So you have an unwinnable lawsuit alleging wrongful denial of ERISA benefits. How do you stop the bleeding?

Paying the claim during the lawsuit may moot the claims and end it right there, even if plaintiff continues to seek attorney fees.

Here’s the decision of Templin v. Independence Blue Cross, (E. D. Pa. May 13, 2011) (no determination has been made as to publication). It shows what can happen when the ERISA plan decides to pay a claim during a pending lawsuit alleging wrongful denial of benefits.

Does payment of the claim render the lawsuit moot? Yes.

Does plaintiffs’ claim for attorney fees trump the mootness principle? Maybe not.

FACTS: Both plaintiffs were hemophiliacs covered under an ERISA health plan and they sought prescription benefits–payments for a blood medication. After defendants denied the benefit, plaintiffs sued and the Court ordered defendants to conduct an expedited administrative review. Following expedited review, defendants approved the claims. Defendants then moved to dismiss, contending the claims pending before the court were moot. Plaintiffs argued, however that mootness did not apply because plaintiffs’ attorney fees and costs had not been paid.

TRIAL COURT HELD: Defendants approved the claim during the pending lawsuit and therefore the claims are moot, even though plaintiffs’ continue to seek attorneys fees in the lawsuit.

RATIONALE:

  1. “Under traditional mootness principles, ‘[o]nce the defendant offers to satisfy the plaintiff’s entire demand, there is no dispute over which to litigate” and the payment ‘will generally moot the claim.” Op. at 10
  2. The case became moot once the disputed claims for benefits were paid. Id.
  3. “‘[A] request for [attorney] fees does not preserve a claim that otherwise has become moot.'” Op. at 11 (emph. added), citing Tannenbaum v. Unum Life Ins. Co, of Am., 2010 WL 2649875 at 6, n.14 (E.D. Pa, June 30, 2010) and Lewis v. Continental Bank Corp., 494 U.S. 472, 480 (1990)(a plaintiff’s “interest in attorney’s fees is …insufficient to create an Article III case or controversy where none exists on the merits of the underlying claim”). Op. at 11.
  4. Plaintiffs’ attorney fees incurred during the pre-litigation administrative process are not recoverable. “[T]his holding would apply to equal force to [attorney fees incurred during] administrative proceedings post-filing of the complaint in a case where plaintiff failed to exhaust administrative remedies before filing suit.” Op. at 11, n. 14.
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Photo of Mike Reilly Mike Reilly

Mike Reilly is a nationally recognized labor, employment and employee benefits attorney, named one of the “Top 100 Most Powerful Employment Attorneys in the Nation” for the past five consecutive years by Human Resource Executive®. He has decades of experience providing strategic employment…

Mike Reilly is a nationally recognized labor, employment and employee benefits attorney, named one of the “Top 100 Most Powerful Employment Attorneys in the Nation” for the past five consecutive years by Human Resource Executive®. He has decades of experience providing strategic employment advice, and has represented clients in more than 75 jury trials, arbitrations, bench trials and claims before the EEOC and Washington State Human Rights Commission.

Small and large employers retain Mike for his strategic advice and decades of experience in employment issues and litigation, business decisions and litigation avoidance. Mike provides advice in claims involving discrimination, retaliation, wrongful discharge, disability accommodation, ERISA and non-ERISA employee benefit claims, and wage/hour claims. He served as lead counsel in an employee raiding/trade secret case as reported in the Wall Street Journal, and defends employers in class action claims.

Mike’s remarks on employment issues have been quoted in NewsweekCorporate Legal TimesSeattle TimesEmployee Relations Law JournalPuget Sound Business JournalCFO.com, and other professional journals and management publications. Chambers USA’s Guide to America’s Leading Lawyers for Businessrates Mike in the top ranking (band one) for his work in labor and employment law, and has described him as “one of Seattle’s top-rate attorneys” who is “truly phenomenal [with] superb legal instincts” and “an amazingly assertive litigator.” His clients include Nordstrom, Seattle Seahawks, Home Depot, KeyBank, Starbucks, Fred Hutchinson Cancer Research Center, Red Robin and Seattle Chamber of Commerce, among others.