6th Circuit Asks District Court to Consider Plan Reformation in Chrysler Lawsuit

A plan participant relied on language in the SPD regarding eligibility for benefits, and the appellate court found the SPD inaccurately portrayed provisions of the plan document.

The U.S. 6th Circuit Court of Appeals has ruled once again on pension plan litigation filed by a former employee of Chrysler Group.

As with previous decisions in the case, the opinion filed by the 6th Circuit is something of a mixed bag. In short, this second appellate decision reverses the district court’s latest grant of summary judgment to the plan on the lead plaintiff’s request for reformation. On the other hand, the decision affirms summary judgment on the plaintiff’s request for equitable estoppel, and remands the matter again to district court for further proceedings consistent with the latest appellate opinion.

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Background information in plan documents shows the plaintiff believes he is entitled to an early retirement supplement, called “30-and-Out benefits.” According to the original and amended complaints, this belief is based on the summary plan document (SPD) provided by Chrysler to plan participants, which stated the plaintiff did not need to be “actively employed at retirement” to remain eligible for these benefits. But the SPD omitted an exclusionary clause contained in the plan document itself, which said that an employee who was terminated was ineligible for the early retirement supplement.

After the plaintiff was terminated, he applied for his retirement benefits and was denied the 30-and-Out benefits. After unsuccessfully appealing this denial administratively, the plaintiff brought suit under the Employee Retirement Income Security Act (ERISA). The initial lawsuit sought to hold the plan to its representations in the SPD, notwithstanding the exclusionary provision in the plan document, via the equitable remedies available under ERISA Section 502(a)(3).

Latest action in the case

The case has reached the 6th Circuit for a second time on appeal from the U.S. District Court for the Eastern District of Michigan. In the first appellate decision, the circuit court sided with Chrysler on some matters, but it determined in favor of the plaintiff/appellee that the pension plan’s summary plan description (SPD) in fact failed to provide all the information required by ERISA about eligibility for supplemental benefits. At that juncture, the appellate court concluded a participant who relied on the SPD and expected those benefits may be due relief.

In that first appellate decision, the circuit court noted that under ERISA, the SPD must be “written in a manner calculated to be understood by the average plan participant, and shall be sufficiently accurate and comprehensive to reasonably apprise such participants and beneficiaries of their rights and obligations under the plan.” In addition, the court stipulated that an SPD must include “the plan’s requirements respecting eligibility for participation and benefits; a description of the provisions providing for non-forfeitable pension benefits; and circumstances which may result in disqualification, ineligibility, or denial or loss of benefits.”

As part of its first appellate decision, the 6th Circuit remanded the matter of whether “a conflict exists between the SPD and the pension plan because the SPD misleads or fails to state additional requirements contained in the plan document.” In essence, the appellate court agreed that, because of the clear material conflict between the pension plan terms and the SPD, the plaintiff could seek equitable relief under ERISA Section 502(a)(3). Thus, his motion to amend his complaint to add a request for equitable relief under ERISA Section 502(a)(3) was not futile.

Finding himself again in district court, the plaintiff filed an amended complaint. In the first count, he sought equitable relief in the form of reformation, equitable estoppel, and surcharge under ERISA Section 502(a)(3) for a violation of ERISA Section 102(b). Further, in count two, the plaintiff renewed his claim for relief under ERISA Section 502(a)(1)(B). The parties subsequently filed cross-motions for summary judgment. In turn, the magistrate judge recommended that the district court deny the plaintiff’s motion for summary judgment and grant Chrysler’s motion for summary judgment, and the district court adopted the magistrate judge’s report and recommendation in full.

This turn of events resulted in yet another appeal to the 6th Circuit, resulting in the current decision. In particular, the plaintiff appealed the grant of summary judgment with respect to his request for equitable relief in the forms of reformation and equitable estoppel. Ultimately, this second appellate decision reverses the district court’s grant of summary judgment to the plan on the lead plaintiff’s request for reformation. On the other hand, the decision affirms summary judgment on the plaintiff’s request for equitable estoppel, and remands for further proceedings consistent with the latest opinion.

The full text of the decision is available here.

DOL Provides Guidance for Association Health Plans

The guidance addresses ERISA rules for AHPs, state authority over the plans and the timing for establishing an AHP, among other things.

The Department of Labor (DOL) has issued guidance for establishing and maintaining association health plans (AHPs).

In June, the agency finalized regulations to expand the opportunity to offer employment-based health insurance to small businesses through Small Business Health Plans, also known as AHPs.

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Under the DOL’s new rule, AHPs can serve employers in a city, county, state, or a multi-state metropolitan area, or a particular industry nationwide. Sole proprietors as well as their families will be permitted to join such plans. In addition to providing more choice, the new rule makes insurance more affordable for small businesses. Just like plans for large employers, these plans will be customizable to tailor benefit design to small businesses’ needs. These plans will also be able to reduce administrative costs and strengthen negotiating power with providers from larger risk pools and greater economies of scale.

The guidance, presented in a Q&A format, explains that provisions of the Employee Retirement Income Security Act (ERISA) apply to AHPs. “In general, an employee welfare benefit plan covered by ERISA is subject to reporting and disclosure requirements, claims procedure rules, and fiduciary rules. In addition, AHPs and other covered group health plans must comply with health care continuation coverage provisions under the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA), and the health care protections provided in Health Insurance Portability and Accountability Act (HIPAA), the Affordable Care Act (ACA), the Mental Health Parity and Addiction Equity Act and other group health plan laws,” the guidance says.

Plan sponsors must provide to participants the Summary Plan Description, Summary of Material Modifications and the Summary of Benefits and Coverage. AHPs must also have a written plan document and file a Form 5500 annually.

In addition, ERISA requires that plan assets be held in a trust by one or more trustees or by an insurance company as part of an insurance contract. The plan document must provide for one or more named fiduciaries to control and administer the AHP. “Under ERISA, fiduciaries must discharge their duties solely in the interest of plan participants and beneficiaries and for the exclusive purpose of providing benefits and defraying reasonable expenses of administering the plan. In discharging their duties, fiduciaries must act prudently and in accordance with ERISA and the documents governing the plan,” the guidance says.

The guidance document points out that ERISA includes a number of exemptions (called “statutory exemptions”) that allow AHPs to conduct necessary transactions that would otherwise be prohibited. The Labor Department may also grant additional “administrative” exemptions. In addition, the Department of Labor’s Voluntary Fiduciary Correction Program (VFCP) is available for AHPs to correct any errors.

States have some authority over AHPs. The DOL explains that ERISA expressly provides both the Department and state insurance regulators joint authority over AHPs. In addition, states can regulate health insurance issuers and the health insurance policies they may sell to AHPs, and they can regulate self-insured AHPs to the extent the regulation is not inconsistent with ERISA. “The new rule does not diminish state oversight. Employers and plan administrators should check with the applicable state insurance department for more information on that state’s insurance laws,” the agency suggests.

All associations (new or existing) may establish a fully-insured AHP starting on September 1 of this year. Existing associations that sponsored a self-insured AHP on or before the date the new rule was published may expand within the context of the new AHP rule starting on January 1, 2019. All other associations (new or existing) may establish a self-funded AHP starting on April 1, 2019.

The complete guidance may be found here.

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