The U.S. Court of Appeals for the Sixth Circuit recently affirmed the crucial importance of accurate plan summaries in the post-Amara world. To date, part of the legacy of CIGNA v. Amara has been an uptick of cases in which ERISA plaintiffs allege a material mismatch between a plan document and a summary plan description (“SPD”). Plaintiffs petition the court to use the broad equitable remedies available under ERISA § 502(a)(3) after Amara to reform the plan document to reflect the interpretation the plaintiff favors—even if the plan’s terms on the subject were crystal clear.
Continue Reading Reformation Claim May Proceed Despite Clear Plan Terms, Sixth Circuit Holds
Oral Misrepresentation Could Support Fiduciary Breach Claim, District Court Holds
In Lees v. Munich Reinsurance America, Inc., a federal district court in New Jersey recently held that an oral misrepresentation could serve as the basis for a fiduciary breach claim.
The plaintiff in Lees worked for American Re-Insurance Company (a predecessor of the defendant), but was being paid by a related entity. Several years
New Law Reduces PBGC Exposure for Employers That Cease Operations at a Facility
The Consolidated and Continuing Appropriations Act, 2015 (or “Cromnibus”) revamped the notification and funding requirements under § 4062(e) of ERISA. As interpreted by the Pension Benefit Guaranty Corporation (“PBGC”), § 4062(e) often required an employer to make substantial contributions or provide other financial commitments to a defined benefit plan when the employer ceased operations at one or more of its facilities. The new rules are important because they reduce the number of employers and plans that will be exposed to § 4062(e) liability and might also reduce enforcement uncertainty for employers that trigger § 4062(e) liability.
Continue Reading New Law Reduces PBGC Exposure for Employers That Cease Operations at a Facility
Fiduciaries May Be Responsible for Call Center Statements to Fill in Gaps in SPD
A recent Seventh Circuit case, Killian v. Concert Health Plan (Nov. 7, 2013), highlights two important principles for any plan sponsor or fiduciary:
- If a plan document or summary plan description leaves out information and says to call a phone number for details, plan fiduciaries can be responsible for call center representatives’ oral statements and omissions.
- A call center representative might have a responsibility to provide more information than a caller specifically requests, if the caller’s questions indicate that additional information would be important to the caller under the circumstances.
The Killian case involved unfortunate circumstances. An employee was admitted to a hospital for emergency cancer surgery. The insurance certificate for the employee’s health plan cautioned participants to call a phone number to confirm that their health provider was in-network. The employee’s husband followed this suggestion and called the number.
The husband explained to the call center representative that his wife needed immediate treatment, and was seeking admission to St. Luke’s Hospital. The representative could not find St. Luke’s Hospital in her database (possibly because St. Luke’s had changed its name to Rush several years earlier), but told the caller to “go ahead with whatever had to be done.” The caller never asked whether the hospital’s services would be covered, and the representative did not address that question. She told him to call back later.
Continue Reading Fiduciaries May Be Responsible for Call Center Statements to Fill in Gaps in SPD
Supreme Court’s McCutchen Decision Highlights Plan Drafting Opportunity
In its recent decision in U.S. Airways v. McCutchen, all nine justices of the Supreme Court agreed that equitable principles do not override the clear terms of an ERISA plan. Although a majority of the Court went on to find that the plan at issue was ambiguous, the decision makes clear that plan documents—when clear—may fill in gaps in areas that ERISA does not prescribe. Employers may wish to address several of these areas in plan documents. The McCutchen case shows that identifying these areas and drafting clear plan language can help achieve the plan sponsor’s objectives.
Continue Reading Supreme Court’s McCutchen Decision Highlights Plan Drafting Opportunity
Participants Lack Standing to Challenge Defined Benefit Plan Investment Decisions
The Fourth Circuit recently held that participants in a defined benefit plan lacked standing under Article III of the United States Constitution to challenge investment decisions made by the plan’s fiduciaries. David v. Alphin, No. 11-2181 (4th Cir. Jan. 14, 2013). The plan at issue was overfunded and the participants had not failed to receive any benefit to which they were entitled under the plan. The Fourth Circuit held that the plaintiffs had not experienced an injury that would be redressed by a favorable outcome in the litigation. Without such an injury, the plaintiffs did not have constitutional standing under Article III.
Continue Reading Participants Lack Standing to Challenge Defined Benefit Plan Investment Decisions
Fiscal Cliff Legislation Extends Tax Advantages for Popular Fringe Benefits, Expands In-Plan Roth 401(k) Conversions
The United States government narrowly avoided falling over the so-called “fiscal cliff” by enacting the American Taxpayer Relief Act of 2012 (“ATRA”). ATRA’s impact on tax rates has been covered extensively in the national media. ATRA also included several employee benefit provisions that are of interest to employers and their employees.
Continue Reading Fiscal Cliff Legislation Extends Tax Advantages for Popular Fringe Benefits, Expands In-Plan Roth 401(k) Conversions
Puerto Rico Treasury Extends Deadlines for Adopting Required Amendments and Submitting Applications for Determination Letters
In a welcome development for employers working to maintain tax-qualified retirement plans for their employees in Puerto Rico, the Puerto Rico Department of Treasury (the “Hacienda”) last week issued Circular Letter No. 12-09, extending two important deadlines:
- The deadline for amending plans to comply with the Puerto Rico Internal Revenue Code of 2011 (“2011
Supreme Court to Address Plan’s Ability to Recover the Cost of Medical Benefits for Injuries Caused by a Third Party
On Tuesday, November 27th, the Supreme Court will hear oral arguments in U.S. Airways v. McCutchen. The case will address a medical plan’s ability to recover the cost of medical benefits for injuries caused by a third party. McCutchen is important to employers, because a ruling against U.S. Airways might significantly increase the cost of providing medical and other benefits.
Continue Reading Supreme Court to Address Plan’s Ability to Recover the Cost of Medical Benefits for Injuries Caused by a Third Party