Gasper v. EIDP, Inc., No. 24-1959, __ F.4th __, 2025 WL 3510832 (4th Cir. Dec. 8, 2025) (Before Circuit Judges Benjamin, Berner, and Keenan)

ERISA famously has an “anti-alienation” provision which prohibits pension plan participants from assigning their benefits to others. It also has an equally famous preemption clause stating that it “supersede[s] any and all State laws insofar as they may now or hereafter relate to any employee benefit plan.”

These rules were designed to protect pension plan participants from losing control of their benefits and provide a uniform system of federal law to ease plan administration. However, these rules created problems. What if a plan participant gets divorced? Are family court domestic relations orders, or “DROs,” enforceable if they try to divide up the participant’s plan benefits? Some federal courts said yes while others said no.

Congress tried to fix this issue in 1984 by inventing “qualified domestic relations orders,” or “QDROs.” (Fight amongst yourselves about how that should be pronounced.) Under the new rules, state court DROs could become QDROs, and thus enforceable against benefit plans, if they met several criteria.

Of course, the new rules only created more problems. What rules should a federal court use in interpreting QDROs? What if there is an inconsistency between a QDRO and a plan? Must a court be deferential to a plan administrator’s interpretation of a QDRO? Some of these issues were addressed in this week’s notable decision out of the Fourth Circuit.

The plaintiff in the case was David Gasper, who divorced from his spouse of 25 years in 2010. Gasper was employed by defendant EIDP, Inc. and his account in EIDP’s employee retirement plan was one of the assets considered by the North Carolina family court adjudicating the divorce.

Eventually, the family court issued a DRO which reflected the agreement between Gasper (the “Participant” in the plan) and his spouse (the “Alternate Payee” under the plan) over how to divide their assets. Under the DRO, both parties would receive a monthly annuity payment, although Gasper’s would be larger. The DRO further stated that Gasper’s spouse “shall be treated as a surviving spouse,” and “the Alternate Payee’s benefit may be reduced as necessary to cover the cost of the [surviving spouse annuity] awarded to Alternate Payee.”

Gasper submitted the DRO to EIDP for review, and EIDP determined that the DRO met the requirements for a QDRO under ERISA. (The Ninth Circuit has appropriately observed that interpreting QDROs is “a task that, unfortunately, requires some tolerance for acronyms.”) EIDP agreed to “distribute benefits to the alternate payee in accordance with the order and Plan terms,” and stated that “[a]t the participant’s benefit commencement date, the total monthly benefit will be reduced to cover the cost associated with the [surviving spouse annuity]” (emphasis added).

In 2019, Gasper prepared to retire from EIDP. EIDP provided him with a pension election authorization form which outlined his benefit choices. Gasper signed the form, which stated that his monthly benefit would be $3,400. However, after signing the form, Gasper contacted EIDP and informed it that his monthly benefit should be $3,785.26, not $3,400. Gasper contended that, under the terms of the QDRO, his former spouse was supposed to bear the cost of the surviving spouse annuity, not him.

EIDP responded by stating that the “cost” of the surviving spouse annuity was the “actuarial adjustment [made] to convert a benefit payable over the participant’s lifetime to a benefit payable over the joint lifetimes of both the participant and [the] surviving spouse.” The notice further explained that “the total benefit was actuarially adjusted to reflect the joint life expectancy requirement of the [surviving spouse annuity], and then the portion of the total benefit payable to the alternate payee was deducted.” As a result, EIDP stated that “there is no actual ‘cost’ [of the surviving spouse annuity] that may be assigned to the alternate payee, and no optional form that would accomplish that result.” In short, under the terms of the plan the deduction could not be assigned solely to the spouse.

Gasper was not happy and he appealed, albeit unsuccessfully. On appeal, EIDP explained that the QDRO “does not state that the Alternate Payee’s benefit must be reduced in order to cover the [surviving spouse annuity]. Assigning a portion of the cost [i.e., the actuarial adjustment] to both you and your Alternate Payee does not conflict with the QDRO.”

During this time Gasper also requested plan documents. EIDP responded, but Gasper was not satisfied, contending that pages of some documents were omitted, and that documents from certain plan years were missing.

Having exhausted his appeals, Gasper filed suit against EIDP and the plan’s administrator. His two primary claims for relief were (1) wrongful denial of benefits under 29 U.S.C. § 1132, and (2) a claim for statutory penalties for failure to produce documents under 29 U.S.C. §§ 1024, 1132.

The case was decided on cross-motions for summary judgment; the district court granted defendants’ motion and denied Gasper’s. The district court ruled that “(1) the plan administrator correctly interpreted the QDRO and did not abuse her discretion in denying Gasper’s claim that he was entitled to a larger monthly payment, and (2) the plan administrator was responsive to Gasper’s request for documents[.]” (Your ERISA Watch reported on this decision in our September 4, 2024 edition.)

Gasper appealed to the Fourth Circuit, which affirmed in this published opinion. The court began with the standard of review, noting that “our Circuit has not directly addressed whether courts should review de novo, or apply an abuse of discretion standard to, a plan administrator’s interpretation of a QDRO adopting the terms of a DRO entered by a state court.”

The Fourth Circuit agreed with the district court that the correct standard was de novo because “a plan administrator’s special expertise in interpreting plan provisions, which warrants application of an abuse of discretion standard in reviewing such decisions, does not extend to the interpretation of a state court order memorializing the parties’ agreement.” The court ruled that QDROs are essentially “court-approved contracts,” and thus are “subject to ordinary rules of contract interpretation under state law.” However, the plan administrator’s exercise of discretionary authority in calculating benefits under the terms of the plan would be reviewed for abuse of discretion.

The Fourth Circuit then turned to the terms of the QDRO. It agreed with the district court that the language was unambiguous. Gasper pointed to the language stating that “the alternate payee’s benefit may be reduced as necessary to cover the cost” of the surviving spouse annuity, arguing that this meant that the spouse’s benefit should be reduced, not his.

However, the Fourth Circuit ruled that the word “may” “authorizes, but does not require, the plan administrator to allocate the cost of the surviving spouse annuity to the alternate payee’s portion of the benefit.” The fact that other parts of the QDRO used the word “shall” in referring to other agreements between the parties about plan benefits provided further support for the conclusion that “may” gave the administrator wiggle room.

The Fourth Circuit also noted that this interpretation was consistent with the plan documents. The operative summary plan description explained that under the surviving spouse annuity, “the reduction in [the participant’s] monthly pension is actuarially determined at the time [the participant] retires and start[s] to receive pension payments.” A sample calculation showed how that actuarial adjustment for the surviving spouse annuity was implemented through a reduction in the participant’s monthly pension amount.

As a result, the Fourth Circuit concluded that the defendants’ implementation of the QDRO was consistent with both the language of the QDRO and the terms of the plan.

As for Gasper’s claim for statutory penalties, the court concluded that even if Gasper did not receive all the documents he requested in a timely fashion, that did not mean he was entitled to a penalty. The court noted that Gasper “ultimately received all requested documents after filing the present action, and he has not identified any prejudice resulting from his delayed receipt of the identified documents.”

Furthermore, the plan documents Gasper contended he did not receive were “materially identical” to the ones EIDP produced to him regarding the provisions at issue, and there was no “evidence of bad faith or willful misconduct on the part of the plan administrator.” As a result, “the district court did not abuse its discretion in declining to impose statutory penalties under 29 U.S.C. § 1132(c)(1).”

Below is a summary of this past week’s notable ERISA decisions by subject matter and jurisdiction.

Arbitration

Sixth Circuit

Koelbl v. The Sherwin-Williams Co., No. 1:24-CV-02043, 2025 WL 3562641 (N.D. Ohio Dec. 12, 2025) (Judge Bridget Meehan Brennan). The plaintiffs in this action participated in Sherwin-Williams’ health plan, which required a tobacco use declaration and imposed a surcharge for tobacco users. They filed this class action asserting six claims for relief under ERISA, as amended by the Affordable Care Act, alleging that Sherwin-Williams discriminated against them based on health status-related factors. The plaintiffs argue that the plan fails to meet the statutory and regulatory requirements for wellness programs, which are exceptions to the anti-discrimination mandate. Sherwin-Williams responded by filing a motion to compel arbitration and a motion to dismiss. It pointed to signed offer letters from the named plaintiffs that included an Employment Dispute Mediation & Arbitration Agreement, which mandated arbitration for “Covered Disputes” and prohibited class actions. The agreement included a delegation provision, assigning the arbitrator the authority to decide on the arbitrability of disputes. Under the Federal Arbitration Act, the court used a two-step test to determine (1) if there was “a valid contract to arbitrate between the parties,” and (2) if so, “whether the parties’ dispute falls within the arbitration agreement’s scope[.]” The court quickly concluded that step one was satisfied: “The parties do not dispute a valid agreement to arbitrate exists.” Under step two, plaintiffs did not dispute that most of their claims were “Covered Disputes” under the agreement. However, they argued that Count Three, which alleged a claim for breach of fiduciary duty under ERISA, could not be compelled into arbitration because the agreement contained a class action waiver, which is unenforceable in the Sixth Circuit under the recently decided Parker v. Tenneco. As a result, plaintiffs contended that “because Count Three cannot proceed in individual arbitration, the remaining claims also cannot proceed in arbitration.” In response, Sherwin-Williams agreed that Parker barred enforcement of the arbitration clause regarding Count Three, but contended that “the matter must be compelled to arbitration for at least the threshold issue of whether these [remaining] claims must be arbitrated or litigated in court.” Sherwin-Williams pointed to the agreement, which “expressly delegated threshold questions of arbitrability and interpretation of the Agreement to the arbitrator.” The court agreed with Sherwin-Williams, and sent the case to arbitration, ordering the arbitrator to first “consider the arbitrability of the claims considering the Agreement’s language. To the extent the arbitrator finds these claims arbitrable, the claims shall proceed in arbitration. To the extent the arbitrator finds these claims non-arbitrable, the parties will resume litigation in this Court.” Meanwhile, the court ordered a discretionary stay of litigation involving Count Three pending the results of the arbitration proceedings on the other claims given the “significant overlap” between the claims and the potential for “duplicative efforts.” As a result, Sherwin-Williams’ motion to compel arbitration was granted and its motion to dismiss was denied as moot.

Breach of Fiduciary Duty

Tenth Circuit

Brewer v. Alliance Coal, LLC, No. 24-CV-0406-CVE-SH, 2025 WL 3527171 (N.D. Okla. Dec. 9, 2025) (Judge Claire V. Eagan). Plaintiffs Joseph Brewer, Joshua Chuck, and Jason Moody are participants in Alliance Coal, LLC’s defined contribution employee pension benefit plan. They filed this putative class action against Alliance and related defendants alleging that defendants violated ERISA by breaching their fiduciary duties of prudence and loyalty, violating the anti-inurement provision, and failing to monitor other fiduciaries. Specifically, plaintiffs contend that defendants failed to control the plan’s recordkeeping and administrative (RKA) fees and improperly used forfeitures to reduce employer contributions instead of defraying RKA costs. Plaintiffs also allege that defendants breached ERISA’s anti-inurement provision by using forfeited funds to defray company contributions rather than reducing participant RKA costs. Defendants filed a motion to dismiss in which they conceded they were fiduciaries under the plan. However, they argued that plaintiffs failed to raise any inference of imprudence under ERISA regarding RKA fees, as the comparator plans they cited did not provide a “meaningful benchmark.” Defendants also argued that they followed the plan’s terms in using forfeitures and that the plan’s terms did not violate ERISA. The court granted their motion in this order. Regarding the RKA fees, the court found that plaintiffs failed to provide a meaningful benchmark for comparison, as they did not allege that the comparator plans provided the same quality or type of service as that provided by Intrust, the plan’s recordkeeper. In doing so, the court rejected plaintiffs’ proposition that “all recordkeeping services are fungible and thus all plans inherently offer the same quality and type of service.” The court also rejected the proposition that Intrust’s “relative inexperience as a recordkeeper…led to increased RKA costs” and that defendants’ alleged failure to solicit a request for proposal at “a reasonable interval” was necessarily imprudent. The court then moved on to plaintiffs’ forfeiture arguments. The court noted that plaintiffs’ theory regarding defendants’ use of forfeitures was unpopular: “Courts have repeatedly held that ERISA permits the use of forfeiture funds for employer contribution matching.” The court held that plaintiffs’ theory (1) was inconsistent with the Supreme Court’s analysis in Fifth Third Bankcorp v. Dudenhoeffer because it ignored “the context and circumstances of the fiduciary’s actions,” (2) “plaintiffs’ theory seeks to impose liability that goes beyond ERISA’s statutory framework” because “ERISA creates no duty for a fiduciary to maximize profits or benefits,” and (3) “plaintiffs’ theory would disturb decades of policy built on Congress’s and the Department of the Treasury’s understanding that ERISA permits plan administrators to use forfeitures to reduce their contributions before defraying RKA fees.” The court further held that plaintiffs’ forfeiture argument could not support a claim under ERISA’s anti-inurement provision because “the forfeited funds had to have left the plan for an anti-inurement provision claim to be valid,” and here plaintiffs “do not state that any forfeited fees left the plan.” As a result, the court granted defendants’ motion in its entirety. Plaintiffs were granted leave to amend their complaint regarding the RKA fees claim, but were denied leave to amend their forfeiture claims. Leave to amend those claims “would be futile” because “plaintiffs pursue a tentative theory that is unsupported by present law.”

Class Actions

Sixth Circuit

Murphy v. Auto Club Grp., No. 5:24-CV-11168-JEL-CI, 2025 WL 3530071 (E.D. Mich. Dec. 9, 2025) (Judge Judith E. Levy). The plaintiffs in this class action alleged that defendant Auto Club Group violated ERISA, as amended by the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA), by failing to provide timely health insurance notices. The parties reached a settlement, and in this brief workmanlike order the court granted final approval of the class action settlement, finding it fair, reasonable, and adequate. The notice provided to the settlement class was deemed the best practicable under the circumstances and complied with the requirements of Federal Rule of Civil Procedure 23 and due process. No settlement class member objected to the terms of the agreement, nor were there any requests for exclusion. The court determined that the settlement consideration ($1 million) was fair value in exchange for the release of claims against the released parties. The court further determined that the consideration was reasonable and in the best interests of the settlement class members, considering the total value of their claims, the disputed factual and legal circumstances, affirmative defenses, and the potential risks and likelihood of success in pursuing litigation. The court found no collusion in reaching the agreement. The court also found that the class representative and class counsel adequately represented the settlement class, and the class met the criteria for certification under Rule 23. Class counsel’s request for attorneys’ fees amounting to one-third of the settlement fund ($333,333.33) was granted, along with reasonable litigation costs totaling $7,020.17. The class representative, Regis Murphy, was granted a service award of $10,000. As a result, the courtdirected entry of the final approval order, finding no just reason for delay of enforcement or appeal.

Eighth Circuit

Randall v. GreatBanc Trust Co., No. 22-CV-2354 (LMP/DJF), 2025 WL 3513880 (D. Minn. Dec. 8, 2025) (Judge Laura M. Provinzino). Plaintiffs Aryne Randall, Scott Kuhn, and Peter Morrissey filed this class action against Wells Fargo & Co., GreatBanc Trust Company, and Timothy J. Sloan (former CEO of Wells Fargo), alleging breaches of fiduciary duty and prohibited transactions under ERISA in the administration of the Wells Fargo ESOP Fund. Plaintiffs allege that defendants breached their duties to plan participants by overvaluing preferred stock when obtaining convertible Wells Fargo stock for the ESOP Fund and then using the dividend income from the preferred stock to meet Wells Fargo’s employer matching contributions obligations, inuring the plan assets to the benefit of the employer, not the plan. As we reported in our January 29, 2025 edition, the court granted plaintiffs’ unopposed motion for class certification and appointment of class representatives and class counsel. That order certified a class including all participants in the Wells Fargo & Co. 401(k) Plan from September 27, 2016, to December 30, 2022, who held any portion of their Plan accounts in the ESOP Fund, excluding certain individuals associated with defendants. Since then, the parties have negotiated a settlement through which Wells Fargo will deposit $84 million into a qualified settlement fund by January 7, 2026. The court reviewed the proposed settlement and gave it preliminary approval in this order. The court further approved a notice program to inform class members of the settlement, which includes sending notices via email and mail, and publication on a dedicated website. Class members can object to the settlement by February 25, 2026. The court also ordered class counsel to file a motion for attorneys’ fees, costs, expenses, and a service award by February 2, 2026. The court scheduled a final approval hearing for March 17, 2026 to determine the fairness of the settlement, the entry of final judgment, and the approval of the plan of allocation, among other issues.

Disability Benefit Claims

Ninth Circuit

Bechtel v. Wexford Health Sources Inc., No. CV-25-08006-PCT-DLR, 2025 WL 3537563 (D. Ariz. Dec. 10, 2025) (Judge Douglas L. Rayes). Plaintiff Mark Bechtel worked for defendant Wexford Health Sources, Inc., which maintained ERISA-governed short-term disability (STD) and long-term disability (LTD) employee benefit plans. Both plans were insured through Lincoln Financial Group. Bechtel experienced medical issues in late August 2022, leading to a hospital stay. He received benefits under the STD Plan until November 28, 2022, and returned to work on January 4, 2023. However, his medical issues recurred, and Wexford reduced his work hours, reclassifying him as a part-time employee on January 30, 2023. Bechtel was granted unpaid leave from April 12, 2023, to June 1, 2023, but he did not return to work, leading to his termination effective June 3, 2023. He applied for STD benefits again, but Lincoln denied his claim, stating that he was ineligible due to his part-time status, which doomed any potential claim for LTD benefits as well. Bechtel’s appeal was denied in March 2024, and he did not pursue a second appeal. In January 2025, Bechtel filed this action against Wexford and the plans, alleging breach of fiduciary duty under 29 U.S.C. § 1132(a)(3) and failure to pay benefits under § 1132(a)(1)(B). He claimed Wexford failed to inform him of his disability options and that he would have been eligible for benefits if Wexford had reported the correct information to Lincoln. Wexford responded with a motion for summary judgment, contending that Bechtel failed to exhaust administrative remedies as required under ERISA. The court addressed Bechtel’s failure to pay claim under § 1132(a)(1)(B) first. Bechtel conceded that Wexford was not the correct party for this claim, as Lincoln was responsible for paying benefits; indeed, he admitted that Lincoln’s “denial was, unfortunately, proper.” Consequently, the court granted summary judgment to Wexford on this claim. As for Bechtel’s breach of fiduciary duty claim, Wexford contended that this claim was a disguised benefits claim, requiring exhaustion. However, the court found that Bechtel’s request for surcharge and reformation constituted equitable relief, not compensatory damages, and thus did not require exhaustion. The court also disagreed with Wexford’s assertion that the claim depended on plan interpretation, noting it involved fiduciary obligations under ERISA. The court further ruled that Bechtel’s claim was not disguised as a benefits claim, even if it resulted in monetary relief, because Bechtel could not seek relief under § 1132(a)(1)(B) due to his ineligibility for benefits as a part-time employee. Therefore, the court denied Wexford’s motion for summary judgment on the breach of fiduciary duty claim.

ERISA Preemption

Fourth Circuit

Simpson v. Aflac Ins. Co., No. CV DKC 25-1437, 2025 WL 3550800 (D. Md. Dec. 11, 2025) (Judge Deborah K. Chasanow). Plaintiff Marica Simpson filed a pro se complaint against Aflac Insurance Company in state court, alleging breach of contract for failing to reimburse her for $30,000 in premiums she claims should have been refunded to her under a group whole life insurance policy. Aflac removed the case to federal court, asserting ERISA preemption, and then filed a motion to dismiss the complaint and strike Simpson’s jury demand. In its motion, Aflac contended that Simpson’s service was improper because it was made to an unauthorized individual who was not an officer or agent authorized to receive service on behalf of Aflac. The court noted that while the service was indeed insufficient, it was not a fatal flaw because Aflac was not prejudiced by it, and the case was still in its early stages. Therefore, the court denied the motion to dismiss on this ground but reminded Simpson to follow proper service requirements for any amended complaint. Aflac also contended that “Aflac Insurance Company” was not the correct legal entity to be sued, as the policy was issued by Continental American Insurance Company, a subsidiary of Aflac. The court acknowledged confusion due to the use of the “Aflac” trade name but decided not to dismiss the complaint based on this mistake, given the participation of the proper defendant in the litigation and the latitude granted to pro se plaintiffs. Finally, the court addressed the ERISA issues. Aflac contended that Simpson’s state law breach of contract claim was preempted by ERISA, and the court agreed that the insurance policy in question was likely an employee benefit plan. However, the court stated that ERISA preemption does not require dismissal, but rather automatically converts a state law claim into a federal claim, which must then be properly alleged under ERISA. As for the merits of Simpson’s claim, “There is not enough information on the face of the complaint to move forward with an ERISA claim… Plaintiff makes legal conclusions and only provides scarce facts.” As a result, the court denied Aflac’s motion to dismiss, and further denied its motion to strike the jury demand as moot. The court dismissed Simpson’s complaint without prejudice, and she was granted 21 days to file an amended complaint, properly naming Continental American Insurance Company as the defendant, following service requirements, and stating a proper fully alleged claim under ERISA.

Fifth Circuit

Dukes v. Sun Life Assur. Co. of Canada, No. CV 25-623-EWD, 2025 WL 3539154 (M.D. La. Dec. 10, 2025) (Magistrate Judge Erin Wilder-Doomes). Plaintiff Kevin Dukes filed this action in state court against Sun Life Assurance Company of Canada, alleging state law claims for relief arising from Sun Life’s non-payment of long-term disability benefits. Sun Life removed the case to federal court based on ERISA preemption and diversity jurisdiction. The parties then filed a slew of motions: four by Dukes (two related motions to remand to state court and two related motions for Rule 11 sanctions), and one by Sun Life (motion to dismiss). Addressing subject matter jurisdiction first, the court ruled that this “question…is easily resolved, and the Court need not consider whether Defendant has adequately pleaded federal question jurisdiction to answer it because Defendant alleged sufficient facts in the Notice of Removal to establish diversity jurisdiction under 28 U.S.C. § 1332.” This was because plaintiff was a Louisiana resident, Sun Life is a Canadian corporation with its principal place of business in Massachusetts, and the amount in controversy was “established because Plaintiff asserts in the Petition that he is entitled to $725,618.00 in damages[.]” The court further found that Sun Life’s removal was proper because it was filed within the 30-day period after being served with Dukes’ petition, which explicitly sought damages exceeding the federal jurisdictional minimum. The court also noted that the presence of a dispositive motion pending in state court, filed by Dukes, did not prevent removal, as Sun Life did not file the motion. Turning to preemption, the court granted Sun Life’s motion to dismiss, finding that Dukes’ state law claims were preempted by ERISA. Dukes’ breach of contract claim and claims under the Louisiana Insurance Code were preempted because they sought benefits under an ERISA plan and therefore “related to” a plan. Additionally, the court found that even if Dukes’ claims were not preempted, they failed to state a claim under state law because he did not specify which contract provision was breached, and the relevant Louisiana statutes he cited did not apply to his long-term disability coverage. As a result, the court denied Dukes’ motions for remand and sanctions, as Sun Life established subject matter jurisdiction and there was no procedural defect in the removal, and further granted Sun Life’s motion to dismiss because Dukes’ state law claims were preempted by ERISA and/or failed to state a claim. Dukes’ summary judgment motion, which was pending in state court at the time of removal, was also denied.

Sixth Circuit

Baptist Mem’l Health Care Corp. v. Cigna Healthcare of Tenn., Inc., No. 2:25-CV-02750-SHL-TMP, 2025 WL 3517873 (W.D. Tenn. Dec. 8, 2025) (Judge Sheryl H. Lipman). Baptist Memorial Health Care Corporation filed this action against Cigna Healthcare of Tennessee, Inc. in Tennessee state court, alleging unjust enrichment due to underpayment for emergency services Baptist provided to patients who were Cigna members between March 2019 and December 2021. Baptist alleges that it is out-of-network with Cigna, but “is nevertheless obligated by federal and state law to provide emergency and post-stabilization services to Cigna members.” Cigna removed the case to federal court based on ERISA preemption, and Baptist responded with a motion to remand, which was decided in this order. Baptist argued that remand was necessary because Cigna cannot satisfy the two-pronged preemption test from the Supreme Court’s decision in Aetna Health Inc. v. Davila. Under the first prong, Baptist contended it lacked standing to bring an ERISA claim because it is not a plan participant, its complaint does not contest a denial of benefits but rather the rate of payment, and its unjust enrichment claim is based on Tennessee common law, independent of ERISA. Cigna countered that Baptist has standing through its patients’ assignment of benefits; furthermore, Baptist is contesting a denial of benefits under ERISA, and must show the plan itself was unlawful to claim unjust enrichment. The court agreed that Baptist had potential standing as a derivative beneficiary, but emphasized that Baptist was not suing for denial of benefits but under an independent state law theory. “Thus, regardless of whether the Hospital could have brought a claim under ERISA, the Hospital could not have brought these claims under ERISA.” As for Baptist’s “rate of payment” argument, Cigna argued that Baptist’s claims arose within ERISA plans, as the plans limit payment obligations. However, while the court admitted that “ERISA plans are a ‘but-for’ cause of this dispute, in that Baptist would not be suing Cigna but for the ERISA-plan-covered patients who sought its emergency services,” this did not necessarily mean that “Baptist is suing ‘only because of the terms of an ERISA-regulated’ plan.” Thus, the court found Cigna’s argument unavailing, stressing that the suit concerns the rate of payment, not the right to payment, as Cigna paid the claims at issue. Under the second Davila prong, the court agreed with Baptist that it had pled a state-law duty independent of ERISA. The court stated that Baptist “does not challenge the lawfulness of plan terms… Rather, Baptist alleges a violation of a legal duty outside of those terms – namely, a duty to adequately reimburse Baptist for the benefits Cigna allegedly received.” As a result, neither Davila prong was met, and thus the court granted Baptist’s motion to remand. “Ultimately, whether Baptist can make out a case of unjust enrichment may be a close call, but that is a call for another court to make.”

Life Insurance & AD&D Benefit Claims

Fourth Circuit

Brown v. Life Ins. Co. of N. Am., No. 7:25-CV-878-BO-KS, 2025 WL 3543618 (E.D.N.C. Dec. 10, 2025) (Judge Terrence W. Boyle). This case centers around an ERISA-governed group life insurance policy issued by Life Insurance Company of North America (LINA) to Omega World Travel, Inc. The policy included a “Basic Life” portion providing $15,000 in automatic coverage and a “Voluntary Life Insurance” portion allowing employees to elect additional coverage. Kurt Svendsen, an employee of Omega, was covered under both portions, totaling $165,000 in life insurance. However, the policy terminated on November 1, 2023, when Omega switched insurance carriers, and Svendsen died within the 31-day conversion period on November 28, 2023. Lori Brown, the beneficiary, filed a claim for the full $165,000 benefit, which LINA denied on the grounds that the policy had terminated. On appeal LINA acknowledged coverage but limited the benefit to $10,000, citing policy terms. Brown filed this action, alleging claims under ERISA and North Carolina law against both Omega and LINA. Both filed motions to dismiss, which were adjudicated in this order. First, Omega argued that it could not be held liable under ERISA because it was not a fiduciary. The court agreed, contending that fiduciary status requires discretionary authority over plan management or administration, which Omega did not exercise by merely accepting Svendsen’s premiums without notifying him of lapsed eligibility. The court also dismissed Brown’s state law claims against Omega, finding them preempted by ERISA because they all “‘relate to’ the ERISA plan at issue.” As for LINA, the court granted its motion to dismiss the state law unfair and deceptive insurance practices claim asserted against it because Brown conceded that this claim was preempted by ERISA. The relevant state statute is enforceable only by the Commissioner of Insurance, and the private right of action under the state’s Unfair and Deceptive Trade Practices Act is preempted. The court also struck Brown’s jury demand, as the remaining claim under ERISA is equitable in nature. Thus, only the ERISA claim against LINA will proceed, and it will be tried to the court.

Plan Status

Fifth Circuit

Aikens v. Colonial Life & Accident Ins. Co., No. CV 24-0580, 2025 WL 3554622 (W.D. La. Dec. 11, 2025) (Judge S. Maurice Hicks, Jr.). The case involves a dispute over life insurance proceeds following the death of Keelien Lewis on December 31, 2017. Defendant Colonial Life & Accident Insurance Company issued four individual term life insurance policies, each worth $250,000, to individuals associated with a business called “Just What You Expect.” The insured individuals were Daniel Dewayne Aikens, Keelien Lewis, Jason Miles, and Jonathan Sanders, each claiming a 25% ownership in the business, which was named as the beneficiary. Lewis died suspiciously two months after his policy took effect. The initial death certificate listed carbon monoxide toxicity as the cause of death, with the manner of death pending investigation. The final death certificate later listed the manner of death as homicide. Colonial Life investigated the death and learned that Aikens had been charged with several unrelated federal crimes (he was later convicted and sentenced to 16 years in prison for bombings in Alexandria and Monroe, Louisiana), and that news articles indicated he was a suspect in Lewis’ death. Undeterred, Aikens filed this action claiming that Colonial Life violated ERISA by failing to pay him $1,500,000, which he later amended to an eye-watering $35,547,976. This number was based on the allegation that Colonial Life failed to provide various plan documents to Aikens in 2018 and 2019. Meanwhile, Colonial Life deposited the $250,000 in benefits at issue with the court under interpleader rules, named various competing claimants for the funds, and filed a motion for summary judgment, requesting that it be dismissed as a disinterested stakeholder. Aikens opposed this motion, arguing that Colonial Life was a plan administrator under ERISA and owed him statutory penalties for failing to provide documents. Colonial Life contended that it was not a plan administrator and that ERISA did not apply. The court granted Colonial Life’s motion. The court found that interpleader was properly invoked, and that the plan was not governed by ERISA. Specifically, “[t]he record contains no evidence that any employer ever established, maintained, or administered an ERISA-regulated employee welfare benefit plan. Instead, the record shows a set of four individual life insurance policies purchased in November 2017[.]” Furthermore, the policy at issue “was for the benefit of the business, not for the benefit of Lewis as an employee,” and “if the business was owned equally by four individuals…then Lewis was not an employee for whom the employer established an ERISA plan[.]” As a result, “the Court finds that Aikens has failed to establish that the policy at issue is governed by ERISA.” Out of an abundance of caution, the court further ruled that even if the policy was governed by ERISA, Colonial Life was not the plan administrator and thus could not be liable for the statutory penalties sought by Aikens. Thus, the court granted Colonial Life’s motion, dismissed Aikens’ claims against Colonial Life, and discharged Colonial Life from the litigation.

Pleading Issues & Procedure

Second Circuit

Jones v. Turning Stone Enterprises LLC, No. 5:24-CV-1596 (GTS/ML), 2025 WL 3521301 (N.D.N.Y. Dec. 9, 2025) (Judge Glenn T. Suddaby). Plaintiffs David Jones, Keith Wilcox, and Keely Vondell are all employees of defendant Turning Stone Enterprises and participants in the Oneida Nation Enterprises, LLC 401(k) Plan. (Turning Stone Enterprises is owned by the Oneida Indian Nation.) Plaintiffs have asserted six claims under ERISA, including breaches of fiduciary duties and engaging in prohibited transactions, against Turning Stone and the plan’s investment committee arising from their alleged mismanagement of the plan. Defendants filed a motion to dismiss the complaint, asserting three related arguments arising from the Oneida Nation’s status as a federally recognized Indian tribe. Defendants contended: (1) they are instrumentalities of the Oneida Nation and thus entitled to sovereign immunity; (2) ERISA does not abrogate this immunity; and (3) the Oneida Nation has not clearly waived that immunity. Plaintiffs countered by arguing that Congress abrogated tribal sovereign immunity through its 2006 amendments to ERISA. Plaintiffs also argued that defendants waived any claimed immunity because the plan allows participants to file suit in a court of competent jurisdiction, implying federal court jurisdiction for ERISA claims. The court agreed with plaintiffs, ruling that it had subject-matter jurisdiction over their claims. In doing so the court applied the standard for determining congressional abrogation of sovereign immunity, requiring a clear legislative statement. It found that the 2006 ERISA amendments, which included plans established and maintained by Indian tribal governments in the definition of “governmental plans” (which are excluded from ERISA’s ambit), supported this reading because the amendments were limited to “essential government functions” and not “commercial activities.” “The fact that only governmental plans administered by tribes are exempted from ERISA necessarily implies that a commercial plan administered by a tribe would be subject to ERISA.” This provision, when read in context with ERISA’s other provisions, convinced the court that ERISA “evince[s] an intent that commercial plans administered by Indian tribes are covered by ERISA[.]” The court further noted that its conclusion was consistent with those of other courts: “Courts that have rendered decisions on this specific issue have almost uniformly determined that the 2006 amendment to ERISA exempting government plans administered by tribes acts as an expressed intention that non-governmental, or commercial, plans administered by tribes are subject to ERISA and the tribe’s sovereign immunity is abrogated as to those plans.” As a result, the court found a “clear abrogation of sovereign immunity” in ERISA and thus denied defendants’ motion to dismiss for lack of subject-matter jurisdiction.

Provider Claims

Sixth Circuit

Nationwide Children’s Hosp. v. The Raymath Co., No. 3:23-CV-044, 2025 WL 3537584 (S.D. Ohio Dec. 10, 2025) (Judge Thomas M. Rose). C.D., a minor, was a patient at Nationwide Children’s Hospital. Upon arrival at the hospital, C.D.’s parent, T.D., executed a General Consent form, assigning all rights and claims for reimbursement under any applicable insurance “programs” to Nationwide Children’s. Nationwide Children’s subsequently submitted a claim for $611,771.45 to Cigna, which was a third-party administrator for defendant Raymath Company’s self-insured employee health plan. The plan covered medical treatments performed up to May 31, 2021, with a run-out period for claims incurred before June 1, 2021, but not yet paid, ending on November 30, 2021. Cigna initially approved the claim, but Raymath denied it on review due to the expiration of the run-out period. As a result, Nationwide Children’s only received partial payment for its services. Nationwide Children’s brought this action for the remainder, and in response Raymath filed a motion for summary judgment based on the argument that Nationwide Children’s lacked standing to sue. Raymath argued that the assignment of benefits did not include the plan as a category of benefit programs assigned. The court disagreed and found the language of the assignment unambiguous. The court stated that the assignment included four categories of benefit programs: private health insurance policies, Medicare, Medicaid, and “any other programs identified by T.D.” The plan fell within the fourth category, making the assignment valid. Raymath’s attempt to limit the assignment to government-sponsored programs similar to Medicare or Medicaid was rejected, as the assignment contained no such limitation. Furthermore, the court found that Raymath’s interpretation would render other plan language meaningless. The court then examined case law which reflected a “broad consensus” that valid assignments give providers standing to sue for plan benefits under ERISA. As a result, “Because Nationwide Children’s Assignment validly assigned C.D.’s rights and claims to reimbursement to Nationwide Children’s, Nationwide Children’s was conferred standing under ERISA. Therefore, Raymath’s Motion for Summary Judgment…is DENIED.”

Severance Benefit Claims

Tenth Circuit

Bessinger v. Cimarex Energy Co., No. 23-CV-00452-SH, 2025 WL 3527169 (N.D. Okla. Dec. 8, 2025) (Magistrate Judge Susan E. Huntsman). Plaintiff Jay Bessinger was employed as a lead accountant by defendant Cimarex Energy Co., which maintained a Change in Control Severance Plan providing separation benefits to certain employees following a change in control. This dispute arose after Cimarex merged with Cabot Oil & Gas Corporation to form Coterra Energy, Inc., a merger that qualified as a “Change in Control” under the Plan. The Plan provided that a participant would be entitled to separation benefits if his employment was terminated by the employer for reasons other than cause, death, or disability, or if the participant terminated their employment for “Good Reason” within 120 days of learning of such a reason. “Good Reason” included the “requirement” for a participant to relocate their principal place of business to another metropolitan area more than 50 miles away. Bessinger remained employed in Tulsa after the merger and claimed he was informed that the entire accounting department would relocate to Houston. He requested a release as a transition employee and later formally requested benefits under the Plan, asserting that his self-termination was for “Good Reason” due to the relocation requirement. Cimarex denied his request, stating that Bessinger voluntarily resigned to take another job, which did not qualify under the Plan’s provisions. Bessinger appealed the denial, arguing that other employees who resigned for new jobs received benefits and that the Plan did not allow denial based on accepting alternate employment. However, the appeals committee upheld the denial, stating that Bessinger was not “required” to relocate and that his role was a transition role, expected to be eliminated in the future. Bessinger filed suit and the case proceeded to judgment. The court reviewed the case under the arbitrary and capricious standard because the plan granted Cimarex discretionary authority in making benefit determinations. Under this deferential standard of review, the court found “substantial evidence” supporting Cimarex’s decision. The court stated that the term “requiring” in the plan was unambiguous, and under it “Cimarex did not request, demand, command, compel, or otherwise tell Bessinger that he must relocate his principal place of business to Houston. Cimarex asked Bessinger if he was willing to move to Houston, albeit with the common understanding that – eventually – there would be no more accounting jobs in Tulsa. If Cimarex eliminated those Tulsa jobs within two years of the change in control, Bessinger would be entitled to the separation benefit under a different provision of the Plan.” Even if the term was ambiguous, “Cimarex adopted a reasonable interpretation” of it because “Bessinger was never required to move to Houston, was never offered to be relocated to Houston, and his ‘principal place of business remained Tulsa from the date of the change in control to the date of his voluntary termination.’” Bessinger argued that the use of the term “transition” was arbitrary and that other employees in similar situations received benefits. The court found that the term “transition employee” was used to describe employees whose jobs were being eliminated but not yet terminated, and that Bessinger was not similarly situated to those who received benefits. Bessinger also claimed constructive termination, but the court found no evidence supporting this claim. The court further concluded that Bessinger received a full and fair administrative review and there was no evidence that any conflict of interest affected Cimarex’s decision. Ultimately, the court affirmed Cimarex’s denial of benefits, finding that Bessinger failed to demonstrate that the decision was arbitrary and capricious.

Standard of Review

Ninth Circuit

Erica B. v. California Physicians Service, No. 25-CV-03179-HSG, 2025 WL 3527052 (N.D. Cal. Dec. 9, 2025) (Judge Haywood S. Gilliam, Jr.). Plaintiff Erica B. brought this action on behalf of herself and her daughter alleging that defendant California Physicians Service (also known as Blue Shield) wrongfully denied the daughter’s ERISA-covered benefit claims for mental health services. The dispute in this motion concerned the standard of review, and centered on whether the de novo standard or the abuse of discretion standard should apply to claims for services provided between June 17, 2021, and September 30, 2021. (After that date the parties agreed that the de novo standard applied due to California’s statutory ban on discretionary clauses). Blue Shield’s arguments rested on the 2020 Group Health Service Contract, which was effective at the time and included an Evidence of Coverage that granted Blue Shield authority to interpret plan provisions and determine benefits. Plaintiff contended that the contract was unsigned and not part of the administrative record. The court responded that it was not limited to the administrative record in determining the appropriate standard of review. Furthermore, “Plaintiff does not explain why the fact that this document is unsigned means that the Court should ignore Defendant’s sworn declaration that this contract was in effect during the relevant period.” The court thus evaluated the terms of the contract and agreed with Blue Shield that it “unambiguously confers” discretion on Blue Shield. The court rejected plaintiff’s argument that the contract was not a plan document that could confer discretion on Blue Shield, stating, “ERISA does not require a single plan document and the plan document may incorporate other formal or informal documents.” As a result, the court sided with Blue Shield and ruled that “the abuse of discretion standard applies for claims with dates of service before October 1, 2021, and the de novo standard applies to claims on or after that date.”

Patterson v. UnitedHealth Grp., Inc., No. 25-3175, __ F.4th __, 2025 WL 3458953 (6th Cir. Dec. 2, 2025) (Before Circuit Judges Siler, Nalbandian, and Readler).

For regular readers, our case of the week might look eerily familiar. In August of 2023 we covered a case with the exact same name – indeed, both cases are published decisions out of the Sixth Circuit with the same panel of judges. The underlying case number is different, however. What’s going on?

The parties are in fact the same as in the prior case. The plaintiff is Eric Patterson, who was injured in a car accident. He had medical coverage through an ERISA-governed healthcare plan insured by defendant UnitedHealth Group. Mr. Patterson sued the other driver involved in the accident in state court in Ohio, and joined United, seeking a declaratory judgment that United had no right to reimbursement of any potential recovery. United pointed to the summary plan description (“SPD”), which included a right to reimbursement, and maintained there was no other plan document. Eventually, Mr. Patterson settled with the other driver and agreed to pay United $25,000 in reimbursement pursuant to the SPD’s terms.

As (bad) luck would have it, a couple of months later Mr. Patterson’s wife was injured in a second traffic accident. As before, United paid the medical bills and sought reimbursement. Like her husband, Ms. Patterson brought a lawsuit in state court against the other driver, contending that United should not be entitled to reimbursement. However, things went differently this time because United produced a plan document which did not contain a reimbursement right and thus contradicted the SPD. In the end, Ms. Patterson won her state law case, including judgment in her favor on the declaratory relief claim against United. (The Ohio Court of Appeals subsequently affirmed this decision.)

Mr. Patterson was annoyed that his wife was able to avoid reimbursing United while he was not, even though their claims both arose under the same benefit plan and should have been treated similarly. As a result, Mr. Patterson filed a class action against United seeking, among other remedies, the return of the $25,000 he was forced to cough up in his accident case.

The district court dismissed Mr. Patterson’s complaint for several reasons, including on the merits, ruling that his allegations did not fit within any of ERISA’s remedial provisions. In its August 1, 2023 decision the Sixth Circuit affirmed in part and reversed in part. The court agreed that Mr. Patterson had standing to sue for return of his $25,000 settlement payment, but ruled he was not entitled to injunctive relief because he did not plausibly allege any future injury. He also was not entitled to pursue class claims. However, the Sixth Circuit reversed the dismissal of Mr. Patterson’s claim for breach of fiduciary duty under 29 U.S.C. § 1132(a)(3), holding that his complaint plausibly alleged such a claim against United, and that disgorgement of the $25,000 and restitution were forms of equitable relief that he could pursue under Section 1132(a)(3).

That action is still pending in district court. However, this was not satisfactory to Mr. Patterson. Because the district court originally declined to exercise supplemental jurisdiction over his state law claims, Mr. Patterson filed a new complaint in state court asserting those claims once again. On behalf of himself as well as two putative classes, he asserted claims for fraudulent and negligent misrepresentation, conversion, civil conspiracy, and unjust enrichment.

Unsurprisingly, defendants removed this second case to federal court based on ERISA preemption. The parties then filed dueling motions; Mr. Patterson moved to remand the case back to state court while defendants moved to dismiss the case. The district court granted defendants’ motion, viewing Mr. Patterson’s claims as “a repackaged version of his still-pending ERISA lawsuit.” The court concluded that “both actions rested on the same factual events and sought the same outcome: a return of the $25,000 Patterson says he should not have had to pay because of the plan’s terms.” Thus, the court concluded that Mr. Patterson’s state law claims were governed, and preempted, by ERISA.

However, the court did not grant Mr. Patterson leave to amend his complaint to recharacterize his claims under ERISA. The court reasoned that doing so was pointless; Mr. Patterson already had similar if not identical ERISA claims pending in his original case. Thus, instead of allowing duplicate lawsuits with duplicate claims, the court chose to dismiss the second, later-filed action.

Mr. Patterson appealed to the Sixth Circuit once again, and in this published decision the court affirmed the ruling below, this time in its entirety. The court addressed two issues: “the district court’s refusal to remand and its dismissal of Patterson’s complaint.”

On the first issue, Mr. Patterson argued that his state law claims were “wholly independent” of ERISA and could proceed alongside his parallel ERISA suit. The Sixth Circuit explained that ERISA’s complete preemption doctrine allows federal courts to assume jurisdiction over state law claims that duplicate or supplant ERISA’s civil enforcement remedies. The court applied the two-pronged Supreme Court test from Aetna Health Inc. v. Davila to determine complete preemption, i.e., whether Mr. Patterson’s claims were for benefits due under an ERISA plan and whether they implicated a legal duty independent of ERISA.

The Sixth Circuit ruled that Mr. Patterson’s claims met both prongs of the Davila test. The court stated that his claims were essentially for the recovery of benefits under § 1132(a)(1)(B) because they sought return of the $25,000 reimbursement, which was tied to the plan’s terms. The court noted that its conclusion was consistent with “[a] collection of circuits [which] has held that similar state law challenges to an ERISA plan’s reimbursement rights are in essence disguised suits ‘to recover benefits due’ under § 1132(a)(1)(B).”

Mr. Patterson contended that he could not be seeking benefits under § 1132(a)(1)(B) because his benefits had already been paid and thus “the obligation of the ERISA plan to provide benefits was over.” However, the Sixth Circuit saw “no practical difference whether the plan clawed back Patterson’s benefits after paying for his care or simply withheld them until getting its claimed share of the recovery. In either case, benefits are ‘due.’”

Moving on to the second prong of Davila, the Sixth Circuit determined that Mr. Patterson’s claims did not implicate a duty independent of ERISA because they were based on the plan’s terms and required interpretation of the plan: “Each of defendants’ alleged breaches of duty rests entirely upon what Patterson’s ERISA-governed plan does (or does not) say.”

Mr. Patterson contended that no plan interpretation was needed because defendants “only lied about the ‘existence’ of the plan document, not its ‘meaning.’” However, the Sixth Circuit explained that this was incorrect because in order to prevail, “a court – whether an Ohio court or elsewhere – must interpret his ERISA plan and determine whether it created a duty to provide reimbursement-free benefits. That is, ‘[some]body needs to interpret the plan.’”

As a result, the Sixth Circuit determined that the district court properly granted defendants’ motion to dismiss because Mr. Patterson’s state law claims were preempted by ERISA. This left the second issue – “one last housekeeping matter” – of whether the district court should have dismissed without leave to amend.

The Sixth Circuit ruled, “We see no misstep in that approach.” The court explained that Mr. Patterson had already disavowed a claim under Section 1132(a)(1)(B), and thus he could no longer proceed under that provision. As for Section 1132(a)(3), Mr. Patterson’s original action, currently pending on remand from the Sixth Circuit, already contains a claim based on that provision. “To let Patterson replead his state law claims under ERISA would thus result in duplicative proceedings before the same court. In that situation, district courts enjoy the discretion over their dockets to dismiss duplicate cases.” The court observed that “Patterson does not fault the district court for dismissing this later-filed action,” and thus, “Neither do we.”

As a result, the Sixth Circuit affirmed the district court’s dismissal, and thus Mr. Patterson will only be allowed to continue with his original action, limited to relief under Section 1132(a)(3)…unless he files another (fifth!) lawsuit. Stay tuned!

Below is a summary of this past week’s notable ERISA decisions by subject matter and jurisdiction.

Breach of Fiduciary Duty

Third Circuit

Grink v. Virtua Health, Inc., No. 24-CV-09919, 2025 WL 3485686 (D.N.J. Dec. 3, 2025) (Judge Christine P. O’Hearn). Plaintiffs Kelly Grink, Diane Trump, and Steven Molnar are participants in the Virtua Health 401(k) Plan and 403(b) Retirement Program who allege fiduciary breaches and prohibited transactions under ERISA by various defendants associated with both Virtua and Lincoln National, which provided services to the plans. The allegations include (1) imprudent selection and retention of the Lincoln Stable Value Account (“SVA”) as the primary fixed-income investment, resulting in exposure to Lincoln’s credit risk and undisclosed “spread income”; (2) the use of higher-cost mutual fund share classes when lower-cost options were available, leading to excessive fees; (3) underperformance and excessive fees related to several actively managed funds, including Oakmark and Goldman SCV; (4) inadequate monitoring processes and underperformance of the LifeSpan Models TDF investment option; and (5) excessive recordkeeping and administrative fees, resulting in over $11.7 million in fees over five years. The Virtua defendants and the Lincoln defendants both filed motions to dismiss, which were decided in this order. The Virtua defendants argued that the plaintiffs failed to allege that Virtua and the Virtua Board were fiduciaries or that there was a flawed fiduciary process, while the Lincoln defendants contended that they were not fiduciaries for the alleged prohibited transactions and were thus not liable. Addressing the Lincoln defendants’ motion first, the court concluded that the plaintiffs failed to establish that the Lincoln defendants were fiduciaries concerning the alleged prohibited transactions. The court ruled that the complaint “only alleges the Lincoln Defendants were liable as parties in interest to the ‘annuity transactions,’ and nothing else,” i.e., no concrete affirmative conduct, which was insufficient. Furthermore, plaintiffs’ allegations regarding the Lincoln defendants’ fiduciary status related to the execution of the Group Annuity Contract were “conclusory.” The court cited cases holding that annuity providers owe no fiduciary duty to plan participants. As for the Virtua defendants’ motion, the court agreed that neither Virtua nor its Board were named fiduciaries under the plan documents. The court noted that plan sponsorship alone does not confer fiduciary status, as it is considered a corporate or settlor function. However, Virtua was found to be a fiduciary concerning the “annuity transactions” due to its discretionary actions in contracting with Lincoln for the SVA. The court determined that the Virtua Board did not exercise the required control over the management of plan assets to be considered fiduciaries. On the merits, the court found that the plaintiffs adequately alleged a breach of the duty of prudence regarding the Share Class Claims and some Actively Managed Fund Claims. The court determined that the allegations regarding the Oakmark and Goldman SCV funds raised a sufficient inference of imprudence due to their underperformance compared to benchmarks and industry comparators. However, the court found that the allegations related to the MetWest and Europacific Growth funds did not provide sufficient facts for a reasonable comparison, thus failing to state a claim for imprudence. The court also granted the Virtua defendants’ motion to dismiss one of the prohibited transaction counts, as the plaintiffs did not sufficiently allege self-dealing or conflict of interest, nor did they identify a specific transaction with UBS/Morgan Stanley that violated ERISA. In the end, there was something for everyone in this complicated decision. The court gave plaintiffs leave to amend, so we may see another one like it in the near future.

Fourth Circuit

Garner v. Northrop Grumman Corp., No. 1:25-CV-00439 (AJT/WEF), 2025 WL 3488657 (E.D. Va. Dec. 4, 2025) (Judge Anthony J. Trenga). The plaintiffs in this case are participants in defendant Northrop Grumman Corporation’s defined contribution retirement plan. They allege that the defendants failed to adhere to the plan document, breached fiduciary duties, and engaged in prohibited transactions by misusing forfeited plan contributions. Specifically, they contend that defendants should have used forfeited contributions to restore participant accounts or pay plan expenses, instead of reducing the company’s future contribution obligations. They claim that over 20,000 plan participants left the company between 2018 and 2023 with unvested benefits, resulting in $70.8 million in forfeitures, which were used to reduce employer contributions rather than cover $57.4 million in administrative expenses. Plaintiffs alleged failure to follow plan terms, breach of fiduciary duties of loyalty and prudence, failure to monitor, breach of the anti-inurement provision, and engaging in prohibited transactions. Defendants filed a motion to dismiss, which the court granted in full. The court ruled that there was no violation of plan terms because the plan did not mandate a specific order for using forfeitures, allowing them to be used for any of three purposes (paying expenses, restoring accounts, or reducing contributions). For the same reason, the court further ruled that there was no breach of fiduciary duty. The court stated that the plan authorized defendants’ conduct and ERISA does not impose “an exclusive duty to maximize pecuniary benefits.” As for plaintiffs’ anti-inurement claim, the court found that using forfeitures to meet employer contribution obligations did not violate this provision, as the funds were used to provide benefits to participants. Similarly, the court dismissed the prohibited transactions claims, as the plaintiffs did not allege any improper transactions involving plan assets. The court ruled that plaintiffs did not allege that any of the forfeited assets were removed from the plan or were used in a type of “transaction” necessary to impose liability under 29 U.S.C. § 1106. Finally, the court dismissed plaintiffs’ failure to monitor claim, as it was derivative of the fiduciary duty claims. As a result, the court dismissed all of plaintiffs’ claims, a result consistent with the decisions of most other courts on these issues.

Seventh Circuit

Clinton v. Baxter Int’l, Inc., No. 25 CV 3368, 2025 WL 3470685 (N.D. Ill. Dec. 3, 2025) (Judge Lindsay C. Jenkins). Plaintiff Charles Clinton filed this class action against Baxter International Inc. and its Investment Committee, alleging violations of fiduciary duties under ERISA. Clinton claimed that the stable value fund (“SIF”) in Baxter’s retirement plan provided significantly lower returns compared to other similar funds available during the class period from 2019 to 2023. He argued that Baxter failed to maximize returns by not demanding higher crediting rates from insurance companies or seeking alternative investment options. Defendants moved to dismiss, arguing that Clinton failed to state a claim for relief. In his opposition, Clinton alleged that the Investment Committee breached its duty of prudence by selecting and retaining underperforming investment options. However, the court noted that Clinton lacked actual knowledge of the defendants’ decision-making process and relied on inferences and comparisons to other stable value funds. The court agreed with Clinton that the funds he selected for comparison were of the same type as the SIF, i.e., stable value funds. However, the court ruled these funds were inadequate for comparison because Clinton “fail[ed] to provide a uniform sample.” The court explained that Clinton’s “data points are four to six comparators each year from 2019 to 2023 – none of which appear across all five years. The closest he comes to providing a year-to-year comparator are two funds analyzed from 2019 through 2022, but not in 2023. The rest make one or two appearances, and in the latter case, often non-consecutively. All the complaint shows, then, is that the SIF doesn’t boast one of the top four to six crediting rates in a given year. There is no consistent benchmark.” The court also addressed the issue of how the relevant crediting rates should be calculated. Defendants argued that the differences in crediting rates between the SIF and comparator funds were too minor to support a claim of imprudence, and the court agreed, ruling that Clinton’s methodology for calculating these rates was flawed. As a result, the court granted defendants’ motion in its entirety, but without prejudice.

Disability Benefit Claims

Eleventh Circuit

Eggleston v. Unum Life Ins. Co. of Am., No. 24-13678, __ F. App’x __, 2025 WL 3472834 (11th Cir. Dec. 3, 2025) (Before Circuit Judges Jill Pryor, Luck, and Brasher). Plaintiff Yvette Eggleston was a clinical research nurse at Johns Hopkins Bayview Medical Center and a participant in Johns Hopkins’ long-term disability benefit plan, which was insured by defendant Unum Life Insurance Company of America and governed by ERISA. The policy allowed benefits for 24 months if she was unable to perform her regular occupation due to sickness or injury, and beyond that period only if she was unable to work in any gainful occupation. Eggleston stopped working in 2011 due to chronic illnesses and was initially approved for benefits by Unum. After 24 months, Unum continued her benefits based on her medical condition but noted potential for improvement. In 2021, Unum discovered social media posts showing Eggleston engaging in activities that suggested improved functional capacity, prompting a review of her file. Unum concluded that her chronic conditions were stable and controlled, and she could perform sedentary work. Consequently, Unum terminated her benefits, and that decision was upheld by the district court. (Your ERISA Watch covered this decision in our October 30, 2024 edition.) In this per curiam decision, the Eleventh Circuit affirmed. The court applied its six-step framework for reviewing ERISA benefit determinations, and like the district court, skipped directly to step three, in which it assessed whether Unum’s decision was arbitrary and capricious. This standard of review was required because the policy granted Unum discretionary authority to make benefit determinations. The court concluded that “Unum’s multiple medical expert opinions, Eggleston’s social media activity, and Eggleston’s medical records were enough to find that Unum’s decision was not arbitrary and capricious.” The court was convinced that Unum considered all relevant information and “simply reached a different conclusion as to what findings the record supports.” As a result, under a deferential standard of review, the court could not conclude that Unum was unreasonable in crediting the reports of Unum’s reviewing physicians over those of Eggleston’s doctors. The Eleventh Circuit thus affirmed the decision and upheld the denial of Eggleston’s claim.

Discovery

Ninth Circuit

Davalos v. GreatBanc Trust Co., No. 1:25-CV-00706-KES-SKO, 2025 WL 3470168 (E.D. Cal. Dec. 3, 2025) (Magistrate Judge Sheila K. Oberto). The plaintiffs in this putative class action allege various ERISA violations regarding the Western Milling Employee Stock Ownership Plan. Their claims arise from the 2022 sale of stock back to Defendant Kruse Western Inc., in which the plaintiffs allege the plan and its participants did not receive fair market value. Several defendants filed a motion to dismiss, arguing lack of subject matter jurisdiction and that the claims are barred under ERISA’s statute of limitations. The plaintiffs responded with a motion for jurisdictional discovery, which was adjudicated in this order. Plaintiffs claimed they needed discovery to challenge the factual assertions made in the motions to dismiss, in which defendants relied on the Plan’s Form 5500 filings as alleged proof that the Plan and its participants actually benefited from the 2022 sale of stock, thereby asserting that plaintiffs did not suffer any injury. Plaintiffs argued that denying them access to documents relating to the 2022 sale, while allowing defendants to use those same documents to assert a lack of standing, would be unjust and prevent them from effectively responding to the jurisdictional challenge. The court agreed, recognizing that while discovery is typically not permitted before the parties’ Rule 26(f) conference, expedited discovery may be allowed for good cause, particularly where facts relating to jurisdiction are disputed. The court emphasized that it would be inequitable to permit one side to rely on certain evidence while denying the other side the opportunity to challenge or verify it. The court further noted that the defendants would not suffer prejudice because the relevant documents had already been produced to plaintiffs previously, albeit confidentially under Federal Rule of Evidence 408. As a result, the court granted plaintiffs’ motion for jurisdictional discovery.

ERISA Preemption

Ninth Circuit

Healthcare Ally Mgmt. of Cal., LLC v. United Healthcare Servs., Inc., No. 24-5178, __ F. App’x __, 2025 WL 3485391 (9th Cir. Dec. 4, 2025) (Before Circuit Judges Callahan, Owens, and Koh). This is one of a number of cases plaintiff Healthcare Ally Management of California (“HAMOC”) has filed against various insurers seeking reimbursement for treatment it provided to patients. Here, HAMOC filed suit against United Healthcare Services, Inc., alleging state law claims of negligent misrepresentation and promissory estoppel. These claims were based on alleged representations by United during a phone call, promising reimbursement at the “usual, customary, and reasonable” (“UCR”) rate instead of the lower Medicare rate. The district court dismissed these claims on the ground that they were preempted by ERISA, citing the Ninth Circuit’s recent decision in Bristol SL Holdings, Inc. v. Cigna Health & Life Ins. Co., 103 F.4th 597 (9th Cir. 2024). HAMOC appealed. In a brief memorandum decision, the Ninth Circuit affirmed. Noting that ERISA preempts any state laws that “relate to” employee benefit plans, the court identified two categories of state-law claims: those with a “reference to” an ERISA plan and those with an “impermissible connection with” an ERISA plan. HAMOC’s claims fell into both categories. The claims had a “reference to” an ERISA plan because they were premised on the existence of a plan, which was essential for the claims’ survival. The claims also had an “impermissible connection with” an ERISA plan as they would interfere with plan administration and ERISA-regulated relationships. The court noted that allowing HAMOC’s state law claims would create interference with nationally uniform plan administration because benefits would be governed by variable state law interpretations rather than ERISA and plan terms. As a result, the court concluded that HAMOC’s attempt to bind United to UCR rates based on phone call representations was preempted by ERISA, and thus upheld the district court’s ruling below.

Pleading Issues & Procedure

First Circuit

Radoncic v. National Union Fire Ins. Co. of Pittsburgh, PA, No. 2:25-CV-00138-LEW, 2025 WL 3494703 (D. Me. Dec. 5, 2025) (Magistrate Judge John C. Nivison). In 2018, plaintiff Skender Radoncic suffered an injury to two fingers on his right hand, leading to the amputation of his index finger in August 2023. Subsequently, his spouse submitted a claim under her employer’s ERISA-governed group accident insurance benefit plan. Defendant National Union Fire Insurance Company of Pittsburgh, the insurer of the plan, denied the claim in October 2023, stating that the loss was not covered, and this action followed. Radoncic filed a motion to modify the administrative record, seeking the inclusion of certain documents for in camera review by the court. These documents included pre-denial emails, litigation hold notices, file copy requests, a coverage letter, and redacted claims notes. In response, National Union argued that these documents were protected by attorney-client privilege and attorney work product. The court noted that case law recognizes a fiduciary exception to the attorney-client privilege in ERISA cases. This exception prevents an ERISA fiduciary from asserting the privilege against plan beneficiaries on matters of plan administration. However, the privilege can still be invoked for non-fiduciary matters, such as when legal advice is sought for the fiduciary’s own protection. Radoncic contended that the disputed documents were created before the final denial decision in April 2024, thus falling under the fiduciary exception, while National Union argued that the fiduciary exception did not apply because the relationship became adversarial when Radoncic appealed the denial in March 2024. The court granted Radoncic’s motion in part, allowing an in camera review of the documents to assess National Union’s claim of attorney-client privilege. The court ordered National Union to submit the documents at issue to the court and deferred ruling on the merits of Radoncic’s motion until after its review is complete.

Fourth Circuit

West Virginia United Health System, Inc. v. GMS Mine Repair & Maintenance, Inc. Employee Medical Plan, No. 1:25-CV-34, 2025 WL 3455947 (N.D.W. Va. Dec. 2, 2025) (Judge Thomas S. Kleeh). West Virginia University Health System (“WVUHS”) filed this action against GMS Mine Repair and Maintenance, Inc. Employee Medical Plan (“GMS”) and The Health Plan of West Virginia, Inc. (“THP”), accusing them of fraud. GMS operates a self-funded health plan for its employees, administered by THP. WVUHS and THP had a contract for negotiated payment rates for traditional insurance, but no such contract existed for the GMS plan. WVUHS discovered that THP was processing claims for GMS using a reference-based pricing scheme, which led to disputes over payment rates. WVUHS alleged that GMS’ member cards fraudulently imitated THP’s commercial insurance cards, misleading WVUHS into providing services under false pretenses. As a result, WVUHS claimed that GMS and THP reimbursed them at significantly lower rates than agreed, resulting in substantial financial losses. WVUHS initially filed its complaint in state court. THP removed it, contending that WVUHS’ claims were preempted by ERISA. The court disagreed and sent the case back to state court. Next, GMS removed the case, and WVUHS once again moved for a remand. In this order the court granted WVUHS’ motion. The court ruled that GMS was collaterally estopped from removing the case, as the issue of ERISA preemption had been previously decided. The court found that (1) the issue was the same in both removals (i.e., ERISA preemption), (2) the issue was determined by the court in the previous motion, (3) the determination was a “critical and necessary part of the decision in the prior proceeding,” (4) the prior ruling was final and valid, and (5) the parties were the same and GMS had “a full and fair opportunity to litigate the issue in the first removal attempt.” The court reiterated that “[u]nder the plain language of the Plan, the anti-assignment provision appears valid and therefore, WVUHS could not bring a suit under ERISA even if there were a written assignment of benefits. Thus, WVUHS does not have standing to sue THP under ERISA.” GMS attached a newly created waiver of the anti-assignment provision to its notice of removal, but the court scathingly rejected this last-ditch effort to avoid remand: “The Court is not persuaded by GMS’s blatant attempt to manufacture jurisdiction… The Court finds that GMS’s removal attempt at issue showcases that GMS is now trying to change and manipulate the terms of the governing plan to create federal jurisdiction… GMS’s conduct runs afoul good faith and fair dealing and its behavior cannot be condoned.” As a result, WVUHS’s motion was granted once again, and the case will head back to state court for a second time.

Tenth Circuit

M.H. v. United Healthcare Ins. Co., No. 2:22-CV-00307-AMA-DAO, 2025 WL 3443490 (D. Utah Dec. 1, 2025) (Judge Ann Marie McIff Allen). In this case of twists and turns, plaintiffs M.H. and C.H. sued defendants United Healthcare Insurance Company, United Behavioral Health, True Value, and the True Value Company Medical Program alleging that defendants violated ERISA by failing to pay benefits under True Value’s employee healthcare plan. Initially, the parties engaged in settlement negotiations, which were successful. All’s well that ends well? Not so fast. Plaintiffs filed a notice of settlement on May 28, 2024, but withdrew from it on July 25, 2024, claiming that defendants’ counsel failed to provide the promised settlement agreement for signing. A status conference was held on August 14, 2024, and subsequently, the defendants filed a motion to enforce the settlement agreement, which the plaintiffs opposed. In January of 2025, the parties agreed to resolve the case through a second proposed settlement agreement. Defendants prepared an agreement, which the plaintiffs signed and returned, but this time defendants held things up. Defendants explained in a February 27, 2025 filing with the court that they would not sign because True Value had filed for Chapter 11 bankruptcy, which was crucial because the True Value Company Medical Program was self-funded, not insured, and thus True Value was on the hook for part of the settlement. Plaintiffs subsequently filed a motion to enforce the settlement, which the court denied in this order. The court explained that the automatic stay on actions against a debtor imposed by the Bankruptcy Code (11 U.S.C. § 362(a)) prevented the enforcement of the settlement agreement. Plaintiffs tried to “work around the automatic stay by suggesting that True Value could negotiate and enter the settlement even after its bankruptcy filing because the bankruptcy court has authorized True Value to conduct certain business in the ordinary course.” But the court rejected this, ruling that “payments made pursuant to a settlement agreement are not made in the ordinary course of business, and the present litigation is not in the normal course of business[.]” The court agreed with plaintiffs that the automatic stay provision “does not extend to solvent codefendants of the debtor,” and thus had no effect on the case’s other defendants. However, “the Court cannot ignore the reality that the purported agreement Plaintiffs seek to enforce was between all of the Parties,” and thus, because one of the parties had triggered the automatic stay, the entire agreement was void. The court was sympathetic, acknowledging “the complications True Value’s bankruptcy presents to Plaintiffs in pursuing their claims,” but the court concluded that its hands were tied by the automatic stay rule. As a result, the court denied plaintiffs’ motion to enforce the settlement.

Provider Claims

Fifth Circuit

Horizon Surgery Center, PLLC v. D. Reynolds Co., LLC, No. 3:25-CV-00255, 2025 WL 3443191 (S.D. Tex. Dec. 1, 2025) (Magistrate Judge Andrew M. Edison). Plaintiff Horizon Surgery Center, PLLC filed suit against D. Reynolds Company, LLC, the administrator of a health benefit plan governed by ERISA, alleging nonpayment for medical services provided to Mary Bruce, a participant in the plan. Horizon claimed it had confirmed that Bruce’s treatments were eligible for coverage under the plan before providing services in 2021 and 2022. Bruce had assigned her rights to benefits under the plan to Horizon, which alleged it was owed $579,548.40 for the services provided. Horizon asserted five causes of action in its operative complaint; one was for denial of benefits under ERISA (29 U.S.C. § 1132(a)(1)(B)), one was for breach of fiduciary duty under ERISA (29 U.S.C. § 1132(a)(3)), and the remainder were state law claims. Reynolds moved to dismiss all claims except the ERISA denial of benefits claim, arguing that the ERISA breach of fiduciary duty claim was duplicative and the state law claims were preempted by ERISA. In this order a magistrate judge recommended that Reynolds’ motion be granted. The court agreed with Reynolds that Horizon’s ERISA breach of fiduciary duty claim was duplicative of its ERISA denial of benefits claim. The court noted that Horizon’s alleged damages under its § 1132(a)(3) claim – unpaid or underpaid claims – were tied to benefits due under the plan, making § 1132(a)(1)(B) the more appropriate avenue for redress. Additionally, the court found that Horizon’s allegations of flawed administrative claims procedures were properly addressed under § 1132(a)(1)(B), not § 1132(a)(3). The court emphasized that the monetary relief sought by Horizon was legal rather than equitable, further precluding relief under § 1132(a)(3). As for Horizon’s state law claims, the court ruled that they were all preempted by ERISA. The court applied the Fifth Circuit’s two-part test for ERISA preemption, which examines whether the state law claims address areas of exclusive federal concern, such as the right to receive benefits under an ERISA plan, and whether the claims directly affect the relationship among traditional ERISA entities. The court agreed with Reynolds that Horizon’s state law claims were inextricably related to the plan and its terms, as they arose from Horizon’s verification of Bruce’s eligibility under the plan and its claim for payment for services rendered. The court rejected Horizon’s argument that Reynolds’ direct communications created a separate promise and independent relationship, finding that the claims were dependent on the plan’s terms and benefits. Consequently, the court recommended dismissing these claims with prejudice.

Statute of Limitations

Second Circuit

Fromageot v. Britt, No. 3:21-CV-1165-MPS, 2025 WL 3470473 (D. Conn. Dec. 3, 2025) (Judge Michael P. Shea). The case involves a 20-year dispute over life insurance proceeds following the death of Paul Fromageot in 2004. Paul was employed by Alliance Capital and had life insurance through an ERISA-governed employee benefit plan sponsored by the company and insured by Hartford Life. Paul had initially designated his wife, Madeline Fromageot, his parents, and his only child at the time as co-equal beneficiaries. However, after Paul’s death, Madeline claimed that Paul had updated his policies to make her and their four children the primary beneficiaries, with his parents as contingent beneficiaries. Despite this, Hartford Life distributed the proceeds according to the original beneficiary designations. Madeline has been involved in litigation in both state and federal court since 2007, challenging the distribution of these funds. She filed this particular action pro se in 2021, purporting to represent Paul’s estate and her children and their trusts as well. The case has already been dismissed twice, once for lack of subject matter jurisdiction, and again because Madeline failed to properly serve Hartford Life. Her complaint contains twelve causes of action, nine of which are against Hartford Life. Hartford Life filed a motion to dismiss, arguing that Madeline cannot represent others while representing herself, and that her ERISA claims are time-barred. The court agreed and granted Hartford Life’s motion. The court ruled that Madeline had Article III standing because “Madeline is entitled to the reasonable inference that, because the proceeds from Paul’s policy were not deposited into the children’s education funds…Madeline herself was left to foot any bills related to her children’s schooling.” However, the court also ruled that Madeline lacked standing to sue on behalf of Paul’s estate, her children, or their trusts due to her pro se status. As for the merits of her individual claims, the court ruled that her ERISA claims were time-barred by the terms of the Hartford Life policy, which required claims to be filed within three years of proof of loss. “Paul died on June 4, 2004…and so proof of loss was due on September 2, 2004, and Madeline had until September 2, 2007 to file suit against Hartford Life. She did not do so until May 22, 2023 – over 15 years late.” Madeline advanced arguments for extending the limitations period against Hartford Life, including fraudulent concealment and equitable tolling, but these were rejected by the court. The court noted that Madeline did not allege any fraud by Hartford Life; instead, she alleged fraud on the part of Paul’s parents. Furthermore, the conduct at issue occurred after the limitations period ended, and “fraudulent concealment cannot toll a limitations period that has already expired.” The court further explained that equitable tolling did not apply because Madeline had the necessary information to bring her claims well before the limitations period expired, and there were no “extraordinary circumstances” that would entitle her to equitable tolling. As a result, the court granted Hartford Life’s motion to dismiss the ERISA claims against it. The court declined to exercise supplemental jurisdiction over the remaining state law claims, and dismissed those claims without prejudice.

Fifth Circuit

Mitchell v. H-E-B, L.P., No. 25-50227, __ F. App’x __, 2025 WL 3496980 (5th Cir. Dec. 5, 2025) (Before Circuit Judges Jones and Engelhardt, and District Judge Robert R. Summerhays). Plaintiff Arieanna Mitchell brought this action against defendant H-E-B, asserting a single cause of action for “denial of benefits.” The only ERISA provision she cited in support of her claim was Section 510, which makes it “unlawful for any person to discharge…a participant or beneficiary…for the purpose of interfering with the attainment of any right to which such participant may become entitled under the plan.” The district court granted summary judgment to defendant H-E-B, concluding that Mitchell’s claim was untimely under Section 510’s two-year statute of limitations (borrowing from Texas law). Mitchell appealed to the Fifth Circuit, which affirmed in this brief per curiam decision. On appeal Mitchell attempted to characterize her claim as one for breach of fiduciary duty, which has either a three- or six-year statute of limitations, depending on actual knowledge of the breach. However, the Fifth Circuit ruled that Mitchell forfeited this argument by not raising it in the district court. Furthermore, the court held that Mitchell’s complaint inadequately alleged a breach of fiduciary duty, only mentioning such a violation in passing and in the context of explicitly citing Section 510 instead. As a result, Mitchell failed to provide H-E-B with fair notice of any breach of fiduciary duty claim. Thus, the Fifth Circuit concluded that the district court properly dismissed Mitchell’s complaint because it was brought after the expiration of the two-year statute of limitations for Section 510 claims, and affirmed the decision below in its entirety.

‘Twas another slow week in ERISAland, as the federal courts put aside breaches of fiduciary duty for turkey, stuffing, and cranberry sauce. Nevertheless, some judges were devoted enough to delve into ERISA’s intricacies. Read on to find out about (1) the exclusion of expert witness testimony in the class action by NFL players against the league’s disability plan (Alford v. NFL), (2) two diverging discovery rulings in benefit cases (Kelly v. Valeo (no discovery allowed), Miller v. American United (sure, why not)), and (3) whether Johnson & Johnson’s health plan participants have standing to pursue claims that the plan overpaid for prescription drugs (nope, Lewandowski v. Johnson & Johnson). It was a bad week for health care providers as well, as two were bounced out of court on motions to dismiss (Murphy v. Emblem, Abira v. United), and a third lost on appeal (Dedicato v. Aetna).

Below is a summary of this past week’s notable ERISA decisions by subject matter and jurisdiction.

Breach of Fiduciary Duty

Third Circuit

Lewandowski v. Johnson & Johnson, No. 24-671 (ZNQ) (RLS), 2025 WL 3296009 (D.N.J. Nov. 26, 2025) (Judge Zahid N. Quraishi). Plaintiffs Ann Lewandowski and Robert Gregory are former employees of Johnson & Johnson and participants in its health benefit plans who allege that the defendants, Johnson & Johnson and its Pension & Benefits Committee, breached their fiduciary duties under ERISA. Specifically, they contend that defendants mismanaged the prescription drug benefits program, resulting in excessive costs for the plans and their participants. These costs allegedly included higher payments for prescription drugs, premiums, out-of-pocket expenses, deductibles, coinsurance, and copays. The plaintiffs also alleged that the defendants steered beneficiaries toward a mail-order pharmacy that charged higher prices than retail pharmacies, failed to incentivize the use of lower-priced generic drugs, and inadequately negotiated contracts with pharmacy benefit managers (“PBMs”), leading to higher drug prices for participants. Previously, the court granted defendants’ motion to dismiss plaintiffs’ fiduciary breach claims, concluding that plaintiffs lacked standing. (Your ERISA Watch covered this decision in our January 29, 2025 edition.) The court allowed plaintiffs to amend their complaint, and defendants responded with another motion to dismiss. In this order, the defendants prevailed once again on their standing arguments. The court again determined that the plaintiffs’ alleged injuries – higher premiums and out-of-pocket costs – were speculative and not directly traceable to the defendants’ actions. The court found that the connection between the administrative fees paid by the plans to the PBM and the plaintiffs’ contribution rates was tenuous. Additionally, the court noted that the plans vested the defendants with sole discretion to set participant contribution rates, which could be influenced by various factors unrelated to prescription drug benefits. The court also found that the plaintiffs’ allegations of economic harm lacked sufficient specificity and failed to establish a plausible causal connection. The court further ruled that even if the plaintiffs prevailed and obtained the relief they sought, the defendants could still increase participant contribution rates under the terms of the plans without violating ERISA, and thus plaintiffs failed the redressability test. As a result, the court once again ruled that plaintiffs’ complaint did not meet Article III’s standing threshold and dismissed it. The court did give plaintiffs one more try, however, so we will likely see another order on this issue in 2026.

Discovery

Sixth Circuit

Kelly v. Valeo N. America, Inc., No. 2:24-CV-11066-TGB-KGA, 2025 WL 3269526 (E.D. Mich. Nov. 24, 2025) (Judge Terrence G. Berg). Plaintiff Thomas Kelly filed this action asserting that he has been underpaid pension benefits. He worked for Siemens from 1985 to 1993, Valeo North America, Inc. from 1997 to March 1998, and Valeo Sylvania LLC (a joint venture between Valeo and Osram Sylvania) from April 1998 until his termination in 2012 at the age of 51. Valeo concluded that Kelly was not eligible for Early Retirement benefits because he was not employed by Valeo at age 55, a requirement under the Plan. Instead, Kelly qualified for Deferred Vested Pension benefits, which are subject to actuarial reductions for retirement before age 65. Subsequently, Kelly applied for Early Retirement Benefits in 2019, but Valeo denied his application, reiterating that he did not meet the age requirement at the time of his termination. This lawsuit followed. Kelly now seeks discovery based on “perceived bias” by Valeo, as well as procedural errors in the handling of his claim. For example, he contends that the administrative record as produced by Valeo is insufficient; he alleges that it is incomplete, includes irrelevant documents, and omits documents he provided to Valeo. The court denied Kelly’s motion. It found that Kelly failed to provide evidence of bias or procedural defects, offering only general allegations without factual support. While Kelly listed documents he claimed were missing from the record, he did not supply those documents to Valeo for review or explain how their inclusion would impact the administrator’s decision. Furthermore, Valeo asserted that the record included all relevant documents in its possession, except privileged communications, and offered to review and include any additional documents Kelly provided, but Kelly did not pursue this option. The court further found that Valeo complied with ERISA’s procedural requirements, and thus Kelly was afforded due process. The court noted that mere allegations of bias or procedural defects are insufficient to warrant discovery, and that Kelly failed to establish a factual basis for his claims. As a result, the court denied Kelly’s motion and advised him that he could reassert his arguments on summary judgment.

Eleventh Circuit

Miller v. American United Life Ins. Co., No. 8:25-CV-1670-KKM-AAS, 2025 WL 3269397 (M.D. Fla. Nov. 24, 2025) (Magistrate Judge Amanda Arnold Sansone). Plaintiff Vicki Miller brought this action seeking long-term disability benefits under an ERISA-governed group employee plan insured by defendant American United Life Insurance Company. Miller requested permission to conduct discovery beyond the administrative record to support her claim that the denial of her claim was arbitrary and capricious and influenced by self-interest. American did not oppose the request. As a result, the court granted her request for limited discovery, subject to specific parameters agreed upon by the parties. The court allowed Miller to depose American’s corporate representative, limiting her inquiries to the following topics: “1. The exact nature of the information considered by the fiduciary in making the decision. 2. Whether the fiduciary was competent to evaluate the information in the administrative record. 3. How the fiduciary reached its decision. 4. Whether given the nature of the information in the record it was incumbent upon the fiduciary to seek outside technical assistance in reaching a ‘full and fair review’ of the claim. 5. Whether a conflict of interest exists. 6. To determine the proper standard of review. 7. Whether the Defendant followed proper procedures in reviewing and denying the Plaintiff’s claim. 8. Whether the record is complete.” The court emphasized that American reserved the right to object to individual discovery requests, including their format.

ERISA Preemption

Ninth Circuit

Dedicato Treatment Ctr., Inc. v. Aetna Life Ins. Co., No. 24-6487, __ F. App’x __, 2025 WL 3269214 (9th Cir. Nov. 24, 2025) (Before Circuit Judges Wardlaw, N.R. Smith, and Miller). This is an action by plaintiff Dedicato Treatment Center, which specializes in substance abuse treatment, against defendant Aetna Life Insurance Company for underpayment of benefits assigned to Dedicato by three of its patients. Dedicato brought six state law causes of action against Aetna, and the district court dismissed them all, ruling they were preempted by ERISA. Dedicato appealed, and in this very brief three-paragraph memorandum decision, the Ninth Circuit affirmed. Relying on its recent decision in Bristol SL Holdings, Inc. v. Cigna Health & Life Ins. Co., 103 F.4th 597 (9th Cir. 2024), the court explained that a state law claim impermissibly “refers to” an ERISA plan if it is premised on the existence of an ERISA plan or if the plan’s existence is essential to the claim’s survival. Here, Dedicato’s claims referenced the Aetna-administered ERISA plans because they were based on services covered by the plans and sought payments for those services through state contract law. Furthermore, the court found that Dedicato’s claims had an impermissible connection with the ERISA plans because they risked subjecting insurers to liabilities based on numerous phone calls and their varying treatment under state law, which would disrupt uniform plan administration.

Pleading Issues & Procedure

Fourth Circuit

Alford v. The NFL Player Disability & Survivor Benefit Plan, No. CV JRR-23-358, 2025 WL 3274428 (D. Md. Nov. 24, 2025) (Magistrate Judge Erin Aslan). This high-profile case was brought by former National Football League players who applied for disability benefits under the NFL Player Disability & Survivor Benefit Plan. The plan offers a variety of benefits depending on the claimant’s impairments and how they were acquired (e.g., in the line of duty). The players contend that the plan’s allegedly neutral physicians are biased and financially incentivized to render opinions adverse to applicants, undermining the integrity of the claims and appeals process. They further assert a systematic pattern wherein higher compensation correlates with flawed, result-oriented opinions against applicants. The players also assert that defendants breached fiduciary duties by providing misleading information about the plan. Based on these allegations, the players have asserted multiple ERISA violations. In this decision, a magistrate judge ruled on motions from both sides to exclude expert testimony and reports. The players moved to exclude the testimony of defense expert Dr. David B. Lasater, while defendants sought to exclude the testimony of the players’ experts Dr. Anthony Hayter and Joseph A. Garofolo. The court denied the players’ motion to exclude Dr. Lasater, finding that his statistical analysis of plan data was reliable and admissible. Although the plaintiffs challenged the reliability of his opinion, the court determined that their arguments addressed the weight and credibility of his testimony, which must be addressed at trial. As for defendants’ motion to exclude Mr. Garofolo, the court granted it. Mr. Garofolo is an attorney with experience in employee benefits, ERISA, and health, welfare, and retirement plans, who offered “opinions regarding the Plan’s use of Neutral Physicians and other practices that outline what he would have done if he had been a Plan fiduciary.” The court found that much of Mr. Garofolo’s opinions applied law to facts, which invaded on the province of the court: “It is improper for Mr. Garofolo to opine on legal principles related to the issues and claims presented in this case.” Furthermore, the court found his opinion unreliable because, although he recommended certain claim practices, he did not identify any plans that followed those practices. As for Dr. Hayter, the court rejected defendants’ challenge to his rebuttal to Dr. Lasater’s report. However, the court agreed with defendants that parts of Dr. Hayter’s report were not supported by “accepted and reliable methodology,” and were “results-driven” and “outcome-oriented.” The court also criticized parts of Dr. Hayter’s report that accepted the players’ allegations uncritically and without conducting due diligence to ensure their accuracy. As a result, the court excluded these parts of Dr. Hayter’s report as well. Other motions in this case are pending, including a motion for class certification, so this case is far from over.

Provider Claims

Second Circuit

Murphy Medical Associates, LLC v. EmblemHealth, Inc., No. 3:22-CV-00059 (SVN), 2025 WL 3282251 (D. Conn. Nov. 25, 2025) (Judge Sarala V. Nagala). The plaintiffs in this case are medical providers who have filed numerous cases in numerous jurisdictions alleging that they have been underpaid for COVID-19 testing and related services to thousands of patients beginning in March 2020. Plaintiffs alleged that some of these patients were enrollees of health plans sponsored or administered by the defendants. As out-of-network providers, plaintiffs claimed they could only identify enrollees of the defendants’ plans if patients provided their insurance information, which often lacked sufficient detail to determine the governing health plan. Plaintiffs further alleged that the defendants refused to disclose whether the plans were governed by ERISA, despite requests for this information. The court granted defendants’ motion to dismiss plaintiff’s initial complaint on numerous grounds in October of 2024 (Your ERISA Watch covered this decision in our October 9, 2024 edition), but allowed plaintiffs to file an amended complaint. After they did so, defendants filed another motion to dismiss, which was granted in this order. First, the court narrowed the parties, ruling that the only plaintiff that could pursue any claims was Diagnostic and Medical Specialists of Greenwich, LLC (“DMSOG”), because the assignments executed by the patients only mentioned DMSOG. The court then addressed the merits of plaintiffs’ claim for benefits under ERISA and found them wanting, stating, “Plaintiffs have corrected few, if any, of the deficiencies previously identified in the Court’s ruling on Defendants’ motion to dismiss Plaintiffs’ initial complaint.” The court stated that plaintiffs failed to identify the specific health plans at issue, allege facts establishing that ERISA governed the plans, or demonstrate that the plans covered the claims benefits sought. The court also rejected plaintiffs’ argument that the Families First Coronavirus Response Act (“FFCRA”) and the Coronavirus Aid, Relief, and Economic Security Act (“CARES Act”) mandated reimbursement for COVID-19 testing regardless of plan language. Additionally, the court found that plaintiffs failed to exhaust administrative remedies as required under ERISA. Plaintiffs’ conclusory assertions of exhaustion and allegations of futility were deemed insufficient. The court held that plaintiffs did not provide fundamental details about the appeals process or demonstrate that pursuing administrative remedies would have been futile. Finally, the court dismissed the plaintiffs’ state law breach of contract claim, finding that plaintiffs failed to allege the existence of any contract directly between them and the defendants. Without allegations concerning the terms of the non-ERISA health plans, the court could not conclude that plaintiffs could enforce any contractual rights or that any specific contract terms were breached. As a result, the court granted defendants’ motion to dismiss in its entirety. This time it did so “without leave to further replead,” noting that other courts had arrived at similar conclusions in other cases filed by plaintiffs.

Third Circuit

Abira Med. Laboratories, LLC v. United HealthCare Servs., Inc., No. 24-7375 (MAS) (TJB), 2025 WL 3282272 (D.N.J. Nov. 25, 2025) (Judge Michael A. Shipp). Plaintiff Abira Medical Laboratories, LLC (d/b/a Genesis Diagnostics), like Murphy Medical Associates in the above case, has been a prodigious litigant in the last few years. It is a New Jersey-based company providing various laboratory testing services, including clinical laboratory, pharmacy, genetics, rehabilitation, and COVID-19 testing. As in previous cases, Abira claims that laboratory testing service requisitions submitted on behalf of defendant United HealthCare’s insureds included an assignment of benefits, creating contractual obligations for United to pay for the services provided by Abira. After Abira amended its initial complaint, United filed a motion to dismiss it, which was granted by the court in March of 2025. In that order the court did not rule on United’s ERISA preemption arguments because it dismissed the state law claims in Abira’s complaint on other grounds. Abira filed a second amended complaint, which added a claim for benefits under ERISA. United filed another motion to dismiss, which the court ruled on in this order. The court addressed Abira’s ERISA claim first. It was unconvinced by United’s argument that Abira failed to exhaust administrative remedies because Abira alleged that it properly submitted claims and appeals, and United did not meet its burden of proving that Abira failed to exhaust. However, the court was persuaded that Abira had not properly stated a claim for relief because it did not identify any specific ERISA plan or cite plan language entitling it to benefits: “Plaintiff admits it does not even know if certain claims are subject to ERISA plans and provides no allegations on information and belief regarding any provision of any plan for which it alleges it is entitled to relief… Plaintiff’s vague pleading that benefits are due does not satisfy its burden here.” The court also granted United’s motion on Abira’s state law claims, ruling that (1) Abira’s breach of contract allegations were conclusory and thus the complaint “fails to plead sufficient facts regarding the terms of the underlying contract that entitle it to payment,” (2) Abira’s claim for breach of the implied covenant of good faith and fair dealing foundered without an underlying breach of contract claim, and (3) Abira could not pursue a quantum meruit claim because it did not plausibly establish that a duty was owed to it under any underlying non-ERISA plan. As a result, the court granted United’s motion to dismiss, albeit without prejudice. Abira was afforded a final opportunity to address the above deficiencies.

Statute of Limitations

Second Circuit

Abukhadra v. Calyon Supplemental Exec. Ret. Plan, No. 25 CIV. 02134 (LLS), 2025 WL 3281502 (S.D.N.Y. Nov. 25, 2025) (Judge Louis L. Stanton). Omar Abukhadra began working at Credit Agricole Corporate and Investment Bank (“Calyon”) in 1989 and was enrolled in its supplemental executive retirement plan (“SERP”). After his termination in 2005, Abukhadra received a severance payment of approximately $9 million in 2006 and remained eligible for SERP benefits. In 2010, he received a Summary Plan Document (“SPD”) outlining the terms of the retirement plan, and in 2011, he received a Summary of Benefits listing his six highest-salaried years but excluding his severance payment. Abukhadra became eligible for SERP benefits in August 2023 and received a letter detailing payment options. Upon reviewing the letter, he discovered that the SERP’s terms classified his severance payment as “compensation,” meaning it should have been included in the calculation of his retirement benefits. However, Calyon informed him in January 2024 that the severance payment would not be included, relying on the SPD’s definition of “compensation,” which conflicted with the SERP’s definition. Abukhadra filed this action, and Calyon responded with a motion to dismiss, contending that his claim was time-barred under the applicable six-year statute of limitations.  Calyon argued that the statute of limitations began in 2011 when Abukhadra received the Summary of Benefits that omitted his severance payment. The court disagreed, finding that the Summary of Benefits did not contain enough information to place Abukhadra on notice of the miscalculation. The document did not define “compensation,” reference the SERP or SPD, or indicate the conflicting definitions. It merely listed his six highest-salaried years and an annual benefits estimate, which was too indefinite to trigger the statute of limitations. The court further rejected defendants’ argument that Abukhadra, as a sophisticated business executive, should have consulted documents from two decades prior to identify potential inconsistencies, citing Second Circuit precedent that beneficiaries are not required to make a “sophisticated chain of deductions” to identify miscalculations. As a result, the court denied the motion to dismiss, finding that Abukhadra did not have sufficient notice of the alleged miscalculation until August 2023, and thus the statute had not run.