There is no one case that stood out as Case of the Week. However, this week’s batch of decisions highlights several interesting trends. First, healthcare continues to dominate the ERISA litigation scene. Second, as a sign perhaps of tough economic times, we are seeing an increasing number of suits for severance benefits. Finally, collectively-bargained pension plans continue to change and tighten their rules about post-retirement employment and covered participants who counted on their ability to collect pensions while working continue to challenge this.  

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

Breach of Fiduciary Duty

Ninth Circuit

Diaz v. Westco Chems., Inc., No. 22-55823, __ F. App’x __, 2023 WL 3615663 (9th Cir. May. 24, 2023) (Before Circuit Judges Christen and Bress, and District Judge Antoon). In a very concise unpublished decision, the Ninth Circuit affirmed a district court’s summary judgment order in favor of Westco Chemicals, Inc., and the other plan fiduciaries in this breach of fiduciary duty class action involving a defined benefit pension plan. Relying on the Supreme Court’s decision in Thole v. U.S. Bank N.A., 140 S. Ct. 1615 (2020), the Ninth Circuit agreed with the district court that appellants could not satisfy the requirements of Article III standing either individually or on behalf of the plan because the “undisputed evidence in the record shows that the plan is not currently at risk of default,” and the participants were paid the benefits to which they were entitled. Accordingly, whatever misconduct the administrators of the defined benefit plan may have engaged in, the court of appeals concluded that the participants lacked standing to state their claims. Thus, the Ninth Circuit affirmed, concluding the district court correctly granted summary judgment to the fiduciaries.

Hagins v. Knight-Swift Transp. Holdings, No. CV-22-01835-PHX-ROS, 2023 WL 3627478 (D. Ariz. May. 24, 2023) (Judge Roslyn O. Silver). In this putative class action complaint participants of the defined contribution Knight-Swift Transportations Holdings, Inc. Retirement Plan sued Knight-Swift Transportations Holdings, Inc., the plan sponsor, and plan administrator, for breaching its fiduciary duties of prudence and monitoring. Plaintiffs allege that Knight-Swift mismanaged the plan by allowing the plan’s administrative and recordkeeping expenses to expand to imprudent levels through both direct and indirect fees, by failing to invest in available lower cost institutional share classes of otherwise identical funds, and by not properly overseeing and monitoring the performance of the plan’s administrative committee. Knight-Swift moved to dismiss the complaint. Plaintiffs opposed the motion to dismiss and moved to strike twelve exhibits that Knight-Swift filed with its motion to dismiss. The court began its decision by deciding whether to take judicial notice of the disputed documents. It mostly granted plaintiffs’ motion to strike, as plaintiffs challenged the authenticity and accuracy of the exhibits. However, the court did take judicial notice of a Form 5500 of the Knight-Swift Plan and a Form 5500 for another plan that plaintiffs used as a comparator in their complaint. With this matter addressed, the court proceeded with its analysis of the motion to dismiss. To begin, it found that plaintiffs adequately alleged their breach of duty of prudence claims based on both the fees and share classes. Defendants’ arguments, the court ruled, could not properly be addressed or resolved at the pleadings stage. Instead, the court determined that Swift-Knight’s interpretations could not be favored over plaintiffs’, and that plaintiffs’ allegations were enough to state a claim. Lastly, the court denied the motion to dismiss the derivative failure to monitor claim, again concluding that plaintiffs had alleged sufficient details to infer that defendant did not do enough to monitor the actions of the committee. For these reasons, Knight-Swift’s motion to dismiss was denied.

Disability Benefit Claims

Sixth Circuit

Bombassei v. The Lincoln Nat’l Life Ins. Co., No. 22-10593, 2023 WL 3605968 (E.D. Mich. May. 23, 2023) (Judge Denise Page Hood). On March 5, 2021, at the end of the “own occupation” period, plaintiff Cheryl Bombassei’s long-term disability coverage was terminated by defendant Lincoln National Life Insurance Company. Ms. Bombassei, a nurse and nurse practitioner who has been diagnosed with type 2 narcolepsy with extreme daytime sleepiness and rheumatoid arthritis, appealed Lincoln’s decision. After the denial was upheld by Lincoln, Ms. Bombassei commenced this lawsuit. The parties cross-moved for judgment under de novo review. In this order the court awarded judgment in favor of Ms. Bombassei and reinstated her disability benefits. The court was persuaded by the conclusions of Ms. Bombassei’s treating physicians, the Administrative Law Judge who awarded her Social Security Disability benefits, and the testimony of Ms. Bombassei and her family members, that she would be unable to perform any occupation in the economy given her severe impairments. In particular, the fact that Ms. Bombassei must nap for two hours in the middle of the workday in order to control her narcolepsy was proof to the court that “she is inhibited from performing the Main Duties for pretty much any occupation, as one fundamental condition for performing an occupation is being awake.” The court also found “it notable that the reports and opinions of physicians Defendant identifies lack any in-depth analysis regarding Plaintiff’s narcolepsy; in fact, most fail to even acknowledge or discuss Plaintiff’s narcolepsy.” For these reasons, the court was satisfied that Ms. Bombassei is totally disabled under the terms of her policy and that she was therefore entitled to judgment in her favor. Finally, the court reversed the benefits decision outright and ordered Lincoln to “honor Plaintiff’s award of benefits, including the award of past due benefits and interest on past due benefits, as well as pay Plaintiff for future benefits as long as she continues to meet the definition of Total Disability under the policy.” And in this case, the court implied Ms. Bombassei would likely continue to qualify for benefits under the plan’s definition of total disability, as there is no evidence that narcolepsy is curable or that it goes into remission.


Tenth Circuit

M.A. v. United Behavioral Health, No. 2:20-cv-00894-DAK-JCB, 2023 WL 3604420 (D. Utah May. 23, 2023) (Magistrate Judge Jared C. Bennett). In this lawsuit a family of participants and beneficiaries of the Motion Picture Industry Health Plan have sued their plan, United Behavioral Health, and OptumHealth Behavioral Solutions, Inc. under ERISA and the Mental Health Parity and Addiction Equity Act stemming from denials the family received of coverage for mental healthcare services. During discovery in this action defendants produced documents but designated many of them as confidential. Plaintiffs challenged the confidentiality designations of three documents: “(1) a Mental Health Parity Comparison conducted by Defendants; (2) the Milliman Care Guidelines for Subacute/Skilled Nursing Facility Care…; and (3) UBH Clinical Technology Assessments.” Defendants filed a motion for protective order with the court to maintain the confidentiality designations of these disputed documents. Plaintiffs opposed defendants’ motion. The court reviewed the documents during an in camera review and then heard oral argument on the motion. In this order, it issued its decision. As an initial matter, the court held that ERISA’s mandatory disclosure provisions do not automatically require documents to be publicly available. Rather, although the documents are discoverable, it held that that does not mean they cannot also be kept confidential. Instead, the court decided the appropriate course of action would be to apply the traditional balancing test to decide whether the documents at issue should maintain their confidential designations. Upon applying the balancing test, the court permitted defendants to retain the confidentiality designations on the disputed documents. It found that the documents contain confidential, sensitive, and proprietary commercial business information, and that unrestricted disclosure of the documents would result in economic harm to defendants. Regarding plaintiffs’ interest in disclosure, the court wrote only one line, “Plaintiffs, on the other hand, have not demonstrated that the confidentiality designations placed on the Disputed Documents – which have already been produced for use in this case – will any way prevent or unduly burden the prosecution of their claims.” As a result, the court found that defendants’ risk of harm outweighed plaintiffs’ interest in public disclosure and availability of the documents, and therefore granted defendants’ motion to keep the documents designated as confidential.

ERISA Preemption

Third Circuit

Thompson v. Command Alkon Inc., No. 22-344, 2023 WL 3594178 (E.D. Pa. May. 22, 2023) (Judge Gene E.K. Pratter). Plaintiff Linda Thompson sued her former employer Command Alkon, Inc. in state court seeking benefits under her severance plan. Both parties have now moved for summary judgment. Command Alkon argued that the plan is an ERISA-governed plan, and the state law causes of action are therefore preempted. In this decision the court granted Command Alkon’s motion for summary judgment as to the issue of preemption and ordered the parties to provide supplemental briefing on the application of ERISA to this action. To begin, the court agreed with defendant that the plan creates an administrative scheme because Ms. Thompson’s eligibility turns on whether she was terminated for or without cause, a decision which requires “her employer (to) exercise managerial discretion in categorizing the circumstances of Ms. Thompson’s termination.” Moreover, the plan contemplates installments of payments over a maximum of five years, rather than a lump sum. The court felt this too required ongoing administration, meaning the plan qualifies as an ERISA plan. Finally, the court concluded that the employment and severance contract can constitute an ERISA plan even though it only covers one employee, Ms. Thompson. Having established that the plan is indeed governed by ERISA, the court concluded that Ms. Thompson’s state law claims, for breach of contract and violation of Pennsylvania’s Wage Payment and Collection Law, are preempted by ERISA as they “are both premised on the argument that Command Alkon denied her severance benefits owed under her employment agreement,” and because they require review of the plan. For these reasons, the court granted defendant’s summary judgment motion on the issue of ERISA preemption. However, the court did not feel comfortable proceeding on the remainder of the summary judgment motions. Instead, it instructed the parties to submit a joint status update detailing their views on whether Ms. Thompson should be granted leave to amend her complaint to replead her claims under ERISA.

Medical Benefit Claims

Fourth Circuit

Hainey v. SAG-AFTRA Health Plan, No. 8:21-cv-02618-PX, 2023 WL 3645514 (D. Md. May. 24, 2023) (Judge Paula Xinis). Husband and wife Robert and Rosemary Hainey were participants of the SAG-AFTRA Health Plan from January 1, 2017, through December 31, 2020. The healthcare plan changed in 2021. At that time, the plan eliminated supplemental Medicare coverage to retirees and instead allowed enrollees the option to purchase individual insurance on a private exchange and a monthly subsidy through a health reimbursement account. Mr. Hainey sent letters of grievance to the plan when he learned of these and other plan changes. Mr. Hainey believed the changes were not legal. He argued that from 1974 to 1995 his employers contributed deferred income into his Taft-Hartley Fund and that he had a balance of more than $244,000 in a welfare benefit trust. Mr. Hainey maintained that the 2021 plan therefore divested him of his earlier contributions and vested benefits. As part of his communications with the plan at this time, Mr. Hainey requested plan documents and other information required under ERISA Section 502(c)(1)(B). These documents were not provided until after the lawsuit commenced, and one document, the 2020 SPD, was never provided to Mr. Hainey. Upset about the new changes to the plan, Mr. Hainey did not attempt to enroll in the 2021 plan. His wife, however, did, and paid premiums for her enrollment. Ultimately, the plan concluded that Ms. Hainey was not eligible to participate in the plan unless her husband was enrolled in the plan. However, the plan never reimbursed Ms. Hainey for her premiums. Finally, Mr. Hainey underwent certain medical procedures in late 2020. These procedures were never covered by the plan. The plan maintained that because Mr. Hainey was no longer a participant in 2021, it would not pay for these claims. In response to these events, the Haineys brought this lawsuit against SAG-AFTRA, the plan, and its board of trustees, alleging six wide-ranging causes of action; (1) breach of implied contract/unjust enrichment; (2) failure to take up appeal; (3) wrongful cancellation of spousal coverage; (4) breach of fiduciary duty for coverage cancellation and failure to reimburse premium payments; (5) failure to furnish requested documents; and (6) breach of fiduciary duty for mismanagement of plan funds. Defendants moved to dismiss. Their motion was almost entirely granted in this order, with only two small exceptions. The court allowed plaintiffs’ claims relating to defendants’ failure to provide documents and failure to reimburse premiums to proceed. The remainder of the complaint was dismissed, as the court agreed with defendants that the claims failed as a matter of law. On the whole, the court found that plaintiffs could not support their theory that their healthcare benefits vested. To the contrary, it stated that “Defendants were free to change the Plan terms and conditions from year to year. Simply because Plaintiffs were dissatisfied with the changes does not give rise to a cause of action.” Additionally, the claims that were dismissed were dismissed with prejudice, as the court found that amendment would be futile. Finally, the court held that remaining claims will not be tried before a jury.

Fifth Circuit

William J. v. BlueCross BlueShield of Tex., No. 3:22-CV-1919-G, 2023 WL 3635640 (N.D. Tex. May. 24, 2023) (Judge Allen Joe Fish). A father and his minor child sued the father’s employer, Texas Instruments Incorporated, their ERISA welfare plan, the Texas Instruments Incorporated Welfare Benefits Plan, and the plan’s insurance company and third party claims administrator, Blue Cross and Blue Shield of Texas, under ERISA Sections 502(a)(1)(B) and (a)(3) for benefits, failure to provide a full and fair review, and violation of the Mental Health Parity and Addiction Equity Act after the family was denied coverage for the child’s stay at an inpatient treatment center. Defendants moved pursuant to Federal Rule of Civil Procedure 12(b)(6) to dismiss plaintiffs’ complaint. Their motions were granted in part and denied in part in this decision. The court began with plaintiffs’ claims asserted under Section 502(a)(1)(B). As a preliminary matter, the court would not rely on terms in the Summary Plan Description as a basis to dismiss the claim for benefits. Rather, relying on Supreme Court precedent, the court quoted language explaining that SPDs are “communication with beneficiaries about the plan, but that their statements do not themselves constitute the terms of the plan for purposes of §[1132](a)(1)(B).” In addition, the court concluded that plaintiffs’ complaint sufficiently alleged facts to plausibly infer that they were entitled to the benefits that were denied by the plan. Accordingly, the court did not dismiss the claim for benefits. However, plaintiffs also asserted a claim under Section 502(a)(1)(B) for denial of a full and fair review, and the court did dismiss this portion of that claim. It concluded that regardless of defendants’ actions, a possible lack of a full and fair review process does not provide an independent basis to recover benefits. Additionally, the court agreed with defendants that plaintiffs failed to engage with this argument in their reply briefing and therefore had abandoned the issue. This left the court with the Section 502(a)(3) claim for violation of the Parity Act. The court once again agreed with defendants and concluded that the “catchall” provision in (a)(3) “is appropriate when there are no other available avenues for remedy.” Thus, the court concluded that plaintiffs’ Section 502(a)(3) claim was duplicative of their Section 502(a)(1)(B) claim, as the relief they sought for both claims was the same make-whole relief stemming from defendants’ refusal to cover the child’s treatment. Therefore, the court dismissed this claim as well, leaving plaintiffs only with their claim for benefits. Finally, the court denied plaintiffs’ request for leave to amend. The court stated that amendment of the full and fair review claim would prejudice defendants as plaintiffs “wholly omitted it from their pleading.” With regard to the Parity Act claim, the court stated that amendment would be futile because Section 502(a)(1)(B) affords the plaintiffs with adequate relief.

Sixth Circuit

Mark Z. v. Priority Health Managed Benefits, Inc., No. 22-10007, 2023 WL 3587536 (E.D. Mich. May. 22, 2023) (Judge Denise Page Hood). Plaintiff Mark Z. and his daughter M.Z. sued their self-funded employee welfare benefit plan, The Michigan Dental Association Health Plan, and its third-party administrator, Priority Health Managed Benefit, Inc., under ERISA and the Mental Health Parity and Addiction Equity Act after their claims for M.Z.’s stay at two residential treatment programs were denied by the plan. Defendant Priority Health moved to dismiss the claims against it. Its motion was granted in this decision. The court agreed with Priority Health that as a third party administrator its role was to process the claims and to “strictly follow the terms of the Plan.” As a result, the court concluded that Priority Health, despite issuing the denials at issue in this lawsuit, was not a fiduciary with discretionary control or authority. “As the Agreement does not afford (Priority Health) discretion, the Court finds (Michigan Dental Association) ‘did no more than rent the claims processing department of (Priority Health) to review claims and determine the amount payable in accordance with the terms and conditions of the Plan.’” The court also disagreed with plaintiffs that Priority Health asserted authority and control over Plan assets by issuing the final adverse benefit decision. Instead, the court found that there was no evidence that Priority Health handled the plan’s money, and therefore concluded that it did not have control over plan assets. For these reasons, the court dismissed the ERISA Section 502(a)(1)(B) claim against Priority Health. It then went on to dismiss the Parity Act claim as well. Here the court not only found that Priority Health did not have any role in drafting the terms and conditions of the plan, but the court also stated that it did not view the plan terms themselves to be in violation of Mental Health Parity. Additionally, because the court concluded that Priority Health is not a fiduciary, it held it could not be liable for breaches of fiduciary duties under Section 502(a)(3). Accordingly, Priority Health’s motion to dismiss was fully granted.

Pension Benefit Claims

Third Circuit

Schlear v. Carpenters Pension & Annuity Fund of Phil. & Vicinity, No. 22-1843, 2023 WL 3569971 (E.D. Pa. May. 18, 2023) (Judge Mitchell S. Goldberg). In 2021, plaintiff Robert Schlear spoke with a representative from the Carpenters Pension & Annuity Fund of Philadelphia and was informed that he could apply for a Waiver of Suspension of Benefits, which would allow him to collect early pension benefits while maintaining his employment in a non-union managerial role with his employer. However, once he applied, Mr. Schlear’s application for benefits was denied. The plan cited a provision which prohibits applicants from receiving early retirement benefits if they perform union work for a contributing employer. Mr. Schlear appealed the denial, at which time the fund added an additional reason for its denial, that granting Mr. Schlear’s benefits would violate a section of the Internal Revue Code which excludes the payment of retirement benefits to retirees who continue to work for their prior employers, which could potentially cause the plan to lose its tax-exempt status. The denial prompted Mr. Schlear to commence this action under ERISA Section 502(a)(1)(B). He maintains that the fund’s decision to deny his benefits was arbitrary and capricious “because he has not worked as a carpenter during his current employment and would not be performing any carpentry-related work going forward.” In addition, Mr. Schlear argued that other similarly situated plan participants were granted benefits under almost identical circumstances to his in the past. Finally, he contends that defendant actually denied his claim, at least in part, as retaliation against him because of prior disputes he has had with the union and with his employer. Defendant moved to dismiss the complaint, arguing that as a matter of law Mr. Schlear cannot show that the denial was an abuse of discretion. Its motion was denied in this order. The court disagreed that summary judgment decisions in similar cases decided after review of the administrative record and discovery meant that this case ought to be dismissed at the pleadings. To the contrary, the court stated that “Plaintiff’s Complaint creates a plausible inference that Defendant’s decision was not necessarily premised on the IRS considerations,” especially when factoring in the disparate treatment of similarly situated individuals by the plan in the past. Taking all of Mr. Schlear’s allegations as true, the court found that it could infer the denial was unreasonable and based on pretextual reasons. As a result the court was satisfied that Mr. Schlear stated his claim, and therefore declined to dismiss it “at this juncture.”

Pleading Issues & Procedure

Fourth Circuit

Harris v. Johns Hopkins Health Sys. Corp., No. ELH-23-701, 2023 WL 3624733 (D. Md. May. 23, 2023) (Judge Ellen L. Hollander). Plaintiff Tina Harris sued the Johns Hopkins Health System School of Medicine and the Johns Hopkins Health System Corporation in state court in Maryland alleging that her former employer took retaliatory actions against her which deprived her of her vested pension benefits. Johns Hopkins removed the case to federal court on the basis of federal question jurisdiction pursuant to ERISA. Now Johns Hopkins has moved to dismiss the lawsuit pursuant to Federal Rules of Civil Procedure 12(b)(5) and (b)(6). The court construed the Rule 12(b)(5) motion as a motion to quash service. Johns Hopkins challenged the sufficiency of Ms. Harris’ service of process and argued that Ms. Harris did not comply with local rules. The court agreed. However, it decided the proper recourse was not dismissal because Johns Hopkins was not “prejudiced by the insufficient service; the case is in its infancy; and JHHS learned of the suit because it received the summons.” Thus, the court allowed Ms. Harris the opportunity to cure this deficiency and serve an amended complaint in accordance with applicable rules to defendants. The court then addressed Johns Hopkins’ motion to dismiss pursuant to Rule 12(b)(6). Although the court agreed with Johns Hopkins that Ms. Harris’ state law claims could have been brought under ERISA Section 510 and were therefore completely preempted, the court once again declined to dismiss the complaint at the pleadings. Instead, the court allowed Ms. Harris the opportunity to replead and submit an amended complaint under ERISA. As a result, the court denied as moot defendants’ motion to dismiss for failure to state a claim.

Provider Claims

Third Circuit

AHS Hosp. Corp. v. Aetna Health, Inc., No. 22-6601, 2023 WL 3585265 (D.N.J. May. 22, 2023) (Judge John Michael Vazquez). Plaintiff AHS Hospital Corp. sued Aetna Health, Inc. in state court after it was denied reimbursement for care it provided to a plan beneficiary. Aetna removed the action based on the court’s diversity jurisdiction. After the case was removed to federal court, AHS added two causes of action under ERISA Section 502(a)(1)(B), pled in the alternative to its three original state law claims, unsure of whether the plan at issue is governed by ERISA. Aetna subsequently moved to dismiss pursuant to Federal Rule of Civil Procedure 12(b)(6). Aetna first argued that the three state law claims are expressly preempted by Section 514. The hospital responded that the record does not yet establish whether the plan is governed by ERISA. However, the court relied on language in plaintiff’s complaint that “upon information and belief” the plan is “a self-funded plan under ERISA,” to find that the hospital “adequately alleges that the plan is governed by ERISA.” Operating under this conclusion, then, the court found that the state law claims, which seek payment for healthcare services pursuant to the plan, relate to the plan and are therefore preempted. In the second half of the decision, the court agreed with Aetna that the hospital could not bring its ERISA claims for benefits because it failed to identify the relevant plan language establishing Aetna “is responsible for [the beneficiary’s] medical care.” Accordingly, the court dismissed the ERISA causes of action as well. Thus, Aetna’s motion to dismiss was granted, and the complaint was dismissed without prejudice.

Severance Benefit Claims

Seventh Circuit

Smith v. Lutheran Life Ministries, No. 21 C 2066, 2023 WL 3602679 (N.D. Ill. May. 23, 2023) (Judge John H. Lefkow). Plaintiff Lori Smith brought this action against her former employer, Lutheran Life Ministries, and its board of directors under state law and ERISA seeking payments of severance benefits under an employment contract. On February 28, 2023, the court issued an order, summarized in Your ERISA Watch’s March 8th newsletter, granting defendants’ motion to dismiss Ms. Smith’s complaint. In that decision the court concluded that an undefined term in the agreement, “transition period,” referred to a change in control at Lutheran Life. The court interpreted a change of control to mean a change in the board of directors, a change that did not occur. Instead, the change Ms. Smith interpreted as a transition period was a change in the CEO and President of Lutheran Life. Ms. Smith therefore believed that this change, coupled with the CEO’s decision to alter Ms. Smith’s managerial position with the company, constituted a constructive termination entitling her to benefits under the plan. In response to the court’s dismissal in February, Ms. Smith asked the court to reconsider its dismissal of her ERISA claims and her breach of contract claim and sought to file a third amended complaint including these previously dismissed claims. The court bifurcated Ms. Smith’s motion into a motion for reconsideration under Rule 54, and a motion for leave to amend. It tackled the motion for reconsideration first. First, the court found the motion seeking reinstatement of the breach of contract claim to be moot because Ms. Smith had abandoned the claim in her second amended complaint. Thus, the court wrote that it would address the breach of contract claim only in the motion for leave to amend. Regarding the ERISA claims, the court disagreed with Ms. Smith had it had made any clear error in its previous ruling, including with regard to its discussion and interpretation of the undefined term “transition period.” Accordingly, the court did not grant Ms. Smith’s motion for reconsideration. However, the court did grant in part Ms. Smith’s motion for leave to amend. The court allowed Ms. Smith to amend her state law promissory estoppel claim as it related to Lutheran Life’s promise of executive housing. Nevertheless, the court found Ms. Smith’s breach of contract and promissory estoppel claims preempted by ERISA insofar as they sought benefits under the plan. Next, regarding the ERISA claims for benefits and promissory estoppel, the court split the baby. Specifically, it allowed Ms. Smith to amend her complaint to include factual allegations regarding the meaning of the terms “transition period” and “change in control,” finding that the proposed changes affected whether she could plausibly state her claim for benefits. However, the court denied Ms. Smith’s motion to amend her promissory estoppel ERISA claim. It concluded that her amended complaint did not cure the previously identified deficiencies or satisfy the elements to state such a claim. For these reasons, Ms. Smith’s motion was granted in part and denied in part as discussed above. 

Eleventh Circuit

Martinez v. Miami Children’s Health Sys., No. 21-cv-22700-BLOOM/Otazo-Reyes, 2023 WL 3686777 (S.D. Fla. May. 25, 2023) (Judge Beth Bloom). Plaintiff Eddy Martinez was employed by Miami Children’s Health System from 2009 to 2019, at which point he held the position of Chief Information Officer and Senior Vice President. Mr. Martinez would lose this position and be terminated on July 2, 2019, one day after a new interim CEO was appointed to head the company. The newly appointed acting CEO claimed he fired Mr. Martinez “for cause.” Mr. Martinez did not agree, challenged his termination, and applied for severance benefits under his ERISA severance plan. His claim for benefits was denied. In fact, as the uncontroverted evidence of this lawsuit uncovered, Miami Children’s determined that Martinez was not entitled to severance pay before even beginning to formally adjudicate his claim. In fact, anticipating litigation, the company hired a law firm to handle Mr. Martinez’s claim and defend Miami Children’s decision to deny Mr. Martinez severance benefits. In this decision, the court resolved cross-motions for summary judgment, and concluded that “the adjudication process in this case was replete with ‘procedural unfairness.’” Specifically, the court agreed with Mr. Martinez that nothing about the review of his severance claim was neutral or unaffected by the conflict of interest. Rather, the court held that every indication in the record supported the conclusion that “the procedurally deficient claim review in this case led to a deficient investigation, an incomplete administrative record, and a one-sided analysis.” The court wrote that it was “revealing that every factual issue is resolved against Martinez,” and gave several examples of the adversarial and one-sided investigation the claim reviewers engaged in. Accordingly, the court found that Mr. Martinez was denied a full and fair review process and granted judgment in his favor. However, under Eleventh Circuit precedent, the court found the proper course of action was “not to ‘evaluate the merits’ of the Administrator’s decision,” but instead to remand to defendants to re-evaluate the claim and conduct a full and fair review. Thus, despite the egregious manner in which the claim was handled, Mr. Martinez was not awarded benefits by the court.