Bolton v. Inland Fresh Seafood Corp. of Am., Inc., No. 24-10084, __ F.4th __, 2025 WL 2924493 (11th Cir. Oct. 15, 2025) (Before Circuit Judges Jordan and Jill Pryor, and District Judge Federico A. Moreno)

If you want to sue an employee benefit plan because it has denied your claim, federal courts typically require you to first “exhaust your remedies,” i.e., complete all the appeal steps in your plan’s internal review procedure.

However, many benefit-seekers are surprised to learn that this bedrock rule is nowhere to be found in ERISA, the statutory scheme that governs employee benefits. Instead, it is purely an invention by the courts. The courts have provided various public policy reasons for adopting this rule, including (a) ERISA’s similarity to the Labor Management Relations Act, which requires exhaustion, (b) ERISA’s requirement that plans adopt internal review procedures, which plans and participants should be encouraged to use, (c) minimizing the costs of claim settlement, and (d) allowing the facts and issues to be fully fleshed out prior to litigation, among others.

However, plan participants have several remedies under ERISA. They are not simply limited to suing for benefits; they can sue for violations of the statute itself. Do those claims require exhaustion as well? It is this issue that the Eleventh Circuit addressed in our case of the week.

The plaintiffs are participants in the pension plan of Inland Fresh Seafood Corporation of America, Inc., which is an employee stock ownership plan. The plan was created in 2016 when the company used a $92 million loan to purchase all outstanding shares of the company’s stock from the company’s directors and officers.

The plaintiffs criticized this transaction, contending that various defendants breached their fiduciary duties under ERISA Sections 502(a)(2) and (a)(3). The plaintiffs contend that the defendants caused the plan to overpay for the stock by tens of millions of dollars, simultaneously enriching the defendants while devaluing the plaintiffs’ benefits. The plaintiffs sought equitable relief, including “restoration of the plan’s losses, disgorgement of the director and officers’ ill-gotten gains, and other forms of equitable relief.”

There was no dispute that the plan contained an internal appeals procedure. However, the plaintiffs did not exhaust their remedies under that procedure and instead went directly to federal court. In court, plaintiffs contended that (a) they had no obligation to exhaust the plan’s internal appeals, and (b) assuming such an obligation existed, they should be excused from that requirement.

The district court ruled that exhaustion was required and that the plaintiffs were not excused. The district court also refused to grant the plaintiffs a stay so they could pursue a claim under the plan’s procedure, and dismissed the case.

The plaintiffs appealed. The Eleventh Circuit began by acknowledging that while “[a]ll circuits require exhaustion in the ERISA context,” the Eleventh Circuit was special. “Where we diverge is in our application of the exhaustion requirement to statutory violation claims.” The court created this rule 40 years ago in Mason v. Continental Group, 763 F.2d 1219 (11th Cir. 1985). This requirement “is at odds with a large chorus of our sister circuits which – though they require exhaustion for benefits claims – do not require exhaustion for claims alleging violations of ERISA.”

The plaintiffs were well aware of this precedent, but contended that now was the time for the Eleventh Circuit to change its ways and join its fellow courts. However, the court stated, “We reject that call now, just as we have done before… Whatever we may feel about our exhaustion precedent does not relieve us of our responsibility to apply it. After all, a prior published panel decision ‘is controlling ‘unless and until it is overruled or undermined to the point of abrogation by the Supreme Court or by this court sitting en banc.’’”

Plaintiffs contended that the Eleventh Circuit’s rule had been undermined by intervening Supreme Court precedent. However, the court noted that this argument faced “a demanding standard.” To prevail, plaintiffs were required to present a Supreme Court decision that was “clearly on point and clearly contrary to the panel precedent.” In short, it “‘must demolish and eviscerate each of [the] fundamental props’ of the prior-panel precedent.” The Eleventh Circuit determined that none of plaintiffs’ cases were on point – their primary case involved the Prison Litigation Reform Act (“PLRA”), not ERISA – and did not “demolish” or “eviscerate” Mason.

Next, the court addressed plaintiffs’ argument that they were not required to plead exhaustion. Plaintiffs contended that exhaustion is an affirmative defense that defendants must prove, and thus the burden should not fall on plaintiffs to plead compliance. The Eleventh Circuit did not directly resolve the issue of pleading requirements. Instead, it ruled that through their pleading, amendments, and arguments to the district court it was clear that the plaintiffs had “effectively conceded that they did not exhaust before filing suit. It would thus serve no purpose to remand for the district court to entertain a possible amendment from the plaintiffs or for further factual development on exhaustion.” As a result, “We cannot say the district court abused its discretion in dismissing the amended complaint on account of the plaintiffs’ failure to plead exhaustion or a valid exception.”

The plaintiffs also argued on appeal that even if exhaustion was required, that requirement should be excused because (1) the committee to which the plaintiffs would be required to appeal “cannot address the plaintiffs’ claims or provide the relief they seek,” (2) the plan language did not require exhaustion, and (3) exhaustion would have been futile.

The Eleventh Circuit rejected all three arguments. On the first argument, plaintiffs contended that the committee was “limited to administrative tasks or to correcting mistakes of fact in calculating benefits due under the plan, rather than addressing breaches of fiduciary duty,” and that it was not empowered to “hold the defendants personally liable for causing millions of dollars in losses to the plan and compel them to make the plan whole.” The court, however, did “not read the plan or the claims procedures as narrowly as the plaintiffs do.” The court found that the committee had the power “to take up the plaintiffs’ claims” and that the plan “at least ‘offers the potential for an adequate legal remedy.’”

As for plaintiffs’ second argument, the Eleventh Circuit disagreed that “the plan’s language makes exhaustion optional.” The plaintiffs focused on the plan’s permissive language, which provided that participants “may” submit claims, “may” seek review, and “may” file a lawsuit. However, the court concluded that this language “merely reminds the plaintiffs of their ‘general rights under ERISA’ to eventually seek judicial review, but it does not affirmatively excuse them from exhausting the plan’s required claims procedures.” In any event, the court ruled that the plan’s arbitration clause “dispenses with any lingering ambiguity” because it requires participants to bring claims in arbitration, including “claims for breach of fiduciary duty,” and before doing so, “the plan’s claims procedures…must be exhausted.”

The Eleventh Circuit ruled against plaintiffs on their futility argument as well. Plaintiffs contended that it would have been pointless to engage in the plan’s internal review procedure because the outcome was foreordained. However, the court agreed with the district court that the plaintiffs had not presented sufficient evidence to prove that an appeal would have been pro forma. The court acknowledged plaintiffs’ allegations regarding defendants’ conflicts of interest and their adversarial approach to document production, but ultimately ruled that these facts should not “invalidate an administrative proceeding before it has even begun… In fact, the plaintiffs’ futility arguments are premature and speculative because they did not even attempt to exhaust before filing suit. This alone justifies disregarding those arguments.”

Next, the Eleventh Circuit ruled that the district court properly denied plaintiffs’ request for a stay to allow them to exhaust their claims with the plan. The court criticized plaintiffs on procedural grounds, noting that they had not filed a formal motion for such relief, and also questioned their substantive argument that without a stay, their claims might run afoul of the statute of limitations. The court noted that plaintiffs’ claims might not in fact be time-barred because ERISA’s “fraud or concealment” provision might apply to extend their time limit. Plaintiffs complained that they should not have to prove this, but the court ruled that this was the cost of refusing to engage in the plan’s appeal process.

At this point in the opinion the outlook for plaintiffs was obviously bleak. However, things turned quickly. First, the Eleventh Circuit agreed with plaintiffs that the case should be remanded for the district court to specify “the prejudicial scope of its order.” Although the district court had dismissed the action, it did not state whether its dismissal was with or without prejudice. The Eleventh Circuit thus ordered the case to be sent back for clarification.

Even more important was the concurrence by Judge Jordan, which was joined by Judge Pryor. (The panel decision was written by district judge Federico A. Moreno of the Southern District of Florida, sitting by designation.) Judge Jordan complimented Judge Moreno for his “well-written opinion” which he “join[ed]…in full.” However, Judge Jordan stated that he was writing separately “to propose that we convene en banc to consider overruling Mason[.]” Judge Jordan criticized Mason because it “imposed a judicially-created and atextual administrative exhaustion requirement for fiduciary-breach and statutory claims under ERISA,” and offered five “good reasons” for overruling it.

First, Judge Jordan noted that ERISA was a “comprehensive and reticulated” act which does not mention exhaustion at all. “We should not impose a requirement that Congress has omitted.”

Second, Mason created the exhaustion requirement for policy reasons. However, in the PLRA context, as plaintiffs argued, the Supreme Court “has told the lower federal courts that ‘crafting and imposing’ exhaustion rules that ‘are not required’ by the text of a federal statute ‘exceeds the proper limits on the judicial role.’” As a result, “Mason erred in relying on policy considerations to create an atextual exhaustion requirement for fiduciary-breach and statutory claims under ERISA.” If ERISA is to have an exhaustion requirement, “that is a result which must be obtained by the process of amending [ERISA], and not by judicial interpretation.”

Third, Judge Jordan noted that the Eleventh Circuit was out of step with seven other circuits on this issue. Only one other circuit – the Seventh – agreed with the Eleventh, but Judge Jordan noted that the statutory provision on which the Seventh Circuit relied “‘refers only to procedures regarding claims for benefits,’ and therefore does not support creating an exhaustion requirement for non-benefit claims.” Furthermore, the Seventh Circuit’s requirement is less onerous than the Eleventh’s; it is discretionary, not mandatory.

Fourth, Judge Jordan cited secondary authorities, which supported the majority position that exhaustion should not be required in statutory violation actions, and fifth, he observed that “the issue is an important one that is likely to recur.” Judge Jordan noted (and regular readers of Your ERISA Watch are well aware) that fiduciary breach actions are on the rise. Thus, he concluded, “I urge my colleagues to vote to rehear this case en banc and consider overruling Mason.”

As a result, while the outcome was a clear loss for the plaintiffs, they are surely hoping that this was merely a skirmish in the larger war that will play out in front of an en banc Eleventh Circuit. Will the full court reconsider and overrule their 40-year-old exhaustion requirement for statutory ERISA claims? Stay tuned!

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

Attorneys’ Fees

Ninth Circuit

Oksana B. v. Premera Blue Cross, No. C22-1517 MJP, 2025 WL 2931170 (W.D. Wash. Oct. 15, 2025) (Judge Marsha J. Pechman). Plaintiffs in this action are a family that sued Premera Blue Cross, The Tableau Software, Inc. Employee Benefit Plan, and Salesforce.com Health and Welfare Plan under ERISA after their claims for the son’s stay at two residential mental health care facilities, Second Nature and Catalyst, were denied. The district court granted summary judgment in the family’s favor, finding that Premera had abused its discretion and wrongly denied plan benefits for both facilities. The court then issued a decision finding that plaintiffs achieved a high degree of success and awarded the family $49,552.50 in attorneys’ fees and $400 in costs under Section 502(g)(1). Defendants appealed these decisions to the Ninth Circuit. The appeals court reversed the grant of summary judgment in part, holding that the plan did not cover the stay at Second Nature. However, the Ninth Circuit agreed with the district court’s analysis and conclusion that defendants violated ERISA in denying the Catalyst claim and that plaintiffs made a strong showing that they were entitled to coverage. Nevertheless, the Ninth Circuit found that remand to Premera was the appropriate remedy, not an outright award of benefits. Additionally, the court of appeals vacated the award of fees so the lower court could “conduct that analysis anew” in light of its decision. In response, plaintiffs filed a renewed motion for attorneys’ fees, asking for an award of $41,827.50 in fees, and $400 in costs, reducing their fee request by $7,725 to reflect the exclusion of time entries that counsel identified as being solely related to the Second Nature claim. Defendants argued that plaintiffs should not be awarded any attorneys’ fees or costs because they only obtained remand of their Catalyst-related claim to Premera, and otherwise lost their claim concerning the Second Nature stay. The court did not agree. It found that plaintiffs remained entitled to fees under ERISA even after the Ninth Circuit’s decision. “Although Plaintiffs lost their claim that Premera wrongly denied coverage for the Second Nature stay, Plaintiffs succeeded before both this Court and the Ninth Circuit in demonstrating that Premera abused its discretion in denying the Catalyst claim. And both courts have agreed that Plaintiffs made a strong showing that they are entitled to coverage. Thus, the remand is not merely a ‘purely procedural victory’ that falls short of satisfying § 1132(g)(1). Instead, Plaintiffs succeeded in obtaining a meaningful opportunity to obtain benefits. This supports an award.” Moreover, consistent with its previous order, the court found that the Ninth Circuit’s Hummell factors all supported an award of fees and that an award here was appropriate. However, the court agreed with defendants that a haircut over and above plaintiffs’ proposed $7,725 was proper to reflect the mixed success. Ultimately, the court settled on a 20% reduction to the total time billed. The result was an attorneys’ fee award of $39,642, which is 80% of $49,552.50 it originally ordered. Finally, the court again awarded $400 in costs for the filing fee.

Breach of Fiduciary Duty

Fifth Circuit

Lee v. R&R Home Care, Inc., No. 24-836, 2025 WL 2938696 (E.D. La. Oct. 16, 2025) (Judge Susie Morgan). Plaintiffs Douglas Lee, II and Ashlynn Estay bring this action as the beneficiaries of decedent Karen Lee. Before her death, Ms. Lee was an employee of Medical Brokers Management, Inc. and R&R Home Care, Inc. Through her employment, Ms. Lee was a participant in a life insurance benefit plan insured by United of Omaha Life Insurance Company; Mr. Lee and Ms. Estay were the intended beneficiaries. However, unbeknownst to Ms. Lee, on March 1, 2022, the group insurance policy was terminated by United of Omaha. The owner of Medical Brokers Management, Jay Weil, III, allegedly received notice of this termination, but failed to notify Ms. Lee that the policy had terminated or that she had the option to port her coverage to an individual policy, even though United of Omaha had provided Mr. Weil with a sample letter to send to employees to notify them of the termination and to explain options for portability. Moreover, despite the coverage termination, the employers continued to deduct life insurance premiums from Ms. Lee’s paycheck. And, because they failed to notify Ms. Lee when the life insurance policy was cancelled, she was deprived of the opportunity to make other arrangements to obtain life insurance coverage for her heirs. Plaintiffs also allege that defendants failed to provide Ms. Lee with an accurate summary plan description as required by ERISA. Finally, plaintiffs maintain that defendants failed to attempt to obtain new life insurance coverage for Ms. Lee after the United of Omaha policy was terminated. In their lawsuit filed last April, plaintiffs assert that Medical Brokers Management, R&R Home Care, and Mr. Weil committed fiduciary breaches under ERISA and violated Louisiana state law through their actions. Defendants moved to dismiss the complaint. In this decision the court granted in part and denied in part the motion to dismiss. To begin, the court allowed the ERISA fiduciary breach claims to proceed against all three defendants, except to the extent that they alleged defendants breached a duty by failing to obtain new life insurance coverage post-termination. The court stressed that because employers do not have a duty under ERISA to create a plan, and because fiduciary duties exist only while a plan is in effect, the defendants could not have been acting in a fiduciary capacity by failing to secure other life insurance coverage for the employees. Accordingly, the court concluded that plaintiffs failed to state a cognizable ERISA claim based on this conduct. Even so, the court otherwise found that plaintiffs plausibly alleged in all other respects that defendants were acting as fiduciaries, that they breached duties owed to Ms. Lee, and that Ms. Lee was harmed because of the alleged breaches. Moreover, the court concluded that plaintiffs seek the appropriate equitable remedies of surcharge and accounting based on the alleged breaches. The court also found that plaintiffs sufficiently alleged ERISA estoppel claims against all three defendants and denied the motion to dismiss as to these claims. Finally, the court considered plaintiffs’ claims under Louisiana law for breach of fiduciary duty, breach of contract, and detrimental reliance. It quite easily determined that these causes of action were completely preempted by ERISA and that they must be dismissed on that basis. Nevertheless, the court dismissed the claims without prejudice and granted plaintiffs leave to amend their complaint to replead these claims as causes of action under ERISA should they wish to. Thus, as explained above, the court granted in part and denied in part the motion to dismiss.

Class Actions

Ninth Circuit

Chea v. Lite Star ESOP Committee, No. 1:23-cv-00647-SAB, 2025 WL 2938836 (E.D. Cal. Oct. 16, 2025) (Magistrate Judge Stanley A. Boone). Plaintiff Linna Chea filed a motion for preliminary approval of class action settlement and class certification in this ERISA action challenging a 2017 stock transaction involving the Lite Star Employee Stock Ownership Plan. The court granted Ms. Chea’s motion in this order. To begin, the court found that for settlement purposes the class of plan participants and beneficiaries meets the requirements of Rule 23(a) and that certification is appropriate under either subsection Rule 23(b)(1)(a) and 23(b)(1)(B). With regard to Rule 23(a), the court determined that the 200-member settlement class is sufficiently numerous, that the class is united through common questions of law and fact surrounding the transaction, that the alleged harm and underlying conduct are not unique to Ms. Chea but are shared across the class, and that Ms. Chea and her counsel will adequately and fairly protect the interests of the class. As for Rule 23(b), the court found certification appropriate under both Rule 23(b)(1)(A) and 23(b)(1)(B) as resolving the fiduciary breach and prohibited transaction claims on an individual basis runs the risk of creating conflicting judgments, and because the decisions regarding the allegations regarding the transaction will apply to the plan as a whole and affect the rights and interests of all of the participants. Based on the foregoing, the court found that the class should be certified for settlement purposes. It then discussed the particulars of the settlement itself. The settlement agreement provides $2.25 million in aggregate economic value to the plan and its participants. This gross settlement amount represents approximately 45% of the estimated maximum damages. The court concluded that the total relief is within the range of reasonableness, especially when factoring in the considerable risk and time associated with continued litigation. Not only was the court confident for preliminary purposes that the settlement is fair, reasonable, and adequate, but it also concluded that it was the product of an informed arm’s length negotiation, and that it will treat the members of the class equitably. Moreover, the court approved the plan of allocation, and the plan and content of the proposed notice. As for attorneys’ fees, the court concluded that the intended amount of fees, $500,000 (or 22% of the settlement fund), did not present a barrier to preliminary approval of the settlement. For these reasons, the court granted the motion for preliminary approval of the proposed settlement, and scheduled a final approval hearing to be held on January 21, 2026.

ERISA Preemption

Third Circuit

The Plastic Surgery Center, P.A. v. United Healthcare Ins. Co., No. No. 24-10856 (MAS) (TJB), 2025 WL 2918662 (D.N.J. Oct. 14, 2025) (Judge Michael A. Shipp). In last week’s newsletter, Your ERISA Watch reported on two decisions ruling on motions to dismiss in lawsuits brought by The Plastic Surgery Center, P.A. against United Healthcare Insurance Company seeking the outstanding balances of medical bills for care it provided to patients insured under healthcare plans administered by United. This week, the court issued a third nearly identical decision in yet another such lawsuit. As in its related actions, The Plastic Surgery Center asserts three counts against United for breach of contract, promissory estoppel, and negligent misrepresentation, and as before, United moved to dismiss all three. United argued that the factual allegations supporting the purported contracts are refuted by the transcripts of the calls at issue and by the other correspondence between the parties, that the state law claims are expressly preempted by ERISA, and that the complaints fail to state claims upon which relief can be granted. The court disagreed with United that the factual allegations in the complaints are refuted by the pre-authorization communications, and that ERISA preempts the state law claims. Specifically regarding preemption, the court found that the claims asserted do not reference the ERISA-governed healthcare plan and are not impermissibly connected to it. Rather, it determined that these claims arise from independent agreements for coverage based on promises stemming outside of the plans, meaning they will not require interpretation of the plans in order to be resolved. Thus, the court agreed with the provider that the existence of a plan is not a critical factor in establishing liability for the claims here. Accordingly, the court held that plaintiff’s state law claims are predicated on an independent contractual or quasi-contractual duty and that Section 514 does not preempt them. After making these initial holdings, the decision turned to the sufficiency of the three state law claims. The court concluded that plaintiff adequately alleged each of the elements of its breach of contract and promissory estoppel claims under New Jersey law, but that it failed to state a viable claim for negligent misrepresentation. Instead, it found that the negligent misrepresentation claim was barred by the economic loss doctrine because the allegations surrounding this claim stem directly from United’s performance under the contracts. Accordingly, the court granted United’s motion to dismiss the negligent misrepresentation claim, but denied the motion as to the breach of contract and promissory estoppel claims.

Seventh Circuit

PHI Health, LLC v. Dale Martin Enterprises, No. 25 C 4181, 2025 WL 2930817 (N.D. Ill. Oct. 15, 2025) (Judge Sara L. Ellis). Plaintiff PHI Health, LLC filed this lawsuit in Illinois state court against defendants Dale Martin Enterprises, Inc. and Health Care Service Corporation seeking to recover compensation it asserts the defendants owe it for providing life-saving medical air ambulance services to insured patients. In its complaint, PHI Health asserts state law claims for breach of implied contract and unjust enrichment. In April, defendants removed the case to federal court on the basis of complete preemption under ERISA. In this decision the court ruled on PHI’s motion for remand and defendants’ motion to dismiss. The court applied the two-part analysis outlined by the Supreme Court in Davila to determine whether ERISA completely preempts the state law claims. Defendants argued that PHI is seeking to enforce rights that arise under ERISA. PHI disputed that the plan at issue is governed by ERISA and argued that it does not have standing to sue in any event. The court did not find it necessary to resolve these issues. Instead, it determined that the claims at issue implicate independent legal duties, making them outside of ERISA’s purview even assuming that the plan is governed by ERISA and that PHI could have brought its claims pursuant to Section 502(a)(1)(B). “PHI seeks to enforce its alleged contractual rights and recover benefits it claims DME has unjustly retained under Illinois state law, which are legal obligations that arise independent of ERISA.” As pleaded, the court agreed with the provider that its claims do not arise from the right to payment under the plan, and that its action neatly falls into the “rate of payment” category, rather than the “right to payment.” For these reasons, the court concluded that ERISA preemption under Section 502(a) does not apply. And, because the claims do not meet Davila’s test for complete preemption, the court found that PHI lacks standing under ERISA and the case cannot proceed in federal court. Accordingly, the court granted the motion to remand, and denied defendants’ motion to dismiss without prejudice to renewal in state court.

Medical Benefit Claims

First Circuit

Christine K. v. Blue Cross & Blue Shield of Rhode Island, No. 1:25-cv-00352-MSM-PAS, 2025 WL 2918382 (D.R.I. Oct. 14, 2025) (Judge Mary S. McElroy). Plaintiff Christine K. brings this ERISA action on behalf of herself and her minor child against Blue Cross & Blue Shield of Rhode Island and the Blue Cross & Blue Shield of Rhode Island Healthmate Coast-To-Coast Be Well Medical PPO Plan to obtain reimbursement for her child’s stay at Aspiro Wilderness Adventure Therapy for the treatment of mental health conditions. In her complaint Ms. K. asserts two related causes of action: (1) a claim for recovery of benefits and (2) a claim for equitable relief for violation of the Mental Health Parity and Addiction Equity Act. Defendants moved to dismiss the complaint for failure to state a claim pursuant to Federal Rule of Civil Procedure 12(b)(6). The court understood defendants’ motion as presenting two initial questions that needed to be resolved: whether the services provided by Aspiro were covered healthcare services under the plan, and if so, whether those services were nevertheless specifically excluded from coverage under the plan. To begin, the court was persuaded that Aspiro may be an “intermediate care service” within the meaning of the plan, and as a result, that Ms. K plausibly alleges it is a covered healthcare service. As to the thornier issue of whether Aspiro is excluded from coverage because it is a recreational therapy “wilderness program” as Blue Cross maintains, the court stated that it was “not prepared to make this determination based solely on the pleadings.” Rather, when faced with the parties’ “competing interpretations of the services provided by Aspiro and persuasive but non-binding findings from courts outside the First Circuit,” the court was satisfied that the facts viewed in the light most favorable to plaintiff do not support dismissal at this stage of the proceedings. Accordingly, the court denied defendants’ motion to dismiss in its entirety.

Pleading Issues & Procedure

Tenth Circuit

Salhoub v. Metropolitan Life Ins. Co., No. 25-2196-KHV, 2025 WL 2938995 (D. Kan. Oct. 16, 2025) (Judge Kathryn H. Vratil). Plaintiff Faleh Salhoub filed this lawsuit against Metropolitan Life Insurance Company (“MetLife”) under Sections 502(a)(1)(B) and 502(a)(3) of ERISA to challenge the insurer’s termination of his long-term disability benefits. Before the court was MetLife’s partial motion to dismiss the claim for equitable relief for breach of fiduciary duty under Section 502(a)(3). MetLife argued that the fiduciary breach claim is duplicative of the claim for benefits and that Mr. Salhoub cannot maintain both. While Mr. Salhoub conceded that if his remedy under Section 502(a)(1)(B) is adequate, he cannot obtain equitable relief for the same injury, he nevertheless argued that the complaint properly alleges alternative theories of liability. The court agreed. “Here, plaintiff pled alternative theories of liability: one for wrongful denial of benefits under the plan provisions and one for breach of fiduciary duty. Even if MetLife’s alleged breach of fiduciary duty led to its denial of benefits, plaintiff’s claim under Section (a)(3) is not duplicative because liability for breach of fiduciary duty ‘flows from the process, not the denial of benefits itself.’” Thus, at this stage the court was unwilling to ascertain whether Section 502(a)(1)(B) will provide Mr. Salhoub with an adequate recovery and instead allowed him to pursue recovery under both Sections 502(a)(1)(B) and (a)(3). As a result, the court denied MetLife’s motion to dismiss plaintiff’s claim for breach of fiduciary duty.

Remedies

Ninth Circuit

Oneto v. Watson, No. 22-cv-05206-AMO, 2025 WL 2899516 (N.D. Cal. Oct. 10, 2025) (Judge Araceli Martínez-Olguín). This action arises over a denial of health insurance coverage for a esophageal surgery plaintiff Roy Oneto needed to treat swallowing problems during a time when he was a participant in an employee welfare benefit plan administered by Cigna Health and Life Insurance Company. In his complaint Mr. Oneto alleges that he had to wait eight months before he ultimately underwent the surgery, after obtaining medical coverage through a different employer. The parties cross-moved for judgment on the two remaining causes of action against Cigna for breach of fiduciary duties and failure to discharge duties under the plan. Before ruling on the parties’ motions for judgment, the court first addressed their dispute over the proper Federal Rule of Procedure under which their motions should be resolved – Rule 52 or Rule 56. Mr. Oneto insisted that the court must consider the parties’ competing motions for judgment under Rule 56. However, the court did not agree. Instead, it determined that under Ninth Circuit precedent where, as here, the standard of review is for abuse of discretion, the court’s review is limited to the administrative record. Thus, the court concluded that the “the usual tests of summary judgment, such as whether a genuine dispute of material fact exists, do not apply.” The court then considered Cigna’s standing challenge to Mr. Oneto’s ability to recover on either of his causes of action. Cigna argued that Mr. Oneto is not entitled to any relief because his claimed injury is not redressable. The court concurred. “Here, Oneto’s claims for surcharge focus only on Cigna’s purported breach of duty. Oneto seeks to recover as compensatory surcharge the full value of the benefit initially denied by Cigna – $73,061.30 for the value of the surgery he did not receive as a result of Cigna’s purported malfeasance. However, the administrative record before the Court does not reveal that Oneto paid this amount. Indeed, Oneto did not pay for the eventual procedure, and he alleges that his subsequent employer covered the cost of the surgery. Therefore, even if Oneto established that Cigna breached a duty owed, the Court cannot grant the ‘make-whole’ relief requested because there exists no evidence of loss that resulted from a purported breach.” Mr. Oneto offered two alternative calculations of harm: (1) the amount he paid for the surgery under his subsequent insurer; or (2) his non-financial harm in the form of his physical suffering endured in the time between Cigna’s denial and his eventual procedure. But the court was forced to disregard both because there was no evidence of either in the administrative record. “Because Oneto cannot be awarded equitable surcharge on the record before the Court, his harms are not redressable by a favorable ruling. Consequently, he lacks standing and he cannot invoke the Court’s jurisdiction.” Thus, finding that Mr. Oneto lacks standing, the court dismissed his remaining ERISA claims and granted judgment in favor of Cigna.