Justia Insurance Law Opinion Summaries

Appellants filed suit against nine pilots and their spouses asserting claims for equitable relief under 29 U.S.C. 1132(a)(3) of ERISA where appellants alleged that the pilots and their spouses obtained "sham" divorces for the purpose of obtaining lump sum pension distributions from the Continental Pilots Retirement Plan. At issue was whether ERISA, 29 U.S.C. 1056(d)(1), allowed a retirement plan administrator to seek restitution of benefits that were paid to a plan participant's ex-spouse pursuant to a domestic relations order such as a divorce decree, if the administrator subsequently determined that the domestic relations order was based on a "sham" divorce. The court agreed with the district court's holding that subsection 1056(d)(3)(D)(i) did not authorize an administrator to consider or investigate the subjective intentions or good faith underlying a divorce. Therefore, the court affirmed the district court's dismissal of appellants' claims.

Plaintiff, the father of decedent, commenced an action seeking to recover from defendants, decedent's grandparents, for decedent's wrongful death and for her conscious pain and suffering where she accidentally drowned in defendants' pool. At issue was an exclusion in defendants' homeowner's insurance policy excluding coverage for bodily injury to an insured where an insured would receive "any benefit" under the policy. The court held that judgment should have been granted in plaintiff's favor where the exclusion did not operate to bar coverage for the noninsured plaintiff's wrongful death claim for the death of the insured decedent. Accordingly, the court reversed the Appellate Division's judgment and remanded for further proceedings.

The biological mother of three children lived with the children and their adoptive mother and named the adoptive mother as beneficiary on one of her life insurance policies through her employer. She did not name beneficiaries on other policies and, after she died, the insurers rejected claims on behalf of the children. The district court dismissed claims under the Employee Income Security Act (ERISA), 29 U.S.C. 1001, which lists children as default beneficiaries. The Third Circuit vacated and remanded. ERISA grants standing to participants and beneficiaries; whether the term "children," as used in the insurance contracts, includes biological children who have been adopted by a non-participant is ambiguous. There was evidence of the insured's intent to benefit the children, sufficient to create a colorable claim adequate to support standing.