Menu Close Menu

Blog

When Denied ERISA benefits, It Is Important To Request The Summary Plan Description (SPD) and All Plan Documents (even if they don't exist)

Posted by Gregory Paul | Jun 01, 2017 | 0 Comments

The Fifth Circuit Court of Appeals recently held against a plan beneficiary relying upon only the Summary Plan Description (SPD): "The SPD alludes to the existence of a separate "official Plan Document" and provides that "[i]n the event of any discrepancy between this Summary Plan Description and the official Plan Document, the Plan Document shall govern." But when the Plan paid Rhea's medical expenses, the SPD was the only document describing a beneficiary's rights and obligations under the Plan. Rhea v. Alan Ritchey, Inc. Welfare Benefit Plan, 2017 U.S. App. Lexis 9482 (5th Cir. 2017).

ERISA requires plan administrators to provide SPDs to beneficiaries. 29 U.S.C. § 1024(b)(1). An SPD must "reasonably apprise [plan] participants and beneficiaries of their rights and obligations under the plan" and must be "written in a manner calculated to be understood by the average plan participant." Id. § 1022(a). ERISA also mandates that plans "be established and maintained pursuant to a written instrument." Id. § 1102(a)(1). HN2 A plan's written instrument sets forth its terms and must do the following:

(1) provide a procedure for establishing and carrying out a funding policy and method consistent with the objectives of [*5]  the plan and the requirements of this subchapter,

(2) describe any procedure under the plan for the allocation of responsibilities for the operation and administration of the plan(including any procedure described in section 1105(c)(1) of this title),

(3) provide a procedure for amending such plan, and for identifying the persons who have authority to amend the plan, and

(4) specify the basis on which payments are made to and from the plan.

Id. § 1102(b). Courts often refer to written instruments as "plan documents."

As an Attorney representing individuals denied disability benefits and life insurance, the first step after receiving a denial letter is to request the claim file and all plan documents including the Summary Plan Description (SPD). The Plan must provide these documents within 30 days of a written request.

About the Author

Gregory Paul

Gregory G. Paul is a trial lawyer who practices in the areas of disability, employment and toxic tort injury law. He is admitted to practice law in California, Maryland, Missouri, Ohio, Pennsylvania, Texas and West Virginia with additional admissions in federal courts nationwide. Greg is a graduate of the University of Pittsburgh and the University of the Pacific, McGeorge School of Law in Sacramento where he was on the Dean's List and Law Review.  He is a graduate of Gerry Spence's Trial Lawyers College.                        In addition to litigating cases on behalf of people denied benefits and rights, Greg has been a speaker at PBI: Employment Law West: Americans With Disabilities Act , Pittsburgh, PA (2012-2015); National Employment Lawyers Association: Breaking Down the Barriers in the Workplace, Oakland, CA (2010); NBI: Litigating ERISA Cases, Pittsburgh, PA (2008); ADA: Fighting for Fairness, Atlanta, GA (2006) and Chicago, IL (2008). He is a member of American Association for Justice, National Employment Law Association and the Million Dollar Advocates Forum. Greg is the Vice-Chair of the National Legal Advocacy Committee for the American Diabetes Association and recipient of the ADA 2008 National Service Award for Outstanding Advocacy.  LIST OF ADMISSIONS AND BAR ASSOCIATIONS Pennsylvania, 1999 West Virginia, 1999 Maryland, 2000 California, 2004 Ohio, 2005 Texas, 2006  Missouri, 2012 U.S. District Court, Western District of Pennsylvania U.S. District Court, Eastern District of Pennsylvania U.S. District Court, Middle District of Pennsylvania U.S. District Court, Southern District of West Virginia U.S. District Court, Northern District of West Virginia U.S. District Court, District of Maryland U.S. District Court, District of Colorado U.S. District Court, Northern District of Ohio U.S. District Court, Southern District of Ohio U.S. District Court, Eastern District of Texas U.S. District Court, Northern District of Texas U.S. District Court, Southern District of Texas U.S. District Court, Northern District of California U.S. District Court, Eastern District of California U.S. District Court, Central District of California U.S. District Court, Eastern District of Michigan U.S. District Court, Eastern District of Arkansas U.S. District Court, Northern District of Illinois U.S. Court of Appeals, 3rd Circuit U.S. Court of Appeals, 4th Circuit U.S. Court of Appeals, 5th Circuit U.S. Court of Appeals, 6th Circuit U.S. Court of Appeals, 9th Circuit U.S. Court of Appeals, 11th Circuit Supreme Court of the United States Allegheny Bar Association Federal Bar Association American Bar Association The American Association for Justice Million Dollar Advocates Forum National Employment Lawyers Association Sonoma County Bar Association

Comments

There are no comments for this post. Be the first and Add your Comment below.

Leave a Comment

Free Consultation

Please contact us for a free consultation with Greg concerning the denial of short-term or long-term disability benefits. Most clients prefer to have a contingency fee agreement, which means attorney fees are are payable if we are successful.

ERISA Experience

Greg Paul has 18 years experience fighting for long-term disability benefits against insurance companies such as Aetna, CIGNA, Guardian, Hartford, Liberty Mutual, Mutual of Omaha, Principal, Prudential, Reliance Standard, Standard, Sun Life, and Unum.