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Good morning, ERISA Watchers!  This week we want to highlight a district court decision involving a pre-existing condition limitation in a long-term disability (“LTD”) policy, Meche v. Metropolitan Life Insurance Co., No. CV 18-3995, 2020 WL 133284 (E.D. La. Jan. 13, 2020). In this case, MetLife denied Meche’s claim for LTD benefits following a lumbar spine injury he experienced at work. He filed a claim for LTD benefits with MetLife since the injury necessitated his immediate cessation of work activities. The LTD policy contained the following limitation:

Pre-existing Condition means a Sickness or accidental injury for which You:

• received medical treatment, consultation, care, or services; or

• took prescribed medication or had medications prescribed;

in the 12 months before Your insurance, or any increase in the amount of insurance, under this certificate takes effect.
Continue Reading Court Holds MetLife Erred in Applying Pre-existing Condition Limitation to Long-Term Disability Claim Following Workplace Injury

Yesterday, in Retirement Plans Committee of IBM v. Jander, No. 18-1165, 2020 WL 201024 (U.S. Jan. 14, 2020), the U.S. Supreme Court vacated and remanded a closely watched ESOP breach of fiduciary duty case to the Second Circuit Court of Appeals.  The High Court’s per curiam decision is a short one so allow me to give you some background to understand the full picture.

In December 2018, the Second Circuit issued a decision in Jander v. Ret. Plans Comm. of IBM, 910 F.3d 620 (2d Cir. 2018), cert. granted, 139 S. Ct. 2667, 204 L. Ed. 2d 1068 (2019), and vacated and remanded sub nom. Retirement Plans Committee of IBM v. Jander, No. 18-1165, 2020 WL 201024 (U.S. Jan. 14, 2020), where it addressed the question of what standard one must meet to plausibly allege that fiduciaries of an employee stock option plan (“ESOP”) have violated ERISA’s duty of prudence.
Continue Reading Supreme Court Sends Closely Watched Fiduciary Duty Case Back to the Second Circuit Court of Appeals

In this week’s notable decision, Advanced Physicians, S.C. v. Connecticut General Life Insurance Company, et al., No. 3:16-CV-2355-G, 2020 WL 58698 (N.D. Tex. Jan. 3, 2020), a district court in Texas held that the fiduciary exception to the attorney-client privilege prohibits Cigna from withholding privileged documents from a medical service provider related to Cigna’s alleged wrongful denial of insurance claims under the NFL Player Insurance Plan (“Plan”).

By way of background, Advanced Physicians (“AP”) alleged that Defendant Great-West Healthcare-Cigna (“Cigna”), which has discretionary authority to make coverage decisions under the Plan, began wrongfully refusing to pay any of AP’s claims for services that it provided to retired NFL players.  Advanced Physicians, S.C. v. Connecticut Gen. Life Ins. Co., 2017 WL 4868180 (N.D. Tex. Oct. 27, 2017).  The court previously dismissed AP’s claim for relief under ERISA Section 502(a)(3) but permitted its claim for benefits under ERISA Section 502(a)(1)(B) to proceed.  Advanced Physicians S.C. v. Connecticut Gen. Life Ins. Co., No., 2018 WL 1509120, at *3 (N.D. Tex. Mar. 27, 2018).
Continue Reading In NFL ERISA Suit, Court Finds Fiduciary Exception to Attorney-Client Privilege Applies to Cigna’s Privileged Documents