Opinion ID: 215901
Heading Depth: 3
Heading Rank: 1

Heading: Denial of PTD Benefits

Text: The parties’ dispute over Horn’s entitlement to PTD benefits centers on the language of the Description. The Description states that an employee is entitled to PTD benefits if he: (1) becomes “permanently and totally disabled before [he] reach[es] age 65”; (2) files “a claim within 12 months after [he] stop[s] active work with” Owens-Illinois; and (3) is “unable to work for the rest of [his] life at any gainful occupation for which [he is] fitted by [his] education, training, or experience or for which [he] could reasonably become fitted.” Alternatively, under the Description, an employee may qualify for PTD benefits if on or after April 1, 1999, [he is] under age 65 and receive[s] an award for Social Security Disability benefits. That award must be submitted to the insurance company responsible for making the PTD award decisions. Claim filing must meet the requirements described in PTD Benefit Claims and Appeals [on the following page]. The PTD Benefit Claims and Appeals provision in the Description states that claims “for PTD benefits must be filed within 12 months from the last day worked.” The Description also has a longer filing period, which states that an employee may “apply for PTD within five years from [the] last day worked” if the employee has a “disabling medical condition that may change dramatically” and 5 Case: 10-50640 Document: 00511463947 Page: 6 Date Filed: 05/02/2011 No. 10-50640 he “document[s] [his] medical condition with [Owens-Illinois] before the expiration of one year from [his] last day worked.” The Committee rejected Horn’s 2007 and 2008 claims for PTD benefits because he failed to timely appeal the rejection of his 2005 claim for PTD benefits. Horn concedes that he failed to appeal Aetna’s 2005 denial of his request for PTD benefits, and he does not dispute the correctness of the Committee’s conclusion that an appeal of the 2005 decision would be untimely.2 This court requires “[c]laimants seeking benefits from an ERISA plan must first exhaust available administrative remedies under the plan before bringing suit to recover benefits.” Bourgeois v. Pension Plan for Emps. of Santa Fe Int’l Corps., 215 F.3d 475, 479 (5th Cir. 2000). Because Horn did not exhaust the administrative appeals process by appealing the denial of his claim in 2005, his ERISA claim seeking PTD benefits that were denied to him in 2005 is barred. See Swanson v. Hearst Corp. Long Term Disability Plan, 586 F.3d 1016, 1018