Justia U.S. 1st Circuit Court of Appeals Opinion Summaries

Scott Cannon, individually and as the personal representative of the estate of Blaise Cannon, filed a wrongful death and punitive damages claim against Blue Cross and Blue Shield of Massachusetts (BCBS). Cannon alleged that BCBS's denial of coverage for a specific inhaler led to asthma-related complications that contributed to Blaise's death. Blaise was a beneficiary of his partner's BCBS health insurance policy, which was governed by the Employee Retirement Income Security Act of 1974 (ERISA).The United States District Court for the District of Massachusetts granted summary judgment to BCBS on the grounds of ERISA preemption. The court found that Cannon's wrongful death claim was preempted by ERISA because it related to an employee benefit plan and arose from the denial of benefits under that plan. The court also held that the claim conflicted with the remedial scheme established by ERISA, which provides specific civil enforcement mechanisms.The United States Court of Appeals for the First Circuit reviewed the case de novo and affirmed the district court's decision. The appellate court held that Cannon's claim was statutorily preempted under ERISA because it had a connection with the ERISA-regulated health insurance plan. The court also found that the claim was preempted under ERISA's civil enforcement provisions, as it sought remedies for the denial of benefits under the plan. The court rejected Cannon's argument that the Supreme Court's decision in Rutledge v. Pharmaceutical Care Management Association altered the preemption analysis, reaffirming that ERISA preempts state laws that relate to employee benefit plans. The court concluded that Cannon's wrongful death claim was derivative of Blaise's potential claim for benefits, which would have been preempted by ERISA. View "Cannon v. Blue Cross and Blue Shield of Massachusetts, Inc." on Justia Law

The case revolves around the Employees Retirement System of the Government of the Commonwealth of Puerto Rico (ERS), which was established in 1951 as the Commonwealth's pension program for public employees. The appellants are seven individual beneficiaries of pensions paid by ERS. They had been litigating claims against UBS Financial Services Inc. (UBS) in the Commonwealth Court of First Instance related to UBS's role in issuing ERS pension funding bonds in 2008. Meanwhile, in January 2022, as part of its broad authority to promulgate orders necessary to carry out the Puerto Rico Oversight, Management, and Economic Stability Act (PROMESA), the district court confirmed the Modified Eighth Amended Title III Joint Plan of Adjustment (the Plan).The district court had previously confirmed the Plan, which implemented several changes related to ERS and its pension plan payments to retired Commonwealth employees. The Plan replaced the Committee with the Avoidance Action Trustee as the plaintiff with exclusive power to prosecute the Underwriter Action and recover damages that ERS incurred. The Plan also ordered the immediate dissolution of ERS.UBS filed a motion to enforce the Plan, requesting that the district court enjoin the ERS Beneficiaries from pursuing the Commonwealth Action. The district court granted UBS's motion and enjoined the ERS Beneficiaries from pursuing the Commonwealth Action. The district court concluded that the ERS Beneficiaries' Commonwealth Action claims were rooted in a generalized injury and were derivative of ERS's right to recover on its own behalf. The district court further rejected the ERS Beneficiaries' arguments that they were entitled to recover for non-derivative general tort claims against UBS under various Commonwealth statutes.The United States Court of Appeals for the First Circuit affirmed the district court's decision, concluding that the ERS Beneficiaries sought to raise derivative claims that belong exclusively to the Trustee or the Commonwealth. The court held that continued litigation of the FAC's derivative claims violates the terms of the Plan and PROMESA. View "UBS Financial Services Inc. v. Estate of Jose Nazario Serrano" on Justia Law

In this case, the Plaintiff, Barbara M. Parmenter, had subscribed to a long-term care insurance policy offered by her employer, Tufts University, and underwritten by The Prudential Insurance Company of America. The policy was governed by the Employee Retirement Income Security Act of 1974. After Prudential twice increased Parmenter's premium rate payments for her policy, she sued Tufts and Prudential, alleging each breached their respective fiduciary duties owed to her when Prudential increased those rates. The defendants responded with motions to dismiss for failure to state a plausible claim. The district court granted each of their motions and Parmenter appealed.The United States Court of Appeals For the First Circuit found that the language in the policy stating that premium increases would be "subject to the approval of the Massachusetts Commissioner of Insurance" was ambiguous, and could not be definitively interpreted based solely on the pleadings and contract documents currently available. Therefore, the court reversed the district court's decision to dismiss the case against Prudential and remanded it for further proceedings.However, the court affirmed the dismissal of the case against Tufts, as Parmenter's allegations that Tufts failed to prevent the premium rate increases or monitor Prudential did not fall into one of the categories of co-fiduciary liability set forth in section 1105(a) of the Employee Retirement Income Security Act. View "Parmenter v. Prudential Ins. Co. of America" on Justia Law

The First Circuit affirmed the decision of the district court entering summary judgment for Sheet Metal Workers' National Pension Fund (Fund) in this suit brought by David Field for plan benefits pursuant to ERISA section 502(a)(1)(B), 29 U.S.C. 1132(a)(1)(B), holding that Field was not entitled to relief on his allegations of error.Field brought suit for plan benefits arguing that the Fund wrongfully terminated his previously granted disability benefit payments based on findings made by the Appeals Committee of the Board of Trustees of the Fund that Field had engaged in disqualifying employment and had not completed sufficient hours of covered employment to become eligible for the benefit. The district court granted summary judgment for the Fund, concluding that the Appeals Committee did not abuse its discretion and was not arbitrary or capricious in terminating Field's disability benefit payments. The First Circuit affirmed, holding that the Committee acted reasonably and with support by substantial evidence on the record as a whole. View "Field v. Sheet Metal Workers' Nat'l Pension Fund" on Justia Law

The First Circuit affirmed the judgment of the district court dismissing this action against Blue Cross Blue Shield of Massachusetts (BCBSMA) and dismissing the Massachusetts Laborers' Health and Welfare Fund's (Fund) three claims brought under the Employee Retirement Income Security Act of 1974 (ERISA), 29 U.S.C. 1001 et seq., holding that there was no error.For sixteen years, BCBSMA served under contract as a third-party administrator for a self-funded multi-employer group health plan administered by the Fund. In 2021, the Fund brought this suit alleging that, in violation of its contractual obligations, BCBSMA paid medical providers in amounts exceeding rates that BCBSMA negotiated with a network of medical providers. The district court dismissed the action under Fed. R. Civ. P. 12(b)(6) on the grounds that the Fund had failed plausibly to allege that BCBSMA was an ERISA fiduciary with respect to the actions subject to the Fund's complaint. The First Circuit affirmed, holding that the Fund's argument that BCBSMA was a fiduciary failed. View "Mass. Laborers' Health & Welfare Fund v. Blue Cross Blue Shield of Mass." on Justia Law

The First Circuit affirmed in part and vacated in part the order of the district court granting summary judgment in favor of United of Omaha Life Insurance Company (United) and against Lorna Shields on her claims for recovery of plan benefits under 29 U.S.C. 1132(a)(1)(B) of the Employee Retirement and Investment Security Act (ERISA) and breach of fiduciary duty under 29 U.S.C. 1132(a)(3) of ERISA, holding that the district court erred in part.Shields was the beneficiary of a life insurance policy that the decedent, her late husband, acquired through his employer. Shields sued United, bringing claims for recovery of plan benefits and breach of fiduciary duty under ERISA. The district court granted summary judgment for United on both claims. The First Circuit vacated the judgment in part, holding (1) there was no error in the district court's summary judgment rulings with respect to the claim for recovery of benefits; but (2) the district court's grounds for granting summary judgment for United on the breach of fiduciary duty claim did not hold up. View "Shields v. United of Omaha Life Insurance Co." on Justia Law

The First Circuit affirmed the judgment of the district court in favor of an employee's widow in this insurance dispute, holding that the employee did not lose life insurance coverage under his employer's group policy after he developed a brain tumor that disrupted his usual work.Plaintiff, the employee's widow, submitted a statement to Insurer claiming approximately $1 under her late husband's life insurance policy. Insurer denied the claim. Plaintiff then sued, alleging wrongful denial of benefits under section 502(a) of ERISA, 29 U.S.C. 1132(a)(1)(B), (a)(3). The insurance company denied life insurance coverage on the grounds that the employee's coverage under the policy had lapsed. The district court granted summary judgment for Plaintiff. The First Circuit affirmed, holding (1) because the policy language invoked by Insurer in this case was less than clear the rule that ambiguous terms in an insurance policy should be read in favor of coverage applied; and (2) the employee was covered at the time of his demise. View "Ministeri v. Reliance Standard Life Insurance Co." on Justia Law

The First Circuit reversed the judgment of the district court denying arbitration requested by two unions - the United Steel, Paper and Forestry, Rubber, Manufacturing, Energy, Allied Industrial and Service Workers International Union and the United Steelworkers Local 12203 (collectively, Union) - on behalf of former two employees of the Boston Gas Company (Company) as to their claims for pension benefits, holding that this matter called for arbitration.The Union represented the two members in filing grievances regarding their underpaid pensions. The Union submitted the grievances to the Joint Pension Committee, which was unable to resolve the dispute. The Union subsequently sought arbitration over the grievances, but the Company refused to arbitrate. The First Circuit reversed, holding that it was up to an arbitrator, not a court, to determine the matters at issue in this case. View "United Steelworkers v. National Grid" on Justia Law

The First Circuit affirmed the decision of the district court granting Defendant's motion to dismiss as to count one of Plaintiffs' complaint and reversed the dismissal and remanded for further proceedings on counts two through four, holding that dismissal was improper as to the remaining three counts.Plaintiffs, S.R. and T.R. and their child N.R., brought this action against Raytheon Company, T.R.'s employer, after United Healthcare, which administered the company's health insurance plan, refused to pay for N.R.'s speech therapy, alleging various violations of the Employee Retirement Income Security Act of 1974 (ERISA), 29 U.S.C. 1001, et seq. The district court granted Defendant's motion to dismiss in full. The First Circuit held (1) the district court properly dismissed count one of the complaint; but (2) the dismissal of Plaintiffs' remaining claims was improper. View "N.R. v. Raytheon Co." on Justia Law

The First Circuit affirmed the decision of the district court upholding Defendant National Union Fire Insurance Company of Pittsburg, PA's denial of accidental death insurance benefits to Plaintiff following her husband's death because he had committed suicide, holding that the district court did not err.Plaintiff enrolled in an accidental death and dismemberment insurance policy, an employer-sponsored welfare plan affording participants like Plaintiff rights and protections under the Employee Retirement Income Security Act of 1974 (ERISA), 29 U.S.C. 1001 et seq. Plaintiff's husband was insured for a death benefit, with Plaintiff named as the beneficiary. After Plaintiff's husband fell nine stories from a hotel balcony and died, Plaintiff submitted a claim under the policy for accidental death benefits. Defendant denied benefits, concluding that Plaintiff's husband committed suicide, precluding benefits. Plaintiff filed suit under section 502(a)(1)(B) of ERISA seeking the benefits provided for under the policy. The district court granted summary judgment for Defendant. The First Circuit affirmed, holding that Defendant's denial of accidental death benefits was not arbitrary, capricious, or an abuse of discretion. View "Alexandre v. National Union Fire Insurance Co. of Pittsburgh" on Justia Law