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Posted

Spouse and daughter (from previous marriage) both claim they are entitled to distribution of deceased participant's 401k plan account.  Plan administrator reviewed information from both parties and determined that the account be distributed to daughter.  Spouse appealed denial of his claim and submitted additional and new information in support of his appeal.  Attorney for daughter is asking whether she will be provided a copy of documents submitted by spouse in support of his appeal and whether she will have an opportunity to respond.  I cannot find anything in the claims procedure requirements that address this.  My thought is that if the plan administrator determines that the spouse's appeal is well taken and therefore the account should be distributed to him, that is tantamout to a denial of the daughter's claim, requiring the plan administrator to provide her a detailed explanation of the basis for the denial (which would include the information submitted by the spouse in his appeal) and triggering her own appeal right where she can submit her own argument/documents.  Thoughts?

Posted

Yes, and that means the Plan's legal counsel, not counsel for either party.  If "plan administrator" refers to a TPA, the plan's legal counsel can discuss with the TPA legal counsel, but the former overrules the latter.

I'm a retirement actuary. Nothing about my comments is intended or should be construed as investment, tax, legal or accounting advice. Occasionally, but not all the time, it might be reasonable to interpret my comments as actuarial or consulting advice.

Posted
23 hours ago, t.haley said:

My thought is that if the plan administrator determines that the spouse's appeal is well taken and therefore the account should be distributed to him, that is tantamout to a denial of the daughter's claim, requiring the plan administrator to provide her a detailed explanation of the basis for the denial (which would include the information submitted by the spouse in his appeal) and triggering her own appeal right where she can submit her own argument/documents.  Thoughts?

I agree with your thought process BUT as everyone else has opined, such matters are better left for consultation with qualified legal counsel.

Kenneth M. Prell, CEBS, ERPA

Vice President, BPAS Actuarial & Pension Services

kprell@bpas.com

Posted

Although I am an attorney, this is not legal advice to anyone. Consult with the plan's legal counsel. They will tell you to do one of two things: (1) file a lawsuit in federal court called an interpleader in which the plan offers to pay the money to the party determined to be entitled to it by the court -- you may need to deposit the account balance with the court. The court will decide --and your client avoids the worry of paying twice and of having to fight to get the money back from the party who was determined not to be entitled to the account; or (2) decide the claim with counsel's advice and pay the person to whom it is properly payable. 

As far as disclosing materials submitted by the spouse, I know that the ERISA requirements do not compel the plan to share that information with the other person, with two exceptions: (1) if you grant the wife's appeal and inform the daughter that she is not entitled to the benefit, the claims procedure regulations require you to share the information with the claimant; and (2) if someone sues, the mother and daughter will be parties to the lawsuit and their attorneys will be entitled to relevant documents during discovery in the litigation. To short-circuit the process and maybe resolve this short of litigation, I would suggest that you share the information with the daughter and that you propose interpleader as an amicable way to resolve the issue. But Remember, I am not the plan's lawyer -- you will need to defer to him or her for the final recommenation.

Posted

Don't forget to consider whether any communication received is a claim, which then triggers the claim procedures in the plan document.  It's possible that the plan has decided "correctly" but still has not responded to one or more claims according to the plan requirements.  The plan's ERISA counsel will likely remind the plan of this procedure.

I'm a retirement actuary. Nothing about my comments is intended or should be construed as investment, tax, legal or accounting advice. Occasionally, but not all the time, it might be reasonable to interpret my comments as actuarial or consulting advice.

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