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ERISA Summary Plan Descriptions Must Be Clear

Fri Aug 31st, 2018 on     Insurance Claims,    

The Employee Retirement Income Security Act (ERISA) was enacted in 1974, creating a new set of standards and protections for certain covered plans (i.e., private benefit plans granted or sponsored by an employer).  Since its enactment, ERISA has further expanded those standards and protections, which include rules surrounding the Summary Plan Description (SPD).

The SPD is a critical document that details the rights and obligations of the policyholder and beneficiaries pursuant to the insurance plan, as well as identifying information about the plan sponsor, administrator, and other relevant concerns.  Under ERISA, the plan administrator must by default furnish the SPD to the policyholders, and must furnish the SPD to beneficiaries upon request.

When pursuing a claim against your insurer in a dispute involving an ERISA-covered plan, it’s important that you request and obtain an SPD.  Your attorney will evaluate the SPD and help determine your rights and obligations under the plan, and whether those rights have been violated by the insurer or plan administrator.

What Makes an SPD Inadequate?

All employee benefit plans must have an SPD, which details the benefits at-issue, eligibility for such benefits, the timeline for benefits, the procedure for claiming benefits, and the various other rights and obligations of policyholders and beneficiaries under the plan.  An adequate SPD must accurately reflect the contents of the ERISA-covered plan — failure to provide an accurate summation of the plan (with the necessary information), or to legally furnish an updated plan to the policyholder or beneficiary, could expose the plan administrator to liability.

CFR Section 2520.102-3 provides an extensive accounting of the specific content requirements necessary for an adequate SPD.  Generally speaking, the SPD must detail the names and contact information of various authorities, eligibility requirements, benefits information (amount, procedures, etc.), and the rights of the plan participant and beneficiaries.  Further, the plan must be written clearly and in plain language so that it can be understood without specialized knowledge.  An SPD that is written in particularly arcane or complex language may be deemed inadequate (if it is legitimately confusing).

Speak to an Experienced Miami Insurance Claim Lawyer for Further Guidance

Here at Ver Ploeg & Lumpkin, P.A., our insurance attorneys have over two decades of experience handling a range of insurance disputes on behalf of policyholders, including cases that involve ERISA-covered plans and inadequate Summary Plan Descriptions, among other issues.  Our primary focus is on insurance disputes, and as such, we are uniquely well-positioned to navigate the complexities typically associated with litigation relating to ERISA-covered plans.

We are committed to comprehensive, client-oriented representation.  From beginning-to-end of the client engagement process, we work closely with clients to provide personalized advocacy that is tailored to their particular goals — this has led to a number of successes in the form of favorable verdicts and settlements.

Call (305) 577-3996 to speak to an experienced Miami insurance claim lawyer here at Ver Ploeg & Lumpkin, P.A.  We will evaluate your claims and work with you to determine how best to proceed with securing a resolution to your dispute.

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