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benefits under the terms of the Plan. Delta approved her claim for short-term disability

benefits4 and paid her for the entire 26 week period which expired on September 5, 1994.

While she was still receiving short-term disability benefits, Ms. Wolf applied for long-

term disability benefits in accordance with the terms of the Plan. In a letter dated

September 1, 1994, Delta determined that Ms. Wolf was disabled and entitled to benefits.

During the period it was paying benefits to Ms. Wolf, Delta sent a letter dated

March 3, 1995 to her treating physician, Andrew C. Maser, D.O. The letter asked Dr.

Maser several questions regarding Ms. Wolf’s ability to work. However, Delta did not

explain any of the terms in the letter or ask for specific physical limitations5. Dr. Maser

indicated on the form that Ms. Wolf could perform light duty, sedentary or semi-

sedentary work6, though he did not explain what this meant. Delta never followed up on

this information to ask him what duties or work she was capable of performing, instead

taking this information at face value and assuming it meant that Ms. Wolf was no longer

disabled under the terms of the Plan7.

Based solely on Dr. Maser’s reply, Delta terminated Ms. Wolf’s benefits8. In this

letter, Delta stated:

“In order to perfect your claim, you must establish by that on 04/01/95 you are continuously and totally disabled from engaging in any occupation or work for compensation or profit.


” (emphasis added).

4 5 6 The May 18, 1994 letter approving benefits is attached as . The March 3, 1995 letter is attached as . This could mean that she was only able to cook for herself and, in general, take care of basic daily needs. It does not necessarily mean that she was able to perform any work for remuneration which is a requirement of the cases interpreting ERISA plans. E.g., Helms v. Monsanto Co., Inc., 728 F.2d 1416 (11th Cir. 1984).


This fact is significant because whenever Delta received information stating that Ms. Wolf was incapable

8 of work, Delta immediately followed up. This is discussed further, The March 31, 1995 denial letter is attached as .



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