The Eleventh Circuit has joined every other Court of Appeals to consider the issue by holding that an ERISA beneficiary may recover under ERISA’s Section 1132(a)(3), which permits an action for “appropriate equitable relief,” benefits lost as a result of a breach of fiduciary duty. Gimeno v. NCHMD, Inc., 38 F.4th 910 (11th Cir. June 28, 2022).
Justin Polga was a doctor employed by NCHMD, Inc. When Dr. Polga was hired, he elected to add $350,000 in supplemental life insurance to his benefits, and NCHMD’s human resources staff helped him complete the insurance enrollment paperwork. Polga received a benefits summary indicating that he had the supplemental coverage, and premiums for the supplemental coverage were deducted from his pay. But he never received from NCHMD—and therefore never completed—an evidence-of-insurability form required by the insurer. When Dr. Polga died, the insurance company denied his spouse’s claim for the supplemental benefits because it had never received the required form.
Dr. Polga’s spouse, Gimeno, sued NCHMD and its parent under Section 1132(a)(1)(B) of ERISA, which authorizes an action “to recover benefits due to [a beneficiary] under the terms of [an ERISA] plan.” Gimeno alleged that the defendants had breached their fiduciary duties to administer the plan properly, to inform Dr. Polga of his rights and benefits, and to ensure that all required forms were submitted. He sought an order requiring payment of the $350,000 supplemental insurance benefit.
The defendants moved to dismiss, arguing that they were not insurers and thus had no obligation to pay benefits. Gimeno responded with a request to amend his complaint to assert his claims under ERISA’s Section 1132(a)(3), which permits claims for “appropriate equitable relief.” The district court granted the motion to dismiss and denied the leave to amend, holding that amending the complaint would be futile because an award of insurance benefits was not equitable relief.
The Eleventh Circuit, in an opinion written by Judge Brasher and joined by Judge William Pryor and Judge Rosenbaum, reversed. The court began by noting that “equitable relief” refers to relief that was typically available in equity, and that the category includes some kinds of monetary relief. “Courts in equity could order restitution of ‘particular funds or property in the defendant’s possession,’” the court noted, and could also “impose equitable surcharge—an order that a trustee compensate a trust beneficiary for a loss due to a breach of fiduciary duty.” In CIGNA Corp. v. Amara, 563 U.S. 421 (2011), the court observed, the Supreme Court vacated a decision that relied on ERISA’s Section 1132(a)(1)(B) to order a plan administrator to pay higher benefits but also noted, for the benefit of the court on remand, that the remedy sought closely resembled that of “equitable surcharge,” which might be available under Section 1132(a)(3). Since then, every circuit court to address the issue has held that Section 1132(a)(3) creates a cause of action for monetary relief for breaches of fiduciary duty. The Eleventh Circuit joined that group, holding that it was error for the district court to conclude that it would be futile for Gimeno to amend his complaint to add a claim under Section 1132(a)(3).