Plan Can’t Avoid Statutory Penalties
Close
 

Plan Can’t Avoid Statutory Penalties

Plaintiff-doctor, a health care provider suing as the plan participant's assignee, alleged Employee Retirement Income Security Act (ERISA) violations that the health care plan underpaid her for medical services rendered to one of her patients, breach of fiduciary duty and seeking statutory penalties based on the plan’s failure to timely furnish plan documents upon request. After the trial court dismissed the case in its entirety, the appellate court revived the claims for additional benefits and statutory damages. The court held the provider was not required to identify specific terms in the plan establishing coverage in order to state claim for unpaid benefits, and provider was a “beneficiary” able to sue for statutory penalties based on failure to furnish plan documents.

Griffin v TeamCare