You know already that a plan administrator can be liable for statutory penalties under ERISA for failing to provide requested plan documents.

But what if the claims administrator failed to provide documents   Will the claims administrator have to pay statutory penalties?  NO.

But what if an agent of the plan administrator failed to provide documents?  Does the plan administrator have to pay?  NO.

Here’s the case of Delprado v. Sedgwick Claims Management, United Health Group Inc., et al., __ F.Supp. 3d __(N.D. N.Y. March 20, 2013) (Plan administrator immune from statutory penalties under 502(c)(1)(B).)  Special thanks to Professor Roger Baron for noting this on his blog:  (http://erisawithprofessorbaron.com/)

FACTS: Delprado was a claims manager for United Healthcare.  She had joint pain and sought long term disability benefits under the ERISA plan. United Health Care Group, the plan administrator, delegated administration of claims to Sedgwick.  Delprado requested three times that Sedgwick provide forms to file a claim. Four months later, Sedgwick provided the forms. After her claim was denied, she sued seeking reversal of the claim denial and for “statutory penalties” under Section 502(c)(1)(B).

DISTRICT COURT HELD/RATIONALE:

1. Neither 502(a)(1)(B) or 502(a)(3) encompass “statutory damages.”  “[T]he amount of damages a plan participant or beneficiary can recover under 502(a)(1)(B) is not determined by ERISA itself but by the terms of the plan claimed to have been violated.”  Op. at 7.
2. A party is liable for statutory damages under 502(d)(1)(B) only if the terms of the ERISA plan specifically designate the party as the ‘plan administrator.’” Op. at 9.
3. The plan administrator may NOT be penalized because of its agent’s misconduct in failing to provide documents requested by the plan participant. The Court states: “A plan administrator may not be held liable for requests directed to someone other than the administrator.” Giordano v. Thomson, No. 03-CV-5672, 2007 WL 1580081, at *4 (E.D.N.Y. May 29, 2007) (citing Hiney Printing Co. v. Brantner, 243 F.3d 956, 960-61 (6th Cir. 2001)); see also Davenport v. Harry N. Abrams, Inc., 249 F.3d 130, 135 (2d Cir. 2001) (“By its terms, ERISA allows for civil penalties only if an administrator has refused to comply with a request for information.” (emphasis added)). Here, Plaintiff alleges that she made requests for LTD Plan claim forms only to Defendant Sedgwick. Therefore, the Court holds that Defendant UHG, the Plans’ administrator, cannot be held liable under § 502(c)(1)(B) for Defendant Sedgwick’s refusal to provide Plaintiff the claim forms.  Op. at 12.