There were no tricks or treats from the federal courts this Halloween week. Instead, most simply shut their blinds, turned off their lights, and pretended not to be home when the children approached their doors hoping for some candy. Full-sized bars were certainly nowhere to be found, but a few courts offered some disappointing bags of raisins. Perhaps the closest thing to a trick was the Fifth Circuit’s panel rehearing of Angelina Emergency Medicine Associates PA v. Blue Cross, which resulted in a ruling that was virtually indistinguishable from the one the court issued in August. Fingers crossed your Halloween haul is more bountiful!

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

Attorneys’ Fees

Sixth Circuit

House-Forshee v. Benefits Comm. of W. & S. Fin. Grp. Co. Flex. Benefits Plan, No. 1:24-cv-110, 2025 WL 2980448 (S.D. Ohio Oct. 23, 2025) (Magistrate Judge Stephanie K. Bowman). Plaintiff Roberta House-Forshee commenced this action against the Benefits Committee of Western & Southern Financial Group Co. Flexible Benefits Plan and Western & Southern Financial Group, Inc. to challenge their denial of her claim for short-term disability benefits under an ERISA-governed policy. After Ms. House-Forshee brought her lawsuit, defendants reversed the denial of her short-term disability benefit claim and subsequently moved to dismiss the case for lack of jurisdiction based on the doctrine of mootness. The court granted the motion to dismiss, but without prejudice to Ms. House-Forshee’s ability to move for a post-judgment award of attorneys’ fees. In response, Ms. House-Forshee filed a fee motion, which defendants opposed. In this decision Magistrate Judge Stephanie K. Bowman recommended the denial of House-Forshee’s motion. As an initial matter, Judge Bowman accepted Ms. House-Forshee’s legal premise that ERISA Section 502(g)(1) can support a discretionary award of fees on the basis of a “catalyst” theory, i.e., that defendants’ voluntary reversal was the result of initiating litigation. However, the court stressed that attorney fee awards under ERISA are discretionary. Furthermore, Judge Bowman was persuaded that in the present matter defendants offered “persuasive evidence that undermines Plaintiff’s position that the settlement email rather than new medical documentation submitted with Plaintiff’s separate LTD claim was the basis for reopening the appeal and awarding STD benefits.” Judge Bowman viewed Ms. House-Forshee’s contrary position as “weak” and “circumstantial.” Thus, “the limited circumstantial proof that Plaintiff has presented in support of a fee award is insufficient, when viewing the record as a whole, to prove that this STD case was a catalyst for the award of STD benefits. And even if a reviewing court were to conclude that Plaintiff’s evidence is sufficient to satisfy Hardt, the undersigned’s evaluation of the King factors also disfavors the award of any fee.” Consequently, Judge Bowman ruled that no attorneys’ fees should be awarded to Ms. House-Forshee.

Ninth Circuit

Nagy v. CEP America, LLC, No. 23-cv-05648-RS, 2025 WL 2960448 (N.D. Cal. Oct. 17, 2025) (Judge Richard Seeborg). Plaintiffs in this class action are employees of the MedAmerica company who sued the fiduciaries of MedAmerica’s 401(k) retirement plan for breach of fiduciary duty under ERISA. Last December the parties reached a settlement, and this May the court granted preliminary approval of the proposed settlement. Following the October 16 fairness hearing, the court issued this decision granting plaintiffs’ motion for an award of attorneys’ fees, reimbursement of expenses, and service awards for the two named plaintiffs. (In a separate motion, plaintiffs moved for final approval of the settlement agreement). In their fee motion plaintiffs requested an award of 25% of the settlement fund, reimbursement for $13,775.84 in litigation expenses, and $10,000 in service awards for each of the two class representatives. To begin, the court found the $2,179,000 in attorneys’ fees reasonable under the Ninth Circuit’s Vizcaino factors, as the overall result and benefit to the class is significant, particularly when considering the risks associated with continued litigation, and because class counsel took the case on a purely contingent basis. Additionally, the court noted that a 25% fee award is consistent with the Ninth Circuit’s characterization of 20-30% as the “usual range” for attorneys’ fee award percentages in common fund cases. And a lodestar cross-check further supported the fee request. The lodestar multiplier in this case was 2.6, which the court stated is less than lodestar multipliers that have been awarded in other ERISA class actions. Moreover, the court agreed with class counsel that they are entitled to reimbursement of $13,775.84 in out-of-pocket costs that were associated with representing the class. These expenses included travel costs, the expense of arbitrators and mediators, legal research fees, and court fees. Finally, the court was comfortable awarding incentive awards of $10,000 to each of the two class representatives in order to compensate them for their years spent collaborating with their attorneys in this lawsuit. For these reasons, the court granted plaintiffs’ motion and the requested awards.

Class Actions

Seventh Circuit

Shaw v. Quad/Graphics Inc., No. 20-cv-1645-pp, 2025 WL 2972286 (E.D. Wis. Oct. 21, 2025) (Judge Pamela Pepper). Five years ago, plaintiff Sharita Shaw filed a class action complaint against the fiduciaries of the Quad/Graphics Diversified Plan, complaining that they had breached their duties to the plan’s participants and beneficiaries in violation of ERISA. In the summer of 2025, the parties finalized a settlement, after eight months of negotiations in private mediation. Ms. Shaw now asks the court to preliminarily approve of the $850,000 settlement. The court granted that request in this order, preliminarily certified the settlement class, and set a fairness hearing for February 18, 2026. To begin, the court agreed with Ms. Shaw that the settlement class meets the requirements of Rule 23(a) and (b)(1). The court determined that the 25,000 member class easily satisfies numerosity, that common questions exist about whether defendants breached their duties to the plan and whether the plan suffered losses as a result, that Ms. Shaw is typical of the other class members who “want to hold the fiduciaries accountable for their alleged breaches,” and that representation by Ms. Shaw and the law firm of Walcheske & Luzi, LLC has been adequate to date. In addition, the court was satisfied that the non-opt out class can be appropriately certified under Rule 23(b)(1) because recovery for the fiduciary breach claims will inure to the plan as a whole and because the fiduciaries need consistent rulings regarding the operation of the plan. As for the settlement itself, the court determined that it appears to be fair, reasonable, and adequate for all the class members, and the result of informed arm’s length negotiations. Further, the court found the $850,000 recovery, which represents 18.9% of the plaintiffs’ estimated losses, decent and in line with other ERISA class action settlements that have received approval from courts across the country. Finally, the court noted that the “risks, costs and potential delay in this case are significant.” Thus, the court granted preliminary approval to the settlement pending the fairness hearing early next year.

Disability Benefit Claims

Ninth Circuit

Lukman v. Metropolitan Life Ins. Co., No. 24-cv-02427-YGR, 2025 WL 2950185 (N.D. Cal. Oct. 9, 2025) (Judge Yvonne Gonzalez Rogers). This litigation stems from plaintiff Vera Lukman’s denied application for long-term disability benefits under a plan insured by defendant Metropolitan Life Insurance Company (“MetLife”). Ms. Lukman submitted a claim for benefits after receiving the maximum duration of short-term disability benefits. She had left work from her position as a software engineer at Google in November 2020 due to a combination of psychiatric and physical symptoms, including concentration issues, cognitive decline, and various somatic impairments, primarily gastrointestinal-related. MetLife offered four reasons for denying Ms. Lukman’s claim: (1) the medical evidence did not demonstrate that she suffered from psychiatric or physical functional limitations, based upon normal physical examinations and labs; (2) Ms. Lukman’s self-reported symptoms were not supported by clinical evidence; (3) her symptoms showed significant improvement over time; and (4) the statements of her physicians and her non-work life activities demonstrated that she could work full-time. In ruling on the parties’ cross-motions for judgment under Federal Rule of Civil Procedure 52, the court considered each of these reasons. Before it did so, however, the court weighed whether to consider Ms. Lukman’s extra-record evidence that she presented to MetLife after it had concluded the appeals process. Ms. Lukman argued that the court should consider this evidence due to MetLife’s failure to comply with ERISA’s regulations governing the notice and disclosure requirements. While it appeared the court found validity in this argument, it nevertheless decided not to consider the extra-record evidence. The court explained that it did not need to rule on this issue because the record evidence provided sufficient information on its own to support a finding in favor of Ms. Lukman under the applicable de novo standard of review. First, the court noted that each of the doctors who examined and treated Ms. Lukman determined that she was unable to perform the duties of her job as a software engineer based on testing, lab work, assessments, their own examinations, and formal diagnoses. It found these factors supported a finding that Ms. Lukman was partially disabled under the plan’s definition of disability. Next, the court rejected MetLife’s argument that Ms. Lukman’s self-reported symptoms failed to demonstrate disability. Not only did none of the treating physicians question the legitimacy of Ms. Lukman’s complaints, but Ms. Lukman “sought treatment for her symptoms as early as 2017 and continued to seek a firm diagnosis and treatment throughout her disability application and appeal, including three-times weekly intensive therapy treatments, sleep tests, and a variety of other examinations. Plaintiff’s treating physicians noted at various times that her physical and psychological symptoms were likely to impact her ability to focus. Moreover, [her doctors] documented [her] inability to concentrate, including that her concentration deteriorated during the relevant time period.” The court added that Ms. Lukman’s inability to concentrate was observed by the treating doctors directly. As a result, the court found that the subjective self-reported symptoms supported a finding of disability. In addition, the court disagreed with MetLife that the record showed improvement in Ms. Lukman’s symptoms or that there was evidence that Ms. Lukman could work full-time. MetLife had argued that Ms. Lukman could work full-time because she attempted to return to work part-time, but the court did not agree. It said instead that Ms. Lukman’s actions were “consistent with an employee who is attempting yet struggling to return to full-time work due to her significant physical symptoms and difficulty concentrating.” Moreover, the court did not find Ms. Lukman’s expressed desire to pursue a PhD at some point as evidence that she was capable of doing so. And the fact that Ms. Lukman’s house was being remodeled was entirely irrelevant in the court’s view, as there was no suggestion that Ms. Lukman was engaging in that work herself. Thus, based on the court’s review of the administrative record, it found that Ms. Lukman established by a preponderance of the evidence that she was partially disabled under the plan’s definition of disability, meaning she was unable to earn 80% or more of her pre-disability earnings. As one final note, the court addressed MetLife’s argument that Ms. Lukman could not meet the plan’s definition of partial disability because she was not working during the claim’s elimination period. The court viewed this argument as “specious” and illogical, and stated that it did not compel a different result. Accordingly, the court entered judgment in favor of Ms. Lukman and ordered the parties to meet and confer to resolve the amount of disability benefits due to her.

ERISA Preemption

Third Circuit

The Plastic Surgery Center, P.A. v. Cigna Health & Life Ins. Co., No. 24-10227 (GC) (JTQ), 2025 WL 2977796 (D.N.J. Oct. 22, 2025) (Judge Georgette Castner). The Plastic Surgery Center, P.A. is a New Jersey-based healthcare provider that specializes in performing plastic and reconstructive surgery. The Plastic Surgery Center filed this lawsuit in state court against Cigna Health and Life Insurance Company alleging claims of breach of contract, promissory estoppel, and negligent misrepresentation after Cigna covered only a fraction of billed costs for a medically necessary surgical procedure it performed on an insured patient. Plaintiff maintains that Cigna’s rate of reimbursement was contrary to the terms of the single case agreement the parties entered into before the surgery, wherein Cigna agreed to compensate the surgery center at in-network rates. After removing the lawsuit to federal court based on diversity jurisdiction, Cigna filed a motion to dismiss the complaint pursuant to Federal Rule of Civil Procedure12(b)(6). Cigna advanced two arguments: (1) ERISA Section 514 preempts the state law causes of action; and (2) assuming ERISA is not found to preempt plaintiff’s claims, plaintiff failed to plausibly plead each of its three causes of actions. The court addressed each argument and explained why it disagreed with them both. Concerning ERISA preemption, the court determined that the claims neither make reference to the patient’s plan nor have an impermissible connection to it. Specifically, the court determined that the single case rate agreement is a separate obligation for which Cigna incurred an independent contractual duty, which expressly disclaims any relationship to the ERISA-governed plan. Further, the court stated that the “alleged agreement at the heart of Plaintiff’s claims mentions the Plan only for its in-network payment rates,” and “[i]dentifying these in-network rates requires only ‘cursory examination’ of the in-network provider fee schedule.” The court also concluded that the alleged agreement does not affect the relationship among traditional ERISA entities, and that the claims won’t interfere with plan administration, or undercut ERISA’s stated purpose of protecting plan participants and beneficiaries. For these reasons, the court disagreed with Cigna that the state law causes of action are expressly preempted. The court then addressed the sufficiency of the state law claims as pled, and concluded that at this stage of the proceedings, the complaint’s allegations sustain all three claims. Accordingly, the court denied Cigna’s motion to dismiss in its entirety.

Exhaustion of Administrative Remedies

Second Circuit

Lucas v. Hartford Life & Accident Ins. Co., No. 24-CV-7561 (VEC), 2025 WL 2961561 (S.D.N.Y. Oct. 20, 2025) (Judge Valerie E. Caproni). Plaintiff Suzanne Lucas brings this ERISA case to challenge defendant Hartford Life and Accident Insurance Company’s decision to terminate her long-term disability benefits. Before the court were motions filed by Hartford for a stay of the case and remand for further consideration of the claim, or alternatively, for leave to file a motion for summary judgment on the issue of administrative exhaustion. Ms. Lucas opposed Hartford’s motions. She argued that Hartford failed to decide her appeal within 45 days and that it had therefore forfeited any opportunity for further administrative review. In this decision the court decided not to remand to Hartford at this juncture, but to allow it to file a motion for summary judgment on the ground that Ms. Lucas failed to exhaust her administrative remedies. The court declined to remand Ms. Lucas’s claim to Hartford because it stated that remand is a remedy to be imposed after a review of an ERISA benefits determination. Because the court has yet to conduct any review in this case, it concluded that it would be premature to remand to Hartford at this point in the litigation. However, the court disagreed with Ms. Lucas’s assertion that Hartford’s failure to comply with ERISA’s 45-day decision window forecloses its ability to order remand at any point. On the contrary, the court said her argument about Hartford’s non-response to her appeal is better suited in response to the question of whether her duty to exhaust has ceased, and stated that she was conflating administrative exhaustion with remand. While the court pointedly expressed no view as to whether Ms. Lucas has satisfied her duty to exhaust, it nevertheless determined that Hartford should be permitted to raise that threshold issue. Therefore, the court found it appropriate to grant Hartford leave to move for summary judgment on this basis. Accordingly, to the extent Hartford’s motion requested this relief, it was granted.

Life Insurance & AD&D Benefit Claims

Fourth Circuit

Estate of Green v. The Hartford Life & Accident Ins. Co., No. 24-cv-1910-ABA, 2025 WL 2986815 (D. Md. Oct. 23, 2025) (Judge Adam B. Abelson). On June 1, 2019, Sidney Green died in a motorcycle accident. The week before his death, Mr. Green had been let go from his work at Piedmont Airlines, Inc. Due to this termination, The Hartford Life and Accident Insurance Company denied Mr. Green’s family’s claim for accidental death benefits. Mr. Green’s Estate brought this case to challenge that denial. Both parties moved for judgment in their favor. In this decision the court concluded that Hartford’s denial was not an abuse of discretion, and thus granted judgment in its favor. In particular, the court emphasized that the plan terms make clear that coverage ends on “the date Your Employer terminates Your employment.” Thus, the court found that the denial was appropriate, as there was no genuine dispute that as of the date of his death Mr. Green was no longer an active employee of Piedmont and thus no longer a participant in the accidental death plan. The court therefore agreed with Hartford that the record evidence supported its conclusion that Piedmont had terminated Mr. Green’s employment prior to his death and that his family was not eligible for the benefits. Aside from this holding, however, the court also agreed with Hartford that Mr. Green’s family failed to timely exhaust the internal appeals procedures as required by the plan. The court concluded that there was no genuine dispute that the family’s appeal letter “was untimely under both the unambiguous language of the Plan and the calculation of the 180-day deadline in the denial letter.” Accordingly, the court held that the Estate failed to timely exhaust the internal appeals procedures and that Hartford was also entitled to summary judgment on this basis. For these reasons, the court granted Hartford’s motion for summary judgment and denied the Estate’s cross-motion.

Fifth Circuit

Metropolitan Life Ins. Co. v. Wallace, No. 3:24-CV-1520-X, 2025 WL 2986137 (N.D. Tex. Oct. 22, 2025) (Judge Brantley Starr). Facing competing claims to benefits under employer-sponsored life insurance coverage and accidental death coverage belonging to decedent Ambrose Bless, Metropolitan Life Insurance Company (“MetLife”) filed this interpleader action. In an earlier decision the court granted MetLife’s motion for interpleader relief. Here, the court ruled on defendant Jennifer Leigh Wallace’s motion for summary judgment. Under the terms of the plans MetLife had the discretion to decide who should receive the benefits in the event there was no designated beneficiary. Moreover, the policies stated that the payments should be made to the decedent’s spouse or domestic partner before the decedent’s parents. Mr. Bless and Ms. Wallace were common-law spouses, together for decades. The two owned a house and shared a bank account. Referring to this information, MetLife concluded that Ms. Wallace was a higher-priority beneficiary than Mr. Bless’s parents. When the parents challenged this decision, MetLife requested that the court step in. In this decision the court concluded, “MetLife’s denial of the Bless Parents’s claims – based on its determination that Jennifer Leigh Wallace qualified as Mr. Bless’s Domestic Partner under the Plans – is uncontroverted, supported by the evidence, and therefore the Benefits under the Plans should be awarded to Wallace.” Consequently, the court granted Ms. Wallace’s motion for judgment.

Pleading Issues & Procedure

Fourth Circuit

Rose v. Guardian Life Ins. Co. of Am., No. 8:25-cv-03866-DCC, 2025 WL 2972236 (D.S.C. Oct. 21, 2025) (Judge Donald C. Coggins, Jr.). Plaintiff David Rose filed this action against Guardian Life Insurance Company of America bringing claims for breach of contract, bad faith, improper claim practices, and violations of ERISA in connection with numerous payment issues concerning his long-term disability benefits. Guardian moved to dismiss Mr. Rose’s action, and also moved to strike his jury trial request. The court granted in part and denied in part the motion to dismiss, and granted the motion to strike. As an initial matter, the court dismissed the state law claims, as Mr. Rose consented to their dismissal. The court then turned to the question of whether Mr. Rose’s ERISA claims are barred by the relevant statute of limitations. Mr. Rose asserted various ERISA claims, including claims for statutory penalties, fiduciary breach, and benefits. ERISA provides the statute of limitations for the fiduciary breach claims, while the policy sets forth a three-year limitations period for the plan-based claims. At this juncture, the court could not say whether any of the ERISA claims are barred by any applicable statute of limitations, and because it is unclear from the record currently before the court whether the statutes of limitations are applicable to this action, the court declined to dismiss any of the claims as untimely at this early stage in the proceedings. However, the court granted the motion to dismiss the claim for statutory penalties, as it is undisputed that the plan administrator of the long-term disability policy is Barnes Group, Inc., not Guardian, and the penalties provided for in ERISA § 502 apply only to plan administrators. Finally, the court granted the motion to strike the jury demand “because ERISA provides essentially equitable relief for which jury trials typically do not lie.”

Sixth Circuit

Chaudron v. Edward Jones & Co., No. 2:25-CV-73, 2025 WL 2979695 (E.D. Tenn. Oct. 22, 2025) (Magistrate Judge Cynthia R. Wyrick). In this action plaintiff Kaylin G. Chaudron challenges defendants Edward Jones & Co. L.P. and Metropolitan Life Insurance Company’s denial of claims for life insurance and short-term disability benefits. Before the court was Ms. Chaudron’s motion to amend her complaint to add a claim for breach of fiduciary duty pursuant to Section 502(a)(3), to add a claim for civil penalties based on Edward Jones’s failure to provide her with a complete file, and to seek relief and damages against the defendants “under state and federal law…to the extent deemed applicable and appropriate.” Defendants opposed Ms. Chaudron’s request for leave to amend, and argued that the proposed amendments are futile. Agreeing, the court denied Ms. Chaudron’s motion. First, the court concurred with defendants that the breach of fiduciary duty claim does not seek appropriate equitable relief, and is instead duplicative of her claims for benefits under Section 502(a)(1)(B) because it is based on the same facts and injuries. Second, the court agreed with defendants that Ms. Chaudron cannot maintain a statutory penalty claim because under Sixth Circuit case law such claims only apply for failure to provide specific documents expressly enumerated under § 1024(b)(4). It held, “Plaintiff has not clearly stated what documents she requested from Defendants that were not provided, making it impossible for the Court to determine whether Plaintiff has set forth a plausible claim for civil penalties pursuant to § 1132(c).” Finally, the court took issue with the inclusion of the generic request for relief and damages under undefined state and federal law. Regarding state law, the court found the amendment futile because ERISA governs this action and would preempt any state law claims. And as for federal law, the court found that Ms. Chaudron already includes a general reservation of rights provision in her original complaint, which renders the inclusion of a new general reservation of rights clause unnecessary. Based on the foregoing, the court found the proposed amendments futile at this juncture, and thus denied plaintiff’s motion for leave to include them.

Nirenberg v. Couzens, Lansky, Fealk, Roeder & Lazar, P.C., No. 24-cv-10619, 2025 WL 2976842 (E.D. Mich. Oct. 17, 2025) (Judge Robert J. White). Plaintiff Henry Nirenberg is a state court-appointed fiduciary who filed this case in state court asserting claims for (1) legal malpractice against Defendants Jack S. Couzens and the law firm Couzens, Lansky, Fealk, Roeder & Lazar, P.C. (the Couzens Defendants); (2) legal malpractice against Defendants Mark W. Sadecki and the law firm Sadecki & Associates, P.L.L.C. (the Sadecki Defendants); (3) breach of trust and an ERISA violation against Defendants Kathleen Jenkins and the accounting firm Jenkins, Magnus, Volk, and Carrol, P.C. (the Jenkins Defendants); (4) conversion against the Couzens Defendants, Jenkins, and Defendant Susan Habel; and (5) an ERISA claim against Ms. Habel. All of these claims arise from allegedly improper distributions from two trust accounts, the Harold B. Doremus Trust (the HBD trust) and the Burke Building Centers Inc. Profit Sharing Trust (the PSP trust). The PSP trust is governed by ERISA. Several motions were before the court. Mr. Nirenberg moved to remand his state law causes of action back to state court. Ms. Habel, the Couzens Defendants, and the Sadecki Defendants all filed respective motions to dismiss Mr. Nirenberg’s claims. Finally, the Couzens and Sadecki Defendants filed motions to dismiss the Jenkins Defendants’ crossclaims. The court denied the motion to remand, granted Ms. Habel’s motion to dismiss, granted in part and denied in part the Legal Defendants’ motions to dismiss the crossclaims, denied the Sadecki Defendants’ motion to dismiss Mr. Nirenberg’s claims, and granted in part and denied in part the Couzens Defendants’ motion to dismiss Mr. Nirenberg’s claims. To begin, the court denied Mr. Nirenberg’s motion seeking to remand the state claims back to state court because it concluded that the state and federal claims arise from a common nucleus of operative facts and are inextricably intertwined with one another. As a result, the court concluded that supplemental jurisdiction over the state law claims is warranted. Regarding the ERISA claim asserted against Ms. Habel, the court held that it must be dismissed because the HBD trust, as the beneficiary of the deprived funds, failed to exhaust administrative remedies. Although Mr. Nirenberg styled his ERISA claim against Ms. Habel as a statutory breach of fiduciary duty claim, the court nevertheless felt that it was essentially a claim alleging improper distributions contrary to the terms of the PSP trust and therefore fundamentally a plan-based claim subject to the exhaustion requirement. Moreover, the court also concluded that Mr. Nirenberg failed to sufficiently plead that Ms. Habel knew, when she became the PSP trustee, that the distributions were improper. However, the court allowed the ERISA claim against the Jenkins Defendants to proceed, as well as the legal malpractice claims, the breach of trust claim, and some of the Jenkins Defendants’ crossclaims. The remaining state law claims and crossclaims were all dismissed for various non-ERISA-related reasons. Accordingly, the court’s ruling was mixed for almost all of the parties, and resolution of large parts of this action will not take place until after discovery has concluded.

Provider Claims

Fifth Circuit

Angelina Emergency Medicine Associates PA v. Blue Cross & Blue Shield of Alabama, No. 24-10306, __ F. 4th __, 2025 WL 2984898 (5th Cir. Oct. 23, 2025) (Before Circuit Judges Smith, Higginson, and Douglas). Plaintiffs-appellants in this ERISA action are fifty-six Texas emergency medicine physician groups who sued twenty-four Blue Cross Blue Shield-affiliated plans from outside of Texas alleging that the Blue Plans underpaid them for 290,000 reimbursement claims. After a settlement with some of the defendants, more than 75% of the claims were dismissed. The district court later granted summary judgment in favor of defendants on the remaining claims. The district court identified five issues with plaintiffs’ claims: (1) the physician groups were not named in the assignments; (2) the assignments did not include a right to sue; (3) the assignments themselves were not produced; (4) the underlying plans contained valid anti-assignment clauses; and (5) the physician groups failed to exhaust administrative remedies under the applicable plans before filing suit. (Your ERISA Watch reported on this ruling in our January 17, 2024 edition.) Plaintiffs appealed. On August 8, 2025, the Fifth Circuit revived nearly all of plaintiffs’ claims, affirming the district court’s decision only as to the claims where no written assignment was produced. In that decision, the court of appeals identified several issues that require further examination. First, the Fifth Circuit held that the lower court was wrong to dismiss the provider’s claims for lack of standing because the assignments were made to “health care providers” rather than naming the physician groups themselves. The court of appeals agreed with plaintiffs that the term “provider” is ambiguous and subject to two or more reasonable interpretations. At a minimum, the Fifth Circuit held that the lower court should have allowed the parties to introduce evidence of the intended scope of the assignments, and its grant of summary judgment was accordingly premature. Next, the Fifth Circuit rejected the district court’s holding that the assignments provided only a right to administrative relief rather than the right to seek legal relief. The appeals court stressed that the assignments assign “all rights.” It wrote, “there is no basis in the law for requiring that an assignment specifically state it provides a right to sue when it assigns ‘all rights.’ The district court erred in finding that claims assigning rights or insurance benefits did not assign a right to sue.” The Fifth Circuit then turned to the claims where the physician groups do not have written assignments. The court of appeals affirmed the dismissal of these claims and concluded that the district court acted reasonably in doing so. In addition to finding issues with the assignments, the district court had also dismissed claims where the underlying plans contained anti-assignment provisions. The Fifth Circuit reversed this basis for dismissal. It concluded that there were genuine issues and open questions about whether the Blue Plans were estopped from enforcing the anti-assignment clauses. It stated that the matter of estoppel “is a fact issue that the district court must determine as to each claim.” Finally, the Fifth Circuit held that the district court was too quick to dismiss claims for failure to exhaust administrative remedies. “At bottom, the Physician Groups argue that they made all possible efforts to obtain the underlying plans and understand alternative appeals processes, while still following the publicly available appeals process, but were not given copies of the plan. We have previously held that a claimant’s efforts, or lack thereof, to obtain the plan can be a key fact in finding whether the claimant has cleared the hurdle of ERISA exhaustion. At a minimum, there is a factual dispute as to whether the Physician Groups could have discovered the member appeals process without action by [Blue Cross], and whether it would have been reasonable to require the Physician Groups to undertake that separate process when they were already being partially paid by [the Blue Plans].” Based on the foregoing, the Fifth Circuit vacated summary judgment as to all claims except those with no written assignment in evidence. Blue Cross then petitioned for rehearing en banc. Treating Blue Cross’s motion as a petition for panel rehearing, the Fifth Circuit granted the motion, withdrew its previous opinion, and substituted it with a new one this week. The new decision is very similar to the previous one. On the whole, the Fifth Circuit maintained its prior holdings, and in the end reached the same result – affirming summary judgment as to the claims with no written assignment in evidence and otherwise vacating summary judgment as to the remaining claims. Accordingly, the appeals court once again remanded these remaining claims to the district court for evidentiary determinations as to the validity of the underlying assignments and the exceptions to exhaustion. Thus, despite granting Blue Cross’s motion, the panel upheld its previous positions, and things stand today where they stood a few months ago, with the physician groups’ action resurrected, and with the possibility that plaintiffs may yet receive further compensation for some or all of the remaining claims at issue.