When you request ERISA health care plan documents for your client, the first response you typically get is something like this: “We are not the plan administrator and have no duty to provide you with these documents.” This message is typically sent with a handful of documents that are far less than what was requested.
That is because most healthcare plans outsource reimbursement to third-party companies to file and collect on these liens. Unfortunately, these companies may have no duty to provide you all of the documents your client is entitled to see — or at least the companies don’t believe they are subject to the duty. The duty to provide documents lies solely with the designated “plan administrator.”
So who is this “plan administrator” and how do I find them?
If you’re dealing with a lien from a healthcare plan regulated by ERISA, there must be a designated plan administrator as required by the ERISA code section. This is usually a human resource employee, or other employee of the company, who is the designated contact for requesting and obtaining documents about the plan.
Typically, you will find this person designated in the plan’s Form 5500 which is typically available with a request to the lien-holder. If you know the name of the employer, can sometimes find the Form 5500 online at freeerisa.com. If you are provided a Summary Plan Description (SPD) for the plan, there should also be a contact page providing full contact information for the designated plan administrator. If you don’t have these documents, write to the lien holder and tell them to provide you with the contact information for the designated “plan administrator” so that you can request all of the documents.
The ERISA code section at 29 U.S.C. 1024(b) provides a host of documents that the plan administrator must provide to your client when requested. These include copies of the Summary Plan Description, the annual report, the trust agreement, contracts, and other “instruments under which the plan is established or operated.” A list of these is documents is located at 29 U.S.C. 1024(b), which you can simply cut and paste into your request.
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 provides some leverage to you for obtaining the documents. As the days accrue without your client’s documents in hand, the greater the plan administrator’s potential liability to your client. In fact, it’s about $3,000 a month for every month you don’t get the documents.
This is another reason we highly recommend making your plan document requests early in the case. You don’t want to be chasing down contact information for the plan administrator once your case has settled. Even once you make a proper request, the plan administrator has 30 days to provide you the documents, which is just 30 more days your client’s funds are sitting in trust.