You already know that when a Summary Plan Description conflicts with ERISA plan language, the ERISA plan language controls.

But what happens when all you have is a Summary Plan Description (SPD), and… no ERISA Plan? Can the SPD become the Plan, and authorize subrogation reimbursement? YES.

Here’s the case of Board of Trustees/National Elevator Health Plan Benefit v. Moore, _ F.3d _ (6th Cir. August 25, 2015) (PDF) (Subrogation: Language in Summary Plan Description authorized required reimbursement of medical expenses paid by Plan).

FACTS: The ERISA plan paid $34,204 in medical expenses for injuries Kyle Moore sustained in an accident. After Moore settled his tort claim for $500,000, the ERISA plan sought reimbursement. Moore claimed, however, that there was no ERISA plan language requiring reimbursement. The only document submitted in the record was the Summary Plan Description (SPD), which did provide require reimbursement.

ISSUE: Is the Summary Plan Description a Controlling Plan Document Requiring Subrogration Reimbursement?

6th CIRCUIT HELD: YES.

  1. “[I]f the language in a SPD conflicts with the language in an ERISA plan, a district court is required to enforce ‘the terms of the plan.’” Op. at 6.
  2. “Nothing in Amara prevents a document from functioning both as the ERISA plan and an SPD, if the terms of the plan so provide.” Op. at 7 (Emphasis in original).
  3. “[A]n SPD describing employee benefits that anticipate the existence of a Plan, but is issued long in advance of the Plan, constitutes the actual plan, as well as a summary of a plan ‘that is nowhere else in writing.’” Op. at 8.
  4. The 3rd Circuit and the 11th Circuit (in unpublished decisions) have also recognized that a SPD can function as the controlling ERISA plan “in the absence of a separate plan document.” Op. at 7-8.
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Photo of Mike Reilly Mike Reilly

Mike Reilly is a nationally recognized labor, employment and employee benefits attorney, named one of the “Top 100 Most Powerful Employment Attorneys in the Nation” for the past five consecutive years by Human Resource Executive®. He has decades of experience providing strategic employment advice, and has represented clients in more than 75 jury trials, arbitrations, bench trials and claims before the EEOC and Washington State Human Rights Commission.

Small and large employers retain Mike for his strategic advice and decades of experience in employment issues and litigation, business decisions and litigation avoidance. Mike provides advice in claims involving discrimination, retaliation, wrongful discharge, disability accommodation, ERISA and non-ERISA employee benefit claims, and wage/hour claims. He served as lead counsel in an employee raiding/trade secret case as reported in the Wall Street Journal, and defends employers in class action claims.

Mike’s remarks on employment issues have been quoted in NewsweekCorporate Legal TimesSeattle TimesEmployee Relations Law JournalPuget Sound Business JournalCFO.com, and other professional journals and management publications. Chambers USA’s Guide to America’s Leading Lawyers for Businessrates Mike in the top ranking (band one) for his work in labor and employment law, and has described him as “one of Seattle’s top-rate attorneys” who is “truly phenomenal [with] superb legal instincts” and “an amazingly assertive litigator.” His clients include Nordstrom, Seattle Seahawks, Home Depot, KeyBank, Starbucks, Fred Hutchinson Cancer Research Center, Red Robin and Seattle Chamber of Commerce, among others.