The Third Circuit U.S. Court of Appeals, in Mirza v. Insurance Administrator of America, Inc., recently held that a notice of benefit denial under ERISA must include a statement of any time limits for filing a claim for judicial review in order for such limits to be enforceable under ERISA. The claimant exhausted the internal appeals process under the employer’s group health plan and received a final benefit denial letter from the claims administrator. Although the letter included a statement of the claimant’s right to bring a civil action under Section 502 of ERISA, the letter did not mention the plan’s one-year limitations period for filing a lawsuit. The federal district court dismissed the lawsuit as being time-barred because notice of the limitations period was contained in the plan’s summary plan description (“SPD”). In reversing, the Third Circuit held that regardless of whether the claimant had notice of the plan’s… Continue Reading
A participant sued both his employer and the insurance company with respect to a long-term disability (“LTD”) policy that had been purchased by the employer. The participant alleged an ERISA breach of fiduciary duty for the failure to increase LTD benefits in accordance with the terms of the summary plan description (“SPD”). The U.S. Court of Appeals for the Sixth Circuit ruled that the employer (1) functioned as an ERISA fiduciary when it prepared and distributed the SPD to participants, and (2) breached its fiduciary duty by furnishing the participant with a misleading SPD. In particular, the SPD provision describing the annual increase in benefits did not refer to the other sections of the SPD on which the employer and the insurer had relied to deny the benefits increase. Also, the insurer’s self-serving interpretation of the SPD to deny increased benefits was determined to constitute a breach of the insurer’s… Continue Reading
A U.S. District Court recently held that posting an SPD on an employer’s intranet was insufficient to fulfill its obligation under ERISA to furnish SPDs to plan participants. The case involved a denied claim for life insurance benefits brought by a deceased plan participant’s beneficiaries. The participant had stopped paying life insurance premiums when she became disabled and stopped working. She also had not submitted proof of her disability to the insurance company, so she was ineligible for the policy’s premium waiver benefit that would have maintained her coverage during disability without additional premium payments. The beneficiaries argued, and the court agreed, that the participant did not have notice of the premium waiver’s requirements because she never received a current SPD. The evidence showed that the employer only made the SPD available to its employees via its internal intranet. Therefore, the participant could not have accessed the SPD after she… Continue Reading
Change in Interpretation Eliminating Unreduced Benefits for Terminated Vested Participants Violates ERISA’s Anti-Cutback Rule
An employer’s defined benefit plan provided unreduced early retirement benefits starting at age 60 for terminated vested participants and had been consistently so interpreted for a number of years. The employer later determined that early retirement benefits should be actuarially reduced, made a “clarifying” amendment to the plan, and thereafter either reduced or stopped making pension payments to allegedly “overpaid” participants whose benefits began before the changed interpretation and amendment. The U.S. Court of Appeals for the Third Circuit upheld a district court determination that the employer had violated ERISA’s anti-cutback rule and awarded the employees the withheld payments plus interest. In dismissing the employer’s arguments, the Third Circuit found that requiring claims exhaustion would have been futile and that the employer could not rely on favorable provisions in an SPD when the SPD clearly stated that in the event of any conflict with the plan, the plan terms would… Continue Reading
In the case of Moyer v. Metropolitan Life Ins. Co., the U.S. Court of Appeals for the Sixth Circuit held that a notice of benefit denial under ERISA must include not only a statement of the claimant’s right to judicial review of the benefit denial, but also any associated time limits for filing a claim for judicial review. Moyer was a participant in an employer-sponsored long-term disability plan that was subject to ERISA (the “Plan”). MetLife was the designated claims fiduciary under the Plan. MetLife denied Moyer’s claim for benefits and his subsequent internal appeal of that denial. Nearly four years later, Moyer sued MetLife for the denied benefits under Section 502 of ERISA. The Plan document specified a three-year limitations period for filing such a lawsuit, but neither MetLife’s benefit denial notice to Moyer nor the Plan’s summary plan description (“SPD”) included any such limitations period. The district court… Continue Reading
At a Q&A session between the U.S. Department of Labor (“DOL”) and the American Bar Association, the DOL was asked whether delivering summary plan descriptions (“SPDs”) by mailing them on a CD to employees who do not normally work on computers would satisfy ERISA’s regulations regarding the delivery method for SPDs. Generally, delivery methods must be reasonably calculated to ensure distribution and receipt of the SPD. The DOL responded to this question by opining that such a delivery method may not be reasonably calculated to ensure receipt because the plan administrator has not taken any measures to determine if participants have the necessary technology and ability to retrieve information from the CDs. However, the DOL’s response reflects only an unofficial, nonbinding staff view and thus does not necessarily represent an official position of the DOL.
A U.S. federal district court assessed the maximum penalty available under ERISA ($110 per day) against an employer for failing to timely provide an accurate and up-to-date summary plan description (“SPD”) upon a participant’s request. In 2010, the participant requested an SPD for the company’s long term disability plan. The employer provided a copy of the 2006 SPD, at which point the participant asked if there was a more recent SPD. The employer did not respond, and so the participant hired an attorney. In response to the attorney’s request for documents, the employer again provided the 2006 SPD and stated that additional information would be provided, though it never was. The attorney then arranged a visit to the employer’s office to inspect the plan documents, at which point, five months after the initial request, the employer provided summaries of material modifications showing the changes to the plan since the 2006… Continue Reading