Justia U.S. 7th Circuit Court of Appeals Opinion Summaries

SuperValu, Inc. participated in a multiemployer pension plan, contributing on behalf of its employees for over a decade. In September 2018, SuperValu sold several stores to Schnuck’s Markets, Inc., with five of those stores employing workers covered by the pension plan. This sale qualified for a statutory “safe harbor,” meaning SuperValu did not incur withdrawal liability for the sold stores, as Schnuck’s agreed to continue contributions. Later, SuperValu closed its remaining stores and fully withdrew from the plan, triggering withdrawal liability. The pension fund calculated SuperValu’s total liability and the annual installment payments required, using statutory formulas. In calculating the payment schedule, the fund deducted the sold stores’ contribution base units for only the most recent five years, not the entire ten-year lookback period, which resulted in higher annual payments for SuperValu.SuperValu challenged the fund’s calculation, arguing that the contribution base units for the sold stores should have been excluded for all ten years, not just five. The dispute was submitted to arbitration under federal law, where the arbitrator ruled in favor of the fund. SuperValu then sought review in the United States District Court for the Northern District of Illinois, Eastern Division. The district court granted summary judgment to the fund, holding that the relevant statutory text did not require the deduction of the sold stores’ units for the entire ten-year period, and that SuperValu’s arguments based on legislative history and statutory purpose could not override the plain language.On appeal, the United States Court of Appeals for the Seventh Circuit reviewed the district court’s decision de novo. The Seventh Circuit held that the statute governing the payment schedule for withdrawal liability does not require a pension fund to deduct contribution base units for stores sold under the safe harbor provision for the entire ten-year lookback period. The court affirmed the district court’s judgment. View "SuperValu, Inc. v. UFCW Unions and Employers Midwest Pension Fund" on Justia Law

A professional musician employed by the Indianapolis Symphony Orchestra was placed on furlough in March 2020 due to the COVID-19 pandemic. In December 2020, she developed severe symptoms, including dizziness and tinnitus, after contracting COVID-19, which rendered her unable to perform. She was rehired by the orchestra in September 2021 but soon went on sick leave because her symptoms persisted. In February 2022, she applied for long-term disability benefits under her employer’s group policy, stating that her last day of work was in March 2020 and that her disability began in December 2020.The insurance company denied her claim, reasoning that she was not an “active, full-time employee” at the time her disability began, as required by the policy. The claimant appealed internally, submitting new information that she had returned to work in September 2021 but was again unable to perform due to her illness. The insurer treated this as a fundamentally different claim, maintaining its denial and advising her to file a new application based on the later date.She then filed suit under the Employee Retirement Income Security Act (ERISA) in the United States District Court for the Southern District of Indiana. Both parties moved for summary judgment, and the district court granted summary judgment in favor of the insurer, finding that she was not eligible for benefits based on her initial application and that her new information constituted a separate claim for a different loss.On appeal, the United States Court of Appeals for the Seventh Circuit reviewed the case de novo and affirmed the district court’s judgment. The court held that the claimant was not eligible for benefits for a disability beginning in December 2020, and that her subsequent information regarding a September 2021 onset constituted a new claim, requiring exhaustion of administrative remedies before judicial review. View "Moratz v. Reliance Standard Life Insurance Co." on Justia Law

Clinton Mahoney, the sole member and manager of Mahoney & Associates, LLC, signed an agreement obligating the company to contribute to the Railroad Maintenance and Industrial Health and Welfare Fund, an employee benefit fund. When the Fund could not collect delinquent contributions from Mahoney & Associates, it sued Mahoney personally, citing a personal liability clause in the agreement. The district court granted summary judgment to the Fund, concluding that Mahoney was personally liable based on the clause.The United States District Court for the Central District of Illinois initially entered judgment on July 31, but it did not comply with Federal Rule of Civil Procedure 58. Mahoney filed a notice of appeal on September 26, and the district court later entered a corrected judgment on October 11. Mahoney filed a second notice of appeal the same day. The district court had awarded the Fund attorneys’ fees based on the trust agreement.The United States Court of Appeals for the Seventh Circuit reviewed the case de novo. The court found that there was a genuine dispute of material fact regarding Mahoney’s intent to be personally bound by the trust agreement, as he signed the memorandum in a representative capacity, which conflicted with the personal liability clause. The court concluded that this issue could not be resolved at summary judgment. The court also addressed Mahoney’s laches defense but found it waived due to his failure to address relevant complications. Consequently, the Seventh Circuit reversed the district court’s grant of summary judgment and vacated the award of attorneys’ fees, remanding the case for further proceedings. View "Railroad Maintenance and Industrial Health & Welfare Fund v. Mahoney" on Justia Law

Olayinka Oye, a director at PricewaterhouseCoopers, applied for long-term disability benefits through her employer's plan, administered by Hartford Life and Accident Insurance Company, due to fibromyalgia. Initially, Hartford denied her claim but later reversed its decision and awarded her benefits. In 2020, Hartford reevaluated her condition and terminated her benefits, concluding she was no longer disabled. Oye filed a lawsuit seeking to reinstate her benefits under the Employee Retirement Income Security Act (ERISA).The United States District Court for the Northern District of Illinois conducted a "paper trial" and found that Oye's fibromyalgia, while limiting, did not render her disabled under the plan. The court noted that consultative reports from Hartford's doctors, which were detailed and tied to Oye's medical records, outweighed the brief and conclusory letters from Oye's treating physicians. Additionally, the court found that Oye's mental health issues contributed significantly to her limitations, disqualifying her from additional benefits under the plan.The United States Court of Appeals for the Seventh Circuit reviewed the case. The court affirmed the district court's decision, emphasizing that the district court owed no deference to Hartford's prior determination of disability. The appellate court found no clear error in the district court's findings, noting that the district court carefully considered the evidence and provided adequate reasoning for its decision. The court also addressed Oye's contention that the district court should have discussed a 2017 consultative report, concluding that the district court was not obligated to address every piece of evidence and had reasonably focused on more recent reports. The Seventh Circuit affirmed the district court's judgment in favor of Hartford. View "Oye v Hartford Life and Accident Insurance Company" on Justia Law

Event Media Inc. and Pack Expo Services, LLC, were contributing employers to the Central States, Southeast and Southwest Areas Pension Fund. Both companies withdrew from the Fund and incurred withdrawal liability obligations. The dispute centers on how to calculate these obligations, specifically whether post-2014 contribution rate increases should be included in the calculation.The United States District Court for the Northern District of Illinois, Eastern Division, held that the employers' post-2014 contribution rate increases should be excluded from the calculation of their withdrawal liability payments. The court reasoned that these increases were required by a rehabilitation plan and thus should be disregarded under 29 U.S.C. § 1085(g)(3).The United States Court of Appeals for the Seventh Circuit reviewed the case and affirmed the district court's decision. The appellate court held that the post-2014 contribution rate increases were indeed required by the rehabilitation plan and should be excluded from the calculation of the employers' withdrawal liability payments. The court concluded that neither of the exceptions outlined in 29 U.S.C. § 1085(g)(3)(B) applied in this case, as the increases were not due to increased levels of work, employment, or periods for which compensation is provided, nor were they used to provide an increase in benefits permitted by subsection (f)(1)(B). Therefore, the Fund must use the 2014 contribution rate, not the higher 2019 rate, in calculating the employers' withdrawal liability payments. View "Central States, Southeast and Southwest Areas Pension Fund v. Event Media Inc." on Justia Law

Michael Gifford, a beneficiary of the Operating Engineers 139 Health Benefit Fund, sought reimbursement for out-of-network medical expenses incurred during his treatment for a stroke and subsequent brain aneurysm surgery. The Fund denied the claim, stating the services were not provided in an emergency and were not medically necessary. Gifford's wife, Suzanne, appealed the decision, but the Fund upheld the denial after consulting two independent medical reviewers who concluded the surgery was not an emergency and not medically necessary.The United States District Court for the Eastern District of Wisconsin granted the Fund's motion for summary judgment, agreeing that the Fund's decision was not arbitrary and capricious. The court also granted the Fund's motion for a protective order, limiting discovery to the administrative record. The Estate of Michael Gifford, represented by Suzanne, appealed the decision, arguing that the Fund failed to conduct a full and fair review by not considering a surgical note from Dr. Ahuja, which was not included in the administrative record.The United States Court of Appeals for the Seventh Circuit affirmed the district court's decision. The appellate court held that the Fund's denial of benefits was not arbitrary and capricious, as the Fund reasonably relied on the independent medical reviewers' reports and the administrative record. The court also found that the Fund was not required to seek out additional information not provided by the claimant. Additionally, the court upheld the district court's grant of the protective order, finding no abuse of discretion in limiting discovery to the administrative record. The court concluded that the Fund provided a full and fair review of the claim, and the denial of benefits was reasonable. View "Estate of Gifford v Operating Engineers 139 Health Benefit Fund" on Justia Law

Paul Carnes, an employee of Consolidated Grain and Barge Co., was diagnosed with degenerative disc disease in 2019 and received medical treatment for it. HMO Louisiana, Inc., the administrator of Consolidated Grain’s employer-sponsored health plan governed by ERISA, paid for some of Carnes’s treatments but not all. Carnes filed a workers’ compensation claim against his employer, which was settled without the employer accepting responsibility for his medical claims. With an outstanding medical balance of around $190,000, Carnes sued HMO Louisiana, alleging it violated Illinois state insurance law by not paying his medical bills and sought penalties for its alleged "vexatious and unreasonable" conduct.The United States District Court for the Central District of Illinois dismissed Carnes’s complaint on the grounds that his state law insurance claim was preempted by ERISA. The court allowed Carnes to amend his complaint to plead an ERISA claim, but instead, Carnes moved to reconsider the dismissal. The district court denied his motion and ordered the case closed. Carnes then appealed the final order.The United States Court of Appeals for the Seventh Circuit reviewed the case de novo. The court affirmed the district court’s decision, agreeing that Carnes’s state law claim was preempted by ERISA. The court noted that ERISA’s broad preemption clause supersedes any state laws relating to employee benefit plans, and Carnes’s claim fell within this scope. The court also found that ERISA’s saving clause did not apply because the health plan in question was self-funded, making it exempt from state regulation. The court concluded that Carnes’s attempt to frame his suit as a "coordination of benefits dispute" was an impermissible effort to avoid ERISA preemption. Consequently, the court affirmed the dismissal of Carnes’s case. View "Carnes v. HMO Louisiana, Inc." on Justia Law

Angela Midthun-Hensen and Tony Hensen sought insurance coverage for therapies for their daughter K.H.'s autism from Group Health Cooperative between 2017 and 2019. The insurer denied coverage, citing a lack of evidence supporting the effectiveness of speech therapy for a child K.H.'s age and sensory-integration therapy for autism at any age. The family's employer-sponsored plan only covered "evidence-based" treatments. After several medical reviews and appeals upheld the insurer's decision, the parents sued, alleging violations of the Employee Retirement Income Security Act (ERISA) and state law regarding autism coverage.The United States District Court for the Western District of Wisconsin ruled in favor of the insurer, finding no violations of state law or ERISA. The plaintiffs then focused on their claim that the insurer's actions violated the Mental Health Parity and Addiction Equity Act (MHPAEA), which mandates equal treatment limitations for mental and physical health benefits. They argued that the insurer applied the "evidence-based" requirement more stringently to autism therapies than to chiropractic care, which they claimed lacked scientific support.The United States Court of Appeals for the Seventh Circuit reviewed the case and affirmed the district court's decision. The appellate court found that the insurer's reliance on medical literature, which varied in its recommendations based on patient age, was permissible under the Parity Act. The court also noted that the plaintiffs failed to demonstrate that the insurer's treatment limitations for mental health benefits were more restrictive than those applied to "substantially all" medical and surgical benefits, as required by the statute. The court concluded that the plaintiffs' focus on a single medical benefit was insufficient to prove a violation of the Parity Act. View "Midthun-Hensen v. Group Health Cooperative of South Central, Inc.," on Justia Law

Donald Artz, an electric distribution controller at WEC Energy Group, retired due to multiple sclerosis (MS) and sought long-term disability benefits from a plan administered by Hartford Life and Accident Insurance Company. Hartford denied his claim, asserting that Artz was not "disabled" within the plan's definition. Artz filed a lawsuit under the Employee Retirement Income Security Act, alleging that Hartford's disability determination was arbitrary and capricious because it misconstrued the plan's terms and failed to provide a reasonable explanation for its decision.The case was initially heard in the United States District Court for the Eastern District of Wisconsin. The district court upheld the denial of benefits at summary judgment, concluding that Artz had placed too much emphasis on the duties of his specific position at WEC rather than the "essential duties" of his job in the general workplace as required by the company’s plan. The court also underscored the independent medical reviews commissioned by Hartford and found the medical evidence supported the conclusion that Artz’s MS did not prevent him from working a standard 40-hour week as a power-distribution engineer.The case was then appealed to the United States Court of Appeals for the Seventh Circuit. The appellate court affirmed the district court's decision, finding that Hartford had communicated rational reasons for its decision based on a fair reading of the plan and Artz’s medical records. The court concluded that the plan administrator provided sufficient process and that the Employee Retirement Income Security Act requires no more. The court noted that while Artz's condition was serious, the evidence did not show that the severity and persistency of his symptoms resulted in functional impairment as defined by the policy. View "Artz v. Hartford Life & Accident Insurance Company" on Justia Law

The case involves Appvion, Inc., a Wisconsin-based paper company, which was sold to its employees through an Employee Stock Ownership Plan (ESOP) in 2001. The company declared bankruptcy in 2017. Grant Lyon, acting on behalf of the ESOP, filed a lawsuit against various individuals and corporations, alleging that they fraudulently inflated the price of Appvion in 2001 and that the price remained inflated until Appvion’s bankruptcy. The district court dismissed almost all the claims.On appeal, the United States Court of Appeals for the Seventh Circuit affirmed the dismissal of some claims and reversed and remanded others. The court affirmed the dismissal of claims related to actions before November 26, 2012, as they were time-barred under the Employee Retirement Income Security Act (ERISA). However, the court reversed the dismissal of claims related to actions after November 26, 2012, finding that the plaintiff had adequately alleged that the defendants breached their fiduciary duties under ERISA by failing to ensure that the company's valuations were sound. The court also reversed the dismissal of claims alleging that the defendants engaged in prohibited transactions and co-fiduciary liability. The court affirmed the dismissal of state-law claims against the defendants, finding them preempted by ERISA. View "Appvion, Inc. Retirement Savings and Employee Stock Ownership Plan v. Buth" on Justia Law