Killian v. Concert Health Plan, 742 F.3d 651

Susan Killian diagnosed with metastatic lung cancer in Feb 2006, underwent emergency brain surgery at Rush, and died months later.
Killian enrolled in Royal Management’s group plan administered by Concert; Concert denied or heavily discounted coverage for Rush services.
Estate administrator James Killian sued Concert, Concert Health Plan, Royal Management, and Royal Plan for denial of benefits, breach of fiduciary duty, and statutory penalties.
ERISA plan documents were incomplete or silent on provider network status; participants were instructed to call a plan-provided number to verify network participation.
The card and policy directed use of specific numbers for provider participation and utilization review; the record shows confusion about which numbers applied and whether Rush was in Network.
On remand, court limited review to whether Rush/Drs. were in-network and whether a breach of fiduciary duty occurred due to the calls, with other issues reserved.

Issue	Plaintiff's Argument	Defendant's Argument	Held
Breach of fiduciary duty for failure to provide a summary plan description	Kilian argues lack of SPD harmed estate by obscuring network status	Defendants contend no harm showed from missing SPD	Ruled: breach conceded for SPD but no harm shown; uphold summary judgment on this claim
Breach of fiduciary duty from April 7, 2006 calls about network status	Kilian contends Concert failed to inform out-of-network status during calls	Concert argues no notice given; calls were for preadmission not network inquiry	Remanded for trial on whether calls put Concert on notice and whether breach caused harm
Mootness and standing of the estate litigation	Estate’s claims remain a live controversy	Estate moot due to closure and lack of remaining liability	Not moot; live controversy remains; remand appropriate for liability/remedy aspects
Remedy for breach of fiduciary duty if proven	Estate seeks monetary and declaratory relief	Equitable relief limited by ERISA	Remand for remedies consistent with ERISA and contract principles; potential declaratory relief considered

Kenseth v. Dean Health Plan, Inc., 610 F.3d 452 (7th Cir. 2010) (duty to convey complete information when fiduciary aware of beneficiary's status)
Bowerman v. Wal-Mart Stores, Inc., 226 F.3d 574 (7th Cir. 2000) (incomplete plan documents expose fiduciary to liability for agent mistakes)
Love v. National City Corp. Welfare Benefits Plan, 574 F.3d 392 (7th Cir. 2009) (substantial-compliance with notification can still fail under ERISA)
Chafin v. Chafin, 133 S. Ct. 1017 (2013) (case becomes moot only if no practical relief remains; heavy burden on movant)
Kenseth v. Dean Health Plan, Inc., 610 F.3d 452 (7th Cir. 2010) (reiterates duty to inform and errors by plan representatives)
Eastern v. Amara, 131 S. Ct. 1866 (2011) (equitable relief concepts under ERISA; surcharges/estoppel potential)