In Soehnlen v. Fleet Owners Ins. Fund, 844 F.3d 576 (6th Cir. 2016), an employer, its CEO, and an hourly employee (for themselves and as representatives of a putative class of similarly situated employees) sued the defendant for violating ERISA and PPACA (Obamacare) by maintaining per-participant and per-beneficiary caps on benefits. Plaintiff employer bought supplemental health insurance to eliminate those caps. The Plan asserted that it was a grandfathered plan and therefore not required to eliminate the caps.
The district court dismissed plaintiffs’ claims for lack of standing, and the Sixth Circuit affirmed, providing another example of the tightening of federal standing after Spokeo, Inc. v. Robins, 136 S.Ct. 1540 (2016). Spokeo is discussed in more detail in a previous post.
Plaintiffs asserted a claim for monetary and injunctive relief under 1132(a)(1)(B). The court assumed that plaintiffs had asserted a valid claim under ERISA, but noted that this was not enough to provide standing, as the plaintiffs must also show that they meet the elements of Article III. To meet the Article III element of a concrete injury, plaintiffs asserted that certain members of their class suffer from conditions that previously required medical expenses in excess of the Plan’s caps, and that some members will delay medical treatment to avoid exceeding the cap. However, the court ruled that the plaintiffs themselves had to have suffered a particularized, concrete injury, and could not avoid that requirement by proceeding as class representatives. The court also held that merely paying money into a non-compliant plan does not create a concrete or particularized injury.
Plaintiffs also asserted a claim under 1132(a)(3) for monetary relief and to enjoin future violations. The court held that plaintiffs must establish an injury-in-fact to obtain monetary relief under that section, and failed to do so. The court also rejected plaintiffs’ argument that they could obtain equitable relief without showing actual harm; the court observed that, to the extent such an exception exists, it applies only when a plaintiff is alleging a breach of fiduciary duty claim on behalf of the plan.