Opinion ID: 3064083
Heading Depth: 3
Heading Rank: 1

Heading: Wachovia’s LTD Plan

Text: The Plan is an employee welfare benefit plan governed by the Employee Retirement Income Security Act of 1974 (“ERISA”), 29 U.S.C. § 1001, et seq.. Wachovia’s Benefits Committee is designated as the “Plan Administrator” and is granted sole discretionary authority regarding the interpretation of the terms and provisions of the Plan. The designated third-party Claims Administrator for the Plan, Liberty Life Assurance Company of Boston (“Liberty Mutual”), makes initial decisions regarding eligibility for disability benefits. To receive LTD benefits under the Plan, claimants must prove that they meet the Plan’s definition of “disabled.” The Plan describes the requisite “proof” of disability as: 2 (a) the evidence in support of a claim for benefits in a form or format satisfactory to the Claims Administrator, (b) an attending Physician’s statement in a form or format satisfactory to the Claims Administrator, completed and verified by the Participant’s attending Physician, and (c) provision by the attending Physician of standard diagnosis, chart notes, lab findings, test results, x-rays and/or other forms of objective medical evidence that may be required by the Claims Administrator in support of a claim for benefits. Notwithstanding the foregoing, the Plan Administrator, or the Claims Administrator acting as agent of the Plan Administrator, may also consider other evidence of a claimed Disability, including, but not limited to evidence discovered or otherwise developed by the Plan Administrator or the Claims Administrator. WAC14611 (emphasis added). What a claimant must prove to establish disability depends on how long she has received benefits. During the first twenty-four months of coverage, a claimant would be “disabled” if she shows that she had an illness or injury that made her unable to perform all of the regular duties of her then-current job. After twenty-four months, the claimant would be “disabled” only if she established that her condition made her unable to perform all of the duties required for any occupation for which her background and experience would make her qualified. However, if her disability is based on a mental illness, she generally cannot receive more than twenty-four months of LTD benefits.2 The Plan defines 1 The administrative record in this case was filed as part of Wachovia’s motion for summary judgment (R1-14) and Bates numbered from WAC0077 to WAC1529. All references to documents from that record will use the corresponding Bates number. 2 Claimants are exempt from this rule if they are either in a hospital or confined for treatment for at least fourteen consecutive days after the twenty-four-month period is over. 3 “mental illness” as “mental, nervous, or emotional diseases or disorders of any type.” WAC1442.