Adam V. Russo | April 4, 2007
In this case, a TPA was sued by their clients (employers and those employer’s employees), for mishandling their plans’ funds. The TPA trustees in turn hoped to sue their attorney, claiming that their attorney should have notified them of the fund management issues and improper expenditures. The court found that the attorney did not have discretionary control over the assets of the plan, access to funds, or powers to administer the plans, and was therefore not a fiduciary. Even if the attorney knew of the transactions and failed to disclose them, the fund trustees would be unable to demonstrate how the attorney’s actions or lack of action proximately caused the mismanagement of the funds. (more…)
Category: ERISA, Fiduciary Liability, Third Party Administrators |
No Comments »
Tags:
Adam V. Russo | April 4, 2007
In this case, an employee stopped working due to a medical condition and began receiving disability benefits from her employer’s self funded ERISA plan. After two years the case was reassessed, the TPA terminated the benefits. The insured filed suit against the TPA, seeking both payment of past claims and re-instatement of future benefits. The TPA moved to dismiss arguing that it was not a proper defendant in this case because it did not have any financial responsibility to the employee. The employer and plan, the TPA asserted, were the proper defendants. The court denied the motion to dismiss, however, stating that the TPA’s discretionary power over the payment of claims made it a fiduciary to the plan and plan members. (more…)
Category: Claims Procedures, Claims Review, Coordination of Benefits, ERISA, Fiduciary Liability, Third Party Administrators |
No Comments »
Tags:
Adam V. Russo | April 4, 2007
Section 502(a)(3)(B) of ERISA permits a fiduciary to bring a civil action “to obtain equitable relief to enforce the terms of the plan”. To obtain this “equitable relief,” the basis for the fiduciary’s claim and the relief it seeks must be equitable in nature. Importantly, a fiduciary cannot seek to impose personal liability, as that would be a legal remedy. The Policy in this case required repayment of an overpayment of benefits that resulted when a claimant received benefits in the amount of $ 19,612. The Plan requested reimbursement and the beneficiary refused, stating that she no longer had any of the funds. (more…)
Category: Claims Procedures, ERISA, Federal Circuits, Fiduciary Liability, Provider Reimbursement, Standings |
No Comments »
Tags:
