When a spouse is sick or injured, claiming disability benefits may not be your first priority. You are usually focused on your spouse’s treatment, comfort, and convalescence. In a recent ERISA case, a woman in this position brought a lawsuit after the Central Pension Fund of the International Union of Operating Engineers & Participating Employers (“the Fund”) denied her claim for her husband’s disability benefits. The Fund had determined that because she made the claim too late—she made the claim after her husband had passed away—she could not claim disability benefits on his behalf. Alderman v. Cent. Pension Fund of the Int’l Union of Operating Eng’rs & Participating Emplrs., No. 1:14-CV-94-TLS, 2016 U.S. Dist. LEXIS 4673 (N.D. Ind. Jan. 14, 2016). Plaintiff, Mrs. Alderman, alleged that she attempted to make a claim for disability benefits on her husband’s behalf while he was alive, but was misinformed by someone (without authority) at the Fund office, who informed her that her husband could not apply for benefits under the Fund’s disability plan until he first received a Social Security Administration (“SSA”) award of disability benefits. Ultimately, this was not correct information, but Mrs. Alderman waited until after receiving a disability award from SSA, which supported that Mr. Alderman had been disabled for a year and half prior to his death. Regardless, the Fund completely denied Mrs. Alderman’s claim because it was not a timely filing—meaning a claim for disability would only be paid to a deceased participant if it had been properly claimed prior to the participant’s death. The Court drew issue with the fact that the Fund failed to properly give Mrs. Alderman its true basis for denial—that Mrs. Alderman’s husband was the only person considered to be a “participant” under the terms of the plan and therefore the only person entitled to even make a claim for disability benefits under the plan. Interestingly, the plan language itself failed to make clear that a participant had to be alive in order to make a claim for benefits or, alternatively, that a spouse could not stand in the participant’s shoes. The Court remanded Mrs. Alderman’s claim to the Fund, ordering that Fund consider Mrs. Alderman’s claim to be timely.
If you are seeking disability benefits on behalf of a sick or injured family member, call an experienced ERISA attorney today.
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