Nevada Resort Ass’n-Int’l Alliance of Theatrical Stage Emps. & Moving Picture Mach. Operators of the US & Canada Loc. 720 Pension Tr. v. JB Viva Vegas, LP, No. 24-2791, __ F.4th __, 2026 WL 32577 (9th Cir. Jan. 6, 2026) (Before Circuit Judges Rawlinson, Miller, and Desai)

In a first for Your ERISA Watch, we are covering a withdrawal liability case as our notable decision for the second week in a row. Last week, the Ninth Circuit tackled the issue of what constitutes the “building and construction industry” under ERISA, as amended by the Multiemployer Pension Plan Amendments Act (MPPAA). In this week’s edition, the very same court – indeed, the very same panel of judges – focused its attention on the MPPAA’s use of the term “employees in the entertainment industry.”

As we explained last week, Congress enacted the MPPAA in 1980 to strengthen pension protections in multiemployer plans. Before the MPPAA, ERISA “did not adequately protect multiemployer pension plans from the adverse consequences that resulted when individual employers terminated their participation in, or withdrew from, multiemployer plans.” Thus, under the MPPAA, an employer that withdraws from a multiemployer pension plan is liable for its share of the plan’s unfunded vested benefits in order to help keep the plan afloat.

However, employers do not always have to pay withdrawal liability because the MPPAA includes several exceptions. Last week we discussed one of them: work in the “building and construction industry.” In that case the court ruled that asbestos abatement fell within that exception because Congress intended the term “to include not only the erection of new buildings, but also maintenance, repair, and alterations that are essential to the buildings’ usability.” This case involved a different exception revolving around “employees in the entertainment industry.” Would the court interpret this term expansively as well?

The plaintiff in this case was – deep breath – the Nevada Resort Association-International Alliance of Theatrical Stage Employees and Moving Picture Machine Operators of the United States and Canada Local 720 Pension Trust. In the past, employees covered by the Trust’s pension plan primarily performed entertainment work. However, as time passed, Las Vegas hotels and other venues began hosting more conventions and trade shows. The Trust recognized this trend, and in 2013 it amended its plan restatement to state that it “is not an Entertainment Plan under ERISA.”

Meanwhile, from 2008 to 2016 the defendant, JB Viva Vegas LP, contributed to the plan on behalf of the stagehands for its production of “Jersey Boys.” When the musical closed, JB stopped contributing to the plan. The Trust demanded $913,315 in withdrawal liability.

In arbitration proceedings JB disputed its liability, contending that it qualified for the MPPAA’s entertainment exception. The arbitrator agreed, but when the case moved to federal court the assigned district court judge invalidated the award. The court ruled that the arbitrator “improperly shifted the burden of proof to the Trust and should have determined the plan’s status as an entertainment plan based on the year that JB withdrew from the plan, rather than the year it joined.” As a result, the court vacated the award and remanded to the arbitrator.

On remand, the arbitrator reversed itself and granted summary judgment to the Trust. The arbitrator concluded that the MPPAA was ambiguous because “it does not specify the amount of entertainment work an employee must perform to qualify as an entertainment employee.” Furthermore, the arbitrator held that the Trust reasonably concluded that the plan does not “primarily cover employees in the entertainment industry” because “less than half of its employees earned more than half of their wages from entertainment work.”

JB was understandably displeased with its reversal of fortune and filed this action to challenge the arbitrator’s decision. The parties filed cross-motions for summary judgment but JB went bust again; the court granted the Trust’s motion while denying JB’s. The district court ruled that “the plan does not primarily cover entertainment employees because fewer than half of its employees earned the majority of their wages from entertainment work.” JB appealed, and the Ninth Circuit issued this published opinion.

The Ninth Circuit noted that the MPPAA’s entertainment exception applies if “(1) the employer contributes to the plan ‘for work performed in the entertainment industry, primarily on a temporary or project-by-project basis,’ (2) ‘the plan primarily covers employees in the entertainment industry,’ and (3) the employer ends its entertainment work in the jurisdiction and does not resume the work within five years.”

The crux of the dispute was the second element. The parties agreed that a pension plan “primarily” covers entertainment employees if more than half of the covered individuals are employees in the entertainment industry. However, they disagreed about what constituted an “employee in the entertainment industry.” The Trust argued that “over 50 percent of an individual’s work must be in the entertainment industry for the individual to be an ‘employee[ ] in the entertainment industry,’” while JB argued that “the statute imposes no minimum entertainment-work requirement.”

The court observed that this was a question of first impression, and as expected looked first to the text of the statute. The court ruled that “the plain text of the entertainment exception unambiguously covers individuals performing any amount of entertainment work.” The court stated, “Under a plain reading of the text, an individual who performs work in the entertainment industry is an ‘employee in the entertainment industry.’ That is all that is required.” The statute did not state that a person’s work had to be “substantially” or “primarily” in the entertainment industry to qualify; “any amount of entertainment work suffices.”

The Trust argued that the provision was ambiguous because it gives “no instruction on how to determine if an employee should qualify as in the entertainment industry.” However, the court stated, “instructions are unnecessary…the text is plain on its face: an individual qualifies if they work in the entertainment industry.”

The Trust also argued that even if the statute was unambiguous, the court should still recognize a minimum entertainment-work requirement because ruling otherwise would lead to “absurd results.” The Trust argued that “it makes little sense to classify someone as an ‘employee[ ] in the entertainment industry’ when the person performs a minimal amount of entertainment work.”

However, the court responded that it could not take such liberties when the plain meaning of the statute indicated otherwise. Furthermore, the court observed, “Given the part-time nature of most entertainment work, it is possible that Congress intended ‘employees in the entertainment industry’ to include individuals who work multiple jobs or projects, some of which involve entertainment work and some of which do not.” In short, “Because the entertainment exception is unambiguous, we must enforce its clear meaning and refrain from writing in limitations that do not exist.”

The court further ruled that even if the text were ambiguous, as the Trust argued, it would still rule the same way because “the best reading of the exception is that ‘employees in the entertainment industry’ are individuals performing any amount of entertainment work.” The court noted that Congress “knew how to impose quantitative limits” when drafting the MPPAA because it had done so in other parts of the legislation. “Congress inserted language like ‘insubstantial portion,’ ‘substantially all,’ or ‘primarily’ to limit the applicability of withdrawal exceptions to employers and plans conducting a certain amount of work” when discussing other industries, such as construction and trucking. However, Congress did not do so with respect to the “entertainment industry”; the phrase “does not include any limiting language.”

As a result, the Ninth Circuit held that the Trust’s plan “‘primarily covers employees in the entertainment industry’ because there is no minimum entertainment-work requirement and the majority of employees covered by the plan perform some entertainment work.” The case was thus reversed and remanded, giving employers two victories in two days over how to interpret the MPPAA’s withdrawal liability exceptions.

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

Breach of Fiduciary Duty

Second Circuit

Dempsey v. Verizon Communications, Inc., No. 24 CIV. 10004 (AKH), 2026 WL 72197 (S.D.N.Y. Jan. 8, 2026) (Judge Alvin K. Hellerstein). The plaintiffs in this action are former participants in defendant Verizon Communications Inc.’s defined benefit pension plans. They filed this action against Verizon and related entities alleging that the defendants breached their fiduciary duties and engaged in prohibited transactions by purchasing annuities from Prudential Insurance Company of America (PICA) and RGA Reinsurance Company in terminating the plans through what is commonly known as a “pension risk transfer,” or PRT. Plaintiffs allege that PICA and RGA were unsuitable providers because they posed a high risk of default due to their use of captive reinsurance and modified co-insurance practices. They further argued that the annuity providers’ financial practices reduced transparency and increased liabilities, creating a substantial risk of future harm to plaintiffs’ benefits. Plaintiffs also alleged that the annuity transaction resulted in a $200 million shortfall between the plan assets transferred and the liabilities, violating ERISA. Defendants filed motions to dismiss, which the court ruled on in this order. First, defendants contended that plaintiffs lacked standing because they failed to allege a substantial risk of future harm or any present injury. They contended that the plaintiffs’ claims were speculative and that the annuity providers were reputable companies with strong financials, making the risk of default implausible. The court agreed, ruling that plaintiffs’ allegations were “conclusory and speculative.” The court stated that financial records showed “adequate assets and strong credit ratings for each of the Annuity Providers,” which were “substantial companies.” Furthermore, “reinsurance and modified coinsurance are common industry practices,” and “the use of such common industry practices does not create a substantial risk of default.” The court also rejected plaintiffs’ argument that their equitable remedies could create standing, because the diminution in value plaintiffs identified represented “an accounting value difference, not actual cash or profits realized by Verizon.” In any event, “Seeking an equitable remedy is insufficient to create standing without a concrete injury.” The court then addressed the merits of plaintiffs’ claims for breach of fiduciary duty and loyalty. The court agreed with plaintiffs that Verizon exercised fiduciary duties in selecting the annuity providers. However, plaintiffs failed to plausibly allege that a prudent fiduciary would not have selected those providers. Again, the court stated that the providers were “reputable insurance companies,” and plaintiffs “are unable to allege that the actual investments made by the Annuity Providers are suspect or point to other markers that would imply a high risk of default.” The court also rejected plaintiffs’ duty of loyalty claim based on allegations of conflict of interest. The court ruled that the financial connections between the defendants were “common business relationships” and thus did “not support a plausible inference of liability absent other allegations to support disloyalty.” Finally, the court addressed plaintiffs’ prohibited transaction claims. The court dismissed these as well, ruling that the sale of annuity contracts did not constitute the provision of services, and thus, the annuity providers were not parties in interest under ERISA. The court also found no prohibited transaction in Verizon’s balance sheet benefit from the annuity transaction, as there was no actual transfer of plan assets to Verizon. Thus, in the end, the court granted defendants’ motions to dismiss the case in their entirety. The dismissal was with prejudice because “Plaintiffs have not asked to replead and, it would seem, a repleading would be futile.”

Third Circuit

Cho v. The Prudential Ins. Co. of Am., No. 25-1134, __ F. App’x __, 2026 WL 74499 (3d Cir. Jan. 9, 2026) (Before Circuit Judges Krause, Phipps, and Fisher). Plaintiff Young Cho, a former employee and participant in The Prudential Insurance Company of America’s employer-sponsored defined contribution retirement plan, brought this putative class action against Prudential and its investment oversight committee (IOC). Cho contends that Prudential breached its fiduciary duty and failed to monitor its fiduciaries under ERISA due to deficiencies in its investment monitoring process, leading to imprudent investment decisions. Cho did not convince the district court, which granted summary judgment in favor of Prudential, concluding that Cho failed to raise a triable issue of fact regarding Prudential’s prudence in its investment decisions. Cho appealed to the Third Circuit, which issued this unpublished ruling. On appeal, Cho argued that Prudential’s fiduciary process was not sufficiently independent or grounded in objective data. Cho contended that Prudential’s external professional investment consultant, Bellwether Consulting LLC, “was not truly independent from the IOC” because it was founded by former Prudential employees and was “engaged without a competitive bidding process.” Cho also argued that the IOC’s quarterly meetings were too brief, briefing materials were not received sufficiently in advance, Prudential appointed unqualified members to the IOC, and it preferred its own affiliated investment products. The Third Circuit was not impressed. The court emphasized that the duty of prudence is a process-driven obligation, focusing on the fiduciary’s conduct in making investment decisions. The Third Circuit agreed with the district court that Prudential employed appropriate methods to investigate and determine the merits of investments. The court noted that the IOC’s process, which included engaging an independent consultant, holding regular meetings, and receiving regular updates, was adequate to satisfy ERISA’s duty of prudence. The IOC actively engaged with not just Bellwether, but also an internal group of investment professionals at Prudential, and there was no indication of passive acceptance of recommendations without independent investigation. The court also found that the IOC evaluated and monitored both affiliated and non-affiliated funds using the same criteria and process, receiving independent advice throughout. The court further concluded that the IOC engaged in a robust process for selecting and monitoring investments, and the record evidence confirmed generally positive performance for the challenged funds compared to benchmarks. As a result, the court affirmed the lower court’s issuance of summary judgment in Prudential’s favor.

Disability Benefit Claims

Fifth Circuit

Portier v. Hartford Life & Accident Ins. Co., No. CV 24-1717, 2026 WL 45078 (E.D. La. Jan. 7, 2026) (Judge Ivan L.R. Lemelle). From 2021 to 2023 Jody Portier received benefits from Hartford Life & Accident Insurance Company under an ERISA-governed group long-term disability benefit policy. During this period the policy had an “Own Occupation” standard, which required him to be unable to perform his specific job. After 24 months, the standard changed to “Any Occupation,” requiring Portier to be unable to perform the duties of any job to continue receiving benefits. Hartford conducted an Employability Analysis Report (EAR) to identify suitable occupations for Portier, considering his limitations. The EAR suggested that Portier could work as a “Superintendent, Maintenance,” a sedentary job with flexibility for breaks. As a result, Hartford terminated Portier’s benefits, informing him that he did not meet the policy’s “Any Occupation” definition of disability. Portier appealed this decision, providing additional medical opinions and personal statements about his conditions, including coronary artery disease, Crohn’s disease, knee osteoarthritis, and others. In response, Hartford obtained a report from an independent physician, who acknowledged Portier’s impairments but concluded that he could work full-time with certain limitations. Hartford upheld its decision based on this report. In doing so, Hartford acknowledged that Portier had been awarded Social Security disability benefits, but distinguished them on the ground that “the standards governing the award of social security benefits differs from those that apply to the award of LTD benefits.” Portier then filed this action. The parties filed cross-motions for judgment, which were adjudicated in this order. The court applied the abuse of discretion standard of review and ruled that Hartford’s decision was supported by substantial evidence, including medical records and opinions from both treating and independent physicians. Portier argued that Hartford failed to consider his self-reported complaints and the EAR was flawed. However, the court found that the administrative record contained numerous references to Portier’s complaints and Hartford had considered them. The court also found no procedural unreasonableness in Hartford’s actions, distinguishing this case from others where procedural issues affected the decision. Ultimately, the court granted Hartford’s motion for judgment on the administrative record and denied Portier’s motion, concluding that Hartford’s decision was not arbitrary or capricious.

Sixth Circuit

Elliott v. Unum Life Ins. Co. of Am., No. 3:25 CV 2303, 2026 WL 35851 (N.D. Ohio Jan. 6, 2026) (Judge James R. Knepp II). Eric J. Elliott, proceeding pro se, filed this action against Unum Life Insurance Company of America and Vontier Employment Services, LLC seeking injunctive, declaratory, and monetary relief under ERISA. Two months after filing the complaint, Elliott filed a one-page motion for a temporary restraining order seeking to “enjoin[] the termination of Long-Term Disability (LTD) benefits by the administrator, and preserving Plaintiff’s eligibility for the 60% LTD Buy-Up pending final adjudication of this matter.” (Your ERISA Watch can only assume that this action is related to a previous dispute we reported on between Elliott and Unum in our September 3, 2025 issue, although that action had a different case number and seemed to involve a different issue. His TRO requests in both cases met the same fate, however.) The court denied Elliott’s motion. The court noted that while pro se pleadings are given liberal construction, litigants must still adhere to the Federal Rules of Civil Procedure. Furthermore, a TRO is “an extraordinary and drastic remedy” and requires a “clear showing” of entitlement. Elliott could not clear this bar. The court could not conclude that he was likely to succeed on the merits of his ERISA claims based solely on his allegations.  Additionally, Elliott did not adequately demonstrate irreparable harm, as the harm described was economic and could potentially be remedied with monetary damages: “The Motion’s only cited support for irreparable injury is Plaintiff’s own conclusory statement of such… And the Complaint describes only economic harm, which Plaintiff has not persuasively demonstrated cannot be cured with monetary damages should he prove Defendants violated ERISA and that is he is entitled to greater long-term disability benefits than he has been provided.” The court concluded by indicating that it would schedule a case management conference once defendant Vontier had been served and answered the complaint.

Eighth Circuit

Hardy v. Unum Life Ins. Co. of Am., No. 23-563 (JRT/JFD), 2026 WL 36063 (D. Minn. Jan. 6, 2026) (Judge John R. Tunheim). In our September 11, 2024 edition we reported on plaintiff Mark W. Hardy’s victory in this action, in which the court concluded that defendant Unum Life Insurance Company of America wrongfully terminated his claim for long-term disability benefits. The parties could not agree on the amount of benefits due pursuant to the judgment, so the court requested additional briefing, which it assessed in this order. The court’s September 2024 order required Unum to pay Hardy retroactive benefits from the date of termination through the date of the order. Unum had responded by paying Hardy $90,445.98 on November 3, 2025 for the time period of December 11, 2020 through September 1, 2024, which the court found satisfied its obligations for that time period. The court also approved an interest rate of 4.37 percent for retroactive benefits because the parties had agreed upon that rate. As for the time period of September 2, 2024 to the present, Unum argued that the court’s judgment “does not award prospective benefits because (1) it does not expressly do so, and (2) the Policy requires ongoing proof of disability, and there is no evidence for Unum or the Court to evaluate on or after September 1, 2024, to determine whether Hardy is entitled to further benefits.” The court rejected both arguments, ruling that Unum was required “to pay Hardy benefits from September 2, 2024, to the present and continuing thereafter. Hardy is entitled to disability benefits until Unum determines that Hardy is no longer disabled under the terms of the Policy.” The court then addressed how those benefits should be calculated. Unum contended that Hardy’s 2025 benefits should be reduced by the amount of his anticipated December 2025 bonus, but the court vetoed this approach: “Under the Policy, Hardy is required to submit proof of earnings on a quarterly basis, after which Unum may adjust the benefit amount. The Policy does not permit Unum to estimate the amount of Hardy’s bonus and adjust his benefits.” The court ended its order with a warning: “The Court notes that the parties have likely expended more in attorneys’ fees litigating these issues than the amount separating their respective positions. Accordingly, the Court strongly encourages the parties to try resolve any remaining issues before seeking further relief from the Court.”

Discovery

Fourth Circuit

Ross v. International Brotherhood of Elec. Workers Pension Benefit Fund, No. 2:25-CV-00449, 2026 WL 74290 (S.D.W. Va. Jan. 9, 2026) (Judge Irene C. Berger). Plaintiff George A. Ross contends that the two defendants in this case, the International Brotherhood of Electrical Workers Pension Benefit Fund and the National Electrical Benefit Fund, improperly suspended his benefits. The core issue revolves around whether any benefit plan provision permitted the suspension and clawback of Ross’ pension based on his work as an estimator. Ross sought to conduct discovery into defendants’ decision-making processes and potential conflicts of interest, arguing that “‘the same decision makers orchestrated the suspension of Plaintiff’s benefits under both funds’ and the denial of benefits reflected an interest in keeping proceeds within the funds.” Ross further contended the administrative record as it currently sits “would not permit the court to evaluate the impact of the conflict of interest.” The assigned magistrate judge disagreed and denied Ross’ motion to conduct discovery. Ross objected, and in this ruling the district court judge agreed with the magistrate and overruled his objections. The court explained that “[w]hile any conflict of interest will be considered in evaluating whether the suspension of the Plaintiff’s benefits was an abuse of discretion or otherwise violated ERISA, additional discovery is not necessary to facilitate the Court’s consideration.” The court stated that the central issue was “relatively straightforward,” and “[d]iscovery into matters outside the administrative record will not likely assist in resolving that issue.” As a result, the magistrate judge’s “order denying discovery was not clearly erroneous or contrary to law.”

Life Insurance & AD&D Benefit Claims

Fifth Circuit

Guidry v. Metropolitan Life Ins. Co., No. CV 25-18-SDD-RLB, 2026 WL 49720 (M.D. La. Jan. 7, 2026) (Judge Shelly D. Dick). In this action plaintiff Katherine Crow Albert Guidry seeks to recover $504,000 in life insurance proceeds after the death of her husband, Jason Guidry. Jason worked for defendant Waste Management and received his coverage through its employee life insurance plan. In her complaint Katherine alleged that defendants created “a confusing chain of events to disqualify the decedent from the rights he secured prior to his cancer diagnosis to prohibit [Katherine’s] ability to collect on the policy of insurance.” Katherine brought suit under ERISA and three Louisiana statutes against Waste Management, Metropolitan Life Insurance Company, and Life Insurance Company of North America. (MetLife was the insurer and claim administrator of the life insurance plan, while LINA provided administrative services under Waste Management’s disability leave policies.) In this order the court ruled on four motions for either summary judgment or judgment on the administrative record brought by the three defendants, as well as motions to dismiss brought by Waste Management and MetLife. First, the court addressed Waste Management’s and MetLife’s motion for summary judgment, which was directed solely at the standard of review. The court found that the Waste Management benefit plan vested MetLife with discretionary authority to determine eligibility for benefits and to construe the terms of the plan, and thus the abuse of discretion standard of review applied. Next, the court considered LINA’s motion for summary judgment, which was based on ERISA preemption. The court found that ERISA preempted all of Katherine’s state law claims related to the employee benefit plan at issue, and thus dismissed them. The court then addressed the merits of Katherine’s claims. Katherine alleged that Jason “was not accorded all of his vacation time and Family Medical Leave Extended Time that allowed him to be classified, according to the Plan Administrators, as ‘actively at work’ as required under the Plan for entitlement to Optional Life Insurance coverage.” The court concluded that these allegations could not create liability for any of the three defendants. Taking Waste Management first, “the record shows that MetLife, not Waste Management, denied Plaintiff’s claim[.]” As a result, Katherine had no claim against Waste Management. As for MetLife, the court ruled that its denial of Katherine’s claim was not an abuse of discretion. According to the court, MetLife reasonably denied coverage because Jason was on a leave of absence, and not “actively at work,” on the date the optional coverage took effect. The court acknowledged Katherine’s argument regarding vacation time and medical leave, but stated there was “no evidence to support this assertion,” and “[t]here is also no evidence supporting Plaintiff’s theory that MetLife (or any of the Defendants) ‘manipulated the process to place him outside of his employment prematurely’ in an intentional effort to eliminate the Optional Life Insurance coverage.” As for LINA, Katherine argued “it is ‘suspicious’ that LINA did not give notice as to the status of Jason Guidry’s leave request until the date of his death.” However, the court ruled that there was no evidentiary support for her claims. “LINA approved the requests for leave and short-term disability coverage and was not involved in the denial of Optional Life Insurance. Further, there is no evidence supporting the argument that LINA (or any of the Defendants) convinced Jason Guidry or Plaintiff ‘that they would be better off’ if Jason Guidry sought leave status and short-term disability, thereby depriving them of Optional Life Insurance coverage.” As a result, the court granted the motions for summary judgment and judgment on the administrative record, resulting in the dismissal of Katherine’s claims against all defendants. The motions to dismiss were terminated as moot.

Medical Benefit Claims

Sixth Circuit

Patterson v. Swagelok Co., No. 1:20-CV-566, 2026 WL 74074 (N.D. Ohio Jan. 9, 2026) (Judge J. Philip Calabrese). Readers of Your ERISA Watch are familiar with the long-running dispute between husband and wife Eric and Laura Patterson on one side, and Eric’s employer, Swagelok Company, and the administrator of Swagelok’s employee health insurance plan, United Healthcare, on the other. (Just last month, we reported on the most recent installment, a published decision from the Sixth Circuit.) Both of the Pattersons were involved in separate motor vehicle accidents and received medical treatment paid for by United. They sought compensation from the insurers of the other drivers involved in their accidents and obtained settlements. United then pursued reimbursement of the medical costs it paid, based on a subrogation and reimbursement provision in a summary plan description of the healthcare policy. The Pattersons challenged the existence of such rights in the plan, leading to extensive litigation in both state and federal courts. Currently the Pattersons have two actions pending in federal court and one action pending in state court. The Pattersons consolidated their federal allegations into a single complaint, and the defendants moved to dismiss this combined complaint. First, the court addressed defendants’ standing arguments. The court found that Laura could not pursue any claims under ERISA because she was “not suffering a past, present, or future harm”; the court noted that the reimbursement action against her was “perpetually stayed” and “is expected to be voluntarily dismissed.” However, the court ruled that she had standing to allege claims under the Fair Debt Collection Practices Act (FDCPA) and under state law because she had alleged concrete injuries such as attorneys’ fees, costs, and loss of use of settlement funds due to multiple lawsuits. As for Eric, there was no dispute that he had standing under ERISA to pursue individual relief for the $25,000 he paid to defendants. However, the court ruled that under the law-of-the-case doctrine, Eric was limited to seeking recovery of that amount only pursuant to the Sixth Circuit’s rulings, and he could not pursue any claims on behalf of the plan. Furthermore, Eric conceded he could no longer pursue any of his state law claims, as they were preempted. The court noted that the Sixth Circuit did not address whether Eric could represent a class, leaving open the possibility of class action proceedings down the road. Next, the court addressed the issue of collateral estoppel, determining that it could not be applied at this stage due to unresolved questions about the applicability of plan documents and privity between defendants and the plan. The court then addressed Laura’s claims, ruling first that she could not maintain a FDCPA claim because defendants did not treat the subrogation or reimbursement rights as a debt in default. As for her remaining state law claims, the court ruled that ERISA completely preempted her civil conspiracy claim but not her claims for malicious prosecution, abuse of process, or tortious interference, as these claims were based on defendants’ non-fiduciary conduct. In short, the court granted in part and denied in part the motion to dismiss, allowing Eric to proceed with ERISA claims and Laura to proceed with her state law claims, except for civil conspiracy.

Pension Benefit Claims

Second Circuit

Williams v. Metro North Railroad Human Resources Dep’t, No. 25-CV-7473 (LTS), 2026 WL 72156 (S.D.N.Y. Jan. 7, 2026) (Judge Laura Taylor Swain). Derick Williams was employed by Metro-North Railroad as a coach cleaner and was terminated in 2018. A few months later he attempted to obtain a “retirement ID pass” from Metro-North Railroad’s human resources department but was told he was not eligible due to his termination. Williams believes that he is eligible for the pass because his right to it vested before his termination. As a result, he filed this pro se action claiming that Metro-North violated ERISA by denying him access to a vested benefit and failing to provide a plan document. The court previously granted Williams’ request to proceed in forma pauperis, i.e., without paying fees, but in this order it dismissed his complaint. The court explained that “[t]o state a claim under ERISA, a plaintiff must allege: (1) that the benefit plan is governed by ERISA, (2) that the plaintiff is a participant in the plan, and (3) that the defendant breached its duty to pay the plaintiff under the terms of the plan.” However, Williams “offers no details concerning the ‘retirement ID pass’ that is the subject of this lawsuit. He neither describes the nature of the ‘retirement ID pass’ nor explains what, if anything, he would be able to obtain with the pass. Plaintiff does not allege any facts that would allow the Court to conclude that the ‘retirement ID pass’ confers benefits consistent with an employee welfare benefit plan or an employee welfare pension plan under ERISA.” As a result, the court ruled that he had failed to state a claim under ERISA. Furthermore, the court noted that Williams had not brought his suit against the proper defendant. Williams “names Metro-North Railroad Human Resources Department as the sole defendant, but he does not allege any facts suggesting that Metro-North Human Resources Department is the ‘administrator’ or the ‘plan sponsor’ of Metro-North Railroad’s retirement plan. He has therefore failed to state an ERISA claim against Defendant Metro-North Human Resources Department.” The court thus dismissed Williams’ action, but gave him 30 days to amend his complaint to allege a proper claim for relief under ERISA against the correct party.

Provider Claims

Fifth Circuit

Columbia Hosp. at Medical City Dallas Subsidiary, LP v. Anthem Health Plans of Virginia, Inc., No. 3:25-CV-0689-X, 2026 WL 36075 (N.D. Tex. Jan. 6, 2026) (Judge Brantley Starr). This is a reimbursement dispute between a group of acute care facilities in North Texas, collectively referred to by the court as “Medical City,” and Anthem Health Plans of Virginia over medical care provided in 2021-22 to three patients who were insured by Anthem. Medical City contends that the treatment it provided was medically necessary and that it communicated with Anthem through Blue Cross Blue Shield of Texas according to the procedures of the Blue Card Program, of which Anthem is an affiliate. Anthem partially paid for one patient’s treatment but ultimately denied reimbursement for the remaining claims, citing lack of medical necessity or failure to obtain preauthorization. Medical City seeks $342,007.83 in unpaid reimbursement pursuant to four claims: “breach of contract (Count I), breach of an implied-in-fact contract (Count II), breach of the health plans (Count III), and breach of contract for non-ERISA plans (Count IV).” Anthem moved to dismiss Count III for lack of derivative standing, moved to dismiss the remaining counts for failure to state a claim, and alternatively moved to compel arbitration. The court ruled that Medical City plausibly pled derivative standing based on the patients’ assignments of benefits, which were effected through a “Conditions of Admission” form. The court also found that Medical City plausibly alleged breach of contract, asserting that Anthem, though a non-signatory, was bound by the hospital agreement Medical City signed with Blue Cross Texas, with which Anthem was affiliated through the Blue Card Program. The court noted that “Anthem denied the claims based on alleged lack of medical necessity and failure to obtain preauthorization – not because it was not bound by the Agreement.” Thus, Medical City had properly alleged that Anthem impliedly assumed the Agreement’s obligations. Finally, the court noted that the parties agreed that the hospital agreement at issue “contains a valid arbitration clause, including a delegation clause governing the arbitrability of claims.” Thus, because “Medical City’s claims arise out of and relate directly to the Agreement, the Court must enforce the arbitration agreement under the Federal Arbitration Act.” As a result, the court granted Anthem’s motion to compel arbitration and denied without prejudice the remainder of Anthem’s Rule 12(b)(6) motion because “the valid arbitration agreement and delegation clause deprive the Court of jurisdiction to decide the merits of the remaining claims.” The court ordered the parties to update the court every three months on the status of the arbitration proceedings.