Opinion ID: 4501855
Heading Depth: 3
Heading Rank: 1

Heading: The amount the Employee is eligible for

Text: under:

plan; or
. . . 6. The disability or retirement benefits under the United States Social Security Act, or any similar plan or act, as follows: a. Disability benefits the Employee is eligible to receive. - 3 - After Martinez had been receiving long-term disability benefits under the Plan for nearly a year, he submitted a claim in November 2013 to the United States Department of Veterans' Affairs (the VA) for service-connected disability compensation pursuant to the Veterans' Benefits Act, 38 U.S.C. § 1110. The VA awarded Martinez Veterans' Benefits in January 2015, retroactive to July 19, 2013, based on a number of health conditions caused or aggravated by his military service, including multiple sclerosis. Martinez promptly notified Sun Life that his claim for Veterans' Benefits had been granted. By letter dated March 25, 2015, Sun Life informed Martinez that his Veterans' Benefits were considered Other Income Benefits subject to offset under the Plan and, as a result, his monthly Plan benefits would be decreased from $2,500 to $465. Sun Life also sought reimbursement of $32,560 for past overpayments. In describing Martinez's Veterans' Benefits as Other Income Benefits, the letter excerpted the entire Other Income Benefits section of the Plan1 without further specifying which provision authorized the offset. The letter also notified Martinez of his right to appeal Sun Life's decision. Martinez responded by asking Sun Life for clarification of which Other Income Benefits provision it relied upon for its decision. Sun Life referred Martinez to Sections 1.f and 6 of the 1We provide the complete Other Income Benefits section of