Cockerill v. Corteva, Inc., No. CV 21-3966, 2025 WL 1523002 (E.D. Pa. May 27, 2025) (Judge Michael M. Baylson).

Although it was a slow week in general for ERISA cases in the federal courts, it was a big week for the plaintiffs in this action and their attorneys, which include Kantor & Kantor. For the past four years plaintiffs, two classes of DuPont workers and retirees, have been litigating over whether they were misled concerning certain early retirement benefits and improperly denied other benefits after the merger of E.I. DuPont de Nemours & Company and Dow Chemical Company. In 2019, these two companies split into three: DuPont de Nemours Inc., Dow Inc., and Corteva.

Plaintiffs were employees of the old DuPont and continued to work at the new company with the DuPont name. However, even though they were working in the same jobs at the same workplaces, plaintiffs lost the ability to obtain early and optional retirement benefits because the old DuPont, and its pension plan, had been moved into the new Corteva entity.

Plaintiffs in one class, who were under the age of 50 at the time of the spin-off, contended that they were still entitled to early retirement benefits once they reached the age of 50 either because of the plan language or because they were not told about this change and so did not know that they had lost valuable benefits. Plaintiffs in the other class, who were over the age of 50, contended that they were not only misled about the impact of the spin-off on their benefits, but were also improperly denied optional retirement benefits when they lost their jobs at the old DuPont because of the spin-off.

The court held a six-day bench trial and issued its findings of fact and conclusions of law on December 18, 2024. The court ruled in favor of plaintiffs on the majority of their claims, holding that: (1) defendants’ interpretation of the plan regarding optional retirement benefits for the over-50 class was arbitrary and capricious; (2) defendants “did not inform Class Members how the spin-off would affect their benefits in a manner that a reasonable employee could understand,” and thus breached their fiduciary duties under ERISA; and (3) defendants violated ERISA’s anti-cutback provisions because their arbitrary and capricious interpretation “had the effect of amending the Plan and cutting back Optional Retirement Class Members’ benefits.”

The court ruled in favor of defendants on two counts, concluding that: (1) the plan’s language regarding early retirement benefits was ambiguous and defendants’ interpretation that under-50 workers were not eligible was reasonable; and (2) plaintiffs had not met their burden of showing that defendants intentionally interfered with their benefits in violation of ERISA Section 510.

The result was a satisfying victory for plaintiffs in both classes. (For those seeking a more detailed recap, Your ERISA Watch reported on this decision in our January 1, 2025 edition.)

In a series of orders issued over the last week, the court has now wrapped up the proceedings. The court issued its judgment on May 30, 2025, directing defendants to “prepare and implement a plan to effectuate all the Court’s conclusions and provide the required benefits to members of the classes as previously certified.” Three days earlier, on May 27, the court issued its order regarding attorneys’ fees and costs.

The court’s fees order began with high praise for plaintiffs’ counsel. The court acknowledged that “[t]he prosecution of an ERISA case is no small undertaking[.]” Regardless, “Plaintiffs’ counsel were always well prepared for every event in this Court, had prepared and filed excellent legal memoranda, and represented their clients, the class representatives, and the members of the putative classes, with great skill and ability[.]”

Indeed, “It would not be an overstatement for this Court to say all of the lawyers, from several different law firms who represented Plaintiffs in this case, were well prepared, had the facts at their fingertips so the presentation at trail and at oral arguments could be made efficiently and without delay or obfuscation.”

Defendants’ lawyers received praise as well: “Defendants’ counsel did not miss any opportunities to represent their clients in the best way possible, in the fine traditions of great Philadelphia lawyers. The Court specifically complimented defense counsel on several occasions on their efforts on behalf of their clients.”

However, because of plaintiffs’ success, which “brought about very substantial benefits in favor of their clients in this important case,” and “will benefit future classes of employees in ERISA litigation,” the court determined that an award of fees was appropriate. Plaintiffs “deserve a substantial amount of attorneys’ fees for their undertaking this case at great risk, and having demonstrated their very strong preparation and their skill in presenting evidence at trial, and defending the verdicts in their favor on post-trial motions, Plaintiffs’ counsel deserve to be appropriately compensated.”

The court then examined the five factors set forth by the Third Circuit in Ursic v. Bethlehem Mines, 719 F.2d 670 (3d Cir. 1983), for evaluating fee requests in ERISA cases. The court determined that (1) defendants were culpable because there was “abundant evidence that Defendants made misrepresentations and even more seriously, cloaked their decisions in subtle but misleading terminology so it was difficult for the employees of the Defendants to know exactly what was happening to them and their pension rights”; (2) defendants had the ability to pay fees; (3) awarding fees would “further the objectives of ERISA and will likely deter behavior that falls short of bad faith conduct”; (4) numerous people would benefit from the court’s ruling; and (5) the relative merits of the parties’ positions favored plaintiffs.

As for the specific rates requested by plaintiffs, the court noted that they “are on the high side,” but it also acknowledged that “[t]here has recently been a large increase in the amount of fees charged by lawyers handling complex litigation,” and thus the rates “are not unreasonably high.” The court stressed that “Defendants’ counsel made no efforts to document what rates they were charging their clients,” which undercut defendants’ arguments that plaintiffs’ claimed rates were excessive.

Defendants contended that the court should use “community legal services” rates in determining the proper award, but the court rejected this, noting that those rates “have been set for attorneys, many of whom are young and starting out on their professional careers[.]” In contrast, plaintiffs’ counsel were “well qualified, and they carried out their agreement to represent the Plaintiffs in this case, with great skill, dedication, excellent professional responsibility and conduct[.]”

The court also emphasized that plaintiffs’ counsel had taken the case on contingency: “Plaintiffs’ counsel have worked on this case for almost five years, without getting paid a dime, for very extensive work. Plaintiffs’ counsel’s performance was exemplary. They were prepared when the Court had hearings and at the trial, their briefs were well done without any miscitations or misleading arguments. Plaintiffs were ‘on point’ all the time.”

Defendants further argued that fees should be reduced because they had presented “good faith defenses.” The court disagreed, noting that defendants “made no company-wide communications as to the reasons for the spinoff or the actual plan for the spinoff.” As a result, many employees did not realize that the spinoff had affected their benefits, and in fact, “the great majority of class members…were severely prejudiced by not realizing that their retirement rights had either been wiped out, or severely reduced.”

In short, the court characterized defendants’ arguments as “basically a combination of hindsight, sour grapes, nitpicking, and unrealistic afterthoughts in trying to save their clients some of the money which Plaintiffs’ counsel deserve.”

As for the hours expended by plaintiffs’ counsel, the court noted that that it had “carefully reviewed the Plaintiffs’ petition, and rejects the Defendants’ claims that there is any overstatement of hours spent[.]” Based on its first-hand observations of counsel’s handling of the case, the court “accepts the Plaintiffs’ representations as to what work was done, how long it took, and what are comparable rates in the marketplace.”

As a result, the court granted plaintiffs’ motion in full, and found their request for $6,099,469.50 in attorneys’ fees and $389,492.85 in costs to be reasonable. In an accompanying order, the court further ruled that a 1.5 multiplier was appropriate “because of the factors present in this case, including: contingency, risk, superlative performance on behalf of their clients, and excellent briefing on all legal issues.” In a subsequent order, the court clarified that, with the 1.5 multiplier, the total fee award was $9,149,204.25. The three class representatives were also awarded service payments for their efforts during the case.

The court noted in its decision that it was “well aware that Defendants have promised to appeal from the final judgment of this Court[.]” As a result, there likely will be more to come on this case, and of course Your ERISA Watch will keep you posted regarding any developments.

Plaintiffs were represented by Kantor & Kantor attorneys Elizabeth Hopkins and Susan L. Meter, in cooperation with attorneys at Edward Stone Law and Feinberg, Jackson, Worthman & Wasow LLP.

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

Breach of Fiduciary Duty

Ninth Circuit

Cramer v. Standard Life Ins. Co. of Am., No. 3:25-cv-00384-GPC-DEB, 2025 WL 1519417 (S.D. Cal. May 28, 2025) (Judge Gonzalo P. Curiel). Plaintiff Janice Cramer’s late husband, Andrew Cramer, was an employee of defendant Point Loma Nazarene University (“PLNU”). While employed by PLNU, Mr. Cramer elected to become insured under a group life insurance policy issued by Standard Insurance Company of America. Mr. Cramer took medical leave in August 2022, and his employment was subsequently terminated at an unspecified date due to his illness. In January 2023, Mr. Cramer died. The complaint alleges that PLNU and Mr. Cramer paid Standard all premiums necessary to maintain both Mr. Cramer’s basic and supplemental life insurance coverage under the plan. Mr. Cramer did not convert his group life insurance coverage to an individual policy. Ms. Cramer alleges that PLNU and Standard breached their fiduciary duties to Mr. Cramer. She contends that PLNU specifically failed to provide her husband notice of conversion rights or offer waiver of life insurance premiums, and because of this Mr. Cramer had no life insurance coverage when he passed away. Ms. Cramer seeks legal and equitable relief under Section 502(a)(3) for PLNU’s alleged fiduciary breach. Before the court here was PLNU’s motion to dismiss. It argued that Ms. Cramer cannot assert her claim against it because she did not exhaust the plan’s internal administrative remedies prior to filing her action. The University further argued that the fiduciary breach claim is a claim for benefits in disguise. The court did not agree. As for exhaustion, the court stressed that the requirement of administrative exhaustion does not apply to a breach of fiduciary duty claim. Moreover, the court determined that the complaint plausibly alleges that defendants breached their fiduciary duties by failing to provide timely notice to Mr. Cramer of his right to convert following termination of coverage and by failing to provide the Cramers with conversion or portability rights under the plan. Even though Ms. Cramer is seeking to be made whole in the form of a monetary sum equal to the benefits she would have received under the life insurance policy, the court stated that this fact does not convert her fiduciary breach claim into a claim for benefits. Rather, under Amara, Ms. Cramer is pursuing an appropriate form of equitable relief, namely surcharge. Additionally, the court disagreed with PLNU that Ms. Cramer cannot pursue a claim for individualized relief under Section 502(a)(3). Finally, the court held that Ms. Cramer could not bring a claim for benefits under Section 502(a)(1)(B) even if she wanted to, as it would not provide her with any adequate relief. “That avenue is wholly closed off to her because she is not part of any plan that she can recover benefits from or enforce rights under.” Accordingly, the court agreed with Ms. Cramer that she must rely on Section 502(a)(3) because she would otherwise “have no remedy at all.” Having determined that there is no depletive claim being made here, Ms. Cramer was not required to exhaust, and that she put forth viable theories of breach, the court found that Ms. Cramer pled enough to allege a breach of fiduciary duty claim that is facially plausible, and therefore denied PLNU’s motion to dismiss. (Kantor & Kantor represents Ms. Cramer in this action.)

Disability Benefit Claims

Eighth Circuit

Bray v. Symetra Life Ins. Co., No. 24-cv-119 (ECT/JFD), 2025 WL 1504311 (D. Minn. May 27, 2025) (Judge Eric C. Tostrud). In 2016, plaintiff Vincent Bray began work as a box stacker at a farm in Minnesota. This was physically demanding work which required Mr. Bray to lift loads weighing up to 75 pounds “over the head and below the waist.” Not long after he started working for the farm, on May 2, 2016, he suffered an on-the-job injury to his left shoulder. The injury required three surgeries and many other lesser medical interventions to treat it. Even after his third surgical procedure, Mr. Bray continued to experience shoulder pain. In fact, over the ensuing years, Mr. Bray developed complications in his other shoulder and his cervical spine, all likely stemming from the original injury. Unable to continue carrying heavy loads, Mr. Bray applied for long-term disability benefits under his employer’s policy with Symetra Life Insurance Company. Symetra determined that Mr. Bray was disabled and approved his claim. Under the policy, the term “disabled” is defined for the first sixty months as a sickness or injury that prevents the claimant from performing the material and substantial duties of his “regular occupation.” After those initial five years, the plan defines “disabled” under a more demanding “any gainful occupation” standard. Mr. Bray continued to receive benefits from March 17, 2018 until July 16, 2022. Symetra terminated Mr. Bray’s benefits during a period when he was incarcerated and unable to provide the insurance company with updated documentation and proof of regular medical care. Following his release from prison, Mr. Bray appealed Symetra’s decision to terminate his benefits. In response to Mr. Bray’s appeal, Symetra hired two medical reviewers. Symetra upheld its decision to terminate Mr. Bray’s benefits effective July 16, 2022. It explained that its reviewers had concluded that Mr. Bray’s medical records did not support restrictions or limitations which would preclude him from performing the material duties of any gainful occupation, and therefore he did not meet the policy definition of disability. After Mr. Bray exhausted the administrative appeals process, he filed this civil action against Symetra asserting a single claim for wrongful denial of benefits under Section 502(a)(1)(B). Mr. Bray and Symetra filed competing motions for judgment on the administrative record. Before the court discussed the termination decision itself, it needed to resolve a threshold dispute over the applicable standard of review. Although there was no question that the plan granted Symetra with discretion to determine benefits eligibility, Mr. Bray argued that a Minnesota statute barring discretionary review applies to his policy and that his claim should be reviewed de novo. The statute at issue applies to policies issued or renewed after January 1, 2016. The plan was issued on January 1, 2014, but was amended on January 1, 2016. Therefore, the question was whether the amendment was an issuance or renewal for the purposes of the Minnesota statute. Ultimately, the court held that it was not, as the amendment made only “discrete” changes to the plan. Thus, the court concluded that the Symetra policy was not issued or renewed in the relevant sense on or after January 1, 2016, and therefore it would apply an abuse of discretion review to Symetra’s decision to terminate Mr. Bray’s benefits. The remainder of the decision was a tale of two halves. The court noted that its result was “a mixed bag that reflects the claim’s unusual procedural history and the evidence in the administrative record.” On one hand, the court agreed with Mr. Bray that Symetra applied the wrong policy provision to justify its decision not to award him benefits between July 16, 2022, and March 16, 2023, by judging his claim against an “any occupation” standard when it should have evaluated it against the “own occupation” standard. Had Symetra applied the own occupation standard, it is clear that Mr. Bray would have continued to receive his benefits, as even Symetra’s reviewers agreed with Mr. Bray’s treating providers that he could not lift more than ten pounds and thus could not perform the heavy lifting his job demanded. Given this error, the court found that Symetra’s denial of benefits over this period was an abuse of discretion. It determined that Mr. Bray should be awarded benefits for this eight-month period. Judgment was therefore entered in favor of Mr. Bray, and against Symetra, for this first half of the equation. The court directed the parties to discuss the amount of benefits due, the amount of pre- and post-judgment interest, and claims for attorneys’ fees and costs. However, the decision did not end there. On the other hand, the court determined that Symetra’s termination of benefits during the “any gainful occupation” period was supported by substantial evidence and reasonable, both procedurally and substantively. “Procedurally, Mr. Bray had a full and fair opportunity to show that he was entitled to benefits after March 16, 2023, but he largely passed on that chance. Regardless, the record evidence establishes that Mr. Bray is not entitled to benefits after that date.” Not only did the court find Symetra’s decision reasonable, but it actually found it to be “the better decision considering the evidence in the administrative record, “ as the “predominant opinion appearing in the administrative record is that Mr. Bray can work with restrictions.” Even Mr. Bray’s own doctors intermittently opined that they believed he could perform sedentary work. As a result, the court found that the record established that Mr. Bray is not entitled to benefits during the “any occupation” period, and accordingly entered judgment in favor of Symetra regarding Mr. Bray’s claim for benefits during the “any gainful occupation” period beginning on March 17, 2023. 

Discovery

Eighth Circuit

Jones v. Zander Group Holdings, Inc., No. 8:24CV428, 2025 WL 1506162 (D. Neb. May 27, 2025) (Magistrate Judge Michael D. Nelson). Plaintiff William H. “Chip” Jones, II initiated a class action lawsuit in the Middle District of Tennessee against his former employer, the Zander Insurance Agency, the agency’s two trust owners, and its trustees, alleging they violated ERISA through their “malfeasance” regarding the rights of participants under two ERISA-governed deferred compensation plans, a 401(k) plan and an Employee Stock Ownership Plan (“ESOP”). In broad strokes, Mr. Jones alleges that in 2021 defendants engaged in conduct which they (a) pushed him and other former employees out of their stock investments through an ESOP stock repurchase, (b) provided statutorily inadequate and improper notice about the ESOP transaction, (c) sent a notice letter that contained information that was misleading, (d) failed to provide requested plan documents, and (e) rolled over funds in the 401(k) plan without written election. Mr. Jones contends that these actions violated the plain language of the ESOP and ERISA. Mr. Jones asserts claims against defendants for violation of Section 204(h), breach of fiduciary duty, statutory penalties for failure to furnish documents upon written request, interference, breach of contract, and unjust enrichment. He seeks to represent a class of all ESOP participants whose accounts were rolled over on or around December 31, 2021. Defendants have filed a motion to dismiss Mr. Jones’ action. That motion remains pending. In the meantime, the parties have engaged in written discovery. As part of that discovery defendants issued document and deposition subpoenas to Mr. Jones’ former attorneys, Peter Langdon and Joan Cannon, and their law firm McGrath North Mullin & Kratz, PC LLO. Mr. Jones moved to quash these subpoenas. Because McGrath North is located in Omaha, the motions to quash the subpoenas directed to the firm and its lawyers were filed in the District of Nebraska. In this decision the Nebraska court granted Mr. Jones’ motions to quash. As an initial matter, the court was skeptical of the relevance of the information and documents sought from McGrath North. Defendants argued that what Mr. Jones believed his rollover options were and why he believed what he believed are relevant to the allegations in the complaint. But the court was not convinced, and stated that it did not have any bearing on whether defendants’ conduct violated the terms of the ESOP, ERISA, or any other law. Defendants further argued that the legal advice McGrath North provided to Mr. Jones is relevant to their argument that Mr. Jones lacks Article III standing. In particular, they allege that Mr. Jones caused his own injury by failing to take actions to prevent his ESOP assets from being rolled over to the 401(k) plan by default to avoid losses flowing from that rollover. The court was again unconvinced by defendants’ argument. The court agreed with Mr. Jones that the harms his complaint alleges are traceable not to his own conduct but to the conduct of the defendants. Furthermore, the court stated that the information, documents, and testimony defendants seek from the firm remain protected by the attorney-client and work-product privileges because Mr. Jones did not place his outside legal advice “at issue” in the underlying lawsuit, or lose privilege to the entirety of his communications by sharing a handful of emails with the Department of Labor in 2022. Thus, the court held that “Defendants have not demonstrated the documents sought from McGrath North are relevant or that any documents sought are nonprivileged.” For similar reasons, the court granted Mr. Jones’ motion to quash the deposition subpoena directed to McGrath North and his former attorneys. “As discussed above, the limited work and legal advice provided to Plaintiff by the McGrath North attorneys has little to no relevance to the underlying litigation. Moreover, to the extent the firm has any marginally relevant information, such information is privileged and is not ‘crucial’ to the underlying case.” For these reasons, the court granted Mr. Jones’ motions to quash defendants’ subpoenas.

Pleading Issues and Procedure

Third Circuit

Mundrati v. Unum Life Ins. Co. of Am., No. 2:23-1860, 2025 WL 1519220 (W.D. Pa. May 28, 2025) (Magistrate Judge Patricia L. Dodge). Plaintiff Pooja Mundrati sued Unum Life Insurance Company of America to challenge its denial of her claim for long-term disability benefits. In a decision issued on March 24, 2025, the court concluded that Unum’s decision was arbitrary and capricious and therefore entered summary judgment in favor of Dr. Mundrati. (Your ERISA Watch covered that decision in our April 2, 2025 edition). As the prevailing party, Dr. Mundrati moved for an award of attorneys’ fees and costs under Section 502(g)(1). Unum was directed to file a response, but rather than responding to the merits of Dr. Mundrati’s motion Unum moved to stay all proceedings pending the resolution of its appeal to the Third Circuit. Finding nothing unusual or complex in Dr. Mundrati’s very standard fee motion under ERISA, the court declined to stay the fee petition until resolution of the appeal. It held that the weight of authority is clear that a pending appeal, standing alone, is not a sufficient reason to postpone resolution of a fee decision. “Moreover, as Plaintiff asserts, she submitted her claim for disability benefits in 2021 and has been waiting over four years to obtain a judgment that she is entitled to benefits. She notes that this Court determined that Defendant’s denial of benefits was arbitrary and capricious. She adds that she has not been employed since 2021 and has been without income since then.” Thus, the court denied Unum’s motion to stay. However, although Dr. Mundrati argued that Unum waived its right to contest her motion for attorneys’ fees, the court granted Unum the opportunity to file a response to her motion, as it found that permitting it the opportunity to respond to the merits was the fairest course of action.

Provider Claims

Third Circuit

The Plastic Surgery Center, P.A. v. United Healthcare Ins. Co., No. 24-8584 (MAS) (TJB), 2025 WL 1531143 (D.N.J. May 29, 2025) (Judge Michael A. Shipp). Plaintiff The Plastic Surgery Center, P.A. is a plastic and reconstructive surgery provider based in New Jersey. Plaintiff is out-of-network with defendant United Healthcare Insurance Company. A patient insured under a plan issued and administered by United required specialized surgical procedures. On October 5, 2020, the surgical center and United entered into a single case agreement wherein United agreed to pay the provider the in-network rate for the preapproved surgeries, and in exchange, the provider forfeited its right to balance bill the patient. The next day, The Plastic Surgery Center performed the procedures on the patient. It then billed United a total of $1,648,962.00. United paid the Center only $48,788.63. In this lawsuit the Center seeks the outstanding balance. Plaintiff filed its action in state court and asserted three causes of action: (1) breach of contract; (2) promissory estoppel; and (3) negligent misrepresentation. United removed the action, and then filed a motion to dismiss the complaint. It offered three reasons for dismissal. First, United argued that the factual allegations supporting the purported contracts are refuted by call transcripts. Second, it argued that ERISA Section 514 preempts plaintiff’s claims. Finally, it argued that the complaint fails to state its claims. The court in this order held that the claims are not preempted by ERISA and that the complaint sufficiently states claims for breach of contract and promissory estoppel, but not for negligent misrepresentation. It therefore granted the motion to dismiss as to the third cause of action, but otherwise denied the motion. As an initial matter, the court declined to consider the call transcripts as they are outside of the pleadings, not relied on in the complaint, and their authenticity is in dispute. The court then addressed the issue of ERISA preemption. It concluded that plaintiff’s claims do not make reference to the ERISA plan as they are not based on the plan but rather on an independent contractual or quasi-contractual duty stemming from the single case agreement between the parties. The court further found that the claims do not have an impermissible connection with the ERISA plan as they do not directly affect the relationship between traditional ERISA entities, they do not interfere with plan administration, and they do not “undercut ERISA’s stated purpose.” Having concluded that the three state law causes of action are not preempted under Section 514, the court proceeded to consider the sufficiency of the pleadings. It found that the complaint adequately alleges facts for the elements of its breach of contract and promissory estoppel claims. However, the court agreed with United that the complaint failed to state a claim for negligent misrepresentation upon which relief could be granted as the complaint does not allege or argue an independent duty imposed by law separate from the single case agreement. “Because Plaintiff’s allegations speak directly to Defendant’s performance under the Agreement, Count Three is therefore barred by the economic loss doctrine.” For this reason, the court dismissed count three. Otherwise, the court denied the motion to dismiss, permitting the surgery center to pursue its two remaining causes of action against United.

The Regents of the Univ. of Cal. v. Horizon Blue Cross Blue Shield of N.J., No. 2:24-cv-7482 (BRM) (CLW), 2025 WL 1502920 (D.N.J. May 27, 2025) (Judge Brian R. Martinotti). The Regents of the University of California, on behalf of the University of California Irvine Medical Center, sued Horizon Blue Cross Blue Shield of New Jersey in New Jersey state court for breach of implied-in-fact contract, or alternatively, quantum meruit. This action involves underpayment of benefits between July and December of 2018 for three patients who were beneficiaries of ERISA-governed health plans sponsored and administered by Horizon and stems from the terms of two written contracts the hospital has with the Anthem Blue Shield family of providers, which it alleges includes Horizon Blue Shield. Horizon Blue Shield removed the action to federal court and moved to dismiss the complaint as preempted by ERISA Section 514. In this somewhat murky decision, the court agreed with Horizon that the state law claims are preempted and that without the ERISA-governed plans, there would be no cause of action. “Although the Complaint does contain allegations concerning at least some of UCI Medical Center’s obligations under its Contracts with BSC and Anthem, respectively, the Court finds the Complaint fails to allege sufficient details showing Horizon’s own obligations under the same, including with respect to both: (1) the Programs, their relevant terms, and how and to what effect they bind Horizon with respect to this action; and (2) the Contracts, their operative terms, and how UCI Medical Center interpreted and applied them in each patient’s case such that Horizon was reasonably expected to pay for the treatment. Without these details, the Court is left to speculate about the effect of the alleged relationship between membership in one or both Programs and performance under one or both Contracts, and, importantly, how the interplay between the Programs and the Contracts gave rise to the alleged payment obligations for Horizon that is independent of its pre-existing administrative responsibilities under the ERISA-governed plans. As a result, the Complaint could be read as an attempt by UCI Medical Center to obscure that the benefits and costs in dispute relate to ERISA-governed plans.” The court was not persuaded by plaintiff’s argument that this case constitutes a “rate of payment” dispute, rather than action seeking the “right to payment” under the terms of ERISA plans. The court stated it was unwilling to speculate about the parties’ prior course of conduct or industry customs absent sufficient factual allegations about these topics or other relevant details concerning the two contracts at issue, the relationships between the parties, or the Anthem network programs. Rather, the court agreed with Horizon Blue Shield that the payments it made were pursuant to the terms of its patients’ ERISA-governed plans, and that the hospital’s claims cannot be separated from the terms of those plans. Accordingly, the court granted Horizon’s motion to dismiss, and dismissed the complaint without prejudice and with leave to amend consistent with this opinion.

Standard of Review

Ninth Circuit

Daniel C. v. Chevron Corp., No. 24-cv-03851-SK, 2025 WL 1537648 (N.D. Cal. May 20, 2025) (Magistrate Judge Sallie Kim). After working for the Chevron Corporation for four years, plaintiff Daniel C. applied for disability benefits under the company’s short-term disability policy due to major depressive disorder. A couple of months after he began receiving short-term disability benefits, Daniel was injured in a car accident and was in a coma for ten days. On June 14, 2018, Daniel applied for long-term disability benefits. He indicated on his application that his disability was post-concussion syndrome and traumatic brain injury. The plan’s claims administrator, ReedGroup, approved his claim for long-term disability benefits. However, on June 30, 2020, ReedGroup informed Daniel that it was terminating his benefits. In this lawsuit plaintiff challenges that decision under ERISA. The parties filed cross-motions for summary judgment. However, the parties agree that the case cannot be decided by summary judgment under de novo standard of review, and they dispute the appropriate standard of review. In this decision the court addressed that dispute, and because it ultimately determined that de novo review applies, denied both motions for summary judgment and left resolution of the merits for another day pursuant to Rule 52. There was no question that the plan vests Chevron with discretionary authority and permits delegation of that authority. At issue was whether Chevron properly delegated its discretionary authority to ReedGroup. It did not do so in the plan document. Instead, the plan document grants discretionary authority to the “claims administrator.” Chevron argued that because the Summary Plan Description (“SPD”) identifies ReedGroup as the claims administrator, the SPD functions as the designation instrument and triggers abuse of discretion review. The court did not agree. It noted that, “the Plan requires that any delegation of fiduciary responsibilities occur ‘pursuant to a written instrument that specifies the fiduciary responsibilities so delegated to each such person.’ Naming ReedGroup in the SPD does not satisfy this requirement. As the Ninth Circuit held in Shane [v. Albertson’s, Inc.], a delegation ‘not in compliance with the…Plan’s stated requirements’ triggers de novo review.” The court added that the SPD cannot function as the delegation instrument because it does not specify the fiduciary responsibilities delegated to ReedGroup, and because it is not a written instrument of the plan. Accordingly, the court concluded that the SPD is insufficient to demonstrate that Chevron made a valid and unambiguous delegation of authority to ReedGroup. Therefore, the court concluded that defendant failed to present sufficient evidence to demonstrate that abuse of discretion review was appropriate, and consequently the court held that it will review ReedGroup’s denial of benefits de novo.

Statute of Limitations

Sixth Circuit

White v. Allstate Ins. Co., No. 1:24-cv-1506, 2025 WL 1532464 (N.D. Ohio May 29, 2025) (Judge J. Philip Calabrese). Pro se plaintiff Kenneth White discovered in November 2022 that his variable life insurance policy with Lincoln Benefit Life Company was surrendered and converted to a new policy on October 16, 2009. That policy lapsed on January 16, 2010. The new policy also had changes from the old one, including removing Mr. White’s children as his beneficiaries and changing his address. Mr. White alleges that all of this took place behind his back, that his signature was forged, and that employees of Allstate Insurance Company (later Lincoln Benefit Life) were not authorized to effectuate these changes or issue the new policy. The present action is the fourth such case Mr. White has filed against Allstate, Lincoln, and the individual insurance agents in connection with these events. His complaint asserts claims for breach of contract, breach of fiduciary duty under ERISA, identity theft, and fraud. Defendants moved to dismiss. They argued that each cause of action is barred under the relevant statute of limitations. The court agreed and granted the motion to dismiss the complaint. Under Ohio law, a cause of action accrues when the wrongful act was committed. Accordingly, the alleged breach of contract accrued when the first policy was allegedly fraudulently converted to the second policy on October 16, 2009. However, Mr. White did not file any lawsuit pursuing his claims until April 2022, well after Ohio’s eight-year limitation period had expired. Mr. White’s other claims fared no better. The identity theft claim had a five-year statute of limitations, while the fraud claim had a statute of limitations of four years. The court found both claims time-barred. Claims for breach of fiduciary duty under ERISA, meanwhile, must be brought “within three years of the date the plaintiff first obtained ‘actual knowledge’ of the breach or violation forming the basis of the claim, but in no event later than six years after the breach or violation.” More than six years have passed between October 2009 and the time when Mr. White first sued the parties in 2022. Thus, the court found the ERISA claim untimely too. Finally, the court determined that Mr. White possessed constructive knowledge and that he failed to pursue his rights with reasonable diligence. Accordingly, it held that he does not qualify for equitable tolling, including under the fraudulent concealment doctrine. The court therefore agreed with defendants that the action was untimely, and so granted the motion to dismiss, closing the case.

Statutory Penalties

First Circuit

Guitard v. A.R. Couture Construction Corp., No. 24-cv-296-LM, 2025 WL 1488508 (D.N.H. May 22, 2025) (Judge Landya B. McCafferty). Plaintiff David Guitard was an employee of A.R. Couture Construction Corporation for approximately thirty-seven years. Through his employment with the company, Mr. Guitard was a participant in its ERISA-governed retirement plan. At issue here was the fact that Mr. Guitard did not always receive annual statements regarding the plan. In particular, he did not receive these statements for plan years 2016-2020, or 2022-2023. Mr. Guitard also lacked his individual account statements for these same years. Mr. Guitard needed this information in order to understand his retirement benefits. As a result, through his counsel, Mr. Guitard wrote to A.R. Couture to obtain the missing statements. For ten months Mr. Guitard was given the runaround, told by his former employer that it would provide the requested statements imminently. It never did. So, Mr. Guitard sued the company under ERISA § 1132(c)(1) seeking an order from the court directing A.R. Couture to provide the requested statements, as well as statutory damages in the amount of $45,000, and reasonable attorneys’ fees and costs. On November 13, 2024, A.R. Couture executed a waiver of service stating that it understood it must file an answer within 60 days from the date the request was sent and that failure to do so would result in a default judgment entered against it. Mirroring the corporation’s failure to respond to Mr. Guitard, A.R. Couture failed to respond to the complaint. The 60-day deadline came and went. The clerk of the court subsequently entered a default against A.R. Couture. Still there was silence. Accordingly, Mr. Guitard moved for default judgment. Satisfied that it has jurisdiction over both the subject matter and the parties, that the allegations in the complaint state a specific and cognizable claim for relief, and that the defaulted party had fair notice of its opportunity to object, the court granted Mr. Guitard’s motion. The court stated, “[t]he facts alleged in Guitard’s complaint are sufficient to establish that A.R. Couture is liable under 29 U.S.C. § 1132(c)(1). Guitard has alleged that he made a written request for the missing annual statements, via counsel, to A.R. Couture by way of the October 27, 2023 letter. He has further alleged that A.R. Couture failed to furnish copies of the requested statements within 30 days. Guitard also plausibly alleges that the Plan is covered by ERISA, and that A.R. Couture is the Plan administrator. These allegations are sufficient to state a claim.” The court additionally determined that Mr. Guitard’s requested relief against A.R. Couture was appropriate. Mr. Guitard calculated damages of $45,000 by multiplying the number of days that elapsed between the passage of the 30-day deadline and the filing of the motion for default judgment – 450 – by the maximum daily statutory damages amount established in 29 U.S.C. § 1132(c)(1) – $100. The court determined that damages of $100 per day was appropriate given the ongoing failure to produce the documents, the fact that Mr. Guitard has a pressing need for the missing statements, A.R. Couture’s failure to explain or defend its delay, and the fact that the company “has engaged in a pattern of actions that could support a reasonable inference of dilatory intent.” The court further agreed with Mr. Guitard that an order requiring A.R. Couture to provide the missing annual plan statements and participant account statements he requested in writing is also reasonable and appropriate. Finally, the court determined that Mr. Guitard is entitled to reasonable attorneys’ fees under Section 502(g)(1). The court noted that despite promises from defendant that the statements would be forthcoming, they never provided them, and concluded that this behavior shows a degree of culpability or bad faith attributable to A.R. Couture. Further, awarding fees would deter other plan administrators from acting in a similar manner, which would benefit members of this plan and others. Although the court determined that a reasonable award of attorneys’ fees is merited under the circumstances, it nevertheless could not award a specific amount without the information necessary to calculate a lodestar. Thus, the court directed Mr. Guitard to file an affidavit that contains the necessary information for the court to make this determination. For these reasons, the court granted Mr. Guitard’s motion for default judgment and ordered A.R. Couture to pay $45,000 to Mr. Guitard and provide him with the missing plan statements and individual participant account statements for the relevant plan years.