Obtaining the proper plan documents and contract language is essential to evaluating whether an ERISA-regulated healthcare plan has a right to seek reimbursement from an injured party's tort recovery. That's the raison d'etre of 29 U.S.C. 1024(b)(4), which lays out what documents the plan administrator has a duty to provide the beneficiary when requested. Failure to provide the requested documents within 30 days can subject the plan administrator to penalties of $110 a day, pursuant to statute 29 U.S.C. 1132.
But how do you enforce the penalty and who is liable to pay it? That's answered in an informative article by Chattanooga disability benefits attorney Eric Buchanon.
The 11th Circuit has upheld penalties when plan administrators fail to timely provide documents when requested by plan beneficiaries. Curry v. Contract Fabricators, Inc., 891 F. 2d 842, 848 (11th Cir. 1990). In fact, a Georgia district court upheld a $5000 penalty against a plan administrator in 1996. Hamilton v. Mecca Inc., 930 F. Supp. 1540, 1557 (S.D. Ga. 1996). In each of these cases, the plan administrator was personally liable for the failure to provide requested documents from the plan beneficiary.
Buchanon's article offers an exhaustive list of other circuits which have enforced these penalties, citing approximately 50 cases in which a court has upheld fines. However, how courts decide when penalties are appropriate, and to what degree, varies considerably according to cases cited in the article.
These cases show that the penalties referenced in ERISA regulations do have teeth. When faced with a reluctant or non-responsive plan, a letter citing these cases may be the motivation a plan administrator needs to finally provide the documents the beneficiary has a right to see.
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.
But how do you enforce the penalty and who is liable to pay it? That's answered in an informative article by Chattanooga disability benefits attorney Eric Buchanon.
The 11th Circuit has upheld penalties when plan administrators fail to timely provide documents when requested by plan beneficiaries. Curry v. Contract Fabricators, Inc., 891 F. 2d 842, 848 (11th Cir. 1990). In fact, a Georgia district court upheld a $5000 penalty against a plan administrator in 1996. Hamilton v. Mecca Inc., 930 F. Supp. 1540, 1557 (S.D. Ga. 1996). In each of these cases, the plan administrator was personally liable for the failure to provide requested documents from the plan beneficiary.
Buchanon's article offers an exhaustive list of other circuits which have enforced these penalties, citing approximately 50 cases in which a court has upheld fines. However, how courts decide when penalties are appropriate, and to what degree, varies considerably according to cases cited in the article.
These cases show that the penalties referenced in ERISA regulations do have teeth. When faced with a reluctant or non-responsive plan, a letter citing these cases may be the motivation a plan administrator needs to finally provide the documents the beneficiary has a right to see.
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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