Employee Benefits

Record contained sufficient evidence to support jury’s verdict in favor of plaintiff in action alleging that defendant violated anti-retaliation provisions of FMLA when defendant terminated plaintiff shortly after she asserted her FMLA right seeking leave to take care of her autistic child for several hours 2 days per week. Jury could properly believe evidence that: (1) defendant’s management was upset over plaintiff’s request to be allowed to stay home and work at time defendant was demanding that all of its workers work at workplace; and (2) defendant’s management falsely told plaintiff that FMLA could not be used to authorize leave to take care of sick child, under circumstances where plaintiff had experienced unsuccessful attempts to obtain day care for said child. Also, plaintiff was entitled to double her actual damages, where, as here, defendant failed to show that its actions in terminating plaintiff were done in good faith. Also, plaintiff was entitled to full attorneys’ fees award, even though plaintiff did not prevail on her FMLA interference claim, where both of plaintiff’s FMLA claims were similar in nature and were based on largely same facts.

Dist. Ct. did not err in granting defendant-insurance company’s motion for summary judgment in action under ERISA alleging that defendant wrongfully terminated plaintiff’s long-term disability benefits, after determining that plaintiff could perform two occupations that matched plaintiff’s capabilities. Plaintiff failed to show that her termination of benefits was either arbitrary or capricious, since defendant offered “reasoned explanation” for said termination, where: (1) surveillance evidence of plaintiff performing shopping and driving chores without any assistive device supported defendant’s expert opinion and refuted opinion of plaintiff’s expert; (2) although plaintiff had not previously performed jobs identified by defendant’s expert, terms of plan only required defendant to identify jobs that “may reasonably become” filled by plaintiff due to her education and training. Fact that defendant had previously awarded long-term disability benefits to plaintiff did not require different result, since ERISA allows plan administrators to perform periodic reviews of beneficiaries’ disability status. Also, plaintiff was not entitled to limited discovery on issue of defendant’s potential conflict, where record showed that: (1) defendant obtained numerous independent physician peer reviews before terminating plaintiff’s long-term disability benefits; (2) defendant contacted plaintiff’s own physicians and addressed their concerns; and (3) defendant sent surveillance video to plaintiff’s physicians to ensure that video was assessed objectively.

Record failed to support ALJ’s denial of claimant’s application for Social Security disability benefits based on his congestive heart failure condition, COPD, obesity, hypertension and dyspnea. While ALJ disbelieved testimony from claimant’s two treating physicians that claimant was totally disabled from gainful employment because, according to ALJ, said physicians had given evidence concerning claimant’s activities that contradicted his medical record, said physicians’ testimony that claimant could walk 30 minutes per day did not negate claimant’s need to sleep at work for 3 hours per day, which would preclude him from obtaining gainful employment. Fact that claimant had worked as part-time cook for three-month period did not mean that he could perform full-time gainful employment, where record failed to contain details surrounding said employment and why he left his job. Moreover, testimonies of treating physicians were entitled to considerable weight, while testimonies of non-treating physicians, who believed that claimant could perform full-time gainful employment, were based on incomplete medical record.

Record failed to support ALJ’s denial of claimant’s application for Social Security disability benefits based upon claimant’s back and obesity conditions, which, according to claimant, left her in too much pain to work. While ALJ adequately considered claimant's obesity condition and claimant waived most of her arguments regarding whether ALJ could properly rely on opinion of vocational expert who indicated that claimant could perform certain sedentary jobs, remand was required, since ALJ improperly violated Treating Physician Rule by rejecting opinion of claimant’s treating doctor who stated that claimant was unable to sit or stand for any prolonged period of time, and by failing to explain why claimant’s activities were inconsistent with her treating physician’s opinion.

Dist. Ct. did not err in granting defendant-employer’s motion for summary judgment in action alleging that defendant breached implied covenant of good faith and fair dealing by terminating its bonus plan prior to time when said plan was required to cease due to new governmental regulation that prohibited defendant from giving said bonuses to plaintiff and his co-workers based on their ability to recruit and retain students to defendant’s school. Terms of bonus plan allowed defendant to change terms of plan at any time. Moreover, while governmental regulation was not scheduled to take place for another five months after defendant discontinued bonus plan, plaintiff could not reasonably expect that bonuses would not be terminated prior to effective date of regulation, and actual motivation for termination of bonus plan, i.e., financial downturn in business, cannot be characterized as being in bad faith or beyond objectively reasonable expectations. Fact that defendant gave different rationale for discontinuing bonus plan did not require different result.

In ERISA action by plaintiffs-welfare plans alleging that defendants-employers owed contributions to said plans based on language contained in four collective bargaining agreements, Dist. Ct. did not err in determining that defendants owed $1.8 million, after finding that: (1) collective bargaining agreements called for payments based on every hour defendants were paid, as opposed to every hour employees worked; and (2) auditor hired by plaintiffs was not required to offset any overpayments made by defendants when calculating underpayments. Auditor was not required to calculate said offsets since burden of proof regarding existence of overpayments was on defendants. Moreover, Dist. Ct. could properly find that report of defendants’ auditor, who only found $1.2 million in underpayments, was unreliable, where: (1) said report was generated by “in-house” auditor who lacked relevant experience; and (2) said report was based on unexplained assumptions.

Dist. Ct. did not err in granting plaintiffs-pension funds’ motions for summary judgment in ERISA actions against defendants-employers in ERISA action seeking to have defendants pay for delinquent contributions to said plans under circumstances where: (1) relevant language in plans called for defendants to contribute specified dollar amount “for each hour for which an employee receives wages” under the collective bargaining agreement; (2) union that had negotiated said collective bargaining agreements had been subsequently decertified; and (3) defendants ceased making contributions as of date of decertification. Defendants’ obligation to pension funds survived decertification of union, and nothing in ERISA made obligation to contribute to pension plans dependent on existence of valid collective bargaining agreement. Ct. further noted that instant pension plans were third-party beneficiaries of collective bargaining agreements and were entitled to enforce said agreements even if union could not enforce them.

Dist. Ct. did not err in dismissing plaintiff-self-funded health plan’s action under section 502(a)(3) of ERISA seeking reimbursement from defendants-health insurance companies for medical expenses that plaintiff paid on behalf of its beneficiaries, where said beneficiaries also owned health insurance policies from said defendants. Plaintiff failed to state viable section 502(a)(3) claim, where its request for monetary relief from defendants’ general assets was legal in nature, and section 502(a)(3) allows only claims for equitable relief. Fact that basis for plaintiff’s claim is equitable in nature did not require different result, since requested relief itself must be equitable. Ct. further found that plaintiff’s request for declaration that future medical expenses of its beneficiaries must be paid by defendants was not ripe for decision. Ct. also recognized that result of case meant that plaintiff in future is left with only one way to resolve instant issue, which required that plaintiff deny payments to its members who have other insurance and then sue other insurers for declaratory judgment, which left beneficiaries in worse position even though it purchased additional health insurance.