Sadly, we have no notable decision to highlight for you this week. Still, the federal courts tackled numerous issues across the ERISA spectrum, including pension, health, disability, and severance claims.
Read on to learn about (1) whether a plan administrator can get hit with statutory penalties for not producing administrative service agreements upon request (Bill H. v. Anthem); (2) a judge refusing to reconsider her dismissal of a challenge to Alcoa’s offloading of billions in pension risk to annuity company Athene (Camire v. Alcoa); (3) the latest in a series of cases addressing the legality of tobacco surcharge provisions in health plans (Noel v. PepsiCo); (4) the Fifth Circuit’s rejection of a claim for benefits under the Anadarko change of control severance plan (Miller v. Anadarko), creating an arguable circuit split; (5) the dismissal of yet another lawsuit against a health insurer by medical provider Rowe Plastic Surgery (Rowe Plastic Surgery v. Anthem); and last, but not least, (6) the end of an ESOP breach of fiduciary duty case resulting in an award of $11,029.50 in damages…accompanied by $2.36 million in attorneys’ fees (Robertson v. Argent Trust).
Of course, there’s more in the event these teasers do not whet your appetite. We’ll see you next week.
Below is a summary of this past week’s notable ERISA decisions by subject matter and jurisdiction.
Attorneys’ Fees
Fifth Circuit
Catalani v. Catalani, No. 5:25-CV-01585-JKP, 2026 WL 526722 (W.D. Tex. Feb. 25, 2026) (Judge Jason Pulliam). This is an interpleader action concerning the distribution of assets from the B. Catalani, Inc. Employees’ Profit Sharing Plan. (Fun fact: B. Catalani is a Texas produce supplier whose registered trademark slogan is “Let-tuce Supply You.”) Dan Catalani, a participant in the plan, passed away in 2024, leaving behind his wife, Anna Catalani, and two daughters, Allison and Amanda Catalani. Shortly before his death, Dan submitted a beneficiary designation form to the plan in which he designated Allison and Amanda as beneficiaries, each to receive fifty percent of the remaining amount in his account. At issue was whether the Qualified Joint Survivor Annuity (QJSA) rules in ERISA applied. If they did, the designation would not control and Anna would receive fifty percent while Allison and Amanda would receive twenty-five percent each. According to the three family members, they contacted the plan before the lawsuit was filed and asked for time to discuss an amicable resolution in an effort to avoid litigation. They were eventually able to agree on a 50/25/25 distribution, as contemplated by QJSA rules. However, before they could finalize the agreement, the plan and its trustees allegedly jumped the gun, filed this interpleader action, naming the three family members as competing claimants, and deposited the funds at issue with the court. Because the family had agreed on the allocation of funds, they filed a motion to enter final judgment. Meanwhile, plaintiffs filed a motion for attorney’s fees, seeking $107,000. The court held a hearing in which it made an “oral pronouncement of an award of costs and attorney’s fees to Plaintiffs in the amount of $10,000.00,” but in this order, after reviewing Fifth Circuit authorities on the issue, the court “reconsidered its pronouncement.” First, the court noted that plaintiffs admitted they were “seeking ‘more than the fees [they] incurred in drafting the Interpleader and Declaratory Action’”; instead, they sought “all of the fees [they] have incurred in trying to resolve this conflict.” Furthermore, and more importantly, the court found that plaintiffs were “partially to blame” for the litigation. The reason there was a dispute over whether the QJSA rules applied was because the plan administrator “missed the box” it was supposed to check during a 2006 amendment and restatement of the plan which would have applied the QJSA rules. As a result, “the Court finds Plaintiffs initiated litigation that, at its base, simply required the untangling of Plaintiffs’ own errors. Because Plaintiffs’ actions ‘are in part responsible for causing this litigation,’ rewarding their endeavors with costs and attorney’s fees is inappropriate here.” Finally, the court noted that “Plaintiffs’ counsel did not demonstrate to the Court’s satisfaction that it is a disinterested stakeholder,” as required under Fifth Circuit precedent. Plaintiffs stated that part of the reason they brought the action was because they wanted “to make sure that there’s no exposure” to the trustees and the plan. The court did not “find it necessary to determine the degree to which Plaintiffs are disinterested stakeholders,” but merely noted the contradiction “for any reviewing court.” As a result, the court granted defendants’ motion to enter final judgment reflecting their agreement to the 50/25/25 disbursement, and denied plaintiffs’ motion for fees and costs.
Breach of Fiduciary Duty
Second Circuit
Noel v. PepsiCo, Inc., No. 24-CV-7516 (CS), 2026 WL 558118 (S.D.N.Y. Feb. 27, 2026) (Judge Cathy Seibel). Krista Noel is an employee of Frito-Lay, a subsidiary of PepsiCo, and is a participant in PepsiCo’s ERISA-governed health plan. The plan imposes a tobacco surcharge of on participants who indicate during enrollment that they used tobacco in the previous six months. If participants complete a four-week tobacco cessation program between May 1 and November 30, they are exempt from the surcharge for the following plan year. If completed later, the surcharge is removed prospectively, but no reimbursement is provided for the period before completion. Noel filed this putative class action against PepsiCo and related defendants, alleging that the tobacco surcharge is unlawful because participants who complete the program mid-year do not receive retroactive reimbursement for surcharges already paid, violating ERISA’s requirement that participants receive the “full reward.” Noel also claimed that defendants failed to communicate to participants the availability of a reasonable alternative standard and breached their fiduciary duty by implementing the unlawful program and using proceeds to offset their contributions to the plan. Defendants moved to dismiss for lack of subject matter jurisdiction and failure to state a claim. The court addressed jurisdiction first, examining whether Noel had standing to bring her claims. Defendants contended that the time limitations she challenged “never actually affected” her because of the specific timing of her participation and her spouse’s non-participation in the program. Defendants further contended that Noel could not challenge the allegedly deficient notices because she completed the program even though the notices never changed, thus there was no traceable injury. The court was unimpressed by defendants’ arguments, noting that their facts “do not contradict Plaintiff’s allegation that she paid a surcharge that she contends was unlawful. This allegation suffices to establish a concrete harm for standing purposes… Plaintiff need not allege that she was specifically impacted by the elements of the Ex Program that rendered it noncompliant; the mere fact that Defendants required her to pay a surcharge without offering a compliant program suffices to establish that her injury is traceable to Defendants’ unlawful conduct.” The same rationale supported Noel’s standing on her breach of fiduciary duty claim as well. However, the court ruled that Noel did not have standing to seek injunctive or prospective relief because she failed to demonstrate a likelihood of future injury. Moving on to the merits of Noel’s claims, the court noted that the term “full reward” was not defined by ERISA or its regulations, but ruled that even if it accepted Noel’s interpretation of that term – i.e. requiring “the full amount across the entire Plan year” – the plan satisfied this requirement. “Defendants explicitly allowed participants to avoid the surcharge entirely by completing the Ex Program within the designated period during the previous year… Because ERISA only requires employers to provide one opportunity per year for participants to qualify for the reward under the program…Defendants’ program is compliant even assuming that they are required to remove the entire annual surcharge in order to remit the ‘full reward[.]’” The court dismissed Noel’s claims regarding inadequate notification on the same grounds; the notifications could not be illegal if the program it described was legal. Finally, the court dismissed Noel’s breach of fiduciary duty claim, ruling that defendants were performing a settlor, not a fiduciary, function in designing the allegedly deficient plan. Noel argued that defendants engaged in fiduciary acts by carrying out their duties in administering the plan, but this distinction was “illusory…[t]here can be no breach of fiduciary duty where an ERISA plan is implemented according to its written, nondiscretionary terms[.]” Nor was the court convinced by Noel’s argument that defendants used the tobacco surcharge “to offset their own obligations to contribute to the Plan.” The court noted that Noel brought this claim on behalf of the plan under 29 U.S.C. § 1132(a)(2), and it was “unclear how this conduct could have caused injury to the Plan, as opposed to the individuals from whom the surcharge was collected,” because “[t]he amount contributed to the Plan would seemingly be the same, regardless of whether the contributions were coming from Defendants or tobacco-using participants.” As a result, the court granted defendants’ motion to dismiss in its entirety, and declined to grant leave to amend, noting that Noel had already amended once and did not request further amendment.
Ninth Circuit
Robertson v. Argent Trust Co., No. CV-21-01711-PHX-DWL, 2026 WL 508808 (D. Ariz. Feb. 20, 2026) (Judge Dominic W. Lanza). Plaintiff Shana Robertson brought this case as a putative class action against the Argent Trust Company, claiming that the company breached its fiduciary duties and engaged in prohibited transactions in its administration of the Isagenix Worldwide, Inc. Employee Stock Ownership Plan (ESOP). Argent scored an early win in the case when the court granted its motion to compel arbitration. Robertson had argued that the arbitration provision in the plan was unconscionable under Arizona law and void under the effective vindication doctrine because it restricted her rights under ERISA, but the court disagreed and found the provision enforceable. (Your ERISA Watch reported on this decision in our August 3, 2022 edition.) But be careful what you wish for; it was all downhill from there for Argent. The court denied Argent’s request for attorney’s fees for winning its motion to compel, lifted the stay temporarily to allow Robertson to add eight defendants, and then Robertson prevailed in arbitration in June of 2025 after a five-day hearing. The arbitration panel ordered Argent and the selling shareholder trusts to pay Robertson $11,029.50 in damages, $2,359,909 in attorneys’ fees, and $132,310.97 in costs. Robertson moved to confirm these awards. In September of 2025 the court denied Robertson’s motion because it desired more information about the basis for the underlying awards. Robertson provided that information in a new motion, while the trusts, joined by Argent, filed a motion to vacate the awards. The trusts argued that the arbitration panel exceeded its power under the Federal Arbitration Act by “exercis[ing] jurisdiction over an entity lacking the legal capacity to be a party to the proceedings,” and “ignor[ing] settled principles of trust law requiring that actions involving common law trusts be brought against the trustee as the proper legal representative of the trust.” The trusts also argued that they “were not parties to the arbitration agreement” because they were nonsignatories. Addressing the second argument first, the court agreed with Robertson that the trusts were bound by the agreement under the assumption doctrine, under which a nonsignatory “may be bound by an arbitration clause if subsequent conduct indicates that the party is assuming the obligation to arbitrate.” The court found that the trusts’ “conduct demonstrated a clear intent to arbitrate Plaintiff’s ERISA claim” because they “actively participated in the arbitration proceeding,” “retained separate counsel,” “participated in a five-day hearing,” “offered merits-based defenses to Plaintiff’s ERISA claim that were distinct from Argent’s merits-based defenses,” and “failed to submit evidence that they ever objected to the Panel’s jurisdiction over them due to their status as nonsignatories.” Under these facts, the court ruled, “This is a classic case of assumption.” The court then discussed the trusts’ second argument. The trusts contended that they were “not the real parties in interest and…lacked the capacity to be sued.” Robertson pointed out that ERISA’s definition of “party in interest” includes a trust, and noted that hundreds of reported cases included trusts as a defendant. The court ruled that the arbitration panel did not show “manifest disregard for the law” in deciding against the trusts on this issue. Instead, “the Panel believed the relevant decisional law supported Plaintiff’s position; also viewed the relevant statutory provisions as supporting Plaintiff’s position; and then proceeded to apply what it believed was the correct understanding of the law to the facts.” The trusts may have disagreed with this outcome, but “‘[i]t is not enough for petitioners to show that the panel committed an error – or even a serious error”…‘[p]arties engaging in arbitration may trade greater certainty of correct legal decisions by federal courts for the efficiency and flexibility of arbitration, but that is their choice to make.’” As a result, the court granted Robertson’s motion to confirm the arbitration award and denied the trusts’ and Argent’s motion to vacate. Judgment was entered in Robertson’s favor and the case was terminated.
Disability Benefit Claims
Sixth Circuit
Tobin v. Unum Life Ins. Co. of Am., No. 1:24-CV-1012, 2026 WL 508810 (W.D. Mich. Feb. 13, 2026) (Judge Jane M. Beckering). Mary Rose Tobin was an account executive for a marketing agency in Grand Rapids, Michigan. Her position required her to make complex judgments, lead communication projects, maintain client relationships, manage project scopes and budgets, and work extended hours. In January of 2022 Tobin experienced a severe headache that persisted despite various treatments, including a trip to the emergency room. Eventually, she was diagnosed with “acute intractable headache” and was forced to stop working. Tobin submitted a claim for benefits under her employer’s ERISA-governed short-term disability benefit plan, which was paid in full by the plan’s administrator, Unum Life Insurance Company of America. Tobin then sought benefits under her employer’s long-term disability plan and a waiver of premium under her life insurance plan, both insured and administered by Unum as well. Unum initially approved these claims as of April 2022, but terminated them in March of 2023 “in light of updated information that it had received concerning Tobin’s medical status.” Tobin appealed both denials, submitting additional medical records and vocational assessments, but to no avail. Tobin thus brought this action and filed a motion for judgment on the administrative record. The court reviewed the case de novo, as stipulated by the parties. The court found that Tobin satisfied her burden of showing that her sickness precluded her from performing her duties as an account executive. The court relied on statements from Tobin’s physicians, who had personally examined her, found no evidence of malingering, and opined that she was disabled due to ongoing complaints of daily headache, nausea, fatigue, lightheadedness, brain fog, and decreased concentration. The court also credited evidence from a neuropsychological evaluation which corroborated Tobin’s struggles with sustained attention and concentration. The court concluded that these symptoms and findings supported the conclusion that Tobin’s symptoms precluded her from returning to her job. The court also addressed Unum’s evidence and found it less compelling. The court criticized Unum’s medical reviewers for relying heavily on the lack of a definitive etiology for Tobin’s headaches and for dismissing her symptoms as self-reported. The court emphasized that ERISA does not require a plaintiff to show a particular etiology to prove disability and that the LTD policy expressly allowed for self-reported symptoms for conditions like headaches. The court further criticized Unum’s file reviewers for second-guessing the credibility determinations made by Tobin’s treating physicians, who had directly observed her and described her symptomology as reliable and genuine. The court also noted that Unum’s file reviewers failed to conduct an independent medical examination, which “raised questions” under Sixth Circuit authority about the thoroughness and accuracy of their conclusions. The court concluded that the weight afforded to Unum’s file reviews should be heavily discounted due to these deficiencies. It was not a total victory for Tobin, however. The court found that Tobin did not satisfy her burden of showing that her sickness precluded her from performing “any gainful occupation,” which was the definition of disability for the premium waiver benefit under the life insurance policy, and for the LTD policy after 24 months of benefit payments. The court ruled that while Tobin’s medical and vocational experts provided substantial evidence regarding her inability to work as an account executive, they did not offer similar support for the conclusion that she was unable to work in any gainful occupation. In doing so, the court gave “significant weight” to the neuropsychological report, which concluded that “Tobin may be able to work, even if she cannot perform the highly skilled and demanding work of an account executive.” As a result, the court granted Tobin’s motion for judgment on the administrative record, but only in part. The court ordered the parties to meet and confer and submit a joint proposed judgment consistent with the court’s ruling and addressing any potential attorney’s fee award.
Ninth Circuit
Guy v. Reliance Standard Life Ins. Co., No. 2:24-CV-00293-JCG, 2026 WL 539534 (D. Ariz. Feb. 20, 2026) (Judge Jennifer Choe-Groves). Carla Guy worked as an intensive care unit registered nurse for HonorHealth, and was a participant in HonorHealth’s ERISA-governed employee long-term disability benefit plan, insured and administered by Reliance Standard Life Insurance Company. Guy experienced various medical conditions and symptoms from 2018 to 2019, including thyroid removal surgery in March 2019. She stopped working in March of 2020 due to “severe fatigue, brain fog, and joint pain” and submitted a claim for benefits to Reliance. Reliance initially denied Guy’s claim on the ground that she retained the ability to perform the material duties of her job. On appeal, Reliance’s two reviewing physicians gave different opinions. Reliance’s psychiatrist concluded that Guy was impaired and unable to work through September of 2022, but not thereafter. Reliance’s internal medicine specialist concluded there was no documentation of restriction or impairment from March 2020 onward. Reliance ultimately concluded that Guy was disabled, but only by mental illness, and thus the plan’s limitation on benefits for mental illness disabilities applied. Guy filed this action under 29 U.S.C. § 1132(a)(1)(B) and the parties submitted briefs on the merits. The parties agreed that the applicable standard of review was abuse of discretion because the plan gave Reliance discretionary authority to determine benefit eligibility, but disagreed as to whether Reliance’s structural conflict of interest as benefit evaluator and payor should serve to reduce any deference owed under that standard. The court determined it would “consider each of Plaintiff’s claims independently and in totality to determine if Defendant abused its discretion in denying Plaintiff’s claim.” The court ruled that Reliance (a) improperly required objective evidence to support Guy’s chronic fatigue symptoms, (b) disregarded or selectively ignored medical evidence regarding Guy’s physical condition, (c) inadequately investigated Guy’s claim by not conducting an independent medical examination, (d) “relied on an inaccurate assessment of Plaintiff’s occupation” by categorizing it as sedentary, (e) “gave little consideration to the Social Security Administration’s disability decision” even though “it was substantive information that Plaintiff submitted for review,” and (f) “fail[ed] to view Plaintiff’s conditions and symptoms in the aggregate,” instead “only looking at the symptoms and conditions present in the medical evidence singularly,” which meant that Reliance “failed to consider the possibility that the combined effect of Plaintiff’s conditions was disabling.” As a result, the court concluded that Reliance abused its discretion and reversed its benefit denial decision. The court further concluded that Guy was entitled to reasonable attorneys’ fees and costs and ordered her to file a motion in that regard with supporting documentation.
Talley v. Provident Life & Accident Ins. Co., No. 8:24-CV-01860-FWS-DFM, 2026 WL 523704 (C.D. Cal. Feb. 25, 2026) (Judge Fred W. Slaughter). Edward Talley worked as a project team leader at Johnson Controls, Inc., where he supervised mechanics, and was a participant in Johnson’s employee long-term disability benefit plan. In 2019 he submitted a claim for benefits under the plan, citing cognitive loss, brain dysfunction, major depressive disorder, and memory loss. Provident Life and Accident Insurance Company, the insurer of the plan, approved Talley’s disability claim based on a mental disorder, which subjected it to a 24-month limitation on benefit payments. The Social Security Administration (SSA) also found Talley disabled and awarded him benefits, citing neurocognitive disorder, depression, and cervical degenerative disc disorder. In 2021, Provident Life reminded Talley that his claim was subject to the mental disorder limitation, but Talley disagreed. Provident Life agreed to pay benefits beyond the 24-month period under a reservation of rights while further evaluating his claim, but ultimately it terminated Talley’s benefits in January of 2022. Talley appealed, arguing in part that his job required demanding physical tasks like climbing ladders and lifting. However, Provident Life disagreed, finding that these tasks were not essential duties of his occupation, and denied Talley’s appeal. Talley then brought this action under 29 U.S.C. § 1132(a)(1)(B), and the case proceeded to a one-day trial, after which the court issued this ruling. The court agreed with the parties that the default de novo standard of review applied. Under this standard, the court found that “Plaintiff’s evidence persuasive in demonstrating that he is disabled in some form.” However, it also found that Talley did not adequately demonstrate that his condition was not covered by the 24-month mental disorder limitation. The court stated that the SSA’s disability determination “provides limited support” for Talley because it was based on a different standard, the record before the SSA was more limited, and the SSA “described Plaintiff’s physical functional capacity which appears sufficient to sufficiently perform his job.” The court also noted the lack of evidence certified by a physician confirming an organic cognitive impairment that would evade the 24-month limitation. The court further found Provident Life’s evidence, which included multiple medical reviews, persuasive. These evaluations suggested that Talley’s symptoms were of psychological origin and did not support a diagnosis of a neurodegenerative condition. Physical exams by Talley’s own physicians showed “normal physical capabilities,” further supporting the conclusion that Talley was not entitled to further benefits. As a result, the court concluded that Talley “fails to provide sufficient evidence linking his purported medical condition to the performance of his job duties such that he would be disabled under the Policy, after the 24-month mental disorder limitation period expired.” The court further stated that even if it accepted Talley’s description of his job duties, this was insufficient to demonstrate disability under the policy. Thus, the court entered judgment in Provident Life’s favor.
ERISA Preemption
Fifth Circuit
Ardoin v. Williams, No. CV 22-865-JWD-SDJ, 2026 WL 560358 (M.D. La. Feb. 27, 2026) (Judge John W. deGravelles). Marsha Ardoin is an employee of Industrial Fabrics, Inc. who wanted to buy life insurance for her spouse, John Ardoin. Through her employer, Marsha requested coverage from Russia Williams, an agent for HUB International Gulf South, which was a licensed insurance broker for Southern National Life Insurance Company (SNLIC). With Williams’ assistance, Marsha thought she had arranged insurance for John with SNLIC that would go into effect on January 1, 2022. She alleges that premiums were deducted from her paycheck in January of 2022 reflecting that arrangement. However, John passed away suddenly on January 25, 2022. Williams told Marsha that she needed to complete an evidence of insurability (EOI) form, “despite Williams’[s] previous representations that [Plaintiff] had already completed everything necessary to obtain the requested insurance coverage.” Marsha did so and was told by Williams that the form would be backdated and effective January 1. As you might expect, SNLIC saw things differently when Marsha filed her life insurance claim; it denied the claim because the required EOI form was not timely submitted. Marsha filed this action in state court against Williams, HUB, and SNLIC asserting state law claims for relief. SNLIC responded by removing the action to federal court on ERISA preemption grounds, and then filed a motion for summary judgment “on two issues: (1) whether the Policy ‘vests the administrator with discretionary authority to determine eligibility for benefits and/or construe and interpret the terms’ of the Policy, and (2) ‘whether ERISA preempts all state law claims related to the [Policy].’” The court first discussed whether the policy was an ERISA plan, and expressed frustration because while Marsha did not dispute that it was an ERISA plan (instead she focused on whether ERISA preempted her claims), “neither party has asserted, as an undisputed fact, that the Policy is an ‘employee welfare benefit plan’ within the meaning of 29 U.S.C. § 1002(1).” The court “gleans only that the Policy is voluntary and that Industrial Fabrics, Inc. collected premiums and remitted them to SNLIC,” which was not enough information to know whether the policy fell within ERISA’s “safe harbor” provision. As a result, because the burden of proving ERISA-related issues rested with SNLIC as the moving party, the court denied SNLIC’s motion, although it “will allow SNLIC to re-urge the motion. At this time, the Court will not decide whether the Policy vests SNLIC with discretionary authority or whether ERISA preempts any/all of Plaintiff’s state law claims.” However, the court discussed preemption anyway in an effort to assist the parties with future briefing, requesting that they be more specific regarding which claims were preempted, which defendants’ actions were being challenged, which of Marsha’s claims “involve principal ERISA entities” and “require interpretation of the Policy’s provisions,” and how her claims “relate to” an ERISA plan. “In the event that SNLIC reurges its motion, it will be incumbent upon SNLIC to specify which state law claims are preempted and why – that is, ‘to put flesh on [the] bones’ of its arguments.”
Ninth Circuit
Damiano v. The Prudential Ins. Co. of Am., No. 25-CV-09628-NC, 2026 WL 539619 (N.D. Cal. Feb. 26, 2026) (Magistrate Judge Nathanael M. Cousins). Rose Marie Damiano alleges that, in the middle of a marital dissolution action with her husband Gopal Vasudevan, she served a subpoena on Lockheed Martin to determine the extent of Vasudevan’s insurance and confirm her beneficiary status. Lockheed Martin allegedly referred her to Prudential, which responded that it had no documents related to Vasudevan. After Vasudevan died, Damiano discovered two life insurance policies issued by Prudential which were part of employee welfare benefit plans sponsored by Lockheed Martin. Damiano alleges that Prudential paid benefits from these policies – in the amounts of $1,889,970.14 and $237,103.66 – to Vasudevan’s named beneficiaries in violation of California Family Code § 2040 (which creates an automatic restraining order regarding, among other things, “changing the beneficiaries of insurance”). Damiano filed this action, asserting state law claims for fraud and negligent misrepresentation, alleging that “had Prudential responded to the subpoena properly, she would have been on notice of this violation and would have been in position to seek relief from the court.” Prudential moved to dismiss, contending that (1) Damiano’s claims were preempted by ERISA, (2) her claims were barred by California Insurance Code § 10172 (discharging life insurers of liability if they have properly paid a claim without receiving prior notice of another claim), and (3) Damiano failed to specifically plead all essential elements of her claims as required by Federal Rule of Civil Procedure 9(b). The court did not reach Prudential’s second and third arguments because it agreed with the first, ruling that both of Damiano’s claims were preempted by ERISA. The court noted that there was no dispute that “Vasudevan’s two life insurance policies were part of employee welfare benefit plans sponsored by Lockheed Martin.” Thus, the only issue was whether Damiano’s claims “related to” the plans; if so, they were preempted under 29 U.S.C. § 1144(a). The court ruled that they did because “[t]he crux of Damiano’s claims of fraud and negligent misrepresentation is that Prudential intentionally or negligently failed to disclose the existence of Vasudevan’s policies that were included in the ERISA plans when it stated that it had no information on Vasudevan.” Thus, “but for Vasudevan’s ERISA plans, Prudential would not have had an obligation to disclose the plan’s existence and Plaintiff would not be suing under state law… Moreover, her damages for these claims depend on the ERISA plans’ existence and beneficiaries… Thus, the ERISA plans play a critical factor in establishing liability[.]” As a result, the court ruled that Damiano’s claims were preempted, and granted Prudential’s motion to dismiss. The ruling was with prejudice, because “amendment would be futile.” Damiano was not a participant or beneficiary of the ERISA plans, and thus had no standing to reallege a claim under ERISA.
Medical Benefit Claims
Ninth Circuit
Connor v. Meta Platforms, Inc. Health & Welfare Benefit Plan, No. 3:25-CV-01836-SI, 2026 WL 524167 (D. Or. Feb. 25, 2026) (Judge Michael H. Simon). Emma Connor is a transgender woman and an employee of Meta Platforms, Inc. She submitted a pre-determination request under Meta’s Health and Welfare Benefit Plan to its administrator, Meritain Health, for gender-affirming surgical procedures, including clavicle shortening, scapular spine shaving, and rib remodeling. Meritain denied this request, determining that the procedures were not covered by the plan. Connor appealed but received no response, so she filed this action, alleging entitlement to plan benefits under 29 U.S.C. § 1132(a)(1)(B). Defendant filed a motion to dismiss, arguing that Connor lacked standing and failed to state a claim. Addressing standing first, the court quickly disposed of the issue by noting that Connor was a participant in the plan, submitted a claim, and was denied benefits, and thus she had suffered a cognizable harm that could be remedied by her claim. The court then turned to whether Connor had adequately stated a claim, which required her to “identify a provision of the Plan that would entitle her to…benefits.” The plan’s “Transgender Services” section included coverage for “Medically Necessary Gender Affirmation Treatment,” provided pre-determination was obtained. Connor cited the “reconstructive and complementary procedures” subsection as the basis for her entitlement to coverage, while defendant argued that the procedures she sought were not covered because they were “not included in a series of tables at the end of the Transgender Services section and because they are not included in the ‘Aetna Guidelines.’” The court noted that the plan’s language suggested that it covered procedures not explicitly listed in the tables, and that “it is difficult…to see how clavicle shortening, scapular spine shaving, and rib remodeling are not ‘reconstructive procedures intended to feminize the body,’” which was a covered category in the plan. As for the plan’s pre-determination requirement, the court ruled that Connor satisfied it by submitting a letter from a qualified health professional documenting her gender dysphoria and capacity to consent to treatment. The court questioned defendant’s reliance on the Aetna Guidelines on this issue, noting that “the section on pre-determination requirements for those procedures does not mention the Aetna Guidelines. This omission calls into question whether the Aetna Guidelines even apply to reconstructive and complementary procedures.” Finally, although defendant contended that the plan excluded coverage of the requested procedures, the court found that the plan and guidelines were ambiguous, and thus “many material questions must be answered to determine whether the requested procedures are covered or excluded.” Thus, “Viewing the facts in the light most favorable to Plaintiff and giving Plaintiff the benefit of all reasonable inferences, the Court concludes that Plaintiff has stated a claim.” As a result, defendant’s motion to dismiss was denied.
Dancekelly v. Deloitte LLP, No. CV 23-4101-DMG (MRWX), 2026 WL 555538 (C.D. Cal. Feb. 26, 2026) (Judge Dolly M. Gee). Tanya Dancekelly was employed by Deloitte LLP and was a participant in its ERISA-governed self-funded employee health plan, administered by UnitedHealthcare. Dancekelly had a history of morbid obesity and underwent laparoscopic band surgery in 2010. She experienced complications with her lap band, including vomiting, chest pain, and acid reflux, and thus in 2020 she underwent three medical procedures: a hiatal hernia repair, a lap band removal, and a sleeve gastrectomy. United pre-authorized the procedures but later denied full reimbursement, claiming the hiatal hernia repair was incidental to the sleeve gastrectomy. Dancekelly and her providers appealed, but the denial was upheld, and thus she filed this action under 29 U.S.C. § 1132(a)(1)(B) seeking plan benefits. The case proceeded to a half-day bench trial after which the court issued these findings of fact and conclusions of law. The court began by ruling that the correct standard of review was abuse of discretion because the plan “unambiguously vests” United with discretion to make benefit determinations, interpret the plan, and make factual determinations. However, the court reduced its deference to United’s decisions because of procedural irregularities. Specifically, the court found that United failed to explain the basis for its decision with reference to plan documents or guidelines, failed to produce copies of relevant records, and did not engage in a “good faith exchange” because it did not respond appropriately to Dancekelly’s physicians’ inquiries. “Such a chaotic pattern of communication cannot be deemed a good faith exchange of information.” As for the merits, the court concluded that United’s denial of the hiatal hernia repair and partial reimbursement of the lap band removal and sleeve gastrectomy was an abuse of discretion. The court found that the hiatal hernia repair was not incidental to the sleeve gastrectomy, as it was a standalone medical condition diagnosed and confirmed prior to the procedures. Furthermore, United’s pricing determinations, which were based on determinations by Data iSight, were also an abuse of discretion because they conflicted with the plan, which required consideration of “whether the fees are competitive or whether they are restricted by geographic area[.]” The court thus ruled entirely in Dancekelly’s favor, and remanded the claim for a re-determination consistent with the court’s order.
Pension Benefit Claims
First Circuit
Angus v. Burman, No. 24-CV-328-MRD-AEM, 2026 WL 578770 (D.R.I. Mar. 2, 2026) (Judge Melissa R. DuBose). Carl Angus worked at E.W. Burman, Inc., a general contractor, for 38 years. In January of 2023, he informed Edward and Paul Burman, respectively the president and treasurer of the company, that he intended to retire and move to Portugal. He “mentioned that he wanted to cash-out his funds from the E.W. Burman Inc. Profit Sharing Plan and Trust[], an employer sponsored defined-contribution Plan, as soon as possible.” Angus received $1,356,369.31 from the plan on July 21, 2023, based on the account value as of December 31, 2022. However, Angus was not happy. He contends that his account should have been valued as of December 31, 2023, which would have resulted in over $170,000 in additional funds due to 2023 market performance. Angus’ claim and appeal were denied, and thus he brought this action against Edward, Paul, and the company alleging claims under ERISA for (1) benefits owed pursuant to 29 U.S.C. § 1132(a)(1)(B); (2) breach of fiduciary duty pursuant to 29 U.S.C. § 1132(a)(2)-(a)(3); and (3) violation of ERISA’s anti-inurement rule pursuant to 29 U.S.C. § 1103(c)(1). The parties filed cross-motions for summary judgment which were decided in this order. The court began with the standard of review. Angus contended that it should be de novo because, even though the plan granted defendants discretionary authority to make benefit determinations, his claim was “fraught by procedural irregularities.” The court acknowledged that defendants did not produce certain emails during Angus’ claim and appeal, but this did not deprive him of a “full and fair review,” and thus the court applied the arbitrary and capricious standard of review. This deferential standard did not save the day for defendants, however. The court ruled that Angus was a “Terminated Participant,” not a “retiree,” under the plan, and therefore pursuant to the plan’s rules, the account valuation and payout should have occurred on or after December 31, 2023, not 2022. The court rejected defendants’ argument that the plan allowed Angus to “elect” an earlier distribution, and instead interpreted the plan to mean that Angus could only elect to delay his distribution, not advance it before a date scheduled by the plan. Furthermore, Angus’ request for benefits “as soon as possible” was irrelevant. “[N]othing in the record supports that he and the Defendants agreed to change the terms of the Plan to enable his distribution to take place mid-year,” and even if such an agreement existed, “ERISA plans must be in writing and cannot be modified orally.” Furthermore, such an agreement would not be considered because it would “cause conflict with the clear and unambiguous Plan provisions.” As a result, “the Administrator’s decision is not supported by substantial evidence,” and the court granted Angus summary judgment as to his first count for relief, noting that it did not need to rule on the other two claims because they were brought in the alternative. The court ordered the parties to submit a briefing schedule to address an appropriate remedy.
Seventh Circuit
Skowronski v. Briggs, No. 22 C 07359, 2026 WL 560033 (N.D. Ill. Feb. 27, 2026) (Judge John J. Tharp, Jr.). Steven Skowronski was a participant in the IBM 401(k) Plus Plan. In 2020, he designated his children, Sean Skowronski and Megan Kirchner, and his romantic partner, Sandra Jensen Briggs, as one-third equal beneficiaries of his account. At that time, Steven and Briggs were not in a legally recognized partnership, but about a month later they entered into a civil union. Steven died in 2022, and the plan’s committee determined that Briggs, because she was Steven’s civil union partner at the time of his death, qualified as his “spouse” under the plan. As a result, all assets in Steven’s 401(k) account were transferred to an account in Briggs’ name. Sean and Kirchner objected and initiated this action against Briggs and various IBM defendants, seeking a declaratory judgment upholding the January 2020 beneficiary designations. Briggs and the IBM defendants filed motions to dismiss. The court noted that the parties disagreed regarding the appropriate standard of review, but because “the validity of the beneficiary determination depends on whether the legal definition of ‘spouse’ in Illinois extends to civil union partners…this Court proceeds de novo.” The court then tackled both motions, starting with Briggs’. “The only issue in contention is whether a civil union partner is a spouse under the terms of the Plan… This Court concludes that the answer is yes.” The court explained that the plan’s definition of “spouse” incorporated Illinois law, and the legal definition of “spouse” under Illinois law “extends to civil union partners.” Sean and Kirchner argued that Illinois law did not apply because the benefits at issue were governed by federal law, and urged the court to follow “a Department of Labor Technical release explaining that the terms ‘‘spouse’ and ‘marriage’…do not include individuals in…a domestic partnership or a civil union’ as those terms appear in ERISA and the tax code.” However, the court ruled that the plan language controlled, and here “the Plan’s definition of spouse explicitly looks to ‘the marriage laws of the state…of a Participant’s residence.” The court then turned to IBM’s motion and quickly granted it for the same reasons. “As discussed above, the IBM defendants did not err in determining that Briggs was the sole beneficiary. Because they did not breach any fiduciary duty to the plaintiffs, dismissal of all claims against them is proper.” Finally, the court rejected Sean and Kirchner’s request for attorney’s fees against IBM because they did not achieve “some degree of success on the merits.”
Pleading Issues & Procedure
Fifth Circuit
Giusti v. Alliant Ins. Servs., Inc., No. CV 25-1347, 2026 WL 538286 (E.D. La. Feb. 26, 2026) (Judge Lance M. Africk). Ernest J. Giusti, III brought this putative class action on behalf of “franchise owners and employees” of Goosehead Insurance against Alliant Insurance Services, Inc., United Health Group, Inc., United Healthcare, Inc., and Assured Benefits Administrators, Inc., alleging mismanagement of Goosehead’s employee healthcare plan. Giusti alleges that he and his family members, who were plan beneficiaries, paid premiums, but defendants allegedly “failed to pay and/or timely pay in accordance with the plan.” This led to medical providers withdrawing care, contact from collection agencies, and out-of-pocket payments to continue receiving care. Then, Giusti alleges, the plan was suddenly canceled without warning, leaving unpaid claims outstanding “with no mechanism for an administrative appeal or remedy.” As a result, Giusti has alleged claims under ERISA and various Louisiana laws, including breach of contract and unjust enrichment. Defendants filed motions to dismiss, arguing that (1) the complaint should be dismissed for impermissible “group” or “shotgun” pleading, (2) the complaint failed to state a claim under ERISA, (3) ERISA preempts the state law claims, and (4) the class allegations should be stricken because the proposed class is not ascertainable. First, the court ruled that Giusti’s complaint did not amount to impermissible group or shotgun pleading. Giusti admitted that “he does not specifically allege the actions each defendant took that caused or contributed to the untimely payments and non-payments of his approved benefits.” However, he argued that his complaint gave fair notice of his claims, and that the responsibility each defendant had in the denials of his claims was hidden from him. The court gave Giusti the benefit of the doubt because his complaint “explains the roles and interconnectedness of the defendants,” and was “sufficient to give defendants notice of the nature of plaintiff’s claims and the grounds upon which they rest, such that defendants can adequately respond and defend against the claims.” The court then addressed Giusti’s ERISA claims. The court noted that Giusti sought relief pursuant to 29 U.S.C. § 1132(a)(1) or, in the alternative, § 1132(a)(3). Defendants contended that they were not proper parties under the (a)(1) claim because the plan named a non-party, HPS Advisory Services, LLC, as the plan administrator and fiduciary. However, “whether a defendant is a fiduciary or plan administrator such that it is a proper defendant pursuant to § 1132(a)(1)(B) does not turn only on whether the defendants are so named in the Plan, but includes an inquiry into whether that defendant exercised ‘actual control’ over the claims process.” Furthermore, the court noted that the plan sections cited by defendants on this issue did not address the payment of approved claims, over which defendants may have had fiduciary control. Thus, the court denied the motion to dismiss as to Giusti’s (a)(1) claim. As for Giusti’s (a)(3) claim, the court was confused by his allegations: “at some points, plaintiff’s amended complaint seems to seek the benefits owed to him and the other members of the putative class from the Plan that were deemed covered by the Plan but were never dispersed. At other points, plaintiff’s alleged harm seems to include damages associated with defendants’ prolonged retention of benefits already approved and owed to him and his amended complaint could be read to seek equitable relief of such allegedly improper, prolonged retention.” The court thus ruled that “[a]mbiguities as to the relief sought by plaintiff” made it impossible to determine whether Giusti had a valid (a)(3) claim. The court noted that the plan had been terminated, which suggested that the (a)(1) claim might not provide adequate relief and that (a)(3) equitable relief might thus be justified. Because of the “lack of clarity in the amended complaint and lack of briefing by the parties on the issue of the relief requested and recoverable by plaintiff given the alleged harm and cancellation of the Plan,” the court decided “it is appropriate to deny the motion to dismiss and allow plaintiff one additional opportunity to cure this, and other, potentially dispositive ambiguities in a second amended complaint.” Thus, the court did not reach defendants’ other arguments regarding ERISA preemption and striking the class allegations from the complaint, so we will likely see another motion to dismiss and another ruling in the future.
D.C. Circuit
Camire v. Alcoa USA Corp., No. CV 24-1062 (LLA), 2026 WL 508003 (D.D.C. Feb. 24, 2026) (Judge Loren L. AliKhan). This is a putative class action by employees of Alcoa USA Corporation challenging Alcoa’s decision to transfer approximately $2.79 billion of its pension risk to Athene Annuity and Life Co. and Athene Annuity & Life Assurance Company of New York between 2018 and 2022 through the purchase of several group annuities. Plaintiffs contend that Athene’s annuities are invested in risky assets and thus the transfers place their benefits in jeopardy, violating statutory and fiduciary duties under ERISA. Defendants filed a motion to dismiss which the court granted in March of 2025. The court invoked the Supreme Court’s 2020 decision in Thole v. U.S. Bank N.A. in ruling that plaintiffs did not have standing to bring their action because they had not adequately pled that their benefits were at “imminent risk of harm.” The court reasoned that, in order to suffer harm, a long chain of events would have to happen, including Athene’s collapse, resulting in catastrophic losses that could not be mitigated, an inability to secure alternative funding, and then losses that exceeded the amount insured by state regulators. For the court, this series of events was too “highly attenuated” to establish imminent risk, and thus it granted defendants’ motion to dismiss for lack of standing. Before the court here was plaintiffs’ motion for reconsideration under Federal Rule of Civil Procedure 59(e) in which they sought leave to file a second amended complaint under Rule 15(a). The court addressed the legal standard first – should it use the Rule 59(e) test or the Rule 15(a) test in deciding the motion? Citing D.C. Circuit authority, the court agreed with defendants that Rule 59 applied because it had dismissed plaintiffs’ complaint without prejudice. The court explained that relief under Rule 59 is “disfavored” and “extraordinary,” and that plaintiffs did not meet their burden. Plaintiffs “do not contend that an intervening change of controlling law has occurred since the court’s dismissal, that new evidence has become available, or that amending the judgment is necessary to correct a clear error or prevent manifest injustice.” Furthermore, plaintiffs did not “argue that any statutes of limitations or other barriers would prevent them from filing a new action after this court’s dismissal without prejudice.” As a result, plaintiffs “do not need any relief from this Court in order to file the Proposed Amended Complaint in a separate action in this judicial district.” Thus, the court denied plaintiffs’ reconsideration motion, and they must now decide whether they want to try again with their new complaint in a new civil action.
Provider Claims
Second Circuit
Rowe Plastic Surgery of N.J., LLC v. Anthem Blue Cross Blue Shield of Colorado, No. 23-CV-4536 (RER) (JAM), 2026 WL 540767 (E.D.N.Y. Feb. 26, 2026) (Judge Ramón E. Reyes, Jr.). Rowe Plastic Surgery is back, having filed this action against yet another insurance company, Anthem Blue Cross Blue Shield of Colorado, alleging state law claims for breach of contract, unjust enrichment, promissory estoppel, and fraudulent inducement. As the court noted, and as loyal readers of this publication are aware, Rowe has filed “30 nearly identical lawsuits” against insurers seeking reimbursement based on telephone calls with the insurers in which Rowe was allegedly promised one rate but eventually paid something far lower. Anthem filed a motion to dismiss, and the 31st time was not the charm for Rowe. The court noted that Rowe made the same arguments in this case that it made in its other cases, which were not successful there and were not successful on appeal at the Second Circuit. Thus, “In an effort to avoid beating a very dead horse, this opinion relies on the correct and well-reasoned arguments from opinions in this District, the Southern District of New York, and the Second Circuit that have addressed essentially identical issues between Plaintiffs and various insurance providers.” First, the court ruled that Rowe’s claims were preempted by ERISA. Rowe contended that its claims were based on the telephone calls with Anthem and not the contents of the relevant benefit plans, and thus ERISA did not govern, but the court, quoting another case involving Rowe, ruled that “‘any legal duty’ [Anthem] ‘has to reimburse [Plaintiffs] arises from its obligations under the patient’s ERISA plan, and not from some separate agreement or promise,’ and thus ‘[Plaintiffs’] claims are expressly preempted by ERISA § 514(a).’” The court further found that even if some of Rowe’s claims were not preempted by ERISA, they failed to state a claim. The court ruled that (1) there was no breach of contract because the phone conversation with Anthem “did not create a contract and did not constitute a promise to pay a particular sum”; (2) there was no unjust enrichment because “the plaintiff must show that ‘the services were performed for the defendant,’ and not at the ‘behest of someone other than the defendant’”; (3) there was no promissory estoppel because “Plaintiffs do not plead a ‘clear and unambiguous promise’”; and (4) there was no fraudulent inducement because the allegations supporting this claim were “repurposed” from Rowe’s insufficient breach of contract claim. As a result, the court granted Anthem’s motion to dismiss in its entirety, with prejudice. Obviously, this was not the result Rowe wanted, but perhaps it should be thankful that this time its claims were not called “frivolous” and “ridiculous,” and it was not threatened with sanctions.
Third Circuit
SM Medical Holdings Corp. v. United Healthcare Servs., Inc., No. 25-1549 (ZNQ) (JBD), 2026 WL 540175 (D.N.J. Feb. 26, 2026) (Judge Zahid N. Quraishi). SM Medical Holdings Corporation purchased the receivables of medical provider Dynamic Medical Imaging – DMI, LLC. It then filed this action against United Healthcare Services, Inc., contending that United owed it $1,133,062.44 for medical imaging services provided by Dynamic. It alleged only one state law cause of action, for account stated, listing hundreds of sub-claims for individual patients. United filed a motion to dismiss, arguing that “(1) several sub-claims on their face relate to entities other than United; (2) [ERISA] preempts the sub-claims pertaining to ERISA; (3) the Medicare Act preempts the sub-claims pertaining to Medicare and Plaintiff failed to exhaust all administrative remedies; and (4); Plaintiff fails to plead a plausible account stated claim for the remaining sub-claims.” In a concise order, the court agreed with United across the board. Plaintiff admitted that 275 of the sub-claims involved plans not administered by United, and thus those claims were dismissed. As for ERISA, the court ruled, and plaintiff did not contest, that many of the sub-claims were governed by ERISA, and thus its state law claim was preempted as to those sub-claims. “‘Claims involving denial of benefits…require interpreting what benefits are due under the plan’ and ‘are expressly preempted’…Simply stated, the Court cannot decide Plaintiff’s claim as to the ERISA plans without analyzing and interpreting the plans at issue.” Thus, the court dismissed the ERISA-related sub-claims with prejudice. Regarding the sub-claims based on Medicare-regulated plans, the court ruled that these claims were “inextricably intertwined” with Part C of the Medicare Act, and thus they required administrative exhaustion under the Act. Plaintiff failed to allege exhaustion of administrative remedies, and thus the court dismissed these sub-claims without prejudice. Finally, the court dismissed the remaining sub-claims without prejudice because plaintiff failed to state a plausible claim for account stated. The court noted that plaintiff “includes scant factual background,” “has not sufficiently alleged any previous transactions between Dynamic and Defendant,” “has not sufficiently alleged that any agreement existed between Dynamic and Defendant,” and “has not sufficiently alleged that Defendant made any promise to pay the amount Plaintiff alleges is due.” As a result, these sub-claims were dismissed without prejudice. As a result, United’s motion to dismiss was granted in full, and plaintiff was given 30 days to file an amended complaint.
Seventh Circuit
Northwestern Memorial Healthcare v. Highmark Blue Cross Blue Shield, No. 25-CV-02481, 2026 WL 562727 (N.D. Ill. Feb. 28, 2026) (Judge Andrea R. Wood). Northwestern Memorial Healthcare (NMHC) provided emergency medical services to three patients who were beneficiaries of health insurance plans administered by Highmark Blue Cross Blue Shield. NMHC had a contract with Blue Cross and Blue Shield of Illinois (BCBS Illinois) that required it to treat individuals insured by any member company of the national Blue Cross Blue Shield Association, which included Highmark. In 2021 and 2022, NMHC submitted claims according to the contract totaling $220,445.11, but Highmark paid only $62,875.56. NMHC thus filed this action, asserting a claim for breach of implied contract or, alternatively, a claim for quantum meruit. Highmark moved to dismiss, arguing that the state-law claims related to one of the patients were preempted by ERISA, and that neither the breach of implied contract nor the quantum meruit claim was adequately pleaded. Highmark argued that “NMHC’s right to recover the full charges related to that Patient’s medical treatment requires interpreting and applying terms of their ERISA plan[.]” However, the court found that “there are allegations in the [complaint] that at least raise the possibility that the Patient’s state-law claims can be resolved without consulting their health plan.” The court noted Highmark’s pre-authorization for treatment, which suggested that Highmark already considered the treatment medically necessary and covered, and thus “resolving NMHC’s state-law claims as to the Patient…’would not require interpretation or application of the terms of’ that plan.” As for NMHC’s specific claims, the court granted Highmark’s motion to dismiss the breach of implied contract claim, finding that NMHC’s provision of medical care did not constitute consideration for an implied contract because NMHC was already obligated to provide such services under the BCBS Illinois contract. However, the court denied the motion to dismiss the quantum meruit claim, concluding that NMHC had sufficiently alleged that Highmark’s actions gave NMHC a reasonable expectation of payment and that Highmark benefited from the services provided. The court acknowledged the general rule precluding a quantum meruit claim against a third-party beneficiary to an express contract, but here “[n]ot only did NMHC perform non-gratuitous medical services for Highmark’s insureds on the understanding that it would be compensated consistent with the terms of the BCBS Illinois contract, but Highmark also led NMHC to reasonably believe that it would be fully paid for its services by, among other things, pre-authorizing and approving those services as medically necessary. Such allegations suffice to plead a quantum meruit claim against Highmark notwithstanding the existence of the BCBS Illinois contract.” Highmark also argued that the quantum meruit claim could not proceed because “NMHC provided its medical services for the benefit of the Patients, not Highmark.” However, the court ruled that this “ignores the [complaint’s] allegation that Highmark benefitted from NMHC treating the Patients in the following ways: improved health outcomes for the Patients resulting in lower costs for Highmark; increased customer satisfaction; and increased market share by offering Highmark’s customers access to high-quality hospitals like NMHC.” This was sufficient for the court, and thus it allowed NMHC’s quantum meruit claim to proceed.
Severance Benefit Claims
Third Circuit
Karim v. RB Health (US) LLC, No. 25-14829 (SDW) (JRA), 2026 WL 578753 (D.N.J. Mar. 2, 2026) (Judge Susan D. Wigenton). Sarah Karim was a marketing analytics manager for RB Health (US) LLC in 2024 when RB told her that her employment would terminate in 2025 due to a reorganization. The notice letter told her she could apply for open positions within the company and that she would be entitled to a severance package if she did not decline a comparable position, resign, or was terminated for cause by the termination date. Karim asked about her 401(k) retirement account, and was allegedly told that employer contributions would be 100% vested for employees terminated as part of the reorganization. Karim alleges she was not offered a comparable role at RB and eventually was hired by another company. She filed this action asserting three claims against RB: “(1) violation of New Jersey’s Millville Dallas Airmotive Plant Job Loss Notification Act…(the ‘Warn Act’); (2) breach of contract to pay severance; and (3) breach of contract to vest 401(k).” RB removed the case to federal court and filed a motion to dismiss the first two claims, and a motion to stay the third claim and compel arbitration on it. The court began by denying the motion as to Karim’s Warn Act claim. RB argued that Karim was offered continued employment, and thus she did not suffer a “termination of employment” under the Warn Act. However, the court found that Karim sufficiently alleged a termination due to reorganization without an offer of a comparable position, making her claim plausible. On Karim’s severance claim, she did not dispute that the severance plan was governed by ERISA, but contended that RB’s “Notice Letter created a separate contractual right to severance benefits.” The court rejected this argument and dismissed Karim’s claim, agreeing with RB that its severance plan was governed by ERISA and therefore ERISA preempted her state law claim. Regarding Karim’s 401(k) claim, RB asked the court to stay it because it contended that Karim had not yet exhausted her administrative remedies, and in any event she was required to arbitrate her claim. Karim contended that her claim was not subject to arbitration. The court agreed with RB that Karim had not satisfactorily alleged that she exhausted her appeals regarding her 401(k): “Plaintiff’s Complaint only alleges that Plaintiff emailed a company representative regarding the Plan instead of filing a claim as required by the Plan.” Furthermore, “the 401(k) Plan, which is governed by ERISA, contains a valid and enforceable arbitration provision.” As a result, the court denied RB’s motion only as to Karim’s Warn Act claim, but granted it regarding everything else. The court instructed Karim that she could file an amended complaint once arbitration is complete.
Fifth Circuit
Miller v. Anadarko Petroleum Corp. Change of Control Severance Plan, No. 25-20113, __ F. App’x __, 2026 WL 542628 (5th Cir. Feb. 26, 2026) (Before Circuit Judges Jones and Engelhardt, and District Court Judge Robert R. Summerhays). Brad Miller worked for Anadarko Petroleum Corporation for approximately 35 years. In August of 2019, Occidental Petroleum Corporation (Oxy) acquired Anadarko, which triggered the “change of control” provision in Anadarko’s Change of Control Severance Plan. Following the acquisition, Miller kept working for Oxy, but he claimed that his role and responsibilities were significantly diminished, and his salary was reduced, leading him to believe he qualified for benefits under the plan. Miller submitted a Good Reason Inquiry Form in May of 2020 and resigned the next month. The benefits committee denied his claim on the ground that a “good reason event” did not occur, asserting that “Oxy had neither materially and adversely diminished his duties and responsibilities nor materially reduced his salary.” Miller unsuccessfully appealed, and then brought this action under ERISA, seeking benefits from the plan under Section 502(a)(1)(B) and alleging a breach of fiduciary duty under Section 404(a). On summary judgment, the district court applied an abuse of discretion standard and granted summary judgment in favor of the plan and the committee. (Your ERISA Watch covered this decision in our March 19, 2025 edition.) Miller appealed, arguing that (1) the district court should have reviewed the committee’s decision de novo and (2) the Committee erred in denying his claim. Addressing the standard of review first, the Fifth Circuit ruled that the abuse of discretion standard was appropriate because the plan granted the committee discretionary authority to interpret its terms. The plan stated that the committee had the discretion to interpret ambiguous plan terms, and “[t]he validity of any such finding of fact, interpretation, construction or decision shall not be given de novo review if challenged in court, by arbitration or in any other forum, and shall be upheld unless clearly arbitrary or capricious.” Miller contended that de novo review was appropriate because the plan only gave the committee discretion to interpret ambiguous terms, and “good reason” was unambiguous. The Fifth Circuit ruled that this was wrong for two reasons: (1) the plan further conclusively stated that the relevant section “may not be invoked by any person to require the Plan to be interpreted in a manner which is inconsistent with its interpretation by the Committee”; and (2) the term “good reason” was intrinsically ambiguous because it required discretionary “comparisons and the weighing of several factors.” The court noted that this conclusion was consistent with Gift v. Anadarko, a case decided by the Fifth Circuit in 2024 which interpreted the same plan provisions (discussed in our November 13, 2024 edition). The court also distinguished a 2025 Tenth Circuit decision interpreting the plan, Hoff v. Amended & Restated Anadarko Petroleum Corp. Change of Control Severance Plan (covered in our February 12, 2025 edition) on the ground that neither party in that case argued that “good reason” was ambiguous, and in any event, the facts were stronger for the plaintiff in that case. The Fifth Circuit then turned to the merits of Miller’s claim and upheld the committee’s decision, ruling that it did not abuse its discretion. The court found that the committee’s decision was based on substantial evidence, including interviews and documentation, which supported the conclusion that Miller’s duties and responsibilities were not materially and adversely diminished. The court found that the committee had provided reasonable explanations for its conclusions, and indeed, found that some of Miller’s job changes actually gave him “broader exposure to other parts of management, operations, and executive leadership.” As a result, the court ruled that the committee’s decision was not an abuse of discretion and affirmed the judgment in the plan’s favor.
Statute of Limitations
Eleventh Circuit
Bill H. v. Anthem Blue Cross, No. 8:25-CV-647-TPB-LSG, 2026 WL 575161 (M.D. Fla. Mar. 2, 2026) (Judge Tom Barber). Bill H. brought this action regarding benefit claims he submitted to the ERISA-governed Amgen Traditional PPO Health Plan on behalf of his son, S.H., who was a beneficiary of the plan. S.H. suffered from autism spectrum disorder and other behavioral issues, for which he received treatment in 2022. Anthem Blue Cross, the plan’s claim administrator, initially approved benefits for two months but eventually determined that further treatment was not medically necessary and denied additional coverage. Bill H. appealed, but Anthem upheld the denial on October 12, 2022. An external review further upheld the denial on June 21, 2023. Bill H. filed suit against Anthem, Amgen, and the plan on November 29, 2024, alleging four claims for relief: (1) recovery of benefits; (2) violation of the Mental Health Parity and Addiction Equity Act; (3) breach of fiduciary duty; and (4) statutory penalties for failing to provide requested documents. Defendants moved to dismiss, arguing (1) counts 1-3 were time-barred, (2) count 2 was duplicative of the claim for benefits under count 1, and (3) Anthem was not responsible for producing responsive documents under count 4, while Amgen provided all documents it was legally required to produce. The court noted that while analogous state law provided a limitation period for claims under count 1, and ERISA provided a limitation period for counts 2-3, “[p]arties, however, may agree in an ERISA plan to a time limit for filing suit different from the one provided by statute.” Here, the plan contained “a one-year period on actions brought under § 502(a) of ERISA, running from the decision in any administrative appeal.” As a result, Bill H.’s complaint was too late because he filed it in November of 2024, more than one year after the June 2023 final denial. As a result, Bill H. could only proceed if he could “avail himself of equitable tolling or equitable estoppel or can point to a controlling statute that prohibits enforcement of the Plan’s limitation provision.” The court found that tolling and estoppel were unavailable because the plan’s language was clear and could not be construed as a misrepresentation. Bill H. argued that the letters denying his claim did not include an express statement regarding the plan’s limitation period, as required by ERISA regulations, and thus the court should decline to enforce it. However, the court found this argument foreclosed by the Eleventh Circuit’s 2015 decision in Wilson v. Standard Ins. Co., and held that Bill H. was still required to show tolling or estoppel regardless of the violation. Finally, Bill H. argued that the one-year limitation was void under 29 U.S.C. § 1110, which “invalidates any contract provision that ‘purports to relieve’ a fiduciary from responsibility or liability for any obligation or duty under ERISA.” The court disagreed, ruling that the limitation did not relieve a fiduciary of responsibility but merely shortened the time period for filing suit, which was permissible. Finally, the court addressed Bill H.’s claim for statutory penalties. The court agreed that Anthem was not responsible for producing the documents requested by Bill H. because it was not a plan administrator, and noted that Amgen had produced plan documents as requested. The court thus focused on whether Amgen’s failure to produce its administrative service agreements with Anthem constituted a violation. The court noted that the Eleventh Circuit had not addressed the issue, and circuit courts differed, with the Seventh and Tenth Circuits ruling that such agreements must be produced to avoid penalties, while the Ninth Circuit suggested otherwise. (Your ERISA Watch covered the Tenth Circuit’s decision, M.S. v. Premera Blue Cross, as our case of the week in our October 9, 2024 edition.) The court found the Seventh and Tenth Circuit rulings persuasive and allowed Bill H.’s statutory penalty claim to proceed, although it cautioned that defendants could raise the issue again on summary judgment, and that any award of penalties was discretionary. The court noted that amendment was “likely futile,” but allowed Bill H. to file an amended complaint on counts 1-3 “if he may do so in good faith.”