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.
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