Opinion ID: 780581
Heading Depth: 2
Heading Rank: 1

Heading: the bellsouth short term disability plan

Text: 2 BellSouth Telecommunications, Inc., provides short term disability benefits to eligible employees through its BellSouth Short Term Disability Plan, and it has delegated to Kemper National Services, Inc., the exclusive discretionary authority to interpret and administer the terms of the Plan. (To simplify things we will refer to both corporations as BellSouth.) The Plan sets up a two-tier claim and appeal procedure for participants who wish to make a disability claim. First, the plan participant must file a claim for benefits documenting the claimed disability. If that claim for benefits is denied, the Plan allows an appeal, providing: 3 Any participant whose claim for Benefits has been denied in whole or in part and who wants this denial to be reviewed must submit a written appeal of the claim denial within 60 days after receipt of notice of denial. 4 In accordance with 29 U.S.C. §§ 1022 and 1024(b), BellSouth provided a summary plan description to plan participants and beneficiaries, including the plaintiff and appellant in this case, Gloria Watts, which contains an explanation of the terms of the Plan. ERISA requires employers to put certain information in the summary plan description, including the procedures to be followed in presenting claims for benefits under the plan ... and the remedies available under the plan for the redress of claims which are denied in whole or in part. 29 U.S.C. § 1022(b). BellSouth complied with this requirement and described the Plan's claim and appeal procedure in the summary plan description. 5 The introductory paragraph to the Benefit Claim And Appeal Procedures section of the summary plan description states: The procedure that must be followed in order to pursue your claim and appeal rights is described below. Under the heading Appeal Procedure, the summary plan description states that A claimant may use this procedure if: ... Written denial of the claim is received ... and the claimant wishes to appeal the denial. The appeal procedure is then described: 6 If the claim for benefits is denied, or deemed denied, in whole or in part, and the claimant or a person duly authorized by the claimant wishes to appeal this denial, such appeal must be submitted in writing within 60 days after receipt of the denial.... Written request for review of any denied claim should be sent to the Secretary/Assistant Secretary, EBC, EBCRC or other Committee delegate.... 7 To clarify, what we have been talking about thus far are the administrative remedies the Plan provides for participants and how those remedies are described in the summary plan description given to participants. 8 In addition to those administrative remedies, participants have at their disposal federal and state court remedies under ERISA, and those court remedies must also be described in the summary plan description. ERISA authorizes the Secretary of Labor to require that the administrator of any employee benefit plan furnish to each participant and to each beneficiary receiving benefits under the plan a statement of the rights of participants and beneficiaries under this subchapter. 29 U.S.C. § 1024(c). One of those rights is to bring a lawsuit challenging the denial of benefits. 29 U.S.C. § 1132(a)(1)(B). The Secretary, implementing this statutory authority, has issued a regulation mandating that summary plan descriptions include a statement of the plan participants' legal rights under ERISA, and the regulation includes a model statement of rights which is recommended for use. See 29 C.F.R. § 2520.102-3(t). The pertinent language of the model statement provides that [i]f you have a claim for benefits which is denied or ignored, in whole or in part, you may file suit in a state or Federal court. Id. § 2520.102-3(t)(2). The summary plan description BellSouth provided to Watts and other participants contained a statement under the heading Your Rights Under ERISA, which repeated verbatim the language of the model statement recommended by the Secretary in the regulation.