Lou v. Accenture United States Group Health Plan

Background

Albert B. Lou was employed by Accenture LLP from April 2019 through December 15, 2022. Through that employment, he was eligible to participate in the Accenture United States Group Health Plan. Lou enrolled himself and his daughter, A.L., in the plan’s preferred provider organization plan, administered by Health Care Service Corporation doing business as Blue Cross Blue Shield of Illinois (BCBSIL).

Lou submitted claims for coverage of A.L.’s in-home skilled nursing care. BCBSIL paid some claims but not others. Lou filed this ERISA action against Accenture LLP, the Accenture United States Group Health Plan, and BCBSIL concerning the allegedly wrongfully denied claims.

After Accenture notified Lou that his employment would end as part of a group layoff, it provided him with a separation agreement. The agreement offered separation benefits, including six months’ salary, a variable cash benefit, a $12,000 COBRA payment, and outplacement services. It also contained a broad general release covering “any and all claims of any nature whatsoever” against Accenture and defined “Released Parties” to include Accenture’s affiliates, representatives, fiduciaries, and agents.

Lou repeatedly asked Accenture to exclude his ERISA claims from the release. Accenture did not make that change. Lou signed the agreement on February 24, 2023, and later stated that he understood the release did not cover the pending lawsuit or claims against the health plan and its claims administrator.

Motions and legal standard

Lou moved for summary adjudication on whether he had released his ERISA claims and whether he was entitled to benefits under 29 U.S.C. § 1132(a)(1)(B) and (a)(3). Accenture LLP and the Plan filed a cross-motion for summary judgment, arguing that Lou had released his claims. BCBSIL separately moved for summary judgment, arguing that Lou lacked standing and that it had correctly administered the Plan.

Summary judgment is appropriate when the evidence shows no genuine dispute about a fact that could affect the outcome and the moving party is entitled to judgment under the law. The court must not weigh evidence or decide witness credibility when determining whether such a dispute exists.

Analysis

The Court first addressed the release because that issue could resolve the case without deciding whether Lou was entitled to benefits. The Court applied the heightened scrutiny used for ERISA releases and considered whether Lou knowingly and voluntarily agreed to the release under the totality of the circumstances. The factors included Lou’s education and business experience, the parties’ roles in creating the waiver, the agreement’s clarity, the time available for review, access to independent legal advice, and the consideration provided for the waiver.

The Court found that Lou’s education and extensive business-management experience supported a knowing and voluntary release. The Court found the parties’ respective roles neutral because Lou proposed revisions and Accenture discussed them and extended the review period, but Lou ultimately did not meaningfully determine the waiver’s provisions.

The Court concluded that the release clearly covered Lou’s ERISA claims. Although the agreement did not specifically use the word “ERISA,” it covered all claims of any nature and specifically included claims related to Lou’s employment. The Court also relied on the surrounding circumstances: Lou was actively litigating and mediating the ERISA case while reviewing the separation agreement, repeatedly sought an ERISA carveout, and was told that Accenture would not revise the agreement.

The Court found that Lou had more than 100 days to review the agreement, had seven days after signing to reconsider and revoke it, and had advice from two lawyers. These factors supported a knowing and voluntary release. The Court also found that Accenture provided the consideration required by the separation agreement and that separate consideration for releasing the ERISA claims was not necessary.

The Court therefore held that Lou knowingly and voluntarily released his ERISA claims against Accenture when he signed the separation agreement.

Application to the Plan and BCBSIL

The Court also held that the release covered the Accenture United States Group Health Plan even though the agreement did not name the Plan specifically. Accenture sponsored and controlled the Plan within the meaning of the separation plan’s definition of an affiliate.

The Court further held that BCBSIL was a fiduciary of the Plan because it had discretionary authority to make final decisions about whether medical claims would be paid or denied. Because the release covered fiduciaries and agents of released entities, the Court concluded that it also covered Lou’s claims against BCBSIL.

Future benefits and disposition

The Court rejected Lou’s argument that the release could not cover claims for future benefits. It reasoned that the claims in the lawsuit existed before Lou signed the separation agreement, even though the requested relief included clarification of future rights under the Plan. The Court consequently did not reach whether Lou was entitled to payment for A.L.’s past or future care.

The Court granted the Accenture defendants’ motion for summary judgment and denied Lou’s motion for summary adjudication. Because the Court found that Lou had waived his claims against BCBSIL, it terminated BCBSIL’s motion for summary judgment as moot and terminated Lou’s request for judicial notice as moot. The Clerk was directed to enter judgment for the defendants and close the case.