Who is the fiduciary for claims decisions
Many agreements state that the administrator does not act as a fiduciary while simultaneously granting it discretionary authority over claims and appeals. Discretion is what creates fiduciary status under ERISA, and a contract disclaimer does not undo it.
Decide deliberately whether the TPA holds named-fiduciary status for benefit determinations, and make the answer consistent with the plan document.
Performance standards with no remedy
Turnaround, accuracy, and financial-accuracy standards are frequently stated without a consequence for missing them. A standard without a remedy is a marketing statement.
- Tie a meaningful share of fees to measured performance.
- Define the measurement method and who audits it.
- Require reporting at a cadence you can act on, not annually in arrears.
Data ownership and audit rights
The plan owns its claims data. Contracts often restrict the format, frequency, and cost of access, and limit independent audits to the administrator's chosen firm. Both restrictions undermine your ability to monitor prudently.
Run-out, termination, and the exit ramp
Run-out administration terms, per-claim fees after termination, and the handling of pending appeals decide how expensive it is to change vendors. Negotiate the exit while you still have leverage — at signing.
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