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6/8/12 10:11 AM
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 Not designed solely to see if Steve72 posts here anymore


Plaintiff is being denied benefits under an ERISA long-term disability plan covered by an insurance contract from a thrid party insurer.  The Plan is administered by the employer, but the third party insurance company makes the determination as to whether or not to pay benefits.

Employee and employer think benefits should be paid, but insurance company does not want to pay.

There is law in the 7th circuit (my circuit) that says an employee may only sue the Plan under ERISA for denial of benefits.  The insurance company is not a proper defendant. 

In this instance, assuming the employer is the proper party to respond to a suit for unpaid benefits filed against the Plan (due to the employer's status as plan administrator), a lawsuit against the Plan seems comical since the employer wants the employee to receive benefits anyway.

Moreover, if the plaintiff prevails against the Plan, the insurance company is not a party to that suit so it will likely continue to take the position that it does not have to pay.  The Plan doesn't have any other assets other than the policy it purchased to pay benefits.

How does someone proceed in this instance?  Instead of the employee suing the Plan, should the Plan instead sue the insurance company for breach of fiduciary duty owed to the Plan to properly pay benefits and sue for a declaratory judgment that the employee is entitled to benefits?  Assuming the Plan obtains such a declaratory judgment, then the Plan would have assets to pay the employee.

6/8/12 4:46 PM
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Fake Pie
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LIGHT UP THE STEVE72 SIGNAL!
6/8/12 5:29 PM
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ttt for Steve72
6/8/12 7:58 PM
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 Federal income taxes are illegal and so is the Fed.  (that should do it)
6/9/12 7:27 AM
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 The South had a clear Constitutional right to secede from the Union.
6/9/12 7:31 AM
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 The Slaughterhouse cases were rightly decided.
6/9/12 10:33 AM
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 The power to coin money does not equate to the ability to issue fiat currency.
6/9/12 11:37 AM
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LOL!!!

Baiting Steve72... Gold. Phone Post
6/9/12 2:26 PM
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6/10/12 8:10 AM
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 Definitely not pee
6/15/12 2:37 PM
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 RIP June Carter72
6/18/12 5:47 PM
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He's still not taking the bait??
6/23/12 9:10 AM
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Steve72
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LOL
6/23/12 9:12 AM
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Steve72
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Not sure I understand. The insurer must be a fiduciary to the plan if it's making a final claims determination. Why wouldn't a 502(a)(1)(B) action, even if nominally against the plan, bind all of the fiduciaries (PA and claims fiduciary) to act in accordance with the court's decision?
6/23/12 11:23 PM
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The prodigal son returns!!! Phone Post
6/26/12 8:23 PM
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 LOL, having a discussion on this forum is like posting messages in the classifieds a la Suddenly Susan.  
6/27/12 5:17 PM
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Trust, my friend, I'm afraid I'm going to have to ask you to immediately turn in your man-card for making a specific Suddenly Susan reference, especially in that it was done so in such a matter-of-fact manner. Phone Post
6/28/12 10:49 AM
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Edited: 06/28/12 10:51 AM
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Tatera v. The Prudential Ins. Co. of America, 2011 WL 3876954

LEXIS 98460 (N.D. Ill. Sept. 1, 2011).
6/28/12 2:47 PM
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 I think I have to do 503(a)(3) against the insurer.

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