Case Law Applicable to ERISA Civil Suits vs. Insurance Companies

Other Cases of Interest

Pro Se, In Forma Pauperis, "Wrong Without a Remedy" and More.

Harte v. Bethlethem Steel Corp (98-2052 3rd Circuit 2/00) (Case summary in another section) In addition to the other items of interest, this case is interesting because the 3 judge appelate opinion refers at least twice to what "the jury" would do or think. If ERISA precludes a jury trial, why then would the 3d Circuit Court of Appeals talk about a jury in an ERISA case?
Adkins v. Du Pont U.S. Supreme Court ADKINS V. E. I. DU PONT DE NEMOURS & CO. , 335 U.S. 331 (1948) 335 U.S. 331 Argued on Motion for Leave to Proceed In Forma Pauperis Oct. 18, 1948. Decided Nov. 22, 1948. [ Adkins v. E. I. du Pont De Nemours & Co. 335 U.S. 331 (1948) ][335 U.S. 331 , 332]
Witcher v. Witcher Memorandum Pro Se (Less Stringent Standards Doctrine for Pleadings), In Forma Pauperis, Avoiding Actions for Dismissal,
Bast v. Prudential Insurance Company of America (9th Circuit 6/98 amended 8/98)"...Unfortunately, without action by Congress, there is nothing we can do to help the Basts and others who may find themselves in this same unfortunate situation."
Andrews-Clarke v. Travellers (US Dist Court Mass 10/97) Some great stuff from the Court on ERISA's hurting those it was designed to help.
On the Disparity between physical and mental disability benefit periods in an employer LTD welfare benefit plan: Skip to the last page of Kimber v. Thiokol Corp (10th Cir, 11/99) "We adopt the reasoning of (a whole bunch of post-1995 circuit court decisions) and hold that the ADA does not prohibit an employer from operating a long term disability benefits plan which distinguishes between physical and mental disabilities." (The EEOC even submitted a plaintiff's brief on this one, but the court shot it down in flames.)
(Res Judicata and more including pre-emption and definition of fiduciary, not really sure where to put this case)
Lea v. Republic Airlines, Inc., 903 F. 2d 624 (9th Circuit, 1990) (lawyer's) Oversight erects no bar of res judicata with respect to claims that could have been pursued in earlier litigation.
Pacificare Inc. v. Martin, 34 F. 3d 834 (9th Circuit 9/94) Another "several topics" case:
1. (citing Lea v. Republic)"The Ninth Circuit has expressly refused to create federal common law causes of action under ERISA.
2. Insurers can be ERISA fiduciaries if "they are given the discretion to manage plan assets or to determine claims made against the plan ...[or if they have] the authority to grant, deny, or review denied claims."
3. ..."to state a claim under section 1132 (a)(3)...[claimant] must be suing for equitable relief to enforce the terms of the plan." (expressly, as opposed to suing for breach of contract)
4. In the dissenting opinon, Judge Norris states as FACT that: "A plaintiff is not required to cite legal authority in its compliant; it is only required to allege facts which would entitle it to relief under any legal theory." (The Webmaster supposes that this might be important if the defendant moves for summary judgment on the complaint.)
Pisciotta v. Teledyne, 94-55862 (9th Circuit, 8/1996) Another off-topic case (retirees suing over health benefits) but full of interesting stuff:
1. ERISA requires written instrument (SPD) and that has 12 elements. Booklets without those elements are not SPDs and don't control benefits.
2. Any ERISA claimant who suffers because of a fiduciary's failure to comply with ERISA's procedural requirements is ordinarily not entitled to a substantive remedy such as the retroactive re-instatement of benefits.
3. If there is a disclosure in a booklet (or SPD??) stating that the contract controls, then if it is available for inspection by employees it does control.
4. There is some discussion of promissory estoppel and equitable estoppel.
5. There is some discussion of the tolling of the statute of limitations (ERISA section 1113 (a)(2), expressly rejecting the continuing violation theory in ERISA cases. (But be careful, it looks like the statute was amended since this case was filed.)
Spray et al v. Associated (California Appeals Court 5/99)99 CDOS 3241 CT:CACA2, DT:19990504 ABS: Failure of an insurer to give a statutorily required notice of time limits will estop the insurer from invoking the time limit as a defense, even if the statute gave no private cause of action.
Northlake Med. v. Waffle House, 97-9371 (11th Circuit 11/98) "ERISA does not provide a statute of limitations for suits brought under" [section 1132] "502(a)(1)(B) to recover benefits. Thus courts borrow the most closely analogous state limitations period." Contractual limitations on ERISA actions are enforceable, regardless of state law, provided they are reasonable.
Dettman v. Cigna (US District Court for the Eastern District of Pennsylvania [3d Circuit], April 1999 Case is a denial of a co-defendant's motion to dismiss. Plaintiff didn't even bother to respond to the motion AND STILL WON (not sure how that worked). Essence of this decision: In a complaint, the plaintiff need only give the defendant fair notice of what the plaintiff's claim is and the grounds upon which it rests. Plaintiffs don't have to set out their case in detail. (Multiple Cases Cited As Authority)
Sarchet v. Chater, 95-3283 (7th Circuit 1996) Fibromyalgia Social Security Case -- "It is fortunate rather than otherwise that not every person in the United States who might be eligible to feed at the public trough does so at the first opportunity." (and more.)
Christiansen v. First Insurance Company of Hawaii, Ltd. (93-0238, Intermediate Court of Appeals, State of Hawaii, 3/98.) (off-topic case -- non-ERISA, non-LTD, but is an insurance company battle.) Of interest is following quote from this long case: "Without the threat of a tort action, insurance companies have little incentive to promptly pay proceeds rightfully due to their insureds, as they stand to lose very little by delaying payments."
Desaracho v. Custom Food, 98-15003 (9th Circuit, 3/00) Nothing to do with ERISA, but nice discussions of motions in limine and motions to strike expert testimony.

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