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Former Employee Had Right as ERISA Plan "Participant" to Request Copy of SPD

Former Employee Had Right as ERISA Plan "Participant" to Request Copy of SPD

Ensley v. North Georgia Mountain Crisis Network, Inc., 2014 WL 1053590 (N.D. Ga. Mar. 19, 2014)


ERISA and Life Insurance News
(August 29, 2014)

Ensley filed suit under a number of theories after her employment was terminated by the defendant. Among other things, she contended that the administrator of her former employer’s health benefit plan had violated ERISA by failing to timely provide to her a copy of a summary plan description. She contended that she was entitled to administrative penalties as a result.

Under 29 U.S.C. § 1024(b), a plan administrator must provide plan participants with a copy of the SPD upon written request. ERISA defines the term “participant” in relevant part as “any employee ... who is or may become eligible to receive a benefit of any type from an employee benefit plan which covers employees of such employer ... , or whose beneficiaries may be eligible to receive any such benefit.” 29 U.S.C. § 1002(7).

The defendants admitted that Ensley was not provided with a copy of the SPD within the timeframe set out in the statute. Nonetheless, they argued that she was not entitled to an SPD because her written request for the document was made after the termination of her employment when she was no longer a plan “participant” within the meaning of ERISA.

The court rejected the defendants’ argument, noting that in Firestone Tire & Rubber Co. v. Bruch, 489 U.S. 101, 117-18 (1989), the Supreme Court “found that ‘participants’ include former employees who have a reasonable expectation of returning to covered employment or a colorable claim to vested benefits.” Under that decision, the court continued, “the former-employee claimant ‘must have a colorable claim that (1) he or she will prevail in a suit for benefits, or that (2) eligibility requirements will be fulfilled in the future.’”

The court agreed that Ensley had “at least a colorable claim to benefits.” As a result, the court concluded, the plan administrator “did have an obligation to provide her with plan information following her attorney’s written request ....” The court reserved ruling on awarding statutory penalties until overall damages had been addressed.

Click here to view the full August 2014 Edition of the ERISA and Life Insurance News.

Authors
H. Sanders Carter
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Kenton J. Coppage
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Mary B. Ramsay
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Jennifer Noland Rathman
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