BENEFITS DIGEST

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A publication of The Inner Firm

Wednesday, October 14, 2026

№ 73

31 items · ~17 min read

Retirement Plans (8)·Health & Welfare (9)·Leave & Time Off (1)·Court Decisions & Case Commentary (13)

The One Thing

A plan’s claims process can’t be treated as a universal waiting room for ERISA lawsuits. In Bolton v. Inland Fresh Seafood, the full Eleventh Circuit overturned its longstanding rule requiring participants to exhaust administrative remedies before bringing statutory ERISA claims, including fiduciary-breach claims. The court found no basis for that requirement in the statute. The case concerns an employee stock ownership plan’s allegedly overpriced stock purchase, but the procedural holding reaches beyond ESOPs. There are two important limits. Ordinary claims for benefits remain subject to the circuit’s existing exhaustion rules. And the court didn’t decide whether a plan can impose a contractual exhaustion requirement for statutory claims. This plan’s language made its process optional. Sponsors in Alabama, Florida and Georgia have lost a familiar defense, but rewriting a claims provision isn’t a court-approved substitute.

Retirement Plans (8)

How Can a Plan Sponsor Handle a Late Audit and 5500 Filing?
PLANSPONSOR 2026-10-13

An unfinished audit leaves a 403(b) sponsor with a filing problem, not an obvious extension. Groom Law Group and CAPTRUST recommend getting a realistic completion date from the auditor and taking that information to outside ERISA counsel. The DOL’s Delinquent Filer Voluntary Compliance Program may help address a late filing, but the authors advise getting counsel’s direction on whether and when to use it. Their answer doesn’t endorse submitting an incomplete Form 5500.

Year-End Compliance Review for Single-Employer Defined Benefit and Defined Contribution Retirement Plans
Milliman 2026-10-13

Year-end review needs to reach beyond the amendment signature page. Milliman’s checklist for single-employer retirement plans covers participant notices, benefit-statement delivery, annual filings, pension premiums and funding certifications, alongside required and discretionary amendments. The administrative work differs between defined benefit and defined contribution plans, and some obligations depend on the plan’s design and calendar. The bulletin also urges sponsors to look backward for amendments that should already have been adopted and consider the available correction procedures if something was missed. Its useful organizing point is to put document changes, operational compliance and participant communications on the same review list. A document deadline doesn’t by itself tell the sponsor when a provision must operate or when employees must receive a notice.

Alternative Assets—DOL Proposal and the Six Defined Factors: The Liquidity Factor
Fred Reish 2026-10-12

A retirement plan can need cash even when its participants aren’t asking for withdrawals. A termination, recordkeeper change or merger can create demands that an investment’s redemption restrictions make difficult to meet. Fred Reish examines the plan-level liquidity example in the DOL’s proposed investment-selection rule. One proposed path would let fiduciaries rely on an eligible mutual fund’s regulated liquidity program. For other vehicles, including collective investment trusts, the example calls for a written representation or appropriate due diligence about a comparable program, critical review of any representation, and attention to information that calls it into question. The proposal would offer a route to a prudence presumption for this factor, not the only way to satisfy ERISA. A representation would still need to be read and understood, not merely filed.

Saver’s Match Seen as Crucial ‘New Entry Point’ Into Retirement Investing for Latinos
401(k) Specialist 2026-10-13

Finhabits estimates that 13.6 million Latino adults could meet the income requirements for the federal Saver’s Match, which applies to eligible contributions beginning with the 2027 tax year. That’s potential eligibility, not a count of people who will enroll or receive a match. Its report models $615 billion to $1.02 trillion in retirement balances over 30 years using assumed participation, contributions, matching payments and investment returns. Those figures are illustrations, not forecasts. The report’s practical emphasis is on making retirement saving easier to understand and sustain, including guidance in English and Spanish. An incentive won’t bring people into the system by itself if opening an account, making contributions or claiming the match remains confusing.

IRIC Seeks to Standardize Retirement Income Terminology
PLANSPONSOR 2026-10-09

Retirement income terminology can promise more than a product delivers. The Institutional Retirement Income Council wants the industry to distinguish broad retirement income strategies from contractual guarantees, and lifetime income from payments intended to last only a fixed period. PLANSPONSOR reports on Kevin Crain’s proposed vocabulary, which also separates protected income from guaranteed income. A systematic withdrawal program, for example, doesn’t become a promise of income for life just because someone calls it a retirement paycheck. For sponsors evaluating products and participant communications, the useful question is what backs the payment and how long that backing lasts.

Americans Unprepared for Retirement Income After Age 80, Guardian Finds
401(k) Specialist 2026-10-13

Only 34 percent of adults surveyed for Guardian’s Retirement Redefined research said they had actively planned for income at age 80 and beyond, compared with 48 percent who had planned for ages 60 through 69. The research covered more than 2,000 U.S. adults and found uncertainty about which years of retirement would cost the most. More than half hadn’t worked with a financial adviser. Guardian argues that advice and guaranteed income products can help address the gap; that recommendation comes from an insurer with an interest in the market. The practical question for retirement education is broader than an account balance. Participants also need to consider how they’ll pay their bills if retirement lasts much longer than they expected.

Retirement Plan Participants Want Control, Allspring Study Finds
401(k) Specialist 2026-10-13

Participants may trust their employer’s retirement plan without wanting to leave their money there forever. An Allspring and Defined Contribution Institutional Investment Association survey of more than 1,500 respondents found that nearly a third wanted guaranteed income benefits in their workplace plan, while 70 percent placed greater importance on access and control. Adviser use increased sharply as retirement approached, and participants working with advisers were more likely to move assets out of the plan. Allspring’s analysis urges sponsors to think explicitly about whether they want to retain retirees’ assets or help participants move into another arrangement. Low fees, useful guidance and a range of income options matter to that choice. The survey describes competing participant preferences; it doesn’t establish that an in-plan annuity or a rollover is the right answer for everyone.

When Was the Last Time You Read Your Own Plan Document?
The Rosenbaum Law Firm P.C · via JD Supra 2026-10-13

The rules an employer thinks its retirement plan follows may not be the rules in the signed document. Ary Rosenbaum urges sponsors to revisit eligibility, employer contributions, vesting, loans and other provisions rather than relying on memory or an old explanation from a provider. A change in personnel or payroll practices can widen the gap between the written terms and day-to-day operation. His recommendation is to read the document with the people administering the plan and resolve discrepancies. Routine familiarity with the provisions makes it easier to identify a problem before it becomes a recurring operational error.

Health & Welfare (9)

Choosing the Right Partner: How Employers and Taft-Hartley Plans Can Evaluate Point Solution Vendors
Milliman 2026-10-13

A health vendor’s savings estimate is only as useful as the assumptions behind it. Milliman’s guide to evaluating point solutions, the separate specialized programs sold alongside a medical plan, asks employers and Taft-Hartley plans to start with the problem they’re trying to solve and the population they want to reach. Pricing deserves close attention, including what counts as an engaged member, which cases trigger a fee and whether shared savings can be independently measured. Before signing, sponsors should agree on the baseline, data access, reporting and performance guarantees they’ll use to judge results. They should also check whether the service duplicates existing benefits and who will handle implementation and member outreach. The strongest sales presentation may still produce a poor fit if the plan can’t measure the promised value or members can’t navigate the extra program.

Designing and Negotiating Affordable Pharmacy Benefits
Segal 2026-10-13

A promise to pass through all rebates doesn’t necessarily capture every payment a pharmacy benefit manager receives from manufacturers. In a newly posted reprint from the second-quarter Benefits Quarterly, Segal’s Edward Kaplan examines how contract definitions, pricing exclusions and reconciliation terms can change the economics of a pharmacy benefit deal. Sponsors should look beyond headline discounts to the drugs and claims those discounts cover, the treatment of generic pricing, and fees or offsets that can dilute a guarantee. The article also considers formulary and clinical management choices. Its contracting advice is a reason to compare the complete arrangement and monitor actual performance, not to assume that a larger rebate or a particular cost-sharing design always produces better value.

Will Rebranding ICHRAs Boost Enrollment?
Employee Benefit News 2026-10-13

Calling individual coverage health reimbursement arrangements CHOICE may make them easier to explain, but benefits specialists disagree about whether the new name will attract employers. These arrangements let employers contribute toward employees’ individual health insurance instead of offering a traditional group policy. Benefitbay’s Brandy Thompson sees clearer messaging in the rebrand, while StretchDollar’s Marshall Darr argues that administrative obstacles matter more than terminology. The EBN report points to renewal timing, individual-market premiums, provider networks and contribution levels as practical concerns. Take Command Health’s Jack Hooper wants changes that would make the arrangements work more smoothly with marketplace assistance. Those are proposals and industry preferences, rather than changes employers can assume the new label has already delivered.

Rep. Pallone Proposes Replacement of No Surprises Act Arbitration With QPA Payment Standard
Holland & Knight · via JD Supra 2026-10-10

Rep. Frank Pallone’s Lower Premiums, Faster Payments Act would replace federal surprise-billing arbitration with a payment standard tied to the qualifying payment amount, generally an inflation-adjusted median contracted rate. The proposal would apply to services furnished beginning January 1, 2028, and require payment within 30 days of receiving the bill. It would also revise how the qualifying payment amount is calculated, including treatment of expected bonuses and risk-sharing payments, and expand audits. The existing statutory roles for specified state laws and all-payer models wouldn’t simply disappear. Holland & Knight explains the proposed shift away from case-by-case arbitration; the bill text shows why the calculation of the payment benchmark would become even more consequential. This is a proposed overhaul, not a change employers should implement now.

New Bill Would Overhaul the No Surprises Act’s Arbitration Process
Healthcare Dive 2026-10-12

Rep. Frank Pallone is proposing to replace federal surprise-billing arbitration with payments tied to a statutory benchmark. Healthcare Dive examines the proposal against complaints about the cost and volume of the existing dispute process and disagreement among healthcare stakeholders over how out-of-network care should be paid. Moving away from individual arbitration would make the payment benchmark—generally an inflation-adjusted median contracted rate—more consequential. The proposal remains legislation under discussion, not a payment rule plans can begin applying. Providers and plans would face different incentives under a fixed benchmark, which helps explain why reform is contested.

Open Enrollment Is Your Benefits Compliance Stress Test
Mitratech · via JD Supra 2026-10-13

Open enrollment tests whether benefit documents, payroll systems, vendor arrangements and employee communications agree. Mitratech’s Angela Surra recommends starting preparations well before enrollment opens, confirming responsibilities and checking the notices and eligibility information employees will receive. The article treats the process as an opportunity to find inconsistencies that a last-minute communication campaign can miss. Employers still need to distinguish their own preparation schedule from the actual deadlines attached to particular notices and plan requirements.

With GLP-1 Costs Rising, a New Study Could Help Employers Target Coverage
Employee Benefit News 2026-10-13

A Health Transformation Alliance analysis of linked health records and claims identifies patient characteristics associated with stronger responses to GLP-1 drugs. Employee Benefit News reports that the research draws on a 12.7 million-patient sample and examines blood sugar and weight outcomes. HTA CEO Rob Andrews argues that employers should ask whether treatment produces lasting health improvements, rather than judging coverage solely by prescription spending. He also draws an important limit. Patterns across populations can’t reliably predict whether an individual will respond and shouldn’t replace decisions between patients and their doctors. Longer-term healthcare cost effects remain uncertain. The findings offer questions for evaluating a coverage program, not a ready-made set of eligibility restrictions.

GLP-1 Savings Grow When Employees Stay on Treatment Longer
Employee Benefit News 2026-10-13

A GlobalData Healthcare and Omada report projects greater medical savings for GLP-1 users who remain on treatment longer, but the figures exclude the drugs’ cost and the price of Omada’s lifestyle program. EBN reports that the model uses data from 24,595 commercially insured Omada members who took a GLP-1 for at least six months and compares them with a modeled scenario without either intervention. Projected five-year medical savings reach $8,578 per member for the group treated at least six months and $11,142 for those treated at least a year. These are modeled savings, not five years of observed net savings for employers. Omada’s chief medical officer argues for evaluating health risks beyond weight and helping patients sustain clinically appropriate treatment.

Beware of Cutting Off GLP-1s Too Soon
Employee Benefit News 2026-10-12

Reaching a target weight shouldn’t automatically end GLP-1 coverage, argues Dr. Tim Church, Wondr Health’s chief medical officer. His EBN commentary describes obesity as a chronic condition and warns that stopping successful treatment can bring weight regain and renewed health risks. He urges employers to examine who makes discontinuation decisions, what support patients receive afterward and whether the program tracks outcomes beyond short-term weight loss or pharmacy spending. Church doesn’t argue that everyone needs medication indefinitely. He favors individualized clinical decisions supported by behavioral care. His case for continued treatment is a vendor medical officer’s policy argument, not proof that keeping every patient on a GLP-1 will reduce an employer’s total costs.

Leave & Time Off (1)

DC Reduces Paid Family and Medical Leave Benefits Under Universal Paid Leave Program Effective October 1, 2026
DLA Piper · via JD Supra 2026-10-14

The District of Columbia reduced benefits under its Universal Paid Leave program effective October 1, 2026. DLA Piper explains that medical leave falls from 12 weeks to 10 and family caregiving leave from 12 weeks to six, while parental and prenatal leave remain at 12 and two weeks. The maximum weekly benefit is $1,100. Employers should use the updated notice and review communications and any benefits that coordinate with the program. The duration reductions run through September 30, 2030; employers shouldn’t assume every changed dollar amount automatically returns to its former level then.

Court Decisions & Case Commentary (13)

Full Eleventh Circuit Ends Required Administrative Exhaustion for Statutory ERISA Claims
U.S. Court of Appeals for the Eleventh Circuit 2026-10-13

Participants bringing statutory ERISA claims in the Eleventh Circuit no longer face the court-created requirement to complete a plan’s administrative claims process first. The full Eleventh Circuit’s Bolton decision overrules that part of its longstanding precedent in a dispute over an employee stock ownership plan’s allegedly overpriced stock purchase. The court found no statutory basis for requiring exhaustion of fiduciary-breach claims. It preserved the existing exhaustion rule for ordinary benefit claims and left mandatory contractual exhaustion provisions unresolved because the plan before it made the process optional. The decision returns the litigation for further proceedings; it doesn’t establish that the stock transaction was unlawful.

Eleventh Circuit Finds No Administrative Exhaustion Required for Statutory ERISA Claims
Seyfarth Shaw · Beneficially Yours 2026-10-13

The full Eleventh Circuit’s decision in Bolton removes the circuit’s judge-made exhaustion requirement for statutory ERISA claims. Seyfarth focuses on the resulting need to review plan language and litigation strategy. The distinction matters because the court found this ESOP’s administrative process optional and expressly left open whether a plan could require exhaustion by contract. It also left the existing rule for ordinary benefit-denial claims alone. The decision reverses the dismissal and sends the case back for further proceedings; it doesn’t decide whether the challenged stock purchase breached a fiduciary duty. Sponsors reviewing mandatory language should treat its enforceability as an unresolved question, not as a replacement defense the court has already blessed.

Eleventh Circuit Drops Its ERISA Exhaustion Requirement for Fiduciary Breach Claims: What Plan Sponsors Need to Know About Bolton v. Inland Fresh Seafood Corp. of Am., Inc.
Falcon Rappaport & Berkman 2026-10-13

Falcon Rappaport & Berkman examines what the Eleventh Circuit’s Bolton decision means for sponsors facing fiduciary-breach litigation. Participants no longer have to complete a plan’s administrative process solely because the circuit previously imposed that requirement on statutory ERISA claims. The firm recommends reviewing claims provisions, governance and litigation preparedness. The opinion itself leaves open whether mandatory plan language could create an enforceable contractual requirement and preserves the existing treatment of ordinary benefit claims. Reviewing the document is sensible preparation, but the court hasn’t approved a wording change that restores the defense it rejected.

Supreme Court Declines to Review Ruby Tuesday Executives’ Deferred Compensation Suit
Supreme Court of the United States 2026-10-13

The Supreme Court declined on October 13 to hear former Ruby Tuesday executives’ suit against Regions Bank over their deferred compensation. The executives’ money was held in a rabbi trust, whose assets remained available to the company’s creditors in bankruptcy. They received a partial recovery through a bankruptcy settlement, then pursued the bank. The Sixth Circuit held that ERISA displaced their state-law claims and that the monetary compensation they sought wasn’t available under ERISA’s provision for equitable relief. The denial leaves that ruling standing without endorsing its reasoning. For executives, the underlying risk remains worth understanding. Putting deferred compensation in a rabbi trust doesn’t protect it from the employer’s creditors.

Tobacco Surcharge Class Action Filed Against Baylor Scott & White Health
U.S. District Court for the Northern District of Texas 2026-10-12

Baylor Scott & White Health is the latest employer to face a tobacco-surcharge class action. In a complaint filed October 12 in the Northern District of Texas, an employee says the health system’s self-funded medical plan charges tobacco users $30 per person each pay period, up to $60, roughly $780 a year for employee-only coverage. She alleges that the plan’s cessation program, surcharge refunds and disclosures don’t meet the requirements for a lawful tobacco surcharge. The plan’s participant materials say the surcharge applies until an employee completes cessation coaching and submits an affidavit, with no promised refund of amounts already collected, and the complaint says the 174-page summary plan description never mentions the surcharge at all. The suit also adds fiduciary-breach and prohibited-transaction claims over the handling of the withheld dollars, which the plan’s own documents route to a welfare trust. The plan had more than 49,000 active participants at the end of 2024. These are allegations, not findings.

Union Moves to Hold CarePoint Debtors in Contempt Over Unpaid 2024 401(k) Contributions
U.S. Bankruptcy Court for the District of Delaware 2026-10-12

A confirmed bankruptcy plan didn’t end the fight over CarePoint Health’s employee retirement money. Health Professionals and Allied Employees, a union representing workers at the New Jersey hospital system, has asked the Delaware bankruptcy court to enforce its February administrative order, compel immediate payment of the 2024 employer 401(k) contributions and hold the reorganized debtors, Hudson Regional Hospital and the hospital managers in contempt. A court-approved stipulation required the debtors to escrow the 2024 contributions in equal monthly installments from March through August 2026 and remit them to the plan’s third-party administrator, Corebridge Financial, by August 31, with lost earnings calculated as ERISA requires. The motion says the 2023 contributions were paid but no 2024 escrow or payment ever happened. The filing presents the union’s side; objections are due October 26, and the hearing is set for November 19.

Federal Court Dismisses Ex-Partner’s 401(k) Suit Against Husch Blackwell
Hall Benefits Law 2026-10-13

A former Husch Blackwell partner couldn’t establish an ERISA violation by treating the firm’s year-end profit-sharing contributions as employee wages withheld from pay. Hall Benefits Law reports that the court granted summary judgment for the firm because the disputed amounts weren’t plan assets before they were deposited. The court distinguished a partner’s draws from employee wages and rejected the argument that further discovery was needed before ruling. The result turns on the contributions and arrangement before the court. It doesn’t authorize employers to retain employees’ withheld salary deferrals or use plan assets for operating expenses.

Does a Late ERISA Appeal Decision Cost the Insurer Deference? Court Reviews Hartford’s Long-Term Disability Denial De Novo and Vacates It
Roberts Disability Law 2026-10-13

Hartford missed a disability-appeal deadline and lost the benefit of deferential court review. In Farley v. Hartford, a Missouri federal judge ruled September 30 that the insurer’s late response required an independent review of its denial, using the record as it stood when the appeal deadline expired. The court also found substantive flaws. Hartford identified jobs requiring retraining that the policy didn’t require, and its vocational analysis conflicted with the physical restrictions its own reviewing doctor imposed. The judge vacated the denial and sent the claim back to Hartford for a renewed review, without ordering immediate payment of benefits.

Adviser Accused of Embezzling His Firm’s Employee Retirement Savings, Ponzi Scheme
PLANSPONSOR 2026-10-13

An Ohio financial adviser allegedly stole employees’ retirement contributions, then used proceeds from a fraudulent mortgage to repay the plan. An October 1 federal indictment charges Seku Shabazz, formerly known as Jason Brooks, with embezzling about $38,081 withheld from approximately 24 employees’ paychecks. It separately alleges that he failed to remit about $44,632 in employer matching contributions to the Great Lakes Financing LLC 401(k) Profit Sharing Plan. Prosecutors say he later used others’ identities to obtain a mortgage on their home and directed roughly $97,069 of the proceeds toward fully repaying the plan, including lost earnings. The 13-count indictment also covers an alleged investment scheme involving more than $1.2 million. These are allegations, not findings of guilt.

20 Years of Excessive Fee Litigation: Lessons for Plan Sponsors and Fiduciaries
Lockton 2026-10-14

Twenty years of excessive-fee litigation have made retirement-plan governance a recurring litigation issue. Lockton reviews the evolution of claims involving investment options, service-provider compensation and fiduciary oversight, along with the financial and insurance consequences of defending them. The article emphasizes records of decision-making and attention to the way coverage responds when claims arise. A settlement doesn’t necessarily establish that a plan’s process was unlawful, and insurance doesn’t substitute for that process. Lockton’s perspective is that sponsors should consider litigation readiness and coverage alongside ongoing plan administration.

District Court Rules Voluntary Benefit Falls Under ERISA’s Purview
PLANSPONSOR 2026-10-13

An employee’s payment of every premium didn’t keep her supplemental disability policy outside ERISA. In Whitlock v. Provident, the court found that Lockton’s role included negotiating a discount, presenting the policy as part of its benefits package and receiving commissions. That involvement defeated the regulatory exemption for certain voluntary insurance arrangements. The court separately ruled that Whitlock hadn’t proved entitlement to partial-disability benefits. PLANSPONSOR reports on the decision. The two results answer different questions about the policy’s legal status and the evidence supporting the claim.

S.D. Cal.: ERISA Governs a “Voluntary” Supplemental Disability Policy, and the Benefits Claim Falls Short
Roberts Disability Law 2026-10-12

Roberts Disability Law’s analysis of Whitlock v. Provident reaches beyond the label on a voluntary benefit. The employer’s endorsement and receipt of commissions brought the supplemental disability policy under ERISA, but the claimant still had to prove that she met its partial-disability definition. A reduction in earnings satisfied one element; it didn’t establish the required limits on her ability to work. The court also found that the final appeal decision used the appropriate disability standard despite a problem in the initial denial. The insurer won on the record, including evidence about the claimant’s continued work in her own business.

Abandoned 401(k) Plan in Washington State Gets DOL-Appointed Fiduciary
PLANSPONSOR 2026-10-09

A closed Washington aircraft-services business left employees with retirement accounts they couldn’t access. PLANSPONSOR reports that a federal court appointed AMI Benefit Plan Administrators Inc. as independent fiduciary for Commercial Aircraft Interiors’ abandoned 401(k) plan after the Labor Department sued. DOL’s complaint identified 59 participants and about $260,000 in plan assets as of January 8, 2026, and said the remaining company representative lacked authority to complete the necessary work. The September 29 default judgment authorizes the independent fiduciary to administer and distribute the remaining assets and terminate the plan.