Military Exclusion
July 28, 2009 | 2nd, Exclusion, Plan Language | No CommentsIn MacLeod v. Proctor & Gamble Disability Benefit Plan, 460 F. Supp. 2d 340 (D. Conn. 2006) the administrator denied the participant’s application for benefits on the grounds that the claimed disability resulted from the participant’s prior military service and therefore was excluded from coverage. At oral argument, the administrator admitted that its decision was based on the “categorical military exclusion” and did not entail an individualized consideration of the particular facts of the application. The plan at issue, however, specifically provided that in the event of an “illness, accident or injury occurs while the Participant is working for pay for some person or organization other than the Company, payment of benefits under the Plan shall be made only at the discretion of the [administrator] after their review of the facts of the case.” Although the court did not find that the administrator’s conclusion that the participant’s disability occurred during his time in the military was arbitrary and capricious, it concluded that the manner in which the administrator evaluated the claim was an unreasonable interpretation of the plan language and remanded the matter.