Synergy Blog

From Roger Baron: N.C. Federal Judge ORDERS recalcitrant ERISA plan to turn over “plan document”

Reprinted with permission from Roger Baron

Many of us have encountered frustration in attempting to secure the “plan document” from an ERISA plan which is basing its claim on an SPD. The U.S. District Court for North Carolina dealt with this frustration in Strickland v. AT&T Benefit Plan, 2012 WL 4511367 (W.D.N.C.) this past Monday.  The court ordered the plan to produce its “plan document,” recognizing that terms of an SPD are not, in and of themselves, enforceable under Cigna v. Amara.  Here is what the judge stated,

“Finally, the Court notes that Defendant has yet to provide Plaintiff a copy of the actual plan documents, thus precluding Plaintiff from determining whether the SPDs are consistent with the plan documents. See (Doc. No. 24 at 2 n. 1) (“Although Plaintiff’s counsel had requested copies of plan documents as far back as August 17, 2007 (AR 0015–16), the full plan document never has been produced.”). The Fourth Circuit explained in McCravy II that, “per Amara, ‘summary documents, important as they are, provide communication with beneficiaries about the plan, but that their statements do not themselves constitute the terms of the plan….’ “ 2012 WL 2589226, at *5 n. 5 (quoting Amara, 131 S .Ct. at 1878); see also Skinner v. Northrop Grumman Retirement Plan B, 673 F.3d 1162 (9th Cir.2012). Thus, Defendant has “not provided evidence suggesting that the actual terms of the plan were ever communicated to [Plaintiff], beyond the SPD.” Israel, 2012 WL 3116544, at *6 n. 11; see also McCravy, 2012 WL 2589226, at *5 n. 5. Defendant is ORDERED to provide Plaintiff with a copy of the relevant plan documents within thirty (30) days of entry of this Order.”

Click HERE to view the full opinion

TESTIMONIALS

I wanted to pass my highest recommendation to Synergy who we routinely get involved in cases when Medicare issues come up, especially when dealing with Medicare Set Asides. Synergy went beyond the call of duty in a recent case that was settled and dealt one-on-one with our clients and their family. They spent time on the phone with them to be sure they got all their questions answered and did a fantastic job dealing with Medicare.

J. Daniel Clark
Clark Martino, P.A.

"Coincidentally, on the day of a recent Synergy Seminar on Medicare & ERISA lien resolution I received a letter on an ERISA lien. This letter followed much back and forth between myself and the recovery vendor for BCBS. Despite my efforts they were adamant there would be no (zero)(zilch)(nada) reduction and provided case law to support their position. I tried Synergy’s Lien Resolution Services since I had just heard their Director of Lien Resolution speak. Synergy got them to reduce their claim by a third in less than ten (10) days. The result was quick and the fee very reasonable. If you have a tough ERISA lien and your typical efforts don’t work, give Synergy a try."

Michael S. Smith, Esq.
Lesser, Lesser, Landy & Smith, PLLC

WordPress Image Lightbox