McKee Foods Corp. v. BFP Inc., No. 25-5416, __ F.4th __, 2026 WL 936759 (6th Cir. Apr. 7, 2026) (Before Circuit Judges McKeague, Readler, and Davis)

Pharmacy benefit managers (PBMs) play a pivotal role in American health care. They act as intermediaries between insurers, benefit plans, pharmacies, and manufacturers. Among the services they provide are administrative services, negotiating drug rebates, setting up pharmacy networks, and working with health plans to structure and manage benefits.

As the Sixth Circuit noted in this decision, PBMs have become “ubiquitous.” PBMs administer prescription drug benefits for around 270 million people, which is basically “everyone with a prescription drug benefit.” The three major nationwide PBMs are CVS Caremark, Express Scripts, and OptumRx, which together process about 80% of prescription claims.

Ideally, the expertise, volume, and exclusivity PBMs bring to the market enable lower prices for health plans and their beneficiaries. However, PBMs have their critics. Many PBMs are part of the ever-growing vertical integration of health care, which means they (or their corporate parents) own their own pharmacies. PBMs have been accused of giving their own pharmacies “preferred” status in their networks and “steering” customers to those pharmacies.

As a result, state and local governments have sought to regulate PBMs, alleging that these steering practices have led to the closure of smaller, rural, out-of-network pharmacies, thus limiting prescription drug access in the communities they serve.

Of course, because health care is often delivered through employee benefit plans, PBMs and their practices are deeply intertwined with ERISA. Recently, as governments have sought to tighten the reins on PBMs, one question keeps recurring: does ERISA preempt these regulations? This was the question faced by the Sixth Circuit in this week’s notable decision.

The case has an unusual origin. It did not begin, as you might think, as a dispute between a PBM and the government. Instead, it began as a dispute between a snack cake manufacturer and a local pharmacy based in Ooltewah, Tennessee.

The plaintiff was McKee Foods Corporation, which most people know through its bakery brands such as Little Debbie’s and Drake’s. McKee offered an ERISA-governed health benefit plan to its employees, which included a prescription drug program managed by the PBM MedImpact. In establishing the program, McKee also created a preferred pharmacy network.

Defendant BFP, Inc. (which does business as Thrifty MedPlus Pharmacy) used to be in McKee’s preferred pharmacy network. However, McKee kicked Thrifty Med out after an audit “revealed issues with its billing practices.” Thrifty Med contested this, and waged a multi-year campaign to get reinstated to the program.

Central to Thrifty Med’s efforts was the State of Tennessee’s enactment of Public Chapter 569 in 2021, followed by Public Chapter 1070 in 2023. These legislative initiatives were triggered by the Supreme Court’s 2020 decision in Rutledge v. PCMA, in which the high court ruled that certain Arkansas laws regulating the reimbursement rates PBMs offered to pharmacies were not preempted by ERISA. (This case was Your ERISA Watch’s notable decision in our December 16, 2020 edition.)

Rutledge emboldened Tennessee to take on PBMs by passing PC 569. Among other things, this statute “barred PBMs and covered entities from making participants pay higher or additional copays or coinsurance when obtaining prescriptions,” and “barred PBMs and covered entities from interfering with a patient’s choice of pharmacy” through the use of “inducement, steering, or offering financial or other incentives.”

Tennessee later amended these provisions by passing PC 1070. This new law “revised the prohibitions against PBMs and covered entities…to prevent interference with provider choice and restrict incentives that persuade patients to choose PBM-owned pharmacies.” It also “expanded the definitions of ‘pharmacy benefits manager’ and ‘covered entity’ to include plans governed by ERISA.” Finally, it “added language requiring PBMs to admit to their networks any willing pharmacy and precluding pharmacy favoritism.”

After PC 569 was enacted, Thrifty Med sought reinstatement to the McKee plan’s pharmacy network. McKee said no, which prompted three administrative complaints by Thrifty Med in 2021. (All three were eventually dismissed.)

McKee, annoyed by the onslaught, filed this action in 2021, seeking declaratory and injunctive relief. The State of Tennessee intervened as a party. McKee argued, among other things, that ERISA preempted Tennessee’s PBM laws. McKee sought a declaration to that effect, an injunction against the enforcement of the PBM laws, and an order preventing ThriftyMed from seeking reinstatement to McKee’s network.

The district court granted ThriftyMed’s motion to dismiss, finding that McKee’s claims were moot following the passage of PC 1070. However, on appeal the Sixth Circuit disagreed and sent the case back to the district court. (We covered this ruling in our March 27, 2024 edition.)

On remand, McKee added the State of Tennessee and the Commissioner of the Tennessee Department of Commerce and Insurance as defendants. The district court dismissed the State on sovereign immunity grounds but allowed McKee’s claims against the Commissioner to proceed. On dispositive motions, the court granted McKee relief, finding that McKee had standing to bring a pre-enforcement challenge and that the PBM laws had an impermissible connection with ERISA plans, thus preempting them. (This ruling was covered in our April 9, 2025 edition.) By this point Thrifty Med had become an afterthought; the court dismissed the pharmacy because it had ceased efforts to join McKee’s network.

The Commissioner appealed and this published decision, featuring the same lineup of judges as in the prior appellate ruling, was the result.

First, the Commissioner raised various procedural issues, which the Sixth Circuit quickly swatted away. The Commissioner argued that McKee had no standing to bring its ERISA claims, but the court ruled that McKee was acting as both a sponsor and a plan fiduciary, which gave it standing to sue under ERISA. Furthermore, ERISA authorized McKee to seek declaratory relief as a fiduciary.

Next, the Commissioner argued that the federal courts did not have jurisdiction to hear the case. However, the court ruled that it had jurisdiction over McKee’s pre-enforcement challenge because McKee “intended to engage in a course of conduct arguably affected with a constitutional interest and proscribed by statute” by dictating which pharmacies could be included in its plan, thereby limiting beneficiary choice under Tennessee’s PBM regulations. Furthermore, there was a “credible threat of enforcement” because of (1) the prior challenges to McKee’s network by ThriftyMed, and (2) repeated comments by the Commissioner that “he and his Department will enforce the PBM laws against ERISA plans – going as far as to single them out in at least two letters and a response to public comments.”

The Commissioner’s final procedural argument was that he had sovereign immunity. The court rejected this, finding that McKee’s claims against the Commissioner met the Ex Parte Young conditions of (1) “the complaint alleges an ongoing violation of federal law,” and (2) it “seeks relief properly characterized as prospective.”

Having wolfed down the appetizers, the court arrived at the main course of its meal: were Tennessee’s PBM regulations preempted by ERISA? The court examined ERISA’s preemption clause, which states that ERISA “supersede[s] any and all State laws insofar as they may now or hereafter relate to any employee benefit plan.” The Supreme Court has held that a state law “relates to” an ERISA plan if it has “either an impermissible ‘connection with’ the plan or a ‘reference to’ it.” The district court focused on the “connection with” prong, and thus the Sixth Circuit did as well.

The court examined separately the “any-willing-provider” provisions and the “incentive provisions” of Tennessee’s PBM laws. The “any-willing-provider” provisions required plans to admit into their networks any pharmacy willing to accept the terms and conditions of the plans. The court found that these laws were preempted by ERISA because they mandated a specific benefit structure, governed a central matter of plan administration, and disrupted nationally uniform plan administration.

The court emphasized that one of the primary goals of using a PBM was to create a network of preferred pharmacies that generated cost savings; the Tennessee laws “seek to upend this structure” by giving all pharmacies the ability to become “preferred.” This approach “requires a plan to be designed in a particular way. ERISA prohibits this.” Furthermore, the PBM laws affected “the scope and extent of a plan’s pharmacy network,” and required plans “to tailor benefits in ways specific to Tennessee,” both of which interfered with uniform plan implementation.

The Sixth Circuit explained that this conclusion was consistent with the Supreme Court’s decision in Rutledge because the Arkansas regulations in Rutledge were solely aimed at costs while Tennessee’s laws “diminish, if not outright eliminate, a plan’s ability to design its network in a way most accommodating and beneficial to its participants.”

As for the “incentive provisions” of the PBM laws, the court explained that they generally prohibited PBMs from offering financial incentives to steer patients to certain pharmacies. However, these provisions “impede cost-sharing arrangements, an important facet of pharmacy network structure.” The laws effectively “divvy up the allocation of who bears what cost and include things like copays and coinsurance…The effect [] is to impose across-the-board, universal copays and other fees at every pharmacy in a given network.” This interference was too much for the Sixth Circuit: “These provisions disrupt uniformity in McKee’s Health Plan and impermissibly dictate its plan’s design.”

Having found both sets of provisions preempted, the Sixth Circuit then examined whether they might be spared by ERISA’s “savings” clause, which saves from preemption state laws regulating insurance. The court ruled that the Commissioner had waived this argument by not raising it below, and in any event, it was not meritorious because the McKee plan was self-funded, which meant that state insurance laws could not reach it pursuant to ERISA’s “deemer” clause.

As a result, the district court’s ruling that Tennessee’s PBM laws were preempted by ERISA was upheld by the Sixth Circuit: “States can enact laws looking to regulate health care and PBMs. But those laws cannot trespass into ERISA’s territory. Because the Tennessee laws McKee challenges have an impermissible connection with ERISA plans, they are preempted.”

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

Arbitration

Eleventh Circuit

Snelling v. Coca Cola Beverages Florida, LLC, No. 8:25-CV-02444-JLB-LSG, 2026 WL 925652 (M.D. Fla. Apr. 6, 2026) (Judge John L. Badalamenti). Nicole M. Snelling worked for Coca Cola Beverages Florida, LLC and participated in its “P3 Connections Program.” This program is designed to be “the exclusive method through which Work-Related Issues will be resolved, with binding Arbitration being the final forum for any Work-Related Issue that is a Legal Dispute[.]” Snelling filed this action, which included, among other causes of action, two counts under ERISA alleging: “(1) that Defendant failed to properly provide Plaintiff with a timely and compliant COBRA election notice and (2) that Defendant breached its fiduciary duty by failing to ensure that Plaintiff received such COBRA notices and failed to administer and transition Plaintiff’s ‘HSA benefits.’” Coca Cola filed a motion to compel arbitration of the entire action based on the P3 Connections Program. The assigned magistrate judge issued a report and recommendation (R&R) in which she recommended granting the motion; Snelling objected to the recommendation, raising three arguments. First, Snelling argued that arbitration was premature because the parties had not yet mediated. However, the court noted that the Program included a mediation provision, and “[t]he parties need not mediate this case in federal court.” Second, Snelling argued that the P3 Program did not delegate decision-making regarding the arbitration’s scope to the arbitrator, but the R&R and the court disagreed: “The P3 Connection Program defines ‘Legal Dispute’ to include ‘any disagreement between an Employee and Coke Florida regarding the interpretation or scope of this Program.” Third, Snelling argued that her ERISA claims were not encompassed by the P3 Program’s arbitration provision. On this issue the court agreed, differing from the magistrate judge. “The P3 Connection Program exempts ‘an Employee’s claim for…any benefits under a plan governed by [ERISA]’ from its definition of ‘Work-Related Issue.’… [The ERISA] counts both concern benefits under a plan governed by ERISA… Accordingly, those two claims are not subject to arbitration under the plain language of the P3 Connections Program.” However, despite this conclusion, the court still adopted the R&R’s ruling that Snelling’s ERISA claims did not bar the court from compelling arbitration of Snelling’s other claims. The P3 Program provided that if only some of an employee’s claims are excluded from arbitration, “then the claims subject to arbitration shall proceed to arbitration and the claims excluded from arbitration will be stayed pending a final outcome of the arbitration proceedings.” Thus, the court stayed the case pending arbitration of Snelling’s non-ERISA claims.

Breach of Fiduciary Duty

Third Circuit

Chrupcala v. Firstrust Savings Bank, No. CV 25-6578, __ F. Supp. 3d __, 2026 WL 927226 (E.D. Pa. Apr. 6, 2026) (Judge Chad F. Kenney). Kyle Chrupcala was an employee of Firstrust Savings Bank and participated in the bank’s ERISA-governed 401(k) and Profit Sharing Plan. The plan has an atypical investment strategy; according to Chrupcala the bank “has sole control over how employer contributions are invested and does not permit participants to direct the investment of any employer contributions to their accounts.” Instead, the bank directs its contributions exclusively into its “proprietary certificates of deposit and savings accounts,” the Firstrust Fund. Chrupcala contends that this investment strategy, which focuses on capital preservation and reducing volatility risk, is inappropriate for long-term investment objectives and resulted in losses to the plan. He filed this putative class action against the bank, asserting two causes of action under ERISA: violation of 29 U.S.C. § 1104(a)(1) for breach of the fiduciary duties of prudence and loyalty (Count I), and violations of 29 U.S.C. §§ 1106(a) and 1106(b)(1) for engaging in prohibited transactions (Count II). The bank filed a motion to dismiss for failure to state a claim, which resulted in this published decision. On Count I, the court found that Chrupcala plausibly alleged a breach of the duty of prudence by showing that Firstrust’s investment strategy was outside a range of reasonableness, given the long-term investment objectives of the plan participants. The court noted that the earnings rate of Firstrust’s contributions was 2.27% from 2000 to 2024, which was well below the 4.2% rate of inflation. The court rejected Firstrust’s argument that compliance with plan requirements shielded it from liability, emphasizing that ERISA’s duty of prudence supersedes plan terms. As for the duty of loyalty, the court found that Chrupcala’s allegations that Firstrust benefited from the investment strategy and reduced its withdrawal risks were sufficient to suggest a breach. The court noted that discovery might reveal that Firstrust’s actions were consistent with its fiduciary duties, but at this stage Chrupcala’s allegations “just pass the bar of plausibility[.]” The court then turned to Count II, the prohibited transaction claim, ruling that Chrupcala plausibly alleged violations of 29 U.S.C. §§ 1106(a)(1)(D) and 1106(b)(1) by showing that Firstrust used plan assets for its own benefit. Firstrust asserted as a defense the exemption outlined in Section 1108(b)(4) (addressing investment of plan assets in bank deposits). The court noted that “[w]hether a Section 1106(b)(1) claim is subject to an ERISA exemption under Section 1108(b)(4) appears to be an issue of first impression in this Circuit.” Ultimately, the court agreed that it was a proper defense, but ruled that its applicability was not apparent from the face of the complaint: “Whether employer contributions were invested ‘in deposits which bear a reasonable interest rate’ is a question of fact that requires discovery before it can be resolved.” The court arrived at a similar conclusion regarding Firstrust’s statute of limitations argument, ruling that this defense could not be resolved without discovery into when Chrupcala had “actual knowledge” of the material facts. In doing so, the court rejected Firstrust’s argument that “Plaintiff had actual knowledge based simply on the fact that he participated in the Plan, ergo he must have known that employer contributions were being directed towards the Firstrust Fund since that information was available to him.” As a result, Firstrust’s defenses may yet win the day, but that day is not today; its motion to dismiss was denied in its entirety.

Leslie v. Rentokil N. Am., Inc., No. 5:25-CV-01423-JLS, 2026 WL 950490 (E.D. Pa. Apr. 8, 2026) (Judge Jeffrey L. Schmehl). Kristin Leslie and Amy Ross are employees of Rentokil North America, Inc., the pest control company. They brought this putative class action alleging that they were required to pay a tobacco surcharge to maintain health insurance coverage under Rentokil’s employee health plan. Plaintiffs contend that the tobacco surcharge violates the non-discrimination provisions of ERISA, specifically 29 U.S.C. § 1182, because Rentokil did not offer a reasonable alternative standard to being tobacco-free, failed to provide proper notice of such a standard, and did not offer reimbursement of the surcharge paid prior to completing a smoking cessation program. They also allege that Rentokil breached its fiduciary duty under 29 U.S.C. §§ 1104 and 1106 by using plan assets to benefit itself at the expense of plan participants. Rentokil filed a motion to dismiss for lack of subject matter jurisdiction under Rule 12(b)(1) and for failure to state a claim under Rule 12(b)(6). Rentokil argued that plaintiffs lacked standing because they “failed to allege that it would have been ‘unreasonably difficult due to a medical condition’ or ‘medically inadvisable’ for them to cease using tobacco products,” and did not request a waiver or alternative method of satisfying the plan’s requirements. Rentokil acknowledged that this argument was countered by 2013 regulations which “eliminated the ‘unreasonably difficult due to a medical condition’ or ‘medically inadvisable’ requirement that ERISA imposed on outcome-based programs,” but contended that the regulations were invalid because they conflicted with statutory language. The court disagreed, finding that the regulations did not conflict with ERISA and that Congress granted the relevant agencies the authority to promulgate such regulations. Furthermore, the court cited two cases disfavoring Rentokil’s argument, and noted that none supported Rentokil. The court further ruled that plaintiffs had standing because “Rentokil caused them a concrete injury when it imposed a tobacco surcharge that is traceable to Rentokil’s decision to impose tobacco surcharges under a discriminatory ERISA plan, which can be redressed with a refund of the surcharge which Plaintiffs seek in their Prayer for Relief.” On the merits, the court ruled that plaintiffs satisfactorily alleged that the plan did not offer “the full reward” as required by ERISA regulations because it did not provide retroactive reimbursement upon compliance with the wellness program procedures. The court found this understanding supported by the preamble to the 2013 regulations, which the court interpreted to mean that “[t]he term ‘full reward,’ then, must entail something more than merely the absence of the surcharge.” Rentokil also argued that plaintiffs’ interpretation of “full reward” conflicted with ERISA Section 702(b), which was designed to reward participants for adhering to health promotion programs. The court did not discern any conflict, concluding that the terms “adhere” and “full reward” are “actually distinct requirements.” Finally, the court found that Rentokil acted as a fiduciary, not a settlor, because Rentokil engaged in ongoing activity: “Rentokil withheld millions of dollars in tobacco surcharges from participants’ paychecks and used those funds to reduce its own financial obligations to the Plan.” To the extent Rentokil argued that it did not retain these funds, and they remained in the plan, the court ruled that this issue “can be fleshed out in discovery.” As a result, Rentokil’s motion was denied in its entirety.

Ninth Circuit

Berkeley v. Intel Corp., No. 5:23-CV-00343-EJD, 2026 WL 948725 (N.D. Cal. Apr. 8, 2026) (Judge Edward J. Davila). This class action (certified by the court on June 27, 2025) involves participants in Intel Corporation’s Minimum Pension Plan (MPP). The MPP was designed as a supplement to Intel’s Retirement Contribution Plan (RCP), and ensures a minimum monthly annuity for participants, compensating for any shortfall from the RCP. MPP pension benefits are paid as a single life annuity (SLA) for non-married participants, and are converted to joint and survivor annuities (JSAs) for married participants. The MPP used actuarial assumptions to calculate the JSA conversion, specifically the “GAM-83 mortality table” and interest rates set by the Pension Benefit Guaranty Corporation (PBGC). Plaintiffs contend in this action that these assumptions are outdated and unreasonable, and that the plan’s JSA calculations are not “actuarially equivalent” to SLAs as required by ERISA. They allege that Intel and the MPP administrative committee have violated “(1) the joint and survivor annuity requirements in 29 U.S.C. § 1055; (2) the anti-forfeiture rules of 29 U.S.C. § 1053; and (3) the Administrative Committee’s fiduciary duty to the class.” Defendants filed a motion for judgment on the pleadings, or, alternatively, for summary judgment. The court agreed with defendants that the term “actuarially equivalent” in 29 U.S.C. § 1055 does not inherently require the use of “reasonable” actuarial assumptions. The court examined the ordinary meaning, Congressional intent, and a Department of Treasury regulation, concluding that there is no evidence that Congress intended to impose a reasonableness requirement. The court accepted defendants’ argument that “‘actuarial equivalence’ merely reflects a mathematical principle, devoid of an implied ‘reasonableness’ requirement.” Here, that requirement was satisfied because the GAM-83 mortality table and PBGC interest rates used such principles and were employed consistently throughout the plan. The court acknowledged that other courts disagreed with this interpretation – most prominently the Sixth Circuit in Reichert v. Kellogg, decided just last month – but emphasized that the record in this case was different because it contained the 1976 Society of Actuaries Report, which “sought to ‘standardize and clarify’ actuarial terms to ‘achiev[e] compliance’ with ERISA,” and omitted any reference to reasonableness. The court further stressed that Section 1055 did not use the word “reasonable,” while other sections of ERISA did, thereby suggesting that “if Congress intended to impose a similar requirement to SLA and JSA conversions, it would have done so.” The court then turned to plaintiffs’ Section 1053 anti-forfeiture claim, ruling that this claim was tied to the Section 1055 claim because both relied on the same theory of unreasonable actuarial assumptions. Because the court found no violation of Section 1055, it also granted summary judgment on the forfeiture claim. Finally, the court ruled that the administrative committee did not breach its fiduciary duty because the use of the GAM-83 mortality table and PBGC interest rates did not violate ERISA. Additionally, the court found no evidence that the MPP authorized the committee to change the actuarial assumptions, as the plan terms did not grant such authority. As a result, the court granted defendants’ motion for summary judgment. Given the Eighth Circuit’s contrary ruling in Reichert, an appeal to the Ninth Circuit seems likely.

Discovery

Eighth Circuit

Tripp v. Unum Life Ins. Co. of Am., No. 4:26-CIV-04003-CBK, 2026 WL 936072 (D.S.D. Apr. 7, 2026) (Judge Charles B. Kornmann). Kristy Tripp filed this action contending that Unum Life Insurance Company of America wrongfully denied her claim for ERISA-governed long-term disability benefits. The court ordered the parties to file a joint discovery report. In the report Unum claimed that “this matter is exempt from the initial disclosure under Fed. R. Civ. P. 26(a)(1)(B)(i) and from any discovery, contending that this matter is limited to review of the administrative record before the plan administrator, who is the defendant.” Tripp, on the other hand, contended that discovery was appropriate. Tripp argued that Unum hired an attorney to assist her in obtaining Social Security Disability Insurance (SSDI) benefits, which she argued “would implicate the defendant’s breach of its fiduciary duty to plaintiff in its determination whether she is entitled to disability benefits – such fact may imply a preference for insureds to seek and obtain SSDI in lieu of plan benefits.” The court acknowledged that “[p]roof of such an allegation would not be part of the administrative record.” As a result, the court ruled, “When there are allegations of procedural irregularity in the plan fiduciary’s denial of benefits, district courts may admit ‘supplemental evidence for the limited purpose of determining the proper standard of review.’… Compliance with Rule 26 preliminary disclosures and discovery is appropriate in this case.” The court thus ordered the parties to file a revised joint report.

ERISA Preemption

Ninth Circuit

Aanerud v. Northrop Grumman Corp., No. 2:25-CV-01167-MEMF-PVC, 2026 WL 928619 (C.D. Cal. Mar. 31, 2026) (Judge Maame Ewusi-Mensah Frimpong). Paul B. Aanerud was employed by Northrop Grumman for nearly 40 years, where he contributed to a 401(k) account under the ERISA-governed Northrop Grumman Savings Plan. He created the Aanerud Trust in 1994. In 2002 he married Sandra Overman-Aanerud, and in 2006 he designated the trust as the primary beneficiary of his 401(k) account. Overman-Aanerud executed a spousal consent form allowing this designation. In 2012, Aanerud allegedly submitted an electronic beneficiary designation changing his primary beneficiary to Overman-Aanerud. After Aanerud’s death, his son, Gary Aanerud, claimed that the 2012 designation was fraudulent and that the assets should be distributed to the Trust pursuant to the 2006 designation, but the plan denied his claim. Gary filed suit against the plan and Overman-Aanerud, asserting six causes of action: (1) claim for benefits under ERISA, 29 U.S.C. § 1132(a)(1)(B), (2) constructive fraud, (3) undue influence, (4) negligence, (5) breach of fiduciary duty under 29 U.S.C. §§ 1104, 1132(a)(3), and (6) breach of fiduciary duty under 29 U.S.C. §§ 1104, 1132(a)(3), 1133. Only the second and third claims for constructive fraud and undue influence were asserted against Overman-Aanerud. Overman-Aanerud filed a motion to dismiss, arguing that Gary’s two claims against her were inadequately pleaded and both were preempted by ERISA. The court found that Gary’s constructive fraud claim was subject to Rule 9(b) pleading standards, which require particularity in alleging fraud.  Gary argued for a relaxed standard due to the circumstances being within Overman-Aanerud’s knowledge, and the court agreed, ruling that his allegations were sufficient under that standard.  The court determined that the complaint adequately alleged a confidential relationship and that Overman-Aanerud changed the beneficiary designation without Aanerud’s knowledge, satisfying the elements of constructive fraud. The court also applied Rule 9(b) standards to Gary’s undue influence claim, as it was intertwined with his fraud allegations. This claim was also sufficiently pled because Gary alleged undue influence by detailing Overman-Aanerud’s position of trust and Aanerud’s vulnerability due to age and cognitive impairment. Gary’s luck ran out on preemption, however. The court agreed with Overman-Aanerud that both claims were preempted by ERISA because the claims, “at their core, seek to invalidate the 2012 beneficiary designation determination made by the Administrative Committee.” Gary contended that through these claims he was not directly seeking benefits in the 401(k) account, but “the allegations explicitly assert that the 2012 beneficiary designation is invalid due to Overman-Aanerud’s fraud or undue influence which altered the primary beneficiary against Aanerud’s intentions.” As a result, because “Gary Aanerud appears to seek the invalidation of an ERISA beneficiary designation – the 2012 designation – its state law claims can reasonably be said to directly reference an or connect to an ERISA plan, thereby directly conflicting with 29 U.S.C. § 1132(a).” As a result, the court granted Overman-Aanerud’s motion to dismiss, without leave to amend, because Gary “has failed to identify how he could amend his claims to avoid ERISA preemption.”

Belz v. Wright, No. 25-CV-00517-DKW-RT, 2026 WL 937993 (D. Haw. Apr. 7, 2026) (Judge Derrick K. Watson). In 2018 Monica Belz was hired by Kauai Federal Credit Union (KFCU) as its president and CEO. In 2020 they entered into a Split Dollar Agreement (SDA), a retirement compensation benefit in which KFCU would fund premiums on a life insurance policy owned by Belz. The SDA allowed Belz to borrow against the policy starting in 2030 and 2040, or immediately if her employment was terminated due to disability. In June of 2024, Belz alleged she experienced severe health issues rendering her unable to work, and requested termination due to functional disability. Belz contends that in response KFCU stopped paying her salary and refused to classify her as disabled or pay her benefits, despite medical affirmations of her condition. Belz filed this action in state court, asserting seven state law claims against numerous defendants. The defendants removed the case to federal court and then filed this motion to dismiss, arguing that Belz’s state law claims were preempted by ERISA and inadequately pled. Belz moved to remand the case to state court, asserting that her claims were not governed by ERISA. The court noted that in the Ninth Circuit, “a relatively simple test has emerged to determine whether a plan is covered by ERISA: does the benefit package implicate an ongoing administrative scheme?” Belz argued that the SDA did not meet this test because there “is nothing discretionary about the determination of disability, or the timing, amount or form of the payment” under the SDA. The court disagreed: “The reality is far different. Analyzing the actual provisions of the SDA shows that a significant part of the agreement demands discretionary decisionmaking on the part of KFCU, including provisions which are central to Belz’s claims.” This included the definition of disability, whether there was “good reason” to terminate employment, and the “reasonableness” of the SDA’s annual borrowing cap. As a result, the SDA was an ERISA plan, giving the court jurisdiction over the case and requiring the denial of Belz’s motion to remand. The court then turned to Belz’s individual claims and determined that they were all preempted by the SDA plan because the existence of the SDA was a “critical factor” in each. Belz’s claims explicitly referred to the SDA and alleged she was denied benefits under it, thus enabling ERISA preemption. Belz contended there was an independent basis for her claims – her employment agreement – but the court noted that “[i]n cases involving both ERISA and non-ERISA contracts, the Ninth Circuit has found that where ‘at least some of the contracts at issue…are ERISA plans,’ a plaintiff’s claims may still be completely preempted by ERISA.” As a result, the court found that the SDA was an ERISA plan and that it preempted Belz’s claims. It thus denied her motion to remand and granted defendants’ motion to dismiss. The court gave Belz leave to amend.

Pleading Issues & Procedure

Third Circuit

In Re: Cigna ERISA Litigation, No. 25-CV-2465-JMY, 2026 WL 949101 (E.D. Pa. Apr. 8, 2026) (Judge John Milton Younge). The plaintiffs in this case are current and former employees of Cigna and participants in the Cigna Group 401(k) Plan. They allege that Cigna and various related defendants violated ERISA by investing plan funds into the Cigna Fixed Income Fund, which underperformed compared to other available investment vehicles on the market. Plaintiffs also challenge the plan’s use of forfeitures, contending that forfeitures should have been used to pay the plan’s administrative expenses rather than offset the cost of Cigna’s matching contributions. Defendants filed a motion to stay the proceedings, which the court considered in this order. Defendants argued that in January the Supreme Court granted certiorari to review the Ninth Circuit’s decision last year in Anderson v. Intel Corp. Investment Policy Committee (which we covered in our May 28, 2025 edition), and that the issues in that case were “directly relevant to the resolution of one of the issues asserted by Defendants in their motion to dismiss – that is the question about whether a plaintiff must plausibly plead a ‘meaningful benchmark’ that can be compared to the challenged underperforming investment vehicle to be able to establish an ERISA claim based on a legal theory of fiduciary imprudence.” The court denied defendants’ motion. The court reasoned that a stay would not serve judicial economy or be fair to the plaintiffs: “a stay would unnecessarily delay disposition of this litigation when resolution of issues in Anderson will not dispose of all theories of liability asserted by Plaintiffs…  Entry of a stay would mean staying the progress of Plaintiffs’ allegations regarding Defendants’ allocation of forfeitures, a central factual theory encompassing all seven counts in the Complaint. In contrast, forfeiture related claims are not at issue in Anderson.” The court further found that a stay would be “inappropriate because the impact of the potential decision in Anderson on ERISA litigation is too tentative and uncertain to warrant staying this matter in its current procedural posture.” The court noted that there were “factual distinctions and subtle nuances between this case and Anderson” that “limit the potential impact that Anderson might have on contested matters in this case.” Furthermore, it was impossible to predict “whether the United States Supreme Court will render a dispositive ruling or establish a consistent pleading standard for all ERISA cases,” or when that would even occur. As a result, the court determined that a stay was not warranted, and the case will proceed as usual.

Ninth Circuit

Karim v. International Alliance of Theatrical Stage Employees, No. 2:25-CV-11929-SPG-PD, 2026 WL 930227 (C.D. Cal. Mar. 31, 2026) (Judge Sherilyn Peace Garnett). Audra Karim is a wardrobe, dresser, and sewing professional who has been a member of IATSE Local 768 since 2008. She alleges that in 2024 she filed internal charges against the former secretary-treasurer of Local 768 for commingling of funds, and against two other former board members “for conduct she perceived to be threatening and retaliatory.” She contends that she was mistreated and intimidated during the proceedings, which concluded in a finding that her charges were “specious.” Karim alleges that IATSE then fined her $17,000, which she could not pay within 30 days, and thus she was suspended from the union. She has subsequently been threatened with expulsion; her appeal is apparently pending. In this pro se action she has alleged twelve causes of action against IATSE, Local 768, and various individuals, including, for our purposes, “failure to remit required contributions to benefit plans under ERISA[.]” Three motions were before the court in this order: Karim’s motion for a temporary restraining order (TRO), IATSE defendants’ motion to dismiss, and Local 768 defendants’ motion to dismiss or to join the IATSE motion. The court denied the Local 768 motion to dismiss under Rule 12(b)(5), finding that Karim’s service was sufficient under Federal Rule of Civil Procedure 4. As for the merits of the parties’ arguments, the court granted in part and denied in part the IATSE motion to dismiss on various grounds. It also denied Karim’s TRO motion because she did not demonstrate irreparable harm, as her alleged harms were compensable by monetary damages or not imminent. As for Karim’s ERISA claim in particular, defendants contended that Karim did not specify which defendants she was targeting, and furthermore she did not plead that they were fiduciaries or how they breached any fiduciary duty. The court agreed, ruling that “Plaintiff does not identify any relevant ERISA plan and alleges no facts suggesting that any of the named Defendants have the discretionary authority required for such a designation. Moreover, as Defendants argue, the [complaint] is not entirely clear which Defendants are alleged to violate which ERISA provisions.” The court further ruled that “Plaintiff’s references to §§ 1104, 1106, and 1132 each raise different claims, with different elements that need to be separately alleged.” Regarding Karim’s claim for benefits under § 1132(a)(1)(B), the court ruled that her complaint was “devoid of any allegations identifying the provisions of any applicable ERISA plan and demonstrating how Defendants’ actions violated those provisions.” As a result, Karim’s ERISA claim was dismissed, although the court gave her leave to amend.

Provider Claims

Fifth Circuit

ER Addison, LLC v. Aetna Health, Inc., No. 3:25-CV-2861-D, 2026 WL 948511 (N.D. Tex. Apr. 8, 2026) (Judge Sidney A. Fitzwater). Four free-standing emergency centers in Texas (“ER”) brought this action against Aetna Health Inc. and its affiliates alleging that Aetna underpaid them for emergency healthcare services they provided on an out-of-network basis to Aetna’s insureds. In a prior lawsuit, ER sued Aetna under ERISA and Texas law, but the court dismissed the suit, ruling that ER lacked standing to assert the ERISA claims of Aetna’s insureds, and declining to hear ER’s supplemental state law claims. (Your ERISA Watch covered this ruling in our July 16, 2025 edition.) Subsequently, ER re-filed their claims in state court, claiming that the Fifth Circuit’s 2025 decision in Angelina Emergency Medicine Associates PA v. Blue Cross & Blue Shield of Alabama constituted a “change in intervening law,” giving them a second chance. (We covered Angelina in our October 29, 2025 issue.) Aetna removed the case to federal court and filed a motion to dismiss, which was decided in this order by the same judge as in the first case. The court granted Aetna’s motion to dismiss in part and denied it in part. The court dismissed the negligent misrepresentation claim, agreeing with Aetna that ER failed to plausibly allege reliance or harm, as the alleged misrepresentations occurred after ER submitted claims to Aetna. The court also dismissed ER’s unjust enrichment claim, finding it duplicative of ER’s state-law contract claim. (Under Texas law, “quasi-contractual claims are unavailable when a valid, express contract governing the subject matter of the dispute exists.”) The court declined to dismiss ER’s breach of contract claim for pre-2020 services, ruling that the Texas Emergency Care Statutes (which create a mandatory binding arbitration process) did not apply to services rendered before January 1, 2020. The court further found that ER’s allegations focused on Aetna’s payment obligations under its own plans, and not on violations of the statute. However, the court dismissed ER’s breach of contract claim for services provided after January 1, 2020 due to lack of standing. The court found that Aetna’s insureds did not suffer a concrete injury because the Texas Emergency Care Statutes (like the No Surprises Act (NSA)) shielded them from liability for out-of-network coverage costs, and thus ER had no derivative standing to sue. As for ER’s ERISA claim, the court denied Aetna’s motion to dismiss this claim for lack of standing under the NSA because that law took effect on January 1, 2022, and ER agreed to dismiss all claims involving treatment after that date. The court also found that ER’s allegations regarding underpayment were plausible and that it was not required to exhaust administrative remedies because doing so would have been futile. The court further found that ERISA completely preempted ER’s state-law breach of contract claim “to the extent that this claim is based on the denial of benefits under an ERISA-regulated benefit plan[.]” Finally, the court denied Aetna’s motion to dismiss claims for Texas Teachers Retirement System plan benefits on sovereign immunity grounds, as Aetna did not meet its burden to prove it was an arm of the state. Thus, in sum, the court dismissed ER’s claims for negligent misrepresentation, unjust enrichment, and breach of contract for post-2019 services, while allowing other claims to proceed.

Rieth-Riley Constr. Co. v. Trustees of Operating Engineers’ Loc. 324 Fringe Benefit Funds, No. 25-1823, __ F.4th __, 2026 WL 915042 (6th Cir. Apr. 3, 2026) (Before Circuit Judges Clay, Gibbons, and Hermandorfer)

ERISA practitioners are well aware of the broad preemptive scope the statutory scheme has. Congress has determined that ERISA displaces “any and all State laws insofar as they may now or hereafter relate to any employee benefit plan,” 29 U.S.C. § 1144(a), thus making almost every dispute over the operation and application of benefit plans an exclusively federal concern. Indeed, every week we here at Your ERISA Watch catalogue cases where ERISA has preempted claims brought by plaintiffs (see below for examples in GS Labs, LLC v. Aetna and Gordon v. Sun Life).

In this week’s notable decision, however, we learn that ERISA preemption is not the pinnacle. Indeed, claims brought under ERISA can sometimes be preempted by something else. Read on to learn what that is and why one judge thinks that doesn’t make any sense.

The plaintiff in the case was Rieth-Riley Construction Company, the Indiana-based asphalt, concrete and paving outfit. Rieth-Riley and the Trustees of Operating Engineers’ Local 324 Fringe Benefit Funds (Local 324) are not on especially good terms with each other. They have been up to the Sixth Circuit twice in the last four years, litigating disputes arising from their collective bargaining agreements (CBAs) – or lack thereof, depending on your perspective. (See our August 17, 2022 and June 12, 2024 editions for more details.)

In this decision they are back again for a third visit to the Sixth Circuit. The dispute arises from road construction work performed by Rieth-Riley in Michigan. Between 2013 and 2018, Rieth-Riley and Local 324 operated under a CBA which required Rieth-Riley to contribute to several of Local 324’s funds. The agreement was set to expire in June of 2018, but was mutually terminated one month prior to avoid triggering its “evergreen clause,” which would cause it to “continue in force from year to year” following its expiration.

After the CBA terminated, Local 324 refused to negotiate a new CBA, and Rieth-Riley attempted to continue contributing to the funds. These contributions were initially refused because the funds believed their relationship was governed by Section 8(f) of the National Labor Relations Act (NLRA), which does not obligate employers and unions to bargain for a new agreement or maintain the status quo during negotiations. Eventually, the funds agreed that Section 9(a) of the NLRA applied, which does obligate parties, after the expiration of a CBA, to maintain the status quo, including continuing fund contributions and bargaining in good faith.

The funds accepted the contributions until September of 2024, when they threatened to stop doing so unless Rieth-Riley gave the funds “‘written confirmation’ of its ‘agreement to comply with and be bound by the [Fringe] Funds’ trust agreements, plan documents, policies and procedures enforceable under CBA and federal law.’”

Rieth-Riley refused, contending that the funds had status quo obligations to continue accepting contributions. This led the funds to stop accepting contributions from October 1, 2024 onward. Rieth-Riley and three of its employees then brought this action alleging that the trustees violated their fiduciary duties of loyalty and prudence under ERISA by refusing to accept contributions.

The district court dismissed plaintiffs’ complaint, finding that their ERISA claims were preempted by the “Garmon doctrine.” This doctrine, created by the Supreme Court in its 1959 case San Diego Bldg. Trades Council v. Garmon, requires courts to “defer to the exclusive competence of the National Labor Relations Board” (NLRB) on issues “arguably subject” to Sections 7 or 8 of the NLRA.

Plaintiffs appealed to the Sixth Circuit, which issued this published opinion. The appellate court affirmed, agreeing with the district court that the Garmon doctrine controlled.

Plaintiffs contended that the Garmon doctrine (1) only applies to state law claims, and (2) only applies to federal claims “within the jurisdiction of the NLRB,” i.e., not ERISA claims. The Sixth Circuit rejected both arguments. The court emphasized that the doctrine applies to all federal claims arising from activities arguably subject to the NLRA, including ERISA claims. Plaintiffs argued that “their ERISA claims cannot be ‘arguably subject’ to the NLRA because the NLRB lacks jurisdiction to adjudicate those claims,” but the Sixth Circuit termed this “a specious interpretation of the Garmon doctrine.” The court noted that plaintiffs cited no supporting case law and highlighted that plaintiffs’ own theory of the case involved a violation of Section 8 of the NLRA, which squarely brought their claims within the Garmon doctrine.

The Sixth Circuit further ruled that plaintiffs’ ERISA claims did not satisfy the “independent federal remedy exception” to the Garmon doctrine. The court found that plaintiffs’ ERISA allegations were “part and parcel” of the funds’ obligations under the NLRA, thus making them sufficiently intertwined such that the labor law questions were not “mere collateral issues.” According to the Sixth Circuit, “Plaintiffs’ ERISA claims can succeed ‘only if’ Defendants’ ‘conduct violates the NLRA,’ rendering the NLRA issues ‘anything but collateral.’”

Finally, the Sixth Circuit affirmed the district court’s rulings denying plaintiffs’ request for preliminary injunctive relief and denying Rieth-Riley’s motion for leave to file an amended complaint. Plaintiffs “failed to demonstrate a likelihood of success on the merits” and amendment would have been “futile.” As a result, the Sixth Circuit affirmed the dismissal of plaintiffs’ claims under the Garmon doctrine. If they still want relief, apparently they will have to get it from the NLRB.

Judge Whitney Hermandorfer penned a concurrence in which she agreed that Garmon preemption applied, but noted that “aspects of Garmon square poorly with jurisdictional first principles.”

She noted that ordinarily federal courts have an obligation to hear cases within their jurisdiction, and “federal statutes do not ‘preempt’ other federal statutes.” Thus, Garmon preemption is a “misnomer.” Judge Hermandorfer also noted problems with how such preemption could “toggle on and off” depending on how parties pressed their claims. She further warned that “applying Garmon to shunt statutory interpretation questions from courts to the [NLRB] might not withstand…scrutiny” under the Supreme Court’s 2024 decision in Loper Bright Enterprises v. Raimondo.

As a result, Judge Hermandorfer considered the 65-year-old Garmon decision to be on “shaky footing,” but was forced to concur with her two panelists because Garmon, and the Sixth Circuit case law interpreting it, barred adjudication of plaintiffs’ claims.

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

Arbitration

Fifth Circuit

Gupta v. Louisiana Health Serv. & Indemnity Co., No. CV 24-404-JWD-SDJ, 2026 WL 867763 (M.D. La. Mar. 30, 2026) (Judge John W. deGravelles). This case arises from a dispute between a physician, Dr. Narinder Gupta, and related plaintiffs, versus two health insurers, Louisiana Health Service & Indemnity Company (better known as Blue Cross and Blue Shield of Louisiana) and HMO Louisiana, Inc. Defendants contended that plaintiffs breached their physician agreement with defendants under Louisiana law and initiated arbitration proceedings. The arbitrator awarded defendants the total recoupment amount they sought, $129,223.35, but plaintiffs moved to vacate that award. Plaintiffs argued that the arbitrator “so imperfectly executed her arbitral powers that ‘a mutual final and definite award upon the subject matter submitted was not made’ pursuant to 9 U.S.C. § 10(a)(4).” Plaintiffs then amended their motion by asserting that defendants violated ERISA, and that ERISA preempted defendants’ recoupment remedy, which allegedly gave the federal court subject matter jurisdiction to consider plaintiffs’ arguments. Defendants moved to dismiss plaintiffs’ motion, contending that the court did not have jurisdiction to hear plaintiffs’ complaints under the Supreme Court’s 2022 decision in Badgerow v. Walters. (In Badgerow, the Supreme Court rejected the “look-through” approach on post-arbitration motions and ruled that federal jurisdiction exists over such motions only if the “face of the application” shows that federal law entitles the applicant to relief.) The court agreed with defendants and dismissed plaintiffs’ claims. (Your ERISA Watch covered this ruling in our March 19, 2025 edition.) Plaintiffs filed a motion for reconsideration, which the court adjudicated in this order. Plaintiffs argued that the court failed to consider their ERISA and due process claims and did not apply Fifth Circuit jurisprudence which purportedly narrowed the application of Badgerow. Defendants opposed the motion, asserting that plaintiffs “rehashed” previous arguments and failed to meet the threshold for reconsideration. The court agreed with defendants. It ruled that plaintiffs’ arguments were largely the same as those previously made and that new arguments, such as those concerning due process, could have been made earlier. The court emphasized that 9 U.S.C. § 10 provides the exclusive grounds for vacating an arbitral award and requires an “independent jurisdictional basis,” which plaintiffs failed to establish on the face of their application. Instead, plaintiffs sought to bring additional claims regarding ERISA in conjunction with their motion to vacate, which was “procedurally improper.” Furthermore, even if the court could review plaintiffs’ arguments, they “plainly call for the Court to ‘look through’ the Amended Motion to the underlying dispute – e.g., to determine whether the relevant claims arose out of ERISA plans, to determine whether Defendants and, by extension, the Arbitrator violated ERISA and Plaintiffs’ due process rights.” This constituted “the exact analysis precluded by Badgerow.” The court also rejected plaintiffs’ contention that two recent Fifth Circuit cases narrowed Badgerow, finding that neither case was relevant to the jurisdictional issue at hand. Lastly, the court denied plaintiffs leave to amend, ruling “[t]here is no complaint here” to amend. The court stated that Federal Rule of Civil Procedure 15(a)(2) does not apply to post-arbitration motions, and any amendment would be futile regardless.

Breach of Fiduciary Duty

Second Circuit

Rudasill v. Swiss Re American Holding Corp., No. 25-CV-1403 (ALC), 2026 WL 861676 (S.D.N.Y. Mar. 30, 2026) (Judge Andrew L. Carter, Jr.). Plaintiffs Nia Rudasill, Eileen Gillis, Michael Schlem, and Roberto Vuoto are participants in the Swiss Re Group U.S. Employee’s Savings Plan, an ERISA-governed retirement plan administered by Swiss Re American Holding Corporation and associated entities. Plaintiffs allege that defendants, who are responsible for managing the plan’s investments, breached their fiduciary duties under ERISA “by selecting and retaining poor investment fund options when other, more beneficial options were readily available, and by misusing the retirement plan’s forfeiture funds.” Plaintiffs alleged four counts in their complaint, but dismissed counts I (excessive recordkeeping fees) and IV (failure to monitor the recordkeeper). The remaining counts are II (imprudent investments) and III (misuse of forfeiture funds). Under count II, plaintiffs alleged that defendants imprudently selected the J.P. Morgan Smart Retirement Target Date Fund, share-class R5 (JPM R5 TDF), as the default investment for participants. They contended that this fund had a higher expense ratio and lower performance compared to the R6 share-class, resulting in reduced returns for plan participants. Plaintiffs also argued that there were other comparable investments available that consistently outperformed the selected options. Under count III, plaintiffs contended that defendants misused the plan’s forfeiture funds by amassing them instead of using them as required by the plan and a proposed IRS regulation. Defendants filed a motion to dismiss for failure to state a claim. Addressing plaintiffs’ imprudent investments claim first, the court ruled that plaintiffs had sufficiently alleged facts to demonstrate a breach of fiduciary duty regarding the selection of the JPM R5 TDF share-class. The court noted that the existence of less expensive and better-performing share-classes could support an inference of imprudence. The court further found that plaintiffs’ allegations regarding alternative investments were properly supported. Plaintiffs adequately contended that defendants “failed to apply requisite and known industry-standard fiduciary tools utilized to evaluate investments, thereby, not acting in the sole interest of Plan participants.” (Plaintiffs primarily relied on Morningstar data from investments in the same category, which showed that other similar investments outperformed the investments chosen by defendants.) As for plaintiffs’ forfeiture claim, the court found that plaintiffs sufficiently alleged that defendants may have breached their fiduciary duties by amassing forfeiture funds instead of using them. Even though the IRS regulation relied on by plaintiffs was only proposed, the court noted that ERISA still required defendants to act in the best interests of plan participants, and “[t]he amassing of funds detailed in the Complaint may still have violated their duty under ERISA… Discovery may provide more insight to how the Swiss Re fiduciaries are using the funds. Accordingly, Plaintiffs have sufficiently alleged Swiss Re Defendants may be in breach of their fiduciary duties to use forfeiture funds prudently.” The court thus denied defendants’ motion to dismiss in its entirety.

Third Circuit

Berkelhammer v. ADP TotalSource Group, Inc., No. 20-CV-5696 (EP) (JRA), 2026 WL 867136 (D.N.J. Mar. 30, 2026) (Judge Evelyn Padin). This complicated six-year-old class action, as we have chronicled, has been up to the Third Circuit and back. Before the court here were defendants’ motion for summary judgment as to all claims, plaintiffs’ motion for summary judgment as to their prohibited transaction claims, and motions from both sides attempting to exclude expert testimony. As background, the plaintiffs are employees of ADP TotalSource (ADPTS), the giant human resources outsourcing company. They represent a class of participants and beneficiaries of the ERISA-governed ADPTS Retirement Savings Plan. Plaintiffs brought this action against ADPTS, the plan’s committee, and other related entities alleging that the plan and its fiduciaries are liable under ERISA for excessive recordkeeping fees and underperformance after the plan adopted Voya Financial, Inc. as its recordkeeper and included a variety of Voya target date funds (TDFs) in its investment line-up. Plaintiffs alleged, among other things, (1) breach of fiduciary duty and prohibited transactions under ERISA against ADPTS, the committee, and related entities; (2) prohibited transaction claims related to the payment of plan assets to ADPTS and service providers; (3) breach of fiduciary duties for failing to remove the Voya TDFs from the Plan and for excessive fees associated with the Voya TDFs; and (4) a derivative claim for failure to monitor fiduciaries. There was something for everyone in this lengthy decision, which issued a mixed ruling on the various motions. The court addressed the expert motions first; one was brought by plaintiffs and four were brought by defendants. The court granted plaintiffs’ motion to the extent defendants’ expert offered opinions or testimony regarding “what ERISA requires,” because that involved legal issues, and to the extent the expert addressed issues only relevant to abandoned or dismissed claims. As for defendants’ motions to exclude, the court largely denied them, although it applied the same standard regarding “what ERISA requires” and abandoned claims, and excluded testimony from one expert regarding “the amount of loss sustained by Plaintiffs.” Moving on to the summary judgment motions, the court granted in part and denied in part both sides’ motions for summary judgment. The court found genuine disputes of material fact precluding summary judgment on several claims, including the breach of fiduciary duty and prohibited transaction claims, noting that the parties offered competing evidence regarding procedural imprudence, loss, and objective imprudence. The court also addressed the applicability of statutory exemptions under ERISA § 1108 to plaintiffs’ prohibited transaction claims, ruling that the “law of the case” doctrine prohibited defendants from relitigating some of their defenses under that statute. The court further allowed plaintiffs to rely on evidence of payments from Voya to support their breach of fiduciary duty claim, but not for their prohibited transaction claims. Finally, the court found that plaintiffs had abandoned claims related to Voya platform fees and retention of excess assets in the plan’s expense reimbursement account. In short, this 74-page, 66-footnote decision was frankly too complicated for your humble editor to summarize concisely, and as a result we recommend you consult the opinion itself for more detail if you have not fallen asleep by now. Suffice it to say that the case appears to headed for trial, although who knows when that will be given how long the case has been pending.

Seventh Circuit

Acosta v. Board of Trustees of Unite Here Health, No. 1:22 C 01458, 2026 WL 891909 (N.D. Ill. Mar. 31, 2026) (Judge Rebecca R. Pallmeyer). The Board of Trustees of Unite Here Health (UHH) operate a national multi-employer ERISA-governed benefit plan providing benefits for workers in the retail, hospitality, and service industries. The plaintiffs are participants in two of UHH’s twenty “Plan Units” serving areas in Southern California. They allege that UHH breached its fiduciary duties under ERISA “by allocating costs incurred by the Fund in a way that is unfair to Plan Units 178 and 278, and by incurring excessive amounts of administrative expenses.” Plaintiffs sought relief under ERISA §§ 502(a)(2), 502(a)(3), and 409 for breaches of fiduciary duty. Count I contended that the board breached their fiduciary duties through the Administrative Expense Allocation Policy, which allegedly tied allocation of administrative expenses to each Plan Unit’s relative contribution rate to the fund, and by unfairly applying a 66% discount to Plan Units in Las Vegas. Count II asserted that the trustees incurred excessive and unreasonable total administration expenses. Plaintiffs sought remedies including restitution of lost income, disgorgement of profits, an injunction against excessive administrative fees and unfair allocation practices, and a court order transferring plan assets to another pension plan unconnected to UHH, the “Santa Monica Fund.” Plaintiffs have already survived two motions to dismiss and obtained an order certifying a class. Before the court here were the parties’ cross-motions for summary judgment. Defendants also moved to exclude testimony from plaintiffs’ expert witness. Addressing Count I first, the court concluded that plaintiffs “have what may be meritorious criticisms of UHH’s overall allocation policy, but they have not shown how that policy caused them actual harm, nor have they established that the policy UHH employs to calculate the contribution rates for their Plan Units is not a reasonable one.” The court noted that plaintiffs acknowledged that UHH set contribution rates for their Plan Units using a percentage-of-benefits approach, not a percentage-of-contributions approach. As a result, “Plaintiffs have not been subject to excessive contribution rates as a result of this approach and have not suggested how, otherwise, they have been harmed.” Plaintiffs argued that there were knock-on effects from this arrangement that affected their contribution rates, but “beyond conjecture and speculation, Plaintiffs have failed to point to any evidence regarding how UHH’s general allocation approach, or the Las Vegas discount, actually increased the contributions that Plaintiffs are required to pay.” To be sure, the court was not thrilled with defendants, stressing that they “have done a poor job of explaining their apparent failure to review this allocation approach on a regular basis, or justifying the discount applied to administrative expenses allocated to the Las Vegas Plan Units.” However, “Defendants cannot…be held liable for procedural imprudence alone.” Plaintiffs were still required “to demonstrate that imprudent decision-making resulted in an objectively unreasonable decision that harmed them in some way,” which they failed to do. Moving on to Count II, regarding excessive expenses, the court ruled that plaintiffs’ claim was insufficient as a matter of law because their expert’s comparison did not adequately consider the services rendered by UHH compared to other plans. The court noted that “it is legally insufficient to simply assume that all administrative expenses are the same between plans and then conduct a comparison of averages to support a claim regarding excessive costs,” which “is precisely what [plaintiffs’ expert] has done in developing his opinion.” Thus, the court ruled for defendants on Count II as well. Finally, the court added some comments regarding plaintiffs’ requested remedies. It stated that (1) “Plaintiffs’ argument that they can recover lost wages is unsupported, as ERISA is limited to equitable relief,” (2) it was unclear whether plaintiffs had standing to request injunctive relief because “it appears that UHH no longer provides benefits to the named class members,” and (3) the court is “at a loss regarding the propriety” of transferring funds to the Santa Monica Fund, because “the Santa Monica Fund provides benefits to participants who are not members of the class and never received benefits from UHH.” However, because defendants prevailed on the merits of plaintiffs’ claims, “the court need not attempt to weed through this confusion in more detail.” Thus, the court granted defendants’ summary judgment motion, denied plaintiffs’, struck defendants’ motion regarding plaintiffs’ expert as moot, and entered judgment for defendants.

Dayak v. Reyes Holdings, LLC, No. 22-CV-02974, 2026 WL 881653 (N.D. Ill. Mar. 31, 2026) (Judge John F. Kness). Plaintiffs Matthew J. Dayak, Jeffrey S. Jacobs, and Thomas Dore filed this action on behalf of the Reyes Holdings 401(k) Thrift Plan, themselves, and all others similarly situated. The defendants are Reyes Holdings, LLC, its board of directors, and its employee benefits committee, who are fiduciaries of the plan. Plaintiffs contend that defendants breached their fiduciary duties of loyalty and prudence under ERISA by failing to ensure that “the investments available to Plan participants are appropriate, had no more expenses than reasonable and performed well as compared to their peers.” Plaintiffs asserted two claims in their complaint. In count one, plaintiffs alleged that the committee breached its duty by charging excessive recordkeeping fees and selecting underperforming target date funds as plan investments. They argued that defendants failed to review the plan’s investment portfolio adequately, maintained costly funds despite better alternatives, and did not control recordkeeping costs. In count two, plaintiffs alleged that Reyes and the board of directors failed to monitor and evaluate the committee’s performance, did not have a system for evaluating plan investments, and did not remove inadequate committee members. Defendants filed a motion to dismiss both counts for failure to state a claim. On count one, the court split plaintiffs’ complaint into “recordkeeping fee allegations” and “target date suite allegations.” Regarding recordkeeping fees, defendants argued that plaintiffs miscalculated them based on incomplete information from the plan’s publicly filed Form 5500s. However, the court ruled that plaintiffs’ miscalculation did not defeat their claim, as they alleged that proper calculations would still show excessive fees. The court also found that plaintiffs provided enough context to suggest that their proposed comparator plans were “meaningful benchmarks” for the plan’s fees, meeting the plausibility standard. Additionally, the court held that plaintiffs’ allegations that defendants did not conduct a request for proposal further supported their claim for imprudence. As for the target date suite allegations, the court again concluded that plaintiffs’ allegations, although “thin,” were sufficient to infer imprudence, as they alleged underperformance over time, including at the three- and five-year marks. Because the court ruled that count one was plausible, the court also denied the motion to dismiss count two, which was derivative of count one. As a result, the court denied defendants’ motion in its entirety, and the case will continue.

Shulak v. BMO Financial Corp., No. 25-CV-02232, 2026 WL 879652 (N.D. Ill. Mar. 30, 2026) (Judge Andrea R. Wood). John Shulak, a participant in the BMO 401(k) Savings Plan, brought this putative class action against BMO Financial Corporation and the plan’s benefits administration committee. The plan is an ERISA-governed defined contribution retirement plan to which participants and BMO contribute. Shulak alleged that defendants used unvested, forfeited contributions to the plan in a manner that benefited themselves rather than the plan participants. Specifically, the committee used forfeited employer non-elective contributions to offset future employer contributions instead of paying plan expenses, which Shulak argued was against the interests of plan participants. The plan provided that forfeited employer non-elective contributions “shall be applied to pay [P]lan expenses as permitted under subsection 11.6 or to reduce future non-elective contributions.” Despite these two options, Shulak alleged that “the Committee has almost exclusively consistently chosen to use forfeitures to offset future employer non-elective contributions.” Shulak asserted several claims under ERISA, including (1) breach of the fiduciary duties of loyalty and prudence under 29 U.S.C. § 1104(a), (2) breach of the anti-inurement provision under 29 U.S.C. § 1103(c)(1); (3) engaging in a prohibited transaction under 29 U.S.C. § 1106, and (4) failing to monitor fiduciaries. Defendants filed a motion to dismiss for failure to state a claim. Addressing breach of fiduciary duty first, the court found that the plan gave the committee discretion in using forfeitures either to pay plan expenses or to reduce future employer contributions. Shulak failed to allege that the plan required the committee to choose a particular option: “[T]he Plan does not mandate that one option be prioritized over another.” The court acknowledged that ERISA’s fiduciary duties trumped the plan document, but ruled that these duties did not obligate defendants to always pay administrative costs over plan expenses. “Like the majority of district courts that have addressed substantially similar claims, the Court believes that interpreting ERISA’s fiduciary duty provisions as ‘creat[ing] an unqualified duty to pay administrative costs’ would ‘improperly extend the protection of ERISA beyond its statutory framework.’” The court further noted that Shulak’s complaint “alleges not only that Defendants breached their fiduciary duties by failing to allocate forfeitures to pay expenses other than the Committee Expenses but also by failing to ‘allocat[e] forfeited funds to participants’ accounts.’” The court ruled that this “would effectively create a new benefit in the payment of administrative expenses even as the Plan provides no such entitlement.” As for Shulak’s anti-inurement claim, the court ruled that this provision was not violated because the forfeitures remained within the plan and were used to provide benefits in the form of future employer contributions, even if this did create an “incidental benefit” for BMO. Furthermore, the court held that the allocation of forfeitures toward future benefits payments did not constitute a prohibited transaction because it was not a “transaction” in the sense used by Congress in § 1106. Finally, because the court dismissed all of the above claims, it also dismissed Shulak’s derivative claim for failure to monitor. Thus, the court granted defendants’ motion in full, but gave Shulak leave to amend.

Eighth Circuit

Shipp v. Central States Manufacturing, Inc., No. 5:23-CV-5215, 2026 WL 868217 (W.D. Ark. Mar. 30, 2026) (Judge Timothy L. Brooks). Central States Manufacturing, Inc., a metal roofing and siding company, established an employee stock ownership plan (ESOP) in 1991, which acquired all outstanding shares of the company using loan proceeds, with shares held in trust and allocated over time to employees as retirement benefits. Over time, the company grew and its stock became more valuable. In 2018, the CEO unexpectedly retired and the board tasked the CFO with figuring out the best way to repurchase the CEO’s shares, which represented a significant percentage of the ESOP’s value. Repurchasing was required by the plan upon an employee’s retirement, and the size of the CEO’s shares, as well as those of other long-time employees holding significant stock, was problematic because repurchasing “was certain to create a dent in Central States’ overall finances.” Ultimately, a two-step releveraging transaction was approved which involved the purchase and subsequent repurchase of 2.2 million shares by the ESOP. In this class action the plaintiffs, three former senior employees of the company, alleged that Central States, its board of directors, and GreatBanc Trust Company, who advised Central States, breached fiduciary duties under ERISA by recommending and executing the second part of the releveraging transaction. They contended that the second step was unnecessary and diluted the value of their shares. Plaintiffs also alleged that Central States and its board violated ERISA by charging the ESOP too much for the releveraged stock and causing the ESOP to incur unnecessary debt. In 2024 the court denied defendants’ motion to dismiss the case (as we reported in our July 17, 2024 edition), so defendants filed a motion for summary judgment, which was decided in this order. Defendants contended in their motion that “Plaintiffs’ ‘stock dilution’ theory does not qualify as a concrete, particularized loss sufficient to confer Article III standing,” and even if it did, “neither Central States nor its Board acted as ERISA fiduciaries in Transaction Two but rather made exclusively corporate decisions for the benefit of the company.” Furthermore, while GreatBanc may have been a fiduciary, defendants argued “there is no genuine, material dispute over whether GreatBanc satisfied its fiduciary duties to the ESOP in that transaction.” The court quickly dispensed with the standing issue, noting that “Plaintiffs’ dilution theory is a novel one, and a review of the caselaw has failed to turn up a similar fact pattern.” As a result, the court deemed it “prudent to assume for the sake of argument that the dilution theory satisfies Article III standing and confront the merits of Plaintiffs’ § 1104 claims.” On the merits, the court ruled that the Central States defendants were not acting as ERISA fiduciaries in the releveraging transaction. The court concluded that the transaction was a corporate decision made with the company’s financial health in mind and did not give rise to liability under ERISA’s fiduciary standards. The court noted that “[v]irtually all of an employer’s significant business decisions affect the value of its stock, and therefore the benefits that ESOP plan participants will ultimately receive.” Thus, “business decisions are not considered plan fiduciary decisions simply because they impact the plan in some respect.” Furthermore, the court chided plaintiffs for focusing only on the downsides of the transaction “and only those personal to them. They ignore that Transaction Two benefited the Plan by replenishing the ESOP with 2.2 million more shares to distribute to active and future Participants over the next three decades. Plaintiffs – all terminated or retired employees with large ESOP accounts – think less about the Plan than about their individual stock portfolios.” The court further found no prohibited transactions under § 1106(b) because “it is undisputed that the ESOP purchased shares in Transaction Two below fair market value[.]” As for GreatBanc, the court found no evidence that it breached its fiduciary duties, as it conducted extensive due diligence and “secur[ed] a middle-of-the-range share price for Transaction One and a below-market share price for Transaction Two.” Consequently, the court granted defendants’ motion and dismissed plaintiffs’ claims against both Central States and GreatBanc, as well as the duty-to-monitor claim against Central States.

Ninth Circuit

Armenta v. WillScot Mobile Mini Holdings Corp., No. CV-25-00407-PHX-MTL, 2026 WL 864463 (D. Ariz. Mar. 30, 2026) (Judge Michael T. Liburdi). WillScot Mobile Mini Holdings Corporation sponsors and administers an ERISA-governed defined contribution retirement plan for its employees. As in many such plans, participants fund the plan through payroll deductions while WillScot provides matching contributions. Participants are immediately vested in their own contributions and earnings, but they only become fully vested in the matching contributions after four to six years. If a participant leaves before becoming fully vested, the matching contributions and earnings from those contributions are forfeited. The plan provides, “Any forfeitures occurring during a Plan Year may be used to pay administrative expenses under the Plan at any time, if so directed by the Administrator…[A]ny forfeitures not used to pay administrative expenses under the Plan shall be applied to reduce the contributions of the Employer for the immediately following Plan Year[.]” Ariel Armenta, a WillScot employee, filed this action alleging that WillScot violated ERISA by using forfeited plan assets almost exclusively to reduce its contributions rather than defray administrative expenses. Armenta’s original complaint contained five causes of action, but in September of 2025 the court dismissed four of them with prejudice. (Your ERISA Watch covered this ruling in our September 24, 2025 edition.) The court dismissed the fifth claim – breach of the duty of prudence – without prejudice and allowed Armenta to amend her complaint, which she did. As a result, WillScot filed the pending motion to dismiss. The court noted that “Armenta has alleged no new facts to plausibly allege that the plan administrator’s decision-making process was flawed in violation of the duty of prudence. Instead, she revives failed arguments from the first motion to dismiss.” The court again ruled that the plan “gives the plan administrator discretion to use forfeited funds to reduce administrative expenses or reduce WillScot’s matching contributions… It does not require that the funds be used in a particular order.” Furthermore, “ERISA permits plan administrators to use forfeited funds to offset the employer’s matching contributions.” The court acknowledged that Armenta would rather have WillScot pay expenses with the forfeited funds, but “WillScot’s decision-making process does not automatically become flawed merely because it exercises its discretion in a manner Armenta disapproves.” Instead, Armenta was required to prove that WillScot’s “decision-making process was flawed… Disagreeing with the final decision, rather than alleging flaws in the process leading up to that decision, does not satisfy the pleading standards.” Armenta also argued that WillScot’s decisions were infected by a conflict of interest, but the court again found that these claims were insufficient. “Armenta’s allegation of a conflict is entirely conclusory and rests solely on her disagreement with the plan administrator’s discretionary decision. That is insufficient.” Indeed, the court found that WillScot’s conduct was consistent with its duty of prudence because it “ensures that participants [receive] their promised benefits.” The court acknowledged the many recent cases on this issue, but noted that “[m]any…are inapposite to the present dispute because their plan language is more restrictive of the fiduciary’s discretion… Furthermore, none of the cases cited are binding precedent on this Court, and they are unpersuasive for the Court’s determination.” As a result, the court granted WillScot’s motion to dismiss, this time with prejudice, because “Armenta was previously given the opportunity to cure her pleading defects…but failed to do so.”

Maneman v. Weyerhaeuser Co., No. C24-2050-KKE, 2026 WL 884985 (W.D. Wash. Mar. 31, 2026) (Judge Kymberly K. Evanson). Weyerhaeuser Company, the century-old timberland company, maintained an ERISA-governed defined benefit pension plan for its retired employees. In 2019, the company entered into a pension risk transfer (PRT) transaction, transferring $1.5 billion of its pension obligations to Athene Annuity and Life Company. This transaction affected approximately 28,500 plan participants. This decision was made by the plan’s annuity committee in conjunction with third-party advisor State Street Global Advisors Trust Company (SSGA). The plaintiffs in this putative class action are participants in the plan who contend that Athene “engages in a high-risk, high-reward investment strategy that allows it to charge employers a lower premium but offers no benefits to retirees who do not stand to gain from the upside of Athene’s investments.” They contend that Athene’s financial practices pose a risk to their retirement benefits and devalue them. As a result, they asserted that Weyerhaeuser, SSGA, and affiliated defendants breached their fiduciary duties under ERISA by engaging in the PRT. They also alleged that the PRT constituted a prohibited transaction under ERISA. Defendants filed motions to dismiss, arguing that plaintiffs lacked standing to sue and failed to state a claim. Addressing standing first, the court concluded that plaintiffs had standing because they alleged a concrete injury in the form of a less valuable pension benefit. Specifically, plaintiffs “suffered a present, concrete injury in the form of a riskier – and, thus, less valuable – annuity than they would have received had Defendants met their fiduciary obligations.” Defendants contended that the Supreme Court’s ruling in Thole v. U.S. Bank N.A. foreclosed standing, but the court disagreed, noting that in the PRT context the risk of a bad decision in selecting an annuity provider falls on pensioners, unlike in Thole, where there was no PRT and the employer bore the risk. Defendants further argued that plaintiffs had no standing because they had “no interest in the annuities’ present value” because they had no right to “assign or alienate” the annuities. The court rejected this as well, ruling that “the concept of ‘value’ is not so narrow…this Court is unconvinced that the ability to sell or alienate an annuity is essential to showing injury based on a decline in the annuity’s value.” The court also found traceability for standing purposes to Weyerhaeuser through its selection of SSGA as the plan’s fiduciary. However, plaintiffs’ arguments fared less well on the merits, as the court concluded that they failed to plausibly allege a breach of fiduciary duty. The court found that plaintiffs’ allegations concerning Athene’s risk factors largely postdated the 2019 transaction, and the pre-2019 allegations were insufficient to demonstrate that Athene was a poor choice at the time of the PRT. The court further found that plaintiffs did not plausibly allege a breach of the duty of loyalty, as the potential conflicts of interest identified were either too tenuous or arose after the transaction. As for plaintiffs’ prohibited transaction claims, the court rejected them as well. The court ruled that plaintiffs’ argument that Athene was a “party in interest” was “circular” and “would lead to the absurd result of prohibiting all PRTs involving an annuity provider even though ERISA expressly authorizes them elsewhere.” The court also rejected plaintiffs’ self-dealing claim, citing Ninth Circuit authority that purchasing annuities to terminate a pension plan does not constitute a per se violation of ERISA. As a result, the court granted defendants’ motion to dismiss, but gave plaintiffs leave to amend.

Tenth Circuit

Parker v. TTEC Holdings, Inc., No. 1:24-CV-03148-DDD-CYC, __ F. Supp. 3d __, 2026 WL 917789 (D. Colo. Mar. 30, 2026) (Judge Daniel D. Domenico). Shemia Parker is an employee of TTEC Holdings who was required to pay a “tobacco surcharge” of $57.69 per pay period in order to remain eligible for continued health insurance under TTEC’s ERISA-governed employee health plan. Parker alleges that the TTEC plan provided that she could avoid the surcharge by submitting a negative nicotine test, participating in a “nicotine cessation program,” or submitting an affidavit for “prescribed nicotine replacement therapy.” Parker contends that this program did not satisfy ERISA’s requirements. She alleged that (1) the plan did not provide a reasonable alternative standard under ERISA to receive “the full reward” under TTEC’s wellness program, and did not disclose the availability of an alternative standard, (2) TTEC breached its fiduciary duty by managing the plan in violation of the law and the relevant plan terms, and (3) the surcharge was an illegal fee because the wellness program did not meet statutory requirements. TTEC moved to dismiss. First, it argued that Parker lacked standing because she would not have received the discount even under her preferred version of the cessation program: “She never tested negative, began the cessation program, or sought out any other alternative.” The court disagreed: “TTEC misunderstands Ms. Parker’s argument and her requested relief. Her argument is not that she should receive the discount, it is that the tobacco surcharge is an illegal fee.” The court found that Parker had standing because she alleged a “classic pocketbook injury” by paying illegal fees, which was sufficient for standing. Furthermore, this injury was redressable because the court could potentially order a refund of the fees if the surcharge was deemed illegal. This refund would be “not because she is entitled to the discount, but because the surcharge was illegal in the first place.” Next, TTEC argued that Parker failed to state a claim because the tobacco surcharge met ERISA’s requirements. The court agreed that Parker did not adequately plead that the cessation program was not a reasonable alternative. Parker failed to provide sufficient factual support for her assertion that the program required participants to quit smoking and test negative to avoid the surcharge. The court acknowledged that the plan document indicated the existence of a cessation program, but Parker did not demonstrate its insufficiency except by pointing to a “rather confusing email” from TTEC management. The court also rejected Parker’s argument that ERISA’s requirement of a “full reward” required retroactive reimbursement of surcharges already paid. The court interpreted the statute to mean that the plan must offer the same reward to those pursuing the alternative, but it need not repay amounts paid before qualifying for the discount. The court distinguished this case from other cases ruling that a retroactive reward was required because in this case “retroactive relief is available to no participants.” As for Parker’s claim that the plan failed to provide proper notice, TTEC’s only challenge to this claim was based on standing, and the court had already found that Parker had standing. Finally, the court dismissed Parker’s claim for breach of fiduciary duty, ruling that Parker did not plausibly allege fiduciary conduct. The court explained that ERISA’s fiduciary duty requirement is not implicated when an employer acts as a settlor and makes decisions regarding the plan’s form or structure. Additionally, Parker did not plead any losses to the plan: “Parker argues that TTEC implementing the unlawful plan led to more employee contributions and required less employer contribution… This may describe a loss to her personally, but the plan received the same amount of money either way.” As a result, TTEC’s motion was granted in part and denied in part. The court gave Parker leave to amend to address the court’s concerns.

Class Actions

Second Circuit

R.B. v. United Behavioral Health, No. 1:21-CV-553 (MAD/PJE), 2026 WL 865732 (N.D.N.Y. Mar. 30, 2026) (Judge Mae A. D’Agostino). Plaintiff R.B. initiated this action in 2021 against United Behavioral Health (UBH) asserting violations of ERISA and the Mental Health Parity and Addiction Equity Act of 2008 (Parity Act). R.B. “challenged UBH’s alleged practice of excluding from insurance coverage all mental health and substance abuse treatment services rendered at residential treatment centers where any component of the center’s programming is considered ‘unproven, experimental, or investigational[.]’” In 2023 the court granted R.B.’s motion for class certification (as discussed in our September 20, 2023 edition), and after the Second Circuit rejected UBH’s appeal, the parties engaged in successful settlement discussions. R.B. filed a motion for final approval of the settlement agreement. A group of class members opposed the class settlement, but the court rejected their arguments and as a result they later “stipulated to the withdrawal of [] their objections and reclassified attorneys’ fees.” As a result, R.B.’s motion for approval became unopposed and the court evaluated it in this order. The court found the settlement agreement to be fair, reasonable, and adequate. The settlement included a plan of allocation with three tiers: “Wilderness, Multiple, and Experimental.” There were 279 class members in the Wilderness tier, three class members who had two wilderness claims, 47 class members in the Multiple tier, and nine class members in the Experimental tier. As a result, “Class members in the Wilderness tier will receive approximately $936.72; class members who have two wilderness claims will receive approximately $1,873.44; class members in the Multiple tier will receive approximately $9,367.20; and class members in the Experimental tier will receive approximately $18,734.40.” The total settlement amount was $1,415,000, which the court deemed “within the range of reasonable settlements that would have been appropriate in this case, based on the nature of the claims, the potential recovery, the risks of litigation, and settlements that have been approved in other similar cases.” The court emphasized that the settlement was not a product of fraud or collusion and was negotiated at arm’s length. The court determined that the class was adequately represented and that the notice to class members was sufficient and complied with legal requirements. The court also noted that the settlement treated class members equitably relative to each other. The court further stated that it had addressed and resolved all objections. As for attorney’s fees, the court approved an award amounting to one-third of the settlement fund, or $471,667, which was “consistent with similar settlements in the Second Circuit and other fee awards in similar class action settlements that have been finally approved throughout the country.” The court also granted $31,994 in costs and a service award of $15,000 to R.B. As a result, the court granted all motions before it and the case was dismissed with prejudice.

Disability Benefit Claims

Second Circuit

Booth v. First Reliance Standard Life Ins. Co., No. 24 CIV. 3927 (KPF), 2026 WL 861640 (S.D.N.Y. Mar. 30, 2026) (Judge Katherine Polk Failla). Pearline Booth suffered severe injuries in a 2017 automobile accident which resulted in pain and physical limitations. At the time, Booth was a registered nurse at Montefiore Medical Center and a participant in Montefiore’s ERISA-governed long-term disability benefit plan. Following the accident, Booth was unable to return to work, so she filed a claim for benefits with the plan’s insurer, First Reliance Standard Life Insurance Company. Reliance approved her claim in 2018 under the plan’s “regular occupation” definition of disability, which meant she could no longer return to work as a nurse. In 2022, however, Reliance reviewed the file and concluded that Booth could return to work under the plan’s “any occupation” definition of disability, which kicked in after 60 months of benefits. As a result, Reliance terminated Booth’s benefits effective March 7, 2023. Booth submitted an appeal, but Reliance denied it, and thus she filed this action under ERISA seeking payment of plan benefits. The parties filed cross-motions for summary judgment in which they dueled over the proper standard of review and whether Booth was entitled to further disability benefits. Booth argued that the court should review Reliance’s decision de novo because Reliance (1) “refused to provide certain materials it relied upon to make its Decision,” and (2) violated ERISA’s claim procedure regulation by failing to provide a decision within 45 days on her appeal. The court rejected the first argument, finding that Booth’s argument was directed more at the merits than the standard of review. However, it accepted the second argument, ruling that Reliance’s decision was 66 days late. Reliance contended that it invoked a 45-day extension under the regulation, but the court disagreed because no “special circumstances” existed to justify it. “Courts in this District are clear that a plan’s written notice that it needs additional time to allow for physician or vocational review of a claimant’s file is not a special circumstance.” (The court cited Bianchini v. Hartford for this proposition, which was decided by a different judge in the same district only six days earlier.) The court also ruled that Reliance was not permitted to toll the deadline while waiting for a response from Booth, and that it missed the 45-day deadline even without this extension. Furthermore, “these violations were not inadvertent or harmless” because Reliance “purposefully” and “improperly” invoked the 45-day extension. As a result, the court employed the less deferential de novo standard of review because of Reliance’s procedural errors (although it dropped a footnote to explain that it would rule the same way “[e]ven under a more deferential arbitrary and capricious standard of review[.]”) Moving on to the merits, the court concluded that Booth was entitled to benefits because she met the plan’s “any occupation” definition of disability. The court noted that both parties agreed Booth could not lift more than five pounds, which for the court did not allow her to return to “any occupation.” Reliance identified sedentary occupations it contended Booth could perform, but the court found that these required the ability to lift ten pounds “occasionally,” which Booth could not do. As a result, the court granted Booth’s summary judgment motion and denied Reliance’s.

DelValle v. Unum Group Corp., No. 22-CV-07717-LTS, 2026 WL 878595 (S.D.N.Y. Mar. 31, 2026) (Judge Laura Taylor Swain). Plaintiff Eneida DelValle worked as an investigative news producer for CBS and was a participant in CBS’ ERISA-governed short-term disability (STD) and long-term disability (LTD) benefit plans, which were insured by defendant First Unum Life Insurance Company. DelValle contracted COVID-19 in December 2020, was hospitalized, and was later diagnosed as a “COVID-19 long hauler” by her physician. She stopped working in March of 2021, after which she received the full complement of STD benefits from Unum. However, when DelValle submitted her claim for LTD benefits, Unum denied it, contending she did not meet the LTD plan’s definition of disability throughout the plan’s waiting period, or “elimination period.” DelValle filed this action against Unum and its parent company, Unum Group Corporation, asserting improper denial of LTD benefits in violation of ERISA. The parties filed cross-motions for summary judgment which the court ruled on in this order. At the outset, the court agreed with the parties that the default de novo standard of review applied because the plan did not grant discretionary authority to Unum in rendering benefit decisions. However, the procedural posture of the case stymied the court because, “As the Second Circuit has explained, when faced with a conflict between two [or more] potentially credible physician’s reports, neither party is entitled to summary judgment where, as here, a Plan Administrator’s decision is subject to de novo review: ‘Such a credibility determination is appropriate at a trial, but it exceeds the scope of a judge’s authority in considering a summary judgment motion.’” The court did note that “Defendants are mistaken that medical evidence collected after the Elimination Period is ‘insufficient to create an issue of fact’ with regard to their motion for summary judgment.” However, after examining all of the evidence, both during and after the elimination period, the court concluded that there were too many disputed issues of material fact to resolve on summary judgment. The court was only able to resolve one issue, agreeing with defendants that “Unum Group Corp. ‘is the parent corporation of First Unum Life Insurance Company’ and ‘is not an insurer, has no privity of contract with plaintiff, and is not a proper party to this lawsuit.’” The court therefore dismissed DelValle’s claims against Unum Group Corporation only. The court then referred the parties to the court’s mediation program and to the assigned magistrate judge for pretrial management.

Seventh Circuit

King v. Reliance Standard Life Ins. Co., No. 1:23-CV-443-GSL, 2026 WL 873872 (N.D. Ind. Mar. 31, 2026) (Judge Gretchen S. Lund). Megan King worked as a senior care specialist for Medtronic and was a participant in Medtronic’s ERISA-governed employee disability benefit plan, which was insured and administered by Reliance Standard Life Insurance Company. King was diagnosed with acromegaly in August 2018 due to a pituitary adenoma, underwent a pituitary hypophysectomy, and subsequently submitted claims for short-term and long-term disability benefits to Reliance. Reliance approved King’s claim for short-term benefits, and then approved her transition to long-term benefits. After twelve months of benefits the policy required King to be unable to perform the duties of “any occupation” in order to continue receiving benefits. In 2022 Reliance determined that King no longer met this definition because there was no medical evidence supporting King’s inability to perform sedentary occupations due to her physical condition. Reliance did acknowledge that King was impaired due to major depression and anxiety disorder, but benefits for these conditions were limited under the policy to twelve months, so Reliance terminated her benefits in 2023. King appealed, providing updated medical records, a vocational evaluation, and a favorable Social Security disability determination, but Reliance upheld its decision. King thus brought this action under ERISA seeking reinstatement of her benefits. The parties filed cross-motions for judgment, which were decided in this order. The standard of review was de novo because Reliance failed to timely render a decision on King’s appeal. The court stressed that “neither party is disputing the fact that King is disabled. Instead, King is arguing her debilitating symptoms are a result of a physical condition while Reliance claims that King’s mental condition is the actual cause.” The court sided with Reliance. The court found insufficient evidence in the record to conclude that King’s disability was caused by a physical injury or sickness as defined by the policy. The court reviewed treatment notes, medical opinion forms, and other evidence, finding no “direct link” between King’s physical condition and her debilitating symptoms. The court further ruled that “the 2020 [Social Security] decision undermines King’s argument” that she was disabled by physical illness in 2023. Not only was the decision out-of-date, “but like a majority of record before this Court, nothing in the decision directly links King’s debilitating limitations and restrictions to her physical condition.” As a result, the court denied King’s motion, granted Reliance’s, and entered judgment in Reliance’s favor.

Ninth Circuit

Dever v. The Lincoln Nat’l Life Ins. Co., No. 2:24-CV-02435-DJC-JDP, 2026 WL 880238 (E.D. Cal. Mar. 31, 2026) (Judge Daniel J. Calabretta). Plaintiff Shelley Dever worked for 22 years as a registered nurse at Dignity Health, assessing patient health, developing nursing care plans, and maintaining medical records. She was a participant in Dignity Health’s ERISA-governed long-term disability (LTD) benefit plan, insured by defendant Lincoln National Life Insurance Company. Dever stopped working in 2020 due to lupus, fibromyalgia, chronic pain, depression, and a lumbar herniated disc. She filed an LTD claim with Lincoln, which Lincoln initially approved because Dever was not able to perform the duties of her “own occupation.” However, when the plan definition of disability shifted to a more difficult “any occupation” standard after she received 24 months of benefits, Lincoln determined that Dever did not meet this standard and terminated her benefits. In denying her claim, Lincoln contended that Dever could return to work as a “Nurse, Consultant.” Dever appealed unsuccessfully and then filed this action under ERISA, seeking to reverse Lincoln’s decision. The parties filed cross-motions for judgment under Federal Rule of Civil Procedure 52, and the court applied the default de novo standard of review as agreed by the parties. The court stated that “the central issue is whether Plaintiff has demonstrated, by a preponderance of the evidence, that she suffers from a physical or cognitive limitation preventing her from performing sedentary work as a Nurse Consultant as of November 17, 2022.” The court agreed that she had, finding that Dever suffered from cognitive limitations preventing her from performing the duties of the “Nurse, Consultant” role. The court relied heavily on the results of a neuropsychological evaluation, which concluded that Dever was unable to work due to cognitive impairments and related psychological symptoms. The court acknowledged that the test was not perfect because Dever failed one of the eight validity measures and demonstrated “inter individual variability.” However, the court found that overall, the test was supported by the record, which included Dever’s documented history of depression, mental fogginess, and short-term memory issues. However, the court found that Dever failed to establish, by a preponderance of the evidence, that she was physically unable to perform the duties of “any occupation.” The court reviewed the results of Dever’s functional capacity evaluation (FCE), which she claimed supported her physical deficits, but observed that “it does not appear to include objective validity measures that would demonstrate reliability. The FCE relies heavily on Plaintiff’s self-reported tolerances and did not document many physiological response changes in conjunction with Plaintiff’s performance.” The court also found that the record supported that plaintiff could perform sedentary work due to “unrestricted” sitting limitations. As a result, “While Plaintiff has not demonstrated functional limitations that would meet the any occupation definition of disability, Plaintiff has proven, by a preponderance of the evidence, that her cognitive limitations would prevent her from performing the Nurse Consulting role, the only potential employment identified by Defendant.” Thus, the court granted Dever’s motion for judgment, denied Lincoln’s, and ordered Lincoln to pay LTD benefits from November 17, 2022 to the present with prejudgment interest at the statutory rate.

ERISA Preemption

Second Circuit

State of New York v. UnitedHealthcare of New York, Inc., No. 1:25-CV-00087 (AMN/DJS), 2026 WL 873086 (N.D.N.Y. Mar. 31, 2026) (Judge Anne M. Nardacci). The State of New York filed this action in New York state court against UnitedHealthcare of New York, Inc., Oxford Health Plans (NY), Inc., and Oxford Health Insurance, Inc. for allegedly breaching contracts with a state-owned hospital, Stony Brook University Hospital (SBUH). SBUH was an in-network provider in defendants’ insurance networks and provided “observation services” to emergency room patients while deciding whether to admit them. The state contends that defendants stopped reimbursing SBUH for observation services lasting less than eight hours, citing a 2020 policy change. The state contends this policy change breached the contracts, which required reimbursement regardless of the length of stay. In its complaint, the state asserted four state law claims: (1) breach of the contracts between SBUH and defendants, (2) unjust enrichment, (3) declaratory judgment, and (4) interest and collection fees in connection with a debt owed to the state pursuant to N.Y. State Fin. Law § 18. Defendants removed the case to federal court, claiming federal question jurisdiction under ERISA. The state then moved to remand the case back to state court, arguing that the claims were based on the contracts and were not preempted by ERISA. Meanwhile, defendants filed a motion to dismiss. The parties then conducted jurisdictional discovery regarding the state’s motion, after which the court ruled on the motion in this order. The court employed the Supreme Court’s two-prong test from Aetna Health Inc. v. Davila to determine whether the state’s claims were completely preempted. On the first prong, the court found that defendants did not establish that SBUH had derivative standing to bring an ERISA claim because defendants failed to prove valid assignments of ERISA claims from their insureds to SBUH. The court stated, “Defendants do not appear to have submitted complete documents, the relevant documents, or even excerpts from the versions of documents applicable at the time of the parties’ dispute. Moreover, the excerpts Defendants have submitted either contradict or do not support a number of Defendants’ characterizations.” Furthermore, the court noted that the contracts between SBUH and defendants expressly prohibited SBUH from seeking reimbursement from patients, further undermining defendants’ argument for derivative standing. As for prong two, the court determined that the state’s claims were based on independent legal duties arising from the contracts, not from any ERISA plan. “Simply put, Plaintiff’s claims concern ‘the computation of contract payments or the correct execution of such payments’ and the ‘independent contractual obligations’ between Stony Brook and Defendants.” The court reviewed the claims at issue and concluded that “Defendants have failed to establish that coverage for emergency room Observation services was actually denied under any Plan.” As a result, the parties’ dispute involved “the amount of reimbursement due under the Contracts,” and not “the denial of ERISA benefits[.]” Finally, the court found that defendants “lacked an objectively reasonable basis for removal” and thus awarded costs and fees to the state. The court reiterated that defendants “have repeatedly submitted selective excerpts and inaccurately characterized many of those excerpts to support their arguments,” and “had ample time to conduct such an investigation prior to filing a notice of removal.” Thus, the case was remanded back to state court and defendants will have pay for the state’s costs in obtaining that result.

Ninth Circuit

Oak v. MultiCare Health System, No. 3:25-CV-05913-DGE, 2026 WL 879066 (W.D. Wash. Mar. 31, 2026) (Judge David G. Estudillo). Francis Faye Oak is employed by MultiCare Health System as a bereavement counselor and is a participant in the MultiCare Health System Flexible Benefits Program, MultiCare MyConnected Care Plan, an ERISA-governed medical benefit plan. Oak is a transgender woman who has been receiving gender-affirming health care. She sought pre-authorization for gender-affirming facial feminization surgery under the plan, but her claim was denied on the ground that the plan excluded such treatment from coverage. Oak thus filed this action in Washington state court. In her complaint she acknowledged that that the procedures she sought are excluded from coverage under the plan, but alleged that the exclusion is intentionally designed to target transgender employees and therefore constitutes illegal sex and/or sexual orientation discrimination under the Washington Law Against Discrimination (WLAD). Oak sought a judgment declaring the exclusion unlawful, injunctive relief to stop the discriminatory policy, actual damages, emotional distress damages, attorney’s fees, and other remedies permitted under the WLAD. MultiCare removed the case to federal court, asserting federal question jurisdiction under ERISA. Oak moved to remand the case back to state court, arguing that ERISA does not apply to her claim because she pled her claims solely under the WLAD. The court noted that ERISA Section 514(a) “broadly preempts ‘any and all State laws insofar as they may now or hereafter relate to any [covered] employee benefit plan,’” but this section, when raised as a defense, “is an insufficient basis for original federal question jurisdiction under § 1331(a) and removal jurisdiction under § 1441(a).” The court construed MultiCare’s conflict preemption argument to be an affirmative defense to Oak’s WLAD claim, and thus “§ 514 does not confer federal question jurisdiction and removal based on § 514 was, and continues to be, improper.” The court further ruled that complete preemption under ERISA § 502(a) did not apply because, under the Supreme Court’s Davila test, Oak’s WLAD claim (1) did not seek to recover benefits, enforce rights, or clarify rights under an ERISA-governed plan, because the procedures she sought were explicitly excluded from the plan, and (2) implicated an independent legal duty under the WLAD, which existed regardless of the ERISA plan, as it pertained to the employer’s obligation to provide a non-discriminatory compensation package. Furthermore, “determining whether Defendant complied with its duties under the WLAD requires interpretation of state law, not interpretation of the Plan.” As a result, neither Davila prong applied and thus ERISA did not preempt Oak’s claims. The court thus granted Oak’s motion and remanded the case back to state court.

Life Insurance & AD&D Benefit Claims

Second Circuit

Metropolitan Life Ins. Co. v. Bakx, No. 23-CV-1474 (KAD), 2026 WL 867496 (D. Conn. Mar. 30, 2026) (Judge Kari A. Dooley). This is an interpleader action filed by Metropolitan Life Insurance Company following the death of William E. Murray, IV. Murray worked for The Travelers Companies, Inc., and was insured for $480,000 in benefits under Travelers’ ERISA-governed employee life insurance plan, administered by MetLife. Murray did not designate a beneficiary under this plan before he died, and two people contended that they should receive the benefits: Sarah Bakx, his ex-wife, and Cristina Martinez, his wife at the time of his death. Bakx’s claim was based on a marriage dissolution agreement requiring Murray to maintain $500,000 in life insurance benefits for their minor son and provide annual proof of compliance. Martinez’s claim was based on the plan’s terms, which prioritize the surviving spouse when no beneficiary is designated. The dissolution agreement allowed Bakx to make a priority claim against Murray’s estate if he did not comply with the agreement’s terms during his lifetime. He did not, and thus Bakx made such a claim after his death and “received the total proceeds of the CETERA 401(k) account that the decedent maintained in the amount of $212,835.88 on behalf and for the benefit of their minor son.” After the case was filed, Martinez declared bankruptcy and thus the trustee of her bankruptcy estate substituted in as her successor in interest. The trustee filed a motion to dismiss for lack of subject matter jurisdiction and a motion for summary judgment, which the court ruled on in this order. The trustee argued that the life insurance proceeds should be distributed according to the plan documents, which designated the surviving spouse, i.e., Martinez, as the beneficiary in the absence of a designated beneficiary. The trustee also contended that state laws and remedies were preempted by ERISA and thus unavailable to Bakx. The court denied the motion to dismiss, ruling that it had subject matter over the case under federal interpleader rules. However, it granted the trustee’s motion for summary judgment. The court found that the plan documents required the distribution of benefits to the surviving spouse, Martinez, because no beneficiary was designated. The court emphasized that ERISA requires administrators to manage plans according to the governing documents, and thus Martinez, as the surviving spouse, was the rightful distributee. The court found Bakx’s arguments in opposition “difficult to understand” and “spun of whole cloth.” Bakx asserted arguments “as a plan fiduciary” but the court explained that “[s]he had no role under the plan documents and the marriage dissolution did not somehow turn her into a fiduciary under ERISA.” In short, “There is simply no suggestion that she can posthumously reform his ERISA benefits plan in a fashion that would force him to honor his marriage dissolution agreement. To the contrary, the parties had negotiated a remedy in the event that the Decedent were to breach the life insurance provision. As a remedy, Ms. Bakx is entitled to a priority claim against his estate, which is a remedy she has pursued.” Finally, the court rejected Bakx’s argument that she should be entitled to a constructive trust under Connecticut law. The trustee argued that this claim was preempted by ERISA, but the court saw no need to address that argument because “even under Connecticut law, she is not entitled to a constructive trust.” As a result, the trustee prevailed and the interpled funds will go to Martinez’ bankruptcy estate.

Fifth Circuit

Langley v. Metropolitan Life Ins. Co., No. 3:24-CV-2832-K, 2026 WL 865736 (N.D. Tex. Mar. 30, 2026) (Judge Ed Kinkeade). Marvin Langley alleges he was working for Southwest Airlines Company in November of 2023 when he was injured while inspecting aircraft panels. Langley was lifting the 50+-pound panels by hand and injured his left eye, resulting in loss of vision. He was diagnosed with “a Central Retinal Vein Occlusion (‘CRVO’) with macular edema in his left eye, as well as ‘retinal hemorrhaging,’ secondary to CRVO, also in his left eye.” Langley filed a claim for accidental dismemberment benefits under the Southwest Airlines Company Welfare Benefit Plan, which was denied by the plan’s insurer, Metropolitan Life Insurance Company. MetLife contended there was no evidence that Langley’s loss of sight was “solely and directly due to an accident.” Langley’s appeal was unsuccessful, so he filed suit in Texas state court against MetLife and Southwest, asserting claims for wrongful denial of benefits under ERISA, unfair or deceptive settlement practices, and negligence. Defendants removed the case to federal court, after which MetLife filed a Motion for Judgment on the Administrative Record under Federal Rule of Civil Procedure 52. Before addressing the merits of Langley’s claims, the court addressed two procedural matters. First, Langley argued that MetLife’s motion should be treated as a motion for summary judgment, but the court ruled that Rule 52 was the appropriate procedural mechanism for analyzing claims for wrongful denial of benefits under ERISA. Second, the court determined that the correct standard of review in evaluating MetLife’s motion was the default de novo standard of review because there was no disagreement between the parties on the issue. On the merits, MetLife argued that Langley was not entitled to benefits because he “cannot point to a single piece of evidence in the [a]dministrative [r]ecord that proves that an accidental injury occurred that was the sole and direct cause of the loss of sight in his left eye.” MetLife also cited the plan’s pre-existing illness exclusion. The court noted that Langley “provides almost no argument in opposition to MetLife’s Motion,” and instead he focused on whether MetLife’s motion should be converted into a motion for summary judgment, contending that “[t]here are genuine disputes of material fact or law regarding Plaintiff’s loss of vision from unavoidable exposure to lifting heavy wing panels.” This was not good enough for the court, which, after “carefully conduct[ing] a de novo review of the administrative record,” found that Langley did not meet his burden of proving that he was entitled to benefits. The court cited a lack of evidence in the record showing that Langley’s injury was the “Direct and Sole Cause” of his loss of sight, as required by the plan. Specifically, Langley’s retinal specialist indicated that the injury was not solely responsible for the loss, and his optometrist could not determine the cause of the CRVO. Furthermore, the record showed pre-existing eye conditions and hypertension, which contributes to CRVO. As a result, the court granted MetLife’s motion and affirmed its benefit denial. The case will thus continue against Southwest without MetLife.

Medical Benefit Claims

Seventh Circuit

James D. v. Health Care Service Corp., No. 1:25-CV-03681, 2026 WL 891868 (N.D. Ill. Mar. 31, 2026) (Judge Edmond E. Chang). James D. and his daughter D.D. are covered by the Transcanada USA, Inc. Employee Medical Plan, an ERISA-governed health plan administered by Health Care Service Corporation, better known as Blue Cross Blue Shield of Texas. D.D. received mental health treatment at two facilities in Utah, Wingate Wilderness Therapy and Uinta Academy, for about seven months in 2022. James D. submitted claims to Blue Cross for both facilities, but Blue Cross denied them. It denied the Wingate claims based on the plan’s exclusion of coverage for wilderness programs, while the Uinta denial was based on a lack of 24-hour nursing, which was required for residential treatment centers in order to qualify for coverage under the plan. Plaintiffs brought this action against Blue Cross and the plan alleging violations of ERISA and the federal Mental Health Parity and Addiction Equity Act of 2008. Defendants filed a motion to dismiss both counts for failure to state a claim. On their ERISA claim, plaintiffs responded by contending that Wingate offered “outdoor behavioral health services,” not “wilderness programs,” which they admitted were excluded from coverage. However, this was a distinction without a difference for the court: “This argument assumes that the two terms are mutually exclusive, but the plan states that wilderness programs are one example of behavioral health services… And in any event, without some explanatory factual allegations, it defies reason to suggest that a program named ‘Wingate Wilderness Therapy’ offers a behavioral health service that is not a ‘wilderness program.’” Furthermore, “Plaintiffs do not claim that Uinta provides 24-hour onsite nursing, so the plan plainly excludes it from coverage as a residential treatment center.” As for plaintiffs’ Parity Act claim, plaintiffs contended that the plan’s requirements for mental health benefits were more restrictive than those for medical and surgical benefits. However, the court concluded that the 24-hour nursing requirement did not violate the Parity Act because similar requirements applied to analogous medical and surgical benefits, such as skilled nursing facilities. The court also rejected the argument (which it acknowledged was supported by other courts) that the source of the requirements – state and federal law as opposed to plan language – created a disparity, as the Parity Act focuses on whether the limitations themselves are more restrictive, not their origins. “Whether the limitations are ‘as written’ or ‘in operation,’ 29 C.F.R. § 2590.712(c)(4)(i), the upshot is that equal limitations arising from different sources do not create a disparity in the limitations.” As a result, the court granted Blue Cross’ motion to dismiss, but without prejudice, allowing plaintiffs to file an amended complaint if they “genuinely believe that they can fix the deficiencies identified in this Opinion.”

O.F. v. Health Care Service Corp., No. 1:25-CV-00127, 2026 WL 885184 (N.D. Ill. Mar. 31, 2026) (Judge Edmond E. Chang). This order by Judge Chang is very similar to the same-day ruling he issued in the James D. case examined above. The case involves the same attorneys, the same insurer defendant, and the same causes of action with the same legal issues at play. As a result, the outcome was unsurprisingly the same. Here the plaintiffs were O.F. and his daughter M.F., who filed this action against Blue Cross Blue Shield of Texas after Blue Cross denied ERISA-governed benefit claims for M.F.’s treatment at two facilities in Utah: Aspiro Wilderness Adventure Therapy and La Europa Academy. Blue Cross denied the Aspiro claims based on the applicable benefit plans’ exclusion for “behavioral health outdoor/wilderness services,” while the La Europa claims were denied due to the lack of 24-hour nursing availability, which was a requirement for a facility to be considered a covered residential treatment center under the plans. As in James D., O.F. asserted two counts: one for plan benefits under ERISA and one for violation of the Mental Health Parity and Addiction Equity Act of 2008. Blue Cross filed a motion to dismiss for failure to state a claim challenging both counts. Addressing the ERISA claim first, the court noted that Texas law prohibits discretionary clauses in insurance plans, which meant that the court reviewed Blue Cross’ denial of benefits de novo. Under this standard, O.F.’s allegations that Blue Cross committed procedural violations, and that he did not get a “full and fair review” under ERISA, were irrelevant: “de novo review renders the plan’s past procedural steps as largely unimportant.” Thus, the court turned to the merits and agreed with Blue Cross that the plans explicitly excluded wilderness programs, and required 24-hour nursing for residential treatment centers, which meant that “there is no coverage for the treatment programs under the plans.” As for the Parity Act claim, the court found it unpersuasive. Again, the court concluded that the 24-hour nursing requirement did not violate the Parity Act because similar requirements applied to analogous medical and surgical benefits, such as skilled nursing facilities. The court also again rejected the argument that the source of the requirements (plan text versus state and federal law) created a disparity because the Parity Act focuses on the limitations themselves and not their origins. Additionally, the court found no plausible Parity Act violation based on the wilderness-treatment exclusion, as the plans excluded “non-therapeutic care” for both mental health and medical benefits. As a result, as in the James D. case, the court granted Blue Cross’ motion, but without prejudice, allowing O.F. to amend the complaint if he can do so consistent with the court’s rulings.

Ninth Circuit

Rogers v. Blue Cross & Blue Shield of Massachusetts, Inc., No. 8:25-CV-01501-MRA-DFM, 2026 WL 851306 (C.D. Cal. Mar. 24, 2026) (Judge Monica Ramirez Almadani). Eric Rogers alleges that he suffers from severe gastrointestinal problems which have caused accelerated decay of his teeth and lower jawbone. Rogers’ dentist determined that Rogers required a full mouth extraction and replacement of all his teeth. However, the administrator of Rogers’ ERISA-governed health plan, Blue Cross and Blue Shield of Massachusetts (BCBS), denied coverage for this treatment, contending that the procedures were dental and not medical. Rogers underwent the treatment, consisting of three surgeries, resulting in $107,290 in claims. However, Blue Cross continued to deny coverage, citing the plan’s dental care exclusion. As a result, Rogers filed this action under ERISA seeking payment of plan benefits. He contended that the surgeries should be covered under the plan’s provisions for outpatient surgical services, which include oral surgery when performed by a covered provider. Rogers further argued that the plan’s dental care exclusion is ambiguous and should not apply to his medically necessary oral surgeries. BCBS moved to dismiss under Federal Rule of Civil Procedure 12(b)(6). The court denied its motion. The court found that Rogers plausibly alleged that the “Surgery as an Outpatient” provision of the plan entitled him to coverage for the oral surgeries by his dentist, who was a covered provider under the plan. The court emphasized that the burden is on plan administrators to prove the applicability of plan exclusions, and ambiguities in an ERISA plan are construed in favor of the insured. Under these standards, BCBS failed to meet its burden of proving the applicability of the plan’s dental care exclusion because the exclusion was ambiguous and the plan did not define the term “dental care.” BCBS offered several facts and documents extrinsic to the complaint to support its arguments, such as the dentist’s website and information regarding medical coding, but the court found that “these arguments are largely irrelevant, because none expound on the meaning of ‘dental care’ as that phrase is used in the Plan.” Furthermore, these documents could not be considered at the motion to dismiss stage. Finally, the court concluded that the ancillary anesthesia services were plausibly covered as they were related to the covered surgeries. The court did not address whether the alleged untimeliness of Blue Cross’ appeal decision would independently entitle Rogers to benefits, as it found sufficient grounds to deny the motion based on the coverage provisions.

Tenth Circuit

Richard K. v. BlueCross BlueShield of Illinois, No. 2:23-CV-491-TC, 2026 WL 883948 (D. Utah Mar. 31, 2026) (Judge Tena Campbell). Richard K. is a participant in the ERISA-governed Boeing Company Consolidated Health and Welfare Benefit Plan; W.K. is his child and a beneficiary under the plan. Defendant BlueCross BlueShield of Illinois (BCBSIL) is the plan’s third-party claims administrator. W.K. received medical care in 2021 and 2022 at two facilities, Evoke at Entrada and Vista Adolescent Treatment Center. Both are licensed in Utah and provide sub-acute inpatient treatment for adolescents with mental health, behavioral, and/or substance abuse issues. BCBSIL denied claims for benefits for W.K.’s treatment at Evoke, citing a plan exclusion for wilderness programs, and also denied preauthorization for treatment at Vista, stating that Vista did not meet the plan’s requirement for 24-hour nursing care. Richard K. unsuccessfully appealed and then filed this action, asserting two claims: (1) recovery of benefits under ERISA, 29 U.S.C. § 1132(a)(1)(B), and (2) equitable relief for violation of the Mental Health Parity and Addiction Equity Act of 2008 (Parity Act), 29 U.S.C. § 1132(a)(3). Defendants filed a motion to dismiss, challenging (1) the timeliness of plaintiffs’ benefits claim for treatment at Evoke, (2) plaintiffs’ standing to pursue their Parity Act claims, and (3) the sufficiency of the Parity Act claims. Addressing timeliness first, the court found that plaintiffs’ claim was timely. The plan’s denial letter did not adequately inform plaintiffs of the 180-day deadline for filing suit, as required by Department of Labor regulations. Defendants contended that they were only required to give such notice in the final denial of an appeal, and that plaintiffs had skipped the second-level appeal; thus, they did not have to give notice in their first-level appeal denial. The court rejected this argument, ruling that the regulation’s notice requirement “applies to any adverse benefit determination[.]” Because of defendants’ failure to comply, the court struck the 180-day limitation period as unenforceable and applied Utah’s six-year statute of limitations for breach of contract, under which plaintiffs’ filing was timely. Next, the court held that plaintiffs had standing to bring Parity Act claims. Defendants contended that plaintiffs did not allege that W.K. will require future treatment, and thus equitable relief was unavailable. However, the court found that defendants’ argument “misunderstands the purpose of the Parity Act, which allows the court to fashion equitable relief – including by removing requirements in the Plan that violate the Parity Act and remanding a review of the Plaintiffs’ claim for benefits to the insurer.” The court further ruled that the Parity Act claims were not duplicative of plaintiffs’ claim for benefits because they served a distinct purpose beyond seeking reimbursement for past treatment. Turning to the sufficiency of the Parity Act claims, the court ruled that plaintiffs adequately pleaded such claims for both Evoke and Vista. For Evoke, the court noted that the plan was ostensibly “neutral on its face” because the wilderness exclusion applied to any kind of treatment, physical or mental. However, the exclusion could still be discriminatory if applied more restrictively to mental health treatments than to analogous medical/surgical treatments. Based on “the lack of any information about the extent of that exclusion or how the plan administrator applied the exclusion in practice,” the court allowed the claim to move forward. For Vista, the court found that BCBSIL imposed an additional requirement for 24-hour nursing care not present in the plan, which could constitute a discriminatory limitation under the Parity Act. As a result, plaintiffs’ claims survived defendants’ motion to dismiss and the case will continue.

Z.C. v. United Healthcare Benefits Plan of Cal., No. 1:25-CV-13, 2026 WL 867415 (D. Utah Mar. 30, 2026) (Judge Tena Campbell). Plaintiff Z.C. filed this action individually and on behalf of his minor child, C.C., against United Healthcare Benefits Plan of California and OptumHealth Behavioral Solutions of California. Plaintiffs alleged that defendants violated ERISA by denying plaintiffs’ claims for benefits for mental health treatment received by C.C. at Elevations Residential Treatment Center in 2022 and 2023. Previously, C.C. was admitted to a partial hospitalization program due to severe issues with anxiety, self-harm, and suicidal ideation, after which he was admitted to Elevations. Optum denied payment for C.C.’s treatment at Elevations from April 12, 2022 onward, contending that his condition no longer met the necessary criteria for residential treatment. Plaintiffs appealed, but Optum upheld the denial for all but the first two weeks of treatment. Plaintiffs thus filed this action, asserting two claims for relief: (1) recovery of benefits under ERISA, 29 U.S.C. § 1132(a)(1)(B), and (2) equitable relief based on defendants’ violation of the Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA), under 29 U.S.C. § 1132(a)(3). Defendants filed a motion to dismiss, arguing that plaintiffs did not adequately specify the plan terms under which C.C.’s treatment should have been covered, and that they failed to adequately state a Parity Act claim. Addressing the benefits claim first, the court found that plaintiffs adequately alleged that C.C.’s treatment was medically necessary and covered under the benefit plan. The court noted that defendants themselves referred to the relevant plan terms, which covered medically necessary mental health treatments. Furthermore, plaintiffs alleged that defendants used outdated criteria, ignored parts of C.C.’s medical records, and provided examples of C.C.’s treatment sabotage and regression. Thus, these allegations were sufficient to plausibly suggest that C.C.’s treatment was medically necessary. Regarding the Parity Act claim, the court found that plaintiffs adequately pled the elements of an as-applied Parity Act violation. Plaintiffs alleged that defendants applied acute criteria to determine C.C.’s medical necessity for mental health treatment, which was not required for analogous medical/surgical care. The court thus found that plaintiffs plausibly alleged a disparity between the treatment limitations applied to mental health benefits and those applied to medical/surgical benefits. The court emphasized that to the extent plaintiffs were unable to allege certain information to support their Parity Act claim, this was due to defendants’ refusal to produce requested documents, such as “a copy of the governing plan documents, a copy of the CALOCUS-CASII criteria that the Defendants used to determine coverage, and ‘any medical necessity criteria for mental health and substance use disorder treatment and for skilled nursing or rehabilitation facilities[.]’” The court stated, “Where there is a discrepancy of information, ‘courts are declining to hold plaintiffs ‘responsible for documents and information that remain within defendants’ exclusive control,’ especially because plaintiffs should ‘not be punished for not offering those facts when their repeated requests to learn the same have been ignored.’’” Thus, the court denied defendants’ motion to dismiss in its entirety.

Pension Benefit Claims

Fourth Circuit

Walls v. McCullough, No. CV MJM-25-852, 2026 WL 863990 (D. Md. Mar. 30, 2026) (Judge Matthew J. Maddox). William Walls retired as a seaman in 2009 and began receiving a monthly pension of $372.44 from the Masters Mates & Pilots Pension Plan. In June of 2020, however, the plan suspended Walls’ benefits because he allegedly failed to comply with the plan’s requirement that he “certify on a periodic basis, including annually, the receipt of benefit payments on such forms and in such manner as prescribed by the Trustees.” The plan administrator, Patrick McCullough, told Walls that his benefits had been suspended because he violated Section 6.09(e) of the plan regulations by failing to verify “on forms provided by the Plan Office that he [wa]s not working in ‘Disqualifying Employment[.]’” Walls corresponded with McCullough and other plan representatives over the next year but alleges that he was denied access to certain information and documents. Walls then appealed, and in 2021 he was successful, receiving a year of retirement pay. However, Walls alleges he “never received a written decision of the appeal and was told that no transcript of his appeal was available.” Then, in June of 2023, Walls was once again told that absent the receipt of a plan-issued verification form, he would not be paid benefits as of May 2024. As a result, Walls brought this pro se action against the union, the plan, and various related defendants seeking relief under ERISA §§ 502(a)(1)(B) and § 502(a)(3). After the case was removed from Texas state court and transferred to the District of Maryland, the union and plan defendants moved to dismiss for failure to state a claim. The court granted the motion as to the union because Walls indicated he was “not opposed” to its dismissal. As for the plan defendants, the court examined Walls’ pro se complaint and “construe[d] the cause of action asserted in the First Amended Petition as an ERISA claim for declaratory judgment to clarify Plaintiff’s rights under § 502(a)(1)(B).” The court concluded that Walls had not sufficiently pleaded this claim because his complaint did not present a “definite and concrete” dispute regarding his rights under the plan. The court noted that Walls acknowledged the plan’s requirement for verification forms, which resolved any dispute over whether he had to submit them. Furthermore, Walls did not show that the plan “failed to comply with the Plan’s appeal procedures when Plaintiff appealed the 2020 withholding of his pension benefits,” or that he was told by the plan that “he would not be able to appeal the then-impending abrogation of his pension benefits in May 2024.” As a result, Walls “fails to state a plausible cause of action for declaratory judgment clarifying his rights under the Plan, and his claim under § 502(a)(1)(B) must be dismissed.” Additionally, the court determined that Walls did not exhaust the plan’s administrative remedies regarding the 2024 benefit suspension. “Plaintiff exhausted this remedy in the past but does not show that he did so again after learning that his pension payments would be ‘abrogated’ in May 2024.” Finally, regarding Walls’ claim for equitable relief under § 502(a)(3), the court concluded that Walls did not allege any violation of ERISA or the plan and thus improperly sought relief under this provision. The court noted that relief under § 502(a)(3) is only available when other ERISA remedies are inadequate, and that Walls did not offer any substantive argument on the issue in his briefing. As a result, the court granted defendants’ motions to dismiss and closed the case.

Fifth Circuit

Moody v. National Western Life Ins. Co., No. 1:25-CV-00743, 2026 WL 896223 (W.D. Tex. Mar. 26, 2026) (Judge David Alan Ezra). Ross Rankin Moody is the former chairman and CEO of National Western Life Insurance Company (NWLIC), a subsidiary of National Western Life Group, Inc. (NWLGI). Moody worked at National Western for over 40 years and alleges he was promised pension benefits under the company’s “Non-Qualified Defined Benefit Plan for the President of National Western Life Insurance Company” (the NQDB Plan). Moody also received long-term incentive (LTI) awards during his employment. In 2023 NWLGI entered into a merger agreement with Prosperity Life Group. Moody alleges he was asked to sign an agreement to favor the acquisition, after receiving assurances from the company that his LTI and severance payments would be included in the calculation of his benefits under the NQDB Plan. However, Moody contends that after the merger a new committee formed by Prosperity recalculated his benefits, excluding “any pay that Plaintiff earned and accrued during his employment but received after his termination.” This resulted in the exclusion of his LTI and severance payments. Moody appealed to no avail and then filed this action against NWLIC and related defendants, asserting eight claims for relief under ERISA regarding the NQDB Plan and other benefits. Defendants filed a motion to dismiss as to counts II and III, focusing on the NQDB Plan dispute. These claims alleged “(II) ERISA Estoppel Under Federal Common Law and as Equitable Relief Under ERISA Section 502(a)(3); (III) Denial of a Full and Fair Review Under ERISA Section 503.” Defendants argued that Count II was duplicative of Moody’s claim for plan benefits under Count I, which was brought pursuant to Section 502(a)(1)(B). The court agreed that Moody could not bring his estoppel claim under 502(a)(3), ruling that “Fifth Circuit law prohibits Plaintiff from asserting a claim under Section 502(a)(3) in these circumstances. Here, Plaintiff’s Section 502(a)(3) claim is based on the same inherent injury as his Section 502(a)(1)(B) claim: the allegedly incorrect calculation of his benefits. Although Plaintiff may label his relief differently (equitable rather than legal), in essence, Plaintiff seeks the same remedy with both claims: the ‘proper’ calculation of his benefits.” However, the court noted that in Count II Moody alleged estoppel under not just ERISA, but federal common law. Thus, “while the Court agrees with Defendants that Plaintiff cannot assert an estoppel claim under Section 502(a)(3) in these circumstances, it does not agree that Plaintiff is similarly precluded from bringing his estoppel claim under common law.” The court noted that “courts in this Circuit have continued to evaluate ERISA estoppel claims alongside Section 502(a)(1)(B) claims ‘without considering the possibility that the latter could preempt the former.’” Thus, “the Court will not, at this early stage, prohibit Plaintiff from bringing his ERISA estoppel claim under federal common law.” The court further found that Moody had adequately stated the elements of an estoppel claim by alleging (1) a material misrepresentation, (2) reasonable and detrimental reliance on the misrepresentations, which were made regarding ambiguous plan language, and (3) extraordinary circumstances because he “pleaded acts of bad faith and circumstances where Plaintiff diligently inquired about benefits and was repeatedly misled.” As for Count III, defendants contended that ERISA’s “full and fair review” provision, Section 503, imposes obligations on plans, not employers, and thus NWLIC was an improper defendant. Moody argued that “the NQDB Plan is ‘an unfunded ‘top-hat’ plan that has no meaningful existence apart from [NWLIC],’” but the court found this assertion to be conclusory. It ruled that Moody did not sufficiently plead specific facts showing that the NQDB Plan was a “top hat” plan or that NWLIC “was the plan,” and thus dismissed Count III as to NWLIC. However, the court disagreed with defendants that Count III was duplicative of Count I (the Section 502(a)(1)(B) claim), noting that a denial of full and fair review under Section 503 could represent an independent basis to overturn a plan administrator’s denial of benefits. As a result, the court granted in part and denied in part defendants’ motion to dismiss, allowing Moody to proceed with his common law ERISA estoppel claim and his Section 503 claim against the NQDB Plan.

Plan Status

Second Circuit

Montero v. City of New York, No. 1:25-CV-02482 (JLR), 2026 WL 866851 (S.D.N.Y. Mar. 30, 2026) (Judge Jennifer L. Rochon). Antony Montero was employed by the Office of Labor Relations (OLR), a subdivision of the City of New York, to provide mental health services at Lincoln Hospital. Montero alleges that during his employment he reported several issues, including being required to deliver mental health services without a valid permit and receiving pornographic images on his work-issued phone, both of which were ignored by the defendants. Montero also ran into resistance when he disclosed his wife’s serious illness and requested a disability accommodation for himself, which led to his removal from the work schedule and unauthorized sharing of his medical records. In February of 2025, Montero was allegedly removed from his position “without providing notification of any cause” and shortly thereafter he was terminated for misconduct. Montero then filed this pro se action against the City, OLR, and various City employees. He asserted a cavalcade of claims, including for disability discrimination and retaliation under the ADA, wage theft under the FLSA and NYLL §§ 191 and 193, Fourteenth Amendment due process violations, FMLA interference and retaliation, common law defamation, denial of reasonable accommodation and retaliation under NYSHRL and NYCHRL, Title VII and NYCHRL hostile work environment claims, HIPAA and ADA privacy violations, and NYLL § 593(3) violations. Of course, because this is Your ERISA Watch, he also asserted a claim under ERISA. Defendants moved to dismiss all counts in Montero’s complaint for failure to state a claim. In his ERISA claim Montero alleged that his “termination resulted in the loss of dependent medical coverage, a protected benefit under ERISA.” Defendants responded that this claim could not be prosecuted because government plans are exempted from ERISA. The court agreed, citing 29 U.S.C. § 1003(b)(1), which provides that “[t]he provisions of this subchapter shall not apply to any employee benefit plan if…such a plan is a governmental plan.” The City’s plan qualified because it was “a plan established or maintained for its employees by the Government of the United States, by the government of any State or political subdivision thereof, or by any agency or instrumentality of any of the foregoing.” 29 U.S.C. § 1002(32). As a result, the court dismissed Montero’s ERISA claim with prejudice. The court dismissed the remainder of Montero’s federal claims for other reasons, and declined to exercise supplemental jurisdiction over his state law claims. As a result, the case was closed.

Pleading Issues and Procedure

Second Circuit

Kamanou-Goune v. Guterres, No. 25-CV-6430 (GBD), 2026 WL 924030 (S.D.N.Y. Apr. 3, 2026) (Judge George B. Daniels). In this unusual case the plaintiff, Marie-Gisele Kamanou-Goune, alleges in her pro se complaint that she began working at the United Nations as an unpaid intern in 1989. In 1995, she received a “Permanent Appointment” but was later “degraded to Associate Programmer” for unknown reasons. She then took leave to pursue a Ph.D. in biostatistics and resumed her employment at the UN two years later. In November of 2021, after contracting COVID-19, she returned to her home country, Cameroon, for treatment and was recommended for disability or early retirement benefits by a hospital there. In 2022 Kamanou-Goune returned to New York and submitted the medical report to the United Nations Medical Service. However, she was allegedly told she was an “ex staff member” and was not allowed to return to work. In July of 2025, she contacted the United Nations Joint Staff Pension Fund (UNJSPF), inquiring about retirement benefits, but was told “there is no client in the Fund’s system with [her] name.” Kamanou-Goune then filed this action against António Guterres, Secretary-General of the United Nations, and Rosemarie McClean, Chief Executive of Pension Administration at UNJSPF, alleging they failed to rehire her due to her disability and denied her access to retirement benefits. The court granted her request to proceed in forma pauperis and then evaluated her complaint, construing it as asserting claims under Title I of the Americans with Disabilities Act (ADA) for discrimination based on disability and under ERISA for denial of benefits. The court did not get far, noting immediately that the United Nations “enjoys absolute immunity from suit” under the Convention on Privileges and Immunities of the United Nations, a treaty signed by the United States, “unless ‘it has expressly waived its immunity.’” As a result, Guterres, a “senior executive” of the UN, was entitled to full diplomatic and functional immunity. The court further found that McClean “appears to be a senior executive at the United Nations,” and thus “she is entitled to the same diplomatic immunity and functional immunity as Defendant Guterres.” Even if McClean was not a senior executive, “the claims asserted against Defendant McClean appear to arise from acts performed within her official capacity and falling within her function as a United Nations employee; thus, she is immune from this suit.” After dismissing the federal claims, the court declined to exercise supplemental jurisdiction over any potential state law claims, and further denied Kamanou-Goune leave to amend her complaint, as any amendment would be futile given the UN’s immunity.

Provider Claims

Third Circuit

Abira Medical Laboratories LLC v. Meritain Health, Inc., No. CV 24-3140, 2026 WL 906677 (E.D. Pa. Mar. 30, 2026) (Judge Mary Kay Costello). Long-time readers of Your ERISA Watch are familiar with Abira Medical Laboratories, d/b/a Genesis Diagnostics, a medical laboratory test service that has filed dozens of lawsuits across the country in recent years against various health insurers and benefit plans, alleging the non-payment or underpayment of claims. Indeed, this is one of two cases involving Abira just this week. In this case, Abira sought payment for 102 claims based on an assignment of benefits from patients who were insured by Meritain Health, Inc. Abira’s second amended complaint (SAC) alleged four causes of action: “(1) ERISA benefits; (2) breach of contract for non-ERISA claims, (3) breach of the implied covenant of good faith and fair dealing for non-ERISA claims, and (4) quantum meruit/unjust enrichment for non-ERISA claims.” Meritain filed a motion to dismiss. The court addressed standing first, ruling that Abira lacked derivative standing for 60 of its 62 ERISA claims because 27 of the 29 ERISA plans contained enforceable anti-assignment provisions, invalidating the assignments on which Abira relied. Abira argued that Meritain “waived its right to enforce the anti-assignment provision because it did not invoke the anti-assignment provision during the administrative claims process and made partial payment on some claims.” However, the court noted that this argument had been rejected by the Third Circuit in another case: “routine processing of a claim form, issuing payment at the out-of-network rate, and summarily denying the informal appeal do not demonstrate ‘an evident purpose to surrender’ an objection to a provider’s standing in a federal lawsuit.’” Abira also failed to demonstrate that the plans’ anti-assignment clauses were ambiguous or that it sought and received any authorization from Meritain for assignments. Next, Meritain argued that Abira’s ERISA claims should be dismissed because the SAC did not cite specific plan provisions entitling it to recovery. The court acknowledged that “District Courts within this Circuit have required different levels of specificity related to the plan provisions,” but ultimately found that Abira’s allegations were too “conclusory” and “cookie cutter” to survive. The court noted that the case involved 29 different policies, but Abira only referenced “fragments of two” in its SAC. In short, “Abira’s allegations in the SAC are too imprecise to render its claims facially plausible.” The court also dismissed fifteen claims related to patients enrolled in Medicare Advantage plans because Abira failed to exhaust administrative remedies as required under the Medicare Act, thus depriving the court of jurisdiction. These rulings resulted in the dismissal of 77 of Abira’s 102 claims. As for the remaining 25, Meritain argued that these should also be dismissed because even with the patient, policy, and provider information supplied by Abira, Meritain “cannot identify them within its systems.” The court agreed, ruling that “Abira has not provided fair notice regarding the 25 unidentified claims” under Federal Rule of Civil Procedure 8: “Meritain cannot reasonably prepare a response to claims it cannot locate within its systems.” Finally, the court dismissed Abira’s request for punitive damages because such damages were not recoverable under ERISA or any of Abira’s state law claims. The court thus granted Meritain’s motion to dismiss, but gave Abira a “final opportunity” to amend its complaint.

Ninth Circuit

Abira Medical Laboratories LLC v. Blue Cross Blue Shield of Arizona Inc., No. CV-24-01485, 2026 WL 900075 (D. Ariz. Apr. 2, 2026) (Judge Susan M. Brnovich). In our second case involving Abira this week, Abira (referred to as Genesis in this order) sued Blue Cross Blue Shield of Arizona for underpayment and refusal to pay various claims for BCBS-insured patients. Before the court here was Genesis’ second amended complaint (SAC), which asserted breach of contract and ERISA benefit denial claims, as well as claims for fraudulent misrepresentation, negligent misrepresentation, and promissory estoppel. BCBS moved to dismiss. Addressing the latter three claims first, the court dismissed them with prejudice for two procedural reasons. First, “Genesis failed to amend these claims pursuant to this Court’s previous Order giving it thirty days to do… Second, these claims exceed the scope of this Court’s most recent grant of leave to amend.” Moving on to Genesis’ ERISA claim, the court noted that it had dismissed the ERISA claim in Genesis’ first amended complaint (FAC) “because it ‘only contain[ed] bald assertions regarding the existence of an ERISA plan’ and failed ‘to identify the ERISA plans and services at issue.’… The Court need not revisit this analysis because Genesis fails to argue that the SAC now meets this standard.” Instead, Genesis argued that it qualified for an “exception” to that standard “based on its lack of access to specific plan language and other relevant documents.” However, the court stated that in its SAC the only allegation Genesis provided suggesting that it had attempted to uncover such information was “a single email sent well over a year after this lawsuit was initiated and after filing the Complaint and FAC,” which “does little to excuse Genesis’s failure to provide any factual enhancement in its SAC which are based on claims ostensibly a decade old.” The court further stated that “Genesis is no stranger to this Court’s findings. Other courts have similarly found that Genesis is not entitled to the ERISA pleading exception.” As a result, the court dismissed Genesis’ ERISA claim with prejudice, noting that “this conclusion obviates any need to evaluate whether Genesis’ state law claims are preempted by its ERISA claim.” Finally, the court denied BCBS’ motion to dismiss Genesis’ contract claims, as it had previously found these claims to be adequately pled. Thus, Genesis’ ERISA claims are no more but its contract claims will proceed.

GS Labs, LLC v. Aetna, Inc., No. 25-CV-08525-RFL, 2026 WL 904293 (N.D. Cal. Apr. 2, 2026) (Judge Rita F. Lin). The Families First Coronavirus Response Act (FFCRA) and the Coronavirus Aid, Relief, and Economic Security (CARES) Act required health insurers to cover COVID-19 diagnostic testing at no additional cost to insureds and reimburse providers at a negotiated rate or the cash price listed by the provider. Plaintiff GS Labs alleges that it provided COVID testing to patients insured by defendant Aetna, Inc., and that Aetna underpaid or refused to pay many of its claims. It filed this action against six Aetna entities and six employers who provided health insurance through plans administered by Aetna, asserting claims for violation of the Racketeer Influenced and Corrupt Organizations Act (RICO), as well as state law claims for false advertising, fraud, negligent misrepresentation, promissory estoppel, and violations of California’s Unfair Competition Law (UCL). Aetna filed a motion to dismiss. The court granted the motion as to the RICO claims because GS Labs failed to adequately allege the predicate acts of mail and wire fraud; it did not sufficiently demonstrate that Aetna formed a fraudulent scheme or had the specific intent to deceive. The court also noted that GS Labs did not allege the false representations with the particularity required by Federal Rule of Civil Procedure 9(b). Additionally, GS Labs failed to establish the existence of an enterprise, as the relationships between Aetna and the employers were typical business arrangements. As for GS Labs’ state law claims, the court dismissed the claims for false advertising, fraud, negligent misrepresentation, and promissory estoppel because GS Labs did not sufficiently allege that Aetna failed to comply with its representations, nor were the representations stated with sufficient particularity. The court also dismissed GS Labs’ claims under the UCL. The “unfair” and “fraudulent” prong claims were dismissed for the same reasons as the other state law claims. The “unlawful” prong claim was dismissed because it was preempted by ERISA. The court found that “GS appears to allege that the at-issue billings were all issued in connection with ERISA plans, as GS contends that Defendants failed to follow ERISA’s applicable requirements in adjudicating pertinent administrative appeals.” As a result, its claims “are necessarily premised on the existence of those ERISA plans,” and thus “GS’s claim under the UCL’s unlawful prong for alleged violations of these statutes is an ‘attempt[ ] to secure plan-covered payments…through the alternative means of state [ ] law.’” The court found this to be “precisely the type of claim that ERISA expressly preempts.” Finally, the court dismissed all of GS Labs’ state law claims against five of the six Aetna defendants due to lack of personal jurisdiction, as GS Labs did not provide individualized allegations about each entity’s contacts with California. The court thus granted Aetna’s motion to dismiss, although it granted GS Labs leave to amend.

Vytal Surgical Inst., Inc. v. Teamsters W. Region & Loc. 177 Health Care Plan, No. 2:25-CV-04542-SVW-AS, 2026 WL 917613 (C.D. Cal. Mar. 30, 2026) (Judge Stephen V. Wilson). Vytal Surgical Institute, Inc. provided surgical services to five patients in 2020 and 2021. These patients were members of the Teamsters Western Region and New Jersey Health Care Fund and had assigned their insurance coverage rights to Vytal. Vytal alleges that the insurers handling the claims confirmed to Vytal that the payment for their services, which was out-of-network, would be “80% of the customary rate.” Vytal further alleges that the plan did not pay this rate, and its appeals to the plan were unsuccessful. This action followed in which Vytal alleged two causes of action against the plan: (1) failure to pay ERISA plan benefits under 29 U.S.C. § 1132(a)(1)(B), and (2) breach of fiduciary duties under 29 U.S.C. § 1132(a)(3). The plan filed a motion to dismiss. Addressing the claims in order, the court noted that the plan’s “Limitation On When A Lawsuit May Be Started” section stated, “a non-network health care provider/facility is not a claimant that is permitted to start a lawsuit or other legal action to obtain Plan benefits.” Thus, “by the clear text of the ERISA Plan,” the court ruled that Vytal could not file a lawsuit to recover benefits. Vytal contended that this language was ambiguous “because the Lawsuit Limitation section repeatedly refers to ‘you’ or ‘your’ without defining these terms,” but the court considered this irrelevant because “[t]he specific provision that tells us that out-of-network health care providers cannot initiate lawsuits does not bear on a definition of ‘you’ or ‘your.’” Furthermore, another section of the plan “specifically states that any mention of ‘you’ in the Plan refers to individual claimants, so there is no ambiguity as to what ‘you’ means in the Lawsuit Limitation section.” Finally, Vytal argued that the plan was ambiguous “because the previous section uses the terms ‘claimant’ and ‘authorized representative’ interchangeably.” This argument was “meritless” because the section “specifically defines ‘you’ and ‘your’ to include both claimants and authorized representatives.” The court thus moved on to Vytal’s breach of fiduciary duty claim. The court found that (1) the anti-assignment provision in the plan did not prevent Vytal from bringing this claim because the provision referred to claims for benefits, not fiduciary breach claims, (2) the plan’s restriction on lawsuits by non-network providers also applied to claims for benefits, not claims for breach of fiduciary duty, (3) the plan’s argument regarding Vytal’s alleged failure to exhaust administrative remedies did not apply to breach of fiduciary duty claims, and (4) the plan’s argument that Vytal’s claim was time-barred by the plan’s one-year contractual limitation period failed because the plan’s authorities “did not address the situation where a plaintiff brings a breach of fiduciary duty claim under ERISA and whether an ERISA plan’s contractual limitations provision could supersede 29 U.S.C. § 1113, which outlines the statute of limitations governing breach of fiduciary duty claims.” As a result, the court granted the plan’s motion to dismiss, but only as to the claim for benefits; the breach of fiduciary duty claim will proceed.

Severance Benefit Claims

Sixth Circuit

Orlandi v. Osborne, No. 3:20-CV-2237, 2026 WL 860527 (N.D. Ohio Mar. 30, 2026) (Judge Jeffrey J. Helmick). In 2018, Marathon Petroleum Corporation (MPC) acquired rival oil company Andeavor (formerly known as Tesoro Corporation), which included Virent, Inc., a wholly owned subsidiary of Andeavor. The plaintiff in this case, Stacey Orlandi, was the CEO of Virent and a participant in various Andeavor employee benefit programs, including the Andeavor Executive Severance and Change in Control Plan (CIC Plan), the Andeavor 2011 Long-Term Incentive Plan (LTI Plan), and the 2018 Virent Incentive Compensation Program (VICP). After the acquisition, Orlandi resigned in January of 2019 and sought change in control benefits under the CIC Plan. Orlandi claimed that her resignation was for “Good Reason” under the CIC Plan due to a “significant diminution” of her position after the MPC takeover. Her claim was denied by Jonathan Osborne, who was MPC’s Director of Compensation and Benefits and the CIC Plan administrator. Orlandi’s appeal was also unsuccessful and thus she brought this action asserting three claims: “(1) an ERISA violation for denial of benefits under the CIC Plain; (2) breach of contract for denial of benefits under the LTI Plan; and (3) breach of contract for failure to pay her a VICP bonus in 2018.” The parties filed cross-motions for judgment which the court ruled on in this order. Addressing the ERISA claim first, the court noted a dispute over the proper standard of review. The plan gave Osborne discretionary authority to make benefit determinations under the CIC Plan, but Orlandi contended that Osborne “abdicated of all his powers and the process of analyzing Ms. Orlandi’s claim to MPC’s legal department.” The court stated that ordinarily it would engage in a fact-intensive determination to determine “who actually made the benefit determination,” but here “this potentially complicated analysis is not necessary because Orlandi’s claim would fail under even the de novo standard of review.” The primary question was whether Orlandi’s voluntary termination was for “Good Reason.” Orlandi relied on a letter stating that if she was offered a new role after an evaluation period, she would need to waive her rights under the CIC Plan. However, the court found that a mere reference to a possible future waiver did not constitute a change or failure to continue benefits sufficient to constitute “Good Reason.” Orlandi also argued that her role’s temporary and uncertain nature constituted a significant diminution of her position, duties, responsibilities, and status. The court rejected this claim, finding that the CIC Plan did not “prohibit uncertainty” and that Orlandi’s role during the evaluation period did not significantly diminish her duties or responsibilities. Specifically, “Orlandi offers no evidence to demonstrate any diminution of her duties or responsibilities, much less ‘a significant diminution.’ Throughout the administrative levels and in her briefing here, Orlandi has made only passing references to her duties and responsibilities.” As a result, the court ruled that Orlandi’s resignation was not for a “Good Reason” under the CIC Plan. This decision was dispositive of Orlandi’s breach of contract claims as well. Because the court determined that Orlandi’s resignation was not for “Good Reason,” she was not entitled to benefits under the LTI Plan or the VICP either. The court thus granted judgment to defendants on those claims also.

Standard of Review

Ninth Circuit

Moorhead v. Unum Life Ins. Co. of Am., No. 25-CV-01826-HSG, 2026 WL 874398 (N.D. Cal. Mar. 30, 2026) (Judge Haywood S. Gilliam, Jr.) Brenna Moorhead is a California-based attorney who worked for the Boston-based law firm of Goodwin Proctor, LLP and participated in the firm’s ERISA-governed employee benefit plans. These plans included long-term disability (LTD) and life insurance benefits funded by group policies purchased by the firm from Unum Life Insurance Company of America. Moorhead alleges that she became disabled in 2023, after which she submitted a claim for disability benefits under the LTD plan, and a claim for waiver of premium benefits under the life insurance plan. Unum denied both claims and her subsequent appeals, and thus she filed this action. At issue was the appropriate standard of review, on which the parties filed cross-motions. Unum argued for an abuse of discretion standard, while Moorhead contended that the default de novo standard should apply. Moorhead argued that under ERISA’s “savings clause,” 29 U.S.C. § 1144(b)(2)(A), the court should apply Section 10110.6 of California’s insurance code, which prohibits the inclusion of policy language granting discretionary authority to insurers. Applying Section 10110.6 would void the provisions in the LTD policy on which Unum relied for deferential review. However, Unum argued that the LTD policy contained a choice-of-law provision declaring that the policy was governed by Massachusetts law, which does not contain the same statutory prohibition as California. The court chose to follow federal choice-of-law rules, which required the court to enforce the provision unless doing so was unreasonable or unfair. The court concluded that it was fair and reasonable to apply the choice-of-law provision. “The policy was entered into between Goodwin and Unum in 1972, long before Section 10110.6 took effect, and before Unum or Goodwin could have purposefully selected Massachusetts law to avoid the effects of Section 10110.6.” Furthermore, the firm “is a Massachusetts-based entity with its principal place of business in Boston, Massachusetts, and…has thousands of employees throughout the world[.]” As a result, “the Court finds the uniform application of Massachusetts choice of law to each dispute arising under the LTD policy to be reasonable.” The court stated that under this approach “the Plan’s beneficiaries ultimately benefit from consistent enforcement of the Plan’s choice of Massachusetts law.” Moorhead contended that this result would “read the savings clause out of ERISA,” but the court was unconvinced, stating that the savings clause “simply preserves the states’ ability to ‘regulate[ ] insurance, banking, or securities,’” and the court’s ruling “does not undermine California’s ability to regulate insurance.” Thus, the court denied Moorhead’s motion and granted Unum’s, which means Unum’s decision will be reviewed for abuse of discretion.

Statute of Limitations

Second Circuit

Cunningham v. USI Ins. Servs., LLC, No. 21 CV 01819 (NSR), 2026 WL 881338 (S.D.N.Y. Mar. 31, 2026) (Judge Nelson S. Roman). Lauren Cunningham, an employee of USI Insurance Services, LLC (USI) and a participant in the USI 401(k) Plan, initiated this class action under ERISA against USI, its board of directors, the plan’s committee, and other defendants. Participants such as Cunningham were charged recordkeeping and administrative fees, or “Retirement Plan Services” (RPS). The plan’s RPS provider from 2009 to 2023 was USI Consulting Group (USICG), a wholly-owned subsidiary of USI. Cunningham joined the plan in 2017 and now contends that defendants “caused USICG to be paid twice the reasonable rate for providing RPS to the Plan.” In doing so, defendants allegedly prioritized USICG’s financial interests over limiting expenses for plan participants, in violation of ERISA. Cunningham’s initial complaint, filed in 2021, alleged breaches of duty of prudence, failure to adequately monitor other fiduciaries, and breach of duty of loyalty under ERISA. The court dismissed it in 2022 because “Plaintiff failed to provide how she had calculated the Plan’s indirect fees and to sufficiently allege that the services provided by other recordkeepers to alleged comparator plans were materially the same as those provided by USCIG.” Cunningham amended, but the court dismissed her complaint again, ruling that “Plaintiff had cured the first deficiency but still failed to provide a ‘reliable benchmark’ against which to analyze whether USICG’s fees were excessive.” (Your ERISA Watch covered these rulings in our April 6, 2022 and December 20, 2023 editions.) Cunningham then filed a second amended complaint, but after the hearing on defendants’ third motion to dismiss, Cunningham filed a motion seeking leave to amend her second amended complaint to add a prohibited transaction claim under 29 U.S.C. § 1106(a)(1). The court denied her motion in this order. The court agreed with defendants that Cunningham’s proposed claim was untimely under both ERISA’s six-year statute of repose (Section 1113(1)) and three-year statute of limitations (Section 1113(2)). The six-year statute of repose had run regardless of whether it began in 2009 when USICG was retained as the RPS provider or when Cunningham was hired in 2017. Furthermore, Cunningham could not rely on the relation-back doctrine because that doctrine does not apply to statutes of repose. The court also determined that Cunningham had “actual knowledge” under Section 1113(2) of the material facts necessary to state a claim by 2017, when she became a plan participant, thus triggering the three-year statute of limitations. After all, “Plaintiff does not dispute that she was aware that USICG served as USI’s RPS provider,” or that she received transaction processing, services, and communications from USICG. Thus, “Plaintiff necessarily knew the essential contours of the challenged transaction – namely, that the Plan engaged USICG, a USI affiliate, to provide recordkeeping services.” As a result, the three-year statute was triggered in 2017, but Cunningham did not file until 2021 and thus her claim was time-barred. Finally, the court rejected Cunningham’s argument that she could not have brought her prohibited transaction claim earlier due to rulings in the case of Cunningham v. Cornell, which was eventually decided by the Supreme Court, as nothing in that case stopped her from asserting her claim at the outset. As a result, the court denied Cunningham’s motion for leave to amend, and set a renewed briefing schedule on defendants’ motion to dismiss.

Hill v. XPO, Inc., No. 24-CV-1697 (SFR), 2026 WL 884149 (D. Conn. Mar. 31, 2026) (Judge Sarah F. Russell). Richard Hill is a former employee of XPO, Inc. He filed this putative class action against XPO and its subsidiary, GXO Logistics, Inc., challenging a provision in defendants’ ERISA-governed health insurance plans that requires tobacco users to pay a “tobacco surcharge” as a condition of enrollment. The plans require participants to declare tobacco use, and those who do must pay an additional $100 per month. Participants can avoid this fee by participating in a tobacco cessation program, but the surcharge is not removed retroactively, and any payments made are not refunded. The plans also allegedly do not include a provision stating that the recommendations of a participant’s physician will be accommodated. Hill’s complaint asserted five claims under ERISA. Count one contended that participants in the tobacco cessation program should have been eligible for reimbursement for surcharge payments already made. Count two alleged that defendants failed to provide statutorily required notice of the tobacco cessation program. Count three was brought in a representational capacity on behalf of the plans under ERISA § 502(a)(2), asserting that defendants breached their fiduciary duties by assessing and collecting the tobacco surcharges in violation of the law and the relevant plan terms. Count four accused defendants of breaching their fiduciary duties by applying surcharge funds to diminish their contributions to the plan. Count five alleged that defendants violated the terms of the plan by discriminating based on health status. Defendants moved to dismiss, arguing that Hill’s claims were untimely and that count three failed to state a claim. The court addressed each count in order. Under counts one and two, the court concluded that the federal four-year catchall limitations period enacted by Congress in 1990, 28 U.S.C. § 1658, applied because these counts were made possible by the adoption of ERISA § 702, which occurred after 1990. The court acknowledged that some courts had applied analogous state law limitation periods to claims under ERISA § 502(a), but found that these rulings only applied to “denial-of-benefit claims because plan members have been able to challenge denial of benefits since 1974.” The court thus denied defendants’ motion on these counts because they did not argue they were untimely under the catchall period. On count four, the court applied ERISA’s three-year “actual knowledge” limitation period in § 413 because the count alleged breach of fiduciary duty. The court could not determine from the complaint when Hill acquired “actual knowledge,” and thus mostly denied defendants’ motion to dismiss this count, finding it time-barred only to the extent it challenged defendants’ decision to impose the tobacco surcharge. On count five, the court concluded that state law supplied the correct limitations period because it “allege[d] a defendant failed to act in accordance with a plan.” As a result, Delaware law applied under the plan’s choice-of-law provision, which dictated a one-year statute of limitations. Hill’s claim was untimely under this law and thus the court dismissed it. As for count three, the court deemed it timely because again, it could not determine when Hill gained “actual knowledge” under § 413 of the alleged violations. Furthermore, the court concluded that the allegation that defendants impermissibly withheld contributions to the plans plausibly supported an inference that defendants acted as fiduciaries, and thus were not immune from liability as plan settlors. The court further found that the complaint plausibly alleged an injury to the plans, as it contended that “the Plans should have profited from the tobacco surcharges and instead only broke even.” Finally, the court addressed standing, agreeing with defendants that Hill lacked standing to seek prospective injunctive relief because he was no longer employed by defendants. As a result, the case will continue on all claims except count five, and without the prospect of injunctive relief.

Konyukhova v. Walgreen Co., No. 24-CV-4390 (VEC) (SDA), 2026 WL 880381 (S.D.N.Y. Mar. 31, 2026) (Judge Valerie Caproni). Esmiralda Konyukhova is a pharmacist who began working at Walgreens in April of 2010. In her pro se complaint she alleges that between 2014 and 2021 she experienced denied work schedule changes, harassment, unrealistic work expectations, demotions, negative performance reviews, and internal complaints. Konyukhova allegedly became disabled in 2021, but her claim for short-term disability (STD) benefits was denied, and thus she was terminated in 2022. She filed a charge of discrimination with the EEOC in December 2022 and a complaint with the New York State Division of Human Rights in February 2023, which she later dismissed. In her third amended complaint in this action she has included claims under Title VII of the Civil Rights Act of 1964, the Americans with Disabilities Act (ADA), the New York State Human Rights Law (NYSHRL), the New York City Human Rights Law (NYCHRL), and ERISA. Specifically, she alleged delayed payment of benefits under ERISA § 502(a)(1)(B), breach of fiduciary duty under ERISA § 502(a)(3), and violations of ERISA § 510. The case was referred to the assigned magistrate judge for general pretrial purposes and to make reports and recommendations regarding dispositive motions. Defendants filed a motion to dismiss, which the magistrate judge recommended granting in part and denying in part. Both sides objected to the report and recommendation (R&R), and thus the court reviewed their objections and issued this order. Regarding Konyukhova’s ERISA claims, the court granted defendants’ motion to dismiss the § 502(a)(1)(B) claim as time-barred, noting that the one-year limitations period in the STD benefit plan was reasonable and adequately communicated. The court granted defendants’ motion regarding Konyukhova’s ERISA § 510 claims as well. Borrowing from New York law, the court found that these claims had a two-year statute of limitations which began running from the date of Konyukhova’s termination in 2022, and thus her 2024 complaint was too late. However, the court denied defendants’ motion to dismiss Konyukhova’s § 502(a)(3) claim. The court concluded that Konyukhova adequately alleged a breach of fiduciary duty based on “incomplete or misleading communications regarding the terms of the Plan, her claim status, her benefits, and her requests.” This claim was not time-barred because “[t]he one-year limitations period set forth in the Plan and referenced above does not apply to fiduciary duty claims.” In her objections Konyukhova also indicated that she wanted to bring a claim for statutory penalties under ERISA § 502(c), but the court referred that issue back to the magistrate judge. Ultimately, the court adopted the R&R in full, and thus some of Konyukhova’s claims will proceed while others were dismissed.

Sixth Circuit

Gordon v. Sun Life Assurance Co. of Canada, No. 2:25-CV-11132-TGB-KGA, 2026 WL 900907 (E.D. Mich. Mar. 31, 2026) (Judge Terrence G. Berg). Michael Gordon filed this action in state court against Sun Life Assurance Company of Canada, the insurer and administrator of his former employer’s (Prime Healthcare Services) long-term disability benefit plan. He claimed he was entitled to benefits under the plan due to injuries from a traffic accident in 2019. Gordon alleged he was diagnosed with several injuries, including a traumatic brain injury, headaches, memory loss, and impaired cognitive function, all of which rendered him unable to work. Gordon alleged three counts against Sun Life: “one count for breach of contract under Michigan law, one count for violation of the terms of the Plan in violation of federal ERISA § 502(A)(l)(B), and one count for breach of fiduciary duty in violation of ERISA § 502(A)(3).” Sun Life removed the case to federal court and filed a motion to dismiss, arguing first that Gordon’s state law count was preempted by ERISA. Gordon did not respond to this argument, and the court agreed with Sun Life: “Courts routinely dismiss such claims as preempted by ERISA, and so will this Court.” Next, Sun Life argued that Gordon’s remaining ERISA claims were time-barred under a three-year contractual limitations provision in the plan’s insuring policy. Sun Life argued that Gordon’s clock began running no later than December of 2020, but he did not file his complaint until 2025, and thus it was late. The policy, which was “subject to the laws of” California, stated that “[n]o legal action brought to recover on this Policy may start: 1. until 60 days after Proof of Claim has been given; nor 2. more than 3 years after the time Proof of Claim is required.” Gordon conceded that his complaint was late under this provision, but argued that he timely filed under Michigan’s six-year statute of limitations, and that the three-year contractual period was illegal under Michigan Administrative Code Rule 500.2212, which bars “shortened limitation of action clauses” in certain policies. The court applied the forum state’s (Michigan) choice-of-law rules to determine whether California or Michigan law applied; those rules in turn relied on the Conflict of Laws Restatement. The Restatement provides that “[t]he law of the state chosen by the parties to govern their contractual rights and duties will be applied if the particular issue is one which the parties could have resolved by an explicit provision in their agreement directed to that issue.” The court found that the contracted limitation period was such an explicit provision, and that “ERISA allows parties to contract to a specific period of limitations as long as it is reasonable and enforceable.” As a result, California law applied, regardless of Gordon’s arguments regarding the superiority of Michigan public policy. The court further ruled that Section 500.2212 did not apply because “the policy was not ‘issued, delivered, or advertised’ in Michigan but in California.” The court observed that “[t]here may be valid reasons for applying the [Rule] to group disability insurance policies issued outside Michigan when some of the beneficiaries of those policies reside in Michigan. However, the Michigan legislature and courts have not extended the approval requirement to out-of-state-issued policies[.]” As a result, “the contractual limitations provision shortening the period of limitations to three years in this case is enforceable under California law, reasonable, and not contrary to Michigan public policy (to the extent Michigan law, as the law of the forum state, should be considered),” and thus Sun Life’s motion to dismiss was granted, with prejudice.

Seventh Circuit

Wiederhold v. Res-Care, Inc., No. 4:24-CV-00003-SEB-TAB, 2026 WL 874928 (S.D. Ind. Mar. 31, 2026) (Judge Sarah Evans Barker). Minda Wiederhold filed this putative class action against her former employer, Res-Care, Inc., alleging that Res-Care’s ERISA-governed employee health benefit plan unlawfully imposed a tobacco surcharge. Wiederhold worked at Res-Care from 2011 to 2023. In 2019, Res-Care informed employees that the tobacco surcharge would be effective January 1, 2020. Employees were required to complete a tobacco attestation form during open enrollment, and the surcharge was deducted from employees’ paychecks. In her deposition, Wiederhold stated she “discovered the tobacco surcharge in January 2020 when she reviewed her first earnings statement of the new year and saw the $25 deduction expressly noted therein.” In her complaint Wiederhold alleged that the surcharge violated ERISA’s nondiscrimination provision by imposing a premium based on health status. The complaint included three counts: (1) failure to provide a reasonable alternative standard for obtaining a full reward for plan compliance, (2) failure to provide adequate notice of a reasonable alternative standard, and (3) breach of fiduciary duties by collecting the surcharge for Res-Care’s own benefit, violating 29 U.S.C. §§ 1104(a)(1), 1106(a)(1), and 1182(b). Res-Care filed a motion for summary judgment, arguing that (1) the statute of limitations barred Wiederhold’s claims, (2) Wiederhold failed to exhaust administrative remedies, (3) Res-Care was not acting in a fiduciary capacity, and (4) ERISA did not permit the equitable remedies Wiederhold sought. The court did not make it past the first argument, agreeing with Res-Care that Wiederhold’s claims were untimely. The court noted that under ERISA Wiederhold was required to bring her claims within three years of her “actual knowledge” of the alleged breach or violation. The court found “there is no dispute that Ms. Wiederhold had actual knowledge of the tobacco surcharge by January 2020.” Wiederhold argued that even if that was true, she “‘did not gain actual knowledge of the breach concerning the lack of a reasonable alternative standard’ – that is, a way to avoid the tobacco surcharge – ‘until she learned about the existence of the non-compliant tobacco cessation program shortly before she filed this action on January 8, 2024.’” However, the court ruled that this argument “conflates ‘knowledge of…illegality’ with knowledge of ‘the essential facts’ of a violation, only the latter of which bears on our assessment of the applicable statute of limitations.” Indeed, the court found that Wiederhold’s unawareness of the reasonable alternative standard should have made her more alert to a violation, not less. As a result, the court ruled that “Ms. Wiederhold gained actual knowledge of the facts essential to her claim in January 2020, thereby triggering the start of the three-year statute of limitations under § 1113(2). Because Ms. Wiederhold did not initiate this lawsuit until January 2024, approximately one year after the three-year deadline, the statute of limitations renders her claims untimely. Accordingly, Res-Care’s motion for summary judgment shall be granted.”

Eleventh Circuit

Gamache v. Hogue, No. 1:19-CV-21 (LAG), 2026 WL 867506 (M.D. Ga. Mar. 30, 2026) (Judge Leslie A. Gardner). This is a class action by former employees of Technical Associates of Georgia, Inc. (TAG), a staffing, engineering, and technical services company, who were participants in the TAG Employee Stock Ownership Plan (ESOP). They sued various company executives, administrative committee members, and other plan fiduciaries for engaging in prohibited transactions and for breaching fiduciary duties under ERISA. The court held a bench trial in July of 2024, and this order represented the court’s findings of fact and conclusions of law. The ESOP was established in 2006, when it purchased 100,000 shares from the company’s founders for $17.5 million, financed by cash contributions and promissory notes. In 2011, TAG refinanced the 2006 loans, and TAG executives John Hogue and Graham Thompson entered into new employment agreements as part of the refinancing. Plaintiffs contend that this refinancing, in conjunction with various stock transactions and asset transfers, changed the stock ownership share in the plan, caused losses to the plan, and were fraudulently concealed from the non-fiduciary participants of the plan. Plaintiffs sought various forms of relief, including voiding the prohibited transactions, disgorgement of profits from the transactions, removal of defendants as plan fiduciaries, and a constructive trust over the proceeds from the transactions at issue. The claims for relief at trial were: (1) a prohibited transactions claim against Hogue and Thompson for engaging in prohibited plan-fiduciary transactions by dealing with ESOP assets in their own interest; (2) a prohibited transactions claim against Hogue, Thompson, and James Urbach, a “special independent fiduciary,” for causing the ESOP to engage in transactions that constituted transfers of ESOP assets to parties-in-interest; (3) breach of fiduciary duty and co-fiduciary liability against Urbach and the ESOP Administrative Committee defendants for failing to remedy the prohibited transactions; and (4) breach of the duty to monitor against the TAG board of directors for failing to monitor or take appropriate action against Urbach, Hogue, and Thompson. The court ruled in favor of defendants on all four claims, ruling that the claims were time-barred under ERISA’s statute of repose and limitations, 29 U.S.C. § 1113. Plaintiffs argued that Section 1113’s “fraud or concealment” exception applied to extend their time to file suit, but the court disagreed. The court ruled that plaintiffs, not defendants, had the burden of proving the exception, and that plaintiffs failed to meet their burden because defendants “did not actively conceal information about the 2011 Refinance, their ownership of the ESOP, or their 2011 Employment Agreements.” The court found that “[t]he evidence at trial demonstrated that Defendants Hogue and Thompson voluntarily disclosed their ownership of ESOP stock on multiple occasions to multiple different TAG employees…Importantly, there is no evidence that Defendants actively concealed any material information.” The court discounted plaintiffs’ argument that the ESOP’s Form 5500s “did not include all of the specifics of the 2011 Refinance or the ESOP’s ownership” because “concealment by mere silence is not enough.” As a result, the court ruled that the fraudulent concealment exception did not operate to toll the limitations period set forth in Section 1113. This conclusion doomed all of plaintiffs’ claims. All four claims were based on the 2011 transactions, and thus plaintiffs had six years, or until 2017, to bring their claims, but they did not file until 2019. As a result, barring an appeal, this seven-year-old case, based on a six-year statute of repose, is over.

Venue

Third Circuit

Chavez-Deremer v. DeAngelo Contracting Services, LLC, No. 3:25-CV-00861, 2026 WL 897377 (M.D. Pa. Mar. 30, 2026) (Judge Karoline Mehalchick). DeAngelo Brothers, LLC is a residential lawn care business founded by two brothers which later merged with DBi Services, LLC, also started by the brothers, which provided transportation infrastructure and contract services. The joint company established an ERISA-governed health benefit plan for its employees in 2000. In 2016 the company was sold to Sterling Partners, and in 2020, DeAngelo Contracting Services, LLC (DCS) was founded, purchasing certain assets from the company. The original joint company then ran into financial trouble. It entered into a loan agreement with PNC Bank, which later seized the company’s bank accounts, including employee premiums owed to the plan and not yet remitted to the plan’s administrator, Aetna. The company ceased operations in October 2021, and by December 2021, DCS purchased most of the company’s assets. The failing company did not fund the plan, leading to Aetna terminating coverage due to unpaid contributions. The company entered bankruptcy in 2023. The Secretary of Labor, which had taken over plan administration, filed a proof of claim in the bankruptcy case and then filed this complaint, alleging breach of fiduciary duty and prohibited transactions against DCS, PNC Bank, and related entities. Before the court here was PNC’s motion to transfer venue from the United States District Court for the Middle District of Pennsylvania to the Northern District of Texas. PNC argued that the case should be transferred because it is “inextricably tied to the [pending] Bankruptcy Case,” which was proceeding in Texas. First, the court determined that the Northern District of Texas was an appropriate venue because it had subject matter jurisdiction under 28 U.S.C. § 1334(b) and personal jurisdiction due to nationwide service of process. Next, the court applied the Third Circuit’s private interest Jumara factors, which included the plaintiff’s choice of forum. This was given less weight because the Secretary had already filed a proof of claim in the Texas bankruptcy case. As for the other private interest factors, the court found that the issue of where the claims arose disfavored transfer because the company’s ERISA violations occurred in Pennsylvania and the company was headquartered in Pennsylvania. However, the convenience of the parties and witnesses favored transfer due to the financial implications of litigating in Pennsylvania. The court agreed with PNC that “money expended on ‘litigating across the country in Pennsylvania takes away from the recovery of all unsecured creditors – including the Secretary and the Plan participants.’” As for Jumara’s public interest factors, the court emphasized the importance of avoiding inconsistent determinations with the bankruptcy case and reducing litigation costs, which favored transferring the case to Texas. As a result, the court ruled that weight of the private and public interest factors favored transferring the case. It thus granted PNC’s motion and the case will proceed in the Northern District of Texas alongside the bankruptcy case.

Lahoud v. Merrill Lynch, No. CV 25-08800-MEF-AME, 2026 WL 891676 (D.N.J. Mar. 31, 2026) (Magistrate Judge André M. Espinoza). John Lahoud and Georgina Nico were employed as financial advisors by Merrill Lynch and participated in the company’s deferred compensation agreement known as the “WealthChoice Contingent Award Plan.” Under this plan, a portion of the advisors’ incentive compensation was conferred as a cash award, which vested and became payable over time. However, the plan included a “Cancellation Rule” through which an award would be forfeited if the employee left Merrill before the vesting date. Lahoud and Nico resigned in June of 2021 and later brought this action, asserting claims for declaratory and equitable relief under ERISA, seeking a declaration that the plan is governed by ERISA and that the Cancellation Rule violated ERISA. They also sought recovery of the deferred compensation awards they claimed they were entitled to receive under the plan. Defendants filed a motion to transfer the case to the United States District Court for the Western District of North Carolina, citing the forum selection clause in the award agreements signed by plaintiffs in connection with the plan’s operation. The court granted defendants’ motion pursuant to 28 U.S.C. § 1404(a). The court found that the forum selection clause was valid and enforceable, clear and unambiguous, and provided only two possible fora for litigation, both of which were in North Carolina. Plaintiffs contended that the agreement allowed for litigation “where this grant is made/or to be performed,” which included New Jersey, where they worked. However, the court found that this clause “can only be understood as a subordinate, nonrestrictive clause,” which, although “inartful,” did not “upend the forum selection clause’s straightforward, unambiguous text, directing that any litigation must proceed solely in North Carolina’s state or federal court.” As a result, “the governing forum selection clause is clear” and thus the court granted defendants’ motion to transfer the case to the Western District of North Carolina.

As usual, the end of the federal court reporting period under the Civil Justice Reform Act (every March 31 and September 30) resulted in a slew of cases last week, which will likely continue into next week. It turns out federal judges are procrastinators just like the rest of us.

Fear not, however, as Your ERISA Watch was on top of it. No single case stood out, and there was only one appellate decision (from the Second Circuit, on the navel-gazing topic of “what is a plan asset anyway?” (Powell v. Ocwen Financial)), but there is plenty to chew on below.

Read on to learn about: (1) three medical benefit cases returning to the District of Utah after they were remanded to healthcare giant United Healthcare for further review, with diverging results (Anne A. v. United, Amy G. v. United, and D.B. v. United); (2) three cases asserting the misuse of forfeited plan contributions, with all three ending in predictable strikeouts for the plaintiffs (Gaetano v. MVHS, Estay v. Ochsner, Parker v. Tenneco); (3) two cases by disability benefit recipients complaining that Hartford Life & Accident Insurance Company miscalculated their benefits (Sakwa v. Hartford, Harling v. Hartford); (4) two cases asserting shenanigans in the valuation of employee stock ownership plans (Secretary of Labor v. Gleason, Daly v. West Monroe Partners); and last, but not least, (5) a monster healthcare provider case involving 63,390 claims of emergency medical care and $272,913,789 in billed services (South Austin Emergency Center v. Blue Cross Blue Shield of Texas). Maybe everything really is bigger in Texas!

Come back next week and see if the deluge continues…

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

Breach of Fiduciary Duty

Second Circuit

Gaetano v. MVHS, Inc., No. 6:25-CV-118 (AJB/CBF), 2026 WL 850360 (N.D.N.Y. Mar. 27, 2026) (Judge Anthony J. Brindisi). John Gaetano, Bertha Nogas, Kathi Martin, and Maryanne Taverne are former employees of Mohawk Valley Health System, Inc. (MVHS) and participants in the MVHS, Inc. 401(k) Plan, an ERISA-governed defined-contribution retirement plan. Plaintiffs allege that MVHS mismanaged the plan by failing to prudently select and monitor plan investments, charging excessive fees, and improperly using forfeited funds. Plaintiffs asserted four counts: (1) breach of fiduciary duties by failing to investigate alternative share classes and funds, failing to monitor recordkeeping fees, and improperly using forfeited funds; (2) breach of the duty of prudence by failing to monitor recordkeeping fees; (3) violation of ERISA’s anti-inurement provision; and (4) engaging in prohibited transactions by using forfeited accounts to lessen MVHS’ matching contributions. MVHS filed a motion to dismiss for lack of standing and failure to state a claim. The court tackled the standing issue first. It ruled that (a) Martin lacked standing for all claims as she was not a plan participant, (b) Taverne lacked standing for claims related to funds she did not invest in, and (c) all plaintiffs lacked standing for claims regarding the plan’s stable fund options because they did not invest in them. The court further determined that plaintiffs had standing for remaining claims related to the John Hancock Fund and the Harbor Fund, excessive recordkeeping fees, and improper use of forfeited funds, as these involved plan-wide mismanagement affecting all participants. The court ruled that plaintiffs had class standing to bring these claims as well, finding that “Plaintiffs’ incentives are aligned with those of the absent class members because they each allege they personally lost a portion of their retirement savings due to defendant’s challenged conduct.” This was a short-lived victory for plaintiffs, however, as the court ruled that they did not meet their pleading burden on the merits. The court found that (a) plaintiffs’ “conclusory” allegations did not provide sufficient factual support for their claims of imprudence regarding share class selection and recordkeeping fees, (b) the claims related to forfeitures were not viable because the plan explicitly allowed MVHS discretion in how to use forfeitures, and plaintiffs did not allege that they received less than what the plan promised, (c) the use of forfeitures to reduce employer contributions did not constitute a prohibited transaction under ERISA, and (d) the anti-inurement claim failed because plaintiffs did not allege that forfeited assets were removed from the plan or used for purposes other than paying obligations to the plan’s beneficiaries. As a result, while plaintiffs had standing to bring some of their claims, those claims were not pled sufficiently. Thus, MVHS’s motion was granted and the case was dismissed.

Powell v. Ocwen Financial Corp., No. 23-999, __ F. 4th __, 2026 WL 828159 (2d Cir. Mar. 26, 2026) (Before Circuit Judges Chin, Carney, and Sullivan). The six named plaintiffs in this case are trustees of The United Food & Commercial Workers Union & Employers Midwest Pension Fund. They invested in six classes of residential mortgage-backed securities (RMBSs), which are financial instruments pooling large amounts of residential loans. The trustees sued nineteen defendants, including Ocwen Financial Corporation, Ocwen Loan Servicing LLC, Ocwen Mortgage Servicing, Inc., and Wells Fargo Bank, N.A., alleging that they were responsible for servicing the underlying mortgages, mismanaged those loans, engaged in self-dealing, and failed to act in the best interests of their investors. The trustees contended that this conduct amounted to breaches of fiduciary duties and prohibited transactions under ERISA. The defendants filed a motion for summary judgment which the district court granted. The district court reasoned that while the RMBSs may have been plan assets, the mortgages underlying the plan’s investments were not. As a result, defendants were not liable under ERISA for any malfeasance in managing the mortgages. (Your ERISA Watch covered this ruling in our June 7, 2023 edition.) Plaintiffs appealed to the Second Circuit, which issued this published decision. The appellate court acknowledged that “identifying a plan’s assets is a critical step in identifying plan fiduciaries,” but, unhelpfully, “ERISA does not explicitly define what constitute ‘plan assets.’” Instead, Congress delegated this job to the Department of Labor, which enacted a regulation outlining a “general rule” that “when a plan invests in another entity, the plan’s assets include its investment, but do not, solely by reason of such investment, include any of the underlying assets of the entity.” However, the regulation also has a “look-through” exception, which extends ERISA’s fiduciary protections where the plan’s investment is in certain “equity interests.” The purpose of the exception is to include “‘investments that are vehicles for the indirect provision of investment management services’…such as ‘pooled investment funds[.]’” The question in this case was “whether the Plan’s investments in the six trusts are ‘equity interests’ under the DOL’s plan-asset regulation” and therefore qualified for the regulation’s “look-through” exception. The Second Circuit split the six RMBS classes into two groups: the “Indenture Trusts” and the “REMIC [real estate mortgage investment conduit] Trusts.” For the Indenture Trusts, the court affirmed the district court’s ruling that the notes issued by these trusts did not qualify as plan assets under ERISA. The notes were treated as indebtedness with no substantial equity features, and the mortgages backing these notes were not considered plan assets. The court emphasized that the notes reflected a traditional debt structure, exposing noteholders only to credit risks, not equity risks. However, the court arrived at a different conclusion regarding the REMIC trusts. The Second Circuit concluded that the regular-interest certificates issued by these trusts represented beneficial interests, thus qualifying as equity interests under the plan-asset regulation. Consequently, the mortgages underlying these certificates were considered plan assets. The court highlighted that the trust agreements clearly identified certificate holders as beneficiaries, entitling them to trust income, which aligned with the definition of a beneficial interest. Finally, the court briefly addressed the issue of Ocwen’s fiduciary status. Ocwen and Wells Fargo argued that “even if the mortgages are plan assets, we should nonetheless affirm the district court’s judgment on the alternative ground that Ocwen’s servicing of the mortgages does not qualify as a fiduciary function for purposes of ERISA.” However, the Second Circuit noted that the district court did not reach this issue and it declined to do so in the first instance. It therefore remanded “to allow the district court to consider in the first instance whether Ocwen acted in a fiduciary capacity with respect to the mortgages underlying the three REMIC trusts.”

Schultz v. Glens Falls Hosp., No. 1:25-CV-00581 (MAD/PJE), 2026 WL 850332 (N.D.N.Y. Mar. 26, 2026) (Judge Mae A. D’Agostino). Kimberley Schultz is an employee of Glens Falls Hospital and receives health insurance through the ERISA-governed Glens Falls Hospital Health Plan. Schultz alleges that under the plan she is assessed a “tobacco surcharge” of approximately $20 per paycheck, totaling $520 per year, which she must pay in order to maintain her insurance. Schultz contends that the plan violates ERISA’s statutory requirements and implementing regulations and thus brought this action asserting two claims for relief. First, Schultz alleged that the tobacco surcharge is unlawful because it is imposed without a wellness program, as required by ERISA, 29 U.S.C. § 1182. Second, Schultz alleged that the hospital breached its fiduciary duties to the plan and plan participants by imposing and collecting the allegedly unlawful surcharges, thereby violating 29 U.S.C. §§ 1104 and 1106. The hospital moved to dismiss, arguing that Schultz lacked Article III standing to bring her claims and that the complaint failed to state a claim. Addressing count one first, the court found that Schultz plausibly alleged a concrete injury for standing purposes because she asserted that she paid a tobacco surcharge that the hospital was not legally authorized to levy. The hospital argued that Schultz did not allege that she used tobacco, but “[w]hether Plaintiff uses tobacco is entirely irrelevant.” The court also dismissed the hospital’s argument that “even if there was a wellness program, Plaintiff would not have qualified,” because she suffered the $20 weekly injury “despite Defendant’s failure to implement any wellness program, as statutorily required.” As for the merits of count one, the court rejected the hospital’s argument that tobacco use is not a health status-related factor under Section 1182. The hospital also made arguments regarding what constituted a “reasonable alternative standard” under ERISA, but the court stated, “The glaring problem with Defendant’s arguments as to the merits of Count One is…there is no wellness program at all. As such, setting aside any interpretation of the Regulations, Defendant has failed to comply with ERISA’s statutory requirements entirely. Simply put, the Court cannot evaluate the technical compliance of a wellness program that does not exist, so Defendant’s reasonable alternative standards and notice arguments are irrelevant.” As for count two, the court ruled that Schultz had standing for the same reasons it found she had standing to bring count one. However, the court ruled that Schultz failed to plausibly allege that the plan suffered any losses from the hospital’s alleged fiduciary breaches, which was required because she was bringing her claim under Section 1132(a)(2). The court noted that individual injuries alone cannot support a Section 1132(a)(2) claim, and Schultz’s allegations of self-dealing did not demonstrate harm to the plan itself.  Additionally, the court found that Schultz’s argument regarding prohibited transactions was insufficient, as the complaint did not allege that the hospital retained the surcharge proceeds beyond the 90-day limitation for withheld wages to become plan assets. As a result, Schultz’s claim for unlawful imposition of a discriminatory surcharge will proceed, but her breach of fiduciary duty claim was dismissed.

Fifth Circuit

Anderson v. Southwest Airlines Co., No. 3:25-CV-0214-S, 2026 WL 820860 (N.D. Tex. Mar. 25, 2026) (Judge Karen Gren Scholer). The plaintiffs in this putative class action are participants in the ERISA-governed Southwest Airlines Co. Retirement Savings Plan. Plaintiffs contended that one of the funds in the plan, the Harbor Capital Appreciation Fund, an actively managed large-cap growth fund, “has chronically underperformed both similar comparator funds and its own self-selected target benchmark” over three-, five-, and nine-year periods. Plaintiffs argued that a prudent fiduciary would have removed the Harbor Fund from the plan by 2019. Plaintiffs alleged that Southwest and related defendants breached their fiduciary duties by retaining the Harbor Fund and failing to monitor fiduciaries to whom they delegated responsibilities. Defendants moved to dismiss, arguing that (1) plaintiffs cannot state a claim for breach of fiduciary duty based solely on underperformance, (2) plaintiffs did not plead any meaningful benchmarks, (3) plaintiffs cannot assert imprudence based on challenging a single fund, (4) other prudent investors selected the Harbor Fund, and (5) plaintiffs’ failure to monitor claim was derivative of its breach of fiduciary duty claim, and, in any event, “the Fifth Circuit has not recognized such a claim.” The court made short work of the motion in denying it. The court declined to adopt the “meaningful benchmark” requirement at the motion to dismiss stage, as neither the Supreme Court nor the Fifth Circuit has established such a requirement. Furthermore, the court stated there was “no binding precedent explaining what, exactly, a meaningful benchmark is,” and thus “the Court is left without a reliable standard to determine whether Plaintiffs’ proffered comparator funds are sufficiently similar to the Harbor Fund to constitute meaningful benchmarks.” The court further found that challenging a single fund does not preclude a breach of fiduciary duty claim because “the Fifth Circuit has not established any such rule, and courts in this circuit have refused to dismiss breach of fiduciary duty claims involving a single fund.” The court also noted that “[r]egardless of other investors’ decisions about the Harbor Fund, the Court concludes that Plaintiffs have adequately pleaded imprudence in the context of the Plan.” Finally, regarding the failure to monitor claim, the court found sufficient support for its existence and allowed it to proceed, as multiple district courts within the Fifth Circuit have recognized such claims. As a result, the case will continue as pled.

Estay v. Ochsner Clinic Foundation, No. CV 25-507, 2026 WL 809570 (E.D. La. Mar. 24, 2026) (Judge Jane Triche Milazzo). Plaintiffs Megan Estay and Francesca Messore are long-time employees of Ochsner Clinic Foundation and participants in Ochsner’s 401(k) retirement plan. They allege in this putative class action that Ochsner, as the sponsor of the plan, and the Retirement Benefits Committee, as the plan administrator, “breached their duties under ERISA when they used plan forfeitures to reduce Ochsner’s matching contribution obligation rather than defray the administrative expenses of the plan.” Under the plan, forfeitures occur when a participant’s employment is terminated before matching contributions from Ochsner vest. The plan allows these forfeitures to be used at the fiduciaries’ discretion to either pay administrative expenses or reduce future employer matching contributions. Plaintiffs argued that defendants consistently chose to use forfeitures to reduce Ochsner’s matching contributions, which was in Ochsner’s best interest rather than the participants’ best interest. They also claimed that the defendants failed to use the full forfeiture amounts and left some unused at the end of the year. Plaintiffs asserted several claims under ERISA, including breach of the duty of loyalty, breach of the duty of prudence, prohibited transactions under § 1106(a)(1) and (b)(1), and failure to monitor other fiduciaries. Defendants moved to dismiss, and in September of last year, the court granted their motion, ruling that defendants acted in compliance with the plan and ERISA by making a discretionary choice to allocate forfeitures to employer matches. (Your ERISA Watch covered this ruling in our September 24, 2025 edition.) However, the court gave plaintiffs leave to amend. They filed an amended complaint, which was followed by another motion to dismiss which the court evaluated in this order. Once again, the court granted defendants’ motion, this time with prejudice. The court found that the plan gave the defendants discretion to allocate forfeitures to reduce employer contributions or pay administrative expenses. The plaintiffs failed to establish a breach of loyalty because ERISA does not require fiduciaries to maximize profits, only to ensure participants receive promised benefits. The court also noted that plaintiffs’ theory would require forfeitures to be used for administrative expenses, creating an additional benefit not contemplated in the plan. The court noted that in its first ruling, it observed that “a majority of courts had reached the same conclusion. Since that time, the list of courts joining the majority continues to grow.” As for the duty of prudence, the court held that the plaintiffs did not allege specific facts indicating a flawed decision-making process. The court acknowledged plaintiffs’ “detailed factual allegations,” but “at bottom Plaintiffs still contend that an inference of imprudence is created when a fiduciary chooses to apply forfeitures to discretionary employer matching contributions over administrative fees. Without more, giving credence to such an inference would create a categorical rule that fiduciaries are always assumed to act imprudently when they apply forfeitures to discretionary employer matching contributions over administrative fees. This Court refuses to assume imprudence simply because Plaintiffs would have preferred a different outcome.” The court also rejected the claim that delays in utilizing forfeitures constituted imprudence, as the plan explicitly stated that forfeitures are to be “held in the Trust and will continue to share in the allocation of earnings” until an allocation decision was made. As for plaintiffs’ prohibited transaction claim, the court found that they failed to allege a “transaction” within the meaning of Section 1106. The use of forfeitures for employer contributions was an “intra-plan transfer” and not a transaction. Furthermore, the payment of administrative fees from participant accounts “surely does not implicate the sort of self-dealing contemplated by § 1106(b).” Finally, the court ruled that plaintiffs’ claim alleging failure to monitor was derivative of their other claims and thus failed for the same reasons. The court thus granted defendants’ motion and closed the case.

Sixth Circuit

Dawson v. Brookfield Asset Mgmt. LLC, No. 1:25-CV-00852-PAB, 2026 WL 835553 (N.D. Ohio Mar. 26, 2026) (Judge Pamela A. Barker). Simon Dawson, an employee of Brookfield Asset Management LLC and a participant in the Brookfield 401(k) Savings Plan, filed this putative class action against Brookfield and the plan’s investment committee. Dawson alleged that defendants selected and retained imprudent American Century Fund Target Date Funds (TDFs) despite the availability of more suitable options. He also alleged that defendants failed to monitor the fiduciaries responsible for the plan’s administration and management. Dawson’s complaint included two primary claims: (1) breach of the fiduciary duty of prudence under ERISA, and (2) failure to adequately monitor other fiduciaries under ERISA. He alleged that the American Century TDFs underperformed compared to their benchmarks and other large TDFs in the market, including those in the same Morningstar category. Dawson also highlighted the funds’ high turnover rates – i.e., how often the funds changed their investments – as a red flag that should have prompted further investigation by the fiduciaries. He claimed that these issues resulted in significant financial losses for the plan participants. Defendants filed a motion to dismiss for failure to state a claim. The court agreed with defendants that Dawson failed to allege sufficient underperformance of the American Century TDFs to infer imprudence. The court noted that the alleged underperformance was modest, with the funds generally showing positive returns despite slightly underperforming their benchmarks. The court emphasized that merely pointing to another investment that performed better over a short period does not suffice to plead an imprudent decision, as fiduciary duty focuses on the decision-making process rather than short-term results. The court specifically addressed Dawson’s comparisons to the S&P 500 Target Date Index, alleged Morningstar comparators, and alleged “Large TDF Comparator Funds.” It found that (a) the S&P Index was not an adequate comparator because the American Century TDFs were actively managed, and in any event the TDFs “had positive returns, and only slightly underperformed the S&P 500 Target Date Index,” (b) plaintiff’s allegations regarding the Morningstar comparators were “more robust,” but still did not demonstrate “meaningful underperformance,” and (c) the Large TDF Comparator Funds, like the Morningstar funds, did not demonstrate sufficient underperformance. Additionally, the court found that Dawson’s allegations of high turnover rates did not independently infer imprudence, especially given the lack of substantial underperformance. The court noted that high turnover rates, combined with underperformance, could suggest imprudence, but Dawson’s allegations did not meet this threshold. Finally, because Dawson’s duty-of-prudence claim failed, his derivative failure-to-monitor claim also failed. The court thus granted defendants’ motion to dismiss.

Gipson v. Medical Mutual of Ohio, No. 1:24-CV-00103, 2026 WL 836617 (M.D. Tenn. Mar. 26, 2026) (Judge William L. Campbell, Jr.). The plaintiffs in this case were all beneficiaries of an ERISA-governed medical insurance plan sponsored by Reserve National Insurance Company. The plan included a portability provision which allowed them to continue receiving benefits in the event of a change in employment or cancellation of the plan’s underlying group insurance policy. Plaintiffs obtained continuing coverage through this provision, and were undergoing cancer treatment, when they were notified that their coverage would end. This cancellation occurred shortly after Reserve National was acquired by Medical Mutual of Ohio. Plaintiffs brought this action contending that Reserve National and Medical Mutual, and their parent companies, Kemper Corporation and United Insurance Company of America, “collectively executed a plan to terminate substantially all of the ported group supplemental coverage Reserve National had in force on its books, in effect closing a book of business that was providing cancer and dread disease coverage to over 30,000 insureds.” Plaintiffs asserted their claims under 29 U.S.C. § 1132(a)(3), seeking declaratory and injunctive relief and payment of all benefits wrongfully withheld. Previously, defendants Kemper and United Insurance filed a motion to dismiss, which the court denied. (Your ERISA Watch covered this ruling in our July 23, 2025 edition.) In this order the court considered the motion to dismiss by the remaining two defendants, Reserve National and Medical Mutual. They sought dismissal under Federal Rule of Civil Procedure 12(b)(1) for lack of subject matter jurisdiction and under Rule 12(b)(6) for failure to state a claim. The court quickly dispensed with the jurisdictional argument, agreeing with plaintiffs that regardless of whether ERISA governed the plan at issue, it had diversity jurisdiction and the case satisfied the requirements of the Class Action Fairness Act. The court found that the class exceeded 100 members, was minimally diverse, and had an amount in controversy exceeding $5,000,000. Next, the court addressed defendants’ arguments regarding equitable relief. They contended that plaintiffs were impermissibly attempting to “repackage denial-of-benefit claims as claims for equitable relief,” and thus plaintiffs’ claims would be better adjudicated under Section 1132(a)(1)(B). The court disagreed, noting that plaintiffs’ claims were “based on the alleged wrongful termination of coverage in violation of plan terms, not claim adjudication… Here, Plaintiffs allege an injury beyond the mere non-payment of claims. They allege injury from the cancellation of their policies while undergoing approved treatment.” Thus, while this injury may have resulted in denied claims, “the Court is not persuaded that Section 1132(a)(1)(B) provides an adequate remedy for the injury alleged by Plaintiffs[.]” The court further found that plaintiffs’ requested remedy, a constructive trust, constituted appropriate equitable relief. Second, defendants argued that plaintiffs could not sue them for breach of fiduciary duty because they were not acting as fiduciaries when they terminated ported group supplemental coverage under the plan. The court rejected this argument as well. The court stated that the decision to terminate coverage directly related to defendants’ obligations under the plans and constituted an exercise of control over plan management or assets. As a result, the court denied defendants’ motion to dismiss.

Parker v. Tenneco, Inc., No. 23-10816, 2026 WL 852046 (E.D. Mich. Mar. 27, 2026) (Judge Judith E. Levy). This case, which has been up to the Sixth Circuit and back, is a putative class action concerning two retirement plans: the DRiV Plan and the Tenneco Plan, which merged into a single Tenneco Plan in July of 2022. The named plaintiffs, Tanika Parker and Andrew Farrier, are participants in the plans who contend that the defendants, fiduciaries under the plans, breached their fiduciary duties under ERISA by mismanaging the plans. Plaintiffs have named 46 defendants, including company sponsors, boards of directors, committees that administered the plans, and individuals who are members of those boards or committees. Plaintiffs contend that defendants failed to replace target date mutual funds with less expensive collective trust versions, chose recordkeeping service providers that charged excessive fees, used forfeited funds to reduce company contributions instead of participant fees, failed to replace investment options with less expensive alternatives, failed to offer the lowest-cost share classes, and chose managed account service providers that charged excessive fees. Defendants filed a motion to dismiss plaintiffs’ second amended complaint. In this order the court granted their motion in part and denied it in part. The court addressed plaintiffs’ forfeiture claims first, ruling that there was no breach of fiduciary duty because plaintiffs “have not provided any context or circumstances related to Defendants’ financial status or actions” that would make defendants’ forfeiture decisions imprudent. Furthermore, defendants’ use of forfeitures for company contributions was not a prohibited transaction because it was not a “transaction” under 29 U.S.C. § 1106(a)(1)(A) or § 1106(b)(1): “The use of forfeitures for company contributions is not a sale, exchange, or lease of property.” Nor did this violate ERISA’s non-inurement provision because the forfeited assets at issue never left the plans; the forfeitures “remain in the Plans and are still being used to ‘provid[e] benefits to participants in the plan.’” Next, the court addressed plaintiffs’ excessive fee claims. The court dismissed several of these due to insufficient allegations. For example, plaintiffs failed to allege adequate comparators for recordkeeping fees and the DRiV plan’s managed account services. However, the court found plaintiffs’ allegations sufficient and allowed claims to proceed relating to the T. Rowe Price Mutual Funds in both plans, the DRiV Plan’s single class investments and Vanguard index funds, and the failure to obtain lower-cost share classes in the DRiV plan. Finally, the court reconsidered a prior order and allowed plaintiffs to include failure to monitor claims in the case for certain defendants, finding that plaintiffs had sufficiently alleged that these defendants controlled or oversaw other fiduciaries who allegedly breached their duties.

Eleventh Circuit

Secretary of Labor v. Gleason Research Assocs., Inc., No. 5:24-CV-01352-MHH, 2026 WL 852129 (N.D. Ala. Mar. 27, 2026) (Judge Madeline Hughes Haikala). Gleason Research Associates, Inc. is an engineering and scientific consulting company that provides services to the government. In 2015 Gleason established an employee stock ownership plan (ESOP) which acquired 100% of Gleason’s outstanding shares for approximately $21.5 million, financed through a loan from Gleason. The ESOP committee, consisting of Charles Vessels, James Kelley, and Brenda Showalter, was appointed to manage the ESOP. Later, new stock was issued, and the Department of Labor contends all three members of the committee breached their fiduciary duties of loyalty and prudence under ERISA as fiduciaries and plan administrators of the ESOP by profiting from the purchase and sale of the new shares at the expense of ESOP participants. The DOL further claims that Gleason, as the plan administrator, failed to monitor the three fiduciaries. The complaint asserts that defendants engaged in self-dealing and authorized transactions that diluted the equity interests of plan participants without adequate compensation. Additionally, the DOL alleges that the defendants caused Gleason to redeem warrants and stock appreciation rights at inflated prices, harming the ESOP’s economic interests. Defendants moved to dismiss for failure to state a claim. The court found that the DOL properly pled that Vessels, Kelley, and Showalter owed fiduciary obligations to the ESOP and its participants and beneficiaries, as they were appointed to the ESOP Committee and acknowledged their fiduciary roles. The court determined that the DOL’s allegations raised a reasonable expectation that discovery would reveal evidence of wrongdoing, and the DOL sufficiently alleged that the defendants breached their fiduciary duties by prioritizing their financial gain over the interests of the ESOP participants. Additionally, the court held that the claims for co-fiduciary liability against Kelley and for failure to monitor against Gleason were derivative of the primary fiduciary breach claims and should proceed. As a result, the court denied defendants’ motion.

Class Actions

First Circuit

Adams v. Dartmouth-Hitchcock Clinic, No. 22-CV-099-LM, 2026 WL 821803 (D.N.H. Mar. 25, 2026) (Judge Landya McCafferty). The plaintiffs in this case are participants in the Dartmouth-Hitchcock Retirement Plan and the Dartmouth-Hitchcock Employee Investment Plan, which are ERISA-governed employee retirement plans. They filed this putative class action in 2022 alleging that the Clinic and related defendants breached their fiduciary duties in managing and monitoring the plans. These failures allegedly led to excessive administrative costs and imprudent investment decisions. Defendants filed a motion to dismiss, but the court denied it. The parties subsequently conducted discovery, negotiated with the assistance of an independent mediator, and reached a settlement. Before the court here was plaintiffs’ unopposed motion seeking preliminary approval of the parties’ proposed class action settlement agreement and preliminary certification of the proposed class for settlement purposes. The court granted the motion, finding that the proposed settlement was likely to be fair, reasonable, and adequate. The settlement was negotiated at arm’s length with the assistance of a mediator after conducting extensive discovery. The settlement amount of $850,000 was “significantly less than what plaintiffs originally estimated their damages to be (over $10,000,000),” but “plaintiffs represent that information learned during discovery and the uncertainty of ongoing litigation has the potential to reduce plaintiffs’ recovery significantly, if not completely.” As a result, the court deemed the settlement reasonable given the potential risks and costs of continued litigation. As for class certification, the court determined that the class met the requirements of Rule 23(a) and Rule 23(b)(1)(B). The class was sufficiently numerous, with over 31,000 participants, and shared common legal and factual questions regarding the defendants’ alleged fiduciary breaches. The claims of the class representatives were typical of the class, and there were no conflicts of interest. The court also found that Capozzi Adler, P.C., the proposed class counsel, was qualified and experienced. The court was concerned with the agreement’s provision regarding class counsel’s attorney fees, which would “amount to no more than one-third of the Gross Settlement Amount.” The court “does not find this percentage to be per se unreasonable, but it notes that such a figure, under the circumstances of this case, gives the court some pause.” Thus, the court indicated that while it would preliminarily approve the proposed fees, it would probe this number further at the upcoming fairness hearing. Finally, the court approved Analytics LLC as the settlement administrator and agreed to the parties’ proposed notices to class members, with some minor corrections to better inform class members of their due process rights.

Seventh Circuit

Daly v. West Monroe Partners, Inc., No. 21 CV 6805, 2026 WL 851252 (N.D. Ill. Mar. 27, 2026) (Judge John Robert Blakey). Matthew Daly was employed by West Monroe Partners, Inc., a digital consulting firm, and was a participant in the West Monroe Employee Stock Ownership Plan, a defined contribution plan governed by ERISA. The plan was designed to invest primarily in company stock and hold that stock in a trust for the benefit of plan participants. Argent Trust Company acted as the plan’s trustee. In April of 2021, Argent Trust completed an annual valuation of the company stock held by the plan, which Daly alleges was too low. Based on this valuation, the value of company stock as of December 31, 2020, was announced to be $515.18 per share. Daly left the company in November of 2020 and elected to take a distribution of his account balance between June and August of 2021. In October of 2021, West Monroe sold 50% of the company to MSD Partners, L.P. at a price of $1,616 per share. The Plan was terminated in November of 2021, and remaining participants received the higher price for their shares. Daly brought this suit against the company, Argent Trust, and other defendants alleging that they breached their fiduciary duties under ERISA by failing to conduct a prudent valuation of the stock in 2020, failing to ensure participants received fair market value for their stock, and failing to disclose material facts to beneficiaries. Before the court here was Daly’s motion for class certification. The court granted Daly’s motion under Rule 23(b)(1). The court found that the proposed class satisfied all four requirements of Rule 23(a): numerosity, commonality, typicality, and adequacy of representation. Specifically, the class was numerous with 146 members, common questions of law or fact existed because defendants’ conduct was uniform with regard to all class members at the time of the 2020 valuation, Daly’s claims were typical of the class, and he could adequately represent the class. Defendants argued that Daly was motivated by animus and thus would not serve as a good class representative, but the court was unimpressed by Daly’s comments, stating that “[c]ases invalidating a plaintiff’s ability to represent a class based upon animus require far more severe expressions of animosity than what Plaintiff’s comments exhibit.” Next, the court concluded that the claims were suitable for class treatment under Rule 23(b)(1) because adjudication of Daly’s suit would be dispositive of the interests of other participants, and separate actions would impair the ability of other participants to protect their interests. Defendants argued that Daly was “‘not seeking to represent the Plan as a whole’ as required by § 502(a)(2) and is not a suitable representative of the plan under the same section because of ‘potential conflict with the interests of other participants in the Plan.’” However, the court ruled that these arguments were foreclosed by precedent, which allowed Daly to represent only a portion of plan participants, and thus no intra-class conflict existed. Finally, the court noted that 33 members of the class had signed class action waivers. The court found that these waivers were valid and enforceable, and not void under the effective vindication doctrine because that doctrine only applied to arbitration waivers, whereas the waivers in this case arose from employment termination agreements. As a result, the court excluded the 33 employees from the class, which was certified as follows: “All participants in the Plan who received a distribution in an amount determined based on the 2020 Valuation of Company stock who did not sign a class action waiver as part of any employment termination agreement with Company.”

Disability Benefit Claims

Second Circuit

Bianchini v. The Hartford Life and Accident Ins. Co., No. 24-CV-6535 (JGLC), 2026 WL 810303 (S.D.N.Y. Mar. 24, 2026) (Judge Jessica G.L. Clarke). Chiara Bianchini was a director of digital marketing and social media advertising at Blackstone Administrative Services Partnership, L.P. She contracted COVID in 2020 and 2022, subsequently experiencing symptoms of long COVID, which included extreme fatigue, headaches, blurred vision, heart palpitations, and cognitive impairments. Bianchini filed a claim for short-term disability benefits under Blackstone’s ERISA-governed employee disability benefit plan, which was insured by Hartford Life and Accident Insurance Company. Hartford denied it. Bianchini subsequently submitted a claim for long-term disability benefits, which Hartford also denied, citing a lack of restrictions or limitations preventing her from performing sedentary work. Bianchini appealed this decision in June of 2024, submitting new evidence. Before Hartford rendered a final decision on the appeal, Bianchini filed this action, asserting a single claim for long-term disability benefits under 29 U.S.C. § 1132(a)(1)(B). Hartford filed a motion for summary judgment, arguing that Bianchini failed to exhaust administrative remedies, while Bianchini filed a motion to supplement the administrative record with live testimony at trial. Addressing Hartford’s motion first, the court found that Hartford violated ERISA’s claims procedure regulation by improperly tolling its appeals determination deadline and failing to properly extend its determination deadline. The court emphasized that Hartford could not toll the deadline while it was waiting on information from third parties: “Fairness…requires that ‘a claimant’s appeal is not stalled indefinitely while the plan seeks information from third parties beyond the claimant’s control.’” Thus, Hartford’s self-granted 45-day extension of its determination deadline was also incorrect because it was based on its tolling calculation error. The court further found that these procedural violations were not for good cause or due to matters beyond Hartford’s control. Thus, Hartford failed to comply with ERISA’s claim regulation and “[a]ccordingly, Hartford’s violations deemed Plaintiff’s administrative remedies exhausted.” The court then moved on to Bianchini’s motion, which was also unsuccessful. The court ruled that Bianchini did not demonstrate good cause to supplement the administrative record with live testimony. The court found that neither Hartford’s structural conflict of interest as both claims administrator and payor nor its procedural deficiencies adversely affected the development of the administrative record. The court noted that the requested testimony would not introduce new factual material but would only assess credibility and clarify existing evidence, which did not warrant supplementation. As a result, both parties’ motions were denied, and the court directed the parties to meet and confer regarding setting the case for trial.

Pistilli v. First Unum Life Ins. Co., No. 24 CIV. 5266 (AKH), 2026 WL 836647 (S.D.N.Y. Mar. 26, 2026) (Judge Alvin K. Hellerstein). Lia Pistilli brought this action asserting that First Unum Life Insurance Company wrongly denied her claim for benefits under her employer’s ERISA-governed long-term disability benefit plan. On October 3, 2025, the court evaluated the parties’ cross-motions for judgment and found that Unum did not act arbitrarily or capriciously in denying her claim. (Your ERISA Watch covered this ruling in our October 8, 2025 edition.) Pistilli has appealed this ruling to the Second Circuit. Meanwhile, on November 15, 2025, Pistilli was awarded disability benefits by the Social Security Administration (SSA). Pistilli filed a motion for relief from judgment based on this award under Federal Rule of Civil Procedure 60(b)(2), or, alternatively, an indicative ruling pursuant to Rule 62.1(a)(3). In this order the court denied Pistilli’s motion. The court stated that it lacked jurisdiction over the Rule 60(b) motion because Pistilli had already filed an appeal. As for Rule 62.1(a), the court explained that it would deny this motion as well because the SSA decision did not exist at the time of the trial and thus did not constitute “newly discovered evidence.” Additionally, the court determined that even if the SSA decision were considered to be newly discovered evidence, it would not change the outcome because “[t]he SSA took the same set of facts and reached a different conclusion on a different standard of analysis. Such an administrative body’s conclusion has no bearing on my assessment and determination on the facts presented to me and would not, and does not, change my decision.” Pistilli also attempted to frame her claim under Rule 60(b)(6), a catchall provision for relief from judgment. However, the court found this unavailing because the reasons for relief could be considered under the more specific Rule 60(b)(2). Even if considered under Rule 60(b)(6), the court concluded that the SSA decision would not have altered the litigation’s outcome for the reasons it already identified. As a result, Pistilli’s motion was denied and she will have to obtain relief from the Second Circuit.

Seventh Circuit

Sakwa v. Hartford Life & Accident Ins. Co., No. 1:25-CV-04546, 2026 WL 822460 (N.D. Ill. Mar. 25, 2026) (Judge Sharon Johnson Coleman). Stuart H. Sakwa was an equity partner at the venerable Chicago law firm of Arnstein & Lehr LLP and was covered under the firm’s ERISA-governed long-term disability benefit plan, which was insured by Hartford Life and Accident Insurance Company. Sakwa became disabled in January of 2013 and was approved for benefits under the plan by Hartford. His benefits were calculated based on his Pre-Disability Earnings (PDE) and Current Monthly Earnings (CME), with the policy excluding contributions to 401(k) and Keogh retirement plans from the definition of “earnings.” However, from 2013 to mid-2018, Hartford included these contributions in its calculations, which increased both PDE and CME, and thus increased Sakwa’s benefits. This was the result of “numerous conversations and written exchanges discussing how Sakwa’s CME would be calculated,” and was memorialized in two 2014 letters from Hartford to Sakwa. However, in 2018 Hartford changed its methodology without notice, claiming it had overpaid Sakwa for the 2016 tax year because his CME should have been calculated without including his 401(k) contributions. Meanwhile, confusingly, it continued to use the original methodology to pay his ongoing benefits. Several appeals by Sakwa and decisions by Hartford followed, during which Hartford advanced new arguments and backtracked on previous arguments. Ultimately, Sakwa filed this action under ERISA, alleging two counts: one for breach of fiduciary duty because Hartford did not consider his 2020 appeal, and one challenging Hartford’s calculation of his monthly disability benefits. Hartford filed a motion to dismiss Sakwa’s first claim based on “(1) ERISA’s three-year statutory limitations period; (2) the Plan’s contractual three-year limitations period; and (3) preclusion under § 1132(a)(3) because the statute provides an adequate remedy.” Hartford contended that Sakwa had “actual knowledge of the alleged breach no later than April 22, 2020 – the date Hartford refused to consider his further appeal,” and thus his first claim was time-barred. The court agreed, ruling that there is “no question that Sakwa became aware of the relevant information on that date,” and thus his claim was late. Additionally, the court found that Sakwa’s equitable relief claim was duplicative of his second count, as an adequate remedy was available under § 1132(a)(1)(B), thus “foreclosing recourse to the catchall provision as a matter of law.” The court then turned to Sakwa’s second claim, which Hartford sought dismissal of because Sakwa “failed to exhaust his administrative remedies by not appealing Hartford’s December 6, 2022 benefit determination within the Plan’s 180-day window.” The court determined that “Sakwa had already exhausted his administrative remedies before filing suit” because Hartford’s April 25, 2022 letter confirmed that its decision “is now final as administrative remedies available under the Policy have been exhausted.” The court stressed that “Hartford cannot represent to a claimant that his administrative remedies have been exhausted, then argue in litigation that the claimant failed to exhaust those remedies.” Furthermore, the court ruled that the December 2022 letter “was not a substantive resolution of the underlying dispute, but instead a ‘correction’ of an arithmetic error that Hartford itself identified without reopening the administrative process.” In any event, “Sakwa was not required to file that appeal because doing so would have been futile” given the unresolved issues over the preceding nine years. As a result, Sakwa will not be able to continue with his breach of fiduciary duty claim, but his claim for recalculation of benefits will proceed.

Ninth Circuit

Gupta v. Intel Short-Term Disability Plan, No. 25-CV-00871-NC, 2026 WL 821590 (N.D. Cal. Mar. 25, 2026) (Magistrate Judge Nathanael M. Cousins). Udit Gupta was employed as a Cloud Software Development Engineer at Intel, where he was covered by Intel’s ERISA-governed short-term disability (STD) and long-term disability (LTD) benefit plans, which were administered by Reed Group LLC. The STD benefits included two plans: the Short Term Disability Plan (STD Plan) and the California Voluntary Short Term Disability Plan (CA-VSTD Plan). From February to September of 2022, Gupta was approved for leave under these plans, supported by medical records from his psychiatrist, chiropractor, and acupuncturist. However, in October of 2022, Reed terminated Gupta’s STD Plan and CA-VSTD Plan benefits on the ground that his medical records no longer demonstrated disability. Gupta appealed the STD Plan denial, but Reed upheld its decision after further evaluations. In August of 2023, Gupta’s counsel initiated an LTD claim, which Reed denied on the ground that Gupta did not satisfy the 52-week elimination period because of the denial of his STD claims. Gupta filed suit under ERISA against Intel, the plans, and other defendants, alleging improper denial of benefits and breach of fiduciary duty. The parties filed cross-motions for judgment under Federal Rule of Civil Procedure 52 which the agreed-upon magistrate judge ruled on in this order. First, the court agreed with defendants that Gupta failed to exhaust administrative remedies by not appealing the denial of his CA-VTSD Plan benefits to the California Employment Development Department, as required by the plan. Second, the court granted Gupta judgment on his claim for STD Plan benefits. The court agreed with defendants that the abuse of discretion standard of review applied because the plan unambiguously conferred discretion on Reed to determine benefit eligibility. The court also agreed that Reed used a reasonable job description in evaluating Gupta’s claim. However, the court found that Reed abused its discretion by improperly dismissing the opinions of Gupta’s treating physicians in favor of its consulting experts’ paper reviews. The court criticized Reed’s medical reviewers, noting that they “did not attempt to contact Plaintiff’s providers,” “did not appreciate that Plaintiff was being treated by a psychiatrist,” inappropriately offered opinions outside their areas of expertise, and did not “explain what evidence supports their conclusions regarding Plaintiff’s ability to work.” The court determined that remand was unnecessary and ordered defendants to pay Gupta STD Plan benefits. As for Gupta’s LTD claim, the court noted that its decision on the STD Plan benefits undermined the support for Reed’s LTD denial as well. Furthermore, “[t]he Court lacks evidence regarding Plaintiff’s condition past February 2023 and, even if it did have that evidence, it would be improper to evaluate it and make an LTD determination.” Thus, the court remanded to Reed for further consideration. Finally, the court granted defendants summary judgment on Gupta’s claim for breach of fiduciary duty, finding that the Intel defendants were not fiduciaries and that Gupta’s claim was duplicative of his claim for benefits. The court ordered the parties to meet and confer regarding its ruling and submit a joint report.

Serrata v. Unum Life Ins. Co. of Am., No. 24-CV-02421-HSG, 2026 WL 849298 (N.D. Cal. Mar. 27, 2026) (Judge Haywood S. Gilliam, Jr.). Edward R. Serrata was working for Sherwin Williams Company as a salesman when, in 2006, he was diagnosed with multiple sclerosis (MS) after experiencing vision issues. Serrata continued working until 2011, when his MS symptoms, including fatigue, leg pain, weakness, and further vision problems, made it difficult for him to perform his job duties. He applied for and received benefits under Sherwin Williams’ ERISA-governed employee disability benefit plan. First, he received short-term disability benefits, which were converted in 2012 to long-term disability (LTD) benefits by the plan’s insurer and claim administrator, Unum Life Insurance Company of America. However, in 2023 Unum terminated Serrata’s LTD benefits, claiming he was not disabled from performing a sedentary occupation. Serrata appealed, but Unum upheld its decision in 2024 and thus Serrata filed this action. In his complaint Serrata contended that his benefits were wrongfully terminated; he sought benefits from the date of termination to the date of judgment. The parties filed cross-motions for judgment under Federal Rule of Civil Procedure 52, and agreed that the default de novo standard of review applied. The court granted Serrata’s motion for judgment and denied Unum’s. The court found that Serrata met his burden of proving by a preponderance of the evidence that he was disabled from any gainful occupation at the time his LTD benefits were terminated. The court credited the opinions of Serrata’s treating neurologist, Dr. Kriseman, and Dr. Cassini, a neurologist with extensive experience in treating MS patients, who both concluded that Serrata’s MS symptoms precluded him from performing sedentary occupational demands on a full-time basis. The court also noted that Unum had paid Serrata LTD benefits for more than nine years under the applicable “any gainful occupation” standard, which supported the conclusion that he continued to be disabled. The court rejected Unum’s reliance on a form completed by Dr. Kriseman on March 10, 2023, which indicated Serrata could perform sedentary work, as Dr. Kriseman later clarified that she did not intend to suggest Serrata was no longer disabled. The court also found that Unum’s conclusions about Serrata’s activity level, MRI stability, and treatment were not sufficient to justify the termination of benefits. Additionally, the court gave minimal weight to the opinions of Unum’s retained physicians, who concluded Serrata could perform sedentary work, because their assumptions were unsupported and they did not consider all relevant evidence. Ultimately, the court concluded that Serrata was unable to perform any gainful occupation due to his MS symptoms, and Unum erred in terminating his benefits. The court directed the parties to meet and confer regarding the filing and briefing schedule for any motion for attorneys’ fees and costs.

Eleventh Circuit

Harling v. Hartford Life & Accident Ins. Co., No. 6:24-CV-1237-ACA, 2026 WL 837100 (N.D. Ala. Mar. 26, 2026) (Judge Annemarie Carney Axon). Evelyn Harling receives benefits under an ERISA-governed long-term disability benefit plan insured by Hartford Life and Accident Insurance Company. Harling was also approved by the Social Security Administration for two benefits: a disability benefit and a benefit for disabled widows. After approving Harling’s claim, Hartford calculated her benefits by only offsetting the primary benefit, and not the disabled widow benefit, even though the plan arguably allowed it to offset both. In February of 2024, after extensive communication on the issue, Hartford informed Harling that both offsets applied and she had been overpaid by over $16,000. Hartford requested reimbursement. Harling then filed this action to prevent Hartford from recovering the funds and reducing her future payments. The parties filed cross-motions for summary judgment which were decided in this order. The court addressed the standard of review first, determining that the arbitrary and capricious standard of review applied because the plan granted Hartford discretion to determine eligibility for benefits and to interpret the policy terms. Harling argued that the de novo standard should apply because (a) the case involved interpretation of statutory definitions, (b) Hartford offered “post hoc” rationales for its decision, and (c) Hartford did not give her a full and fair review. The court disagreed, ruling that (a) Hartford did not incorporate statutory definitions in the policy, (b) post hoc rationales do not change the standard of review, and (c) Harling did not explain how she was prejudiced by Hartford’s alleged failure to provide documentation. On the merits, the court ruled that Hartford’s determination that the disabled widow’s benefit qualified as an offset was reasonable. The policy defined “Other Income Benefits” to include “disability benefits under…the United States Social Security Act,” and thus it was reasonable for Hartford to interpret the disabled widow’s benefit as a “disability benefit” under this definition. Harling made several arguments for why the court should rule in her favor despite this finding, but the court found them unpersuasive. First, the court rejected Harling’s argument that Hartford’s correction of its overpayment constituted a reconsideration of its initial decision. The court found that Hartford’s initial determination letter informed Ms. Harling that her benefits were subject to an offset due to both Social Security benefits, and Hartford’s “invocation of the error provision” to recover the offset payments was not a new determination. Second, the court dismissed Harling’s equitable arguments, including the voluntary payment doctrine, laches, and misrepresentation. The court noted that ERISA federal common law, not state law, governed the action, and Ms. Harling failed to provide sufficient evidence or federal case law to support her claims under these doctrines.  Finally, the court rejected Harling’s argument that the widow’s benefit is not an offset now that she has turned 60, and her claim for equitable estoppel. The court found the first argument premature, and the second was unviable because the policy was not ambiguous and the written representations from Hartford contradicted her position. As a result, the court granted Hartford’s summary judgment motion and denied Harling’s.

Medical Benefit Claims

Sixth Circuit

James L.W. v. American Health Holding, Inc., No. 1:25-CV-239, 2026 WL 849864 (S.D. Ohio Mar. 27, 2026) (Judge Mathew W. McFarland). James L.W. is an employee of Meyer Tool, Inc. and a participant in Meyer’s self-funded ERISA-governed employee health benefit plan. James’ minor child, K.W., is a beneficiary of the plan. In 2022 and 2023 K.W. received inpatient psychiatric care at a facility in Utah. Plaintiffs requested coverage and reimbursement from the plan for these services, but it only approved benefits for part of K.W.’s treatment. Plaintiffs unsuccessfully appealed and then filed this action against Medical Benefits Administrators, Inc. (MedBen), the plan’s “benefit manager,” and American Health Holding, Inc. (AHH), the plan’s “utilization review service.” Plaintiffs asserted claims for recovery of benefits under ERISA pursuant to 29 U.S.C. § 1132(a)(1)(B) and for violation of the Mental Health Parity and Addiction Equity Act (MHPAEA) pursuant to 29 U.S.C. § 1132(a)(3). MedBen and AHH filed motions to dismiss. MedBen’s motion was based on failure to state a claim under Federal Rule of Civil Procedure 12(b)(6), while AHH’s motion was based on lack of subject matter jurisdiction under Rule 12(b)(1). The court applied the Rule 12(b)(6) standard to both motions, and first addressed defendants’ argument that “they lack control over the administration of the Plan and are not Plan fiduciaries, meaning they also are not proper defendants with regard to both claims asserted in the Complaint.” The court rejected this argument and found that the complaint plausibly alleged that MedBen and AHH were ERISA fiduciaries. Although Meyer was named in the plan as the plan administrator, MedBen and AHH had roles that involved discretionary authority over claims decisions, which could plausibly qualify them as fiduciaries. Plaintiffs alleged that MedBen “was responsible for supervision of the management, consideration, investigation, and settlement of claims,” while AHH “was responsible for determining whether to grant Plan beneficiaries pre-admission certification for inpatient care at a covered facility,” and “determining whether to review the medical necessity of continued inpatient care for a Plan beneficiary.” Both entities allegedly “sent Plaintiffs letters responding to concerns, explaining benefits, and relaying final decisions.” The court noted that fiduciary status under ERISA is not limited to those explicitly listed as plan administrators but also includes those exercising discretionary authority over plan management, and thus plaintiffs’ allegations were satisfactory. As for plaintiffs’ MHPAEA claim, the court rejected MedBen’s effort to dismiss it as duplicative of plaintiffs’ claim for benefits. MedBen argued that “the claims cannot proceed together because they stem from the same injury,” but the court focused on remedies rather than common facts. The court noted that dismissal of a § 1132(a)(3) claim as duplicative is only warranted where § 1132(a)(1)(B) provides a full remedy for the alleged injuries. Here, the MHPAEA claim sought remedies unavailable under § 1132(a)(1)(B), such as addressing violations of ERISA itself rather than enforcing plan terms. As a result, the court denied defendants’ motions in their entirety and the case will proceed.

Tenth Circuit

Anne A. v. United Healthcare Ins. Co., No. 2:20-CV-00814-JNP, 2026 WL 811540 (D. Utah Mar. 24, 2026) (Judge Jill N. Parrish). The plaintiffs in this case, Anne A. and her daughter Kate A., brought this action seeking recovery of benefits under the Apple, Inc. Health and Welfare Benefit Plan, an ERISA-governed employee group health benefit plan administered by United Healthcare Insurance Company. Mental health benefits were administered by United Behavioral Health. In 2016 and 2017 Kate received mental health treatment at Chrysalis, a residential treatment center, but defendants denied benefits for this treatment, resulting in a $250,000 bill. Plaintiffs filed this action in 2020, seeking benefits under 29 U.S.C. § 1132(a)(1)(B). In March of 2024, the court ruled that “Defendants arbitrarily and capriciously denied plan benefits for Kate’s treatment at Chrysalis” by not engaging with plaintiffs’ arguments, providing only vague and conclusory explanations, and failing to refer to the medical records. The court thus remanded for further review. Your ERISA Watch covered this ruling in our April 3, 2024 edition, noting that the court’s order was strongly worded and placed limitations on what evidence and rationales defendants could use on remand: “Given these restrictions, it’s unclear how any denial on remand could be anything but another abuse of discretion.” Defendants apparently did not get the same message because on remand they upheld their denial of plaintiffs’ claim. As a result, plaintiffs filed a motion to re-open the case and the parties once again filed cross-motions for summary judgment; plaintiffs also filed a motion for attorney’s fees. Plaintiffs argued that defendants “ignored the court’s remand instructions,” to which defendants shrugged: “Defendants, for their part, do not contest that their post-remand denials blatantly ignored the guardrail instructions the court set.” The court was not happy: “The court is hard pressed to understand Defendants’ actions up to this point[.]” However, defendants got away with it because the court concluded that “its initial remand instructions were too restrictive.” The court decided not to enforce its previous limit on citations to the record, although it “continues to adhere to the limit on new rationales, which the Tenth Circuit has endorsed.” Under this more lenient approach, buttressed by the arbitrary and capricious standard of review, the court found that defendants’ post-remand denials were reasonable and supported by substantial evidence because Kate’s treatment at Chrysalis was not medically necessary. The court agreed with defendants that her condition could have been managed at a lower level of care. The court further found that defendants’ letters “clearly articulated” their conclusions, cited appropriately to Kate’s medical records, and addressed plaintiffs’ arguments and evidence. As a result, defendants’ persistence paid off as the court granted their summary judgment motion and mostly denied plaintiffs’. The only bright spot for plaintiffs was the court’s decision to award them attorney’s fees. The court recognized that plaintiffs initially prevailed in obtaining a remand, and stated that “an award of attorney’s fees would serve an important deterrence function” and “will incentivize plan administrators to engage in a full and fair review in the first instance.” The court ordered plaintiffs to file a separate motion for fees which will be decided at a later date.

D.B. v. United Healthcare Ins. Co., No. 1:21-CV-00098-JNP-CMR, 2026 WL 851250 (D. Utah Mar. 27, 2026) (Judge Jill N. Parrish). Plaintiff D.B. is a participant in an ERISA-governed health benefit plan; A.B. is D.B.’s son and a plan beneficiary. A.B. received treatment at Triumph Youth Services, a residential treatment center, from 2018 to 2020 due to depression, anxiety, and suicidal ideation. However, United Behavioral Health, the plan’s mental health benefit administrator, denied benefits for the treatment, contending that it was not medically necessary, and that he could have been treated in a less intensive setting. D.B. unsuccessfully appealed and then brought this action under ERISA, seeking recovery of benefits and asserting violations of federal mental health parity laws. On June 1, 2023, the judge previously assigned to this case (J. Bruce S. Jenkins) found that UBH’s denial was arbitrary and capricious and remanded the case to UBH for further review. (Your ERISA Watch covered this ruling in our June 7, 2023 edition.) On remand UBH stuck to its guns and upheld its denial. D.B. thus moved to re-open the case in 2024. The court granted the motion, and in 2025 the parties filed cross-motions for summary judgment which were decided in this order. The court applied a deferential standard of review, focusing on whether the denial of benefits was arbitrary and capricious. The court noted that “Judge Jenkins provided Defendants a second chance at engaging in a full and fair review of the claim, in addition to clear remand instructions on how to cure prior deficiencies… Despite this renewed opportunity, Defendants’ post-remand denials, while more detailed than the pre-remand denials, are rife with issues such that the court again finds them to be arbitrary and capricious.” The court found, among other things, that (1) UBH’s denial letters contained conclusory statements without reasoning or citations to the medical record, preventing a full and fair review, (2) UBH did not meaningfully engage with a detailed psychiatric evaluation, providing only a perfunctory two-sentence response to the 47-page report, (3) UBH failed to follow Judge Jenkins’ remand instructions to address specific arguments and evidence presented by D.B., and (4) UBH relied on new guidelines (CALOCUS-CASII) not previously used, which constituted an improper post hoc rationale for denial. The court stated that because of UBH’s failures, “the court is unable to definitively find that A.B.’s treatment was medically necessary,” which “would normally suggest that remand is appropriate.” However, “this case diverges from the norm.” The court found that because of UBH’s “clear and repeated procedural errors… it would be contrary to ERISA fiduciary principles to mandate a remand and provide an additional ‘bite at the apple.’” The court stated that “the specter of continued remand opportunities would simply provide Defendants with, in essence, a way to hack the ERISA process. The court accordingly awards benefits to Plaintiffs, finding remand inappropriate.” The court also determined that attorney’s fees and prejudgment interest were appropriate. Finally, the court declined to rule on D.B.’s Parity Act claim because it was not renewed post-remand, and in any event the court had already awarded plan benefits.

Amy G. v. United Healthcare, No. 2:17-CV-00413-DN, 2026 WL 836549 (D. Utah Mar. 26, 2026) (Judge David Nuffer). This is an action for benefits under an ERISA-governed health care plan. On September 12, 2024, the court concluded that the decision of defendants United Healthcare and United Behavioral Health to deny benefits was arbitrary and capricious, and thus the court entered judgment in plaintiffs’ favor. However, the court did not award benefits and instead remanded the case to defendants for reconsideration. (Your ERISA Watch covered this ruling in our September 18, 2024 edition.) In October of 2024, defendants issued a decision on remand, denying plaintiffs’ claim once again and advising that plaintiffs could appeal. Plaintiffs were unhappy with this decision and filed a motion to reopen the case in December of 2024, seeking to file a motion for summary judgment. Plaintiffs contended that defendants failed to comply with the remand order by considering evidence not part of the administrative record. In the alternative, plaintiffs requested that they be allowed to appeal the redetermination. Defendants opposed this motion, arguing that their reevaluation complied with the remand order and that plaintiffs should have pursued an administrative appeal. Defendants further suggested that any challenge to their redetermination should be made in a new lawsuit. The court was slightly annoyed that “[b]oth parties’ briefing on Plaintiff’s Motion attempt to use the Remand Order as both shield and sword to justify their actions or inaction following the remand of Plaintiffs’ claim for benefits, as well as for reopening the case.” The court noted that “neither party sought clarification of the Remand Order” on the disputed issues, and “[s]uch clarification might have rendered Plaintiff’s Motion unnecessary.” The court further stated that plaintiffs’ motion “is not the appropriate procedural vehicle to make findings of fact and conclusions of law regarding the merits of Plaintiffs’ challenge to the propriety of Defendants’ redetermination denying benefits. It is also not the appropriate procedural vehicle to make findings of fact and conclusions of law on Defendants’ argument regarding a failure to exhaust the Plan’s administrative appeals process.” The court thus limited its inquiry only into whether the case should be reopened, and on this basis it granted plaintiffs’ motion. The court found that plaintiffs’ motion complied with the remand order’s directive by “‘identif[ying] the legal basis on which the case may be reopened and the specific issue or issues for which determination is sought.’ Requiring Plaintiffs to file a new lawsuit to obtain the determinations they seek is contrary to the language and intent of the Remand Order, as well as the purpose of ERISA to promote the ‘efficient resolution of benefits claims.’” The court thus reopened the case and ordered the parties to meet and confer regarding setting a briefing schedule for dispositive motions.

Pension Benefit Claims

Eighth Circuit

Bennett v. Ecolab, Inc., No. 24-CV-0546 (JMB/SGE), 2026 WL 810758 (D. Minn. Mar. 24, 2026) (Judge Jeffrey M. Bryan). Plaintiffs Scott Bennett, Brad Wilde, and David Statton are retired former employees of Ecolab, Inc. and participants in the Ecolab Pension Plan, an ERISA-governed defined benefit plan. The plan offers several optional forms of benefits, including a single life annuity (SLA) for unmarried participants, a joint and survivor annuity (JSA) for married participants, and an early retirement benefit. Plaintiffs, who were all married and elected JSAs, allege that Ecolab used outdated life expectancy rates from a 1971 Group Annuity Table to calculate JSAs, which they claim violates ERISA’s requirement that JSAs be “actuarially equivalent” to SLAs. Plaintiffs contended that life expectancy has “grown steadily since 1971,” and thus the Plan’s reliance on the 1971 Table “has caused proposed class members to lose ‘millions of dollars in benefits’ in the aggregate, effectively ‘penaliz[ing] participants for being married.’” Plaintiffs brought four claims against Ecolab: (1) violation of the joint and survivor annuity requirement under 29 U.S.C. § 1055; (2) violation of the actuarial equivalence requirements under 29 U.S.C. § 1054; (3) violation of ERISA’s anti-forfeiture provisions under 29 U.S.C. § 1053; and (4) breaches of fiduciary duty. Ecolab filed a motion to dismiss under Rule 12(b)(1) for lack of subject matter jurisdiction and Rule 12(b)(6) for failure to state a claim. On count 1, the court granted Ecolab’s motion as to plaintiffs Bennett and Wilde because they did not suffer an injury in fact. The court noted that they opted for early retirement, and under the plan’s early retirement calculations, their actual benefits exceeded what they would have received under Internal Revenue Code Section 417(e), which sets minimum present value requirements for pension plans, and thus they did not suffer a concrete injury. As for count 2, plaintiffs conceded that it should be dismissed because Section 1054 was inapplicable to their claims. On count 3, the court dismissed once again as to plaintiffs Bennett and Wilde due to lack of standing, as they received more than the actuarial equivalent of their normal retirement benefit. However, the court denied the motion to dismiss as to plaintiff Statton, who did not retire early and thus was not subject to the early retirement factor that offset the outdated SLA-to-JSA conversion factor. On count four, the court dismissed as to all plaintiffs because their claim was time-barred under ERISA’s six-year statute of repose. The court rejected plaintiffs’ argument that the breach recurred with each plan update, which would “render virtually meaningless the six-year statute of repose and conflicts with well-settled law.” These decisions left only counts 1 and 3 for plaintiff Statton. The court found that these counts were plausibly pled. Ecolab complained that these claims did not allege “the amount of Statton’s accrued benefit, the specific monthly amount that Statton currently receives under the Plan, nor the amount he would receive by applying section 417(e) actuarial assumptions.” However, the court considered Statton’s benefit calculation form, which was submitted to the court by Ecolab during briefing, and determined that it provided sufficient information for Statton’s claims to proceed. As a result, while Ecolab’s motion was granted in part, the case will continue.

Pleading Issues & Procedure

Sixth Circuit

Gray v. DTE Energy Co. Retirement Plan, No. 2:24-CV-11416-TGB-EAS, 2026 WL 800186 (E.D. Mich. Mar. 23, 2026) (Judge Terrence G. Berg). Vickie Gray was married to Randy Gray for over 25 years until they divorced in 2006. As part of the divorce judgment, Vickie was granted pension benefits and surviving spouse benefits pursuant to Randy’s participation in the DTE Energy Company Retirement Plan. Randy remarried to Joy Gray and retired in 2011. Vickie began receiving pension benefits in 2015, which ceased after Randy’s death in 2018. Vickie later discovered that Randy’s retirement application, signed by Joy, elected survivor benefits for Joy instead of Vickie. Specifically, Vickie alleges that in 2011 Randy and Joy submitted a new election of benefits, assigning the surviving spouse benefits to Joy and falsely certifying that “I am not currently and have never been involved in a Divorce that impacted my pension benefits.” Vickie thus filed this action against the Plan, Joy, and Randy’s estate. She contends that the Plan wrongfully denied her surviving spouse benefits in violation of ERISA, and alleged claims for fraud and misrepresentation against Joy and Randy’s estate. Vickie also sought a declaratory judgment declaring her entitlement to all rights and full surviving spouse benefits of Randy. The Plan filed an answer to Vickie’s complaint, but Joy and the estate “have failed to answer or otherwise respond to this action despite multiple attempts at personal service and alternate service as ordered by the Court[.]” Vickie thus filed a motion for default judgment against Joy and the estate. Meanwhile, Vickie and the plan filed cross-motions for judgment on the administrative record. In this order, the court denied Vickie’s motion for default judgment without prejudice. The court reasoned that in multi-defendant cases, it is the “preferred practice…to delay granting the default judgment motion against only one or some of the defendants until the court reaches a decision on the merits against all.” The court noted that granting default judgment against Joy and the estate could result in a finding that Vickie was entitled to surviving spouse benefits, which would be inconsistent with a subsequent ruling in favor of the Plan on its motion, which would necessitate finding that Vickie was not entitled to those same benefits. Therefore, the court decided to delay the entry of default judgment until Vickie’s claim against the Plan is resolved. The court emphasized that its decision was made only to prevent the possibility of inconsistent verdicts; it “expresses no opinion whatsoever as to the merits of the cross-motions for judgment on the administrative record.”

Provider Claims

Second Circuit

AA Medical, P.C., v. Iron Workers Local 40, 361 & 471 Health Fund, No. 22-CV-1249-SJB-LGD, 2026 WL 836429 (E.D.N.Y. Mar. 26, 2026) (Judge Sanket J. Bulsara). AA Medical, P.C., a surgical practice group, filed this action against the Iron Workers Local 40, 361, and 471 Health Fund challenging the Fund’s decision to deny and limit reimbursement for an arthroscopic knee surgery AA Medical performed on a Fund participant. The surgery in question was performed in 2021 and involved two procedures: (1) an arthroscopy and repair of both menisci (procedure 29883), and (2) a left knee microfracture chondroplasty (procedure 29879). AA Medical submitted an invoice for $158,438.64, but the Fund paid only $3,473.22 for the first procedure, and nothing for the second procedure, contending that it was not medically necessary. AA Medical asserted a single claim under ERISA § 502(a)(1)(B), seeking to enforce its right to benefits under the plan. AA Medical alleged that the Fund unlawfully underpaid for procedure 29883 and denied recovery for procedure 29879. The Fund moved for summary judgment. The court reviewed the Fund’s decisions under the arbitrary and capricious standard of review because the Plan vested it with discretionary authority to determine benefit eligibility. Under this deferential standard, the court found that the Fund’s decision to pay $3,473.22 for the pre-approved procedure was neither arbitrary nor capricious. The Fund relied on the FAIR Health schedule of allowances to determine the allowed amount for procedure 29883 and paid 60% of that allowance, as specified under the Plan’s terms. The court deemed AA Medical’s counter-argument as offering “no more than conclusory assertions with no citation to authority. It argues that the determination was unreasonable because the amount paid was just 2% of the total amount billed… But just because AA Medical was paid less than what it expected or charged, does not render the decision arbitrary or capricious.” In fact, the Plan “makes clear” that it does not always pay benefits equal to or based on the provider’s actual charge, and only covers the “Allowed Charge” amount, which permitted the Fund to consult the Fair Health schedule. As for the denied procedure (29879), the court upheld the Fund’s determination that the microfracture chondroplasty was not medically necessary. The Fund’s consultant reviewed the relevant medical records and concluded that the procedure was not supported by the supplied records. AA Medical argued that there was an issue of fact as to the necessity of the procedure, but the court emphasized that the issue was whether the Fund had a reasonable basis for its decision, not whether the decision was correct. The court also discounted a declaration from the surgeon, finding that it was outside the reviewable record. As a result, the court ruled that the Fund’s determinations were supported by substantial evidence and were not arbitrary or capricious, and granted its motion for summary judgment.

Third Circuit

The Plastic Surgery Center, P.A. v. Aetna Life Ins. Co., No. 23-CV-21439-ESK-AMD, 2026 WL 821139 (D.N.J. Mar. 25, 2026) (Judge Edward S. Kiel). The Plastic Surgery Center has filed 47 related cases in which it seeks reimbursement from Aetna Life Insurance Company for surgical procedures it performed on patients insured by Aetna. The Center, an out-of-network provider, alleges that it entered into agreements with Aetna to perform surgical procedures on the patients in exchange for payment at an in-network rate. However, Aetna reimbursed the Center at significantly lower rates. The Center has asserted three state law claims against Aetna: (1) breach of contract, (2) promissory estoppel, and (3) negligent misrepresentation. To simplify the issues, the parties agreed to present four representative cases to the court at the motion to dismiss stage; the patients involved were K.R., C.S., M.T., and N.D. Aetna contended that K.R. and M.T.’s plans were governed by ERISA, and the court agreed. The court noted that the Center’s claims were based on telephone calls and authorization letters, and that the representations made in these communications “demonstrate that the plan was central to the letter and phone conversations, rather than independent or separate” from the plans. The court found the decision in Princeton Neurological Surgery v. Aetna persuasive (as discussed in our March 8, 2023 edition), where similar claims were preempted because they were based on plan terms rather than independent agreements. As a result, the court dismissed the cases involving K.R. and M.T. As for the other two representative cases, in the C.S. case, the court dismissed the breach of contract, promissory estoppel, and negligent misrepresentation claims for failure to state a claim. The court found that the call transcripts did not demonstrate a meeting of the minds or a clear and definite promise necessary to support these claims. In the N.D. case, the court allowed the breach of contract and promissory estoppel claims to proceed, finding that the call transcripts supported the existence of an agreement to pay at an in-network rate. However, the negligent misrepresentation claim was dismissed due to the economic loss doctrine, which precludes tort claims based on breaches of contractual promises.

Fifth Circuit

South Austin Emergency Ctr. v. Blue Cross Blue Shield of Tex., No. 1:23-CV-1488-RP, 2026 WL 838337 (W.D. Tex. Mar. 24, 2026) (Judge Robert Pitman). The plaintiffs in this mammoth medical benefit case consist of five Texas emergency centers and thousands of patients who were insured by defendants and treated by the centers at their facilities. The defendants are 42 regional entities, or “home plans,” operating under the umbrella of Blue Cross Blue Shield. These defendants participate in the “BlueCard Program,” which allows insured individuals to receive healthcare services outside their plan’s regional service area. The emergency centers are out-of-network providers who allege that defendants have routinely underpaid them for medical services rendered to the patient plaintiffs under claims funneled through Blue Cross Blue Shield of Texas pursuant to the Blue Card Program. The case involves “approximately 63,390 claims for emergency medical care the SCEC Plaintiffs provided to the Patient Plaintiffs, for which the SCEC Plaintiffs billed $272,913,789.00 but only received $40,806,773.20 in reimbursement.” Plaintiffs have asserted two claims for relief: (1) violation of ERISA for claims from insurance plans governed by ERISA; and (2) breach of contract for claims from insurance plans not subject to ERISA. Defendants filed nine motions in total to dismiss the case, which were all referred to an unlucky magistrate judge. The omnibus defendants sought to dismiss the patient plaintiffs for lack of subject matter jurisdiction and to dismiss claims for declaratory judgment and implied contract for failure to state a claim. Other motions to dismiss were filed by various defendants challenging personal jurisdiction and the validity of certain claims. The magistrate judge made numerous rulings, some of which defendants objected to; the court resolved those objections in this order. First, the court addressed the personal jurisdiction arguments made by many of the home plans regarding the breach of contract claim. (The home plans acknowledged that the court had jurisdiction over the ERISA claim.) The court agreed with defendants and ruled that no agency relationship existed between BCBS Texas and the home plan defendants. The court found that BCBS Texas “forwards the claim of an insured individual who received care out of state to that individual’s Home Plan, who then makes the coverage determination and reimburses BCBS Texas for any payment it then makes on behalf of the Home Plan entity[.]” As a result, BCBS Texas did not act as the home plans’ agent and thus the court lacked personal jurisdiction over them. For the same reason, the court disagreed with the magistrate judge’s finding of a common nucleus of operative facts for pendent personal jurisdiction. The court then turned to the omnibus motion, which sought to dismiss the patient plaintiffs for lack of standing. The court noted that “there is no question whether the assignments here were valid – Plaintiffs have alleged that they exist and do not dispute their validity, and Defendants do not dispute their existence or validity either nor raise the existence of any anti-assignment claims.” As a result, because the patients had assigned their claims, they no longer had standing; only the emergency centers did. As for the rest of the magistrate judge’s rulings, they were unchallenged and upheld, and thus the case will continue.

Ninth Circuit

Valley Children’s Hosp. v. Grimmway Enterprises, Inc., No. 1:24-CV-00643 JLT CDB, 2026 WL 832895 (E.D. Cal. Mar. 26, 2026) (Judge Jennifer L. Thurston). Valley Children’s Hospital filed this action against Grimmway Enterprises, Inc. and Grimmway’s ERISA-governed health benefit plan, claiming that they wrongfully denied and failed to pay benefits for the hospital’s treatment of “Patient O,” a minor child covered under the plan. Patient O was born with serious heart defects and received extensive treatment at the hospital, which billed Grimmway and the plan for $8,188,227.20. Of this, $4,843,851.72 was the contracted reimbursable amount, but Grimmway only reimbursed $3,046,084.21, leaving an outstanding balance of almost $1.8 million. The hospital asserted a claim under 29 U.S.C. § 1132(a)(1)(B), contending that it was a proper plaintiff pursuant to an assignment of rights from Patient O. Defendants moved to dismiss for failure to state a claim, contending that the hospital lacked standing to bring the claim because Patient O’s assignment of benefits was barred by an anti-assignment provision in the plan. The hospital opposed the motion, arguing that it sought to enforce rights rather than recover benefits, which should not be precluded by the anti-assignment provision. The court agreed with defendants: “Plaintiff lacks statutory standing because, as currently pled, Patient O’s assignment was invalid.” The court ruled that the hospital’s claim to recover benefits fell within the scope of the anti-assignment provision, which was valid and enforceable under ERISA. “The anti-assignment provision clearly invalidates Patient O’s transfer of ‘benefits.’ If Plaintiff seeks to recover ‘benefits,’ it is therefore stripped of derivative standing under 29 U.S.C. § 1132(a)(1)(B).” The court disagreed with the hospital’s argument that it sought to “enforce rights” rather than “recover benefits,” concluding that “[b]ecause the Hospital sues exclusively for compensatory damages resulting from Grimmway’s alleged failure ‘to pay benefits as required by the Plan,’” its claim was one for benefits under ERISA and thus “must be dismissed for lack of standing under 29 U.S.C. § 1132(a)(1)(B).” The motion was not a total defeat for the hospital, however. The court gave the hospital an opportunity to amend its complaint to assert a procedural claim related to enforcing rights under the plan’s appeals process, “to the extent they can, consistent with Rule 11, articulate one that is not barred by the anti-assignment provision.”

Retaliation Claims

Seventh Circuit

Richards v. Centric Manufacturing Solutions, Inc., No. 25-C-1474, 2026 WL 851277 (E.D. Wis. Mar. 27, 2026) (Judge William C. Griesbach). Stephen Richards filed this action against his former employer, Centric Manufacturing Solutions, Inc., alleging that Centric terminated his employment due to the high cost of his medical treatment for cancer and the associated insurance costs in violation of ERISA. Centric asserted as an affirmative defense in its answer that Richards’ claims were barred by a release agreement he signed as part of a severance package. Centric also filed a counterclaim seeking a declaration that Richards’ ERISA claims were barred by the agreement, or, alternatively, for judgment for the amount paid to Richards under the agreement. Centric then filed a motion for judgment on the pleadings based on this defense. Richards opposed, contending that Centric breached the agreement by failing to pay the promised amounts in a timely manner, specifically the payment for unused paid time off, which he argued was a material breach allowing him to rescind the agreement. The parties agreed that Wisconsin law governed the interpretation of the agreement. The court stated that whether a breach is material is a question of fact, and that rescission is allowed “when a breach is so substantial as to destroy the essential object of a contract.” Centric contended that “Richards is not entitled to rescind the Agreement in this case because the breach he alleges can be fully redressed by an award of damages,” but the court found this argument “unpersuasive.” At this stage of the proceedings, it was not clear to the court whether Centric’s breach was “incidental and subordinate to the main purpose of the contract” or whether the remedy proposed by Centric would “provide ‘clear, adequate, and complete relief.’” Therefore, the court denied Centric’s motion and set the case for a scheduling conference.

Venue

Tenth Circuit

Mark S. v. Carelon Behavioral Health, No. 2:25-CV-00352 JNP, 2026 WL 824111 (D. Utah Mar. 24, 2026) (Judge Jill N. Parrish). Plaintiffs Mark S. and L.S. filed this action in the United States District Court for the District of Utah to recover benefits under 29 U.S.C. § 1132(a)(1)(B) against Carelon Behavioral Health, Chevron Corporation, and the Chevron Corporation Mental Health and Substance Use Disorder Plan after defendants failed to approve benefits for medical treatment received by L.S. Plaintiffs reside in Texas, and Chevron, the plan administrator, is (recently) headquartered in Texas. L.S. received treatment at The Menninger Clinic in Texas and at Solacium New Haven RTC in Utah. Before the court here was defendants’ motion to transfer venue from the District of Utah to the Southern District of Texas pursuant to 28 U.S.C. § 1404(a). The court noted that it had “broad discretion” to grant a change of venue and considered several factors, including the plaintiff’s choice of forum, accessibility of witnesses, cost of proof, enforceability of judgment, and other practical considerations. The court noted that the plaintiff’s choice of forum is given less deference when the plaintiff does not reside in the district and when the facts giving rise to the lawsuit have no significant connection to the chosen forum. Here, the only connection to Utah was L.S.’s treatment; none of the parties resided in Utah and the plan was not administered or breached there. The court found that the Southern District of Texas was a more appropriate forum because the relevant witnesses and documents were located in Texas, where the plan was administered and the breach occurred. Additionally, the court compared docket congestion and found that the Southern District of Texas had shorter times from filing to disposition and trial compared to the District of Utah, which favored transfer. The court thus concluded that practical considerations and the interests of justice supported transferring the case to the Southern District of Texas, and it granted defendants’ motion accordingly.