For example, a case against a Missouri company (which remains confidential) that was brought by Phillip A. Tatlow on behalf of the client, against the employer, for offering insurance coverage for approximately $400,000.00, when the written plan stated that the benefits were less than that (approximately $200,000.00) was recently litigated and settled after mediation.  However, the higher amount of insurance coverage is what the participant thought she was buying when she paid premiums to purchase the plan because a company/employer representative told her that she could purchase the higher amount; she did so and paid premiums over a number of years. Later, when it came time to make a claim under the plan, the plan sponsor and employer stated that the benefits were limited to the lower number because of what the written plan documents stated in the fine print of the plan. However, the plan participant claimed that she had never been given the plan documents as required under ERISA, through the mail or through the internet and that the company defrauded her by orally misrepresenting the terms of the plan. We represented the client against the employer and insurance company and claimed that the Defendants were liable for oral misrepresentation of the terms of the plan under a breach of fiduciary theory and we asked for equitable relief under 29 U.S.C. 1032(a)(1)(3). In the end, this case was resolved in mediation for a substantial sum of money. The case name and details are subject to a confidential agreement. However, cases in which employers misrepresent the terms of the coverage, can be brought under 29 U.S.C. 1032(a)(1)(3) to:

(A) enjoin any act or practice which violates any provision of the …plan, or

(B) obtain other equitable relief (i) to redress such violations….

For the duties required of a fiduciary under ERISA, other parts of the statute should be consulted.

                    [A] fiduciary shall discharge his duties with respect to a plan solely in the interest of the participants and beneficiaries and-

                              (A) for the exclusive purpose of:

                                         (i) providing benefits to participants and their beneficiaries; and :

                                         (ii) defraying reasonable expenses of administering the plan;

                              (B) with the care, skill, prudence, and diligence under the circumstances then prevailing that a prudent man acting in a like capacity and familiar with such matters would use in the conduct of an enterprise of a like character and with like aims;

                              (C) by diversifying the investments of the plan so as to minimize the risk of large losses, unless under the circumstances it is clearly prudent not to do so; and

                              (D) in accordance with the documents and instruments governing the plan insofar as such documents and instruments are consistent with the provisions of this subchapter and subchapter III of this chapter.

29 U.S.C. 1104(a)(1)(A)(B)(C) & (D).

To determine whether you have a valid claim for benefits under ERISA or a valid breach of fiduciary duty, you should choose an attorney that regularly handles ERISA cases because this is a technical area of the law and many attorneys lack the knowledge to handle such cases.

Jill S. Bollwerk
Helping St. Louis area residents with personal injury, workers' compensation & insurance appeals/disputes.