News

Case Summaries

ERISA

[08/31] Cent. States Southeast & Southwest Areas Pension Fund v. O'Neil Bros. Transfer & Storage Co.
In a multi-employer pension fund administrator's suit against an employer seeking interim payment of withdrawal liability under the Employee Retirement Income Security Act, district court's grant of summary judgment for administrator is affirmed as defendant's default is governed by the provisions of 29 U.S.C. section 1399(c)(5)(B), and under that section, as interpreted reasonably by the Pension Benefit Guaranty Corporation (PBGC), the entire amount of the withdrawal payment is immediately payable upon default and that obligation is not deferred because of the pendency of arbitration.

[08/31] Howley v. Mellon Fin. Corp.
In plaintiff's suit for benefits and for unlawful discrimination under ERISA, as well as several related state law claims, arising from denial of plaintiff's claim for benefits under defendant's Displacement Program, district court's grant of plaintiff's motion for summary judgment is affirmed as, although the district court erred in applying a heightened standard of review and by considering the extra-record evidence that managers helped plan plaintiff's termination prior to the sale of the company, it is nonetheless clear that defendant abused its discretion in denying plaintiff's claim for benefits.

[08/30] Bell v. Pfizer, Inc.
In an action for failure to provide ERISA benefits, judgment for defendants is affirmed where defendants' alleged misrepresentations concerned only plaintiff's stock benefits under a non-ERISA plan and, therefore, did not violate any fiduciary obligations under ERISA.

[08/17] Marshall v. Baggett
In an action to recover delinquent contributions to an ERISA plan, judgment for plaintiff is vacated where the district court erred in granting the default judgment because the complaint did not support a judgment against defendant in her individual capacity.

[08/12] Gastronomical Workers Union Local 610 v. Dorado Beach Hotel Corp.
In a suit brought by the trustees of a multi-employer pension fund against employers under 29 U.S.C. section 1132(a)(3), which supplies a cause of action in favor of an ERISA fiduciary, claiming that employers failed to make sufficient payments to keep the Fund in compliance with ERISA's minimum funding requirement for 2005, judgment of the district court is affirmed in part, vacated in part and remanded where: 1) district court's dollar-certain judgment is vacated as, the record states that, by the time the court entered the judgment, the deficiency may have vanished, and the record contains no explanation of the vanishing deficiency sufficient to salvage the judgment; 2) district court did not err in denying remediation under section 502(g)(2); and 3) district court's order denying relief under section 502(g)(1) is vacated in light of the Supreme Court's decision in Hardt, and remanded for the district court to determine whether the trustees have achieved some degree of success on the merits, and decide whether to award attorneys' fees, costs, and/or other remedies encompassed within section 502(g)(1).

[08/10] Young v. Verizon's Bell Atlantic Cash Balance Plan
In plaintiff's class action suit under ERISA section 502(a) and U.S.C. section 1132(a) against Verizon and its Cash Balance Plan, claiming that defendant made two errors in calculating her opening cash balance, and hence her ultimate pension benefit under the plan, district court's grant of defendant's equitable reformation of its plan to correct a scrivener's error is affirmed as, although ERISA's rules for written plans are strictly enforced, they are not so strict as to prevent equitable reformation of a plan that is shown, by clear and convincing evidence, to contain a scrivener's error that is inconsistent with participants' expected benefits.

[08/10] Khoury v. Group Health Plan, Inc.
In an action disputing defendant-insurer's award of residual disability benefits to which plaintiff was entitled, summary judgment for defendant is affirmed where: 1) the district court did not err in finding the appeals committee had before it the very same information that plaintiff contended that defendant intentionally hid; 2) the district court properly considered the existence of a conflict of interest; and 3) the district court did not err in finding defendant's interpretation of the relevant contract provisions was reasonable.

[08/09] Jones v. ReliaStar Life Ins. Co.
In an action claiming that defendant insurer began offsetting the disability benefits plaintiff received under an ERISA plan by the amount of disability benefits he collected from the Department of Veterans Affairs, summary judgment for defendant is affirmed where the district court's decision involved an application of policy language to undisputed facts, and the administrative record was sufficient to permit a fair evaluation of defendant's decision, and thus the district court did not abuse its discretion in denying plaintiff's request for discovery.

[08/04] Holmstrom v. Metro. Life Ins. Co.
In plaintiff's ERISA action against Metropolitan Life Insurance Company (MetLife) for termination of her long-term disability benefits, district court's grant of summary judgment for MetLife on plaintiff's claim for benefits and MetLife's counterclaim to obtain a setoff for Social Security payments plaintiff received, is reversed and remanded where: 1) plaintiff has shown several other reasons for finding that MetLife acted arbitrarily and capriciously in terminating her benefits and then sticking with that decision through the administrative reviews for which plaintiff provided exactly the sort of detailed information that MetLife had demanded; 2) plaintiff's long-term benefits must be reinstated retroactively as of August 5, 2005; and 3) the district court must have an opportunity to consider plaintiff's request for attorney fees and prejudgment interest on remand.

Read More

Government Benefits

[08/31] Jones v. Astrue
In plaintiff's appeal from the district court's judgment upholding the Commissioner of Social Security's denial of her application for disability insurance benefits and supplemental security income, the order is affirmed where: 1) the ALJ had no need to contact plaintiff's treating physician because there was no ambiguity to resolve in her report, and the report contained all the necessary information, including the results of diagnostic testing; 2) the ALJ appropriately considered plaintiff's subjective complaints of pain under Polaski; and 3) substantial evidence on the record as a whole supported the ALJ's decision.

[08/30] Uhm v. Humana, Inc.
In an action against an insurer for nonpayment of Medicare benefits, the dismissal of the action is affirmed where 1) the district court lacked jurisdiction to consider plaintiffs' breach of contract and unjust enrichment claims because they were not properly exhausted under the Medicare Prescription Drug Improvement and Modernization Act; and 2) plaintiffs' fraud and consumer protection act claims, while not subject to the Act’s exhaustion provisions, were expressly preempted.

[08/30] California State Foster Parents' Ass'n v. Wagner
In an action against officials of the State of California under 42 U.S.C. section 1983 claiming a violation of plaintiffs' federal right to payments under the Child Welfare Act (CWA), and seeking declaratory and injunctive relief, judgment for plaintiffs is affirmed where the CWA, at 42 U.S.C. sections 672(a) and 675(4)(A), created an enforceable federal right.

[08/26] US v. Prince
Conviction of defendant for conspiracy to commit money laundering and multiple counts of money laundering, in connection with fraudulent claims for payment for physical therapy services provided to Medicare beneficiaries, is affirmed where: 1) the evidence at trial was sufficient to establish that the defendant committed, or conspired to commit, money laundering by conducting, or aiding and abetting another in conducting, the specified financial transactions knowing that they involved the proceeds of Medicare fraud; 2) a reasonable person would not question the judge's impartiality toward defendant because a government witness was represented by an attorney who previously represented the judge in a prior unrelated matter; and 3) district court did no abuse its discretion by refusing to require the government to provide a pretrial disclosure of its exhibit list.

[08/25] Univ. of Chicago Med. Ctr. v. Sebelius
In University of Chicago Medical Center's claim for $2.8 million in Medicare reimbursements for indirect medical education (IME), based on its total full-time equivalent residents (FTEs) for the 1996 fiscal year that reflected the time medical residents spent conducting educational research unrelated to the care of Medicare patients, a grant of summary judgment in favor of the hospital is affirmed as, pursuant to the Patient Protection and Affordable Care Act, the hospital should have received reimbursement as part of its IME adjustment for pure research in 1996.

[08/20] Hardy Wilson Mem. Hosp. v. Sebelius
In an action against the Secretary of the Department of Health and Human Services and the Centers for Medicare and Medicaid Services (CMS), alleging that CMS's method for calculating reimbursement payments for costs incurred by health care providers' psychiatric units between 2003 and 2005 violated 42 U.S.C. section 1395ww(b)(3)(A) and was inconsistent with the agency’s own regulations, summary judgment for defendants is reversed where the plain text of subsection (c)(4)(iii) did not support defendant's contention that "the only reasonable interpretation of the regulations is that all of subsection (c)(4)(iii) expired in 2003 because the statutory authority under which it was promulgated (the BBA) expired at that time."

[08/20] Florida Med. Ctr. of Clearwater, Inc. v. Sebelius

[08/16] Lockwood v. Comm'r Soc. Sec. Admin.
In a petition for review of the denial of social security benefits to petitioner, claiming that the ALJ erred when she failed to explain in her written decision why she treated a social security claimant as being a person closely approaching advanced age instead of treating the claimant as being a person of advanced age, the petition is denied where the ALJ did not err because she was required by regulation only to consider whether to use the older age category.

[08/13] Castile v. Astrue
District court's affirmance of the Social Security Administration's denial of plaintiff's numerous claims under Title II of the Social Security Act for disability insurance and disability widow's benefits is affirmed where: 1) the ALJ considered all available evidence involving plaintiff's chronic fatigue syndrome and there was substantial evidence supporting the ALJ's conclusion that plaintiff's long-standing complaints did not render her disabled; 2) district court did not err in agreeing with the ALJ's obesity finding that plaintiff was not prevented by her impairments from performing her past work; and 3) district court did not err in upholding the ALJ's credibility determinations as the ALJ thoroughly examined the evidence and clearly articulated his findings.

Read More