A decision handed down yesterday, September 30, 2014 by the United States District Court Central District of California in Mull v. Motion Picture Industry Health Plan, LA CV 12-06693-VBF.
The following analysis come to us from Professor Roger Baron:
Yesterday the U.S. District Court for California, Central Division (Los Angeles) entered its ruling that the Motion Picture Industry ERISA plan’s reimbursement provisions are enforceable because they are contained only in the plan’s Summary Plan Description (SPD) and not in a Plan Document. This situation which developed here was especially burdensome for the ERISA beneficiary and her family. The ERISA plan had paid $148,000 of medical bills and then demanded the victim turn over her entire tort recovery of $100,000, plus interest. When the victim refused, the ERISA plan quit providing health coverage for the victim and her entire family of four. Yesterday’s ruling declared that the reimbursement provision is unenforceable because it was contained in the plan’s SPD and not in a “plan document” as required by Cigna v. AMARA. This opinion rejects arguments that the SPD is also the plan and that it is somehow or another incorporated into the plan. Relevant language from the opinion is set forth below:
As explained in greater detail below, the Court will grant these three plaintiffs’ motion for summary judgment on the ground that the reimbursement / recoupment provision which the Plan has enforced, is contained only in the Summary Plan Description (“SPD”) and not in any document which constitutes “the plan.” The determination that the provision is not legally enforceable also necessarily defeats the defendants’ motion for summary judgment.
Following Amara and Ninth Circuit cases applying it, the Court agrees with the plaintiffs that the Summary Plan Description here does not constitute part of the ERISA Plan itself.
Defendants now argue that the SPD is part of the formal plan document because there is a single entry at page 124 of the SPD indicating that, “[T]his book constitutes both the Plan document and the Summary Plan Description for the Motion Picture Industry Health Plan.” Doc 56 (P’s MSJ) at 28 (citing Ex 1, page 132) … The Court agrees with plaintiffs that “this self-serving statement cannot overcome the controlling provisions of ERISA” and that the SPD here cannot constitute a formal plan document because it lacks three of the four features which 29 U.S.C. § 1102(b) requires of such documents.
As always, we thank Professor Baron for his insight.
This Decision brings to light the importance of procuring the actual Plan Document that was in effect on the date of the beneficiary’s accident. When attempting to resolve such ERISA claims, it is imperative that counsel does not rely solely upon the language contained within the Summary Plan Description.
Precision Resolution provides its clients with a Plan Document Request letter. Once the beneficiary executes the Plan Document Request Letter it can be send directly to the Plan or the Plan Administrator requesting release of the appropriate Plan Documents.
If you are in need of Precision’s Plan Document Request Letter please contact us at 888-961-LIEN.