Opinion ID: 223580
Heading Depth: 1
Heading Rank: 3

Heading: Remedy for Procedural Violation

Text: We now turn to the question of the appropriate remedy for the Plan’s procedural violation. The remedy is not, as the plaintiff argues, an award of benefits. An award of benefits is appropriate only where evidence is “so clear cut that it would be unreasonable for the plan administrator to deny the application for benefits on any ground.” Love, 574 F.3d at 398, quoting Gallo v. Amoco Corp., 102 F.3d 918, 923 (7th Cir. 1996). Where, as here, it is not clear from the record that the plaintiff is entitled to benefits, the more appropriate remedy is to remand to the plan administrator for a de novo benefits determination. Id. The Plan must make a de novo determination of whether Kough is entitled to disability benefits for October 2005 through August 2008. In remanding the disability benefits determination to the Plan, a couple of additional issues deserve discussion. First, because the Plan failed to convey adequately in its 2005 denial letter that it required evidence from the Social Security Administration, the Plan’s de novo benefits determination must be made in light of the evidence Kough was able to secure. It does not No. 10‐2128 Page 6 make sense that Kough would be denied benefits before September 2008 because “the first month the Trustees had the opportunity to consider [the Social Security Administration] evidence was August 2008.” The reason for the delay was the Plan’s violation of the ERISA notice requirements by not notifying Kough that it required this evidence earlier. The second issue is that the Plan, on remand from the district court, already made a decision that Kough was entitled to disability benefits for an eight‐month period, between September 1, 2008 through April 30, 2009. While Kough remains entitled to those benefits, we disagree with Kough that the Plan should be bound by that prior decision for October 2005 through August 2008. The Trustees granted Kough benefits at least in part because it seemed more prudent to pay benefits for a few months rather than to continue with this already protracted litigation. See Short App. 7 (Trustees’ April 23, 2009 decision) (noting that “the potential cost to the Fund of further litigation, and the impact of that cost on the other participants and beneficiaries, exceeds the value of [Kough’s] benefit from the period September 1, 2008 to April 30, 2009.”). The Plan should not be bound by that earlier determination when making a de novo determination of whether Kough is entitled to a larger amount of disability benefits for October 2005 through August 2008. The Plan should consider the benefits decision anew for that period, based on all available information.