Opinion ID: 39691
Heading Depth: 2
Heading Rank: 1

Heading: Coverage under the 1993 Plan; waiver of right to sue.

Text: 18 In their appellate brief the Garcias assert that because LumaCorp revoked and terminated the 1993 Plan when it instituted the New Plan, Mr. Garcia was therefore (1) either covered by the new Plan or (2) not covered by any Plan at all. They argue further that [b]ecause LumaCorp failed and refused to provide Mr. Garcia with the information notifying him of the right to elect under the second plan ... Mr. Garcia was in all probability, not covered by any plan and therefore is not barred from his common law right to sue. 19 The district court did not err in determining that Garcia was covered by the 1993 Plan at the time of his injury. The summary judgment evidence shows that (1) Garcia signed an election form on August 17, 1998, to participate in the 1993 Plan, which was still in effect on the date of his injury; and (2) despite revocation and termination of the 1993 Plan, benefits would continue to be paid for work-related employee injuries that had occurred prior to termination of the 1993 Plan. 20 The New Plan did not cover Garcia's injury because it occurred prior to the New Plan's effective date. Specifically, subsection 2.15(ii) of the New Plan excluded from the definition of covered injuries any pre-existing conditions, defined in subsection 2.25 as any illness, injury, disease, or other physical or mental condition, whether or not work-related, which originated or existed prior to the date of Accident or Occurrence [covered under the New Plan]. Mattingly, as Plan Administrator vested with the sole and absolute discretionary power and authority to construe and interpret the Plan under subsection 6.3, interpreted these provisions as limiting coverage under the New Plan to injuries occurring on or after December 1, 2000. [W]hen an employee benefit plan vests discretion in the administrator, principles of trust law require that we leave the plan administrator's interpretation undisturbed if reasonable. 6 Considering the plain language of subsections 2.15(ii) and 2.25, quoted above, Mattingly's interpretation of the New Plan's coverage was reasonable. 21 Although subsection 11.13 of the New Plan expressly revoked and terminated the 1993 Plan, Mattingly did not interpret this provision to mean that benefits payable under the 1993 Plan for an injury covered by that Plan would be terminated. Rather, unexhausted benefits would continue to be paid under the 1993 Plan until the participant's eligibility ended according to the terms of that plan: 22 Benefit Entitlement Period begins on the day the participant suffers a Work-Related Injury, and ends on the earlier of (1) the date the Approved Treating Physician determines that no further medical treatment is necessary or advisable; (2) the date the Participant's employment is terminated for cause; or (3) the date of the Participant's death. 23 We conclude that Mattingly's interpretation of this provision was reasonable. LumaCorp's revocation and termination of the 1993 Plan did not affect Garcia's entitlement to benefits for his injury, which occurred while that Plan was in effect. 7 The district court did not err in determining that the 1993 Plan — and not the New Plan — covered Garcia's injury. 24