Opinion ID: 2996819
Heading Depth: 3
Heading Rank: 3

Heading: The Denial Letter

Text: Militello also has numerous procedural complaints. For instance, he alleges that the benefits denial letter issued by the Trustees does not satisfy statutory and regulatory requirements. ERISA dictates that specific reasons for denial be communicated to the claimant. See 29 U.S.C. § 1133(1) (“[E]very employee benefit plan shall—(1) provide adequate notice in writing to any participant or beneficiary whose claim for benefits under the plan has been denied, setting forth the specific reasons for such denial, written in a manner calculated to be understood by the participant, and (2) afford a reasonable opportunity to any participant whose claim for benefits has been denied for a full and fair review by the appropriate named fiduciary of the decision denying the claim. . . .”); 29 C.F.R. § 2560.503-1(g)(1).8 8 According to the regulation, “[t]he notification shall set forth, in a matter calculated to be understood by the claimant—(i) The specific reason or reasons for the adverse determination; (ii) Reference to the specific plan provisions on which the determination is based; (iii) A description of any additional material or information necessary for the claimant to perfect the claim and an explanation of why such material or information is necessary; (iv) (continued...) 12 No. 02-3058 “Although the applicable regulations are specific in pronouncing the requirements, strict compliance is not mandated. . . . Rather, substantial compliance with the regulations is sufficient. . . .” Tolle v. Carroll Touch, Inc., 23 F.3d 174, 180 (7th Cir. 1994) (citations omitted). In this case, the Trustees’ denial letter stated that Militello was not eligible “to receive pension benefits for any period that [he is] the owner of Anthony Militello Trucking,” and that the Trustees made this decision because “work, in any capacity, requiring the same skills as those used by Fund participants while employed by contributing employers in the same metropolitan area in which you work is considered Prohibited Reemployment.” The letter also indicated that in order to avoid the suspension of benefits, Militello must “provide documentation verifying that [he] no longer ha[d] any ownership in the Anthony Militello Trucking Company” in the next thirty days. (Compl. Ex. B- 1.) Furthermore, it cited the specific plan provision Militello had allegedly violated. The district court properly determined that this letter satisfied statutory and regulatory requirements. The letter indicated, “in a manner calculated to be understood by the participant,” that the Trustees found Militello ineligible for pension benefits because his actions as owner of Anthony Militello Trucking constituted prohibited reemployment. Although the letter is sparse, the Trustees were required to give only specific reasons, not “the reasoning behind the reasons.” Gallo v. Amoco Corp., 102 F.3d 918, 923 (7th Cir. 1996) (“All [the plan administrator] has to give the applicant is the reason for the denial of benefits; he does not have to explain to him why it is a good reason. To require that would turn plan administrators not just into arbi- (...continued) A description of the plan’s review procedures and the time limits applicable to such procedures . . . .” No. 02-3058 13 trators, for arbitrators are not usually required to justify their decisions, but into judges, who are.”) (emphasis in original).