Opinion ID: 4183805
Heading Depth: 2
Heading Rank: 1

Heading: The Terms of the Plans

Text: The two Plans both explicitly state that they were intended to be “employee welfare benefit plan[s]” under the Employee Retirement Income Security Act of 1974 (“ERISA”). Further, the Plans “shall be governed by and administered under ERISA and . . . [t]he Plan benefits which are provided by or administered by the Insurance Company [MetLife] under an Insurance Contract shall be governed by ERISA.” The Plans vested the Plan Administrator with “specific discretionary powers, duties and authorities” and gave the Plan Administrator the “discretion to delegate to any other person or persons (including, but not limited to, the Insurance Company) authority to act on behalf of the Plan Administrator, including, but not limited to, the authority to make any determination or to sign checks or other instruments incidental to the operation of the Plan for which the Plan Administrator is responsible.” The Plans named the employer as the Plan Administrator and named MetLife as the Insurance Company. 3 Case: 16-15321 Date Filed: 07/06/2017 Page: 4 of 20 The policy documents for both Plans explain that “Beneficiary” means “the person or persons you choose to receive any benefit payable because of your death.” The policies define “You” to mean the “Covered Person named on the Certificate,” here, Lanier Waddell. Additionally, the insured may designate his beneficiary as follows: “You make the choice in Writing on a form approved by [MetLife]. This form must be filed with the records for This Plan.” The policies also provide: You may change the Beneficiary at any time by filing a new form with us. You do not need the consent of the Beneficiary to make a change. When we receive a form changing the Beneficiary, the change will take effect as of the date you Signed it. The change of Beneficiary will take effect even if you are not alive when it is received. Both policies also have provisions governing what happens if the insured dies without designating a beneficiary. The policy documents for the Plans state that: If there is no Beneficiary at your death for any amount of benefits payable because of your death, that amount will be paid to one or more of the following persons who are related to you and who survive you: (a) Spouse; (b) child(ren); (c) parents; (d) brother and sister. However, we may instead pay all or part of that amount to your estate. 4 Case: 16-15321 Date Filed: 07/06/2017 Page: 5 of 20 There is also a Summary Plan Description for both Plans (the “SPD”) that describes the “key features” of both Plans “in easy-to-understand terms.” However, it is the Plan documents and insurance contracts that are controlling and “determine [the insured’s] rights and the rights of [the insured’s] dependents and/or beneficiaries” under the Plans. The SPD states that insureds may name one or more beneficiaries. Further, after the insured’s retirement, the beneficiary or beneficiaries “are the same as those designated while you were actively employed.” According to the SPD, an insured could change his beneficiary at any time. To do so, the insured must “contact the insurer . . . for the appropriate form. After you complete the form, return it to the insurer. Your change takes effect on the date you sign the form, even if you are not alive when the insurer receives it.” According to the SPD, if the insured did not designate a beneficiary, benefit payments would be made to the insured’s: next surviving relative(s) and considered in this order: • your spouse or domestic partner, • your children, • your parents, • your brother and sister. Notwithstanding the foregoing, the insurer may pay all or part of such amount to your estate. 5 Case: 16-15321 Date Filed: 07/06/2017 Page: 6 of 20 The SPD also clearly grants broad discretionary authority to the Plan Administrator: The Plan Administrator has the full discretionary authority and power to control and manage all aspects of the Life Insurance Plans, to determine eligibility for Life Insurance Plan benefits, to interpret and construe the terms and provisions of the Life Insurance Plans, to determine questions of fact and law, [and] to direct disbursements . . . . The Plan Administrator may allocate or delegate its responsibilities for the administration of the plan to others and employ others to carry out or render advice with respect to its responsibilities under each of the Life Insurance Plans, including the discretionary authority to interpret and construe the terms of the Life Insurance Plans, to direct disbursements, and to determine eligibility for Life Insurance Plan benefits. . . . The Plan Administrator has delegated its responsibility to review all other claims and appeals related to benefits [not related to participation eligibility] to the insurer.