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Waiver of Premium and Death Benefit Claims: S.D. Ohio

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  • Waiver of Premium and Death Benefit Claims: S.D. Ohio

    In a recent case from Ohio, the Plaintiff filed suit after her husband passed away. Her husband had participated in his employer's group life insurance plan in the eight years prior to him becoming disabled. After becoming permanently disabled, his employer (and a specifically named individual) offered to continue to pay the insurance premiums, which they did up until the husband's death. The Plaintiff filed a death benefit claim, and Anthem denied it as the insured failed to meet the active employee requirement, and did not apply for a waiver of premiums.

    The court dismissed the Plaintiff's claim finding:

    Under 29 U.S.C. § 1132(c), a plan participant may recover statutory penalties if the plan participant does not receive a summary plan description. Defendant Anthem Life asserts that “it is well established that only plan administrators are liable for statutory penalties under §1132(c).” (Doc. 12) (citing Caffey v. Unum Life Ins. Co., 302 F.3d 576, 584 (6th Cir. 2002) (citing Hiney Printing Co. v. Brantner, 243 F.3d 956, 960 (6th Cir. 2001); Vanderklok v. Provident Life & Accident Ins. Co., 956 F.2d 610, 618 (6th Cir. 1992)). Furthermore, the Sixth
    Circuit has “consistently held that procedural violations [of ERISA] do not give rise to claims for
    substantive damages.” Sears v. Union Cent. Life Ins. Co., 222 Fed. Appx. 474, 479 (6th Cir.
    2007).
    Here, without admitting that such an allegation was necessary to prevail, Plaintiff concedes that she did not allege that Defendant Anthem Life was the plan administrator. Plaintiff argues that – because she is not seeking statutory penalties against Defendant Anthem Life for failing to provide the SPD – her failure to allege that they were the plan administrator is irrelevant. However, Plaintiff’s admission appears to leave her with only one path forward against Defendant Anthem Life, i.e., a claim for substantive damages. This path, however, appears to be barred to the extent that “procedural violations [of ERISA] do not give rise to claims for substantive damages.” Sears, 222 Fed. Appx. at 479.
    Accordingly, Defendant Anthem Life’s motion to dismiss, as it relates to the claims Plaintiff asserted against it, is granted.
    The entire opinion, including cross-claim analysis, is attached below.
    Attached Files
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