Legal News

The Sasser Law Firm — Charlotte, North Carolina

Case Summaries

ERISA

[06/26] Solomon v. Bert Bell/Pete Rozelle NFL Player Retirement
An award of Employee Retirement Income Security Act (ERISA) benefits to a former NFL player displaying symptoms of chronic traumatic encephalopathy (CTE) is affirmed where the board of the NFL Player Supplemental Disability Plan failed to follow a reasoned process or explain the basis of its determination to deny benefits.

[06/06] Pruter v. Local 210's Pension Tr. Fund
In an action seeking damages for fraud, breach of contract and violation of an employee benefit plan, the district court's dismissal of the claims is: 1) affirmed in part where plaintiffs' state law claims arise under the Railway Labor Act (RLA) and are thus preempted; but 2) vacated in part as to dismissal of the RLA claims, as those claims bear a close resemblance to claims brought pursuant to the Employee Retirement Income Securities Act (ERISA), and it is appropriate to borrow and apply ERISA's three?year statute of limitations rather than the six?month limitations period the district court borrowed from Section 10(b) of the National Labor Relations Act (NLRA).

[06/05] Advocate Health Care Network v. Stapleton
In a class action under the Employee Retirement Income Security Act of 1974 (ERISA) against church-affiliated nonprofits that run hospitals and other healthcare facilities, brought by current and former employees of the hospitals, alleging that the hospitals' pension plans do not fall within ERISA's church-plan exemption because they were not established by a church, the Seventh Circuit's judgment affirming the District Court's decision that a plan must be established by a church to qualify as a church plan, is reversed where a plan maintained by a principal-purpose organization qualifies as a 'church plan,' regardless of who established it.

[05/18] McCulloch Orthopaedic Surgical Services, PLLC v. Aetna Inc.
In a suit brought by a surgeon against a health insurance company under the Employee Retirement Income Security Act of 1974 (ERISA), 29 U.S.C. sections1001 et seq., seeking reimbursement for a patient insured by defendant, the district court's dismissal of plaintiff's complaint is vacated where ERISA does not completely preempt an 'out?of?network' health care provider's promissory?estoppel claim against a health insurer in cases where the provider: 1) did not receive a valid assignment for payment under a health insurance plan; and 2) received an independent promise from the insurer that he would be paid for certain medical services provided to the insured.

[05/18] McCulloch Orthopaedic Surgical Services, PLLC v. Aetna Inc.
In a suit brought by a surgeon against a health insurance company under the Employee Retirement Income Security Act of 1974 (ERISA), 29 U.S.C. sections1001 et seq., seeking reimbursement for a patient insured by defendant, the district court's dismissal of plaintiff's complaint is vacated where ERISA does not completely preempt an 'out?of?network' health care provider's promissory?estoppel claim against a health insurer in cases where the provider: 1) did not receive a valid assignment for payment under a health insurance plan; and 2) received an independent promise from the insurer that he would be paid for certain medical services provided to the insured.

[05/11] Orzechowski v. The Boeing Company Non-Union Long-Term Disability Plan
In an ERISA action challenging a decision to terminate the plaintiff's long-term disability benefits, the district court's judgment after bench trial in favor of defendants is reversed where: 1) de novo review was required under California Insurance Code section 10110.6, which voided the discretionary clause contained in the plan; 2) section 10110.6 is not preempted by ERISA because it falls within the savings clause set forth in 29 U.S.C. section 1144(b)(2)(A); and 3) section 10110.6 applied to the plaintiff's claim because the relevant insurance policy renewed after the statute's effective date.

[04/05] Sec'y US Dep't of Labor v. Kwasny
In a case brought under the Employee Retirement and Income Security Act of 1974 (ERISA), the district court's grant of summary judgment is affirmed where the record shows no genuine issue of disputed fact, but remanded for a determination of whether the judgment against defendant should be offset by a previous Pennsylvania state court judgment entered against defendant for the same misdirected employee contributions.

[03/27] Stephanie C. v. Blue Cross Blue Shield of Mass
In an action brought pursuant to the Employee Retirement Income Security Act (ERISA), 29 U.S.C. section 1132(a)(1)(B), seeking reimbursement for certain expenses connected with the treatment of plaintiff's teenage son, the district court's judgment affirming the denial of her claim is affirmed where: 1) because an ERISA plan is a form of contract, and contract-law principles inform the construction of an ERISA plan, the plain language of the plan provisions should normally be given effect; and 2) applying the plain language of the plan, the clear weight of the evidence dictates a finding that the disputed charges were not medically necessary and, thus, were not covered.

[03/27] Doe v. Standard Ins. Co.
In an ERISA benefits suit for long term disability (LTD) payments brought by an environmental lawyer against his insurer, the district court's judgment in favor of the insurer is reversed where: 1) in assessing whether and when Doe became disabled, defendant chose not to use the material duties of an environmental lawyer, but rather those of a lawyer; 2) in doing so, defendant's evaluation as to Doe's disability onset date was based on the wrong standards; and 3) defendants denial of benefits from its determined onset date was arbitrary and capricious.

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