In the matter of Sgro v. Danone Waters of North America, Inc., 2008 U.S. App. LEXIS 13973 (9th Cir. Jul. 2, 2008), an employee – Mitchell Sgro – applied for benefits from his employer’s ERISA Plan.  He incurred $412.00 in copying fees, in the process of supplying documentation and medical records to his employer as part of his claim.

His claim was later denied, and Mr. Sgro pursued his employer and Plan in court for unpaid benefits and the costs he incurred making copies.  He lost, but rather than deal with the costs of an appeal, the Plan settled with Mr. Sgro in resolution of the unpaid benefits.  Mr. Sgro, however, still pursued an appeal solely to recover his copying fees.  

Sgro based his claim for copying fees on a California law, requiring the Plan to reimburse him for costs incurred in supplying them with necessary documentation.  The Ninth Circuit Court of Appeals, however, agreed with the lower District Court and disagreed with Mr. Sgro’s application of the state law.  They found that ERISA preempted the regulation.

When Mr. Sgro pointed out that ERISA prohibits Plans from requiring a fee for benefit applications, the Court pointed out that the plan merely required Sgro to provide documentation, which is quite different from conditioning his application on a fee.  Indeed, Mr. Sgro was not required to produce copies, and there were other no-charge ways to obtain copies (such as obtaining them directly from the Providers).

Cite:

ERISA on the Web

http://www.erisaontheweb.com/2008/07/articles/another-category/us-courts-of-appeals/ninth-circuit-shoots-down-claim-for-copying-charges/

Posted on July 10, 2008 by John Wood (The Wood Law Firm)

Ninth Circuit Shoots Down Claim for Copying Charges

Posted on July 10, 2008 by John Wood

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This entry was posted by Adam V. Russo on Monday, July 14th, 2008 at 12:25 pm and is filed under 9th, California, Preemption. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.