Court Orders Modest Penalty Payment for Insurer's Failure To Provide Policy Upon Request

Early in the case, the plaintiff requested a complete copy of his plan and its related amendments from both his company and from Aetna.  Aetna and Biogen failed to provide a copy of the plan to the plaintiff until well after it was requested, a violation of law that subjects a plan administrator to a penalty of $110 a day.  

ERISA Statute and Preemption of State Law

ERISA is a federal statute regulating employer sponsored benefits, including pensions, health care and disability plans. With respect to the protection of employee benefit rights, the statute grants exclusive jurisdiction to the federal district courts for civil actions brought by a participant or beneficiary, but provides an exception for actions brought by a participant or beneficiary to recover benefits due to him under the terms of the plan, to enforce his rights under the plan or to clarify his right to future benefits. See 29 U.S.C. 

Reporting and Disclosure in the ERISA Statute

The reporting and disclosure provisions of the ERISA statute appear at §§ 1021 – 1031. These sections –

  • Create the reporting and disclosure duties of administrators ( 1021);

  • Describe the summary plan description ( 1022) and annual report (§ 1023) that are the two most important parts of the reporting and disclosure scheme; and

  • Set forth the timing and details of furnishings and filings (§ 1025 and 1026).

Fiduciary Responsibilities Relating to ERISA Disability Plans

Unlike wages, which employees receive directly, employee benefits are established and maintained by other entities, which maintain funds from which to provide benefits to employees in forms other than direct compensation. The entities in question may be tempted to act in ways that benefit themselves rather than the employees who are or may become entitled the benefits, which is precisely what happened all too often in the history preceding the enactment of the ERISA statute.

LTD Plans Not Subject to ERISA

The ERISA statute excepts five types of plans from coverage under the statute in the “Coverage” section found at 29 U.S.C. § 1003(b): (1) government plans; (2) church plans; (3) plans maintained solely for the purpose of complying with applicable workmen’s compensation laws or unemployment compensation or disability insurance laws; (4) plans maintained outside of the United States primarily for the benefit of persons substantially all of whom are nonresident aliens; and (5) excess benefit plans.

Disability Plans Not Subject to ERISA

Disability Plans Not Subject to ERISA. The ERISA statute excepts five types of plans from coverage under the statute in the “Coverage” section found at 29 U.S.C. § 1003(b): (1) government plans; (2) church plans; (3) plans maintained solely for the purpose of complying with applicable workmen’s compensation laws or unemployment compensation or disability insurance laws; (4) plans maintained outside of the United States primarily for the benefit of persons substantially all of whom are nonresident aliens; and (5) excess benefit plans.