Mistakes Resulting in Monetary Surcharge
Against Employers With the legal and remedial framework in place, how has this played out in the real world? Lots of ways.
Don’t forget to answer every question
In presenting the rules, this article focused on first-party entities–employers and insurance companies. But the rules apply to any entity that develops ERISA fiduciary responsibilities, including third-party vendors. Many employers outsource the administration of benefits. When this happens, the vendor may find itself financially responsible for mistakes made in the administration of the benefits.
In Echague v. Metropolitan Life Ins. Co., 43 F. Supp. 3d 994 (N.D. Cal. 2014), we saw liability attach to a vendor for breach of fiduciary duty and surcharge. Carol Echague had $440,000 in life insurance benefits through an ERISA plan offered by her employer. The employer outsourced administration of the life insurance benefits, and multiple other benefits, to TriNet Group, Inc. Ms. Echague stopped working and took a leave of absence after she was diagnosed with cancer.
TriNet sent Ms. Echague several letters that explained to her that it was important for her to understand her rights and responsibilities while on leave. The letters directed her to several written materials, directed her to an online portal, and offered her an 800 number if she had questions regarding her benefits, but never specifically addressed her life insurance. Thereafter, Ms. Echague emailed TriNet, informing it that she did not want any insurance to lapse and inquiring where to send premium payments for continued insurance. In response, TriNet simply resent Ms. Echague copies of its prior letters. It did not provide her with any information directly responsive to her inquiry. Because her employer had always paid the premiums, Ms. Echague did not start paying the premiums on her life insurance. Id. at 1001.
After Ms. Echague died, MetLife denied her husband’s life insurance claim because the policy had lapsed for failure to pay premiums. Mr. Echague appealed, arguing that neither he nor his wife had been informed that the life insurance was at risk of terminating and that neither he nor his wife received notice from anyone that premiums were not being paid. A lawsuit followed. Id. at 1002.
The court found that TriNet could be held liable as a plan fiduciary because it administered the plan despite the delegation of claims determinations to MetLife. For example, TriNet sent COBRA and FMLA notices, transmitted premium payments to MetLife, and kept track of what employees were in the plan. Id. at 1014. However, the court did not find TriNet’s beach was in providing Ms. Echague with non-specific information when she went out on leave of absence. Rather, it was TriNet’s response to the email that breached its fiduciary duties because the response failed to provide complete and accurate information to Ms. Echague regarding her situation. Id. at 1017. The court determined TriNet had a duty to specifically answer Ms. Echague’s question–which it failed to do–and provide more than generic and duplicative information. Id. at 1019-20.
TriNet’s mistake: it failed to provide a specific answer to a specific question. The result: a judgement against it for $440,000 through the doctrine of equitable surcharge. Id. at 1024.
Don’t forget to address every option
Dr. Scott Erwood worked for WellStar Health System, Inc. and had $1,000,000 in life insurance coverage through its ERISA plan. After suffering a seizure, Dr. Erwood was diagnosed with a brain tumor. He stopped working full-time at WellStar, transitioning to part-time employment, before leaving work completely.
Around the time Dr. Erwood stopped working in full, Dr. Erwood and his wife met with WellStar’s benefits representatives to discuss benefits after his employment terminated. At the meeting the Erwood’s repeatedly asked if all their coverage was going to remain the same. It was repeatedly confirmed that it would. The life insurance benefit was discussed, but not one specific aspect–conversion. Erwood v. Life Ins. Co. of North America, 2017 WL 1383922 at *2-3 (W.D. Penn. April 13, 2017).
Under the life plan, after Dr. Erwood ended his FMLA leave (during which he paid premiums to maintain his medical, dental, vision, and life coverage), converting the life insurance benefit from an ERISA benefit to an individual benefit was the only way to continue his life insurance. WellStar did not send Dr. Erwood any information regarding conversion and continuation of the life insurance benefit after FMLA leave ended. This remained true even though WellStar knew Dr. Erwood was dying and that he had been approved for $250,000 of early life insurance benefits under the plan’s Terminal Illness Benefit. Id. at *4-5.
After Dr. Erwood died, his wife made a claim to LINA for the remaining $750,000 in life insurance benefits. LINA denied the claim because Dr. Erwood was no longer an active employee at WellStar nor had he elected to continue his policy via conversion to an individual policy. Id. at *5. Thereafter, Ms. Erwood sued WellStar for breach of fiduciary duty.
The court found that WellStar breached its fiduciary duty owed to Dr. Erwood when it remained silent on the single non-addressed benefits issue during the meeting called for the express purpose of informing the Erwoods about maintaining all of their benefits. WellStar had successfully informed the Erwoods about how to keep all of Dr. Erwood’s benefits in force during the FMLA leave. WellStar had even been successful in informing the Erwoods about how to keep all of Dr. Erwood’s benefits in force after the FMLA leave–with the only exception being his life insurance benefits. Id. at *10.
WellStar’s mistake: it failed to address every single plan requirement to continue plan benefits during a meeting called for the general purpose of providing information about continuing plan benefits. The result: a judgement against WellStar for $750,000 through the doctrine of equitable surcharge.
Don’t forget to keep track of how old people are
Tammy Frye worked for American Greetings, which provided a suite of benefits through MetLife. The responsibility for administration of those benefits was delegated to MetLife. One perk of the plan was the ability to elect certain coverage for dependents–including life and AD&D insurance coverage. However, eligibility for dependent coverage ended when the dependent turned twenty-three.
Ms. Frye elected to obtain various benefit coverages on her son, including life and AD&D insurance. During the process of enrolling her son in coverage, which was done entirely through the website www.americangreetingsbenefits.com, Ms. Frye provided his date of birth. The coverage went into force and premiums continued to be paid through payroll deductions. Frye v. Metropolitan Life Ins. Co., 2018 WL 1569485 at *1 (E.D. Ark. Mar. 30, 2018).
When Ms. Frye’s son turned twenty-three, she did not alert American Greetings or MetLife of this fact. And neither of them alerted Ms. Frye that her son had aged out of coverage. Ms. Frye’s son died in a car crash at the age of twenty-four-and-onehalf. She made a claim for benefits, which MetLife denied on the basis that her son was ineligible for coverage at the time of his death. Frye appealed, arguing that she thought she had insurance; she had never been told about the age cut-off; American Greetings and MetLife knew about her son’s age because it was provided during his enrollment for medical insurance (not the life or AD&D insurance); and neither MetLife nor American Greetings had sent her any information about conversion when her son aged out. The appeal was denied, and a lawsuit followed. Id.
The court ruled that American Greetings and MetLife breached their fiduciary duties owed to Ms. Frye by implementing a flawed administrative process. With specificity, the court determined it was a breach to allow employees like Frye to pay for coverage for dependents who either are ineligible or become ineligible. Id. at *3. The court was clearly vexed by the potential that allowing this to happen might lead to MetLife receiving “essentially risk-free windfall profits from employees who paid premiums on non-existent benefits but who never filed a claim for those benefits.” Id. at *4. It also faulted only American Greetings and MetLife for the failure of communication, as they “are the fiduciaries on the scene.” Id.
American Greetings and MetLife’s mistake: not tracking the age of insureds to ensure they are notified when coverage ends. The result: judgment against both American Greetings and MetLife for the full life and AD&D coverage amounts via surcharge.
Don’t pay premiums for ineligible employees
Referral, a small company with fifteen employees, employed Teresa McGee. It offered employees a life insurance plan that included basic benefits and the opportunity to purchase additional coverage under a voluntary life policy. Between the two, Ms. McGee was insured for $143,550 in life insurance.
Unfortunately, Ms. McGee was diagnosed with breast cancer and had to stop working. Thereafter, Referral’s managing Director told Ms. McGee that he would continue to pay premiums to make sure she continued to maintain her life insurance. He did so because he knew her condition was terminal. Referral was true to its word and paid life insurance premiums for Ms. McGee for over a year after she stopped working. It did not convert Ms. McGee’s insurance or notify her of her conversion rights. Unfortunately, the plan stated that it only covered employees who were in active employment. McBean v. United of Omaha Life Ins. Co., 2019 WL 1508456 at *1-2 (S.D. Cal. Apr. 5, 2019).
The court determined Referral breached its fiduciary duty when it made a misrepresentation to Ms. McGee by informing her that it would continue to maintain her life insurance coverage. This was true even if Referral did not know whether it could continue her coverage via premium payments. The misrepresentation was material simply because it prevented Ms. McGee from making an informed decision regarding her coverage and other options. Id. at *9.
Referral’s mistake: not checking whether the continued payment of premiums would, in fact, continue coverage. The result: judgment against Referral for $143,550 via equitable surcharge – an amount Referral was unable to pay and did not have insurance to cover and may lead to bankruptcy. See Referral Only, Inc. v. Travelers Property Cas. Co. of Am., 2019 WL 1559145 (S.D. Cal. Apr. 10, 2019).
Don’t forget to provide employees with a summary plan description
Michelle Snitselaar worked for Mount Mercy University. Under the terms of Mount Mercy’s life insurance plan, a lawful spouse was eligible for dependent coverage. However, the spouse’s coverage ends on “the date of divorce or annulment.” Snitselaar v. Unum Life Ins. Co. of Am., 2019 WL 279995 at *2 (N.D. Iowa Jan. 22, 2019). At that point the dependent may convert the coverage to an individual policy. However, Ms. Snitselaar and her husband were never provided with a summary plan description regarding this coverage. A violation of ERISA, 29 U.S.C. § 1024(b)(1).
In 2010, Ms. Snitselaar enrolled for life insurance coverage under the plan for herself and her husband. In February 2015, Ms. Snitselaar’s divorce was finalized. Less than three months later, her now ex-husband died. Ms. Snitselaar made a claim for the $60,000 in life insurance she believed was in force. Unum denied the claim because the divorce ended the coverage and the benefit had not been converted. Snitselaar, 2019 WL 279995 at *3. Ms. Snitselaar argued that she was never informed in writing or verbally of the right to convert or that divorce could affect the policy. A lawsuit followed.
The court determined that Mount Mercy “clearly” breached its fiduciary duty by failing to timely deliver a certificate of coverage or summary of benefits to Ms. Snitselaar. But was there harm and causation? Yes. Simply by failing to provide the summary plan description or notice of the conversion rights, Mount Mercy had both harmed Ms. Snitselaar and caused that harm by keeping her uninformed.
Mount Mercy’s mistake: not providing a summary plan description and not keeping track of an employee’s divorce. The result: judgment against Mount Mercy for $60,000 under the equitable “make-whole, monetary relief” of surcharge. Id. at *10.
Don’t forget to tell your insurance company that your terminally ill employees’ life insurance might end
While only at the motion to dismiss stage, Harris v. Life Ins. Co. of N. America, --- F. Supp. 3d ---, 2019 WL 6769660 (N.D. Cal. Dec. 11, 2019), is informative as well. Bruce Harris, the plaintiff’s husband, received life insurance coverage through a plan sponsored by his employer BDO USA, LLP and insured by LINA. After Mr. Harris was diagnosed with cancer, he stopped working and made a long term disability claim to LINA under BDO’s LTD plan. Because the LTD claim was approved, it triggered a provision in the life insurance plan allowing for twelve months of continued life insurance before the insurance terminated if it was not converted or ported. BDO and LINA were aware Mr. Harris’ cancer caused him to leave work, the date he left work, and the cancer prevented him from returning to work.
Shortly after Mr. Harris’ disability claim was approved, BDO and LINA corresponded concerning the “need” to notify Mr. Harris about conversion and portability options under the life insurance plan when the twelve-month continuation period ended. This did not happen. Rather, BDO allowed Mr. Harris to continue making life insurance premium payments several months beyond the termination of his coverage.
Eventually BDO wrote to Mr. Harris and informed him that his employment had terminated. The letter included information about continuation of benefits upon termination. It stated that LINA would contact him and provide him with conversion and portability options for his life insurance policy. Neither LINA nor BDO followed up with Mr. Harris or provided paperwork regarding conversion or portability options.
BDO did not communicate with LINA that the time had come when it “needed” to provide Mr. Harris with this paperwork. BDO filed a motion to dismiss contesting that it was not obligated, as a fiduciary, to provide conversion and portability information to Mr. Harris or to alert him to the lapse of his coverage. In denying the motion, the court recognized three ways BDO had breached its fiduciary duty – subjecting itself to potential equitable remedies, including surcharge.
First, though Mr. Harris had not alleged he inquired of BDO or LINA concerning his conversion or portability rights, BDO was aware that Mr. Harris was severely, even terminally, ill. This awareness, if true, triggered BDO’s fiduciary duty to inform. BDO was on notice Mr. Harris would be interested in continued life insurance. BDO breached its fiduciary duty in failing to provide Mr. Harris with the information to convert and/or port his life insurance policy when BDO knew Mr. Harris would likely want (and need) to continue his coverage.
Second, because BDO made an affirmative representation to Mr. Harris that information and paperwork would be forthcoming, even if from LINA, and BDO did not follow through on its assurance, BDO breached its fiduciary duty.
Third, the acceptance of premiums after Mr. Harris’s coverage had lapsed was a breach of fiduciary duty because it was tantamount to confirming coverage. It was not necessarily case determinative that Mr. Harris did not continue to pay those premiums until the time of his passing.
These cases show that, yes, administering ERISA plans might be complex. But given the relative paucity of case law regarding ERISA surcharge, mistakes may not be as common as the Supreme Court believed. Yet given the ease with which courts will ensure plan participants get the ERISA benefits they reasonably believed they held, it is important for plan administrators and insurers to be extra diligent in the process. And these types of surcharge cases may rise in prominence as claimants learn that monetary relief might be available to remedy breach of fiduciary duty.