Will a recent Supreme Court ruling allow Cigna and other insurers to the change the rules when it comes to the promises made in their Summary Plan Descriptions?
Most disability insurance plans are regulated by ERISA. ERISA was passed to protect the interests of employee benefit plan participants and their beneficiaries. One ERISA requirement is that plan sponsors must provide plan information to plan participants. This information takes the form of a Plan Document, an in depth legal document/contract that actually creates the plan, and a Summary Plan Description, a document designed for employees which condenses and outlines the information contained in the Plan Document for easier comprehension.
For a long time it was assumed that if the information in the Summary Plan Description differed from that of the Plan Document, then the Summary Plan Description could be used as the legally binding document. However, a recent decision by the Supermen Court of the United States (SCOTUS) changed all that.
In the case of Cigna v. Amara, the Supreme Court ruled that insurance plan providers are not legally bound by the statements that appear in a Summary Plan Description, even if these statements are different or misleading from those in a Plan Document. The justices ruled that under ERISA, the Summary Plan Description is just that, a summary, and a plan participant or beneficiary may not recover for misrepresentations in a Summary Plan Description. The fact that an insurance company revises their Plan Document without revising the Summary Plan Description is irrelevant – the only information the courts can consider is that contained within the Plan Document.
You’re Probably Wondering: How Does This Affect My Disability Claim?
We’re still waiting to see exactly how the lower courts apply the Supreme Court decision. In their ruling the SCOTUS suggested equitable estoppel and surcharge are perhaps better suited to the facts in a disability benefits dispute. Estoppel is a judicial device in which a court may prevent, or “estop” a person from making assertions or from going back on his or her word. This means that if an insurer such as UNUM, METLIFE, or HARTFORD misrepresents a Plan Description in the Summary Plan Description, the doctrine of estoppel may still bind them to keep the promises made in the Summary Plan Description.
If you feel your claim was denied due to differences in the details between your insurer’s Plan Description and their Summary Plan Description you should reach out to Marc Whitehead & Associates as soon as possible. We’re familiar with the insurance companies’ tricks and how to counter them. We’ve successfully guided hundreds of disabled workers and military personnel through the disability claims process to obtain the full benefits they deserve. Contact us today to schedule a free consultation with one of our experienced ERISA attorneys to discuss your case.
If you would like more information about ERISA long term disability plans or need assistance appealing a denial of disability benefits, contact the Disability Benefits Attorneys at Marc Whitehead & Associates at www.DisabilityDenials.com.
179 L. Ed. 2d 843, *; 2011 U.S. LEXIS 3540, **;
50 Employee Benefits Cas. (BNA) 2569; 22 Fla. L. Weekly Fed. S 985