Employee Benefits

In application for Black Lung benefits arising out of claimant-coal miner’s lung disease, ALJ did not err in applying “15-year presumption” to grant claimant’s application even though claimant’s prior applications seeking said benefits had been denied. Claimant was required to show change in conditions to support instant application, and instant change in law, which allowed ALJ to apply said presumption, qualified as “change in condition” that could support instant application where said presumption was unavailable in claimant’s prior applications. Moreover, record supported ALJ’s finding that claimant satisfied requirements for said presumption where claimant worked in dusty conditions that were similar to conditions in underground mine, and where medical evidence supported finding that claimant was totally disabled.

Dist. Ct. err in granting defendant-health benefits plan’s motion for summary judgment in ERISA action alleging that defendant breached fiduciary duty to plaintiff-plan participant where plaintiff alleged that defendant failed to provide her with procedure through which she could obtain authoritative pre-approval for her surgery to correct problems associated with prior weight-loss surgery, under circumstances where plaintiff underwent surgery after receiving oral representative that said surgery would be covered under plan, but was informed after surgery that said surgery would not be covered under plan. While basis for Dist. Ct.’s order was finding that plaintiff could not seek monetary recovery for instant equitable claim under section 1132(a)(3) of ERISA, Supreme Ct. decision in Cigna, 131 SCt 1866 would allow plaintiff ability to seek monetary “surcharge” from defendant upon showing of actual harm arising out of breach if she could show on remand that defendant failed to alert her that she could not rely on advice that surgery was covered under plan, and that said advice lulled her into failing to obtain either alternative coverage or alterative treatments.

Dist. Ct. did not err in granting defendant-employer’s motion for summary judgment in plaintiff-former employee’s ERISA action alleging that defendant had failed to give proper notice of amendment to defendant’s pension plan that resulted in reduction of plaintiff’s future benefit accrual where, after amendment had gone into effect, plaintiff had signed general release of all claims against defendant in exchange for severance benefits. Instant contested pension claim was outside realm of ERISA’s anti-alienation provision, and as such, was barred pursuant to terms of general release under Howell, 633 F.3d 552, where plaintiff had constructive notice of his pension claim at time he signed release.

Dist. Ct. did not err in granting defendant-employer investment plan’s motion to dismiss for failure to state cause of action in ERISA action by plaintiffs-employee investors asserting that defendant violated its duty of prudence under section 1104 by continuing to offer employer’s stock fund as one of several options in said plan, despite stock’s poor performance that eventually resulted in 54 percent drop in stock price. Defendant merely complied with terms of plan that required that employer’s stock fund be offered in plan “regardless of fortune” and under all circumstances “no matter how dire.” Mofreover, record showed that instant decline in stock price was not extraordinary so as to overcome any presumption of prudence, where decline was consistent with what rest of stock market experienced. Also, offering employer’s stock fund did not expose plaintiffs to excessive risk, where plan gave plaintiffs other investment options.