Opinion ID: 2998293
Heading Depth: 2
Heading Rank: 1

Heading: Defendant Central States and the Disability

Text: Pension Central States is an employee pension benefit plan, as defined in § 3(2)(A) of the Employee Retirement Income Security Act (“ERISA”). See 29 U.S.C. § 1002(2)(A). Central States is a tax-qualified, not-for-profit trust fund that is administered by employer and employee trustees. The Fund provides retirement and disability pensions to qualified employees who work in the Teamster Industry under collective bargaining agreements that require employers to make contributions on behalf of covered employees to Central States. The Central States Trust Agreement grants the Fund’s trustees the discretion to establish these benefit plans, as well as discretionary authority to administer such plans and decide benefit claims. Payment of plan benefits is governed by the Fund’s Pension Plan Document—particularly, for purposes of this appeal, the 1980 Plan Document (hereinafter, “the Plan”). To become eligible for disability pension benefits, a Fund participant under the age of 62 years must (1) be totally and permanently disabled, see Plan Section 4.06(a) & (c); (2) have ten years of Credited Service under the Plan, see Plan Section 4.06(a)(2); (3) be eligible for Social Security disability benefits, see Plan Section 4.06(a); and (4) become disabled before sustaining three consecutive one-year breaks in service, see Plan Section No. 04-4267 3 4.06(a)(2) & (d).1 Of the terms introduced by these four 1 Plan Section 4.06 provides in pertinent part: (a) A Participant who sustains a total and permanent disability as hereinafter defined (1) Prior to his 62nd birthday; and (2) after completion of 10 years of Credited Service (as defined in Section 3.03) if at least 35 weeks of contributions to the Pen- sion Fund have been made or were required to have been made on behalf of the Partici- pant during each of 5 calendar years of Covered Employment, or at least 225 weeks of contributions have been made or were required to have been to the Pension Fund on his behalf, subject to the Break in Service provisions of Section 3.05; and (3) after contributions by his last Employer on his behalf under a Collective Bargaining Agreement providing for contributions in amounts at least equivalent to those re- quired for Contribution Class 4 or above; shall be eligible for a Disability Pension Bene- fit under this Plan if he is entitled to disability benefits payable under Title II of the Social Security Act (as evidenced by a Certificate of Social Insurance Award) or if said Participant has sustained a disability which would satisfy the medical and physical requirements for such Certificate of Social Insurance Award where the Participant did not receive such Certificate for reasons unrelated to his medical and physi- cal condition. (b) . . . (c) Disability, as used herein, shall be deemed to be total and permanent, for purposes of this section, whenever the Participant is wholly disabled by (continued...) 4 No. 04-4267 individual requirements, three merit immediate note. First and foremost is the term “total and permanent disability.” In order to qualify for a disability pension, the Plan requires that the participant “sustain a total and permanent disability as hereinafter defined.” Plan Section 4.06(a). That “hereinafter” definition is supplied by Section 4.06(c), which provides that [d]isability, as used herein, shall be deemed to be total and permanent, for purposes of this section, whenever the Participant is wholly disabled by bodily injury or disease, and will as a result be permanently, continuously and wholly prevented for life from engaging in any occupation and per- forming any work for wage or profit. With respect to the second requirement—that a participant have ten years of “Credited Service” under the Plan—Section 3.03 of the Plan defines “Credited Service.” Under this provision, a participant will earn one year of Credited Service for each year in which a participant had at least 1000 hours of Covered Employment2 prior to January 1 (...continued) bodily injury or disease, and will as a result be permanently, continuously and wholly prevented for life from engaging in any occupation and per- forming any work for wage or profit. . . . . (d) A Participant shall be eligible for a Disability Pension Benefit if he sustains a total and permanent disability while still in Covered Employment or before sustaining 3 consecutive One-Year Breaks in Service (as defined in Section 3.05(c)). (emphasis added). 2 Plan Section 3.02(a) defines “Covered Employment” as “[a]ny employment of an Employee for which contributions to the (continued...) No. 04-4267 5 1, 1976. For employment after 1976, a participant will earn one year of Credited Service for each year in which at least 35 weeks of contributions to the Fund were made on the participant’s behalf. The requirement that the participant become disabled before sustaining three consecutive one-year breaks in service turns in large part, of course, on what constitutes a “One-Year Break in Service.” Toward that end, Plan Section 3.05(c) provides: “On or after January 1, 1976 a Participant shall sustain a One-Year Break in Service at the end of any calendar year in which he receives less than 10 Vesting Service Weeks.” A “Vesting Service Week,” per Plan Section 3.04(b)(1), is a week in which a contribution “is made or is required to be made to the Pension Fund on [a participant’s] behalf.” Suffice it to say, if a participant stops working covered employment for three straight years, he will be ineligible for the disability pension if he is injured thereafter.