Opinion ID: 1917613
Heading Depth: 3
Heading Rank: 1

Heading: General ERISA principles

Text: ¶ 65 A major objective of ERISA is to establish a uniform administrative scheme, which provides a set of standard procedures to guide processing of claims and disbursement of benefits. Fort Halifax Packing Co. v. Coyne, 482 U.S. 1, 9, 107 S.Ct. 2211, 96 L.Ed.2d 1 (1987). In furtherance of that goal, the United States Supreme Court has concluded that ERISA-governed plans must state the basis for the payment of benefits and that the administrator must administer the plan in accord with the plan's terms, and not on any other basis. Egelhoff, 532 U.S. at 147, 121 S.Ct. 1322. ERISA[] commands that a plan shall specify the basis on which payments are made to and from the plan, § 1102(b)(4), and that the fiduciary shall administer the plan in accordance with the documents and instruments governing the plan, § 1104(a)(1)(D). . . . Id. (citation omitted). Therefore, we must examine Touchpoint's explanation for denying benefits in light of the terms of the policy, because Touchpoint was obligated to conform its decisions in regard to payment, or the denial thereof, to the healthcare policy. Id.