided ‘employee backlash’ by not adequately disclosing the formula’s effect,” and (3) participants suffered a real injury in losing the ability to plan for retirement with an accurate understanding of their benefits. The court thus found there was “clear and convincing evidence” that “Defendants’ violation of ERISA § 102 constituted fraud or inequitable conduct,” and ordered the Coastal Transition Benefit formula reformed to the 2% accrual rate participants reasonably understood from the SPDs. On the Early Retirement subclass, the court sustained in part and overruled in part plaintiffs’ objections. It agreed with plaintiffs that the M&R’s exclusion of three subclass groups improperly imported a “detrimental reliance” requirement rejected by the Supreme Court in CIGNA Corp. v. Amara. The court found that the record “supports a reasonable inference that all Early Retirement subclass members were harmed,” and thus “it is within this Court’s discretion to award them equitable relief.” However, the court agreed with the M&R that plaintiffs’ request for a blanket 36-month award of unreduced benefits to the entire subclass would function as damages rather than equitable relief and would give many members an unwarranted windfall. It instead ordered individualized “make whole” relief tailored to each participant’s actual circumstances.
