To evaluate the respective rights of your client and their healthcare plan in terms of subrogation and reimbursement it is critical to obtain a variety of documents from the "plan administrator."
However, determining just who the plan administrator actually is, and then reaching the administrator and hopefully receiving answers to your requests, are often the first challenges to determining each party's rights.
An article by South Dakota School of Law Professor Roger M. Baron, lays out the importance of making a proper request for these documents, and the pitfalls of seeking the equivalent information from anyone other than the "plan administrator." The article was published in several trial magazines, and is available on his website.
For plans governed by ERISA, federal law 29 U.S.C. 1024 grants the beneficiary (your client) the right to obtain numerous documents from the "plan administrator." This person is designated in the plan documents, and usually a human resources director or someone else working for the client's employer. There are a host of documents the law requires the plan administrator to provide when requested by the beneficiary -- copies of the Summary Plan Description, the annual report, the trust agreement, contracts and other "instruments under which the plan is established or operated." 29 U.S.C. 1024(b). Failure of the plan administrator to provide any of these requested documents within 30 days creates a penalty against the administrator of $110 per day.
This is important because it requires the plan administrator to provide documents you need to evaluate your client's rights within 30 days, or face a penalty. As the days accrue without your client's documents in hand, the greater the plan administrator's potential liability to your client.
But beware of attempting to enjoy this benefit from third-parties allegedly acting on behalf of the plan or even the plan administrator, Baron says. Many healthcare plans outsource subrogation and reimbursement requests to third parties, often referred to as "plan representatives." These third parties may or may not comply with your requests for information. According to Baron's article, you deal with these entities at your own risk, as it is unclear whether these third-parties are at all accountable to the requirements of 29 U.S.C. 1024 and the ensuing penalties.
Baron also offers several helpful hints on identifying the plan administrator, including asking the client to make the request in their own letter or even submitting the request in person. It is unclear he says if the protections of the Federal law are triggered by the attorney, and not the beneficiary, making the request.
Ben Price is a partner at the law firm of Jarrett & Price in Savannah, Georgia. The information on this site is intended for Plaintiff's lawyers only. The content on this site does not establish an attorney-client relationship and in no way should be considered legal advice.
However, determining just who the plan administrator actually is, and then reaching the administrator and hopefully receiving answers to your requests, are often the first challenges to determining each party's rights.
An article by South Dakota School of Law Professor Roger M. Baron, lays out the importance of making a proper request for these documents, and the pitfalls of seeking the equivalent information from anyone other than the "plan administrator." The article was published in several trial magazines, and is available on his website.
For plans governed by ERISA, federal law 29 U.S.C. 1024 grants the beneficiary (your client) the right to obtain numerous documents from the "plan administrator." This person is designated in the plan documents, and usually a human resources director or someone else working for the client's employer. There are a host of documents the law requires the plan administrator to provide when requested by the beneficiary -- copies of the Summary Plan Description, the annual report, the trust agreement, contracts and other "instruments under which the plan is established or operated." 29 U.S.C. 1024(b). Failure of the plan administrator to provide any of these requested documents within 30 days creates a penalty against the administrator of $110 per day.
This is important because it requires the plan administrator to provide documents you need to evaluate your client's rights within 30 days, or face a penalty. As the days accrue without your client's documents in hand, the greater the plan administrator's potential liability to your client.
But beware of attempting to enjoy this benefit from third-parties allegedly acting on behalf of the plan or even the plan administrator, Baron says. Many healthcare plans outsource subrogation and reimbursement requests to third parties, often referred to as "plan representatives." These third parties may or may not comply with your requests for information. According to Baron's article, you deal with these entities at your own risk, as it is unclear whether these third-parties are at all accountable to the requirements of 29 U.S.C. 1024 and the ensuing penalties.
Baron also offers several helpful hints on identifying the plan administrator, including asking the client to make the request in their own letter or even submitting the request in person. It is unclear he says if the protections of the Federal law are triggered by the attorney, and not the beneficiary, making the request.
Ben Price is a partner at the law firm of Jarrett & Price in Savannah, Georgia. The information on this site is intended for Plaintiff's lawyers only. The content on this site does not establish an attorney-client relationship and in no way should be considered legal advice.
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