Published by The Pellegrin Firm October 18, 2020

The Employee Retirement Income Security Act (“ERISA”), a federal law, governs most insurance plans provided by private employers to their employees. This includes health insurance, life insurance, and medical insurance. According to a provision of ERISA, 29 U.S.C. § 1024(b)(1), ERISA plan administrators must provide a summary plan description (“SPD”) to beneficiaries and the SPD must “reasonably apprise [plan] participants and beneficiaries of their rights and obligations under the plan” and must be “written in a manner calculated to be understood by the average plan participant.”

Courts have found that ERISA also requires plans to establish a written instrument setting forth the terms of the plan. However, several courts have found that an SPD and written instrument establishing the plan may be the same document. Bd. Of Trs. V. Moore, 800 F.3d 214, 220 (6^th Cir. 2015); Dudley v. Sedgwick Claims Mgmt. Servs. Inc., 495 F. App’x 470, 471 (5^th Cir. 2012). Therefore, determining what documents govern an ERISA plan (especially when they seemingly conflict) can be exceedingly difficult. In Rhea v. Ala Ritchey, Inc. Welfare Benefit Plan, 858 F.3d 340 (5th Cir. 2017), the New Orleans-based U.S. Court of Appeals for the Fifth Circuit found that a single-page document could serve as an enforceable SPD and written instrument because it contained amendment procedures, a brief description of the plan’s funding, and a grant of authority to the plan administrator. In that case, the court enforced the SPD’s reimbursement provision and required a beneficiary/tort plaintiff to reimburse the plan for medical expenses paid by the plan as a result of medical malpractice.