Employees in Chicago whose claims for long-term disability benefits have been denied receive notice of the denied claim, or adverse benefit determination in writing. That written notice must meet certain minimum standards of content and timing. Aa denied long-term disability claim must communicate the reason for the denial, a reference to the specific plan provisions on which the decision is based, and “a description of any additional material or information necessary for the claimant to perfect the claim and an explanation of why such material or information is necessary . . .” 29 C.F.R. § 2560.503-1(g)(1). This requirement appears to mean the plan must tell you what additional information you can submit to cure the denial. But a recent case fleshed out limits to what it means to “perfect” a claim.
In Ruessler v. Boilermaker-Blacksmith National Pension Trust Board of Trustees, No. 21-3876, 2023 WL 2750829 (8th Cir. Apr. 3, 2023), the plan required in order to apply for disability benefits to have been awarded Social Security disability benefits, and submit the notice of award with the application. After the trustees amended the plan to reduce disability benefits, Ruessler applied for the benefits, though he had not yet been awarded Social Security disability. In the benefit denial, the plan notified Ruessler that in order to perfect his claim, he could submit evidence he had been awarded Social Security disability at the time he applied for disability benefits from the plan. With his appeal, Ruessler submitted a notice of award from Social Security, but it post-dated his application for disability benefits from the plan. The plan then denied his appeal, but awarded him disability benefits starting at a much later date, after the plan reduced the benefits. Ruessler then sued under ERISA § 502(a).
The United States Court of Appeals for the Eighth Circuit ruled against Ruessler, and upheld the plan’s denial of his long-term disability claim. Ruessler argued ERISA gives him the right to submit additional information with his appeal and cure the defect in the original claim application. But the court explained the right to notice of how to perfect a claim does not mean a right to cure any defect. The plan allowed Ruessler to submit documents showing he had been awarded Social Security disability at the time he made his claim for disability benefits to the plan, but he did not do so because he was awarded Social Security after he applied for long-term disability benefits from the plan. He thus could not cure that defect.
If your claim for long-term disability benefits has been denied, contact an experienced ERISA long-term disability lawyer immediately.