Request for Medical Documents

Kizzie

[font size="1" color="#FF0000"]LAST EDITED ON 03-12-03 AT 08:24AM (CST)[/font][p]We have a former employee (terminated in 1998 as per our company policy after receiving six months of short term benefits and no indication of a return to work date) who subsequently received Long Term Disability benefits for three years. LTD is administered by an outside carrier and once a claim is made with the LTD carrier, we are no longer involved in any determination of disability etc. We do, however, receive copies of the status of the claim, as well as copies of other related documentation that involves this individual, from the carrier. The carrier discontinued this individual's benefits in June 2001 because the medical and vocational documentation did not support that the individual remained disabled from any occupation. The individual appealed this decision and the denial was upheld by Appeals through the LTD carrier. This occurred in 2001. The individual now has an attorney who is reviewing the claim for benefits. This attorney has requested from both the carrier and us (the former employer), all documents in our possession including the entire claim file, a complete copy of all Plan documents including administrative information, all notes and reports of any individuals, medical and vocational advisors/consultants whose opinions were relied upon and the Curriculum Vitae of each expert. A consent form from the former employee was included.

We will not release this information without a subpoena and even then it would be questionable since we are not the origin of this information. However, do we have a liability under ERISA to provide any of the above information?

Thanks for any assistance.

Lori B

Watch out for the subpoena. ADA doesn't allow production of medical info absent a court order or voluntary request by the former ee. A subpoena does not rise to the level of a court order. Consider agreeing to a joint protective court order so this doesn't turn into an adversarial thing.

I'm not sure of the ERISA issues and how that might affect above issue with ADA. I look forward to seeing other responses to your post. good luck

Theresa Gegen TX

ERISA may effect the request for plan documents. Under ERISA if an employee requests plan documents in writing from the Administrator (who is listed in the Plan), certain documents must be furnished. If the Administrator does not furnish the documents, then a Court could fine them with a daily fine (of something like $100 per day).

You need to determine if the Company is the administrator. Look at the written plan and summary plan description, it should tell the particpants who to request plan documents from. If it is the Company, you need to provide those immediately. But the documents the adminstrator must provide do not need to be all of the documents requested the the attorney. There are only certain categories (like a copy of the plan, a copy of the SPD, etc).

I suggest you check the SPD, and if the company is required to turn over documents, you contact an attorney who can tell you what you must produce without subpeona.

Good Luck