26 results for 'cat:"ERISA" AND cat:"Contract"'.
J. Ross finds a Long Island surgical practice’s claims against a union benefits fund for breach of contract and unjust enrichment, alleging failure to provide reimbursement for medical services, are preempted by ERISA and declines to remand the case back to state court.
Court: USDC Eastern District of New York, Judge: Ross, Filed On: April 10, 2024, Case #: 2:23cv6145, NOS: Employee Retirement Income Security Act (ERISA) - Labor, Categories: erisa, contract, Labor / Unions
J. Aenlle-Rocha grants an insured's motion to overturn the insurer's denial of benefits for his son's treatment at a residential care facility. The treatment was denied as "not medically necessary" despite the insured's appeal with neuropsychological assessments, five letters of medical necessity from treatment providers, and thousands of pages of medical records and treatment notes. The insured "has satisfied his burden of proving medical necessity as to the treatment at issue with credible, persuasive evidence." The insurer denied the claim without sufficient explanation and "disregarded relevant medical evidence and did not afford [the insured] a full and fair review of his claims."
Court: USDC Central District of California, Judge: Aenlle-Rocha, Filed On: April 9, 2024, Case #: 2:23cv6413, NOS: Other Contract - Contract, Categories: erisa, Insurance, contract
J. Williams grants, in part, the insurers motion to dismiss this multiplan agreement under ERISA dispute brought by three insured employees regarding their health benefits. The employees seek to recover health benefits the insurers withheld, equitable relief under ERISA violations and negligent misrepresentation, tortious interference with the patient-physician contract or relationship, proscribe insurers’ conduct under a promissory estoppel theory and a violation of the Washington Consumer Protection Act. The employees are barred from equitable relief to recover health benefits at this stage, and fail to establish a standing for the multiplan agreement violations. The insurer Cigna is dismissed on all claims, and the others are dismissed from the negligent misrepresentation, tortious interference, promissory estoppel theory and Washington Consumer Protection Act claims. The court also grants the insurers motion to seal certain exhibits.
Court: USDC Connecticut, Judge: Williams, Filed On: March 30, 2024, Case #: 3:22cv769, NOS: Employee Retirement Income Security Act (ERISA) - Labor, Categories: erisa, Settlements, Interference With contract
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J. Davis grants the insurer's motion for summary judgment in the disability benefits seeker's suit challenging the insurer's denial of long-term disability benefits on the basis that the benefits seeker's gunshot wounds and subsequent disability resulted from his commission of an assault, for which charges were later dismissed. The policy at issue's exclusion for disability resulting from the insured's criminal acts applies to the benefit seeker's injuries, which stemmed from an altercation in which he drove his truck into a group of people in a driveway and was shot by one of them.
Court: USDC Minnesota, Judge: Davis, Filed On: March 26, 2024, Case #: 0:22cv1918, NOS: Employee Retirement Income Security Act (ERISA) - Labor, Categories: erisa, contract
J. Fitzgerald grants the trust default judgment for its complaint that the construction contractor did not submit monthly fringe benefit contributions for all hours worked by its employees. The trust shows through the trust agreements that the construction contractor had a duty to produce its records for audit, which it did not do, and that the trust had the authority to examine the construction contractor's payroll and business records to determine if the construction contractor abided by the terms of the trust agreements.
Court: USDC Central District of California, Judge: Fitzgerald, Filed On: March 8, 2024, Case #: 2:23cv4272, NOS: Employee Retirement Income Security Act (ERISA) - Labor, Categories: erisa, contract
J. Joseph grants the joint motion to lift a stay in the pension fund's lawsuit claiming unpaid contributions from the general contractor. The general contractor's motion to enforce the parties' previous settlement agreement to bar the fund from filing a new complaint is denied, but the fund's motion to file a third amended complaint is also denied, as it untimely seeks to add a new claim unrelated to the central claim regarding contributions to the fund for hours worked by the contractor's employees. The parties are ordered to confer on a discovery plan to explore whether the contractor's employees were performing work covered by the collective bargaining agreement from June 1, 2020, through December 31, 2021, and they are ordered to submit a joint letter regarding the plan to the court by January 8, 2024.
Court: USDC Eastern District of Wisconsin, Judge: Joseph, Filed On: December 21, 2023, Case #: 2:22cv1299, NOS: Employee Retirement Income Security Act (ERISA) - Labor, Categories: erisa, contract
J. Haynes finds the district court properly dismissed the dentists' ERISA claims. The dentists initiated this class action alleging the insurer that served as the issuer and contract record-keeper of their employee retirement plan's assets breached its fiduciary duties and engaged in a prohibited transaction with a party-in-interest. The insurer was not a fiduciary and was also not a party-in-interest when it entered the contract. The collection of the surrender fee was not a separate transaction. Affirmed.
Court: 5th Circuit, Judge: Haynes , Filed On: December 14, 2023, Case #: 22-20540, Categories: erisa, Fiduciary Duty, contract
J. Lin dismisses the five individual defendants from the employee's complaint that the backpacking company withheld her wages when a banking error caused her $6,300 contribution and the backpacking company's $600 contribution to her HSA account to be posted after the 2017 contribution deadline. The dismissed parties are not liable for the employee's claims, because she cites no evidence beyond her own word that there was an employment or HSA contract between them, and she does not identify a breach of that contract.
Court: USDC Western District of Washington, Judge: Lin, Filed On: December 8, 2023, Case #: 2:20cv1633, NOS: Employee Retirement Income Security Act (ERISA) - Labor, Categories: erisa, contract
J. Norris grants in part the funds' motion for entry of default judgment in this lawsuit brought under the Employee Retirement Income Security Act regarding unpaid contributions. The company defendants failed to timely respond to the complaint, and the clerk properly entered a default. The court now concludes that the defendant company has breached a repayment agreement, as well as the collective bargaining agreement. The individual defendant is dismissed, however, as to the breach of contract claim against him.
Court: USDC Western District of Tennessee , Judge: Norris, Filed On: October 6, 2023, Case #: 2:23cv2071, NOS: Employee Retirement Income Security Act (ERISA) - Labor, Categories: erisa, contract, Labor
J. Auld denies a former Duke University Medical Center doctor’s second motion to compel discovery pursuant to ERISA to recoup long-term disability benefits under his insurance plan. The doctor requests discovery of information he believes the company has withheld. However, the company has repeatedly provided all information requested and, so, will not be tasked with providing more.
Court: USDC Middle District of North Carolina, Judge: Auld, Filed On: October 4, 2023, Case #: 1:22cv605, NOS: Employee Retirement Income Security Act (ERISA) - Labor, Categories: erisa, Insurance, contract
J. Grimberg finds in favor of the insurance company in a lawsuit from a beneficiary over the denial of her claim for long-term disability benefits filed when she stopped working after being diagnosed with scleroderma. The company successfully argues that given the timing of when the beneficiary became insured under the policy, when she received treatment for worsening symptoms and when she was actually diagnosed, her scleroderma was technically a pre-existing condition because she was treated for it during the three-month "look-back period" prior to her policy becoming effective, even though she was not diagnosed until after this period ended. These facts make the company's denial reasonable and neither arbitrary nor capricious, and the company's motion for summary judgment is granted and the beneficiary's motion for judgment on the administrative record is denied.
Court: USDC Northern District of Georgia, Judge: Grimberg, Filed On: September 29, 2023, Case #: 1:21cv2900, NOS: Employee Retirement Income Security Act (ERISA) - Labor, Categories: erisa, Insurance, contract
J. Schroeder agrees with the findings and conclusions of the magistrate judge and grants-in-part summary judgment to the beneficiary on the claim for wrongful denial of benefits under the Employment Retirement Income Security Act. The insurer's objections are overruled, and the beneficiary is entitled to accidental death benefits since recovery is not barred by any of the cited policy exclusions.
Court: USDC Eastern District of Texas , Judge: Schroeder, Filed On: September 25, 2023, Case #: 5:21cv143, NOS: Insurance - Contract, Categories: erisa, Insurance, contract
J. Fleming grants the ERISA plan administrator's motion to dismiss, ruling the successor company to the original policyholder was not named on the plan and, therefore, was not an intended beneficiary of the plan and cannot seek damages for a one-month gap in coverage.
Court: USDC Northern District of Ohio, Judge: Fleming, Filed On: August 21, 2023, Case #: 4:22cv208, NOS: Employee Retirement Income Security Act (ERISA) - Labor, Categories: erisa, Insurance, contract
J. Russell grants a group of financial and insurance firms their motion to dismiss a second amended ERISA complaint brought by a consulting company. The company argues that its claims are not preempted because the firms misrepresented the life insurance and annuity funding products to fund the ERISA plan. However, because the determination would need to be made that the plan was never suitable for the consulting company and, therefore, require a review of the plan, the company’s claims are preempted.
Court: USDC Maryland, Judge: Russell, Filed On: August 8, 2023, Case #: 1:21cv2493, NOS: Employee Retirement Income Security Act (ERISA) - Labor, Categories: erisa, Insurance, contract
J. Readler finds that the lower court properly dismissed the ERISA claims brought by the injured driver on behalf of other plan members and the plan itself because his speculative allegations about the insurance company's scheme to collect reimbursement payments that were not actually included in the plan lack the specificity necessary to establish standing. However, the fiduciary duty and prohibited transaction claims brought solely by the injured driver were improperly dismissed because they were both equitable claims under ERISA and the $25,000 can be adequately traced by the driver after he settled with and reimbursed the insurance company. Reversed in part.
Court: 6th Circuit, Judge: Readler, Filed On: August 1, 2023, Case #: 22-3167, Categories: erisa, Insurance, contract
J. Coughenour finds in favor of the insurance company for the beneficiaries' claim that the company wrongfully denied their claim for the daughter's stay at a residential mental health treatment provider, as the insurance company claims that another residential treatment stay was not medically necessary under the parent's self-funded Employee Benefits Plan. The insurance company engaged in a meaningful dialogue with the parent when discussing the denial of benefits, and the daughter did not meet the plan's InterQual criteria because it requires that a provider perform weekly psychiatric evaluations, but the provider only performed one evaluation on the daughter during her year-long stay.
Court: USDC Western District of Washington, Judge: Coughenour, Filed On: June 12, 2023, Case #: 2:21cv1611, NOS: Employee Retirement Income Security Act (ERISA) - Labor, Categories: erisa, Insurance, contract
J. Xinis partially grants the Screen Actors Guild’s motion to dismiss breach of contract claims brought by a former actor and his wife regarding health care benefits they invested in 40 years ago. The actor argues that because the couple paid into retirement when he was a union member in the 1980s, he has a right to claim them now. However, ERISA, as a federal program, overrides the state-based union benefits and the couple should seek them through ERISA.
Court: USDC Maryland, Judge: Xinis, Filed On: May 25, 2023, Case #: 8:21cv2618, NOS: Other Contract - Contract, Categories: erisa, contract
J. Quereshi grants a group of sprinkler union education and retirement funds’ motion for default judgment following its claim of ERISA violations by a fire suppression company. Under its collective bargaining agreement with the funds, the company is obligated to contribute and keep records, but it failed to do so for several months in 2021. The company owes the funds $193,963.
Court: USDC Maryland, Judge: Quereshi, Filed On: May 23, 2023, Case #: 8:22cv326, NOS: Employee Retirement Income Security Act (ERISA) - Labor, Categories: erisa, contract, Labor / Unions
J. Hollander grants Johns Hopkins Health Systems its motion to quash allegations of ERISA violations by a former hospital worker. When Johns Hopkins School of Medicine moved to Health Systems, the worker was offered “a paltry severance” in exchange for losing access to her full pension. However, Health Systems was not properly served with the worker’s complaint in the first place and so was not given the chance to respond. Also, the worker is granted leave to amend her complaint.
Court: USDC Maryland, Judge: Hollander, Filed On: May 23, 2023, Case #: 1:23cv701, NOS: Employee Retirement Income Security Act (ERISA) - Labor, Categories: erisa, Pensions, contract