“BCBSTX moves to dismiss Count IV of the Complaint as it applies to it. BCBSTX contends that Count IV must be dismissed because the civil penalties available under ERISA for alleged failure to provide plan documents only apply to plan administrators, and BCBSTX is not a plan administrator.”
G.F. v. Blue cross & Blue shield of Tex. (W.D. Mo. 2021)
Under 29 U.S.C. § 1024(b)(4), plan administrators are required to provide a copy of the plan upon written request. Failure to provide a copy of the plan to the claimant within thirty days subjects the plan administrator to a $110 per day penalty. 29 C.F.R. § 2575.502c-1.
In this case, Blue Cross served as the claims administrator for a self funded ERISA group health plan. When the plaintiff’s claims for surgery expenditures were denied as experimental, she filed suit, including claims for the statutory penalty alleging she failed to timely receive requested plan documents. Blue Cross moved to dismiss her claim.
The court began by noting that he plan administrator is the “person specifically so designated by the terms of the instrument under which the plan is operated.” 29 U.S.C. § 1002(16)(B). The employer is deemed to be the plan administrator in the event no one else is designated.
ERISA specifically makes the plan administrator responsible for providing plan documents, ” so that an insurer or claim administrator that is not the plan administrator may not be held liable for 29 U.S.C. § 1132(c) penalties. Brown, 586 F.3d at 1088; Ross, 285 F.3d at 743-44; Jordan v. Aetna Life Ins. Co., 2012 U.S. Dist. LEXIS 11160, at *1 (granting motion to dismiss statutory penalty claim against claim administrator for alleged failure to provide plan documents). Therefore, the court held for Blue Cross and dismissed the plaintiff’s claim.
Note: See also, Brown v. J.B. Hunt Transp. Servs., 586 F.3d 1079, 1088 (8th Cir. 2009); Ross v. Rail Car Am. Grp. Disability Income Plan, 285 F.3d 735, 743-44 (8th Cir. 2002).” G.F. v. Blue cross & Blue shield of Tex. (W.D. Mo. 2021)