Aetna Life Insurance Company, Inc. offers life insurance products and services. The company provides group disability, basic life, dependent life, accidental death, personal loss, long-term care, and supplemental insurance products. The company also offers beneficiary management services. The company was founded in 1853 and is based in Hartford, Connecticut. Aetna Life Insurance Company, Inc. operates as a subsidiary of Aetna Inc.
151 Farmington Avenue
Hartford, CT 06156
Founded in 1853
Aetna Life Insurance Co. Not Liable for Statutory Penalties as "De Facto" Plan Administrator
Dec 16 13
The U.S. District Court for the Southern District of New York held that an insurer could not be held liable for ERISA sanctions as a "de facto" plan administrator for failure to provide plan documents upon request. Bridget Curran, and her minor son, C.F.C., were insureds under the TriNet Group Inc.'s open access managed plan. Aetna Life Insurance Co. was the underwriter, insurer and agent of the plan, which was governed by ERISA, and TriNet was the issuer and administrator of the plan. C.F.C. underwent scoliosis surgery in January 2011, for which $168,500 was sought under the plan. From Apr. 7, 2011, to May 22, 2012, Curran wrote to Aetna and TriNet seeking documents relating to the approval and subsequent rescission of a $119,658 payment, referencing specific U.S. Department of Labor Regulations enacted pursuant to ERISA, which require production of certain documents. The letters sent to TriNet also requested specific documentation with regard to the adverse determination of the claim. TriNet's response, on July 16, 2012, indicated that TriNet was not the claims fiduciary and that it delegated all claims administration to Aetna, its insurer. To date, Curran has not received any of the requested documents pertaining to the adverse claim determination. Curran brought an action on behalf of herself and C.F.C. asserting a claim for statutory penalties against Aetna, TriNet and the plan for their failure to provide plan documents upon request. Aetna moved to dismiss for failure to state a claim upon which relief could be granted. The district court granted the defendants' motion in part. The text of ERISA makes it clear that sanctions under Â§502(c) may be imposed only against the plan administrator. In Curran's case, the plan instrument, the summary plan description, designated TriNet as the plan administrator, and therefore, only TriNet was subject to statutory damages under Â§502(c). Statutory penalties could not be imposed upon Aetna and the plan because they were not the plan administrator. The district court rejected Curran's argument that Aetna acted as a de facto plan administrator and should be legally held liable for the penalties. The court acknowledged that some courts held that "de facto" administrators can be held liable for statutory penalties, but it declined to follow that line of cases. Thus, Aetna could not be a de facto administrator and sanctions under Â§502 (c) could not be leveled against it.