Class Certification Denied in ERISA Health Coverage Lawsuit

Overview


A federal district court denied class certification to health plan participants who claimed the plan promised them lifetime benefits. The court found too many individualized questions about what the plan told each participant, and the claims could not be resolved on a class-wide basis. Fitzwater, et al. v. Consol Energy, Inc., et al., No. 2:16-cv-09849 and 1:17-cv-03861 (S.D.W.Va., October 15, 2019).

In Depth


Retired miners, who previously worked at mine sites owned by CONSOL Energy, Inc. (CONSOL), sued under ERISA when the company terminated their healthcare benefits. They alleged that beginning in the early 1980s, CONSOL representatives promised them, verbally and in writing, lifetime medical benefits. They alleged that these promises appeared, in part, in slide-show presentations and hand-outs given to many participants, and the company also referred to alleged lifetime benefits in response to the employees’ attempts to unionize in 2010.

The plaintiffs sought a class action on behalf of all participants who were promised the lifetime health benefit. They alleged that the issues were appropriate for class treatment because the defendants promised one single, unified benefits plan with medical, prescription drug, dental, vision and life insurance coverage. But the court denied their request for class certification because the written plan documents did not establish a lifetime plan. Informal documents like summary plan descriptions and plan explanations of terms generally cannot override the terms of the binding plan document, particularly when the informal documents expressly defer to the formal plan documents if there is any conflict. The Court rejected the plaintiffs’ argument that verbal or written representations created binding rights because those alleged rights were not in the plan document itself.

The Court also found that there were too many individualized questions for the case to be handled on a class-wide basis. The claims inherently involved questions about what the plan told which participants and when, which the Court characterized as “scattered” questions about supposed statements without a “uniform message.” The Court noted that the claims also required the plaintiffs to prove which participants actually relied on the alleged representations.

McDermott Thoughts

There have been many recent reports of plaintiff-side law firms investigating potential claims against fiduciaries of ERISA health plans, and the Fitzwater case reminds us that ERISA claims are subject to the same class-action requirements that apply to all claims in federal court. In fact, class certification appears particularly inappropriate when claims involve supposed representations that differ from the express terms of the binding plan documents—so long as the plan documents indicate that any conflicts must be resolved in favor of the plan document’s terms and participants should not rely on representations.

The Fitzwater case also reminds us that plan documents should be carefully drafted to avoid participant misunderstandings and protect plan sponsors and fiduciaries.