Employee Healthcare Benefits

When considering ERISA civil litigation enforcement, you must start with Section 502(a). This section lists the various types of civil enforcement actions authorized under the statute. These claims fall into three broad general categories. First, under ERISA Section 502(a)(1)(b), a plan participant or beneficiary may bring a claim to recover benefits due under the terms of the plan or to clarify rights to future benefits under the plan. This type of claim typically is brought after the plan’s administrator has denied a claim for benefits and the participant or beneficiary has exhausted the plan’s administrative appeal procedure for denied benefit claims.

Second, a plan participant, a beneficiary, or a plan fiduciary may bring a claim under ERISA Section 502(a)(2) against another plan fiduciary seeking relief under ERISA Section 409(a) for a breach of fiduciary duty. A similar claim also may be brought by the Secretary of Labor under ERISA Section 502(a)(2).

Third, a plan participant, a beneficiary, or a plan fiduciary may bring a claim under ERISA Section 502(a)(3) to enjoin any act or practice that violates either Title I of ERISA or the terms of the plan, or to obtain appropriate equitable relief to remedy such a violation. The Secretary of Labor is authorized to bring a similar claim for injunctive or equitable relief under ERISA Section 502(a)(5). This third category of civil claims, known as the “catch-all” category because of its broad scope, has been the subject of numerous Supreme Court cases.

Questions:

1. What would be a system, fair to both plan participants and the administrator, for determining benefits and plan terms?

2. Congress largely placed the enforcement responsibility in the hands of participants. Do you think there should be greater government oversight to protect plan participants and relieve them from having to enforce ERISA (in other words, make the government the primary enforcer)?