News & Analysis as of

Breach of Contract Employee Retirement Income Security Act (ERISA)

Carlton Fields

Eleventh Circuit Vacates Jury Award in Favor of Insurer Where Unjust Enrichment Claim Is Subject of Express Insurance Contract

Carlton Fields on

In MONY Life Insurance Co. v. Perez, the Eleventh Circuit Court of Appeals set aside a jury verdict in favor of MONY Life Insurance Co. on its unjust enrichment claim against policyholder Bernard Perez, holding that an...more

Polsinelli

Sixth Circuit Holds TPAs Do Not Get a Free Pass from ERISA’s Fiduciary Duties

Polsinelli on

In a decision about ERISA’s fiduciary duties and transparency, the Sixth Circuit in Tiara Yachts, Inc. v. Blue Cross Blue Shield of Michigan held that Blue Cross Blue Shield of Michigan (BCBSM), a third-party administrator...more

Holland & Knight LLP

Sixth Circuit Reverses Dismissal of ERISA Healthcare Fee Suit Against Third-Party Administrator

Holland & Knight LLP on

There has been a recent rise in Employee Retirement Income Security Act of 1974 (ERISA) litigation against third-party administrators (TPAs) and other service providers challenging their management of self-funded health...more

ArentFox Schiff

Navigating Out-of-Network Claims: Key Takeaways for Providers From Surgery Center Case in New York Federal Court

ArentFox Schiff on

The US District Court for the Eastern District of New York in Manalapan Surgery Ctr., et al. v. 1199 SEIU National Benefit Fund, No. 23-CV-03525 (EDNY March 12, 2025), recently granted a motion to dismiss a complaint filed by...more

Keating Muething & Klekamp PLL

Benefits Monthly Minute - March 2025

The March Monthly Minute brings you three recent case updates addressing 401(k) forfeiture utilization, TPA responsibility for recovering self-insured plan’s fraudulently paid claims, and continued PBM litigation in the wake...more

ArentFox Schiff

Federal Court Holds That Pathology Group States Viable Claims Against Multiplan and Cigna for Failing to Ensure In-Network Payment

ArentFox Schiff on

A federal court recently rejected arguments by MultiPlan, Inc. and Cigna Health and Life Insurance Company that they had no obligation to ensure payments at the contractually negotiated, in-network rate to Anatomic and...more

Carlton Fields

Case Closed: Overview of Life, Disability, and Long-Term Care Insurance Litigation

Carlton Fields on

In a split decision, the Tenth Circuit Court of Appeals recently affirmed summary judgment in PHT Holding I LLC v. Security Life of Denver Insurance Co., rejecting the plaintiff’s claim that the defendant-insurer breached the...more

Fuerst Ittleman David & Joseph

The Role of Delegation Clauses in Motions to Compel Arbitration When Your Family Member Signs an Arbitration Agreement

It happens every so often: someone signs an agreement to arbitrate legal claims, the agreement has a solid clause delegating arbitrability issues to an arbitrator, and then a member of that person’s family files a claim in...more

Alston & Bird

Insurance Insights for the Dog Days of August

Alston & Bird on

Welcome to the inaugural issue of Insurance Insights, a gathering of notable legal developments and trends relevant to the insurance industry. In this issue, the California Supreme Court covers COVID-19 claims, Georgia...more

Robinson+Cole ERISA Claim Defense Blog

Ninth and Second Circuit Courts of Appeals Rule that Preauthorization Process Does Not Impose Independent Contractual Liability on...

Within days of one another, the U.S. Court of Appeals for the Ninth and Second Circuits ruled—on issues of first impression for both—that ERISA expressly preempts state law breach of contract and promissory estoppel claims...more

Mintz

Texas Court Rules ESG Lawsuit Against Employer's 401(k) Plan Can Proceed

Mintz on

Recently, a Texas federal court denied the defendants' motion to dismiss in a lawsuit featuring allegations that an employer's 401(k) plan, which allegedly relied on ESG principles when making investments, violated ERISA. ...more

Carlton Fields

Ringmaster’s Review: Fall 2023 Litigation on Parade

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In Ross v. Venerable Insurance & Annuity Co., a Missouri appellate court reversed judgment in favor of the named beneficiary of a flexible premium deferred annuity contract. Following the annuitant’s death, the beneficiary...more

Carlton Fields

Expect Focus - Volume III, September 2023

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Regulators Hit Jackpot: Off-Channel Communications - Several years before announcing the first “off-channel” communications enforcement action, the SEC and FINRA cautioned broker-dealers and investment advisers about...more

Saul Ewing LLP

The Friday Five: Five Current ERISA Litigation Highlights - April 2022

Saul Ewing LLP on

This month’s Friday Five covers cases relating to: (1) whether claim administrators can recover overpayments through a breach of contract claim under state law; (2) whether claim administrators can rely solely on a claimant’s...more

Patterson Belknap Webb & Tyler LLP

Commercial Division Reiterates Broad Scope of ERISA Preemption and Difficulty of Pleading Breach of Fiduciary Duty and Conversion...

The Commercial Division’s decision in Rockmore v. Plastic Surgery Associates, LLP demonstrates the broad scope of ERISA preemption and the difficulty of pleading breach of fiduciary duty and conversion claims alongside breach...more

Morrison & Foerster LLP - Left Coast Appeals

This Week at the Ninth: Poultry Preemption and ERISA Estoppel

This week, we take a look at a decision examining the preemptive effect of the Poultry Products Inspection Act, and another considering the interaction between the Employee Retirement Income Security Act and principles of...more

Carlton Fields

Aflac Waives Problematic Clause to Ensure Arbitration

Carlton Fields on

Aflac recently avoided an attempt by several former employees to invalidate an arbitration agreement on the ground that it constituted an impermissible prospective waiver of the employees’ statutory rights by waiving the...more

Hinshaw & Culbertson LLP

The LHD/ERISA Advisor - October 2020: Third Circuit Rules State Law Reimbursement Claims Brought by Out-of-Network Medical...

In Plastic Surgery Center, P.A. v. Aetna Life Ins. Co., 2020 U.S. App. LEXIS 22274 (July 17, 2020), the Third Circuit held that an out-of-network medical provider's state law claims against an insurer were not precluded by...more

Hinshaw & Culbertson LLP

The LHD/ERISA Advisor - October 2020: District Court Holds Breach of Contract Claims are Time-Barred

Plaintiff Gene Myers (“Plaintiff”), a physician, made a claim for individual disability insurance (IDI) benefits under an individual disability policy arising from low back injury caused by wearing a heavy leaded gown worn...more

Epstein Becker & Green

Third Circuit: Provider’s Out-of-Network Claims not Pre-empted by ERISA

Epstein Becker & Green on

In an important win for healthcare providers, on July 17, 2020, the Third Circuit determined in a published opinion that an out-of-network provider’s direct claims against in insurer for breach of contract and promissory...more

Pierce Atwood LLP

Class Action Litigation Related to COVID-19: Filed and Anticipated Cases (Updated November 9, 2020)

Pierce Atwood LLP on

Last updated November 9, 2020 Although the COVID-19 pandemic is still unfolding, class actions related to the coronavirus have already arrived and are on the rise. Despite unprecedented court closures and changing procedural...more

Proskauer - Employee Benefits & Executive...

Seventh Circuit Upholds Dismissal of 403(b) Plan Lawsuit Against Northwestern University in Apparent Split with Third Circuit

Since the beginning of 2016, the ERISA plaintiffs’ bar has filed nearly two dozen complaints targeting university-sponsored 403(b) plans. The majority of these lawsuits assert that plan fiduciaries breached their duties and...more

Rivkin Radler LLP

Employee Benefit Plan Review – From the Courts

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Second Circuit Affirms Decision Rejecting ERISA Claims for Retiree Health Benefits The U.S. Court of Appeals for the Second Circuit has affirmed a district court’s decision dismissing claims under the Employee Retirement...more

Cadwalader, Wickersham & Taft LLP

2019 Year in Review: Securitization Litigation and Regulation

There were significant developments in 2019 as courts continued to issue important decisions in this space and significant legislation impacting the residential mortgage-backed securities (“RMBS”) market came into effect.  A...more

Proskauer - Employee Benefits & Executive...

Best Practices in Administering Benefit Claims #9 – Managing Litigation Utilizing a Plan’s Litigation Tools

As we shifted focus last week from a plan’s administrative claims procedures to defending against a claim for benefits in court, we explained how a well-documented administrative record can enhance the chances of getting a...more

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