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Van Bael v. United Healthcare Services, Inc.

United States District Court, E.D. Louisiana

January 10, 2019

SUNSHINE VAN BAEL
v.
UNITED HEALTHCARE SERVICES, INC.

         SECTION I

          ORDER & REASONS

          LANCE M. AFRICK, UNITED STATES DISTRICT JUDGE

         Before the Court is plaintiff Sunshine Van Bael's (“Van Bael”) motion[1] for penalties against defendant Tulane University (“Tulane”). For the following reasons, the motion is denied.

         I.

         This action arises out of the Employee Retirement Income Security Act (“ERISA”), 29 U.S.C. § 1001, et seq. Van Bael is an assistant professor at Tulane.[2] As a Tulane employee, she is insured by an employee welfare benefit healthcare plan (the “Plan”) sponsored and administered by Tulane.[3] Defendant United Healthcare Services, Inc. (“United Healthcare”) is the Plan's claims administrator; it “handle[s] the day-to-day administration of the Plan's coverage as directed by [Tulane].”[4]

         On February 1, 2018, frustrated by what she describes as United Healthcare's decision to ignore her requests for information, Van Bael sent a letter to Tulane.[5] The letter specifically referenced two claim numbers and requested “a certified copy of any and all documents, records, health benefit plan provisions, internal rules, guidelines and protocols, and any other relevant information pertaining to Ms. Van Bael's policy that corresponds with the . . . claims.”[6] The letter specifically listed ten items, one of which was “[a] certified copy of Sunshine Van Bael's UnitedHealthcare's health insurance policy.”[7]

         According to Van Bael, her request was not fulfilled until September 18, 2018, when United Healthcare sent her attorney the administrative record as part of discovery in this case.[8] Van Bael contends that the document in the administrative record titled “UnitedHealthcare Choice Plus UnitedHealthcare Insurance Company Certificate of Coverage for the Health Reimbursement Account (HRA) Plan 7NE of Tulane University” constitutes the “health insurance policy” she requested in her February 2018 letter.[9] Van Bael asserts that, at the time she made the request, she did not know that the Plan was self-funded because the plan documents she had been provided by United Healthcare did not indicate as much.[10] She argues that this misunderstanding accounts for why she referred to the Tulane Plan as a United Healthcare insurance policy but that the discrepancy is unimportant: “Regardless of the term used, Tulane failed to produce the Plan document” in accordance with ERISA.[11]

         Van Bael also argues that she is entitled to penalties of up to $110 per day for Tulane's failure to produce the Plan document.[12] Because she sent the request on February 1, 2018, and the request was allegedly not complied with until September 18, 2018, Van Bael requests $23, 000 in penalties.[13]

         II.

         ERISA provides that

[a]ny administrator . . . who fails or refuses to comply with a request for any information which such administrator is required by this subchapter to furnish to a participant or beneficiary . . . by mailing the material requested to the last known address of the requesting participant or beneficiary within 30 days after such request may in the court's discretion be personally liable to such participant or beneficiary in the amount of up to $1[1]0 a day from the date of such failure or refusal.[14]

29 U.S.C. § 1132(c)(1)(B). The Fifth Circuit construes ERISA's penalty provision strictly. Fisher v. Metro. Life Ins. Co., 895 F.2d 1073, 1077 (5th Cir. 1990). The decision to grant or deny a request for penalties is within the Court's discretion. See Abraham v. Exxon Corp., 85 F.3d 1126, 1132 (5th Cir. 1996). Van Bael argues that Tulane's failure to respond to her February 2018 request for the Plan document warrants penalties.[15]

         According to Tulane, however, the only ERISA provision that requires a plan administrator to furnish information is 29 U.S.C. § 1024(b)(4), which states in relevant part:

The administrator shall, upon written request of any participant or beneficiary, furnish a copy of the latest updated summary[ ] plan description, and the latest annual report, any terminal report, the bargaining agreement, trust agreement, contract, or other ...

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