Opinion ID: 151538
Heading Depth: 4
Heading Rank: 2

Heading: MetLife's Policy

Text: On January 1, 2004, MetLife replaced UNUM as the insurer and administrator of the Plan. MetLife issued a new policy, comprised of a Certificate of Insurance, or master plan document, as well as a summary plan description. MetLife's policy defines the term disability differently in three places: once in the Certificate of Insurance, and twice in the summary plan description. The Certificate of Insurance defines disabled or disability as: due to sickness or as a direct result of accidental injury:  You are receiving Appropriate Care and Treatment and complying with the requirements of such treatment; and  You are unable to earn:  during the Elimination period and the next 24 months of Sickness or accidental injury, more than 80% of Your Predisability Earnings at Your Own Occupation from any employer in Your Local Economy; and  after such period, more than 80% of your Predisability Earnings from any employer in Your Local Economy at any gainful occupation for which You are reasonably qualified taking into account Your training, education and experience. MetLife's summary plan sets forth two additional definitions of disability. First, the summary plan's Plan Benefits description specifies that a participant is considered disabled when determined to be unable to perform your regular job functions due to sickness, or as a direct result of accidental injury the employee [sic] is receiving appropriate care and treatment and complying with the requirements of such treatment. The summary plan's Definitions section, however, defines disability as a condition in which a person is unable to perform the material and substantial duties of his/her regular occupation due to illness or injury. MetLife's Certificate of Insurance includes a clause specifying Rules for When Insurance Takes Effect if You were insured Under the Prior Plan on the Day Before the Replacement Date, which states:  If You are Actively at Work on the day before the Replacement Date, You will become insured for Disability Income Insurance under this certificate on the Replacement Date.  If You are not Actively at Work on the day before the Replacement Date, You will become insured for Disability Income Insurance under this Certificate on the date You return to Active Work. MetLife's policy, however, also includes two differing definitions of Actively at Work. The Certificate of Insurance defines Actively at Work or Active Work to mean You are performing all of the usual and customary duties of Your job on a Full-Time basis. The summary plan defines Actively at Work or Active Work to mean Being on the job as required of an employee or Independent Contractor of CB Richard Ellis.