District Court Judge Elaine Bucklo of the Northern District of Illinois entered summary judgment in favor of CMN client, First Commonwealth Insurance Company, in a class action brought on behalf of a putative class of dental HMO members under Section 1132(a)(1)(b) of ERISA and the federal common law of promissory estoppel. The class plaintiff contended that First Commonwealth’s marketing brochure and use of market data from outside sources to establish the fee schedule of dental charges in defined geographic areas to determine plan participants’ copayments was misleading.
In ruling for First Commonwealth, the Court adopted CMN’s primary arguments that the named class representative failed to exhaust administrative remedies under ERISA and that he failed to show there were any knowing misrepresentations in the plan documents. The Court also held that it was unreasonable for the plaintiff to rely on the brochure alone since it referred plan participants to other plan documents which provided a more complete description of plan benefits. Upon entry of summary judgment for First Commonwealth, Judge Bucklo then denied the motion for class certification as moot.
The decision in Kaden v. First Commonwealth, No. 05 C 2212, clarifies the law with respect to the exhaustion of administrative remedies doctrine and the requirement that any ERISA estoppel claim must be supported by a knowing misrepresentation. The winning briefs were written by CMN member, David Schmidt, with the assistance of associate, Joseph Jeffery. See attached Memorandum Opinion and Order.
Memorandum Opinion and Order
David F. Schmidt
Joseph J. Hasman
Joseph R. Jeffery