Gimeno v. NCHMD, Inc., No. 21-11833, __ F.4th__ 2022 WL 2309436 (11th Cir. Jun. 28, 2022) (Before Circuit Judges Pryor, Rosenbaum, and Brasher). 

Today’s case of the week goes where many cases have gone before in answering in the affirmative the straightforward question: “Does [ERISA Section 502(a)(3)] create a cause of action for an ERISA beneficiary to recover monetary benefits lost due to a fiduciary’s breach of fiduciary duty in the plan enrollment process?”
Continue Reading The Eleventh Circuit Agrees That Surcharge is Available Equitable Relief

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

This week’s first notable decision is Davis v. Hartford Life & Accident Ins. Co., No. 19-6091, __F.3d__, 2020 WL 6789448 (6th Cir. Nov. 19, 2020), where the Sixth Circuit held that the arbitrary-and-capricious standard of review applied to Hartford’s decision to terminate Davis’s long-term disability (“LTD”) benefits and that Hartford’s decision was not arbitrary and capricious.

Davis stopped working due to chronic back pain, neuropathy, and fatigue caused by multiple myeloma. Hartford approved his LTD claim and paid him 24 months of benefits under the policy’s Own Occupation definition of disability. While investigating whether Davis would continue to qualify for benefits when the policy’s definition of disability changed from Own Occupation to Any Occupation, Hartford conducted surveillance, obtained two reviews of Davis’ medical records, and had Davis examined by an orthopedic surgeon. Hartford showed some of the surveillance footage to Davis’s treating doctors. After viewing surveillance video, Davis’s primary care doctor and neurologist both responded to Hartford that Davis was capable of full-time work.
Continue Reading Sixth Circuit Applies Deferential Standard of Review to Hartford’s Decision to Terminate Long-Term Disability Benefits