What Can A Plan Administrator Do with ERISA / Or PPACA APPEAL Document Requests?

  1. Provide all requested documents in 30 days to avoid ERISA statutory penalties;
  2. If any of the requested documents do NOT exist, please clearly certify that specific document never existed, and the plan will never submit or introduce the said non-existed document in the court for judicial reviews, to avoid any intentional misrepresentation of material facts under ERISA 18 U.S.C. Section 1027, “False Statements or Concealment of Facts in Relation to Documents Required by the Employee Retirement Income Security Act of 1974 (18 U.S.C. Section 1027)”;
  3. If a plan administrator believes any of the requested documents are factually and legally irrelevant to the claim denials and our appeals, please read the following carefully, and THEN certify clearly for each and every document claimed by the plan administrator as irrelevant, and certify that these documents will not and cannot be claimed otherwise or later on by the plan as relevant in the court under judicial estoppel doctrine. Keep in mind that if the plan ever relied upon, or ever intended to use the document in the court, that document is relevant under ERISA 18 U.S.C. Section 1027, “False Statements or Concealment of Facts in Relation to Documents Required by the Employee Retirement Income Security Act of 1974 (18 U.S.C. Section 1027)”
  4. In case of a self-insured or self-fund plan, if a plan administrator does not possess or have access to the requested document, or delegated part of the fiduciary authority or functions to a TPA or claim administrator, such plan administrator must ensure the TPA/ASO has complied with our requests, or the plan administrator must go to get these documents and comply with our requests, as the courts have ruled that the plan administrator is always liable for violating ERISA §1024(b)(4).
  5. In case any document requested in this appeal is claimed, by the plan administrator or fiduciary, as privileged, confidential or otherwise protected work product due to the conflict of interest under 29 U.S.C. §1104 fiduciary duties, please identify, DISCLOSE and certify each and every document with a clear reason(s) upon which a fiduciary will refuse to disclose, and whether such refusal will prevent a fiduciary from discharging his or her duties with respect to a plan solely in the interest of the participants and beneficiaries. A copy of 29 U.S.C. §1104 fiduciary duties is captioned below for your compliance assistance.

From the U.S. Government Printing Office, www.gpo.gov
§1104. Fiduciary duties
(a) Prudent man standard of care
(1) Subject to sections 1103(c) and (d), 1342, and 1344 of this title, 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.[/accordion]

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