‘Twas another slow week in ERISAland, as the federal courts put aside breaches of fiduciary duty for turkey, stuffing, and cranberry sauce. Nevertheless, some judges were devoted enough to delve into ERISA’s intricacies. Read on to find out about (1) the exclusion of expert witness testimony in the class action by NFL players against the league’s disability plan (Alford v. NFL), (2) two diverging discovery rulings in benefit cases (Kelly v. Valeo (no discovery allowed), Miller v. American United (sure, why not)), and (3) whether Johnson & Johnson’s health plan participants have standing to pursue claims that the plan overpaid for prescription drugs (nope, Lewandowski v. Johnson & Johnson). It was a bad week for health care providers as well, as two were bounced out of court on motions to dismiss (Murphy v. Emblem, Abira v. United), and a third lost on appeal (Dedicato v. Aetna).

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

Breach of Fiduciary Duty

Third Circuit

Lewandowski v. Johnson & Johnson, No. 24-671 (ZNQ) (RLS), 2025 WL 3296009 (D.N.J. Nov. 26, 2025) (Judge Zahid N. Quraishi). Plaintiffs Ann Lewandowski and Robert Gregory are former employees of Johnson & Johnson and participants in its health benefit plans who allege that the defendants, Johnson & Johnson and its Pension & Benefits Committee, breached their fiduciary duties under ERISA. Specifically, they contend that defendants mismanaged the prescription drug benefits program, resulting in excessive costs for the plans and their participants. These costs allegedly included higher payments for prescription drugs, premiums, out-of-pocket expenses, deductibles, coinsurance, and copays. The plaintiffs also alleged that the defendants steered beneficiaries toward a mail-order pharmacy that charged higher prices than retail pharmacies, failed to incentivize the use of lower-priced generic drugs, and inadequately negotiated contracts with pharmacy benefit managers (“PBMs”), leading to higher drug prices for participants. Previously, the court granted defendants’ motion to dismiss plaintiffs’ fiduciary breach claims, concluding that plaintiffs lacked standing. (Your ERISA Watch covered this decision in our January 29, 2025 edition.) The court allowed plaintiffs to amend their complaint, and defendants responded with another motion to dismiss. In this order, the defendants prevailed once again on their standing arguments. The court again determined that the plaintiffs’ alleged injuries – higher premiums and out-of-pocket costs – were speculative and not directly traceable to the defendants’ actions. The court found that the connection between the administrative fees paid by the plans to the PBM and the plaintiffs’ contribution rates was tenuous. Additionally, the court noted that the plans vested the defendants with sole discretion to set participant contribution rates, which could be influenced by various factors unrelated to prescription drug benefits. The court also found that the plaintiffs’ allegations of economic harm lacked sufficient specificity and failed to establish a plausible causal connection. The court further ruled that even if the plaintiffs prevailed and obtained the relief they sought, the defendants could still increase participant contribution rates under the terms of the plans without violating ERISA, and thus plaintiffs failed the redressability test. As a result, the court once again ruled that plaintiffs’ complaint did not meet Article III’s standing threshold and dismissed it. The court did give plaintiffs one more try, however, so we will likely see another order on this issue in 2026.

Discovery

Sixth Circuit

Kelly v. Valeo N. America, Inc., No. 2:24-CV-11066-TGB-KGA, 2025 WL 3269526 (E.D. Mich. Nov. 24, 2025) (Judge Terrence G. Berg). Plaintiff Thomas Kelly filed this action asserting that he has been underpaid pension benefits. He worked for Siemens from 1985 to 1993, Valeo North America, Inc. from 1997 to March 1998, and Valeo Sylvania LLC (a joint venture between Valeo and Osram Sylvania) from April 1998 until his termination in 2012 at the age of 51. Valeo concluded that Kelly was not eligible for Early Retirement benefits because he was not employed by Valeo at age 55, a requirement under the Plan. Instead, Kelly qualified for Deferred Vested Pension benefits, which are subject to actuarial reductions for retirement before age 65. Subsequently, Kelly applied for Early Retirement Benefits in 2019, but Valeo denied his application, reiterating that he did not meet the age requirement at the time of his termination. This lawsuit followed. Kelly now seeks discovery based on “perceived bias” by Valeo, as well as procedural errors in the handling of his claim. For example, he contends that the administrative record as produced by Valeo is insufficient; he alleges that it is incomplete, includes irrelevant documents, and omits documents he provided to Valeo. The court denied Kelly’s motion. It found that Kelly failed to provide evidence of bias or procedural defects, offering only general allegations without factual support. While Kelly listed documents he claimed were missing from the record, he did not supply those documents to Valeo for review or explain how their inclusion would impact the administrator’s decision. Furthermore, Valeo asserted that the record included all relevant documents in its possession, except privileged communications, and offered to review and include any additional documents Kelly provided, but Kelly did not pursue this option. The court further found that Valeo complied with ERISA’s procedural requirements, and thus Kelly was afforded due process. The court noted that mere allegations of bias or procedural defects are insufficient to warrant discovery, and that Kelly failed to establish a factual basis for his claims. As a result, the court denied Kelly’s motion and advised him that he could reassert his arguments on summary judgment.

Eleventh Circuit

Miller v. American United Life Ins. Co., No. 8:25-CV-1670-KKM-AAS, 2025 WL 3269397 (M.D. Fla. Nov. 24, 2025) (Magistrate Judge Amanda Arnold Sansone). Plaintiff Vicki Miller brought this action seeking long-term disability benefits under an ERISA-governed group employee plan insured by defendant American United Life Insurance Company. Miller requested permission to conduct discovery beyond the administrative record to support her claim that the denial of her claim was arbitrary and capricious and influenced by self-interest. American did not oppose the request. As a result, the court granted her request for limited discovery, subject to specific parameters agreed upon by the parties. The court allowed Miller to depose American’s corporate representative, limiting her inquiries to the following topics: “1. The exact nature of the information considered by the fiduciary in making the decision. 2. Whether the fiduciary was competent to evaluate the information in the administrative record. 3. How the fiduciary reached its decision. 4. Whether given the nature of the information in the record it was incumbent upon the fiduciary to seek outside technical assistance in reaching a ‘full and fair review’ of the claim. 5. Whether a conflict of interest exists. 6. To determine the proper standard of review. 7. Whether the Defendant followed proper procedures in reviewing and denying the Plaintiff’s claim. 8. Whether the record is complete.” The court emphasized that American reserved the right to object to individual discovery requests, including their format.

ERISA Preemption

Ninth Circuit

Dedicato Treatment Ctr., Inc. v. Aetna Life Ins. Co., No. 24-6487, __ F. App’x __, 2025 WL 3269214 (9th Cir. Nov. 24, 2025) (Before Circuit Judges Wardlaw, N.R. Smith, and Miller). This is an action by plaintiff Dedicato Treatment Center, which specializes in substance abuse treatment, against defendant Aetna Life Insurance Company for underpayment of benefits assigned to Dedicato by three of its patients. Dedicato brought six state law causes of action against Aetna, and the district court dismissed them all, ruling they were preempted by ERISA. Dedicato appealed, and in this very brief three-paragraph memorandum decision, the Ninth Circuit affirmed. Relying on its recent decision in Bristol SL Holdings, Inc. v. Cigna Health & Life Ins. Co., 103 F.4th 597 (9th Cir. 2024), the court explained that a state law claim impermissibly “refers to” an ERISA plan if it is premised on the existence of an ERISA plan or if the plan’s existence is essential to the claim’s survival. Here, Dedicato’s claims referenced the Aetna-administered ERISA plans because they were based on services covered by the plans and sought payments for those services through state contract law. Furthermore, the court found that Dedicato’s claims had an impermissible connection with the ERISA plans because they risked subjecting insurers to liabilities based on numerous phone calls and their varying treatment under state law, which would disrupt uniform plan administration.

Pleading Issues & Procedure

Fourth Circuit

Alford v. The NFL Player Disability & Survivor Benefit Plan, No. CV JRR-23-358, 2025 WL 3274428 (D. Md. Nov. 24, 2025) (Magistrate Judge Erin Aslan). This high-profile case was brought by former National Football League players who applied for disability benefits under the NFL Player Disability & Survivor Benefit Plan. The plan offers a variety of benefits depending on the claimant’s impairments and how they were acquired (e.g., in the line of duty). The players contend that the plan’s allegedly neutral physicians are biased and financially incentivized to render opinions adverse to applicants, undermining the integrity of the claims and appeals process. They further assert a systematic pattern wherein higher compensation correlates with flawed, result-oriented opinions against applicants. The players also assert that defendants breached fiduciary duties by providing misleading information about the plan. Based on these allegations, the players have asserted multiple ERISA violations. In this decision, a magistrate judge ruled on motions from both sides to exclude expert testimony and reports. The players moved to exclude the testimony of defense expert Dr. David B. Lasater, while defendants sought to exclude the testimony of the players’ experts Dr. Anthony Hayter and Joseph A. Garofolo. The court denied the players’ motion to exclude Dr. Lasater, finding that his statistical analysis of plan data was reliable and admissible. Although the plaintiffs challenged the reliability of his opinion, the court determined that their arguments addressed the weight and credibility of his testimony, which must be addressed at trial. As for defendants’ motion to exclude Mr. Garofolo, the court granted it. Mr. Garofolo is an attorney with experience in employee benefits, ERISA, and health, welfare, and retirement plans, who offered “opinions regarding the Plan’s use of Neutral Physicians and other practices that outline what he would have done if he had been a Plan fiduciary.” The court found that much of Mr. Garofolo’s opinions applied law to facts, which invaded on the province of the court: “It is improper for Mr. Garofolo to opine on legal principles related to the issues and claims presented in this case.” Furthermore, the court found his opinion unreliable because, although he recommended certain claim practices, he did not identify any plans that followed those practices. As for Dr. Hayter, the court rejected defendants’ challenge to his rebuttal to Dr. Lasater’s report. However, the court agreed with defendants that parts of Dr. Hayter’s report were not supported by “accepted and reliable methodology,” and were “results-driven” and “outcome-oriented.” The court also criticized parts of Dr. Hayter’s report that accepted the players’ allegations uncritically and without conducting due diligence to ensure their accuracy. As a result, the court excluded these parts of Dr. Hayter’s report as well. Other motions in this case are pending, including a motion for class certification, so this case is far from over.

Provider Claims

Second Circuit

Murphy Medical Associates, LLC v. EmblemHealth, Inc., No. 3:22-CV-00059 (SVN), 2025 WL 3282251 (D. Conn. Nov. 25, 2025) (Judge Sarala V. Nagala). The plaintiffs in this case are medical providers who have filed numerous cases in numerous jurisdictions alleging that they have been underpaid for COVID-19 testing and related services to thousands of patients beginning in March 2020. Plaintiffs alleged that some of these patients were enrollees of health plans sponsored or administered by the defendants. As out-of-network providers, plaintiffs claimed they could only identify enrollees of the defendants’ plans if patients provided their insurance information, which often lacked sufficient detail to determine the governing health plan. Plaintiffs further alleged that the defendants refused to disclose whether the plans were governed by ERISA, despite requests for this information. The court granted defendants’ motion to dismiss plaintiff’s initial complaint on numerous grounds in October of 2024 (Your ERISA Watch covered this decision in our October 9, 2024 edition), but allowed plaintiffs to file an amended complaint. After they did so, defendants filed another motion to dismiss, which was granted in this order. First, the court narrowed the parties, ruling that the only plaintiff that could pursue any claims was Diagnostic and Medical Specialists of Greenwich, LLC (“DMSOG”), because the assignments executed by the patients only mentioned DMSOG. The court then addressed the merits of plaintiffs’ claim for benefits under ERISA and found them wanting, stating, “Plaintiffs have corrected few, if any, of the deficiencies previously identified in the Court’s ruling on Defendants’ motion to dismiss Plaintiffs’ initial complaint.” The court stated that plaintiffs failed to identify the specific health plans at issue, allege facts establishing that ERISA governed the plans, or demonstrate that the plans covered the claims benefits sought. The court also rejected plaintiffs’ argument that the Families First Coronavirus Response Act (“FFCRA”) and the Coronavirus Aid, Relief, and Economic Security Act (“CARES Act”) mandated reimbursement for COVID-19 testing regardless of plan language. Additionally, the court found that plaintiffs failed to exhaust administrative remedies as required under ERISA. Plaintiffs’ conclusory assertions of exhaustion and allegations of futility were deemed insufficient. The court held that plaintiffs did not provide fundamental details about the appeals process or demonstrate that pursuing administrative remedies would have been futile. Finally, the court dismissed the plaintiffs’ state law breach of contract claim, finding that plaintiffs failed to allege the existence of any contract directly between them and the defendants. Without allegations concerning the terms of the non-ERISA health plans, the court could not conclude that plaintiffs could enforce any contractual rights or that any specific contract terms were breached. As a result, the court granted defendants’ motion to dismiss in its entirety. This time it did so “without leave to further replead,” noting that other courts had arrived at similar conclusions in other cases filed by plaintiffs.

Third Circuit

Abira Med. Laboratories, LLC v. United HealthCare Servs., Inc., No. 24-7375 (MAS) (TJB), 2025 WL 3282272 (D.N.J. Nov. 25, 2025) (Judge Michael A. Shipp). Plaintiff Abira Medical Laboratories, LLC (d/b/a Genesis Diagnostics), like Murphy Medical Associates in the above case, has been a prodigious litigant in the last few years. It is a New Jersey-based company providing various laboratory testing services, including clinical laboratory, pharmacy, genetics, rehabilitation, and COVID-19 testing. As in previous cases, Abira claims that laboratory testing service requisitions submitted on behalf of defendant United HealthCare’s insureds included an assignment of benefits, creating contractual obligations for United to pay for the services provided by Abira. After Abira amended its initial complaint, United filed a motion to dismiss it, which was granted by the court in March of 2025. In that order the court did not rule on United’s ERISA preemption arguments because it dismissed the state law claims in Abira’s complaint on other grounds. Abira filed a second amended complaint, which added a claim for benefits under ERISA. United filed another motion to dismiss, which the court ruled on in this order. The court addressed Abira’s ERISA claim first. It was unconvinced by United’s argument that Abira failed to exhaust administrative remedies because Abira alleged that it properly submitted claims and appeals, and United did not meet its burden of proving that Abira failed to exhaust. However, the court was persuaded that Abira had not properly stated a claim for relief because it did not identify any specific ERISA plan or cite plan language entitling it to benefits: “Plaintiff admits it does not even know if certain claims are subject to ERISA plans and provides no allegations on information and belief regarding any provision of any plan for which it alleges it is entitled to relief… Plaintiff’s vague pleading that benefits are due does not satisfy its burden here.” The court also granted United’s motion on Abira’s state law claims, ruling that (1) Abira’s breach of contract allegations were conclusory and thus the complaint “fails to plead sufficient facts regarding the terms of the underlying contract that entitle it to payment,” (2) Abira’s claim for breach of the implied covenant of good faith and fair dealing foundered without an underlying breach of contract claim, and (3) Abira could not pursue a quantum meruit claim because it did not plausibly establish that a duty was owed to it under any underlying non-ERISA plan. As a result, the court granted United’s motion to dismiss, albeit without prejudice. Abira was afforded a final opportunity to address the above deficiencies.

Statute of Limitations

Second Circuit

Abukhadra v. Calyon Supplemental Exec. Ret. Plan, No. 25 CIV. 02134 (LLS), 2025 WL 3281502 (S.D.N.Y. Nov. 25, 2025) (Judge Louis L. Stanton). Omar Abukhadra began working at Credit Agricole Corporate and Investment Bank (“Calyon”) in 1989 and was enrolled in its supplemental executive retirement plan (“SERP”). After his termination in 2005, Abukhadra received a severance payment of approximately $9 million in 2006 and remained eligible for SERP benefits. In 2010, he received a Summary Plan Document (“SPD”) outlining the terms of the retirement plan, and in 2011, he received a Summary of Benefits listing his six highest-salaried years but excluding his severance payment. Abukhadra became eligible for SERP benefits in August 2023 and received a letter detailing payment options. Upon reviewing the letter, he discovered that the SERP’s terms classified his severance payment as “compensation,” meaning it should have been included in the calculation of his retirement benefits. However, Calyon informed him in January 2024 that the severance payment would not be included, relying on the SPD’s definition of “compensation,” which conflicted with the SERP’s definition. Abukhadra filed this action, and Calyon responded with a motion to dismiss, contending that his claim was time-barred under the applicable six-year statute of limitations.  Calyon argued that the statute of limitations began in 2011 when Abukhadra received the Summary of Benefits that omitted his severance payment. The court disagreed, finding that the Summary of Benefits did not contain enough information to place Abukhadra on notice of the miscalculation. The document did not define “compensation,” reference the SERP or SPD, or indicate the conflicting definitions. It merely listed his six highest-salaried years and an annual benefits estimate, which was too indefinite to trigger the statute of limitations. The court further rejected defendants’ argument that Abukhadra, as a sophisticated business executive, should have consulted documents from two decades prior to identify potential inconsistencies, citing Second Circuit precedent that beneficiaries are not required to make a “sophisticated chain of deductions” to identify miscalculations. As a result, the court denied the motion to dismiss, finding that Abukhadra did not have sufficient notice of the alleged miscalculation until August 2023, and thus the statute had not run.