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Bafford v. Northrop Grumman Corporation, No. 20-55222, __ F.3d ___, 2021 WL 1419055 (9th Cir.  2021) (Before Boggs, Smith, and Murguia, Circuit Judges).

This week’s notable decision is a significant Ninth Circuit victory for pension plan participants represented by attorneys from Kantor & Kantor, LLP, and Renaker Hasselman and Scott LLP.  In this published decision, the Ninth Circuit clarified that ERISA does not preempt state-law negligence claims against the plan’s third-party administrator, Hewitt, for its carelessness in miscalculating plan benefits. The court also ruled that online requests for pension benefit statements may constitute “written requests” for benefit statements for purposes of ERISA Section 105, 29 U.S.C. § 1025. The decision was not a complete victory for the participants, however, as the Ninth Circuit also concluded that the miscalculation of benefits by Hewitt involved ministerial and not fiduciary functions, and therefore none of the defendants could be held liable for fiduciary breach under ERISA based on Hewitt’s miscalculations.
Continue Reading Pension Plan Service Providers and Administrators May Be Liable for Misstated Benefits, Even Though Miscalculations Are Not Fiduciary Breaches

In an April Fool’s day decision, the Eighth Circuit holds that (1) a policy anniversary is not a renewal and thus is insufficient to trigger a State ban on discretion, and (2) absent evidence of insufficient training or experience, an opinion from a nurse constitutes a full and fair review. 

This week the Eighth Circuit’s decision in Roebuck v. USAble Life, No. 19-1855, __F.3d__, 2021 WL 1216217 (8th Cir. Apr. 1, 2021) (Before Colloton, Gruender, and Grasz, Circuit Judges), clarified what triggers Arkansas’s ban on discretionary clauses. As in many states, an Arkansas regulation (“Rule 101”) prohibited the inclusion of discretionary clauses in insurance contracts. The purpose of Rule 101 was to prohibit the conflicts of interest that exist when an insurer responsible for paying disability income benefits has discretionary authority to decide what benefits are due. In effect, the invalidation of discretionary clauses required reviewing courts to apply the less deferential de novo standard of review. But did Rule 101 ban discretionary clauses in a policy that was issued prior to the enactment of the rule? The Eighth Circuit held it did not unless the policy had express language stating a renewal date after the rule’s effective date. 
Continue Reading A Policy Anniversary Is Not a Renewal Date

This week’s notable decision is a magistrate recommendation that comes to us from ERISA Watch reader Norris Adams, who represents the plaintiff. Rose v. PSA Airlines, Inc. Group Insurance Plan, No. 3:19-CV-00695-GCM-DCK (W.D.N.C. Mar. 25, 2021), originated in the tragic death of a 27-year-old man, Kyree Devon Holman, who died while waiting for his heart transplant to be approved by his healthcare plan. The administrator of his estate filed suit against the Plan and numerous plan fiduciaries, including claims administrators, UMR, Quantum, and the outside reviewer with which they contracted, MCMC.  
Continue Reading Equitable Relief for a Participant Death