Patterson v. UnitedHealth Grp., Inc., No. 25-3175, __ F.4th __, 2025 WL 3458953 (6th Cir. Dec. 2, 2025) (Before Circuit Judges Siler, Nalbandian, and Readler).

For regular readers, our case of the week might look eerily familiar. In August of 2023 we covered a case with the exact same name – indeed, both cases are published decisions out of the Sixth Circuit with the same panel of judges. The underlying case number is different, however. What’s going on?

The parties are in fact the same as in the prior case. The plaintiff is Eric Patterson, who was injured in a car accident. He had medical coverage through an ERISA-governed healthcare plan insured by defendant UnitedHealth Group. Mr. Patterson sued the other driver involved in the accident in state court in Ohio, and joined United, seeking a declaratory judgment that United had no right to reimbursement of any potential recovery. United pointed to the summary plan description (“SPD”), which included a right to reimbursement, and maintained there was no other plan document. Eventually, Mr. Patterson settled with the other driver and agreed to pay United $25,000 in reimbursement pursuant to the SPD’s terms.

As (bad) luck would have it, a couple of months later Mr. Patterson’s wife was injured in a second traffic accident. As before, United paid the medical bills and sought reimbursement. Like her husband, Ms. Patterson brought a lawsuit in state court against the other driver, contending that United should not be entitled to reimbursement. However, things went differently this time because United produced a plan document which did not contain a reimbursement right and thus contradicted the SPD. In the end, Ms. Patterson won her state law case, including judgment in her favor on the declaratory relief claim against United. (The Ohio Court of Appeals subsequently affirmed this decision.)

Mr. Patterson was annoyed that his wife was able to avoid reimbursing United while he was not, even though their claims both arose under the same benefit plan and should have been treated similarly. As a result, Mr. Patterson filed a class action against United seeking, among other remedies, the return of the $25,000 he was forced to cough up in his accident case.

The district court dismissed Mr. Patterson’s complaint for several reasons, including on the merits, ruling that his allegations did not fit within any of ERISA’s remedial provisions. In its August 1, 2023 decision the Sixth Circuit affirmed in part and reversed in part. The court agreed that Mr. Patterson had standing to sue for return of his $25,000 settlement payment, but ruled he was not entitled to injunctive relief because he did not plausibly allege any future injury. He also was not entitled to pursue class claims. However, the Sixth Circuit reversed the dismissal of Mr. Patterson’s claim for breach of fiduciary duty under 29 U.S.C. § 1132(a)(3), holding that his complaint plausibly alleged such a claim against United, and that disgorgement of the $25,000 and restitution were forms of equitable relief that he could pursue under Section 1132(a)(3).

That action is still pending in district court. However, this was not satisfactory to Mr. Patterson. Because the district court originally declined to exercise supplemental jurisdiction over his state law claims, Mr. Patterson filed a new complaint in state court asserting those claims once again. On behalf of himself as well as two putative classes, he asserted claims for fraudulent and negligent misrepresentation, conversion, civil conspiracy, and unjust enrichment.

Unsurprisingly, defendants removed this second case to federal court based on ERISA preemption. The parties then filed dueling motions; Mr. Patterson moved to remand the case back to state court while defendants moved to dismiss the case. The district court granted defendants’ motion, viewing Mr. Patterson’s claims as “a repackaged version of his still-pending ERISA lawsuit.” The court concluded that “both actions rested on the same factual events and sought the same outcome: a return of the $25,000 Patterson says he should not have had to pay because of the plan’s terms.” Thus, the court concluded that Mr. Patterson’s state law claims were governed, and preempted, by ERISA.

However, the court did not grant Mr. Patterson leave to amend his complaint to recharacterize his claims under ERISA. The court reasoned that doing so was pointless; Mr. Patterson already had similar if not identical ERISA claims pending in his original case. Thus, instead of allowing duplicate lawsuits with duplicate claims, the court chose to dismiss the second, later-filed action.

Mr. Patterson appealed to the Sixth Circuit once again, and in this published decision the court affirmed the ruling below, this time in its entirety. The court addressed two issues: “the district court’s refusal to remand and its dismissal of Patterson’s complaint.”

On the first issue, Mr. Patterson argued that his state law claims were “wholly independent” of ERISA and could proceed alongside his parallel ERISA suit. The Sixth Circuit explained that ERISA’s complete preemption doctrine allows federal courts to assume jurisdiction over state law claims that duplicate or supplant ERISA’s civil enforcement remedies. The court applied the two-pronged Supreme Court test from Aetna Health Inc. v. Davila to determine complete preemption, i.e., whether Mr. Patterson’s claims were for benefits due under an ERISA plan and whether they implicated a legal duty independent of ERISA.

The Sixth Circuit ruled that Mr. Patterson’s claims met both prongs of the Davila test. The court stated that his claims were essentially for the recovery of benefits under § 1132(a)(1)(B) because they sought return of the $25,000 reimbursement, which was tied to the plan’s terms. The court noted that its conclusion was consistent with “[a] collection of circuits [which] has held that similar state law challenges to an ERISA plan’s reimbursement rights are in essence disguised suits ‘to recover benefits due’ under § 1132(a)(1)(B).”

Mr. Patterson contended that he could not be seeking benefits under § 1132(a)(1)(B) because his benefits had already been paid and thus “the obligation of the ERISA plan to provide benefits was over.” However, the Sixth Circuit saw “no practical difference whether the plan clawed back Patterson’s benefits after paying for his care or simply withheld them until getting its claimed share of the recovery. In either case, benefits are ‘due.’”

Moving on to the second prong of Davila, the Sixth Circuit determined that Mr. Patterson’s claims did not implicate a duty independent of ERISA because they were based on the plan’s terms and required interpretation of the plan: “Each of defendants’ alleged breaches of duty rests entirely upon what Patterson’s ERISA-governed plan does (or does not) say.”

Mr. Patterson contended that no plan interpretation was needed because defendants “only lied about the ‘existence’ of the plan document, not its ‘meaning.’” However, the Sixth Circuit explained that this was incorrect because in order to prevail, “a court – whether an Ohio court or elsewhere – must interpret his ERISA plan and determine whether it created a duty to provide reimbursement-free benefits. That is, ‘[some]body needs to interpret the plan.’”

As a result, the Sixth Circuit determined that the district court properly granted defendants’ motion to dismiss because Mr. Patterson’s state law claims were preempted by ERISA. This left the second issue – “one last housekeeping matter” – of whether the district court should have dismissed without leave to amend.

The Sixth Circuit ruled, “We see no misstep in that approach.” The court explained that Mr. Patterson had already disavowed a claim under Section 1132(a)(1)(B), and thus he could no longer proceed under that provision. As for Section 1132(a)(3), Mr. Patterson’s original action, currently pending on remand from the Sixth Circuit, already contains a claim based on that provision. “To let Patterson replead his state law claims under ERISA would thus result in duplicative proceedings before the same court. In that situation, district courts enjoy the discretion over their dockets to dismiss duplicate cases.” The court observed that “Patterson does not fault the district court for dismissing this later-filed action,” and thus, “Neither do we.”

As a result, the Sixth Circuit affirmed the district court’s dismissal, and thus Mr. Patterson will only be allowed to continue with his original action, limited to relief under Section 1132(a)(3)…unless he files another (fifth!) lawsuit. Stay tuned!

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

Breach of Fiduciary Duty

Third Circuit

Grink v. Virtua Health, Inc., No. 24-CV-09919, 2025 WL 3485686 (D.N.J. Dec. 3, 2025) (Judge Christine P. O’Hearn). Plaintiffs Kelly Grink, Diane Trump, and Steven Molnar are participants in the Virtua Health 401(k) Plan and 403(b) Retirement Program who allege fiduciary breaches and prohibited transactions under ERISA by various defendants associated with both Virtua and Lincoln National, which provided services to the plans. The allegations include (1) imprudent selection and retention of the Lincoln Stable Value Account (“SVA”) as the primary fixed-income investment, resulting in exposure to Lincoln’s credit risk and undisclosed “spread income”; (2) the use of higher-cost mutual fund share classes when lower-cost options were available, leading to excessive fees; (3) underperformance and excessive fees related to several actively managed funds, including Oakmark and Goldman SCV; (4) inadequate monitoring processes and underperformance of the LifeSpan Models TDF investment option; and (5) excessive recordkeeping and administrative fees, resulting in over $11.7 million in fees over five years. The Virtua defendants and the Lincoln defendants both filed motions to dismiss, which were decided in this order. The Virtua defendants argued that the plaintiffs failed to allege that Virtua and the Virtua Board were fiduciaries or that there was a flawed fiduciary process, while the Lincoln defendants contended that they were not fiduciaries for the alleged prohibited transactions and were thus not liable. Addressing the Lincoln defendants’ motion first, the court concluded that the plaintiffs failed to establish that the Lincoln defendants were fiduciaries concerning the alleged prohibited transactions. The court ruled that the complaint “only alleges the Lincoln Defendants were liable as parties in interest to the ‘annuity transactions,’ and nothing else,” i.e., no concrete affirmative conduct, which was insufficient. Furthermore, plaintiffs’ allegations regarding the Lincoln defendants’ fiduciary status related to the execution of the Group Annuity Contract were “conclusory.” The court cited cases holding that annuity providers owe no fiduciary duty to plan participants. As for the Virtua defendants’ motion, the court agreed that neither Virtua nor its Board were named fiduciaries under the plan documents. The court noted that plan sponsorship alone does not confer fiduciary status, as it is considered a corporate or settlor function. However, Virtua was found to be a fiduciary concerning the “annuity transactions” due to its discretionary actions in contracting with Lincoln for the SVA. The court determined that the Virtua Board did not exercise the required control over the management of plan assets to be considered fiduciaries. On the merits, the court found that the plaintiffs adequately alleged a breach of the duty of prudence regarding the Share Class Claims and some Actively Managed Fund Claims. The court determined that the allegations regarding the Oakmark and Goldman SCV funds raised a sufficient inference of imprudence due to their underperformance compared to benchmarks and industry comparators. However, the court found that the allegations related to the MetWest and Europacific Growth funds did not provide sufficient facts for a reasonable comparison, thus failing to state a claim for imprudence. The court also granted the Virtua defendants’ motion to dismiss one of the prohibited transaction counts, as the plaintiffs did not sufficiently allege self-dealing or conflict of interest, nor did they identify a specific transaction with UBS/Morgan Stanley that violated ERISA. In the end, there was something for everyone in this complicated decision. The court gave plaintiffs leave to amend, so we may see another one like it in the near future.

Fourth Circuit

Garner v. Northrop Grumman Corp., No. 1:25-CV-00439 (AJT/WEF), 2025 WL 3488657 (E.D. Va. Dec. 4, 2025) (Judge Anthony J. Trenga). The plaintiffs in this case are participants in defendant Northrop Grumman Corporation’s defined contribution retirement plan. They allege that the defendants failed to adhere to the plan document, breached fiduciary duties, and engaged in prohibited transactions by misusing forfeited plan contributions. Specifically, they contend that defendants should have used forfeited contributions to restore participant accounts or pay plan expenses, instead of reducing the company’s future contribution obligations. They claim that over 20,000 plan participants left the company between 2018 and 2023 with unvested benefits, resulting in $70.8 million in forfeitures, which were used to reduce employer contributions rather than cover $57.4 million in administrative expenses. Plaintiffs alleged failure to follow plan terms, breach of fiduciary duties of loyalty and prudence, failure to monitor, breach of the anti-inurement provision, and engaging in prohibited transactions. Defendants filed a motion to dismiss, which the court granted in full. The court ruled that there was no violation of plan terms because the plan did not mandate a specific order for using forfeitures, allowing them to be used for any of three purposes (paying expenses, restoring accounts, or reducing contributions). For the same reason, the court further ruled that there was no breach of fiduciary duty. The court stated that the plan authorized defendants’ conduct and ERISA does not impose “an exclusive duty to maximize pecuniary benefits.” As for plaintiffs’ anti-inurement claim, the court found that using forfeitures to meet employer contribution obligations did not violate this provision, as the funds were used to provide benefits to participants. Similarly, the court dismissed the prohibited transactions claims, as the plaintiffs did not allege any improper transactions involving plan assets. The court ruled that plaintiffs did not allege that any of the forfeited assets were removed from the plan or were used in a type of “transaction” necessary to impose liability under 29 U.S.C. § 1106. Finally, the court dismissed plaintiffs’ failure to monitor claim, as it was derivative of the fiduciary duty claims. As a result, the court dismissed all of plaintiffs’ claims, a result consistent with the decisions of most other courts on these issues.

Seventh Circuit

Clinton v. Baxter Int’l, Inc., No. 25 CV 3368, 2025 WL 3470685 (N.D. Ill. Dec. 3, 2025) (Judge Lindsay C. Jenkins). Plaintiff Charles Clinton filed this class action against Baxter International Inc. and its Investment Committee, alleging violations of fiduciary duties under ERISA. Clinton claimed that the stable value fund (“SIF”) in Baxter’s retirement plan provided significantly lower returns compared to other similar funds available during the class period from 2019 to 2023. He argued that Baxter failed to maximize returns by not demanding higher crediting rates from insurance companies or seeking alternative investment options. Defendants moved to dismiss, arguing that Clinton failed to state a claim for relief. In his opposition, Clinton alleged that the Investment Committee breached its duty of prudence by selecting and retaining underperforming investment options. However, the court noted that Clinton lacked actual knowledge of the defendants’ decision-making process and relied on inferences and comparisons to other stable value funds. The court agreed with Clinton that the funds he selected for comparison were of the same type as the SIF, i.e., stable value funds. However, the court ruled these funds were inadequate for comparison because Clinton “fail[ed] to provide a uniform sample.” The court explained that Clinton’s “data points are four to six comparators each year from 2019 to 2023 – none of which appear across all five years. The closest he comes to providing a year-to-year comparator are two funds analyzed from 2019 through 2022, but not in 2023. The rest make one or two appearances, and in the latter case, often non-consecutively. All the complaint shows, then, is that the SIF doesn’t boast one of the top four to six crediting rates in a given year. There is no consistent benchmark.” The court also addressed the issue of how the relevant crediting rates should be calculated. Defendants argued that the differences in crediting rates between the SIF and comparator funds were too minor to support a claim of imprudence, and the court agreed, ruling that Clinton’s methodology for calculating these rates was flawed. As a result, the court granted defendants’ motion in its entirety, but without prejudice.

Disability Benefit Claims

Eleventh Circuit

Eggleston v. Unum Life Ins. Co. of Am., No. 24-13678, __ F. App’x __, 2025 WL 3472834 (11th Cir. Dec. 3, 2025) (Before Circuit Judges Jill Pryor, Luck, and Brasher). Plaintiff Yvette Eggleston was a clinical research nurse at Johns Hopkins Bayview Medical Center and a participant in Johns Hopkins’ long-term disability benefit plan, which was insured by defendant Unum Life Insurance Company of America and governed by ERISA. The policy allowed benefits for 24 months if she was unable to perform her regular occupation due to sickness or injury, and beyond that period only if she was unable to work in any gainful occupation. Eggleston stopped working in 2011 due to chronic illnesses and was initially approved for benefits by Unum. After 24 months, Unum continued her benefits based on her medical condition but noted potential for improvement. In 2021, Unum discovered social media posts showing Eggleston engaging in activities that suggested improved functional capacity, prompting a review of her file. Unum concluded that her chronic conditions were stable and controlled, and she could perform sedentary work. Consequently, Unum terminated her benefits, and that decision was upheld by the district court. (Your ERISA Watch covered this decision in our October 30, 2024 edition.) In this per curiam decision, the Eleventh Circuit affirmed. The court applied its six-step framework for reviewing ERISA benefit determinations, and like the district court, skipped directly to step three, in which it assessed whether Unum’s decision was arbitrary and capricious. This standard of review was required because the policy granted Unum discretionary authority to make benefit determinations. The court concluded that “Unum’s multiple medical expert opinions, Eggleston’s social media activity, and Eggleston’s medical records were enough to find that Unum’s decision was not arbitrary and capricious.” The court was convinced that Unum considered all relevant information and “simply reached a different conclusion as to what findings the record supports.” As a result, under a deferential standard of review, the court could not conclude that Unum was unreasonable in crediting the reports of Unum’s reviewing physicians over those of Eggleston’s doctors. The Eleventh Circuit thus affirmed the decision and upheld the denial of Eggleston’s claim.

Discovery

Ninth Circuit

Davalos v. GreatBanc Trust Co., No. 1:25-CV-00706-KES-SKO, 2025 WL 3470168 (E.D. Cal. Dec. 3, 2025) (Magistrate Judge Sheila K. Oberto). The plaintiffs in this putative class action allege various ERISA violations regarding the Western Milling Employee Stock Ownership Plan. Their claims arise from the 2022 sale of stock back to Defendant Kruse Western Inc., in which the plaintiffs allege the plan and its participants did not receive fair market value. Several defendants filed a motion to dismiss, arguing lack of subject matter jurisdiction and that the claims are barred under ERISA’s statute of limitations. The plaintiffs responded with a motion for jurisdictional discovery, which was adjudicated in this order. Plaintiffs claimed they needed discovery to challenge the factual assertions made in the motions to dismiss, in which defendants relied on the Plan’s Form 5500 filings as alleged proof that the Plan and its participants actually benefited from the 2022 sale of stock, thereby asserting that plaintiffs did not suffer any injury. Plaintiffs argued that denying them access to documents relating to the 2022 sale, while allowing defendants to use those same documents to assert a lack of standing, would be unjust and prevent them from effectively responding to the jurisdictional challenge. The court agreed, recognizing that while discovery is typically not permitted before the parties’ Rule 26(f) conference, expedited discovery may be allowed for good cause, particularly where facts relating to jurisdiction are disputed. The court emphasized that it would be inequitable to permit one side to rely on certain evidence while denying the other side the opportunity to challenge or verify it. The court further noted that the defendants would not suffer prejudice because the relevant documents had already been produced to plaintiffs previously, albeit confidentially under Federal Rule of Evidence 408. As a result, the court granted plaintiffs’ motion for jurisdictional discovery.

ERISA Preemption

Ninth Circuit

Healthcare Ally Mgmt. of Cal., LLC v. United Healthcare Servs., Inc., No. 24-5178, __ F. App’x __, 2025 WL 3485391 (9th Cir. Dec. 4, 2025) (Before Circuit Judges Callahan, Owens, and Koh). This is one of a number of cases plaintiff Healthcare Ally Management of California (“HAMOC”) has filed against various insurers seeking reimbursement for treatment it provided to patients. Here, HAMOC filed suit against United Healthcare Services, Inc., alleging state law claims of negligent misrepresentation and promissory estoppel. These claims were based on alleged representations by United during a phone call, promising reimbursement at the “usual, customary, and reasonable” (“UCR”) rate instead of the lower Medicare rate. The district court dismissed these claims on the ground that they were preempted by ERISA, citing the Ninth Circuit’s recent decision in Bristol SL Holdings, Inc. v. Cigna Health & Life Ins. Co., 103 F.4th 597 (9th Cir. 2024). HAMOC appealed. In a brief memorandum decision, the Ninth Circuit affirmed. Noting that ERISA preempts any state laws that “relate to” employee benefit plans, the court identified two categories of state-law claims: those with a “reference to” an ERISA plan and those with an “impermissible connection with” an ERISA plan. HAMOC’s claims fell into both categories. The claims had a “reference to” an ERISA plan because they were premised on the existence of a plan, which was essential for the claims’ survival. The claims also had an “impermissible connection with” an ERISA plan as they would interfere with plan administration and ERISA-regulated relationships. The court noted that allowing HAMOC’s state law claims would create interference with nationally uniform plan administration because benefits would be governed by variable state law interpretations rather than ERISA and plan terms. As a result, the court concluded that HAMOC’s attempt to bind United to UCR rates based on phone call representations was preempted by ERISA, and thus upheld the district court’s ruling below.

Pleading Issues & Procedure

First Circuit

Radoncic v. National Union Fire Ins. Co. of Pittsburgh, PA, No. 2:25-CV-00138-LEW, 2025 WL 3494703 (D. Me. Dec. 5, 2025) (Magistrate Judge John C. Nivison). In 2018, plaintiff Skender Radoncic suffered an injury to two fingers on his right hand, leading to the amputation of his index finger in August 2023. Subsequently, his spouse submitted a claim under her employer’s ERISA-governed group accident insurance benefit plan. Defendant National Union Fire Insurance Company of Pittsburgh, the insurer of the plan, denied the claim in October 2023, stating that the loss was not covered, and this action followed. Radoncic filed a motion to modify the administrative record, seeking the inclusion of certain documents for in camera review by the court. These documents included pre-denial emails, litigation hold notices, file copy requests, a coverage letter, and redacted claims notes. In response, National Union argued that these documents were protected by attorney-client privilege and attorney work product. The court noted that case law recognizes a fiduciary exception to the attorney-client privilege in ERISA cases. This exception prevents an ERISA fiduciary from asserting the privilege against plan beneficiaries on matters of plan administration. However, the privilege can still be invoked for non-fiduciary matters, such as when legal advice is sought for the fiduciary’s own protection. Radoncic contended that the disputed documents were created before the final denial decision in April 2024, thus falling under the fiduciary exception, while National Union argued that the fiduciary exception did not apply because the relationship became adversarial when Radoncic appealed the denial in March 2024. The court granted Radoncic’s motion in part, allowing an in camera review of the documents to assess National Union’s claim of attorney-client privilege. The court ordered National Union to submit the documents at issue to the court and deferred ruling on the merits of Radoncic’s motion until after its review is complete.

Fourth Circuit

West Virginia United Health System, Inc. v. GMS Mine Repair & Maintenance, Inc. Employee Medical Plan, No. 1:25-CV-34, 2025 WL 3455947 (N.D.W. Va. Dec. 2, 2025) (Judge Thomas S. Kleeh). West Virginia University Health System (“WVUHS”) filed this action against GMS Mine Repair and Maintenance, Inc. Employee Medical Plan (“GMS”) and The Health Plan of West Virginia, Inc. (“THP”), accusing them of fraud. GMS operates a self-funded health plan for its employees, administered by THP. WVUHS and THP had a contract for negotiated payment rates for traditional insurance, but no such contract existed for the GMS plan. WVUHS discovered that THP was processing claims for GMS using a reference-based pricing scheme, which led to disputes over payment rates. WVUHS alleged that GMS’ member cards fraudulently imitated THP’s commercial insurance cards, misleading WVUHS into providing services under false pretenses. As a result, WVUHS claimed that GMS and THP reimbursed them at significantly lower rates than agreed, resulting in substantial financial losses. WVUHS initially filed its complaint in state court. THP removed it, contending that WVUHS’ claims were preempted by ERISA. The court disagreed and sent the case back to state court. Next, GMS removed the case, and WVUHS once again moved for a remand. In this order the court granted WVUHS’ motion. The court ruled that GMS was collaterally estopped from removing the case, as the issue of ERISA preemption had been previously decided. The court found that (1) the issue was the same in both removals (i.e., ERISA preemption), (2) the issue was determined by the court in the previous motion, (3) the determination was a “critical and necessary part of the decision in the prior proceeding,” (4) the prior ruling was final and valid, and (5) the parties were the same and GMS had “a full and fair opportunity to litigate the issue in the first removal attempt.” The court reiterated that “[u]nder the plain language of the Plan, the anti-assignment provision appears valid and therefore, WVUHS could not bring a suit under ERISA even if there were a written assignment of benefits. Thus, WVUHS does not have standing to sue THP under ERISA.” GMS attached a newly created waiver of the anti-assignment provision to its notice of removal, but the court scathingly rejected this last-ditch effort to avoid remand: “The Court is not persuaded by GMS’s blatant attempt to manufacture jurisdiction… The Court finds that GMS’s removal attempt at issue showcases that GMS is now trying to change and manipulate the terms of the governing plan to create federal jurisdiction… GMS’s conduct runs afoul good faith and fair dealing and its behavior cannot be condoned.” As a result, WVUHS’s motion was granted once again, and the case will head back to state court for a second time.

Tenth Circuit

M.H. v. United Healthcare Ins. Co., No. 2:22-CV-00307-AMA-DAO, 2025 WL 3443490 (D. Utah Dec. 1, 2025) (Judge Ann Marie McIff Allen). In this case of twists and turns, plaintiffs M.H. and C.H. sued defendants United Healthcare Insurance Company, United Behavioral Health, True Value, and the True Value Company Medical Program alleging that defendants violated ERISA by failing to pay benefits under True Value’s employee healthcare plan. Initially, the parties engaged in settlement negotiations, which were successful. All’s well that ends well? Not so fast. Plaintiffs filed a notice of settlement on May 28, 2024, but withdrew from it on July 25, 2024, claiming that defendants’ counsel failed to provide the promised settlement agreement for signing. A status conference was held on August 14, 2024, and subsequently, the defendants filed a motion to enforce the settlement agreement, which the plaintiffs opposed. In January of 2025, the parties agreed to resolve the case through a second proposed settlement agreement. Defendants prepared an agreement, which the plaintiffs signed and returned, but this time defendants held things up. Defendants explained in a February 27, 2025 filing with the court that they would not sign because True Value had filed for Chapter 11 bankruptcy, which was crucial because the True Value Company Medical Program was self-funded, not insured, and thus True Value was on the hook for part of the settlement. Plaintiffs subsequently filed a motion to enforce the settlement, which the court denied in this order. The court explained that the automatic stay on actions against a debtor imposed by the Bankruptcy Code (11 U.S.C. § 362(a)) prevented the enforcement of the settlement agreement. Plaintiffs tried to “work around the automatic stay by suggesting that True Value could negotiate and enter the settlement even after its bankruptcy filing because the bankruptcy court has authorized True Value to conduct certain business in the ordinary course.” But the court rejected this, ruling that “payments made pursuant to a settlement agreement are not made in the ordinary course of business, and the present litigation is not in the normal course of business[.]” The court agreed with plaintiffs that the automatic stay provision “does not extend to solvent codefendants of the debtor,” and thus had no effect on the case’s other defendants. However, “the Court cannot ignore the reality that the purported agreement Plaintiffs seek to enforce was between all of the Parties,” and thus, because one of the parties had triggered the automatic stay, the entire agreement was void. The court was sympathetic, acknowledging “the complications True Value’s bankruptcy presents to Plaintiffs in pursuing their claims,” but the court concluded that its hands were tied by the automatic stay rule. As a result, the court denied plaintiffs’ motion to enforce the settlement.

Provider Claims

Fifth Circuit

Horizon Surgery Center, PLLC v. D. Reynolds Co., LLC, No. 3:25-CV-00255, 2025 WL 3443191 (S.D. Tex. Dec. 1, 2025) (Magistrate Judge Andrew M. Edison). Plaintiff Horizon Surgery Center, PLLC filed suit against D. Reynolds Company, LLC, the administrator of a health benefit plan governed by ERISA, alleging nonpayment for medical services provided to Mary Bruce, a participant in the plan. Horizon claimed it had confirmed that Bruce’s treatments were eligible for coverage under the plan before providing services in 2021 and 2022. Bruce had assigned her rights to benefits under the plan to Horizon, which alleged it was owed $579,548.40 for the services provided. Horizon asserted five causes of action in its operative complaint; one was for denial of benefits under ERISA (29 U.S.C. § 1132(a)(1)(B)), one was for breach of fiduciary duty under ERISA (29 U.S.C. § 1132(a)(3)), and the remainder were state law claims. Reynolds moved to dismiss all claims except the ERISA denial of benefits claim, arguing that the ERISA breach of fiduciary duty claim was duplicative and the state law claims were preempted by ERISA. In this order a magistrate judge recommended that Reynolds’ motion be granted. The court agreed with Reynolds that Horizon’s ERISA breach of fiduciary duty claim was duplicative of its ERISA denial of benefits claim. The court noted that Horizon’s alleged damages under its § 1132(a)(3) claim – unpaid or underpaid claims – were tied to benefits due under the plan, making § 1132(a)(1)(B) the more appropriate avenue for redress. Additionally, the court found that Horizon’s allegations of flawed administrative claims procedures were properly addressed under § 1132(a)(1)(B), not § 1132(a)(3). The court emphasized that the monetary relief sought by Horizon was legal rather than equitable, further precluding relief under § 1132(a)(3). As for Horizon’s state law claims, the court ruled that they were all preempted by ERISA. The court applied the Fifth Circuit’s two-part test for ERISA preemption, which examines whether the state law claims address areas of exclusive federal concern, such as the right to receive benefits under an ERISA plan, and whether the claims directly affect the relationship among traditional ERISA entities. The court agreed with Reynolds that Horizon’s state law claims were inextricably related to the plan and its terms, as they arose from Horizon’s verification of Bruce’s eligibility under the plan and its claim for payment for services rendered. The court rejected Horizon’s argument that Reynolds’ direct communications created a separate promise and independent relationship, finding that the claims were dependent on the plan’s terms and benefits. Consequently, the court recommended dismissing these claims with prejudice.

Statute of Limitations

Second Circuit

Fromageot v. Britt, No. 3:21-CV-1165-MPS, 2025 WL 3470473 (D. Conn. Dec. 3, 2025) (Judge Michael P. Shea). The case involves a 20-year dispute over life insurance proceeds following the death of Paul Fromageot in 2004. Paul was employed by Alliance Capital and had life insurance through an ERISA-governed employee benefit plan sponsored by the company and insured by Hartford Life. Paul had initially designated his wife, Madeline Fromageot, his parents, and his only child at the time as co-equal beneficiaries. However, after Paul’s death, Madeline claimed that Paul had updated his policies to make her and their four children the primary beneficiaries, with his parents as contingent beneficiaries. Despite this, Hartford Life distributed the proceeds according to the original beneficiary designations. Madeline has been involved in litigation in both state and federal court since 2007, challenging the distribution of these funds. She filed this particular action pro se in 2021, purporting to represent Paul’s estate and her children and their trusts as well. The case has already been dismissed twice, once for lack of subject matter jurisdiction, and again because Madeline failed to properly serve Hartford Life. Her complaint contains twelve causes of action, nine of which are against Hartford Life. Hartford Life filed a motion to dismiss, arguing that Madeline cannot represent others while representing herself, and that her ERISA claims are time-barred. The court agreed and granted Hartford Life’s motion. The court ruled that Madeline had Article III standing because “Madeline is entitled to the reasonable inference that, because the proceeds from Paul’s policy were not deposited into the children’s education funds…Madeline herself was left to foot any bills related to her children’s schooling.” However, the court also ruled that Madeline lacked standing to sue on behalf of Paul’s estate, her children, or their trusts due to her pro se status. As for the merits of her individual claims, the court ruled that her ERISA claims were time-barred by the terms of the Hartford Life policy, which required claims to be filed within three years of proof of loss. “Paul died on June 4, 2004…and so proof of loss was due on September 2, 2004, and Madeline had until September 2, 2007 to file suit against Hartford Life. She did not do so until May 22, 2023 – over 15 years late.” Madeline advanced arguments for extending the limitations period against Hartford Life, including fraudulent concealment and equitable tolling, but these were rejected by the court. The court noted that Madeline did not allege any fraud by Hartford Life; instead, she alleged fraud on the part of Paul’s parents. Furthermore, the conduct at issue occurred after the limitations period ended, and “fraudulent concealment cannot toll a limitations period that has already expired.” The court further explained that equitable tolling did not apply because Madeline had the necessary information to bring her claims well before the limitations period expired, and there were no “extraordinary circumstances” that would entitle her to equitable tolling. As a result, the court granted Hartford Life’s motion to dismiss the ERISA claims against it. The court declined to exercise supplemental jurisdiction over the remaining state law claims, and dismissed those claims without prejudice.

Fifth Circuit

Mitchell v. H-E-B, L.P., No. 25-50227, __ F. App’x __, 2025 WL 3496980 (5th Cir. Dec. 5, 2025) (Before Circuit Judges Jones and Engelhardt, and District Judge Robert R. Summerhays). Plaintiff Arieanna Mitchell brought this action against defendant H-E-B, asserting a single cause of action for “denial of benefits.” The only ERISA provision she cited in support of her claim was Section 510, which makes it “unlawful for any person to discharge…a participant or beneficiary…for the purpose of interfering with the attainment of any right to which such participant may become entitled under the plan.” The district court granted summary judgment to defendant H-E-B, concluding that Mitchell’s claim was untimely under Section 510’s two-year statute of limitations (borrowing from Texas law). Mitchell appealed to the Fifth Circuit, which affirmed in this brief per curiam decision. On appeal Mitchell attempted to characterize her claim as one for breach of fiduciary duty, which has either a three- or six-year statute of limitations, depending on actual knowledge of the breach. However, the Fifth Circuit ruled that Mitchell forfeited this argument by not raising it in the district court. Furthermore, the court held that Mitchell’s complaint inadequately alleged a breach of fiduciary duty, only mentioning such a violation in passing and in the context of explicitly citing Section 510 instead. As a result, Mitchell failed to provide H-E-B with fair notice of any breach of fiduciary duty claim. Thus, the Fifth Circuit concluded that the district court properly dismissed Mitchell’s complaint because it was brought after the expiration of the two-year statute of limitations for Section 510 claims, and affirmed the decision below in its entirety.

‘Twas another slow week in ERISAland, as the federal courts put aside breaches of fiduciary duty for turkey, stuffing, and cranberry sauce. Nevertheless, some judges were devoted enough to delve into ERISA’s intricacies. Read on to find out about (1) the exclusion of expert witness testimony in the class action by NFL players against the league’s disability plan (Alford v. NFL), (2) two diverging discovery rulings in benefit cases (Kelly v. Valeo (no discovery allowed), Miller v. American United (sure, why not)), and (3) whether Johnson & Johnson’s health plan participants have standing to pursue claims that the plan overpaid for prescription drugs (nope, Lewandowski v. Johnson & Johnson). It was a bad week for health care providers as well, as two were bounced out of court on motions to dismiss (Murphy v. Emblem, Abira v. United), and a third lost on appeal (Dedicato v. Aetna).

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

Breach of Fiduciary Duty

Third Circuit

Lewandowski v. Johnson & Johnson, No. 24-671 (ZNQ) (RLS), 2025 WL 3296009 (D.N.J. Nov. 26, 2025) (Judge Zahid N. Quraishi). Plaintiffs Ann Lewandowski and Robert Gregory are former employees of Johnson & Johnson and participants in its health benefit plans who allege that the defendants, Johnson & Johnson and its Pension & Benefits Committee, breached their fiduciary duties under ERISA. Specifically, they contend that defendants mismanaged the prescription drug benefits program, resulting in excessive costs for the plans and their participants. These costs allegedly included higher payments for prescription drugs, premiums, out-of-pocket expenses, deductibles, coinsurance, and copays. The plaintiffs also alleged that the defendants steered beneficiaries toward a mail-order pharmacy that charged higher prices than retail pharmacies, failed to incentivize the use of lower-priced generic drugs, and inadequately negotiated contracts with pharmacy benefit managers (“PBMs”), leading to higher drug prices for participants. Previously, the court granted defendants’ motion to dismiss plaintiffs’ fiduciary breach claims, concluding that plaintiffs lacked standing. (Your ERISA Watch covered this decision in our January 29, 2025 edition.) The court allowed plaintiffs to amend their complaint, and defendants responded with another motion to dismiss. In this order, the defendants prevailed once again on their standing arguments. The court again determined that the plaintiffs’ alleged injuries – higher premiums and out-of-pocket costs – were speculative and not directly traceable to the defendants’ actions. The court found that the connection between the administrative fees paid by the plans to the PBM and the plaintiffs’ contribution rates was tenuous. Additionally, the court noted that the plans vested the defendants with sole discretion to set participant contribution rates, which could be influenced by various factors unrelated to prescription drug benefits. The court also found that the plaintiffs’ allegations of economic harm lacked sufficient specificity and failed to establish a plausible causal connection. The court further ruled that even if the plaintiffs prevailed and obtained the relief they sought, the defendants could still increase participant contribution rates under the terms of the plans without violating ERISA, and thus plaintiffs failed the redressability test. As a result, the court once again ruled that plaintiffs’ complaint did not meet Article III’s standing threshold and dismissed it. The court did give plaintiffs one more try, however, so we will likely see another order on this issue in 2026.

Discovery

Sixth Circuit

Kelly v. Valeo N. America, Inc., No. 2:24-CV-11066-TGB-KGA, 2025 WL 3269526 (E.D. Mich. Nov. 24, 2025) (Judge Terrence G. Berg). Plaintiff Thomas Kelly filed this action asserting that he has been underpaid pension benefits. He worked for Siemens from 1985 to 1993, Valeo North America, Inc. from 1997 to March 1998, and Valeo Sylvania LLC (a joint venture between Valeo and Osram Sylvania) from April 1998 until his termination in 2012 at the age of 51. Valeo concluded that Kelly was not eligible for Early Retirement benefits because he was not employed by Valeo at age 55, a requirement under the Plan. Instead, Kelly qualified for Deferred Vested Pension benefits, which are subject to actuarial reductions for retirement before age 65. Subsequently, Kelly applied for Early Retirement Benefits in 2019, but Valeo denied his application, reiterating that he did not meet the age requirement at the time of his termination. This lawsuit followed. Kelly now seeks discovery based on “perceived bias” by Valeo, as well as procedural errors in the handling of his claim. For example, he contends that the administrative record as produced by Valeo is insufficient; he alleges that it is incomplete, includes irrelevant documents, and omits documents he provided to Valeo. The court denied Kelly’s motion. It found that Kelly failed to provide evidence of bias or procedural defects, offering only general allegations without factual support. While Kelly listed documents he claimed were missing from the record, he did not supply those documents to Valeo for review or explain how their inclusion would impact the administrator’s decision. Furthermore, Valeo asserted that the record included all relevant documents in its possession, except privileged communications, and offered to review and include any additional documents Kelly provided, but Kelly did not pursue this option. The court further found that Valeo complied with ERISA’s procedural requirements, and thus Kelly was afforded due process. The court noted that mere allegations of bias or procedural defects are insufficient to warrant discovery, and that Kelly failed to establish a factual basis for his claims. As a result, the court denied Kelly’s motion and advised him that he could reassert his arguments on summary judgment.

Eleventh Circuit

Miller v. American United Life Ins. Co., No. 8:25-CV-1670-KKM-AAS, 2025 WL 3269397 (M.D. Fla. Nov. 24, 2025) (Magistrate Judge Amanda Arnold Sansone). Plaintiff Vicki Miller brought this action seeking long-term disability benefits under an ERISA-governed group employee plan insured by defendant American United Life Insurance Company. Miller requested permission to conduct discovery beyond the administrative record to support her claim that the denial of her claim was arbitrary and capricious and influenced by self-interest. American did not oppose the request. As a result, the court granted her request for limited discovery, subject to specific parameters agreed upon by the parties. The court allowed Miller to depose American’s corporate representative, limiting her inquiries to the following topics: “1. The exact nature of the information considered by the fiduciary in making the decision. 2. Whether the fiduciary was competent to evaluate the information in the administrative record. 3. How the fiduciary reached its decision. 4. Whether given the nature of the information in the record it was incumbent upon the fiduciary to seek outside technical assistance in reaching a ‘full and fair review’ of the claim. 5. Whether a conflict of interest exists. 6. To determine the proper standard of review. 7. Whether the Defendant followed proper procedures in reviewing and denying the Plaintiff’s claim. 8. Whether the record is complete.” The court emphasized that American reserved the right to object to individual discovery requests, including their format.

ERISA Preemption

Ninth Circuit

Dedicato Treatment Ctr., Inc. v. Aetna Life Ins. Co., No. 24-6487, __ F. App’x __, 2025 WL 3269214 (9th Cir. Nov. 24, 2025) (Before Circuit Judges Wardlaw, N.R. Smith, and Miller). This is an action by plaintiff Dedicato Treatment Center, which specializes in substance abuse treatment, against defendant Aetna Life Insurance Company for underpayment of benefits assigned to Dedicato by three of its patients. Dedicato brought six state law causes of action against Aetna, and the district court dismissed them all, ruling they were preempted by ERISA. Dedicato appealed, and in this very brief three-paragraph memorandum decision, the Ninth Circuit affirmed. Relying on its recent decision in Bristol SL Holdings, Inc. v. Cigna Health & Life Ins. Co., 103 F.4th 597 (9th Cir. 2024), the court explained that a state law claim impermissibly “refers to” an ERISA plan if it is premised on the existence of an ERISA plan or if the plan’s existence is essential to the claim’s survival. Here, Dedicato’s claims referenced the Aetna-administered ERISA plans because they were based on services covered by the plans and sought payments for those services through state contract law. Furthermore, the court found that Dedicato’s claims had an impermissible connection with the ERISA plans because they risked subjecting insurers to liabilities based on numerous phone calls and their varying treatment under state law, which would disrupt uniform plan administration.

Pleading Issues & Procedure

Fourth Circuit

Alford v. The NFL Player Disability & Survivor Benefit Plan, No. CV JRR-23-358, 2025 WL 3274428 (D. Md. Nov. 24, 2025) (Magistrate Judge Erin Aslan). This high-profile case was brought by former National Football League players who applied for disability benefits under the NFL Player Disability & Survivor Benefit Plan. The plan offers a variety of benefits depending on the claimant’s impairments and how they were acquired (e.g., in the line of duty). The players contend that the plan’s allegedly neutral physicians are biased and financially incentivized to render opinions adverse to applicants, undermining the integrity of the claims and appeals process. They further assert a systematic pattern wherein higher compensation correlates with flawed, result-oriented opinions against applicants. The players also assert that defendants breached fiduciary duties by providing misleading information about the plan. Based on these allegations, the players have asserted multiple ERISA violations. In this decision, a magistrate judge ruled on motions from both sides to exclude expert testimony and reports. The players moved to exclude the testimony of defense expert Dr. David B. Lasater, while defendants sought to exclude the testimony of the players’ experts Dr. Anthony Hayter and Joseph A. Garofolo. The court denied the players’ motion to exclude Dr. Lasater, finding that his statistical analysis of plan data was reliable and admissible. Although the plaintiffs challenged the reliability of his opinion, the court determined that their arguments addressed the weight and credibility of his testimony, which must be addressed at trial. As for defendants’ motion to exclude Mr. Garofolo, the court granted it. Mr. Garofolo is an attorney with experience in employee benefits, ERISA, and health, welfare, and retirement plans, who offered “opinions regarding the Plan’s use of Neutral Physicians and other practices that outline what he would have done if he had been a Plan fiduciary.” The court found that much of Mr. Garofolo’s opinions applied law to facts, which invaded on the province of the court: “It is improper for Mr. Garofolo to opine on legal principles related to the issues and claims presented in this case.” Furthermore, the court found his opinion unreliable because, although he recommended certain claim practices, he did not identify any plans that followed those practices. As for Dr. Hayter, the court rejected defendants’ challenge to his rebuttal to Dr. Lasater’s report. However, the court agreed with defendants that parts of Dr. Hayter’s report were not supported by “accepted and reliable methodology,” and were “results-driven” and “outcome-oriented.” The court also criticized parts of Dr. Hayter’s report that accepted the players’ allegations uncritically and without conducting due diligence to ensure their accuracy. As a result, the court excluded these parts of Dr. Hayter’s report as well. Other motions in this case are pending, including a motion for class certification, so this case is far from over.

Provider Claims

Second Circuit

Murphy Medical Associates, LLC v. EmblemHealth, Inc., No. 3:22-CV-00059 (SVN), 2025 WL 3282251 (D. Conn. Nov. 25, 2025) (Judge Sarala V. Nagala). The plaintiffs in this case are medical providers who have filed numerous cases in numerous jurisdictions alleging that they have been underpaid for COVID-19 testing and related services to thousands of patients beginning in March 2020. Plaintiffs alleged that some of these patients were enrollees of health plans sponsored or administered by the defendants. As out-of-network providers, plaintiffs claimed they could only identify enrollees of the defendants’ plans if patients provided their insurance information, which often lacked sufficient detail to determine the governing health plan. Plaintiffs further alleged that the defendants refused to disclose whether the plans were governed by ERISA, despite requests for this information. The court granted defendants’ motion to dismiss plaintiff’s initial complaint on numerous grounds in October of 2024 (Your ERISA Watch covered this decision in our October 9, 2024 edition), but allowed plaintiffs to file an amended complaint. After they did so, defendants filed another motion to dismiss, which was granted in this order. First, the court narrowed the parties, ruling that the only plaintiff that could pursue any claims was Diagnostic and Medical Specialists of Greenwich, LLC (“DMSOG”), because the assignments executed by the patients only mentioned DMSOG. The court then addressed the merits of plaintiffs’ claim for benefits under ERISA and found them wanting, stating, “Plaintiffs have corrected few, if any, of the deficiencies previously identified in the Court’s ruling on Defendants’ motion to dismiss Plaintiffs’ initial complaint.” The court stated that plaintiffs failed to identify the specific health plans at issue, allege facts establishing that ERISA governed the plans, or demonstrate that the plans covered the claims benefits sought. The court also rejected plaintiffs’ argument that the Families First Coronavirus Response Act (“FFCRA”) and the Coronavirus Aid, Relief, and Economic Security Act (“CARES Act”) mandated reimbursement for COVID-19 testing regardless of plan language. Additionally, the court found that plaintiffs failed to exhaust administrative remedies as required under ERISA. Plaintiffs’ conclusory assertions of exhaustion and allegations of futility were deemed insufficient. The court held that plaintiffs did not provide fundamental details about the appeals process or demonstrate that pursuing administrative remedies would have been futile. Finally, the court dismissed the plaintiffs’ state law breach of contract claim, finding that plaintiffs failed to allege the existence of any contract directly between them and the defendants. Without allegations concerning the terms of the non-ERISA health plans, the court could not conclude that plaintiffs could enforce any contractual rights or that any specific contract terms were breached. As a result, the court granted defendants’ motion to dismiss in its entirety. This time it did so “without leave to further replead,” noting that other courts had arrived at similar conclusions in other cases filed by plaintiffs.

Third Circuit

Abira Med. Laboratories, LLC v. United HealthCare Servs., Inc., No. 24-7375 (MAS) (TJB), 2025 WL 3282272 (D.N.J. Nov. 25, 2025) (Judge Michael A. Shipp). Plaintiff Abira Medical Laboratories, LLC (d/b/a Genesis Diagnostics), like Murphy Medical Associates in the above case, has been a prodigious litigant in the last few years. It is a New Jersey-based company providing various laboratory testing services, including clinical laboratory, pharmacy, genetics, rehabilitation, and COVID-19 testing. As in previous cases, Abira claims that laboratory testing service requisitions submitted on behalf of defendant United HealthCare’s insureds included an assignment of benefits, creating contractual obligations for United to pay for the services provided by Abira. After Abira amended its initial complaint, United filed a motion to dismiss it, which was granted by the court in March of 2025. In that order the court did not rule on United’s ERISA preemption arguments because it dismissed the state law claims in Abira’s complaint on other grounds. Abira filed a second amended complaint, which added a claim for benefits under ERISA. United filed another motion to dismiss, which the court ruled on in this order. The court addressed Abira’s ERISA claim first. It was unconvinced by United’s argument that Abira failed to exhaust administrative remedies because Abira alleged that it properly submitted claims and appeals, and United did not meet its burden of proving that Abira failed to exhaust. However, the court was persuaded that Abira had not properly stated a claim for relief because it did not identify any specific ERISA plan or cite plan language entitling it to benefits: “Plaintiff admits it does not even know if certain claims are subject to ERISA plans and provides no allegations on information and belief regarding any provision of any plan for which it alleges it is entitled to relief… Plaintiff’s vague pleading that benefits are due does not satisfy its burden here.” The court also granted United’s motion on Abira’s state law claims, ruling that (1) Abira’s breach of contract allegations were conclusory and thus the complaint “fails to plead sufficient facts regarding the terms of the underlying contract that entitle it to payment,” (2) Abira’s claim for breach of the implied covenant of good faith and fair dealing foundered without an underlying breach of contract claim, and (3) Abira could not pursue a quantum meruit claim because it did not plausibly establish that a duty was owed to it under any underlying non-ERISA plan. As a result, the court granted United’s motion to dismiss, albeit without prejudice. Abira was afforded a final opportunity to address the above deficiencies.

Statute of Limitations

Second Circuit

Abukhadra v. Calyon Supplemental Exec. Ret. Plan, No. 25 CIV. 02134 (LLS), 2025 WL 3281502 (S.D.N.Y. Nov. 25, 2025) (Judge Louis L. Stanton). Omar Abukhadra began working at Credit Agricole Corporate and Investment Bank (“Calyon”) in 1989 and was enrolled in its supplemental executive retirement plan (“SERP”). After his termination in 2005, Abukhadra received a severance payment of approximately $9 million in 2006 and remained eligible for SERP benefits. In 2010, he received a Summary Plan Document (“SPD”) outlining the terms of the retirement plan, and in 2011, he received a Summary of Benefits listing his six highest-salaried years but excluding his severance payment. Abukhadra became eligible for SERP benefits in August 2023 and received a letter detailing payment options. Upon reviewing the letter, he discovered that the SERP’s terms classified his severance payment as “compensation,” meaning it should have been included in the calculation of his retirement benefits. However, Calyon informed him in January 2024 that the severance payment would not be included, relying on the SPD’s definition of “compensation,” which conflicted with the SERP’s definition. Abukhadra filed this action, and Calyon responded with a motion to dismiss, contending that his claim was time-barred under the applicable six-year statute of limitations.  Calyon argued that the statute of limitations began in 2011 when Abukhadra received the Summary of Benefits that omitted his severance payment. The court disagreed, finding that the Summary of Benefits did not contain enough information to place Abukhadra on notice of the miscalculation. The document did not define “compensation,” reference the SERP or SPD, or indicate the conflicting definitions. It merely listed his six highest-salaried years and an annual benefits estimate, which was too indefinite to trigger the statute of limitations. The court further rejected defendants’ argument that Abukhadra, as a sophisticated business executive, should have consulted documents from two decades prior to identify potential inconsistencies, citing Second Circuit precedent that beneficiaries are not required to make a “sophisticated chain of deductions” to identify miscalculations. As a result, the court denied the motion to dismiss, finding that Abukhadra did not have sufficient notice of the alleged miscalculation until August 2023, and thus the statute had not run.

Johnson v. Reliance Standard Life Ins. Co., No. 23-13443, __ F.4th __, 2025 WL 3251015 (11th Cir. Nov. 21, 2025) (Before Circuit Judges William Pryor, Grant, and Kidd)

Your ERISA Watch would like to take this opportunity to wish you all a joyous Turkey Day and hope you can all find thanks for something in these trying times. As for us, we are very thankful to have you as readers, and we hope you find our weekly missives informative, educational, and maybe even occasionally entertaining. As always, feel free to drop us a note if you have any comments or suggestions.

It will be an especially happy Thanksgiving for Cheriese Johnson, the plaintiff in our case of the week. In 2015, things started going downhill for Johnson, who began suffering from a variety of unexplained symptoms. These included fatigue, muscle weakness, nausea, vomiting, nosebleeds, joint swelling, dizziness, and cognitive impairment.

Johnson continued working, however, and was hired by The William Carter Company in its human resources department in July of 2016. Three months later, she became covered under Carter’s employee long-term disability benefit plan, insured by defendant Reliance Standard Life Insurance Company.

Unfortunately, Johnson only lasted until January of 2017 at Carter’s, at which time she was forced to stop working due to her worsening symptoms. She applied for benefits with Reliance, but because she had stopped working within one year of the beginning of her coverage, her claim was subject to investigation pursuant to the plan’s preexisting condition provision.

This provision stated that benefits “will not be paid” for a disability that is “caused by,” “contributed to by,” or “resulting from” a preexisting condition. “Preexisting condition” was defined as “any Sickness or Injury for which the Insured received medical Treatment, consultation, care or services, including diagnostic procedures, or took prescribed drugs or medicines” during the three-month “look-back” period before coverage began – here, July through October of 2016.

Johnson certainly received significant treatment during this period. She was treated for many of the symptoms noted above and diagnosed with a number of potential conditions, including fibromyalgia, borderline lupus erythematosus, hypertension, and bronchitis.

However, it was not until February of 2017 that Johnson discovered the true cause of her symptoms. At that time, she underwent a lung biopsy, which led to a diagnosis of scleroderma. Scleroderma is a rare autoimmune disease that causes the thickening and hardening of skin and connective tissue. Serious cases can affect internal organs. Unfortunately, there is no cure.

Reliance completed its investigation and concluded that Johnson was not entitled to benefits because the preexisting condition provision applied. Johnson appealed, arguing that because no doctor suspected she had scleroderma until after the lookback period ended, the provision could not apply. Reliance countered that the symptoms and findings from the lookback period were consistent with scleroderma, and thus it upheld the denial “on the basis that the claimed disability [was] caused by, contributed to by, or the result of” scleroderma.

Johnson filed suit, but the district court agreed with Reliance and granted it summary judgment. (Your ERISA Watch reported on this decision in our October 11, 2023 issue.) Johnson appealed to the Eleventh Circuit Court of Appeals.

The Eleventh Circuit used its six-step approach to determine if Reliance’s decision should be overturned (although it only made it to step three). First, it addressed whether Reliance’s decision was “de novo wrong,” i.e., whether its interpretation of the preexisting condition provision was correct or not, without any deference to Reliance.

The court ruled that it was incorrect. It focused on the words “for which” in the definition of preexisting condition, i.e., was Johnson’s disability the result of an illness “for which the Insured received medical Treatment” during the lookback period?

The court stated, “A lot hinges on for – a word that ‘connotes intent.’” There was no intent to treat scleroderma here, according to the court. “No one ‘intended or even thought’ to treat Johnson ‘for’ scleroderma during the lookback period… Because neither Johnson ‘nor her physicians either knew or suspected that the symptoms she was experiencing were in any way connected with’ scleroderma, it would make little sense to say that she was treated for scleroderma.”

However, this was not the end of the story. Under step two of its analysis, the court concluded that the benefit plan gave Reliance “discretionary authority to interpret the Plan and the insurance policy and to determine eligibility for benefits.” Thus, the court moved on to step three to discuss whether Reliance’s interpretation, even if it was “de novo wrong,” was still “reasonable” under the deferential arbitrary and capricious standard of review.

The court emphasized that this standard of review “really is deferential.” However, “There will be times when ‘the plain language or structure of the plan or simple common sense will require the court to pronounce an administrator’s determination arbitrary and capricious.’” The court determined, “This is one of those times.”

The court ruled that Reliance’s interpretation was unreasonable “because it completely elides the distinction between receiving medical care for symptoms not inconsistent with a preexisting condition and receiving medical care for a preexisting condition itself.” The court presented an analogy:

It is no exaggeration to say that under Reliance Standard’s view, a patient told to drink more water because her headache was likely caused by her dehydration has been treated for cancer if she turns out to have a brain tumor. And that is true even if dehydration really was the root cause of the headache. Headaches, after all, are a symptom of both brain tumors and dehydration. So, to Reliance Standard, treatment for a headache during the lookback period converts any disease or condition that causes headaches into a preexisting condition under the policy.

The court deemed this position “unreasonable – full stop.” Quoting Justice Samuel Alito, from an opinion he wrote when he was on the Third Circuit Court of Appeals (Lawson v. Fortis), the court stated, “considering treatment for symptoms of a not-yet-diagnosed condition as equivalent to treatment of the underlying condition ultimately diagnosed might open the door for insurance companies to deny coverage for any condition the symptoms of which were treated during the exclusionary period.” This type of “backward-looking reinterpretation of symptoms to support claims denials would so greatly expand the definition of preexisting condition as to make that term meaningless: any prior symptom not inconsistent with the ultimate diagnosis would provide a basis for denial.”

In the end, the court viewed Reliance as attempting to rewrite its policy after the fact – “reading it as if it barred coverage for claims arising from conditions that may have originated or existed during the lookback period, not conditions that were treated during that period.” In other words, Reliance’s interpretation “warps the ‘plain and ordinary meaning’ of the policy language, converting a preexisting-condition exclusion into a preexisting-symptom exclusion.” As a result, the court concluded that Reliance’s interpretation was arbitrary and capricious, and reversed and remanded for further proceedings.

The panel was not unanimous, however. Judge William Pryor penned a dissent in which he concluded that Reliance’s interpretation was reasonable. Judge Pryor criticized the majority for relying so heavily on the word “for” in the definition of preexisting condition, and for misinterpreting it. This word “has, at least, eleven different definitions.”

Judge Pryor argued that “‘for’ is read more naturally in the exclusion as meaning ‘because of.’” He agreed with Reliance that Johnson received treatment during the lookback period “‘for the very conditions and symptoms’ that prove that she suffers from scleroderma.” As a result, it was unimportant for the purposes of the preexisting condition provision whether Johnson’s physicians knew that scleroderma was the cause of the symptoms they were treating.

Judge Pryor conceded that “Ms. Johnson’s condition is unfortunate[.]” However, “the terms of her policy plainly contemplate that a condition need not be diagnosed or even suspected to be pre-existing.” As a result, Judge Pryor would have affirmed Reliance’s decision to deny Ms. Johnson’s claim.

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

Breach of Fiduciary Duty

Second Circuit

Carlisle v. The Bd. of Trustees of the Am. Fed. of the N.Y. State Teamsters Conference Pension & Retirement Fund, No. 25-511, __ F. App’x __, 2025 WL 3251154 (2d Cir. Nov. 21, 2025) (Before Circuit Judges Calabresi, Chin, and Lee). In this compact and unpublished decision, the Second Circuit affirmed a district court’s dismissal of a putative fiduciary breach ERISA class action against the trustees and service providers of the New York State Teamsters Conference Pension and Retirement Fund. The panel concluded that the district court properly dismissed the complaint on the ground that it failed to plausibly allege a breach of fiduciary duty against any of the defendants. It held that plaintiff-appellant Robert Carlisle failed to sufficiently allege that the plan’s actuary, Horizon Actuarial Services, LLP, had fiduciary duties under ERISA. And while the trustees and the plan’s financial advisor, Meketa Investment Group, Inc., were undoubtedly fiduciaries and functioned as such regarding the challenged investment strategies, the court of appeals nevertheless found that Mr. Carlisle failed to plausibly allege they breached their duties “based on information available ‘at the time of each investment decision.’” The panel explained that while the complaint alleges that the fiduciaries were aware of the risks associated with their strategies and that other similarly situated plans favored stabler investments, such allegations “do not indicate that the Plan fiduciaries did more than engage in the normal practice of weighing ‘tradeoffs’ and selecting from a ‘range of reasonable judgments’ in the circumstances.” At bottom, the allegations in the complaint simply failed to convince the Second Circuit that the plan’s investment approach was “such an extreme outlier from ‘peer’ multiemployer plans that it was imprudent.” As for the claims of disloyalty, the court of appeals held that it could not plausibly infer from the complaint’s allegations that Meketa’s conflict due to its dual role as both the plan’s non-discretionary investment advisor and its private markets investments manager or the trustees’ investment decisions “were for the purpose of benefiting Meketa or any party other than the plan.” Accordingly, the court found that Mr. Carlisle failed to state fiduciary breach claims and as a consequence the district court properly dismissed his lawsuit.

Fifth Circuit

Brown v. Peco Foods, Inc., No. 3:25-CV-491-TSL-RPM, 2025 WL 3210857 (S.D. Miss. Nov. 14, 2025) (Judge Tom S. Lee). Plan participant Jayson Brown filed this putative class action against his former employer, Peco Foods, Inc., alleging that it violated the terms of its 401(k) retirement plan and its fiduciary duties under ERISA by using forfeitures to reduce its future matching contribution obligations rather than to reduce the plan’s administrative costs. Mr. Brown asserts claims of disloyalty, imprudence, breach of plan document, and prohibited transactions. Peco moved to dismiss them all. In this concise decision the court granted the motion to dismiss. First, the court was persuaded by Peco’s argument that the plan language did not require forfeitures to be spent on administrative expenses before they could be used to reduce employer contributions given the plan’s use of the permissive word “may.” “Here, the court, having considered the parties’ arguments, is of the opinion that the provision at issue, in view of the use of the permissive term ‘may’…does not unambiguously require that Peco apply the forfeitures to administrative expenses before it may apply them to offset employer contributions. Peco’s reading, under which it has discretion to decide how to apply the forfeitures, e.g., whether to apply them, first, to pay administrative expenses of the Plan or to instead offset employer contributions, is a fair and reasonable interpretation of the provision and thus is accepted as the correct interpretation. It follows that Peco’s use of the forfeitures to offset employer contributions did not violate the terms of the Plan and thus, that plaintiff has failed to state a claim.” Furthermore, the court agreed with Peco that its chosen use of the forfeitures was not a violation of its fiduciary obligations, because ERISA requires only that plan participants receive the benefits they are promised. The court noted that “over a dozen” other district courts have considered and rejected similar arguments presented in these forfeiture cases, while “only a handful of courts” have found merit to them. Finally, the court dismissed the prohibited transaction claims. It concluded that inter-plan reallocation of plan assets functioned as a benefit to the plan, and therefore cannot be considered a transaction under Section 1106. Based on the foregoing, the court decided that Mr. Brown failed to state his claims, and ordered that his complaint be dismissed.

Ninth Circuit

Hernandez v. AT&T Services, Inc., No. 2:25-cv-00676-ODW (PVCx), 2025 WL 3208360 (C.D. Cal. Nov. 14, 2025) (Judge Otis D. Wright, II). This decision is the latest in a series of rulings dismissing putative class actions involving forfeited employer contributions in ERISA-governed 401(k) plans. In many ways, this was a cut and paste order which deferred to and drew from numerous rulings we have covered at Your ERISA Watch over the past year in similar actions. As in those cases, the court flat-out rejected plaintiff’s theory of the case, which was that spending forfeited employer contributions on the cost of future employer contributions rather than on defraying administrative expenses violates ERISA’s anti-inurement provision, its prohibition on self-dealing, and the statute’s fiduciary standards. In this particular lawsuit plaintiff Luis Hernandez alleged that AT&T Services, Inc. improperly applied forfeited contributions to reduce future employer obligations in its defined contribution plan. Relying on the precedent set by district court decisions from throughout the country, AT&T moved for dismissal of all causes of action pursuant to Rule 12(b)(6), arguing that Mr. Hernandez’s “sweeping theories of liability…do not state a plausible claim for relief.” The court strongly agreed. It began by addressing the fiduciary breach claims. At bottom, the court held that Mr. Hernandez’s views fail because they contravene ERISA, decades of settled precedent, and set out to create benefits beyond those promised to the participants in the plan. For these reasons, the court dismissed the claims of imprudence, disloyalty, and failure to monitor. Next, the court tackled the anti-inurement claim. It found that AT&T could not have violated 29 U.S.C. § 1103(c)(1) because it did not remove any assets from the plan or use the forfeitures for any purpose other than to pay its obligations to the plan participants. Accordingly, the court dismissed this claim too. Finally, it discussed the prohibited transaction claim. The court ultimately held that Mr. Hernandez could not state such a cause of action because there was no “transaction” here, and because the funds were not “used in a prohibited manner.” As a result, the court granted the motion to dismiss the entirety of the action. Moreover, it determined that amendment would be futile given its steadfast position that Mr. Hernandez’s “ERISA claims rest on a misinterpretation of the Plan’s terms and a novel legal theory that is unsupported by present law.” Thus, the court’s dismissal was without leave to amend.

Disability Benefit Claims

Ninth Circuit

Baltes v. Metropolitan Life Ins. Co., No. 2:23-cv-07404-MRA-JPR, 2025 WL 3199464 (C.D. Cal. Nov. 12, 2025) (Judge Monica Ramirez Almadani). This action was filed by a former senior software engineer at Google, plaintiff Austin Baltes, who sought judicial review of the denial of his claim for long-term disability benefits by defendant Metropolitan Life Insurance Company (“MetLife”). On January 22, 2024, the court granted the parties’ joint stipulation to a de novo standard of review, and on August 26, 2024, the court held a hearing on the parties Rule 52 motions for judgment. In this decision the court issued its findings of fact and conclusions of law and entered judgment in favor of Mr. Baltes. The court found that Mr. Baltes met his burden of showing by a preponderance of the evidence that he was disabled during the relevant time period and unable to perform the substantial and material duties of his occupation due to post-viral fatigue, brain fog, and cognitive impairment. The court determined that Mr. Baltes’ self-reported symptoms were consistent, credible, and supported by corroborating medical records, lab testing results, and statements made by his treating physicians. By contrast, the court noted that MetLife’s reviewing nurses and doctors conducted paper-only reviews, failed to review the complete file or Mr. Baltes’ actual job description prior to rendering their opinions, and crucially inappropriately emphasized what they saw as a lack of objective physical findings to justify the denial of benefits. Because of these shortcomings, the court found the statements of MetLife’s reviewers “to be of little assistance” and assigned them minimal weight, particularly as they never seriously disputed Mr. Baltes’ diagnoses themselves, only the severity of his conditions. For these reasons, the court concluded that Mr. Baltes was disabled under the terms of his plan and entitled to benefits. Thus, the court granted Mr. Baltes’ motion and denied MetLife’s motion.

Eleventh Circuit

Hovan v. Metropolitan Life Ins. Co., No. 24-11167, __ F. App’x __, 2025 WL 3241521 (11th Cir. Nov. 20, 2025) (Before Circuit Judges Jill Pryor and Luck, and District Judge Virginia M. Covington). Plaintiff-appellant Stacy Hovan was employed as a commercial litigator with the law firm Troutman Sanders LLP. In February of 2019, Ms. Hovan stopped working due to a mental health crisis stemming from her bipolar disorder diagnosis. After she stopped working two things happened simultaneously. First, Ms. Hovan applied for disability benefits under an ERISA-governed policy insured by defendant-appellee Metropolitan Life Insurance Company. Second, she entered an intensive outpatient program. She remained at the program until September 22, 2020, when her providers determined that her acute crisis had stabilized. Throughout this time, Ms. Hovan had been approved for and was receiving benefits from MetLife. However, upon discharge from the treatment facility, MetLife terminated the benefits. It concluded that the notes from Ms. Hovan’s ongoing therapy sessions post-discharge failed to establish continued disability or the inability to perform the essential functions of her work as a litigator. The district court ultimately agreed with MetLife’s decision, concluding at the summary judgment stage that it was not de novo wrong. On appeal, the Eleventh Circuit concurred. “For the period after Hovan’s release from PeakView on October 16, 2020, the only evidence that Hovan submitted to MetLife in support of her continued claim of disability was the therapy notes from her sessions with Ms. Stevens. Upon review, we conclude that Ms. Stevens’s therapy notes do not show that Hovan was still disabled and unable to work as a commercial litigator after her release from PeakView.” While the therapy notes were “troubling” and certainly reflected that Ms. Hovan continued to experience psychiatric symptoms consistent with bipolar disorder, including “passive” suicidal ideation, the Eleventh Circuit nevertheless agreed with MetLife they that failed to establish that Ms. Hovan’s judgment, decision-making ability, stress tolerance, or interpersonal functioning were impaired or not adequately controlled. On the record before it, the court of appeals agreed with the lower court that Ms. Hovan could continue performing the essential duties of a commercial litigator following her discharge, despite her serious ongoing mental health concerns, including occasional depression, mania, and anxiety. For this reason, the Eleventh Circuit found that both MetLife and the district court appropriately concluded that Ms. Hovan no longer met the plan’s definition of disabled after her release from the treatment facility and that she could not provide satisfactory proof to the contrary. As a result, the Eleventh Circuit affirmed the district court’s judgment in favor of MetLife and upheld the termination of Ms. Hovan’s benefits.

Exhaustion of Administrative Remedies

Tenth Circuit

Sellers v. Humana Ins. Co., No. 1:24-cv-00162-SMD-GBW, 2025 WL 3204747 (D.N.M. Nov. 17, 2025) (Judge Sarah M. Davenport). This case arises from plaintiff Michael Sellers’ claim for Accidental Death and Bodily injury benefits under a policy issued by Humana Insurance Company following the death of his wife Amber in a car accident. Humana moved for summary judgment and to strike exhibits Mr. Sellers included which it argued were outside of the administrative record. In this decision the court denied both motions, but remanded Mr. Sellers’ claim to Humana for further consideration. The court’s decision centered around the issue of administrative exhaustion. The court deemed Mr. Sellers to have satisfied the exhaustion requirement because Humana failed to comply with its regulatory duties. Specifically, the court found that Humana neglected to have a meaningful dialogue with Mr. Sellers or provide him adequate notice about the deficiencies in his third-party designation of his attorney. “Driving this conclusion is Humana’s paradoxical decision to at once reject Mr. Houliston as Plaintiff’s authorized representative yet only communicate with him regarding the signature requirement.” The court said Humana’s logic was untenable. If the lack of a signature was the difference between “effecting review of a claim denial and not, Humana [needed to] take some affirmative step to inform the claimant of this requirement.” Humana did not do so. And this failure was particularly problematic given that the plan documents do not mention the need for a signature for designating an authorized representative. Accordingly, the court found that Humana did not diligently pursue its duties to ensure that the claims procedures were clearly communicated to Mr. Sellers. Thus, the court concluded that Humana failed to dispel Mr. Sellers’ notion that he was represented by counsel and that his appeal would proceed. As a result, it held that Mr. Sellers had exhausted his administrative remedies. Nevertheless, because the administrative record has not been properly developed, the court concluded that the proper course of action is to remand the claim to Humana for a full review. Thus, the court declined to consider the merits of Humana’s decision to deny the benefit claim at this juncture. Moreover, in light of its decision to remand rather than reach the merits of the denial, the court denied the motion to strike exhibits outside of the administrative record as moot.

Life Insurance & AD&D Benefit Claims

First Circuit

Metropolitan Life Ins. Co. v. Hughes, No. 22-cv-11526-ADB, 2025 WL 3204609 (D. Mass. Nov. 17, 2025) (Judge Allison D. Burroughs). MetLife filed this interpleader action to determine the proper beneficiary of life insurance benefits associated with an ERISA-governed policy for decedent David True. Defendant Douglas Hughes, individually and as representatives of the estates of Renee True and David True, moved for summary judgment in his favor. He argued that Renee’s estate was entitled to the benefits because she was the named beneficiary and survived her husband. Moreover, Mr. Hughes argued that Ryan True, David and Renee’s son and the contingent beneficiary of the policy, was precluded from receiving the proceeds of his father’s life insurance policy, either directly or through his mother, under both Massachusetts law and federal common law because he was found guilty by a Massachusetts jury of the murder of both of his parents and sentenced to two consecutive life sentences. The court agreed with Mr. Hughes on both points and held that as the sole remaining eligible heir of Renee, Mr. Hughes was entitled to the proceeds of David’s life insurance policy. The court entered judgment to this effect.

Medical Benefit Claims

Ninth Circuit

Pritchard v. Blue Cross Blue Shield of Ill., No. 23-4331, __ F. 4th __, 2025 WL 3202338 (9th Cir. Nov. 17, 2025) (Before Circuit Judges Rawlinson and Smith Jr., and District Judge Jed S. Rakoff). A group of transgender participants and beneficiaries in self-funded employer-sponsored health plans sued their third-party administrator, Blue Cross Blue Shield of Illinois, alleging that language in their plan excluding gender-affirming care violated sex-based discrimination provisions of the Affordable Care Act (“ACA”). The district court agreed and found in favor of plaintiffs on summary judgment. Last week, however, a panel in the Ninth Circuit overturned some of the district court’s rulings and remanded for further scrutiny. Central to the Ninth Circuit’s ruling was the recent Supreme Court decision in United States v. Skrmetti, 145 S. Ct. 1816 (2025), wherein the high court found that state law restrictions on the treatment of gender dysphoria do not necessarily constitute discrimination on the basis of sex. Before it addressed Skrmetti, however, the Ninth Circuit joined the district court in rejecting three of Blue Cross’s defenses, which were: (1) the plans were not funded by the federal government; (2) it was acting at the direction of the employers; and (3) it was shielded by the Religious Freedom Restoration Act. Argument two implicated ERISA; Blue Cross argued that ERISA’s statutory emphasis on implementing plan terms as written authorized it to enforce the provisions at issue, even if they were contrary to the ACA. The court acknowledged that the two statutes potentially created a conflict, but “[t]his is a risk BCBSIL accepted when it assumed fiduciary duties to the plan. Every fiduciary faces the same dilemma when there is doubt about the legality of an action it feels compelled to take.” In the end, however, the court found no conflict: “the text and structure of ERISA…do not allow third-party administrators to flout the law on behalf of their employer-customers.” The court’s ruling rested on Section 1144(d) of ERISA, which provides that ERISA does not supersede other federal law, and thus its commands must yield to the ACA. Where the Ninth Circuit diverged from the lower court was on the basic holding that gender-affirming care exclusions are inherently discriminatory. This conclusion, the panel stated, has been undercut by the intervening authority in Skrmetti. They explained, however, that just because the district court’s reasoning failed in light of Skrmetti, the plaintiffs may still ultimately win as the district court could potentially distinguish Skrmetti. In particular, the Ninth Circuit noted that some of the plaintiffs needed hormone treatments for diagnoses other than gender dysphoria, but Blue Cross still would not treat them. The panel said this fact left open the possibility that Blue Cross’s justifications for its actions were a pretext for discrimination. Thus, the panel instructed the district court to reassess whether plaintiffs can establish discrimination under the appropriate legal standard. Judge Rawlinson penned a concurrence in which she argued that the majority had gone too far in opining as to how the district court might interpret Skrmetti on remand. “I see the majority’s analysis as exceeding a remand and conducting a ‘first view’ rather than a ‘review.’”

Pension Benefit Claims

Third Circuit

Princeton Univ. Retirement Plan v. Estate of Jerome F. Andrzejewski, No. 23-1501 (ZNQ) (TJB), 2025 WL 3215721 (D.N.J. Nov. 18, 2025) (Judge Zahid N. Quraishi). In this decision the district court ruled on competing motions for summary judgment filed by the potential beneficiaries of decedent Jerome Andrzejewski’s Princeton University retirement account. Relying on the Supreme Court’s precedent set in Kennedy v. Plan Administrator for DuPont Savings & Investment Plan, 555 U.S. 285 (2009), the court held that defendant Robert Moses was the rightful beneficiary of the proceeds as he was properly designated as the sole beneficiary of the account in 1993, and no change of beneficiary form was ever executed by Mr. Andrzejewski subsequent to this designation and prior to his death. The court stated that the competing beneficiaries, the Estate of Jerome F. Andrzejewski and Denis Andrzejewski, could not offer any facts to contradict this, and instead only offered speculation that Mr. Andrzejewski intended to amend his beneficiary designation as evidenced through his statements to his estate planning attorney. Because the Kennedy decision foreclosed any inquiry into the parties’ intents and desires in favor of the virtues of strict adherence to beneficiary designations, the court held that it need not consider or investigate the Estate and Denis’s arguments. Rather, because neither party established that Mr. Andrzejewski amended the beneficiary designation of his account proceeds in accordance with the plan’s directives, the court held that Mr. Moses was entitled to the benefits at issue. As a final matter, the court declined Denis’ and the Estate’s request to impose a constructive trust, given the fact that they presented no evidence that Mr. Andrzejewski’s designation of Mr. Moses stemmed from a mistake or some other wrongful act. Consequently, the court granted Mr. Moses’s motion for summary judgment, denied Denis’ and the Estate’s cross-motion for summary judgment, and ordered that the retirement benefits be paid to Mr. Moses.

Pleading Issues & Procedure

Second Circuit

Doherty v. Bristol-Myers Squibb Co., No. 24-CV-06628 (MMG), 2025 WL 3204436 (S.D.N.Y. Nov. 17, 2025) (Judge Margaret M. Garnett). On September 29, 2025, the court issued a ruling granting in part and denying in part defendant Bristol-Myers Squibb’s motion to dismiss this putative class action alleging violations of ERISA in connection with the pharmaceutical company’s pension risk transfer and annuitization of its defined benefit pension plan with Athene Annuity and Life Company. (Your ERISA Watch featured the decision as our case of the week on October 8, 2025.) Presently before the court was defendants’ unopposed motion to certify that order for interlocutory appeal. Under 28 U.S.C. § 1292(b), district courts may exercise their discretion to certify an interlocutory appeal where the decision at issue “(1) involves a controlling question of law (2) as to which there is substantial ground for a difference of opinion and (3) as to which an immediate appeal may materially advance the ultimate termination of the litigation.” Here, the court found all three factors were satisfied, and accordingly granted defendants’ motion. First, the court agreed with Bristol-Myers Squibb that its decision that plaintiffs have Article III standing involves a controlling question of law involving at least one purely legal question of whether the pension risk transfer transaction at the heart of this case caused the type of harm required to confer Constitutional standing. Second, the court emphasized that there is a split among the federal district courts as to whether pension risk transfer transactions that purport to promise the same ongoing benefits as the ERISA plans can ever confer Article III standing on the pensioners. This split, including within the Second Circuit, demonstrated to the court that there is substantial ground for difference of opinion on this fundamental issue. Finally, the court stated that the Second Circuit’s ruling will resolve a foundational legal issue and either bring the case to a close or narrow the potential issues the parties must litigate and the court must decide going forward. In either event, “substantial efficiencies will be gained by resolving the standing issue now.” For these reasons, the court agreed with defendants that its September 29 decision should be certified for interlocutory appeal. Accordingly, the court granted defendants’ motion. Finally, the court stayed the case for the pendency of the appeal other than the limited discovery agreed upon by the parties.

Sixth Circuit

Bradley v. Toyota Tsusho America, Inc., No. 5:25-cv-00385-GFVT, 2025 WL 3220087 (E.D. Ky. Nov. 18, 2025) (Judge Gregory F. Van Tatenhove). Decedent Joshua Shepard worked for defendant Toyota Tsusho America, Inc. Mr. Shepard had originally designated his grandmother as his beneficiary pursuant to his coverage under the Toyota employee life insurance benefit plan. However, after the birth of his two young children, Mr. Shepard attempted to change his designation, to name the children and their mother, his longtime partner plaintiff Kaitlyn Bradley, as his beneficiaries. However, the person responsible for filing the paperwork at Toyota left the company, and Mr. Shepard’s beneficiary change form was either lost or destroyed as a result. When he learned about this, Mr. Shepard attempted to start the process over again. He acquired new forms, filled them out, and planned to submit them to the company. Things then took a tragic turn. With the completed forms in his backpack, Mr. Shepard died in a car accident. As a result, despite his clear intentions and affirmative actions to add his partner and children as his beneficiaries, Mr. Shepard was never able to submit the required paperwork. Ms. Bradley originally filed this action in state court on behalf of herself and her children alleging a common law negligence claim. Toyota removed the complaint to federal court on the basis of federal question jurisdiction and then filed a motion to dismiss the complaint pursuant to ERISA preemption. In response, Ms. Bradley amended her complaint to assert a fiduciary breach claim under ERISA instead. Thus, the question before the court here was whether Ms. Bradley’s amended complaint rendered Toyota’s motion to dismiss moot. With little fuss, the court concluded it did. “Bradley’s amended complaint no longer contains any state law negligence counts. Instead, Bradley’s amended complaint advances the lawsuit based on alleged violations of ERISA. The amended complaint and the original complaint are not substantially identical. Bradley changed the legal theory under which she seeks relief against Toyota. Bradley’s amended complaint cured the defects raised by Toyota’s motion to dismiss. Thus, the amended complaint moots the pending motion to dismiss.” Therefore, the court denied the motion to dismiss as moot, and the action will now proceed under ERISA.

Eleventh Circuit

Marrow v. E.R. Carpenter Co., Inc., No. 8:23-cv-2959-KKM-LSG, 2025 WL 3209652 (M.D. Fla. Nov. 18, 2025) (Judge Kathryn Kimball Mizelle). In this putative class action plaintiff Saroya Marrow alleges that her former employer, E.R. Carpenter Co., Inc., failed to provide sufficient notice under the Consolidated Omnibus Budget Reconciliation Act (“COBRA”) of continuing healthcare coverage in violation of ERISA. Specifically, Ms. Marrow points to two shortcomings in the COBRA notice she was mailed: (1) the notice omitted the date when the election form was due; and (2) it included conflicting statements regarding whether the initial payment had to accompany the election form. Ms. Marrow alleges that failing to elect COBRA coverage caused her economic injuries through the loss of health and dental insurance. In this decision the court concluded that Ms. Marrow lacked Article III standing to pursue her action because she failed to identify any evidence that these injuries were traceable to the deficiencies in the COBRA notice she received from Carpenter. The court held, “[r]ather than demonstrate that the notice’s deficiencies caused Marrow’s injuries, the evidence shows only that her injuries were self-inflicted. Thus, even if Carpenter’s notice contained the due date and correctly instructed Marrow of when to make her first payment, Marrow’s testimony establishes that her issues with these non-deficient portions of the notice would have prevented her from electing coverage. Marrow’s injuries are traceable only to herself. A non-deficient notice would have resulted in ‘precisely the same harm.’” Because the court concluded that Ms. Marrow set forth no evidence demonstrating factual causation between her injuries and the deficiencies in the notice she received, the court could not say that her injury was fairly traceable to Carpenter’s misconduct. As a result, the court concluded that Ms. Marrow lacked standing to bring her action, and therefore dismissed the complaint, without prejudice.

Retaliation Claims

Seventh Circuit

Singleton v. AT&T Enterprises, No. 1:24-cv-12485, 2025 WL 3215779 (N.D. Ill. Nov. 18, 2025) (Judge Mary M. Rowland). Plaintiff Michael Singleton brings this ERISA and Title VII action against defendants Illinois Bell Telephone Company, LLC, AT&T Enterprises, and AT&T Incorporated alleging that his termination was a form of discrimination and impermissibly interfered with his pension benefits under ERISA. Defendants moved to dismiss the claim of discrimination under Title VII of the Civil Rights Act with respect to AT&T Enterprises and AT&T Inc. and moved to dismiss the ERISA Section 510 claim in its entirety, or alternatively, with respect to just AT&T Enterprises and AT&T Inc. The court granted the motion to dismiss the Title VII claim with respect to the AT&T defendants, but entirely denied the motion to dismiss the ERISA claim. Regarding the Title VII discrimination claim, the court agreed with defendants that the complaint fails to allege that either AT&T defendant was Mr. Singleton’s direct employer or that they were his employers based on some indirect theory of liability. The complaint, the court stated, “does not allege that AT&T Enterprises and AT&T Inc. ‘directed’ the purported racial discrimination against Plaintiff. Nor does it allege that AT&T Enterprises and AT&T Inc. exercised ‘control’ over Plaintiff’s employment relationship. The Amended Complaint merely alleges in a conclusory fashion that AT&T Enterprises and AT&T Inc. were Plaintiff’s employers. This is insufficient.” Accordingly, the court granted this aspect of defendants’ motion to dismiss. However, it clarified that this dismissal was without prejudice to Mr. Singleton amending his complaint to address this deficiency. Turning to the ERISA claim, the court addressed each of defendants’ three arguments for dismissal: (1) failure to plead specific intent; (2) failure to exhaust administrative remedies; and (3) the AT&T defendants are not proper defendants to this cause of action. The court first held that the complaint sufficiently raises plausible allegations that defendants fired Mr. Singleton to save the roughly $280,000 to $560,000 they would have owed him had they kept him employed until his higher tiered pension had vested. Next, the court noted that the complaint states that Mr. Singleton exhausted all available administrative remedies, or in the event he failed to do so, that exhaustion would have been futile. The court thus declined to dismiss the action based on the affirmative defense of exhaustion. Finally, the court denied defendants’ request for dismissal as to AT&T Enterprises and AT&T Inc. Unlike Title VII, ERISA Section 510 does not require the existence of an employer relationship. The court said that the allegations in the complaint lead to a plausible inference that all defendants engaged in the adverse actions against Mr. Singleton and that each is therefore alleged to be liable for the ERISA violation regardless of whether the AT&T defendants were Mr. Singleton’s direct employer. For these reasons, the court granted in part and denied in part the motion to dismiss.

Statutory Penalties

Tenth Circuit

Mayor v. Metropolitan Life Ins. Co., No. 1:25-cv-00012-DBB-DAO, 2025 WL 3251356 (D. Utah Nov. 21, 2025) (Judge David Barlow). Following the accidental death of her husband Casey, plaintiff Nicole Mayor submitted a claim to Metropolitan Life Insurance Company (“MetLife”) for life insurance and accidental death insurance benefits as the sole beneficiary of her husband’s coverage under ERISA-governed policies. MetLife denied the claim for accidental death benefits on the basis of a policy exclusion. When Ms. Mayor appealed the denial she requested additional information about the policy from MetLife, but these requests, and ultimately the appeal itself, were denied by MetLife. Accordingly, in this action Ms. Mayor seeks the benefits that she was denied. In addition to MetLife, she has sued Casey’s former employer and the plan’s administrator, Union Pacific, and two individual officers of Union Pacific. In her amended complaint, Ms. Mayor asserts two causes of action: (1) a claim for statutory penalties for failure to provide information required by ERISA; and (2) wrongful denial of her claim. Before the court here was defendant MetLife’s motion to dismiss the statutory penalties claim on the grounds that it is the plan’s claims administrator, not the plan administrator. The court agreed and granted the partial motion to dismiss. It held that under Tenth Circuit precedent only the plan administrator can be liable for failing to provide information required under the statute. Ms. Mayor claimed that MetLife is liable for statutory penalties because it “agreed with the plan administrator that MetLife would pay any ERISA penalties for failing to provide material.” It is clear throughout the complaint that Ms. Mayor alleges that Union Pacific and its executives served as the plan administrator. The court held that her theory of liability for MetLife based on these alleged agreements creating an agency relationship between it and Union Pacific simply failed “to state a claim against MetLife for not providing the information required under ERISA.” As a result, the court granted the motion to dismiss the first cause of action as asserted against defendant MetLife.