month period only, because her disability was due to a "nervous,
emotional, mental disease or disorder." (Roberts Aff. at Ex. A.)
Plaintiff received benefits until June 1991, when the checks ceased.
On October 8, 1991, defendant advised plaintiff that the twenty-four
month benefit period had expired on June 25, 1991, and that no further
benefits would be paid. Defendant's letter also informed plaintiff that,
under ERISA, plaintiff had the right to appeal defendant's denial of
benefits. Appeals were required to reach defendant within 60 days of
plaintiffs receipt of the October 8, 1991 letter denying her claim.
On December 2, 1991, plaintiff asked that her claim determination be
reevaluated, and that her benefits be extended until June 25, 1992.
Plaintiffs letter of appeal alleged that, in addition to her mental
injuries, in the twenty-four month she was mentally disabled, plaintiff
sustained debilitating physical injuries in a car accident which left her
In January 1992, defendant informed plaintiff that the company's ERISA
Appeals Committee ("the Committee") had denied her LTD claim because she
had failed to submit any documentation of total physical disability due
to the accident.
During the following two years, plaintiff continued to submit evidence
to defendant of her physical injuries, in the form of medical reports and
bills. By letter on May 28, 1992, and again on August 5, 1992, defendant
reaffirmed the Committee's denial of plaintiffs LTD claim, noting that
the sixty day appeal period for plaintiffs LTD claim had expired.
Defendant reiterated that because the twenty-four month limitation on
benefits for emotional or mental disorders had passed, and the medical
evidence submitted by plaintiff failed to include any "objective
findings" to substantiate her claim of total physical disability,
plaintiff could not recover further LTD benefits.
The Guild-News then asked, on plaintiffs behalf, that the Committee
again review the additional medical evidence plaintiff had submitted. On
December 18, 1992, defendant wrote the Guild-News a letter, explaining
that, although the sixty clay appeal period had long past, the Committee
had reviewed plaintiffs file as a courtesy. The Committee found again
that plaintiff was not entitled to further LTD benefits. In the letter
"cc'd" to plaintiff, defendant wrote:
Although the recent medical information received from
her treating physician indicates a disability due to a
mental or nervous condition, it does not support that
as of the end of the 24 month mental and nervous
limit, June 25, 1991, ihat [sic] Ms. Yuhas had a
physical disability. Also, her LTD file does not
reflect any medical documentation of a physical
disability at the end of the mental and nervous limit
either. Therefore, her LTD claim was closed according
to the policy provision . . .
Nearly one year later, on December 13, 1993, upon receipt of additional
information from plaintiffs orthopedic physician, the Committee reviewed
plaintiffs file yet again. This time, the Committee found, based on the
new evidence, that plaintiff had been physically disabled at the time the
LTD benefits for her mental disorder ceased. Therefore, she was entitled
to a retroactive payment of benefits from October 1, 1991 through May