Opinion ID: 171217
Heading Depth: 2
Heading Rank: 1

Heading: The Voluntary Life Insurance Policy

Text: The terms of Mrs. Weber's Voluntary Life Insurance policy are set forth in a GE Group Certificate, which contained the terms of the Group Insurance Policy issued by GE to Winner and its eligible employees (for simplicity's sake, we will refer to the Certificate as the Policy). Part 1 of the Policy, the Insurance Schedule, provides that there is no waiting period prior to eligibility for the voluntary employee life insurance coverage. It also states that [a]n Employee may elect an amount of insurance in increments of $10,000 to the lesser of $300,000 or five times Basic Annual Earnings, subject to a minimum of $20,000. Part 2 lays out the Policy Definitions. Three of those definitions impact this appeal. First, the Policy defines Actively At Work as follows: You are actively at work on any day if on that day you are: 1. Working at the Employer's usual place of business or at such place or places that the Employer's normal course of business may require; 2. Performing all of the duties of your job on a full-time basis; and 3. Not confined in any institution providing care or treatment of physical or mental infirmities. Second, the policy defines an Eligible Employee as follows: Someone who under the terms of the policy: 1. Meets the requirements in the definition of Employee; and 2. Completes the waiting period (described in the Date of Eligibility section); and 3. Is working within the United States. Lastly, the policy defines an Employee as follows: Someone who meets the following requirements: 1. Is an employee of the Employer, as stated in PART 1: Insurance Schedule; 2. Regularly works at least 30 hours per week at the Employer's usual place of business or at such place or places that the Employer's normal course of business may require, unless otherwise stated in PART 1: Insurance Schedule; 3. Is paid for such work in accordance with applicable Wage and Hour Laws; and 4. Is in a classification eligible for insurance as shown in the Employer's Plan of Insurance or as noted in the Insurance Schedule, if applicable. In a Part 3 subsection entitled Effective Date of Insurance, the Policy states, Once you have met the Conditions of Insurability, you will be insured under the Policy on the latest of: 1. The date you become eligible; 2. The date we approve any Evidence of Insurability we require; or 3. The date shown in our approval of your request for insurance. The Policy cautions, You must, however, be Actively At Work on that date. Otherwise, you will be insured on the date you are again Actively At Work (emphasis added). Lastly, the Policy states that GE is a fiduciary, as that term is used in ERISA.... More specifically, the Policy notes that, [i]n this capacity, [GE] is charged with the obligation, and possesses discretionary authority to make claim, eligibility and other administrative determinations regarding those policies, and to interpret the meaning of their terms and language.