Health Plan's Fiduciary Responsibilities Cover Enrollment Actions

>A judge in the US District Court for the District of Colorado, in affirming a magistrate judge’s recommendation, found that the employer’s failure to enroll an employee in the company’s health care plan on a timely basis constituted a breach of fiduciary duty.   However, the court refused to grant outright summary judgment in favor of the plaintiff finding significant questions of fact in surrounding the timely enrollment of the plaintiff to the company’s benefit plan.  

Case History

>The plaintiff, HIV-positive Shaunn Negley, was an employee at Breads of the World component Panera and sought enrollment in the company’s health care plan.   According to the court documents, Panera refused to enroll Negley in the plan, based upon its determination that his HIV was a preexisting condition and thus not included in applicable plan coverage.

>Negley filed suit against the medical plan, contending its failure to enroll him in the plan in a timely manner resulted in an 18-month period without health care coverage and thus significant costs were incurred on his part.   Negley’s complaint alleged the plan violated its responsibilities as a plan sponsor, administrator and fiduciary under ERISA Section 502(a) for failing to:

• properly enroll him in the plan
• correct direct correspondence to him regarding this action
• act promptly on correspondence sent by Negley regarding the lack of coverage
• exercise a degree of care necessary in such instances.

>However, Panera argued that its actions were “ministerial” in function and thus do not qualify as a fiduciary responsibility under ERISA provisions.   Further, the plan contends that correspondence was mailed to the plaintiff at the address provided, so that even if such duties were considered fiduciary in nature, no breach had occurred.

The case isNegley v. Breads of the World Medical Plan,District of Colorado, Number 02-D-840 (PAC).