Johnson v. Reliance Standard Life Ins. Co., No. 23-13443, __ F.4th __, 2025 WL 3251015 (11th Cir. Nov. 21, 2025) (Before Circuit Judges William Pryor, Grant, and Kidd)

Your ERISA Watch would like to take this opportunity to wish you all a joyous Turkey Day and hope you can all find thanks for something in these trying times. As for us, we are very thankful to have you as readers, and we hope you find our weekly missives informative, educational, and maybe even occasionally entertaining. As always, feel free to drop us a note if you have any comments or suggestions.

It will be an especially happy Thanksgiving for Cheriese Johnson, the plaintiff in our case of the week. In 2015, things started going downhill for Johnson, who began suffering from a variety of unexplained symptoms. These included fatigue, muscle weakness, nausea, vomiting, nosebleeds, joint swelling, dizziness, and cognitive impairment.

Johnson continued working, however, and was hired by The William Carter Company in its human resources department in July of 2016. Three months later, she became covered under Carter’s employee long-term disability benefit plan, insured by defendant Reliance Standard Life Insurance Company.

Unfortunately, Johnson only lasted until January of 2017 at Carter’s, at which time she was forced to stop working due to her worsening symptoms. She applied for benefits with Reliance, but because she had stopped working within one year of the beginning of her coverage, her claim was subject to investigation pursuant to the plan’s preexisting condition provision.

This provision stated that benefits “will not be paid” for a disability that is “caused by,” “contributed to by,” or “resulting from” a preexisting condition. “Preexisting condition” was defined as “any Sickness or Injury for which the Insured received medical Treatment, consultation, care or services, including diagnostic procedures, or took prescribed drugs or medicines” during the three-month “look-back” period before coverage began – here, July through October of 2016.

Johnson certainly received significant treatment during this period. She was treated for many of the symptoms noted above and diagnosed with a number of potential conditions, including fibromyalgia, borderline lupus erythematosus, hypertension, and bronchitis.

However, it was not until February of 2017 that Johnson discovered the true cause of her symptoms. At that time, she underwent a lung biopsy, which led to a diagnosis of scleroderma. Scleroderma is a rare autoimmune disease that causes the thickening and hardening of skin and connective tissue. Serious cases can affect internal organs. Unfortunately, there is no cure.

Reliance completed its investigation and concluded that Johnson was not entitled to benefits because the preexisting condition provision applied. Johnson appealed, arguing that because no doctor suspected she had scleroderma until after the lookback period ended, the provision could not apply. Reliance countered that the symptoms and findings from the lookback period were consistent with scleroderma, and thus it upheld the denial “on the basis that the claimed disability [was] caused by, contributed to by, or the result of” scleroderma.

Johnson filed suit, but the district court agreed with Reliance and granted it summary judgment. (Your ERISA Watch reported on this decision in our October 11, 2023 issue.) Johnson appealed to the Eleventh Circuit Court of Appeals.

The Eleventh Circuit used its six-step approach to determine if Reliance’s decision should be overturned (although it only made it to step three). First, it addressed whether Reliance’s decision was “de novo wrong,” i.e., whether its interpretation of the preexisting condition provision was correct or not, without any deference to Reliance.

The court ruled that it was incorrect. It focused on the words “for which” in the definition of preexisting condition, i.e., was Johnson’s disability the result of an illness “for which the Insured received medical Treatment” during the lookback period?

The court stated, “A lot hinges on for – a word that ‘connotes intent.’” There was no intent to treat scleroderma here, according to the court. “No one ‘intended or even thought’ to treat Johnson ‘for’ scleroderma during the lookback period… Because neither Johnson ‘nor her physicians either knew or suspected that the symptoms she was experiencing were in any way connected with’ scleroderma, it would make little sense to say that she was treated for scleroderma.”

However, this was not the end of the story. Under step two of its analysis, the court concluded that the benefit plan gave Reliance “discretionary authority to interpret the Plan and the insurance policy and to determine eligibility for benefits.” Thus, the court moved on to step three to discuss whether Reliance’s interpretation, even if it was “de novo wrong,” was still “reasonable” under the deferential arbitrary and capricious standard of review.

The court emphasized that this standard of review “really is deferential.” However, “There will be times when ‘the plain language or structure of the plan or simple common sense will require the court to pronounce an administrator’s determination arbitrary and capricious.’” The court determined, “This is one of those times.”

The court ruled that Reliance’s interpretation was unreasonable “because it completely elides the distinction between receiving medical care for symptoms not inconsistent with a preexisting condition and receiving medical care for a preexisting condition itself.” The court presented an analogy:

It is no exaggeration to say that under Reliance Standard’s view, a patient told to drink more water because her headache was likely caused by her dehydration has been treated for cancer if she turns out to have a brain tumor. And that is true even if dehydration really was the root cause of the headache. Headaches, after all, are a symptom of both brain tumors and dehydration. So, to Reliance Standard, treatment for a headache during the lookback period converts any disease or condition that causes headaches into a preexisting condition under the policy.

The court deemed this position “unreasonable – full stop.” Quoting Justice Samuel Alito, from an opinion he wrote when he was on the Third Circuit Court of Appeals (Lawson v. Fortis), the court stated, “considering treatment for symptoms of a not-yet-diagnosed condition as equivalent to treatment of the underlying condition ultimately diagnosed might open the door for insurance companies to deny coverage for any condition the symptoms of which were treated during the exclusionary period.” This type of “backward-looking reinterpretation of symptoms to support claims denials would so greatly expand the definition of preexisting condition as to make that term meaningless: any prior symptom not inconsistent with the ultimate diagnosis would provide a basis for denial.”

In the end, the court viewed Reliance as attempting to rewrite its policy after the fact – “reading it as if it barred coverage for claims arising from conditions that may have originated or existed during the lookback period, not conditions that were treated during that period.” In other words, Reliance’s interpretation “warps the ‘plain and ordinary meaning’ of the policy language, converting a preexisting-condition exclusion into a preexisting-symptom exclusion.” As a result, the court concluded that Reliance’s interpretation was arbitrary and capricious, and reversed and remanded for further proceedings.

The panel was not unanimous, however. Judge William Pryor penned a dissent in which he concluded that Reliance’s interpretation was reasonable. Judge Pryor criticized the majority for relying so heavily on the word “for” in the definition of preexisting condition, and for misinterpreting it. This word “has, at least, eleven different definitions.”

Judge Pryor argued that “‘for’ is read more naturally in the exclusion as meaning ‘because of.’” He agreed with Reliance that Johnson received treatment during the lookback period “‘for the very conditions and symptoms’ that prove that she suffers from scleroderma.” As a result, it was unimportant for the purposes of the preexisting condition provision whether Johnson’s physicians knew that scleroderma was the cause of the symptoms they were treating.

Judge Pryor conceded that “Ms. Johnson’s condition is unfortunate[.]” However, “the terms of her policy plainly contemplate that a condition need not be diagnosed or even suspected to be pre-existing.” As a result, Judge Pryor would have affirmed Reliance’s decision to deny Ms. Johnson’s claim.

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

Breach of Fiduciary Duty

Second Circuit

Carlisle v. The Bd. of Trustees of the Am. Fed. of the N.Y. State Teamsters Conference Pension & Retirement Fund, No. 25-511, __ F. App’x __, 2025 WL 3251154 (2d Cir. Nov. 21, 2025) (Before Circuit Judges Calabresi, Chin, and Lee). In this compact and unpublished decision, the Second Circuit affirmed a district court’s dismissal of a putative fiduciary breach ERISA class action against the trustees and service providers of the New York State Teamsters Conference Pension and Retirement Fund. The panel concluded that the district court properly dismissed the complaint on the ground that it failed to plausibly allege a breach of fiduciary duty against any of the defendants. It held that plaintiff-appellant Robert Carlisle failed to sufficiently allege that the plan’s actuary, Horizon Actuarial Services, LLP, had fiduciary duties under ERISA. And while the trustees and the plan’s financial advisor, Meketa Investment Group, Inc., were undoubtedly fiduciaries and functioned as such regarding the challenged investment strategies, the court of appeals nevertheless found that Mr. Carlisle failed to plausibly allege they breached their duties “based on information available ‘at the time of each investment decision.’” The panel explained that while the complaint alleges that the fiduciaries were aware of the risks associated with their strategies and that other similarly situated plans favored stabler investments, such allegations “do not indicate that the Plan fiduciaries did more than engage in the normal practice of weighing ‘tradeoffs’ and selecting from a ‘range of reasonable judgments’ in the circumstances.” At bottom, the allegations in the complaint simply failed to convince the Second Circuit that the plan’s investment approach was “such an extreme outlier from ‘peer’ multiemployer plans that it was imprudent.” As for the claims of disloyalty, the court of appeals held that it could not plausibly infer from the complaint’s allegations that Meketa’s conflict due to its dual role as both the plan’s non-discretionary investment advisor and its private markets investments manager or the trustees’ investment decisions “were for the purpose of benefiting Meketa or any party other than the plan.” Accordingly, the court found that Mr. Carlisle failed to state fiduciary breach claims and as a consequence the district court properly dismissed his lawsuit.

Fifth Circuit

Brown v. Peco Foods, Inc., No. 3:25-CV-491-TSL-RPM, 2025 WL 3210857 (S.D. Miss. Nov. 14, 2025) (Judge Tom S. Lee). Plan participant Jayson Brown filed this putative class action against his former employer, Peco Foods, Inc., alleging that it violated the terms of its 401(k) retirement plan and its fiduciary duties under ERISA by using forfeitures to reduce its future matching contribution obligations rather than to reduce the plan’s administrative costs. Mr. Brown asserts claims of disloyalty, imprudence, breach of plan document, and prohibited transactions. Peco moved to dismiss them all. In this concise decision the court granted the motion to dismiss. First, the court was persuaded by Peco’s argument that the plan language did not require forfeitures to be spent on administrative expenses before they could be used to reduce employer contributions given the plan’s use of the permissive word “may.” “Here, the court, having considered the parties’ arguments, is of the opinion that the provision at issue, in view of the use of the permissive term ‘may’…does not unambiguously require that Peco apply the forfeitures to administrative expenses before it may apply them to offset employer contributions. Peco’s reading, under which it has discretion to decide how to apply the forfeitures, e.g., whether to apply them, first, to pay administrative expenses of the Plan or to instead offset employer contributions, is a fair and reasonable interpretation of the provision and thus is accepted as the correct interpretation. It follows that Peco’s use of the forfeitures to offset employer contributions did not violate the terms of the Plan and thus, that plaintiff has failed to state a claim.” Furthermore, the court agreed with Peco that its chosen use of the forfeitures was not a violation of its fiduciary obligations, because ERISA requires only that plan participants receive the benefits they are promised. The court noted that “over a dozen” other district courts have considered and rejected similar arguments presented in these forfeiture cases, while “only a handful of courts” have found merit to them. Finally, the court dismissed the prohibited transaction claims. It concluded that inter-plan reallocation of plan assets functioned as a benefit to the plan, and therefore cannot be considered a transaction under Section 1106. Based on the foregoing, the court decided that Mr. Brown failed to state his claims, and ordered that his complaint be dismissed.

Ninth Circuit

Hernandez v. AT&T Services, Inc., No. 2:25-cv-00676-ODW (PVCx), 2025 WL 3208360 (C.D. Cal. Nov. 14, 2025) (Judge Otis D. Wright, II). This decision is the latest in a series of rulings dismissing putative class actions involving forfeited employer contributions in ERISA-governed 401(k) plans. In many ways, this was a cut and paste order which deferred to and drew from numerous rulings we have covered at Your ERISA Watch over the past year in similar actions. As in those cases, the court flat-out rejected plaintiff’s theory of the case, which was that spending forfeited employer contributions on the cost of future employer contributions rather than on defraying administrative expenses violates ERISA’s anti-inurement provision, its prohibition on self-dealing, and the statute’s fiduciary standards. In this particular lawsuit plaintiff Luis Hernandez alleged that AT&T Services, Inc. improperly applied forfeited contributions to reduce future employer obligations in its defined contribution plan. Relying on the precedent set by district court decisions from throughout the country, AT&T moved for dismissal of all causes of action pursuant to Rule 12(b)(6), arguing that Mr. Hernandez’s “sweeping theories of liability…do not state a plausible claim for relief.” The court strongly agreed. It began by addressing the fiduciary breach claims. At bottom, the court held that Mr. Hernandez’s views fail because they contravene ERISA, decades of settled precedent, and set out to create benefits beyond those promised to the participants in the plan. For these reasons, the court dismissed the claims of imprudence, disloyalty, and failure to monitor. Next, the court tackled the anti-inurement claim. It found that AT&T could not have violated 29 U.S.C. § 1103(c)(1) because it did not remove any assets from the plan or use the forfeitures for any purpose other than to pay its obligations to the plan participants. Accordingly, the court dismissed this claim too. Finally, it discussed the prohibited transaction claim. The court ultimately held that Mr. Hernandez could not state such a cause of action because there was no “transaction” here, and because the funds were not “used in a prohibited manner.” As a result, the court granted the motion to dismiss the entirety of the action. Moreover, it determined that amendment would be futile given its steadfast position that Mr. Hernandez’s “ERISA claims rest on a misinterpretation of the Plan’s terms and a novel legal theory that is unsupported by present law.” Thus, the court’s dismissal was without leave to amend.

Disability Benefit Claims

Ninth Circuit

Baltes v. Metropolitan Life Ins. Co., No. 2:23-cv-07404-MRA-JPR, 2025 WL 3199464 (C.D. Cal. Nov. 12, 2025) (Judge Monica Ramirez Almadani). This action was filed by a former senior software engineer at Google, plaintiff Austin Baltes, who sought judicial review of the denial of his claim for long-term disability benefits by defendant Metropolitan Life Insurance Company (“MetLife”). On January 22, 2024, the court granted the parties’ joint stipulation to a de novo standard of review, and on August 26, 2024, the court held a hearing on the parties Rule 52 motions for judgment. In this decision the court issued its findings of fact and conclusions of law and entered judgment in favor of Mr. Baltes. The court found that Mr. Baltes met his burden of showing by a preponderance of the evidence that he was disabled during the relevant time period and unable to perform the substantial and material duties of his occupation due to post-viral fatigue, brain fog, and cognitive impairment. The court determined that Mr. Baltes’ self-reported symptoms were consistent, credible, and supported by corroborating medical records, lab testing results, and statements made by his treating physicians. By contrast, the court noted that MetLife’s reviewing nurses and doctors conducted paper-only reviews, failed to review the complete file or Mr. Baltes’ actual job description prior to rendering their opinions, and crucially inappropriately emphasized what they saw as a lack of objective physical findings to justify the denial of benefits. Because of these shortcomings, the court found the statements of MetLife’s reviewers “to be of little assistance” and assigned them minimal weight, particularly as they never seriously disputed Mr. Baltes’ diagnoses themselves, only the severity of his conditions. For these reasons, the court concluded that Mr. Baltes was disabled under the terms of his plan and entitled to benefits. Thus, the court granted Mr. Baltes’ motion and denied MetLife’s motion.

Eleventh Circuit

Hovan v. Metropolitan Life Ins. Co., No. 24-11167, __ F. App’x __, 2025 WL 3241521 (11th Cir. Nov. 20, 2025) (Before Circuit Judges Jill Pryor and Luck, and District Judge Virginia M. Covington). Plaintiff-appellant Stacy Hovan was employed as a commercial litigator with the law firm Troutman Sanders LLP. In February of 2019, Ms. Hovan stopped working due to a mental health crisis stemming from her bipolar disorder diagnosis. After she stopped working two things happened simultaneously. First, Ms. Hovan applied for disability benefits under an ERISA-governed policy insured by defendant-appellee Metropolitan Life Insurance Company. Second, she entered an intensive outpatient program. She remained at the program until September 22, 2020, when her providers determined that her acute crisis had stabilized. Throughout this time, Ms. Hovan had been approved for and was receiving benefits from MetLife. However, upon discharge from the treatment facility, MetLife terminated the benefits. It concluded that the notes from Ms. Hovan’s ongoing therapy sessions post-discharge failed to establish continued disability or the inability to perform the essential functions of her work as a litigator. The district court ultimately agreed with MetLife’s decision, concluding at the summary judgment stage that it was not de novo wrong. On appeal, the Eleventh Circuit concurred. “For the period after Hovan’s release from PeakView on October 16, 2020, the only evidence that Hovan submitted to MetLife in support of her continued claim of disability was the therapy notes from her sessions with Ms. Stevens. Upon review, we conclude that Ms. Stevens’s therapy notes do not show that Hovan was still disabled and unable to work as a commercial litigator after her release from PeakView.” While the therapy notes were “troubling” and certainly reflected that Ms. Hovan continued to experience psychiatric symptoms consistent with bipolar disorder, including “passive” suicidal ideation, the Eleventh Circuit nevertheless agreed with MetLife they that failed to establish that Ms. Hovan’s judgment, decision-making ability, stress tolerance, or interpersonal functioning were impaired or not adequately controlled. On the record before it, the court of appeals agreed with the lower court that Ms. Hovan could continue performing the essential duties of a commercial litigator following her discharge, despite her serious ongoing mental health concerns, including occasional depression, mania, and anxiety. For this reason, the Eleventh Circuit found that both MetLife and the district court appropriately concluded that Ms. Hovan no longer met the plan’s definition of disabled after her release from the treatment facility and that she could not provide satisfactory proof to the contrary. As a result, the Eleventh Circuit affirmed the district court’s judgment in favor of MetLife and upheld the termination of Ms. Hovan’s benefits.

Exhaustion of Administrative Remedies

Tenth Circuit

Sellers v. Humana Ins. Co., No. 1:24-cv-00162-SMD-GBW, 2025 WL 3204747 (D.N.M. Nov. 17, 2025) (Judge Sarah M. Davenport). This case arises from plaintiff Michael Sellers’ claim for Accidental Death and Bodily injury benefits under a policy issued by Humana Insurance Company following the death of his wife Amber in a car accident. Humana moved for summary judgment and to strike exhibits Mr. Sellers included which it argued were outside of the administrative record. In this decision the court denied both motions, but remanded Mr. Sellers’ claim to Humana for further consideration. The court’s decision centered around the issue of administrative exhaustion. The court deemed Mr. Sellers to have satisfied the exhaustion requirement because Humana failed to comply with its regulatory duties. Specifically, the court found that Humana neglected to have a meaningful dialogue with Mr. Sellers or provide him adequate notice about the deficiencies in his third-party designation of his attorney. “Driving this conclusion is Humana’s paradoxical decision to at once reject Mr. Houliston as Plaintiff’s authorized representative yet only communicate with him regarding the signature requirement.” The court said Humana’s logic was untenable. If the lack of a signature was the difference between “effecting review of a claim denial and not, Humana [needed to] take some affirmative step to inform the claimant of this requirement.” Humana did not do so. And this failure was particularly problematic given that the plan documents do not mention the need for a signature for designating an authorized representative. Accordingly, the court found that Humana did not diligently pursue its duties to ensure that the claims procedures were clearly communicated to Mr. Sellers. Thus, the court concluded that Humana failed to dispel Mr. Sellers’ notion that he was represented by counsel and that his appeal would proceed. As a result, it held that Mr. Sellers had exhausted his administrative remedies. Nevertheless, because the administrative record has not been properly developed, the court concluded that the proper course of action is to remand the claim to Humana for a full review. Thus, the court declined to consider the merits of Humana’s decision to deny the benefit claim at this juncture. Moreover, in light of its decision to remand rather than reach the merits of the denial, the court denied the motion to strike exhibits outside of the administrative record as moot.

Life Insurance & AD&D Benefit Claims

First Circuit

Metropolitan Life Ins. Co. v. Hughes, No. 22-cv-11526-ADB, 2025 WL 3204609 (D. Mass. Nov. 17, 2025) (Judge Allison D. Burroughs). MetLife filed this interpleader action to determine the proper beneficiary of life insurance benefits associated with an ERISA-governed policy for decedent David True. Defendant Douglas Hughes, individually and as representatives of the estates of Renee True and David True, moved for summary judgment in his favor. He argued that Renee’s estate was entitled to the benefits because she was the named beneficiary and survived her husband. Moreover, Mr. Hughes argued that Ryan True, David and Renee’s son and the contingent beneficiary of the policy, was precluded from receiving the proceeds of his father’s life insurance policy, either directly or through his mother, under both Massachusetts law and federal common law because he was found guilty by a Massachusetts jury of the murder of both of his parents and sentenced to two consecutive life sentences. The court agreed with Mr. Hughes on both points and held that as the sole remaining eligible heir of Renee, Mr. Hughes was entitled to the proceeds of David’s life insurance policy. The court entered judgment to this effect.

Medical Benefit Claims

Ninth Circuit

Pritchard v. Blue Cross Blue Shield of Ill., No. 23-4331, __ F. 4th __, 2025 WL 3202338 (9th Cir. Nov. 17, 2025) (Before Circuit Judges Rawlinson and Smith Jr., and District Judge Jed S. Rakoff). A group of transgender participants and beneficiaries in self-funded employer-sponsored health plans sued their third-party administrator, Blue Cross Blue Shield of Illinois, alleging that language in their plan excluding gender-affirming care violated sex-based discrimination provisions of the Affordable Care Act (“ACA”). The district court agreed and found in favor of plaintiffs on summary judgment. Last week, however, a panel in the Ninth Circuit overturned some of the district court’s rulings and remanded for further scrutiny. Central to the Ninth Circuit’s ruling was the recent Supreme Court decision in United States v. Skrmetti, 145 S. Ct. 1816 (2025), wherein the high court found that state law restrictions on the treatment of gender dysphoria do not necessarily constitute discrimination on the basis of sex. Before it addressed Skrmetti, however, the Ninth Circuit joined the district court in rejecting three of Blue Cross’s defenses, which were: (1) the plans were not funded by the federal government; (2) it was acting at the direction of the employers; and (3) it was shielded by the Religious Freedom Restoration Act. Argument two implicated ERISA; Blue Cross argued that ERISA’s statutory emphasis on implementing plan terms as written authorized it to enforce the provisions at issue, even if they were contrary to the ACA. The court acknowledged that the two statutes potentially created a conflict, but “[t]his is a risk BCBSIL accepted when it assumed fiduciary duties to the plan. Every fiduciary faces the same dilemma when there is doubt about the legality of an action it feels compelled to take.” In the end, however, the court found no conflict: “the text and structure of ERISA…do not allow third-party administrators to flout the law on behalf of their employer-customers.” The court’s ruling rested on Section 1144(d) of ERISA, which provides that ERISA does not supersede other federal law, and thus its commands must yield to the ACA. Where the Ninth Circuit diverged from the lower court was on the basic holding that gender-affirming care exclusions are inherently discriminatory. This conclusion, the panel stated, has been undercut by the intervening authority in Skrmetti. They explained, however, that just because the district court’s reasoning failed in light of Skrmetti, the plaintiffs may still ultimately win as the district court could potentially distinguish Skrmetti. In particular, the Ninth Circuit noted that some of the plaintiffs needed hormone treatments for diagnoses other than gender dysphoria, but Blue Cross still would not treat them. The panel said this fact left open the possibility that Blue Cross’s justifications for its actions were a pretext for discrimination. Thus, the panel instructed the district court to reassess whether plaintiffs can establish discrimination under the appropriate legal standard. Judge Rawlinson penned a concurrence in which she argued that the majority had gone too far in opining as to how the district court might interpret Skrmetti on remand. “I see the majority’s analysis as exceeding a remand and conducting a ‘first view’ rather than a ‘review.’”

Pension Benefit Claims

Third Circuit

Princeton Univ. Retirement Plan v. Estate of Jerome F. Andrzejewski, No. 23-1501 (ZNQ) (TJB), 2025 WL 3215721 (D.N.J. Nov. 18, 2025) (Judge Zahid N. Quraishi). In this decision the district court ruled on competing motions for summary judgment filed by the potential beneficiaries of decedent Jerome Andrzejewski’s Princeton University retirement account. Relying on the Supreme Court’s precedent set in Kennedy v. Plan Administrator for DuPont Savings & Investment Plan, 555 U.S. 285 (2009), the court held that defendant Robert Moses was the rightful beneficiary of the proceeds as he was properly designated as the sole beneficiary of the account in 1993, and no change of beneficiary form was ever executed by Mr. Andrzejewski subsequent to this designation and prior to his death. The court stated that the competing beneficiaries, the Estate of Jerome F. Andrzejewski and Denis Andrzejewski, could not offer any facts to contradict this, and instead only offered speculation that Mr. Andrzejewski intended to amend his beneficiary designation as evidenced through his statements to his estate planning attorney. Because the Kennedy decision foreclosed any inquiry into the parties’ intents and desires in favor of the virtues of strict adherence to beneficiary designations, the court held that it need not consider or investigate the Estate and Denis’s arguments. Rather, because neither party established that Mr. Andrzejewski amended the beneficiary designation of his account proceeds in accordance with the plan’s directives, the court held that Mr. Moses was entitled to the benefits at issue. As a final matter, the court declined Denis’ and the Estate’s request to impose a constructive trust, given the fact that they presented no evidence that Mr. Andrzejewski’s designation of Mr. Moses stemmed from a mistake or some other wrongful act. Consequently, the court granted Mr. Moses’s motion for summary judgment, denied Denis’ and the Estate’s cross-motion for summary judgment, and ordered that the retirement benefits be paid to Mr. Moses.

Pleading Issues & Procedure

Second Circuit

Doherty v. Bristol-Myers Squibb Co., No. 24-CV-06628 (MMG), 2025 WL 3204436 (S.D.N.Y. Nov. 17, 2025) (Judge Margaret M. Garnett). On September 29, 2025, the court issued a ruling granting in part and denying in part defendant Bristol-Myers Squibb’s motion to dismiss this putative class action alleging violations of ERISA in connection with the pharmaceutical company’s pension risk transfer and annuitization of its defined benefit pension plan with Athene Annuity and Life Company. (Your ERISA Watch featured the decision as our case of the week on October 8, 2025.) Presently before the court was defendants’ unopposed motion to certify that order for interlocutory appeal. Under 28 U.S.C. § 1292(b), district courts may exercise their discretion to certify an interlocutory appeal where the decision at issue “(1) involves a controlling question of law (2) as to which there is substantial ground for a difference of opinion and (3) as to which an immediate appeal may materially advance the ultimate termination of the litigation.” Here, the court found all three factors were satisfied, and accordingly granted defendants’ motion. First, the court agreed with Bristol-Myers Squibb that its decision that plaintiffs have Article III standing involves a controlling question of law involving at least one purely legal question of whether the pension risk transfer transaction at the heart of this case caused the type of harm required to confer Constitutional standing. Second, the court emphasized that there is a split among the federal district courts as to whether pension risk transfer transactions that purport to promise the same ongoing benefits as the ERISA plans can ever confer Article III standing on the pensioners. This split, including within the Second Circuit, demonstrated to the court that there is substantial ground for difference of opinion on this fundamental issue. Finally, the court stated that the Second Circuit’s ruling will resolve a foundational legal issue and either bring the case to a close or narrow the potential issues the parties must litigate and the court must decide going forward. In either event, “substantial efficiencies will be gained by resolving the standing issue now.” For these reasons, the court agreed with defendants that its September 29 decision should be certified for interlocutory appeal. Accordingly, the court granted defendants’ motion. Finally, the court stayed the case for the pendency of the appeal other than the limited discovery agreed upon by the parties.

Sixth Circuit

Bradley v. Toyota Tsusho America, Inc., No. 5:25-cv-00385-GFVT, 2025 WL 3220087 (E.D. Ky. Nov. 18, 2025) (Judge Gregory F. Van Tatenhove). Decedent Joshua Shepard worked for defendant Toyota Tsusho America, Inc. Mr. Shepard had originally designated his grandmother as his beneficiary pursuant to his coverage under the Toyota employee life insurance benefit plan. However, after the birth of his two young children, Mr. Shepard attempted to change his designation, to name the children and their mother, his longtime partner plaintiff Kaitlyn Bradley, as his beneficiaries. However, the person responsible for filing the paperwork at Toyota left the company, and Mr. Shepard’s beneficiary change form was either lost or destroyed as a result. When he learned about this, Mr. Shepard attempted to start the process over again. He acquired new forms, filled them out, and planned to submit them to the company. Things then took a tragic turn. With the completed forms in his backpack, Mr. Shepard died in a car accident. As a result, despite his clear intentions and affirmative actions to add his partner and children as his beneficiaries, Mr. Shepard was never able to submit the required paperwork. Ms. Bradley originally filed this action in state court on behalf of herself and her children alleging a common law negligence claim. Toyota removed the complaint to federal court on the basis of federal question jurisdiction and then filed a motion to dismiss the complaint pursuant to ERISA preemption. In response, Ms. Bradley amended her complaint to assert a fiduciary breach claim under ERISA instead. Thus, the question before the court here was whether Ms. Bradley’s amended complaint rendered Toyota’s motion to dismiss moot. With little fuss, the court concluded it did. “Bradley’s amended complaint no longer contains any state law negligence counts. Instead, Bradley’s amended complaint advances the lawsuit based on alleged violations of ERISA. The amended complaint and the original complaint are not substantially identical. Bradley changed the legal theory under which she seeks relief against Toyota. Bradley’s amended complaint cured the defects raised by Toyota’s motion to dismiss. Thus, the amended complaint moots the pending motion to dismiss.” Therefore, the court denied the motion to dismiss as moot, and the action will now proceed under ERISA.

Eleventh Circuit

Marrow v. E.R. Carpenter Co., Inc., No. 8:23-cv-2959-KKM-LSG, 2025 WL 3209652 (M.D. Fla. Nov. 18, 2025) (Judge Kathryn Kimball Mizelle). In this putative class action plaintiff Saroya Marrow alleges that her former employer, E.R. Carpenter Co., Inc., failed to provide sufficient notice under the Consolidated Omnibus Budget Reconciliation Act (“COBRA”) of continuing healthcare coverage in violation of ERISA. Specifically, Ms. Marrow points to two shortcomings in the COBRA notice she was mailed: (1) the notice omitted the date when the election form was due; and (2) it included conflicting statements regarding whether the initial payment had to accompany the election form. Ms. Marrow alleges that failing to elect COBRA coverage caused her economic injuries through the loss of health and dental insurance. In this decision the court concluded that Ms. Marrow lacked Article III standing to pursue her action because she failed to identify any evidence that these injuries were traceable to the deficiencies in the COBRA notice she received from Carpenter. The court held, “[r]ather than demonstrate that the notice’s deficiencies caused Marrow’s injuries, the evidence shows only that her injuries were self-inflicted. Thus, even if Carpenter’s notice contained the due date and correctly instructed Marrow of when to make her first payment, Marrow’s testimony establishes that her issues with these non-deficient portions of the notice would have prevented her from electing coverage. Marrow’s injuries are traceable only to herself. A non-deficient notice would have resulted in ‘precisely the same harm.’” Because the court concluded that Ms. Marrow set forth no evidence demonstrating factual causation between her injuries and the deficiencies in the notice she received, the court could not say that her injury was fairly traceable to Carpenter’s misconduct. As a result, the court concluded that Ms. Marrow lacked standing to bring her action, and therefore dismissed the complaint, without prejudice.

Retaliation Claims

Seventh Circuit

Singleton v. AT&T Enterprises, No. 1:24-cv-12485, 2025 WL 3215779 (N.D. Ill. Nov. 18, 2025) (Judge Mary M. Rowland). Plaintiff Michael Singleton brings this ERISA and Title VII action against defendants Illinois Bell Telephone Company, LLC, AT&T Enterprises, and AT&T Incorporated alleging that his termination was a form of discrimination and impermissibly interfered with his pension benefits under ERISA. Defendants moved to dismiss the claim of discrimination under Title VII of the Civil Rights Act with respect to AT&T Enterprises and AT&T Inc. and moved to dismiss the ERISA Section 510 claim in its entirety, or alternatively, with respect to just AT&T Enterprises and AT&T Inc. The court granted the motion to dismiss the Title VII claim with respect to the AT&T defendants, but entirely denied the motion to dismiss the ERISA claim. Regarding the Title VII discrimination claim, the court agreed with defendants that the complaint fails to allege that either AT&T defendant was Mr. Singleton’s direct employer or that they were his employers based on some indirect theory of liability. The complaint, the court stated, “does not allege that AT&T Enterprises and AT&T Inc. ‘directed’ the purported racial discrimination against Plaintiff. Nor does it allege that AT&T Enterprises and AT&T Inc. exercised ‘control’ over Plaintiff’s employment relationship. The Amended Complaint merely alleges in a conclusory fashion that AT&T Enterprises and AT&T Inc. were Plaintiff’s employers. This is insufficient.” Accordingly, the court granted this aspect of defendants’ motion to dismiss. However, it clarified that this dismissal was without prejudice to Mr. Singleton amending his complaint to address this deficiency. Turning to the ERISA claim, the court addressed each of defendants’ three arguments for dismissal: (1) failure to plead specific intent; (2) failure to exhaust administrative remedies; and (3) the AT&T defendants are not proper defendants to this cause of action. The court first held that the complaint sufficiently raises plausible allegations that defendants fired Mr. Singleton to save the roughly $280,000 to $560,000 they would have owed him had they kept him employed until his higher tiered pension had vested. Next, the court noted that the complaint states that Mr. Singleton exhausted all available administrative remedies, or in the event he failed to do so, that exhaustion would have been futile. The court thus declined to dismiss the action based on the affirmative defense of exhaustion. Finally, the court denied defendants’ request for dismissal as to AT&T Enterprises and AT&T Inc. Unlike Title VII, ERISA Section 510 does not require the existence of an employer relationship. The court said that the allegations in the complaint lead to a plausible inference that all defendants engaged in the adverse actions against Mr. Singleton and that each is therefore alleged to be liable for the ERISA violation regardless of whether the AT&T defendants were Mr. Singleton’s direct employer. For these reasons, the court granted in part and denied in part the motion to dismiss.

Statutory Penalties

Tenth Circuit

Mayor v. Metropolitan Life Ins. Co., No. 1:25-cv-00012-DBB-DAO, 2025 WL 3251356 (D. Utah Nov. 21, 2025) (Judge David Barlow). Following the accidental death of her husband Casey, plaintiff Nicole Mayor submitted a claim to Metropolitan Life Insurance Company (“MetLife”) for life insurance and accidental death insurance benefits as the sole beneficiary of her husband’s coverage under ERISA-governed policies. MetLife denied the claim for accidental death benefits on the basis of a policy exclusion. When Ms. Mayor appealed the denial she requested additional information about the policy from MetLife, but these requests, and ultimately the appeal itself, were denied by MetLife. Accordingly, in this action Ms. Mayor seeks the benefits that she was denied. In addition to MetLife, she has sued Casey’s former employer and the plan’s administrator, Union Pacific, and two individual officers of Union Pacific. In her amended complaint, Ms. Mayor asserts two causes of action: (1) a claim for statutory penalties for failure to provide information required by ERISA; and (2) wrongful denial of her claim. Before the court here was defendant MetLife’s motion to dismiss the statutory penalties claim on the grounds that it is the plan’s claims administrator, not the plan administrator. The court agreed and granted the partial motion to dismiss. It held that under Tenth Circuit precedent only the plan administrator can be liable for failing to provide information required under the statute. Ms. Mayor claimed that MetLife is liable for statutory penalties because it “agreed with the plan administrator that MetLife would pay any ERISA penalties for failing to provide material.” It is clear throughout the complaint that Ms. Mayor alleges that Union Pacific and its executives served as the plan administrator. The court held that her theory of liability for MetLife based on these alleged agreements creating an agency relationship between it and Union Pacific simply failed “to state a claim against MetLife for not providing the information required under ERISA.” As a result, the court granted the motion to dismiss the first cause of action as asserted against defendant MetLife.

This week we are reporting on twice as many cases as last week, which sounds like a lot! Unfortunately, there were only three cases in last week’s edition, so suddenly it’s not so impressive. Apparently, the federal courts are still suffering the effects of the government shutdown.

The six cases we did get run the gamut, however. Read on to learn about whether forfeiture claims can make a comeback (no, Del Bosque v. Coca-Cola), whether beneficiaries of an accidental death policy can pursue discovery into the insurer’s conflict of interest (yes, Kramer v. MetLife), whether submitting false expense reports can negate your entitlement to severance benefits (yes, Cella v. Lilly), and whether your 401(k) is protected from garnishment by the federal government if you have been convicted of embezzlement (not really but sort of, United States v. Green).

Hopefully the cases will pick up now that the shutdown is over, although the holidays are coming up which may put a damper on things. We’ll all find out together in next week’s edition.

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

Breach of Fiduciary Duty

Fifth Circuit

Del Bosque v. Coca-Cola Southwest Beverages LLC, No. 3:25-CV-01270-X, 2025 WL 3171326 (N.D. Tex. Nov. 13, 2025) (Judge Brantley Starr). Plaintiffs in this action are participants in Coca-Cola’s 401(k) retirement plan. They allege that Coca-Cola has mismanaged its plan by including an imprudent and costly suite of JP Morgan target date funds and by spending forfeited employer contributions on the cost of future employer contribution obligations. Coca-Cola moved to dismiss this action, arguing that plaintiffs failed to state their claims of imprudence and disloyalty. The court agreed and granted the motion in this order, dismissing the complaint without prejudice. To begin, the court held that plaintiffs’ comparator target date funds were not meaningful benchmarks to demonstrate imprudence because they contained only actively managed investment options while JP Morgan’s funds were comprised of a mix of passive and actively managed funds. Additionally, the court held that inclusion of the funds in the plan was not per se imprudent simply because cheaper options with lower fees existed. In order to state a claim that Coca-Cola breached its fiduciary duty of prudence, the court stated that plaintiffs were required to plead that its selection process was imprudent. Because they did not include such allegations, the court dismissed the target date fund claims. Next, the court dismissed the claim of disloyalty related to the forfeitures. The court was persuaded by the logic of a sister court out of the Eastern District of Louisiana which similarly dismissed a putative fiduciary breach class action arising from the alleged misuse of forfeited funds. Like the court in Louisiana, the district court held that Coca-Cola did not violate the duty of loyalty because ERISA and the terms of the plan authorize the use of forfeiture funds for employer contribution matching. In fact, the court concluded that plaintiffs’ theory would require something that ERISA does not, maximizing profits, and would effectively require that all forfeiture funds be used to create an additional benefit not contemplated in the plan. For these reasons, the court granted Coca-Cola’s motion to dismiss.

Class Actions

Eleventh Circuit

Davis v. United Bank Corp. Retirement Plan Committee, No. 5:24-CV-328-MTT, 2025 WL 3142143 (M.D. Ga. Nov. 7, 2025) (Judge Marc T. Treadwell). In a straightforward and frictionless decision the district court this week preliminarily certified a settlement class of participants in the United Bank Corporation Employee Stock Ownership Plan, appointed named plaintiffs Ruth Davis and Jim Ogletree class representatives and their attorneys at The Barton Firm and Barnes Law Group class counsel, and preliminarily approved of the $2 million settlement in this case alleging fiduciary wrongdoing under ERISA. The court held that the proposed class was adequately defined and clearly ascertainable, and that it satisfied the requirements of Rule 23(a) and (b). Specifically, the court found that the 74-member class satisfies numerosity, that there are common questions of law, fact, and liability surrounding the company stock valuation and liquidation, that plaintiffs and their claims are typical of the class, and that they and their lawyers, R. Joseph Barton and J. Cameron Tribble, are adequate representatives. Moreover, the court considered certification under both Rule 23(b)(1)(B) and (b)(1)(A) appropriate given that the resolution of the plan-wide claims will be dispositive of the interests of all participants in the plan, while independent actions by individual plan participants could result in rulings that set differing or incompatible standards of behavior for the fiduciaries. As for the settlement agreement itself, the court was satisfied that it was the result of serious, informed, arm’s-length negotiations between experienced attorneys. The $2 million settlement amount, representing approximately 43% of the maximum amount plaintiffs asserted they could potentially recover at trial, was also viewed favorably by the court. It saw this figure as not only within the range of reason, but as substantial relief to the class, especially considering the costs, risks, and delay of a trial and an appeal. The court also found that the requested one-third attorneys’ fee award satisfied the standards on preliminary approval. Finally, the court noted that the settlement treats all class members equitably. For these reasons, the court stated that there were no grounds to doubt the fairness of the proposed settlement agreement. The court then ended its decision by approving the content and allocation plan of the settlement notice, appointing the settlement administrator, and scheduling the fairness hearing for March 26, 2026.

Discovery

Tenth Circuit

Kramer v. Metropolitan Life Ins. Co., No. 2:25-cv-00327, 2025 WL 3171499 (D. Utah Nov. 13, 2025) (Magistrate Judge Dustin B. Pead). This case arises from a narcotic drug overdose death. The beneficiaries are seeking accidental death and dismemberment benefits from a MetLife policy and are arguing that MetLife improperly denied their claim for benefits because the decedent had a prescription for oxycodone and was taking the drug as prescribed. Before the court was plaintiffs’ motion to conduct limited discovery regarding MetLife’s inherent conflict of interest based on its role as both the payor of decedent’s benefits and as the entity determining their entitlement to those benefits. The court found that the request for limited, extra-record discovery was appropriate in this action. In particular, the court focused on the fact that this case involves conflicting medical reports, including newly raised medical claims that MetLife added at the last stage of the appeal, leaving the beneficiaries unable to challenge them. Thus, the court said that, “[w]hile the mere existence of a dual role conflict does not in and of itself function as ‘a green light’ for discovery, Plaintiffs have identified specific issues regarding Defendant’s policies, procedures and interpretations which support the propriety of limited discovery to understand the effect, if any, Defendant’s dual role may have played in its decision to deny Plaintiffs’ claims.” However, upon review of plaintiffs’ specific interrogatories and requests for production, the court concluded that a handful of them were overly broad, disproportionate, and outside the scope of Rule 26. The court permitted discovery about the individuals involved in the handling of the claim, including information about their compensation and bonuses, as well as production of copies of claim handling guidelines, training materials, policies, procedures and protocols relating to accidental death claims as relied upon in plaintiffs’ case. The court did not permit, though, information into the hiring, firing, and compensation of all MetLife employees, or production of any reports or investigations from any Insurance Commissioner or regulatory authority, nor allow plaintiff access to all complaints against MetLife from the past ten years, general statistical data, or spreadsheets and calculations. Accordingly, the court granted in part and denied in part the discovery motion.

Pension Benefit Claims

Sixth Circuit

United States v. Green, No. 13-50166, 2025 WL 3187292 (E.D. Mich. Nov. 13, 2025) (Judge David M. Lawson). Defendant Tanaya Green was convicted of embezzlement. As part of her sentence she was ordered to pay restitution of $209,182. Ms. Green stopped remitting funds with about $164,000 worth of payments to go. In response, the government sought a writ of continuing garnishment against Ms. Green’s former employer, Principal Trust. It in turn filed an answer to the writ disclosing that it holds funds in the amount of $27,097.99 on behalf of Ms. Green in a qualified retirement plan. Ms. Green objected to the writ. In this decision the court ruled on the government’s request for an order for the garnishee to pay the entire amount of the retirement account, Ms. Green’s motion requesting to dissolve the lien on her retirement account, and on the parties’ dispute over arrangement of an ongoing payment plan. One of the principal issues was whether the provisions of the Mandatory Victims Restitution Act of 1996 constitute a Congressional exception to ERISA’s anti-alienation provision when it comes to the enforcement of a restitution order against a criminal defendant. The court held that it did, but with some caveats. Chief among these limitations is a spouse’s rights to any retirement payments. The court held, “[w]here a particular pension plan requires that a lump sum payment be made payable only with spousal consent, the government may not cash out these plans without such consent. The Court agrees with the Novak court’s conclusion ‘that criminal restitution orders can be enforced by garnishing retirement funds, but with the funds only payable when the defendant has a current, unilateral right to receive payments under the terms of the retirement plan.’” Here, it was not clear what current rights Ms. Green has to her account funds, what rights her husband may have to them, or whether a lump sum payment is even available under the plan terms. Without resolution of these issues the government’s right to enforce the restitution judgment under the retirement plan cannot be decided at this juncture. Accordingly, the court did not grant the government’s request for an order requiring Principal to pay over the entire amount of the ERISA retirement account, but also did not grant Ms. Green’s request to dissolve the lien on her retirement account either. Instead, the court ordered her to make a lump sum payment of $4,700 against her restitution obligation, and then to make continuing monthly payments of $100 against her restitution obligation. Finally, the court permitted the government to interview Ms. Green under oath to determine her ability to make higher restitution payments, and thereafter to apply to the court to modify the monthly restitution payment order should it feel that this is justified.

Pleading Issues & Procedure

Ninth Circuit

Civello v. Equinix Inc., No. CV-25-01028-PHX-KML, 2025 WL 3181668 (D. Ariz. Nov. 14, 2025) (Judge Krissa M. Lanham). Plaintiff Melissa Civello filed this action against her former employer, Equinix Incorporated, alleging that the company discriminated against her, created a hostile work environment, wrongfully terminated her, acted contrary to state and federal equal pay laws, and violated ERISA. In a previous decision the court granted Equinix’s motion to dismiss this lawsuit. Ms. Civello amended her complaint. In response, Equinix filed a renewed motion to dismiss. In this order the court dismissed the amended complaint with prejudice. It concluded that the complaint failed to state claims under California law because it did not sufficiently plead a connection to the state, that it failed to allege discrimination, reprisal, harassment, and wrongful termination within Title VII’s 300-day window, did not plead a willful violation of the federal Equal Pay Act sufficiently to invoke its three-year statute of limitations, and did not identify any basis for the ERISA claims. In fact, the complaint did not even note what ERISA plan it was referring to, and Ms. Civello refused to produce the written contract underlying the ERISA claims despite the court ordering her to do so. As the court had warned, this failure to plead the existence of the governing contract and to produce the plan resulted in dismissal of the ERISA causes of action. Thus, the ERISA claims were dismissed without leave to amend, just like Ms. Civello’s other causes of action.

Severance Benefit Claims

Seventh Circuit

Cella v. Lilly USA LLC, No. 1:24-cv-00814-TWP-MKK, 2025 WL 3134607 (S.D. Ind. Nov. 10, 2025) (Judge Tanya Walton Pratt). Plaintiff Daniel Cella worked for Lilly USA LLC for twenty-two years. He was terminated in August 2022 following a work trip he had taken a few months earlier. Mr. Cella falsified his travel related expenses to his employer. Specifically, he claimed that a $405.25 hotel no-show fee was a business meal. When Lilly learned about Mr. Cella’s mischaracterization of the no-show fee it terminated his employment, stating that it was a direct violation of its employee expense reporting procedures, and by extension, an immediately separable offense. Subsequent to his termination Mr. Cella applied for benefits under Lilly’s ERISA-governed severance plan. His claim was denied by the benefits committee, which determined that he was not eligible for severance payments under the plan due to the nature of his firing. In this lawsuit Mr. Cella challenges that denial. Confident that its decision was reasonable and consistent with the terms of the plan, the Lilly defendants moved for summary judgment pursuant to Federal Rule of Civil Procedure 56. Mr. Cella argued that summary judgment should be denied because a reasonable factfinder could conclude that the committee failed to afford him a full and fair review, that its decision was biased, and that the denial was arbitrary and capricious. In this order the court disagreed with Mr. Cella, and granted Lilly’s motion for judgment. To begin, the court considered the adequacy of the committee’s review. It determined that the committee had properly considered the evidence provided by Mr. Cella, communicated to him the reason for its denial, adequately explained its thinking, and reasonably based that decision on both evidence in the administrative record and on the plain language of the plan. Moreover, the court concluded that the committee had not denied Mr. Cella a full and fair review on appeal by denying his claim based only on the materials presented by Lilly USA and Mr. Cella. Given the undisputed facts undergirding the termination, the court disagreed with Mr. Cella that the committee was under any obligation to engage in further investigation into his claim for benefits. And as for the committee’s conflict of interest, the court held that it carried little weight here as this was no “borderline” case. Rather, the undisputed evidence made clear that Mr. Cella falsified his travel reimbursement request, that this falsified report was the reason for the termination, and that an employee terminated for falsifying a report is ineligible for benefits under the plan. Considering this, the court agreed with Lilly that the committee’s decision was not improperly biased. At bottom, the court concluded that the denial was not an abuse of discretion, and that the evidence clearly supported the benefit decision. As a result, the court ruled that Lilly was entitled to summary judgment on Mr. Cella’s claim for benefits.

Good things come in threes, just maybe not a whole newsletter worth of ERISA decisions. Sadly though, that’s all the courts gave us to work with this week. Below you can read an unpublished Third Circuit decision affirming an award of early pension benefits to a union employee (Rombach v. Plumbers Local Union No 27 Pension Fund), a dismissal of a putative tobacco surcharge class action (Williams v. Bally’s Management Grp. LLC), and a decision denying a pro se plaintiff’s request for a temporary restraining order in a run-of-the-mill disability benefits dispute (Moody v. Sedgwick). If none of these are to your liking, you’ll just have to keep your fingers crossed that next week proves more eventful. We certainly will be.

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

Pension Benefit Claims

Third Circuit

Rombach v. Plumbers Local Union No 27 Pension Fund, No. 24-2482, __ F. App’x __, 2025 WL 3110791 (3rd Cir. Nov. 6, 2025) (Before Circuit Judges Hardiman, Krause, and Freeman). In this unpublished decision a Third Circuit panel affirmed a decision out of the Western District of Pennsylvania in favor of an ERISA plaintiff whose early retirement benefits were suspended by the Plumbers Local Union No. 27 Pension Fund. For two decades plaintiff Clyde Rombach worked for W.G. Tomko, Inc., during which Tomko made contributions to the pension plan on his behalf. Beginning in 2009, Mr. Rombach was promoted to senior project manager, a non-union supervisory role. Because this was not a union job, Tomko ceased making additional contributions to the plan on Mr. Rombach’s behalf. Once he reached early retirement eligibility age, Mr. Rombach applied for early retirement benefits. At issue in this litigation was the plan’s determination that, while Mr. Rombach was eligible for early retirement, benefits would be suspended as long as he worked at Tomko as a senior project manager. Claiming his benefits were wrongfully suspended, Mr. Rombach sued under ERISA Section 502(a). The parties cross-moved for summary judgment. The district court denied the plan’s motion, granted summary judgment to Mr. Rombach, and ordered the plan to pay his retroactive pension benefits, pension benefits going forward, and pre- and post-judgment interest. (Your ERISA Watch summarized this ruling in our August 7, 2024 newsletter). The plan appealed, advancing three arguments: (1) it did not err in suspending Mr. Rombach’s benefits; (2) the district court should have remanded to the plan with instructions to reconsider the benefit suspension in the event it did err; and (3) the district court erred by ordering it to “reverse the financial and any other impact on Rombach” stemming from the suspension. The Third Circuit “disagree[d] on all fronts.” To begin, the court of appeals concluded that the plan’s interpretation of the term at issue, “trade or craft,” to mean “[i]n a trade or craft utilized in the industry,” was flawed and not entitled to deference. Under de novo review, the appeals court agreed with the lower court that the plan erred in its benefits determination. It concluded that dictionary definitions of “trade or craft” understand the terms to require “some amount of manual or artistic skill.” Mr. Rombach’s senior project manager position did not fit such a definition. Not only did the court of appeals affirm the district court’s conclusion that the plan erred in suspending the early retirement benefits, but it further held that the plan forfeited its argument that remand was the appropriate remedy as it never presented this argument in its summary judgment briefing before the district court. Finally, the Third Circuit rejected the plan’s argument that the district court erred in ordering it to reverse the impacts of the suspension of benefits. The court of appeals found it problematic enough that the plan failed to identify what specific relief it believes to be unlawful, but to add insult to injury, it also failed to raise this argument with the district court, either in its summary judgment briefing or in a motion for reconsideration. Thus, the Third Circuit concluded that the plan forfeited this argument too. Based on the foregoing, the panel affirmed the lower court’s order.

Pleading Issues & Procedure

First Circuit

Williams v. Bally’s Management Grp., LLC, No. 1:25-00147-MSM-PAS, 2025 WL 3078747 (D.R.I. Nov. 4, 2025) (Judge Mary S. McElroy). Plaintiff Tracy Williams is a participant in her employer Bally’s Management Group, LLC’s welfare benefit plan. As part of her participation in the plan, Ms. Williams, along with other tobacco users, have been charged a monthly tobacco surcharge of $65. In this lawsuit Ms. Williams argues that the plan’s tobacco surcharge is unlawful under ERISA. In her complaint, Ms. Williams asserts two claims related to the tobacco surcharge. In count one she claims that Bally’s Management’s imposition of the surcharge violates ERISA and its implementing regulations because it fails to provide the full reward to participants who complete the cessation program by refunding the tobacco surcharge, and because the plan materials fail to sufficiently notify participants of the availability of a reasonable alternative standard for obtaining the full reward. In count two Ms. Williams asserts that Bally’s Management breached its fiduciary duties and engaged in a prohibited transaction by imposing the unlawful tobacco surcharge on plan participants and then using that money to offset its own contributions to the plan. Bally’s Management moved to dismiss both causes of action pursuant to Federal Rules of Civil Procedure 12(b)(1) and 12(b)(6). In this decision the court dismissed count two for lack of subject-matter jurisdiction and count one for failure to state a claim. It began with standing. The court agreed with Bally’s Management that Ms. Williams could not pursue her fiduciary breach/prohibited transaction claim because she failed to sufficiently or plausibly allege how the plan suffered any injury resulting from Bally’s Management’s actions regarding the tobacco surcharge. Because it concluded that the complaint failed to allege any concrete and non-speculative redressable injury to the plan, the court dismissed count two for lack of standing. Before addressing the sufficiency of count one, the court briefly addressed Bally’s Management’s assertion that Ms. Williams was required to exhaust administrative remedies. Not only did the court agree with Ms. Williams that her claims are statutory claims, which do not require exhaustion, but the court added that even if it were to find it had the discretion to impose an administrative exhaustion requirement on these claims, the terms of the plan documents do not appear to provide any avenue for challenging the legality of the tobacco surcharge. As a result, the court found that it would be inappropriate to impose an exhaustion requirement. The court then assessed whether Ms. Williams stated her claims for unlawful imposition of a discriminatory tobacco surcharge. It concluded that she did not. First, the court determined that, as a matter of law, 42 U.S.C. § 300gg-4(j)(3)(A) and 29 C.F.R. § 2590.702(f)(4)(iv) do not require Bally’s Management to provide retroactive reimbursement of the tobacco surcharge. Second, the court found that the summary plan descriptions throughout the relevant years included necessary statements to satisfy the notice requirements under 29 C.F.R. § 2590.702(f)(4)(v) and 42 U.S.C. § 300gg-(4)(j)(3)(E). It added that the plan’s Benefits Guides did not describe the terms of the wellness program such that those same notice requirements were triggered. Accordingly, the court found that Ms. Williams failed to state a claim that Bally’s Management violated ERISA’s notice requirements. As a consequence, the court dismissed every aspect of the claim for unlawful discrimination under 29 U.S.C. § 1182. Thus, as explained above, the court granted Bally’s Management’s motion and dismissed both of Ms. Williams’ causes of action.

Second Circuit

Moody v. Sedgwick Claims Management Services, Inc., No. 25 Civ. 8671 (JHR), 2025 WL 3090149 (S.D.N.Y. Nov. 5, 2025) (Judge Jennifer H. Rearden). Pro se plaintiff Amari J. Moody filed this action against the administrator of the Starbucks Corporation’ employee welfare benefit plans, defendant Sedgwick Claims Management Services, Inc. Mr. Moody maintains that Sedgwick has withheld his complete administrative claim file, its internal communications, and medical review notes, and asserts that he believes it is altering and deleting internal communications and claims records. Operating under these assumptions, Mr. Moody moved for a temporary restraining order and preliminary injunction, seeking an order from the court directing Sedgwick to preserve and produce the complete administrative claim file and to refrain from destroying or altering the data and records related to his claim. The court denied Mr. Moody’s motion in this order. It held that the record before it simply does not support granting the extraordinary relief that Mr. Moody seeks or establish that he is likely to succeed on his claims. Moreover, the court reminded Mr. Moody that all parties to this action, including Sedgwick, are already under the obligation to preserve evidence relevant to the claims and defenses in this litigation, and that any failure to do so may result in sanctions. For these reasons, the court declined to impose the temporary restraining order Mr. Moody sought.