Opinion ID: 204085
Heading Depth: 1
Heading Rank: 2

Heading: Disclosure Obligations

Text: In a separate argument, Medina contends that MetLife's failure to provide him with a copy of the fax to Dr. Stella constituted a sanctionable violation of its disclosure obligations under 29 U.S.C. § 1132(c)(1)(B). That section provides in pertinent part: Any administrator . . . who fails or refuses to comply with a request for any information which such administrator is required by this subchapter to furnish to a participant or beneficiary . . . by mailing the material requested to the last known address of the requesting participant or beneficiary within 30 days after such request may in the court's discretion be personally liable to such participant or beneficiary in the amount of up to $100 a day from the date of such failure or refusal, and the court may in its discretion order such other relief as it deems proper. On April 12, 2007, Medina wrote to MetLife requesting all relevant documents on which it had relied in reaching its decision to deny short-term disability benefits. He specifically asked for a copy of the fax sent to Dr. Stella, along with a confirmation page showing that the fax had successfully been transmitted. On April 25, 2007, MetLife sent Medina the entire case file. Medina's claim on appeal is that because this file did not contain the -12- requested transmission confirmation sheet (the fax itself was produced), MetLife is liable for sanctions under § 1132. Medina's conclusion is a non sequitur. First, the remedy he seeks is not available for his alleged grievance. The substantive requirement that MetLife furnish requested documents after a denial of a claim is located in § 1133, which obligates insurance plans to afford a reasonable opportunity to any participant whose claim for benefits has been denied for a full and fair review by the appropriate named fiduciary of the decision denying the claim. 29 U.S.C. § 1133(2); see also 29 C.F.R. § 2560.503-1(h)(2)(iii) (delineating requirements for a full and fair review). It is well established that a violation of § 1133 and its implementing regulations does not trigger monetary sanctions under § 1132(c). See, e.g., Wilczynski v. Lumbermens Mut. Cas. Co., 93 F.3d 397, 406 (7th Cir. 1996); Sturhlreyer v. Armco, Inc. 12 F.3d 75, 79(6th Cir. 1993); Groves v. Modified Ret. Plan, 803 F.2d 109, 117-18 (3d Cir. 1986). Sanctions are therefore unavailable here. Second, even if sanctions were available, we see no foul that would merit them. Section 1133's implementing regulation provides: [T]he claims procedures of a plan will not be deemed to provide a claimant with a reasonable opportunity for a full and fair review of a claim and adverse benefit determination unless the claims procedures . . . [p]rovide that a claimant shall be provided, upon request and -13- free of charge, reasonable access to, and copies of, all documents, records, and other information relevant to the claimant's claim for benefits. 29 C.F.R. § 2560.503-1(h)(2)(iii). MetLife, which mailed the entire claim file a week after receiving Medina's request, more than sufficiently met the regulation's reasonable access standard. Although Medina demands a fax transmission confirmation in addition to the fax itself, there is no reason to think that such a document was ever part of the file, and its absence is not a violation.