Question: Is there any authority I can cite to a third-party administrator of an ERISA plan to force it to disclose plan documents to me? I believe it is an insured plan, and so subject to state insurance laws, but the third-party administrator has ignored my request that it produce certain plan documents. I would like to see these to determine for myself if the plan is self-funded or insured. Thanks for your help.
Answer: As you are probably aware, ERISA grants a plan participant the right to make a written request and receive certain specified documentation from the plan administrator. This right is stated at 29 U.S.C. § 1024(b)(4) which provides as follows:
The administrator shall, upon written request of any participant or beneficiary, furnish a copy of the latest updated summary, plan description, and the latest annual report, any terminal report, the bargaining agreement, trust agreement, contract, or other instruments under which the plan is established or operated.
The failure to provide this information within 30 days can result in the imposition of a penalty of up to $110 per day for each day of noncompliance. See 29 U.S.C. § 1132(c)(1)(B) and 29 C.F.R. § 2575.502c-1 (increased penalty from $100 to $110).
The problem is that this applies to a plan administrator and not the claims administrator. Under the circumstances of your case I would suggest going directly to the employer with the request (plan administrator) or attempting to argue that the actions of the claims administrator can be imputed to the plan administrator. To this second option, under some circumstances a 502(c) penalty can be based on information requests that were not directed to the plan administrator… Boone v. Leavenworth Anesthesia, Inc. 20 F.3d 1108 (10th cir. 1994)(letters addressed to company’s counsel who handled the business of the plan satisfied the requirement); McKinsey v. Sentry Ins. Co. 986 F.2d 401 (10th Cir. 1993)( If other personnel routinely answer requests from participants, their actions may be imputed to the administrator, and a request to them is equivalent to request to administrator).
I hope you found this response helpful.
Sylvius von Saucken - Chief Compliance Officer
Leave a Comment