Opinion ID: 3028801
Heading Depth: 3
Heading Rank: 2

Heading: LTD Benefits

Text: The District Court’s equitable remedy of granting Gambino an opportunity to pursue his LTD is legally unsupportable. We will reverse the judgment as to that claim. As an initial matter, IKON retains final authority to determine whether Gambino is entitled to LTD benefits, and IKON is the party obligated to pay any LTD benefits due. IKON, however, is not a party to this suit. We therefore approach with skepticism an equitable “remedy” which, in reality, is likely to remedy nothing. More importantly, Gambino never filed a claim with Liberty for LTD benefits. Except in limited circumstances, a federal court will not entertain an ERISA claim unless the plaintiff has exhausted the remedies available under the plan. Harrow v. Prudential Ins. Co. of America, 279 F.3d 244, 249 (3d Cir. 2002); Weldon v. Kraft, Inc., 896 F.2d 793, 800 (3d that Gambino had not provided sufficient evidence to establish disability during the elimination period. Liberty denied Gambino’s claim because it lacked sufficient medical evidence regarding his condition. Without knowing the details of Gambino’s condition, Liberty could not go on to the next step of determining whether that condition rendered him unable to perform his duties, whatever those duties might have been. Liberty’s lack of knowledge regarding Gambino’s specific duties was therefore irrelevant. 13 Cir. 1990). The exhaustion requirement serves a number of important policy interests, including helping reduce the number of frivolous lawsuits under ERISA, promoting consistent treatment of claims, providing a nonadversarial method to settle claims, and minimizing costs of settlement. Harrow, 279 F.3d at 249. Gambino’s failure to seek LTD benefits in the first place surely qualifies as a failure to exhaust. Thus, if Gambino is to find a remedy under ERISA, he must demonstrate that his failure to exhaust falls within an exception to the exhaustion requirement. A plaintiff is excused from exhausting his remedies if it would be futile to do so. Id.; Berger v. Edgewater Steel Co., 911 F.2d 911, 916 (3d Cir. 1990). The law is clear that the plaintiff must show, by making a “clear and positive showing of futility,” that it would have been actually futile to pursue the claim. Harrow, 279 F.3d at 249 (citation omitted). In Harrow, we quoted the Sixth Circuit as holding that “[a] plaintiff must show that it is certain that his claim will be denied on appeal, not merely that he doubts that an appeal will result in a different decision.” Fallick v. Nationwide Mut. Ins. Co., 162 F.3d 410, 419 (6th Cir. 1998) (internal quotation marks and citation omitted). The District Court granted Gambino relief on the ground of futility because it was “entirely foreseeable” that a denial of STD benefits “would likely cause a beneficiary to assume that an LTD claim would be futile.” 2005 WL 4839146, at . The District Court found that Liberty had offered no proof of any instance in which an individual who had been denied STD benefits was nonetheless awarded LTD benefits and that Liberty had never 14 notified Gambino of his right to apply for LTD benefits despite denial of his STD claim. Id. These findings, however, are not relevant as to whether it would actually have been futile for Gambino to apply for LTD benefits. The STD and LTD plans contain different elimination periods. It is possible for a covered person who lacked sufficient medical evidence to establish disability within a two-week window to nonetheless amass sufficient medical evidence to establish disability under the longer six-month period. There are a number of subsequent records of treatment within a six-month period which could have supported an award of LTD benefits. Thus, Gambino’s failure to apply for LTD benefits should not have been excused.