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Brytus v. Spang & Co., 203 F.3d 238 (3rd Cir. 2000)-This case concerns an award of attorneys' fees provided for in ERISA's fee shifting statute (payable by the losing party according to the lodestar method) versus "common fund" attorney's fees (payable often as percentage of recovery.) This court affirmed the district court's denial of counsel's application for recovery of fees from the common fund. See detailed analysis.
McNeil v. Time Insur. Co., 205 F.3d. 179 (5th Cir. 2000)-This court affirmed the district court’s determinations that Time's policy constituted an ERISA plan, and that the state law claims did not fall within ERISA's safe harbor for the operation of laws regulating insurance. This court agreed that a plan in which the only participants are the owners or partners does not constitute an ERISA benefit plan. However, here, the plan covered both Dr. McNeil and the secretary, Ms. Jay. Each of Mr. McNeil’s state law claims addresses the right to receive benefits under the terms of an ERISA plan, and therefore ERISA preempted them. See detailed analysis.
Agrawal v. Paul Revere Life Insur. Co., 205 F. 3d 297 (6th Cir. 2000); 2000 FED App. 0062P (6th Cir.)-This court reversed the district court's finding of ERISA preemption on Dr. Agrawal's state law claims against Paul Revere Life Insurance Company. Citing its decision in Fugarino v. Hartford Life & Accident Insurance Co., 969 F.2d 178 (6th Cir. 1992), this court found that Dr. Agrawal was neither a participant nor a beneficiary because he was the sole shareholder of Agrawal, Inc. See detailed analysis.
Baptist
Memorial Hospital v. Marsaw,
2000 U.S. App. LEXIS 2472 (6th Cir. Feb. 16, 2000)(unpublished)-The
Fund denied payment of BMH's claim on the basis that BMH submitted the claim to
the Fund long after the Fund's limitation period for showing proof of loss had
run and because BMH admitted Marsaw without obtaining the certification as the
Fund's plan required.
Shelby County Health Care Corp. v. Southern Council of Industrial Workers Health and Welfare Trust Fund, 203 F.3d 926 (6th Cir. 2000); 2000 FED App. 0055P (6th Cir.)-Shelby County Health Care Corporation ("Shelby") sued Southern Council of Industrial Workers Health and Welfare Trust Fund (the "Fund") for payment of hospital services rendered to Mason, a former participant in the Fund. Mason suffered injuries in an auto accident. When Mason later filed a claim against the Fund, the plan administrator denied Shelby's claim for benefits on the basis of untimeliness of the claim. The Fund reasoned that because Mason had failed to sign and return a subrogation agreement and questionnaire which the fund had sent him, he had not "filed" his claim within one year of the date on which he incurred the charges.
This court affirmed the district court's summary judgment determination that the Fund's denial for this reason was arbitrary and capricious. See detailed analysis.
Pennington v. Western Atlas, Inc., 202 F.3d 902 (6th Cir. 2000); 2000 FED App. 0044P (6th Cir.)- This court affirmed the district court's holding that Western Atlas, Inc. violated 29 U.S.C. § 1140 when it laid off two employees. See detailed analysis.
Great-West Life & Annuity Insur. Co. v. Allstate Insur. Co., 202 F.3d 897 (6th Cir. 2000); 2000 FED App. 0045P (6th Cir.)-This court affirmed the district court's decision that Allstate had coverage priority for the auto accident expenses of Matthew Gerig. See detailed analysis.
University Hospitals of Cleveland v. Emerson Electric Co., 202 F.3d 839 (6th Cir. 2000); 2000 FED App. 0040P (6th Cir.)-This case concerns a dispute whether a pre-existing condition exclusion prevented a claim for benefits. UHOC here appeals the district court's summary judgment in favor of the Plan's decision to deny benefits. This court reversed and remanded in favor of UHOC. See detailed analysis.
Central States, Southeast and Southwest Areas Pension Fund v. Hunt Truck Lines, Inc., 204 F.3d 736 (7th Cir. 2000). This appeal concerns the timing and process for disputing withdrawal liability payments governed by the Multiemployer Pension Plan Amendments Act of 1980 (MPPAA), 29 U.S.C. §§ 1381-1461. This court found that because Central States had admitted that Wintz's withdrawal occurred in July, and the parties did not contest basic facts, it was well within the court's authority to determine that the fund had not complied sufficiently with the statute to obtain the interim payments. Had there been a factual dispute, the statute would have required payment pending arbitration. See detailed analysis.
Herzberger v. Standard Insurance Co., 205 F.3d 327 (7th Cir. 2000)-This court held that "the mere fact that a plan requires a determination of eligibility or entitlement by the administrator, or requires proof or satisfactory proof of the applicant's claim, or requires both a determination and proof (or satisfactory proof), does not give the employee adequate notice that the plan administrator is to make a judgment largely insulated from judicial review…." This court suggested the following "safe harbor" language for inclusion in ERISA plans: "Benefits under this plan will be paid only if the plan administrator decides in his discretion that the applicant is entitled to them." See detailed analysis.
Anstett v. Eagle-Picher Industries, Inc., 203 F.3d 501 (7th Cir. 2000)-This court, reversing the district court, held that a severance plan entitled the employees of Eagle-Picher’s Plastics Division to severance benefits. See detailed analysis.
Peterson v. Jensen, 2000 U.S. App. LEXIS 3107 (9th Cir. Feb. 28, 2000) (unpublished)-This court affirmed the district court’s grant of summary judgment against Peterson’s ERISA claim for benefits under an alleged plan. This court found that the fact that Jensen opened a SEP-IRA account does not by itself demonstrate that he established a SEP plan for the benefit of his employees. Furthermore, Jensen failed to comply with several requirements of I.R.C. § 408(k). Most notably Jensen did not comply with the "definite written allocation formula" requirement. I.R.C. § 408(k)(5). Because there was no evidence that a SEP plan existed, Peterson's ERISA claim failed. See detailed analysis.
Brokaski v. Delco Systems Operations, 2000 U.S. App. LEXIS 3222 (9th Cir. Feb. 25, 2000) (unpublished)-This court reversed the district court's ruling that ERISA preempted Mr. Brokaski's state-law fraud and breach of contract claims against Delco. The court pointed out: "Under Graham v. Balcor Co., 146 F.3d 1052 (9th Cir. 1998), 'ERISA does not preempt the state claims arising from [a] legal settlement, the subject matter of which is employee benefits, because [such a settlement] does not implicate the administration of an employee benefit plan.' Id. at 1055. ERISA preempts state law claims relating to "employee benefit plan[s]," not state law claims relating to employee benefits." See detailed analysis.
Bedrosian
v. Tenet Healthcare Corporation,
2000 U.S. App. LEXIS 2840 (9th Cir. Feb. 23, 2000) (unpublished)
McDaniel v. Chevron Corp., 203 F.3d 1099 (9th Cir. 2000)- Plan members' sued alleging their plan wrongly adjusted a mortality actuary table by using a "set forward" of nine months due to the difference in life expectancy of males and females. This court determined that the Plan was ambiguous as to whether the Plan Administrator could apply a set forward. The court found that the Plan Administrator could, within his discretion, apply the set forward. Thus, the Plan did not underpay the class' benefits in violation of 29 U.S.C. § 1132(a). Neither did the Plan violated the anticutback rule in 29 U.S.C. § 1054(g). The class's argument that Chevron violated 29 U.S.C. § 1054(g) and § 18(b) of the plan was meritless. 29 U.S.C. § 1054(g) applies only to formal plan amendments, not to interpretations of ambiguous plan language. See detailed analysis.
Reynolds Metal Co. v. Ellis, 202 F.3d 1246 (9th Cir. 2000) an ERISA fiduciary sought to enforce a plan’s contractual reimbursement provisions under ERISA. Reynolds sought reimbursement for payments it made to Robert Ellis. Court affirmed its holding in FMC Medical Plan v. Owens, 122 F.3d 1258, 1260 (9th Cir. 1997) that courts should dismiss actions brought by fiduciaries under ERISA against beneficiaries to enforce reimbursement (or “subrogation”) clauses contained in ERISA plans. See detailed analysis.
Great-West
Life & Annuity Insur. Co. v. Knudson,
2000 U.S. App. LEXIS 1771 (9th Cir. Feb. 7, 2000) (unpublished)
Trujillo v. Cyprus Amax Minerals Co. Retirement Plan Committee, 203 F. 3d 733 (10th Cir. 2000)-Trujillo challenged a decision by the Retirement Plan Committee to reduce his disability retirement benefits by the total amount of a workers' compensation settlement without paying a pro rata share of attorney fees necessary to obtain the settlement. Reviewing under an arbitrary and capricious standard, this court decided it would not set aside the benefit committee's decision. See detailed analysis.
