Category Archives: Litigation

District Court Says No to IRS About RTRPs, Are ERPAs, Enrolled Actuaries or EAs Next?

Almost a month has passed since the U.S. District Court of the District of Columbia issued its opinion about IRS Circular 230 on Jan. 18, 2013, and I’m a little surprised by the lack of discussion about this opinion in ERISA circles because it may be a game-changer when it comes to the IRS permitting non-attorneys to practice before the IRS.

In Loving v. Internal Revenue Service, No. 12-385 (Jan. 18, 2013), the U.S. District Court of the District of Columbia granted summary judgment to three paid tax return preparers who complained that the 2011 addition of section 10.3(f) to IRS Circular 230, creating the category of Registered Tax Return Preparer, would force them to close their businesses if they were forced to comply with Circular 230. Specifically, the Court enumerated the new Circular 230 requirements imposed on those three paid tax return preparers as “annual fees, the entrance exam, and the hefty continuing-education requirement”.

To those of us who practice before the IRS on a daily basis, complying with IRS Circular 230 is nothing new. In my History of Circular 230 class, I was taught that the IRS promulgated Circular 230 in 1966. According to the Court’s 22-page opinion, Circular 230 actually has its origins in an 1884 statute, 31 U.S.C. section 330, which “allows the IRS to regulate “representatives” who “practice” before it.” (quotation marks around “representatives” and “practice” provided by the Court).

Section 10.2(a)(4) of Circular 230 defines practice before the IRS as:

“(4) Practice before the Internal Revenue Service comprehends all matters connected with a presentation to the Internal Revenue Service or any of its officers or employees relating to a taxpayer’s rights, privileges, or liabilities under laws or regulations administered by the Internal Revenue Service. Such presentations include, but are not limited to, preparing documents; filing documents; corresponding and communicating with the Internal Revenue Service; rendering written advice with respect to any entity, transaction, plan or arrangement, or other plan or arrangement having a potential for tax avoidance or evasion; and representing a client at conferences, hearings, and meetings.”

The Court stated the issue before it “turns on whether certain tax-return preparers are representatives who practice before the IRS, and thus are properly subject to the new IRS regulations.” (the new IRS regulations are the 2011 changes to Circular 230). Even though the three tax return preparers are in the business of preparing and filing IRS Form 1040s for unrelated taxpayers, the Court found that they are not representatives who practice before the IRS, and thus were not subject to the new IRS regulations.

According to the Court’s opinion, the IRS argued that “each agency has inherent authority to regulate those who practice before it.” Unlike most agencies, who permit only attorneys to represent the interests of unrelated parties, the IRS has always taken a more pragmatic approach, permitting non-attorneys to represent the interests of unrelated parties before the IRS based upon criteria stated in Circular 230. For example, many years ago, the IRS recognized that Enrolled Actuaries bring a unique understanding to the application of 22 different Internal Revenue Code sections as they pertain to pension and retirement plans, and thus added Section 10.3(d) to Circular 230. This pragmatic approach turned out to be cost-effective for everyone involved. Namely, the IRS could speak directly with the Enrolled Actuary for the plan instead of taking the more circuitous route of speaking to an attorney who could call the Enrolled Actuary for the plan, relay the IRS’ question about an actuarial calculation, obtain the Enrolled Actuary’s response to the question, and then relay the response to the IRS.

Several years after the IRS added Section 10.3(d) to Circular 230, it then added section 10.3(e), permitting Enrolled Retirement Plan Agents, or ERPAs, to practice before the IRS.

In determining whether the IRS can permit non-attorneys to practice before the IRS, the Court focused on the language of 31 U.S.C. section 330(a)(2), which “allows the Secretary to ‘require that the representative demonstrate…(D) competency to advise and assist persons in presenting their cases.” The Court says that it is this language, which “does not disclose who these covered ‘representatives’ are. But it does tell us what the representatives do – what their “practice” is, in the words of both subsections: representatives ‘advise and assist persons in presenting their cases.”

The Court then goes on to say that:

“This statutory equating of ‘practice’ with advising and assisting the presentation of a case provides the first strike against the IRS’ interpretation. Filing a tax return would never, in normal usage, be described as ‘presenting a case.’ At the time of filing, the taxpayer has no dispute with the IRS; there is no ‘case’ to present.”

If, as the Court says, filing a tax return was not included in the statutory framework of Circular 230 practice before the IRS, and if practice before the IRS only includes representing taxpayers who are involved in a dispute with the IRS, such as an appeal, then filing a determination letter application or an EPCRS VCP Application with IRS Employee Plans would also not be included.

After the opinion was issued by the Court, a representative of the IRS said the Service will be working with the Dept. of Justice to appeal this decision.

Court Finds Third Party Administrator Liable as Fiduciary

Despite language in their contract which expressly states that they are not a fiduciary, yesterday the Court of Appeals for the 6th Circuit found Professional Benefits Administrators (PBA) was a fiduciary when it misappropriated funds meant to pay medical claims for 4 companies whose plans PBA administered. Guyan International v. Professional Benefits Administrators, Nos. 11-3126/3640 (Aug. 20, 2012).

PBA is a third party administration firm which entered into a Benefit Management Service Agreement with 4 companies – Guyan International (Permco), Precision Gear, Pritchard Mining Company, and Hocking Athens Perry Community Action Agency (HAPCA). Under the Agreement, PBA would establish a segregated bank account for each plan and the companies would deposit employer contributions and employee payroll contributions into that account. PBA would then pay medical claims presented to the plans by writing checks from this account.

Instead, according to the companies, PBA misappropriated the funds in the account for their own purposes. Permco was the first to file a lawsuit against PBA, alleging that PBA was a fiduciary under ERISA, that PBA had breached its fiduciary duties, that Permco and its Plan had been damaged by this breach, that ERISA pre-empted Permco’s breach of contract claims and that PBA had misappropriated $501,380.75 from Permco. The U.S. District Court for the Northern District of Ohio (Akron) agreed, and granted partial summary judgment to Permco on the ERISA breach of fiduciary duty claim.

Pritchard, HAPCA and Precision Gear than filed their own lawsuits, and were also granted partial summary judgments. The district court awarded $501,380.75 to Permco, $409,943.88 to Pritchard, $384,574.17 to HAPCA and $44,290.12 to Precision Gear.

PBA appealed to the Court of Appeals for the 6th Circuit, requesting that the 6th Circuit reverse the district court’s determination that PBA was a fiduciary under ERISA when it managed or disposed of the plan assets.

The 6th Circuit agreed with the district court, finding that:

“PBA was a fiduciary under ERISA because it exercised authority or control over Plan assets. PBA had the authority to write checks on the Plan account and exercised that authority. Moreover, PBA had control over where Plan funds were deposited and how and when they were disbursed.”

The Court further found that because PBA used plan funds in ways contrary to the Benefit Management Service Agreement, it demonstrated that PBA had practical control over Plan assets once they were received from the companies. Even though the agreement specifically stated that PBA was not a fiduciary, the Court, citing Briscoe v. Fine, 444 F.3d 478 (6th Cir. 2006), said that language in a contract expressly limiting fiduciary status does not override a third party administrator’s functional status as a fiduciary.

Carl H. Gluek, Jennifer L. Whitney and Olivia Lin represented Pritchard Mining Company, Hocking Athens Perry Community Action Agency, Precision Gear and Merit Gear before the 6th Circuit.

Peter Turner represented Guyan International (Permco) before the 6th Circuit.

Steven G. Janik, Crystal l. Nicosia, Colin P. Sammon and Ellyn Mehendale represented Professional Benefits Administrators and Robert Hartenstein before the 6th Circuit.

Court Finds ERISA Plans Invested with Madoff not Madoff Customers

If you’ve been wondering about whether the qualified plans invested with Bernard L. Madoff Investment Securities LLC would be able to recover some of their losses through the $500,000 maximum made available by the Securities Investor Protection Act of 1970 (SIPA) to customers of failed brokerage firms, the U.S. District Court for the Southern District of New York has answered “no” in an opinion issued on July 25, 2012.

Two groups of ERISA claimants had been joined together in a motion requesting recovery under SIPA. The first group consisted of individuals who participated in ERISA-regulated retirement plans that had accounts with Madoff. The second group consisted of entities that are ERISA-regulated plans or individual retirement accounts (IRAs) that invested directly or indirectly in a Madoff account-holder entity such as a hedge fund. No one in either group had their own account with Madoff but were invested with Madoff through feeder funds, where the plan had invested in the feeder fund, and the feeder fund had invested with Madoff.

The ERISA claimants said that if the Court correctly applied ERISA, they qualified as “customers” under SIPA’s definition of customer as “any person who has deposited cash with the debtor for the purpose of purchasing securities”. The Court determined that they were not claimants under that definition of “customer”, finding that “one cannot deposit cash with the debtor if this cash belongs to another”. The Court reasoning was that because assets in an ERISA-regulated plan are held and owned by the plan’s trustees, and not by the participants, the participants could not pursue recovery as a “customer” under SIPA.

FedEx Independent Contractor Misclassification Lawsuits Wait for Answer from Kansas Supreme Court

Recognizing that the FedEx independent contractor class action lawsuit “is of great importance not just to this case but to the structure of the American workplace”, the U.S. Court of Appeals for the 7th Circuit has requested input from the Kansas Supreme Court on whether FedEx drivers are improperly classified as independent contractors in Craig v. FedEx Ground Package System, Inc., No. 10-3115 (CA7 July 12, 2012).

Craig v. FedEx Ground Package System, Inc. involves 479 Kansas FedEx drivers who allege that they were improperly classified as independent contractors rather than employees under the Kansas Wage Payment Act. It is one of 21 cases appealed to the 7th Circuit regarding substantially the same issue about whether FedEx misclassified current and former drivers as independent contractors instead of employees. When these class action lawsuits were originally filed in U.S. district courts throughout the United States, the Judicial Panel on Multidistrict Litigation consolidated the actions and transferred them to the U.S. District Court for the Northern District of Indiana. In 2010, the district court granted summary judgment in favor of FedEx, finding that the drivers could not prevail on their claims. The drivers appealed those decisions to the 7th Circuit Court of Appeals.

Explaining that when hearing appeals involving diversity, the 7th Circuit’s “task is to ascertain the substantive content of state law as it either has been determined by the highest court of the state or as it would be by that court if the present case were before it now”, the 7th Circuit found that it is not clear how the Kansas Supreme Court would decide the issues currently before the 7th Circuit in Craig as the caselaw is not clear and the Kansas Supreme Court has applied a facts-and-circumstances test when deciding similar issues in previous cases. For these reasons, the 7th Circuit requested the Kansas Supreme Court answer 2 questions, and has stayed all proceedings in the 21 FedEx appeals, including Craig, until it receives answers to those questions from the Kansas Supreme Court.

The questions are:

    1. Given the undisputed facts presented to the district court in this case, are the plaintiff drivers employees of FedEx as a matter of law under the Kansas Wage Payment Act (KWPA)?
    2. Drivers can acquire more than one service area from FedEx. See 734 F. Supp. 2d at 574. Is the answer to the preceding question different for plaintiff drivers who have more than one service area?

United Employee Benefit Fund, Govt Reach Agreement Over Loan Allegations

What started with a bang has ended with a whimper. It began with the Dept. of Labor issuing a press release on Aug. 30, 2011, announcing that the DOL was seeking “to recover more than $1 million in improper and delinquent loans made from United Employee Benefit Fund.” It ended with an agreement between the parties to pay their own attorneys fees and expenses, amend the plan documents, and issue some 1099s.

On July 2, 2012, the Dept. of Labor and United Employee Benefit Fund entered into a Consent Order in the U.S. District Court for the Northern District of Illinois, Eastern District, resolving issues the DOL alleged United Employee Benefit Fund had in administering loans within their plan. Specifically, the DOL alleged that United Employee Benefit Fund had issued at least 194 loans from the fund to individual participants between Jan. 1997 and Dec. 31, 2009, some of which lacked proper documentation, were delinquent, or had exceeded 50 percent of the value of the participants’ accrued benefit. In the Consent Order, United Employee Benefit Fund agreed to amend the loan provisions in their plan documents, issue 1099s to participants whose loans are delinquent for more than 120 days, and provide copies of those 1099s to the DOL within 45 days after the 1099 is issued. As part of the agreement, both parties will pay their own attorneys fees, costs and expenses.

The Consent Order does not include any fine or penalty to be paid by UEBF, and the agreement states that it is not binding on any other agency, including the IRS.

The United Employee Benefit Fund was established by the Professional Workers Master Contract Group and the National Production Workers union Local 707 to provide welfare, medical, death, disability and child care facility benefits to the fund’s participants. As of Dec. 31, 2009, UEBF had approx. 281 participants.

Supreme Court Likely to Release Affordable Care Act Opinion on Monday

If you’ve already made your pick in your office pool about when the U.S. Supreme Court will release its opinion regarding the Affordable Care Act, you may not want to read the rest of this post. The Supreme Court has an interesting history when it comes to releasing ERISA-related opinions in June. Consider that the Supreme Court released the following opinions in June:

  • June 2, 1997 – Boggs v. Boggs, 520 U.S. 833 (1997) (Monday);
  • June 2, 1997 – De Buono v. NYSA-ILA Medical and Clinical Service Fund, 520 U.S. 806 (1997) (Monday);
  • June 3, 1985 – Metropolitan Life Ins. Co. v. Massachusetts, 471 U.S. 724 (1985) (Monday);
  • June 7, 2007 – Central Laborers’ Pension Fund v. Heinz, 541 U.S. 739 (2004) (Thursday);
  • June 8, 1998 – Geissal v. Moore Medical Corp., 524 U.S. 74 (1998) (Monday);
  • June 10, 1996 – Lockheed Corp. et al. v. Spink, 517 U.S. 882 (1996)(Monday);
  • June 11, 2007 – Beck v. PACE, Int’l Union, 551 U.S. 96 (2007) (Monday);
  • June 12, 2000 – Pegram v. Herdrich, 530 U.S. 211 (2000) (Monday);
  • June 12, 2000 – Harris Trust and Sav. Bank v. Salomon Smith Barney Inc., 530 U.S. 238 (2000) (Monday);
  • June 15, 2006 – Howard Delivery Service v. Zurich Amer. Insurance Co., 547 U.S. 651 (2006) (Thursday);
  • June 18, 1984 – Pension Benefit Guaranty Corp. v. RA Gray & Company, 467 U.S. 717 (1984) (Monday);
  • June 18, 1990 – Pension Benefit Guaranty Corp. v. The LTV Corp., 496 U.S. 633 (1990) (Monday);
  • June 19, 2008 – Metropolitan Life Ins. Co. v. Glenn, 554 U.S. 105 (2008) (Thursday);
  • June 20, 2002 – Rush Prudential HMO, Inc. v. Moran, 536 U.S. 355 (2002) (Thursday);
  • June 21, 2004 – Aetna Health Inc. v. Davila, 542 U.S. 200 (2004) (Monday);
  • June 24, 1983 – Shaw v. Delta Air Lines Inc., 463 U.S. 85 (1983) (Friday); and
  • June 25, 1998 – Eastern Enterprises v. Apfel, 524 U.S. 498 (1998) (Thursday);

Of these 16 opinions:

  • 11 were released on a Monday;
  • 5 were released on a Thursday; and
  • 1 was released on a Friday.

When it comes to ERISA, Monday at the U.S. Supreme Court could be called ERISA-Monday.

Another truism about the U.S. Supreme Court is that the Court is completely unpredictable when it comes to releasing opinions in specific cases, so while this analysis would indicate the Court will release the Affordable Care Act opinion on Monday (since it is the last Monday in June this year), it is also possible that the Court will release the opinion on Tuesday, Wednesday, Thursday or Friday. In fact, as I write this, the Court may be releasing its opinion in the Affordable Care Act cases. On the other hand, you know which day I have in the office pool.

Today in ERISA History

June 20, 2002 – The U.S. Supreme Court releases its opinion in Rush Prudential HMO, Inc. v. Moran, 536 U.S. 355 (2002), holding that an Illinois statute which provided recipients of health coverage by such organizations with a right to independent medical review of certain denials of benefits, as applied to health benefits provided by a health maintenance organization under contract with an employee welfare benefit plan, is not preempted by ERISA.

In 1996, Debra Moran had pain and numbness in her right shoulder. After conservative treatment for her condition failed, her physician recommended an unconventional treatment for her condition to be performed by a physician who was not affiliated with her HMO. The HMO denied the request, and her subsequent appeals of their decision denying this treatment, on the grounds that the procedure was not “medically necessary”.

Rush Prudential HMO, Inc. was a health maintenance organization that contracted with employee welfare benefit plans covered by ERISA to provide participants with “medically necessary” services. Ms. Moran participated in such a plan through her husband’s employer. After denying her request for the unconditional treatment recommended by her physician, Rush proposed that Ms. Moran undergo standard surgery performed by a physician affiliated with Rush.

Ms. Moran lived in Illinois, which had a state statute requiring independent medical review in the event of a dispute between the primary care physician and the HMO regarding the medical necessity of a covered service proposed by a primary care physician. If the reviewing physician determined the covered service to be medically necessary, the Illinois statute required the HMO to provide the covered service.

Rush refused to provide the independent review as required by the Illinois statute, and Ms. Moran filed a lawsuit in Illinois state court to compel Rush to comply with the state statute. Rush removed the lawsuit to federal district court on the grounds that ERISA “completely preempted” the cause of action.

While the lawsuit was pending, Ms. Moran had the surgery by the unaffiliated physician, and amended her compliant to include a claim for reimbursement from Rush. Rush treated the amended claim as a renewed request for benefits, and began a new inquiry to determine benefits, consulting with 3 doctors who said the surgery had been medically unnecessary.

The federal district court remanded the lawsuit back to Illinois state court, finding that a request for independent review under the Illinois statute did not require an interpretation of ERISA, so the claim was not “completely preempted” by ERISA permitting removal to federal court. The Illinois state court assigned to this case ordered Rush to submit to review by an independent physician, who decided that Ms. Moran’s treatment was medically necessary. Rush refused to concede that the surgery had been medically necessary, and again denied Ms. Moran’s claim in 1999.

Ms. Moran amended her complaint in state court to include reimbursement for her surgery as “medically necessary” under the Illinois statute, and Rush again removed the lawsuit to federal court, arguing that Ms. Moran’s reimbursement claim stated a claim for ERISA benefits and thus was completely preempted by ERISA. The district court agreed with Rush, and denied Ms. Moran’s claim on the ground that ERISA preempted the Illinois statute.

The U.S. Court of Appeals for the 7th Circuit reversed, finding that the Illinois statute regulated insurance, and therefore was not preempted by ERISA, and Rush appealed to the U.S. Supreme Court.

After a long discussion of the history of ERISA preemption as it relates to HMOs, the Court affirmed the decision of the 7th Circuit, finding that an HMO provides health care and it does so as an insurer, and the Illinois statute regulates insurance, so it was not preempted by ERISA.

John G. Roberts, Jr. argued on behalf of Rush before the U.S. Supreme Court with Clifford D. Stromberg, Craig A. Hoover, Jonathan S. Franklin, Catherine E. Stetson, James T. Ferrini, Michael R. Grimm, Sr. and Melinda S. Kollross joining him on the brief. Melinda Sue Kollross argued on behalf of Rush before the U.S. Court of Appeals for the 7th Circuit.

Daniel P. Albers argued on behalf of Debra Moran before the U.S. Supreme Court with Mark E. Rust and Stanley C. Fickle joining him on the brief. Daniel P. Albers argued on behalf of Ms. Moran before the U.S. Court of Appeals for the 7th Circuit.

Today in ERISA History

June 19, 2008 – The U.S. Supreme Court issues its opinion in Metropolitan Life Ins. Co. v. Glenn, 554 U.S. 105 (2008), deciding that when an entity both administers the plan and determines whether an employee is eligible for benefits and pays benefits out of its own pocket, this dual role creates a conflict of interest that should be considered as a factor when a court determines whether the plan administrator has abused its discretion in denying benefits.

Metropolitan Life Insurance Company was both administrator and insurer of the Sears, Roebuck & Company’s long-term disability insurance plan with authority to determine whether an employee’s claim for benefits was valid. Wanda Glenn was a Sears employee diagnosed with severe dilated cardiomyopathy, a heart condition, who applied for disability benefits. After initially approving disability benefits for Glenn, Sears denied benefits after 24 months, finding that Glenn failed to meet the Social Security definition because they believed she was capable of performing full-time sedentary work.

Glenn filed a lawsuit seeking review of MetLife’s denial of benefits. The district court found in MetLife’s favor, and Glenn appealed to the U.s. Court of Appeals for the 6th Circuit. The 6th Circuit reversed the district court’s decision and set aside MetLife’s denial of benefits. MetLife appealed that decision to the U.S. Supreme Court.

The U.S. Supreme Court examined the inherent conflict of interest in MetLife’s role both as administrator and insurer/payor of benefits claims, determining that MetLife saved a dollar for every dollar it denied in benefits claims. The Court then examined the approach taken by the 6th Circuit in applying different factors in determining that MetLife’s denial of Glenn’s claims was improper, and affirmed the 6th Circuit’s decision.

Stanley L. Myers, Ted M. Sichelman, E. Joshua Rosenkranz, Jeremy N. Kudon, Malaika M. Eaton, Sara K. Pildis, and Heeler Ehrman represented Wanda Glenn before the U.S. Supreme Court. Stanley L. Myers argued before the 6th Circuit on behalf of Wanda Glenn.

Amy K Posner, Michelle M. Constandse, Lee T. Paterson, Miguel A. Estrada, Amir C. Tayrani, Minodora D. Vancea, Gene C. Schaerr represented MetLife before the U.S. Supreme Court. C. Scott Lanz argued before the 6th Circuit on behalf of MetLife.

Today in ERISA History

June 18, 1984 – The U.S. Supreme Court releases their opinion in Pension Benefit Guaranty Corp. v. R.A. Gray & Co., 467 U.S. 717 (1984), holding that the application of the withdrawal liability provisions of the Multiemployer Pension Plan Amendments Act of 1980 to employers withdrawing from pension plans during the 5-month period prior to the statute’s enactment did not violate the Due Process Clause of the 5th Amendment.

R.A. Gray was a building and construction firm doing business in Oregon with collectively-bargained employees who contributed to the Oregon-Washington Carpenters-Employers Pension Trust Fund, a multiemployer pension plan. During Feb. of 1980, Gray decided to terminate their collective bargaining agreement when it expired on June 1, 1980, which was deemed to be a complete withdrawal from the multiemployer pension plan.

When the PBGC was created by ERISA in 1974, it was given the task of paying guaranteed benefits for participants whose plans terminated with insufficient assets. This provision was originally to become mandatory for multiemployer plans on Jan. 1, 1978. The date was extended to July 1, 1979 over concerns that the PBGC would not have sufficient funds to pay the amount of claims which could arise by that date due to the number of plans experiencing extreme financial hardship. Congress eventually passed the Multiemployer Pension Plan Amendments Act of 1980 (MPPAA), which President Carter signed into law on Sept. 26, 1980. Effective April 29, 1980 (5 month before it was signed into law), it required an employer withdrawing from a multiemployer pension plan to pay a withdrawal amount equal to the difference between the present value of the plan’s vested benefits and the current value of the plan’s assets.

After Gray was deemed to withdraw from the Oregon-Washington Carpenters-Employers Pension Trust Fund on June 1, 1980, Gray was presented with a withdrawal liability of $201,359. Gray filed a lawsuit in district court seeking relief from paying the withdrawal liability. The district court granted summary judgment in favor of the plan, and Gray appealed to the U.S. Court of Appeals for the 9th Circuit.

The 7th Circuit reversed the district court, finding that the retroactive application of the withdrawal liability violated the Due Process Clause of the 5th Amendment, and the plan and the PBGC appealed to the U.S. Supreme Court.

The Court stated that it was rational for Congress to conclude that the purposes of the MPPAA would be more effective if the withdrawal provisions were applied retroactively because it would prevent employers from attempting to avoid the withdrawal liability by terminating their participation in the plan during the lengthy legislative process, and reversed the 7th Circuit’s decision.

Earlier this year, on March 16, 2012, in Shelter Distribution, Inc. v. General Drivers, Warehousemen & Helpers Local Union No. 89, No. 11-5450 (6th Cir. 2012), the U.S. Court of Appeals for the 6th Circuit cited to Pension Benefit Guaranty Corp. v. R.A. Gray in holding, in a case of first impression, that it is not a violation of public policy for a union to indemnify an employer for any contingent liability incurred due to ERISA and the MPPAA.

Baruch A. Fellner argued before the U.S. Supreme Court on behalf of the plan and the PBGC, with Henry Rose, Mitchell L. Strickler, J. Stephen Caflisch, Peter H. Gould, David F. Power, Nathan Lewin, Seth P. Waxman, William B. Crow, James N. Westwood, William H. Walters, and David S. Paul joining him on the brief.

Thomas M. Triplett argued before the U.S. Supreme Court on behalf of R.A. Gray Co. and filed the brief.

Today in ERISA History

June 12, 2000 – The U.S. Supreme Court releases a pair of decisions about ERISA’s fiduciary provisions both on appeal from the U.S. Court of Appeals for the 7th Circuit.

In Pegram et al. v. Herdrich, 530 U.S. 211 (2000), the Court addressed whether treatment decisions made by a health maintenance organization, acting through its physician employees, are fiduciary acts within the meaning of ERISA, holding that they are not. Dr. Lori Pegram worked for a health maintenance organization which provided pre-paid medical services. Cynthia Herdrich, who was covered by the HMO through her husband’s employer, went to see Dr. Pegram after suffering pain in her groin area. Instead of sending her to a local hospital for an ultrasound, Dr. Pegram scheduled her for an ultrasound 8 days later at a facility owned by the HMO which was 50 miles away. Before the ultrasound was performed, Ms. Herdrich’s appendix ruptured, causing peritonitis, and Ms. Herdrich filed a lawsuit against Pegram and the HMO, alleging medical malpractice, fraud and violations of ERISA’s requirement that fiduciaries discharge their duties with respect to a plan solely in the interest of the participants and beneficiaries.

The district court granted the HMO’s motion to dismiss the claims based in ERISA as the HMO was not involved in the events as an ERISA fiduciary, and Ms. Herdrich prevailed at trial on her medical malpractice claims.

The U.S. Court of Appeals for the 7th Circuit reversed the dismissal of the ERISA claims, holding that the HMO was acting as a fiduciary when its physicians made the challenged decisions and that Ms. Herdrich’s allegations were sufficient to state a claim.

The Supreme Court , after a thorough discussion of ERISA’s fiduciary provisions, holds that mixed eligibility decisions by HMO physicians are not fiduciary decisions under ERISA, and reverses the judgment of the Court of Appeals, finding that Ms. Herdrich’s ERISA count fails to state an ERISA claim.

In Harris Trust and Sav. Bank v. Salomon Smith Barney Inc., 530 U.S. 238 (2000), the Court addressed whether ERISA section 502(a)(3) authorizes a “participant, beneficiary or fiduciary” of a plan to bring a civil action to obtain “appropriate equitable relief” to redress violations of ERISA Title I extends to a lawsuit brought against a nonfiduciary “party in interest” to a transaction barred by ERISA section 406(a). The Court held that it does.

In Harris, the Ameritech Pension Trust (APT or the Plan) provided pension benefits to employees and retirees of Ameritech , its subsidiaries and affiliates. Salomon Smith Barney (Salomon) provided broker-dealer services to the APT Plan, executing nondiscretionary equity trades at the direction of APT’s fiduciaries. During the same period, Salomon sold interests in several motel properties to APT. APT’s purchase of the motel interests was directed by National Investment Services of America (NISA), an investment manager to which Ameritech had deleted investment discretion over a portion of the plan’s assets, making NISA a fiduciary of the Plan.

Harris Trust and Savings Bank, the Plan’s trustee, and Ameritech discovered that the motel interests were nearly worthless, and filed a lawsuit against Salomon under ERISA section 502(a)(3), claiming that NISA, as the Plan’s fiduciary, caused the plan to engage in a prohibited transaction under ERISA section 406(a) in purchasing the motel interests from Salomon, and that Salomon was liable on account of its participation in the transaction as a nonfiduciary party in interest.

Salomon motioned the district court for summary judgment, arguing that ERISA only authorizes a lawsuit against the fiduciary who caused the plan to enter into the transaction and not against a nonfiduciary party to the transaction. The district court did not agree with Salomon and denied the motion for summary judgment, holding that ERISA does provide a private cause of action against nonfiduciaries who participate in a prohibited transaction.

Salomon appealed the U.S. Court of Appeals to the 7th Circuit, which agreed with Salomon and reversed the decision of the district court. Harris appealed this decision to the U.S. Supreme Court.

The Supreme Court agreed that ERISA section 406(a) imposes a duty only on the fiduciary that causes a plan to engage in the transaction, but disagreed with the 7th Circuit conclusion that, absent a substantive provision of ERISA expressly imposing a duty upon a nonfiduciary party in interest, the nonfiduciary party may not be held liable under ERISA section 502(a)(3). The Court said that ERISA section 502(l) compels the conclusion that ERISA section 502(a)(3) supports the ability to bring an action against a nonfiduciary because it contemplates civil penalty actions against 2 classes of defendants – fiduciaries and “other persons” who “knowingly participates in any violation…by a fiduciary.”

The Court then found that in action for restitution against a transferee of tainted plan assets satisfies the “appropriateness” criterion of ERISA section 502(a)(3), reversed the decision of the 7th Circuit and remanded the case for further proceedings.