In Kludka v. Qwest Disability Plan, No. 10-16035, 2011 WL 5024190 (9th Cir. Oct. 21, 2011), the Ninth Circuit reversed and remanded the district court’s dismissal of a claim for long-term disability benefits upon finding that the plan administrator committed two procedural errors when it denied the plaintiff’s claim and the district court made an erroneous factual finding. The Ninth Circuit found that the plan administrator failed to comply with the requirement to explain specifically what information would be needed to perfect the plaintiff’s claim and why that information was necessary. The appeals court also determined that although the plan administrator was aware that the plaintiff was receiving Social Security benefits, it failed to request the relevant records or explain why its denial of plaintiff’s claim conflicted with the Social Security Administration’s determination. The Ninth Circuit also concluded that the district court erroneously assumed that the plaintiff had a standing offer to return to his job with accommodations, when in fact his employer conceded at oral argument that it had not offered to reinstate the plaintiff, and thus plaintiff would have to seek work on the open market and convince a prospective employer to hire him on a part-time basis knowing he had received disability benefits for psychological problems. The Ninth Circuit reasoned that had the district court considered these conditions, it might have determined that the plaintiff was unable to engage in meaningful employment, thus qualifying him for benefits under the plan terms. As a result, the Ninth Circuit remanded the case for reconsideration by the district court as to whether the plan administrator abused its discretion in denying the plaintiff’s claim for benefits.
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