Aug 222014

Continuing an apparent trend toward more frequent fee awards in ERISA cases — a trend initiated by the Supreme Court’s decision in Hardt v. Reliance Standard Life Ins. Co., 560 U.S. 242 (2010), and advanced by the Second Circuit’s decisions in Scarangella v. Group Health, Inc., 731 F.3d 146 (2d Cir. 2013) and Donachie v. Liberty Life Assurance Co. of Boston, 745 F.3d 41 (2d Cir. 2014) — the First Circuit recently deemed fee-eligible a claimant whose “victory” amounted to nothing more than a clarification as to the correct standard of review. In the case, the claimant successfully argued before the First Circuit that the district court had employed an incorrect review standard. On remand, and prior to any adjudication on the merits (under the correct standard), the claimant requested and was denied fees. On appeal again, the First Circuit (in a 2-1 decision) granted fees, deeming the success achieved by the claimant “non-trivial” and sufficiently weighty so as to warrant them.

Gross v. Sun Life Assurance Co. of Canada, 763 F.3d 73 (1st Cir. 2014)

Aug 222014

Although ERISA generally comes into play any time a dispute surfaces in the context of a benefit made available to the claimant through his or her employment, certain exceptions exist. One such exception covers governmental employees. Another concerns individuals covered under a “church plan,” which is a benefit plan covering employees of a church or comparable religious institution.

But what happens when an aggrieved claimant whose benefit plan unmistakably qualifies as a church plan nevertheless brings and prosecutes an ERISA case, only to claim, at the tail-end of the litigation (and after losing on the merits), that in fact ERISA is inapplicable? According to the Sixth Circuit, which deemed the issue non-jurisdictional and therefore subject to forfeiture, the claimant is out of luck.

Russell v. Catholic Healthcare Partners Employee Long Term Disability Plan, 2014 WL 3953722 (6th Cir. Aug. 14, 2014)

Aug 132014

In a decision handed down last week, the Sixth Circuit deemed invalid an otherwise solid “statute of limitations” defense on the ground that the insurer had failed to mention the limitations period in the letter through which the subject adverse benefit determination was communicated to the claimant. Relying on a series of cases, including Novick v. Metropolitan Life Ins. Co., 764 F. Supp. 2d 653 (S.D.N.Y. 2011), the court held that the omission violated the applicable regulation (i.e., 29 C.F.R. 2560.503-1(g)(1)(iv)), thus allowing the claimant’s otherwise late claim to proceed to the merits.

Moyer v. Metropolitan Life Ins. Co., 762 F.3d 503 (6th Cir. 2014)