I’m pleased to report that today’s notable decision, Ariana M. v. Humana Health Plan of Texas, Inc., No. 16-20174, __F.3d__, 2018 WL 1096980 (5th Cir. Mar. 1, 2018), is a case handled by our firm attorneys – Lisa Kantor, Peter Sessions, Elizabeth Green – and our esteemed colleagues, Jim Plummer and Amar Raval of Berg Plummer Johnson & Raval, LLP. 

Since 1991, the Fifth Circuit Court of Appeals, which presides over Texas, Mississippi, and Louisiana federal law, has administered a rule in employee benefit cases. That rule stated that federal courts were required to show deference to the factual findings of a benefit plan administrator, regardless of whether the benefit plan conferred such authority on the administrator. Pierre v. Conn. Gen. Life Ins. Co., 932 F.2d 1552 (5th Cir. 1991). Continue Reading Fifth Circuit Overturns 25-Year-Old Precedent That Disadvantaged Plan Participants

A dispute over retiree healthcare benefits which has been hotly litigated for 14 years reached the end of the road with the Supreme Court’s decision in CNH Indus. N.V. v. Reese, No. 17-515, __S.Ct.__, 2018 WL 942419 (U.S. Feb. 20, 2018).  In this case, retirees brought suit against their employer, CNH Industrial N.V. (“CNH”) seeking a declaratory judgment that they were entitled to lifetime health care benefits, a permanent injunction requiring CNH to maintain the level of retiree health care benefits then in effect, and damages for injuries the retirees might sustain if benefits were terminated.

The United States District Court for the Eastern District of Michigan granted summary judgment to the retirees and awarded them attorneys’ fees.  CNH appealed to the Sixth Circuit Court of Appeals which affirmed in part, reversed in part, remanded, and denied rehearing.  The District Court again granted summary judgment to the retirees.  The Sixth Circuit reversed and remanded.  The District Court then awarded summary judgment to CNH, but on reconsideration awarded summary judgment to the retirees.  CNH appealed again and the Sixth Circuit affirmed and remanded. Continue Reading Supreme Court Hands a Loss to Retirees In Dispute Over Lifetime Health Care Benefits

A few weeks ago one of the notable decisions out of the Eastern District of Tennessee, Jordan v. Reliance Standard Life Insurance Company, 2018 WL 543041 (E.D. Tenn. Jan. 24, 2018), held that the claimant’s failure to file her ERISA lawsuit for benefits upon the administrator’s failure to make a decision on her appeal within 45 days, and her continued pursuit of administrative remedies thereafter, required her to “pursue the administrative pathway to its end.”  

This week’s notable decision out of the Seventh Circuit, Dragus v. Reliance Standard Life Ins. Co., No. 17-1752, __F.3d__, 2018 WL 851164 (7th Cir. Feb. 14, 2018), is the same song to a different beat.  In Dragus, the Seventh Circuit held that Dragus waived the argument that Reliance Standard’s failure to render a timely decision on her claim compelled de novo review simply because she pursued administrative review through an appeal rather than pursued available remedies when the issue arose (i.e. immediately file a lawsuit).  On the merits of the case, the court determined that Reliance Standard’s decision was not arbitrary and capricious, where it relied on four independent physicians who did an “unbiased investigation.”  [Query: Is that really possible?].  Additionally, the court held that Plaintiff was not entitled to supplement the claim record with the Social Security Administration’s decision finding that Dragus is disabled from any gainful employment. Continue Reading In the Seventh Circuit, File Suit Immediately or Lose De Novo Review