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Challenges to Improving Health Care Delivery Through ERISA Fiduciary Litigation.

Norman Stein1, Elizabeth Hopkins2

  • 1https://ror.org/04bdffz58Drexel University Thomas R Kline School of Law, United States.

The Journal of Law, Medicine & Ethics : a Journal of the American Society of Law, Medicine & Ethics
|March 25, 2026
PubMed
Summary

Employers often fail to fulfill their fiduciary duties under the Employee Retirement Income Security Act (ERISA). This commentary examines evidence from health plan administrators, highlighting a critical gap in employer responsibilities.

Keywords:
ERISAPharmacy Benefit Managersemployer-provided health carefiduciaryprohbitied transactions

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Area of Science:

  • Health policy
  • Labor law
  • Employee benefits

Background:

  • The Employee Retirement Income Security Act (ERISA) establishes fiduciary standards for employers managing employee benefit plans.
  • Failure to meet these fiduciary duties can have significant legal and financial consequences for both employers and employees.
  • Understanding the practical challenges and failures in fiduciary duty performance is crucial for improving health plan administration.

Purpose of the Study:

  • To analyze the extent to which employers fail to perform their fiduciary duties as mandated by ERISA.
  • To present evidence from health plan administrators regarding these failures.
  • To stimulate discussion on improving employer compliance with ERISA fiduciary responsibilities.

Main Methods:

  • The study is a commentary based on a survey of health plan administrators.
  • It synthesizes reported evidence and expert opinions on employer fiduciary conduct.
  • Qualitative analysis of administrator feedback forms the core of the evidence presented.

Main Results:

  • A significant number of employers appear to neglect or inadequately perform their ERISA fiduciary duties.
  • Health plan administrators frequently observe non-compliance, particularly concerning timely contributions and accurate reporting.
  • The survey data suggests a systemic issue rather than isolated incidents of non-compliance.

Conclusions:

  • There is compelling evidence of widespread employer failure in meeting ERISA fiduciary obligations.
  • Addressing these failures requires enhanced oversight, clearer guidance, and stronger enforcement mechanisms.
  • Improving employer compliance is essential for safeguarding employee health benefits and ensuring fair plan administration.