Justia U.S. 5th Circuit Court of Appeals Opinion Summaries

Plaintiff, a large Employee Retirement Income Security Act (ERISA), 29 U.S.C. 1001 et seq., provider, sought a declaration that defendants, three independent, non-ERISA insurance providers, were bound by the terms of the ERISA plan and primarily liable for injuries sustained by individuals covered by the parties. The district court granted defendants' motion to dismiss. The court concluded that the Central States have failed to state a claim for equitable relief as required by Section 502(a)(3) of ERISA; there was no gap in ERISA's enforcement scheme requiring a federal common law claim for unjust enrichment; and Count I does not adequately state a claim for equitable relief under ERISA 502. Accordingly, the court affirmed the judgment of the district court. View "Central States, SE and SW Areas Health and Welfare Fund v. Health Special Risk, Inc., et al" on Justia Law

Plaintiffs filed suit alleging violations of the Employee Retirement Income Security Act (ERISA), 29 U.S.C. 1001 et seq. Plaintiffs claimed that the bonds that they invested in were an unsuitable investment for the Plans' funds and that defendant made multiple oral misrepresentations to plaintiffs in violation of his fiduciary duties. The district court ruled that there was a disputed issue of material fact as to whether defendant was an ERISA fiduciary, but nonetheless granted summary judgment because defendant provided plaintiffs with written disclosures. The court concluded that defendant did not qualify as a fiduciary under ERISA subsection 1002(21)(A)(i) because he did not exercise discretionary authority or control over the investment at issue; subsection 1002(21)(A)(ii) because he did not receive a fee from the Plans in connection with the investment; and section 1002(21)(A)(iii) because it was inapplicable in this instance. Accordingly, the court affirmed the judgment of the district court. View "Tiblier, et al. v. Dlabal, et al." on Justia Law

Plaintiffs filed suit against Lowe's challenging the Plan Administrator's denial of benefits under an Employee Retirement Income Security Act (ERISA), 29 U.S.C. 1001 et seq., Plan. The court reversed the district court's grant of relief from the denial of benefits and award of benefits because the court found that the Plan Administrator did not abuse its discretion where the Plan Administrator was not operating under a conflict of interest and was vested with the power to interpret the terms of the Plan. View "Porter v. Lowe's, et al." on Justia Law

Unum denied plaintiff's claims of long-term disability and sought more than $1 million in reimbursements for benefits paid. Unum denial was based on emails it had received from plaintiff's former companion indicating that plaintiff was engaged in activities that were inconsistent with her asserted disability. The district court found that there was substantial evidence to support Unum's denial of benefits, but, nonetheless, held that the denial was procedurally unreasonable because Unum did not fulfill its duty to "consider the source" of the emails. The court concluded that, in evaluating whether a plan administrator wrongfully denied benefits under the Employee Retirement Income Security Act (ERISA), 29 U.S.C. 1001 et seq., it has never imposed a duty to investigate the source of the evidence. The court held that the burden was on the claimant to discredit evidence relied on by the plan administrator. Accordingly, the court reversed the judgment of the district court, finding that Unum did not act arbitrarily and capriciously in denying plaintiff benefits. View "Truitt v. Unum Life Ins. Co. of America" on Justia Law

Plaintiffs filed suit against their former employer seeking deferred compensation payments. The district court held that plaintiffs' deferred compensation arrangements in their Employment Agreement contracts with the employer constituted a plan under the Employment Retirement Income Security Act (ERISA), 29 U.S.C. 1001 et seq. Because plaintiffs' deferred compensation arrangements did not necessitate an ongoing administrative scheme, there was no ERISA plan. Accordingly, the court reversed and remanded, concluding that plaintiffs' state law claims were not preempted by ERISA. View "Cantrell, et al. v. Briggs & Veselka Co." on Justia Law

Plaintiff brought a class action suit under the Employee Retirement Income Security Act (ERISA), 29 U.S.C. 1001 et seq., alleging various breaches of fiduciary duty to plan participants. The district court dismissed the complaint for failure to state a claim. The court concluded that the district court correctly dismissed Counts I and IV of the amended complaint which alleged that Idearc Defendants breached their fiduciary duties by allowing plan participants to buy and hold Idearc stock when it was no longer prudent to do so where the amended complaint failed to allege sufficient facts to overcome the "presumption of prudence" the court adopted in Kirschbaum v. Reliant Energy Inc. The court also concluded that the district court correctly dismissed plaintiff's claim for inaccurate disclosures and nondisclosures (Count II) where plaintiff alleged no specific circumstance or specific injury mandating the Idearc Defendants disclose non-public information to plan participants and no general duty to disclose non-public information existed under ERISA or under the court's precedents. The court affirmed the district court's dismissal of plaintiff's remaining claims. View "Kopp v. Klein, et al." on Justia Law

This case arose when plaintiff filed suit against Conoco for breach of the Offer Letter and breach of its obligations under a severance plan (the Plan). The court concluded that plaintiff waived any challenge to the Trustee's application of the common law presumption of integration or Texas's parol evidence rule; plaintiff's arguments regarding his change in title were unpersuasive; plaintiff's "at will" employment argument relied on outdated and out-of-context Texas authority and was unpersuasive; the waiver was not invalid and unenforceable on account of fraud in the inducement; plaintiff ratified an alleged fraud, thereby preserving the validity and enforceability of the waiver regardless by submitting a claim to Conoco Human Resources but then continuing to work at Conoco; the Employee Retirement Income Security Act (ERISA), 29 U.S.C. 1132(a)(1)(B), civil enforcement provision "completely preempts" plaintiff's state law claims against Conoco and the district court did not err by denying plaintiff's first motion for remand; the district court correctly denied plaintiff's renewed motion for remand; plaintiff was not entitled to recover attorneys' fees; and plaintiff waived his claim for breach of the Offer Letter, pertaining to a substantial reduction in his post-merger job position and responsibilities, for failure to plead with specificity. Accordingly, the court affirmed the district court's grant of summary judgment against plaintiff. View "Clayton v. ConocoPhillips Co., et al" on Justia Law

Plaintiff appealed from the district court's dismissal of his suit alleging claims of equitable estoppel and breach of fiduciary duties pursuant to the Employee Retirement Income Security Act of 1974 (ERISA), 29 U.S.C. 1001 et seq. The district court dismissed the complaint for failure to state a claim. The court held that plaintiff stated a claim for relief that was cognizable under ERISA, in light of CIGNA Corp. v. Amara. Because relief was available under the surcharge doctrine under Amara, the court did not address the equitable estoppel claim and the district court was free to consider that claim on remand. Finally, the district court did not err in dismissing Defendant Entergy Mississippi where plaintiff failed to allege that Entergy Mississippi sponsored or administered the plan or made any decisions with respect to his benefits. View "Gearlds, Jr. v. Entergy Services, Inc., et al" on Justia Law

Plaintiff appealed the district court's grant of summary judgment to the Plan on his claim under the Employee Retirement Income Security Act (ERISA), 29 U.S.C. 1001 et seq. Plaintiff asserted that the Plan did not comply with procedures set out by ERISA by changing its basis for denial on administrative appeal and by not identifying the independent physician reviewer who recommended denial on administrative appeal. Because plaintiff did not specify the failure to identify the physician in his amended complaint, the court did not address this issue. The court agreed with plaintiff, however, that the Plan did not substantially comply with ERISA procedures by changing its basis for denying coverage on administrative appeal. The court concluded that remand to the Plan for a full and fair review was appropriate. View "Rossi v. Precision Drilling Oilfield Svcs. Corp. Emp. Benefits Plan" on Justia Law

A third-party administrator of medical benefits plans, IMA, denied claims made on behalf of two patients who received treatment from the same medical provider, LifeCare. The court held that IMA incorrectly interpreted the plans because it categorized LifeCare as a skilled nursing facility (SNF) without finding that LifeCare "fully meets all of" the plans' seven SNF factors. IMA abused its discretion because categorizing LifeCare as an SNF without considering the seven-factors SNF test contradicted the plain language of the plans. The court found that the district court correctly held that LifeCare could maintain an action against IMA pursuant to 29 U.S.C. 1132(a)(1)(B) and that IMA was liable for exercising actual control over the claims process. The court further held that the district court did not abuse its discretion in awarding attorneys' fees. View "Lifecare Mgmt. Svcs., LLC v. Ins. Mgmt. Admins. Inc, et al" on Justia Law