Patterson v. UnitedHealth Grp., Inc., No. 25-3175, __ F.4th __, 2025 WL 3458953 (6th Cir. Dec. 2, 2025) (Before Circuit Judges Siler, Nalbandian, and Readler).

For regular readers, our case of the week might look eerily familiar. In August of 2023 we covered a case with the exact same name – indeed, both cases are published decisions out of the Sixth Circuit with the same panel of judges. The underlying case number is different, however. What’s going on?

The parties are in fact the same as in the prior case. The plaintiff is Eric Patterson, who was injured in a car accident. He had medical coverage through an ERISA-governed healthcare plan insured by defendant UnitedHealth Group. Mr. Patterson sued the other driver involved in the accident in state court in Ohio, and joined United, seeking a declaratory judgment that United had no right to reimbursement of any potential recovery. United pointed to the summary plan description (“SPD”), which included a right to reimbursement, and maintained there was no other plan document. Eventually, Mr. Patterson settled with the other driver and agreed to pay United $25,000 in reimbursement pursuant to the SPD’s terms.

As (bad) luck would have it, a couple of months later Mr. Patterson’s wife was injured in a second traffic accident. As before, United paid the medical bills and sought reimbursement. Like her husband, Ms. Patterson brought a lawsuit in state court against the other driver, contending that United should not be entitled to reimbursement. However, things went differently this time because United produced a plan document which did not contain a reimbursement right and thus contradicted the SPD. In the end, Ms. Patterson won her state law case, including judgment in her favor on the declaratory relief claim against United. (The Ohio Court of Appeals subsequently affirmed this decision.)

Mr. Patterson was annoyed that his wife was able to avoid reimbursing United while he was not, even though their claims both arose under the same benefit plan and should have been treated similarly. As a result, Mr. Patterson filed a class action against United seeking, among other remedies, the return of the $25,000 he was forced to cough up in his accident case.

The district court dismissed Mr. Patterson’s complaint for several reasons, including on the merits, ruling that his allegations did not fit within any of ERISA’s remedial provisions. In its August 1, 2023 decision the Sixth Circuit affirmed in part and reversed in part. The court agreed that Mr. Patterson had standing to sue for return of his $25,000 settlement payment, but ruled he was not entitled to injunctive relief because he did not plausibly allege any future injury. He also was not entitled to pursue class claims. However, the Sixth Circuit reversed the dismissal of Mr. Patterson’s claim for breach of fiduciary duty under 29 U.S.C. § 1132(a)(3), holding that his complaint plausibly alleged such a claim against United, and that disgorgement of the $25,000 and restitution were forms of equitable relief that he could pursue under Section 1132(a)(3).

That action is still pending in district court. However, this was not satisfactory to Mr. Patterson. Because the district court originally declined to exercise supplemental jurisdiction over his state law claims, Mr. Patterson filed a new complaint in state court asserting those claims once again. On behalf of himself as well as two putative classes, he asserted claims for fraudulent and negligent misrepresentation, conversion, civil conspiracy, and unjust enrichment.

Unsurprisingly, defendants removed this second case to federal court based on ERISA preemption. The parties then filed dueling motions; Mr. Patterson moved to remand the case back to state court while defendants moved to dismiss the case. The district court granted defendants’ motion, viewing Mr. Patterson’s claims as “a repackaged version of his still-pending ERISA lawsuit.” The court concluded that “both actions rested on the same factual events and sought the same outcome: a return of the $25,000 Patterson says he should not have had to pay because of the plan’s terms.” Thus, the court concluded that Mr. Patterson’s state law claims were governed, and preempted, by ERISA.

However, the court did not grant Mr. Patterson leave to amend his complaint to recharacterize his claims under ERISA. The court reasoned that doing so was pointless; Mr. Patterson already had similar if not identical ERISA claims pending in his original case. Thus, instead of allowing duplicate lawsuits with duplicate claims, the court chose to dismiss the second, later-filed action.

Mr. Patterson appealed to the Sixth Circuit once again, and in this published decision the court affirmed the ruling below, this time in its entirety. The court addressed two issues: “the district court’s refusal to remand and its dismissal of Patterson’s complaint.”

On the first issue, Mr. Patterson argued that his state law claims were “wholly independent” of ERISA and could proceed alongside his parallel ERISA suit. The Sixth Circuit explained that ERISA’s complete preemption doctrine allows federal courts to assume jurisdiction over state law claims that duplicate or supplant ERISA’s civil enforcement remedies. The court applied the two-pronged Supreme Court test from Aetna Health Inc. v. Davila to determine complete preemption, i.e., whether Mr. Patterson’s claims were for benefits due under an ERISA plan and whether they implicated a legal duty independent of ERISA.

The Sixth Circuit ruled that Mr. Patterson’s claims met both prongs of the Davila test. The court stated that his claims were essentially for the recovery of benefits under § 1132(a)(1)(B) because they sought return of the $25,000 reimbursement, which was tied to the plan’s terms. The court noted that its conclusion was consistent with “[a] collection of circuits [which] has held that similar state law challenges to an ERISA plan’s reimbursement rights are in essence disguised suits ‘to recover benefits due’ under § 1132(a)(1)(B).”

Mr. Patterson contended that he could not be seeking benefits under § 1132(a)(1)(B) because his benefits had already been paid and thus “the obligation of the ERISA plan to provide benefits was over.” However, the Sixth Circuit saw “no practical difference whether the plan clawed back Patterson’s benefits after paying for his care or simply withheld them until getting its claimed share of the recovery. In either case, benefits are ‘due.’”

Moving on to the second prong of Davila, the Sixth Circuit determined that Mr. Patterson’s claims did not implicate a duty independent of ERISA because they were based on the plan’s terms and required interpretation of the plan: “Each of defendants’ alleged breaches of duty rests entirely upon what Patterson’s ERISA-governed plan does (or does not) say.”

Mr. Patterson contended that no plan interpretation was needed because defendants “only lied about the ‘existence’ of the plan document, not its ‘meaning.’” However, the Sixth Circuit explained that this was incorrect because in order to prevail, “a court – whether an Ohio court or elsewhere – must interpret his ERISA plan and determine whether it created a duty to provide reimbursement-free benefits. That is, ‘[some]body needs to interpret the plan.’”

As a result, the Sixth Circuit determined that the district court properly granted defendants’ motion to dismiss because Mr. Patterson’s state law claims were preempted by ERISA. This left the second issue – “one last housekeeping matter” – of whether the district court should have dismissed without leave to amend.

The Sixth Circuit ruled, “We see no misstep in that approach.” The court explained that Mr. Patterson had already disavowed a claim under Section 1132(a)(1)(B), and thus he could no longer proceed under that provision. As for Section 1132(a)(3), Mr. Patterson’s original action, currently pending on remand from the Sixth Circuit, already contains a claim based on that provision. “To let Patterson replead his state law claims under ERISA would thus result in duplicative proceedings before the same court. In that situation, district courts enjoy the discretion over their dockets to dismiss duplicate cases.” The court observed that “Patterson does not fault the district court for dismissing this later-filed action,” and thus, “Neither do we.”

As a result, the Sixth Circuit affirmed the district court’s dismissal, and thus Mr. Patterson will only be allowed to continue with his original action, limited to relief under Section 1132(a)(3)…unless he files another (fifth!) lawsuit. Stay tuned!

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

Breach of Fiduciary Duty

Third Circuit

Grink v. Virtua Health, Inc., No. 24-CV-09919, 2025 WL 3485686 (D.N.J. Dec. 3, 2025) (Judge Christine P. O’Hearn). Plaintiffs Kelly Grink, Diane Trump, and Steven Molnar are participants in the Virtua Health 401(k) Plan and 403(b) Retirement Program who allege fiduciary breaches and prohibited transactions under ERISA by various defendants associated with both Virtua and Lincoln National, which provided services to the plans. The allegations include (1) imprudent selection and retention of the Lincoln Stable Value Account (“SVA”) as the primary fixed-income investment, resulting in exposure to Lincoln’s credit risk and undisclosed “spread income”; (2) the use of higher-cost mutual fund share classes when lower-cost options were available, leading to excessive fees; (3) underperformance and excessive fees related to several actively managed funds, including Oakmark and Goldman SCV; (4) inadequate monitoring processes and underperformance of the LifeSpan Models TDF investment option; and (5) excessive recordkeeping and administrative fees, resulting in over $11.7 million in fees over five years. The Virtua defendants and the Lincoln defendants both filed motions to dismiss, which were decided in this order. The Virtua defendants argued that the plaintiffs failed to allege that Virtua and the Virtua Board were fiduciaries or that there was a flawed fiduciary process, while the Lincoln defendants contended that they were not fiduciaries for the alleged prohibited transactions and were thus not liable. Addressing the Lincoln defendants’ motion first, the court concluded that the plaintiffs failed to establish that the Lincoln defendants were fiduciaries concerning the alleged prohibited transactions. The court ruled that the complaint “only alleges the Lincoln Defendants were liable as parties in interest to the ‘annuity transactions,’ and nothing else,” i.e., no concrete affirmative conduct, which was insufficient. Furthermore, plaintiffs’ allegations regarding the Lincoln defendants’ fiduciary status related to the execution of the Group Annuity Contract were “conclusory.” The court cited cases holding that annuity providers owe no fiduciary duty to plan participants. As for the Virtua defendants’ motion, the court agreed that neither Virtua nor its Board were named fiduciaries under the plan documents. The court noted that plan sponsorship alone does not confer fiduciary status, as it is considered a corporate or settlor function. However, Virtua was found to be a fiduciary concerning the “annuity transactions” due to its discretionary actions in contracting with Lincoln for the SVA. The court determined that the Virtua Board did not exercise the required control over the management of plan assets to be considered fiduciaries. On the merits, the court found that the plaintiffs adequately alleged a breach of the duty of prudence regarding the Share Class Claims and some Actively Managed Fund Claims. The court determined that the allegations regarding the Oakmark and Goldman SCV funds raised a sufficient inference of imprudence due to their underperformance compared to benchmarks and industry comparators. However, the court found that the allegations related to the MetWest and Europacific Growth funds did not provide sufficient facts for a reasonable comparison, thus failing to state a claim for imprudence. The court also granted the Virtua defendants’ motion to dismiss one of the prohibited transaction counts, as the plaintiffs did not sufficiently allege self-dealing or conflict of interest, nor did they identify a specific transaction with UBS/Morgan Stanley that violated ERISA. In the end, there was something for everyone in this complicated decision. The court gave plaintiffs leave to amend, so we may see another one like it in the near future.

Fourth Circuit

Garner v. Northrop Grumman Corp., No. 1:25-CV-00439 (AJT/WEF), 2025 WL 3488657 (E.D. Va. Dec. 4, 2025) (Judge Anthony J. Trenga). The plaintiffs in this case are participants in defendant Northrop Grumman Corporation’s defined contribution retirement plan. They allege that the defendants failed to adhere to the plan document, breached fiduciary duties, and engaged in prohibited transactions by misusing forfeited plan contributions. Specifically, they contend that defendants should have used forfeited contributions to restore participant accounts or pay plan expenses, instead of reducing the company’s future contribution obligations. They claim that over 20,000 plan participants left the company between 2018 and 2023 with unvested benefits, resulting in $70.8 million in forfeitures, which were used to reduce employer contributions rather than cover $57.4 million in administrative expenses. Plaintiffs alleged failure to follow plan terms, breach of fiduciary duties of loyalty and prudence, failure to monitor, breach of the anti-inurement provision, and engaging in prohibited transactions. Defendants filed a motion to dismiss, which the court granted in full. The court ruled that there was no violation of plan terms because the plan did not mandate a specific order for using forfeitures, allowing them to be used for any of three purposes (paying expenses, restoring accounts, or reducing contributions). For the same reason, the court further ruled that there was no breach of fiduciary duty. The court stated that the plan authorized defendants’ conduct and ERISA does not impose “an exclusive duty to maximize pecuniary benefits.” As for plaintiffs’ anti-inurement claim, the court found that using forfeitures to meet employer contribution obligations did not violate this provision, as the funds were used to provide benefits to participants. Similarly, the court dismissed the prohibited transactions claims, as the plaintiffs did not allege any improper transactions involving plan assets. The court ruled that plaintiffs did not allege that any of the forfeited assets were removed from the plan or were used in a type of “transaction” necessary to impose liability under 29 U.S.C. § 1106. Finally, the court dismissed plaintiffs’ failure to monitor claim, as it was derivative of the fiduciary duty claims. As a result, the court dismissed all of plaintiffs’ claims, a result consistent with the decisions of most other courts on these issues.

Seventh Circuit

Clinton v. Baxter Int’l, Inc., No. 25 CV 3368, 2025 WL 3470685 (N.D. Ill. Dec. 3, 2025) (Judge Lindsay C. Jenkins). Plaintiff Charles Clinton filed this class action against Baxter International Inc. and its Investment Committee, alleging violations of fiduciary duties under ERISA. Clinton claimed that the stable value fund (“SIF”) in Baxter’s retirement plan provided significantly lower returns compared to other similar funds available during the class period from 2019 to 2023. He argued that Baxter failed to maximize returns by not demanding higher crediting rates from insurance companies or seeking alternative investment options. Defendants moved to dismiss, arguing that Clinton failed to state a claim for relief. In his opposition, Clinton alleged that the Investment Committee breached its duty of prudence by selecting and retaining underperforming investment options. However, the court noted that Clinton lacked actual knowledge of the defendants’ decision-making process and relied on inferences and comparisons to other stable value funds. The court agreed with Clinton that the funds he selected for comparison were of the same type as the SIF, i.e., stable value funds. However, the court ruled these funds were inadequate for comparison because Clinton “fail[ed] to provide a uniform sample.” The court explained that Clinton’s “data points are four to six comparators each year from 2019 to 2023 – none of which appear across all five years. The closest he comes to providing a year-to-year comparator are two funds analyzed from 2019 through 2022, but not in 2023. The rest make one or two appearances, and in the latter case, often non-consecutively. All the complaint shows, then, is that the SIF doesn’t boast one of the top four to six crediting rates in a given year. There is no consistent benchmark.” The court also addressed the issue of how the relevant crediting rates should be calculated. Defendants argued that the differences in crediting rates between the SIF and comparator funds were too minor to support a claim of imprudence, and the court agreed, ruling that Clinton’s methodology for calculating these rates was flawed. As a result, the court granted defendants’ motion in its entirety, but without prejudice.

Disability Benefit Claims

Eleventh Circuit

Eggleston v. Unum Life Ins. Co. of Am., No. 24-13678, __ F. App’x __, 2025 WL 3472834 (11th Cir. Dec. 3, 2025) (Before Circuit Judges Jill Pryor, Luck, and Brasher). Plaintiff Yvette Eggleston was a clinical research nurse at Johns Hopkins Bayview Medical Center and a participant in Johns Hopkins’ long-term disability benefit plan, which was insured by defendant Unum Life Insurance Company of America and governed by ERISA. The policy allowed benefits for 24 months if she was unable to perform her regular occupation due to sickness or injury, and beyond that period only if she was unable to work in any gainful occupation. Eggleston stopped working in 2011 due to chronic illnesses and was initially approved for benefits by Unum. After 24 months, Unum continued her benefits based on her medical condition but noted potential for improvement. In 2021, Unum discovered social media posts showing Eggleston engaging in activities that suggested improved functional capacity, prompting a review of her file. Unum concluded that her chronic conditions were stable and controlled, and she could perform sedentary work. Consequently, Unum terminated her benefits, and that decision was upheld by the district court. (Your ERISA Watch covered this decision in our October 30, 2024 edition.) In this per curiam decision, the Eleventh Circuit affirmed. The court applied its six-step framework for reviewing ERISA benefit determinations, and like the district court, skipped directly to step three, in which it assessed whether Unum’s decision was arbitrary and capricious. This standard of review was required because the policy granted Unum discretionary authority to make benefit determinations. The court concluded that “Unum’s multiple medical expert opinions, Eggleston’s social media activity, and Eggleston’s medical records were enough to find that Unum’s decision was not arbitrary and capricious.” The court was convinced that Unum considered all relevant information and “simply reached a different conclusion as to what findings the record supports.” As a result, under a deferential standard of review, the court could not conclude that Unum was unreasonable in crediting the reports of Unum’s reviewing physicians over those of Eggleston’s doctors. The Eleventh Circuit thus affirmed the decision and upheld the denial of Eggleston’s claim.

Discovery

Ninth Circuit

Davalos v. GreatBanc Trust Co., No. 1:25-CV-00706-KES-SKO, 2025 WL 3470168 (E.D. Cal. Dec. 3, 2025) (Magistrate Judge Sheila K. Oberto). The plaintiffs in this putative class action allege various ERISA violations regarding the Western Milling Employee Stock Ownership Plan. Their claims arise from the 2022 sale of stock back to Defendant Kruse Western Inc., in which the plaintiffs allege the plan and its participants did not receive fair market value. Several defendants filed a motion to dismiss, arguing lack of subject matter jurisdiction and that the claims are barred under ERISA’s statute of limitations. The plaintiffs responded with a motion for jurisdictional discovery, which was adjudicated in this order. Plaintiffs claimed they needed discovery to challenge the factual assertions made in the motions to dismiss, in which defendants relied on the Plan’s Form 5500 filings as alleged proof that the Plan and its participants actually benefited from the 2022 sale of stock, thereby asserting that plaintiffs did not suffer any injury. Plaintiffs argued that denying them access to documents relating to the 2022 sale, while allowing defendants to use those same documents to assert a lack of standing, would be unjust and prevent them from effectively responding to the jurisdictional challenge. The court agreed, recognizing that while discovery is typically not permitted before the parties’ Rule 26(f) conference, expedited discovery may be allowed for good cause, particularly where facts relating to jurisdiction are disputed. The court emphasized that it would be inequitable to permit one side to rely on certain evidence while denying the other side the opportunity to challenge or verify it. The court further noted that the defendants would not suffer prejudice because the relevant documents had already been produced to plaintiffs previously, albeit confidentially under Federal Rule of Evidence 408. As a result, the court granted plaintiffs’ motion for jurisdictional discovery.

ERISA Preemption

Ninth Circuit

Healthcare Ally Mgmt. of Cal., LLC v. United Healthcare Servs., Inc., No. 24-5178, __ F. App’x __, 2025 WL 3485391 (9th Cir. Dec. 4, 2025) (Before Circuit Judges Callahan, Owens, and Koh). This is one of a number of cases plaintiff Healthcare Ally Management of California (“HAMOC”) has filed against various insurers seeking reimbursement for treatment it provided to patients. Here, HAMOC filed suit against United Healthcare Services, Inc., alleging state law claims of negligent misrepresentation and promissory estoppel. These claims were based on alleged representations by United during a phone call, promising reimbursement at the “usual, customary, and reasonable” (“UCR”) rate instead of the lower Medicare rate. The district court dismissed these claims on the ground that they were preempted by ERISA, citing the Ninth Circuit’s recent decision in Bristol SL Holdings, Inc. v. Cigna Health & Life Ins. Co., 103 F.4th 597 (9th Cir. 2024). HAMOC appealed. In a brief memorandum decision, the Ninth Circuit affirmed. Noting that ERISA preempts any state laws that “relate to” employee benefit plans, the court identified two categories of state-law claims: those with a “reference to” an ERISA plan and those with an “impermissible connection with” an ERISA plan. HAMOC’s claims fell into both categories. The claims had a “reference to” an ERISA plan because they were premised on the existence of a plan, which was essential for the claims’ survival. The claims also had an “impermissible connection with” an ERISA plan as they would interfere with plan administration and ERISA-regulated relationships. The court noted that allowing HAMOC’s state law claims would create interference with nationally uniform plan administration because benefits would be governed by variable state law interpretations rather than ERISA and plan terms. As a result, the court concluded that HAMOC’s attempt to bind United to UCR rates based on phone call representations was preempted by ERISA, and thus upheld the district court’s ruling below.

Pleading Issues & Procedure

First Circuit

Radoncic v. National Union Fire Ins. Co. of Pittsburgh, PA, No. 2:25-CV-00138-LEW, 2025 WL 3494703 (D. Me. Dec. 5, 2025) (Magistrate Judge John C. Nivison). In 2018, plaintiff Skender Radoncic suffered an injury to two fingers on his right hand, leading to the amputation of his index finger in August 2023. Subsequently, his spouse submitted a claim under her employer’s ERISA-governed group accident insurance benefit plan. Defendant National Union Fire Insurance Company of Pittsburgh, the insurer of the plan, denied the claim in October 2023, stating that the loss was not covered, and this action followed. Radoncic filed a motion to modify the administrative record, seeking the inclusion of certain documents for in camera review by the court. These documents included pre-denial emails, litigation hold notices, file copy requests, a coverage letter, and redacted claims notes. In response, National Union argued that these documents were protected by attorney-client privilege and attorney work product. The court noted that case law recognizes a fiduciary exception to the attorney-client privilege in ERISA cases. This exception prevents an ERISA fiduciary from asserting the privilege against plan beneficiaries on matters of plan administration. However, the privilege can still be invoked for non-fiduciary matters, such as when legal advice is sought for the fiduciary’s own protection. Radoncic contended that the disputed documents were created before the final denial decision in April 2024, thus falling under the fiduciary exception, while National Union argued that the fiduciary exception did not apply because the relationship became adversarial when Radoncic appealed the denial in March 2024. The court granted Radoncic’s motion in part, allowing an in camera review of the documents to assess National Union’s claim of attorney-client privilege. The court ordered National Union to submit the documents at issue to the court and deferred ruling on the merits of Radoncic’s motion until after its review is complete.

Fourth Circuit

West Virginia United Health System, Inc. v. GMS Mine Repair & Maintenance, Inc. Employee Medical Plan, No. 1:25-CV-34, 2025 WL 3455947 (N.D.W. Va. Dec. 2, 2025) (Judge Thomas S. Kleeh). West Virginia University Health System (“WVUHS”) filed this action against GMS Mine Repair and Maintenance, Inc. Employee Medical Plan (“GMS”) and The Health Plan of West Virginia, Inc. (“THP”), accusing them of fraud. GMS operates a self-funded health plan for its employees, administered by THP. WVUHS and THP had a contract for negotiated payment rates for traditional insurance, but no such contract existed for the GMS plan. WVUHS discovered that THP was processing claims for GMS using a reference-based pricing scheme, which led to disputes over payment rates. WVUHS alleged that GMS’ member cards fraudulently imitated THP’s commercial insurance cards, misleading WVUHS into providing services under false pretenses. As a result, WVUHS claimed that GMS and THP reimbursed them at significantly lower rates than agreed, resulting in substantial financial losses. WVUHS initially filed its complaint in state court. THP removed it, contending that WVUHS’ claims were preempted by ERISA. The court disagreed and sent the case back to state court. Next, GMS removed the case, and WVUHS once again moved for a remand. In this order the court granted WVUHS’ motion. The court ruled that GMS was collaterally estopped from removing the case, as the issue of ERISA preemption had been previously decided. The court found that (1) the issue was the same in both removals (i.e., ERISA preemption), (2) the issue was determined by the court in the previous motion, (3) the determination was a “critical and necessary part of the decision in the prior proceeding,” (4) the prior ruling was final and valid, and (5) the parties were the same and GMS had “a full and fair opportunity to litigate the issue in the first removal attempt.” The court reiterated that “[u]nder the plain language of the Plan, the anti-assignment provision appears valid and therefore, WVUHS could not bring a suit under ERISA even if there were a written assignment of benefits. Thus, WVUHS does not have standing to sue THP under ERISA.” GMS attached a newly created waiver of the anti-assignment provision to its notice of removal, but the court scathingly rejected this last-ditch effort to avoid remand: “The Court is not persuaded by GMS’s blatant attempt to manufacture jurisdiction… The Court finds that GMS’s removal attempt at issue showcases that GMS is now trying to change and manipulate the terms of the governing plan to create federal jurisdiction… GMS’s conduct runs afoul good faith and fair dealing and its behavior cannot be condoned.” As a result, WVUHS’s motion was granted once again, and the case will head back to state court for a second time.

Tenth Circuit

M.H. v. United Healthcare Ins. Co., No. 2:22-CV-00307-AMA-DAO, 2025 WL 3443490 (D. Utah Dec. 1, 2025) (Judge Ann Marie McIff Allen). In this case of twists and turns, plaintiffs M.H. and C.H. sued defendants United Healthcare Insurance Company, United Behavioral Health, True Value, and the True Value Company Medical Program alleging that defendants violated ERISA by failing to pay benefits under True Value’s employee healthcare plan. Initially, the parties engaged in settlement negotiations, which were successful. All’s well that ends well? Not so fast. Plaintiffs filed a notice of settlement on May 28, 2024, but withdrew from it on July 25, 2024, claiming that defendants’ counsel failed to provide the promised settlement agreement for signing. A status conference was held on August 14, 2024, and subsequently, the defendants filed a motion to enforce the settlement agreement, which the plaintiffs opposed. In January of 2025, the parties agreed to resolve the case through a second proposed settlement agreement. Defendants prepared an agreement, which the plaintiffs signed and returned, but this time defendants held things up. Defendants explained in a February 27, 2025 filing with the court that they would not sign because True Value had filed for Chapter 11 bankruptcy, which was crucial because the True Value Company Medical Program was self-funded, not insured, and thus True Value was on the hook for part of the settlement. Plaintiffs subsequently filed a motion to enforce the settlement, which the court denied in this order. The court explained that the automatic stay on actions against a debtor imposed by the Bankruptcy Code (11 U.S.C. § 362(a)) prevented the enforcement of the settlement agreement. Plaintiffs tried to “work around the automatic stay by suggesting that True Value could negotiate and enter the settlement even after its bankruptcy filing because the bankruptcy court has authorized True Value to conduct certain business in the ordinary course.” But the court rejected this, ruling that “payments made pursuant to a settlement agreement are not made in the ordinary course of business, and the present litigation is not in the normal course of business[.]” The court agreed with plaintiffs that the automatic stay provision “does not extend to solvent codefendants of the debtor,” and thus had no effect on the case’s other defendants. However, “the Court cannot ignore the reality that the purported agreement Plaintiffs seek to enforce was between all of the Parties,” and thus, because one of the parties had triggered the automatic stay, the entire agreement was void. The court was sympathetic, acknowledging “the complications True Value’s bankruptcy presents to Plaintiffs in pursuing their claims,” but the court concluded that its hands were tied by the automatic stay rule. As a result, the court denied plaintiffs’ motion to enforce the settlement.

Provider Claims

Fifth Circuit

Horizon Surgery Center, PLLC v. D. Reynolds Co., LLC, No. 3:25-CV-00255, 2025 WL 3443191 (S.D. Tex. Dec. 1, 2025) (Magistrate Judge Andrew M. Edison). Plaintiff Horizon Surgery Center, PLLC filed suit against D. Reynolds Company, LLC, the administrator of a health benefit plan governed by ERISA, alleging nonpayment for medical services provided to Mary Bruce, a participant in the plan. Horizon claimed it had confirmed that Bruce’s treatments were eligible for coverage under the plan before providing services in 2021 and 2022. Bruce had assigned her rights to benefits under the plan to Horizon, which alleged it was owed $579,548.40 for the services provided. Horizon asserted five causes of action in its operative complaint; one was for denial of benefits under ERISA (29 U.S.C. § 1132(a)(1)(B)), one was for breach of fiduciary duty under ERISA (29 U.S.C. § 1132(a)(3)), and the remainder were state law claims. Reynolds moved to dismiss all claims except the ERISA denial of benefits claim, arguing that the ERISA breach of fiduciary duty claim was duplicative and the state law claims were preempted by ERISA. In this order a magistrate judge recommended that Reynolds’ motion be granted. The court agreed with Reynolds that Horizon’s ERISA breach of fiduciary duty claim was duplicative of its ERISA denial of benefits claim. The court noted that Horizon’s alleged damages under its § 1132(a)(3) claim – unpaid or underpaid claims – were tied to benefits due under the plan, making § 1132(a)(1)(B) the more appropriate avenue for redress. Additionally, the court found that Horizon’s allegations of flawed administrative claims procedures were properly addressed under § 1132(a)(1)(B), not § 1132(a)(3). The court emphasized that the monetary relief sought by Horizon was legal rather than equitable, further precluding relief under § 1132(a)(3). As for Horizon’s state law claims, the court ruled that they were all preempted by ERISA. The court applied the Fifth Circuit’s two-part test for ERISA preemption, which examines whether the state law claims address areas of exclusive federal concern, such as the right to receive benefits under an ERISA plan, and whether the claims directly affect the relationship among traditional ERISA entities. The court agreed with Reynolds that Horizon’s state law claims were inextricably related to the plan and its terms, as they arose from Horizon’s verification of Bruce’s eligibility under the plan and its claim for payment for services rendered. The court rejected Horizon’s argument that Reynolds’ direct communications created a separate promise and independent relationship, finding that the claims were dependent on the plan’s terms and benefits. Consequently, the court recommended dismissing these claims with prejudice.

Statute of Limitations

Second Circuit

Fromageot v. Britt, No. 3:21-CV-1165-MPS, 2025 WL 3470473 (D. Conn. Dec. 3, 2025) (Judge Michael P. Shea). The case involves a 20-year dispute over life insurance proceeds following the death of Paul Fromageot in 2004. Paul was employed by Alliance Capital and had life insurance through an ERISA-governed employee benefit plan sponsored by the company and insured by Hartford Life. Paul had initially designated his wife, Madeline Fromageot, his parents, and his only child at the time as co-equal beneficiaries. However, after Paul’s death, Madeline claimed that Paul had updated his policies to make her and their four children the primary beneficiaries, with his parents as contingent beneficiaries. Despite this, Hartford Life distributed the proceeds according to the original beneficiary designations. Madeline has been involved in litigation in both state and federal court since 2007, challenging the distribution of these funds. She filed this particular action pro se in 2021, purporting to represent Paul’s estate and her children and their trusts as well. The case has already been dismissed twice, once for lack of subject matter jurisdiction, and again because Madeline failed to properly serve Hartford Life. Her complaint contains twelve causes of action, nine of which are against Hartford Life. Hartford Life filed a motion to dismiss, arguing that Madeline cannot represent others while representing herself, and that her ERISA claims are time-barred. The court agreed and granted Hartford Life’s motion. The court ruled that Madeline had Article III standing because “Madeline is entitled to the reasonable inference that, because the proceeds from Paul’s policy were not deposited into the children’s education funds…Madeline herself was left to foot any bills related to her children’s schooling.” However, the court also ruled that Madeline lacked standing to sue on behalf of Paul’s estate, her children, or their trusts due to her pro se status. As for the merits of her individual claims, the court ruled that her ERISA claims were time-barred by the terms of the Hartford Life policy, which required claims to be filed within three years of proof of loss. “Paul died on June 4, 2004…and so proof of loss was due on September 2, 2004, and Madeline had until September 2, 2007 to file suit against Hartford Life. She did not do so until May 22, 2023 – over 15 years late.” Madeline advanced arguments for extending the limitations period against Hartford Life, including fraudulent concealment and equitable tolling, but these were rejected by the court. The court noted that Madeline did not allege any fraud by Hartford Life; instead, she alleged fraud on the part of Paul’s parents. Furthermore, the conduct at issue occurred after the limitations period ended, and “fraudulent concealment cannot toll a limitations period that has already expired.” The court further explained that equitable tolling did not apply because Madeline had the necessary information to bring her claims well before the limitations period expired, and there were no “extraordinary circumstances” that would entitle her to equitable tolling. As a result, the court granted Hartford Life’s motion to dismiss the ERISA claims against it. The court declined to exercise supplemental jurisdiction over the remaining state law claims, and dismissed those claims without prejudice.

Fifth Circuit

Mitchell v. H-E-B, L.P., No. 25-50227, __ F. App’x __, 2025 WL 3496980 (5th Cir. Dec. 5, 2025) (Before Circuit Judges Jones and Engelhardt, and District Judge Robert R. Summerhays). Plaintiff Arieanna Mitchell brought this action against defendant H-E-B, asserting a single cause of action for “denial of benefits.” The only ERISA provision she cited in support of her claim was Section 510, which makes it “unlawful for any person to discharge…a participant or beneficiary…for the purpose of interfering with the attainment of any right to which such participant may become entitled under the plan.” The district court granted summary judgment to defendant H-E-B, concluding that Mitchell’s claim was untimely under Section 510’s two-year statute of limitations (borrowing from Texas law). Mitchell appealed to the Fifth Circuit, which affirmed in this brief per curiam decision. On appeal Mitchell attempted to characterize her claim as one for breach of fiduciary duty, which has either a three- or six-year statute of limitations, depending on actual knowledge of the breach. However, the Fifth Circuit ruled that Mitchell forfeited this argument by not raising it in the district court. Furthermore, the court held that Mitchell’s complaint inadequately alleged a breach of fiduciary duty, only mentioning such a violation in passing and in the context of explicitly citing Section 510 instead. As a result, Mitchell failed to provide H-E-B with fair notice of any breach of fiduciary duty claim. Thus, the Fifth Circuit concluded that the district court properly dismissed Mitchell’s complaint because it was brought after the expiration of the two-year statute of limitations for Section 510 claims, and affirmed the decision below in its entirety.