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

Plaintiff, a former NFL player, filed suit seeking more generous disability benefits under the Bert Bell/Pete Rozelle NFL Player Retirement Plan. The district court granted summary judgment in favor of the Plan, affirming its benefits determinations that plaintiff was only eligible for "Inactive" player disability benefits instead of the more generous "Football Degenerative" disability benefits he sought. The court held that the district court did not err by applying abuse of discretion review to the Retirement Board's 2011 benefits determination; the district court did not err in using abuse of discretion instead of a heightened standard of review when considering the arbitrator's decision; and the district court's decision affirming the Retirement Board's 2006 and 2011 benefits determination on the merits under the abuse of discretion standard was correct. Accordingly, the court affirmed the district court's grant of summary judgment in favor of the Plan. View "Atkins v. Bert Bell/Pete Rozelle NFL, et al" on Justia Law

In this ERISA benefits case, the plan administrator (Appellant) appealed the district court's judgment that a deceased plan participant's stepsons, rather than his siblings, were entitled to the deceased's benefits. Appellant interpreted the term "children" as used in the plan to mean biological or legally adopted children. The Fifth Circuit Court of Appeals reversed, holding that the district court erred when it set aside Appellant's decision and granted judgment for the deceased's stepchildren, as (1) Appellant's interpretation of the term "children" was legally correct; and (2) nothing in the plan or ERISA required Appellant to incorporate the concept of equitable adoption into the plan definition of "children." View "Herring v. Campbell" on Justia Law

LINA appealed the decision of the district court holding that it abused its discretion in its denial of benefits to plaintiff under the Employee Retirement Income Security Act (ERISA), 29 U.S.C. 1001 et seq. Plaintiff alleged that LINA wrongly denied her the benefits of her common-law husband's ERISA-governed Group Accident Policies where her husband participated in two accidental death and dismemberment policies. The court affirmed the district court's holding that the common law definition of "accident" adopted in Todd v. AIG Life Insurance Co., was controlling in all ERISA accidental death and dismemberment plans where the term "accident" was undefined, irrespective of whether the plan administrator was given discretion to interpret the plan. View " Firman v. Beacon Construction Co., Inc." on Justia Law

Plaintiff appealed the district court's summary judgment dismissing her suit to recover health insurance benefits under an employee plan governed by the Employee Retirement Income Security Act of 1974 (ERISA), 29 U.S.C. 1001-1461. Aetna, a Texas health maintenance organization (HMO), provided and administered the plan's health insurance benefits under an agreement giving Aetna discretion to interpret the plan's terms. Aetna refused to reimburse plaintiff for care she received from a specialist outside of the Aetna HMO to whom she had been referred by a physician in the HMO. Aetna denied her claim because the referral was not pre-authorized by Aetna. The district court found as a matter of law that Aetna did not abuse its discretion in denying coverage. The court found, however, that the plan was ambiguous and the need for pre-authorization was not clearly stated in Aetna's summary description of the plan. And under the circumstances of the case, it could not be said as a matter of law that Aetna did not abuse its discretion in denying coverage. View "Koehler v. Aetna Health, Inc." on Justia Law

Plaintiffs brought an enforcement suit against defendants under the Employee Retirement Income Security Act of 1974, 29 U.S.C. 1001-1461. Plaintiffs alleged that defendants' practice of offering reimbursements for telephone services to retirees who lived outside of defendants' service region constituted a "pension plan" under ERISA. Judge Rodriquez was assigned to the claims at issue here and to Boos v. AT&T, a case involving similar claims. After ruling that the concession at issue in Boos was not a pension plan under ERISA, Judge Rodriquez reconsidered Judge Justice's interlocutory order with respect to plaintiffs' claims in this case. He concluded that the program of retirement benefits was not a pension plan under ERISA and he then entered a final judgment. Because the court concluded that Judge Rodriquez did not abuse his discretion by revising Judge Justice's interlocutory order, the court affirmed the judgment of the district court. View "Stoffels, et al. v. SBC Communications, Inc., et al." on Justia Law

ACS and FKI appealed the district court's decision to dismiss their suit for equitable relief under section 502(a)(3) of the Employee Retirement Income and Security Act of 1974 (ERISA), 29 U.S.C. 1132(a)(3)(B), for lack of jurisdiction. ACS and FKI argued that the district court: (1) erroneously interpreted two Supreme Court cases as requiring dismissal of their claims; (2) abused its discretion in denying their motion for a default judgment against one of the defendants; (3) should have concluded that Chapter 142 of the Texas Property Code was preempted by ERISA; and (4) should have deferred to the FKI Plan administrator's determination of liability. Pursuant to the three-part test in Bombardier Aerospace Emp. Welfare Benefit Plan v. Ferrer, Poirot, & Wansbrough, the court affirmed the district court's decision to dismiss the ERISA claims against Larry Griffin, Judith Griffith, Willie Earl Griffin (the Trustee), and the Larry Griffin Special Needs Trust for lack of jurisdiction. Accordingly, the court found it unnecessary to address the remaining arguments. View "ACS Recovery Services, Inc., et al. v. Griffin, et al." on Justia Law

This appeal arose from the district court's order dismissing plaintiffs' claim for lack of subject matter jurisdiction due to the Railway Labor Act's (RLA), 45 U.S.C. 151, 181, exclusive and mandatory dispute resolution process that applied to plaintiffs' claims. Plaintiffs argue that the RLA did not apply to them because they were no longer "employees" as contemplated by the RLA. Alternatively, plaintiffs argued that even if the RLA applied to them as former employees, they complied with the terms of their Collective Bargaining Agreement (CBA), which allowed them to bring an action in federal district court pursuant to section 501(a)(1)(B) of the Employee Retirement Income Security Act (ERISA), 29 U.S.C. 1001 et seq. The court held that plaintiffs were employees under the RLA pursuant to Supreme Court precedent. In the alternative, plaintiffs were explicitly looking for a "contracted-for" judicial remedy following an adverse RLA-established Retirement Board ruling without showing any of the narrow exceptions to RLA exclusivity. Therefore, the court declined to depart from established precedent preventing parties from creating federal court jurisdiction where there was none. Accordingly, the judgment was affirmed.

Plaintiff's lawsuit arose from defendant's refusal to pay some or all of plaintiff's claims for reimbursement for medical-device procurement and financing services provided in connection with over 2,000 patients insured under the Employee Retirement Income Security Act (ERISA), 29 U.S.C. 1001 et seq., plans administered by defendant. Plaintiff subsequently appealed a summary judgment for defendant. At issue was whether plaintiff's state-law claims of promissory estoppel, quantum meruit, unjust enrichment, negligent misrepresentation, and violations of the Texas Insurance Code, 541.051(A) & (B) and 541.061(1) & (2), were preempted by ERISA. The court reversed with respect to plaintiff's promissory estoppel, negligent misrepresentation, and Texas Insurance Code claims because these claims were premised on allegations and evidence that plaintiff provided the services in reliance on defendant's representations that it would pay reasonable charges for plaintiff's services. The court affirmed with respect to plaintiff's quantum meruit and unjust enrichment claims because these claims depended on plaintiff's assertion that without its services the patients' ERISA plans would have obligated defendant to reimburse a different provider for the same services.

This appeal required the court to determine what effect, if any, a retiree benefits-related provision included in an asset purchase agreement had on the acquiring company's retiree benefits plans governed under the Employee Retirement Income Security Act (ERISA), 29 U.S.C. 1000 et seq. The court held that the provision constituted a valid plan amendment. Moreover, the court held that the provision was assumed, not rejected, in bankruptcy. Accordingly, the court reversed and remanded.

Plaintiff sued his former employer under the Employee Retirement Income Security Act (ERISA), 29 U.S.C. 1001, et seq., to recover profit sharing and retirement benefits that were allegedly withheld from him. The district court granted summary judgment for plaintiff on his claims that the employer breached its fiduciary duty of loyalty and violated ERISA's disclosure requirements. The district court also awarded plaintiff statutory penalties and attorney's fees. The court affirmed the district court's award of damages for breach of fiduciary duty and attorney's fees. The court held, however, that the summary allocation report contained no information about how a participant could elect to receive a rollover distribution, nor did it inform the participant of her rights under the profit-sharing plan. Therefore, the court remanded to the district court for additional findings on whether the employer failed to furnish plaintiff with the requisite documents under ERISA 104(b)(1), and if so, whether that omission served as a basis for statutory penalties.