Opinion ID: 4167896
Heading Depth: 3
Heading Rank: 1

Heading: Boeing’s ERISA Plan

Text: The lawsuit arises from Aetna’s termination of Orzechowski’s benefits under a health and welfare benefits plan that Boeing offers to its non-union employees (the Plan), which is governed by ERISA. The principal plan document is The Boeing Company Master Welfare Plan (Master Plan). This document provides general information about the various benefit plans Boeing offers, but does not detail the various benefits payable through the Plan. The Master Plan has a broad grant of discretionary authority, which has been delegated to a service representative, Aetna.1 This grant includes the power to “determine all questions that may arise including all questions relating to the eligibility of Employees and Dependents to participate in the Plan and amount of benefits to which any Participant or Dependent may become entitled.” The Master Plan incorporates by reference various component benefit programs and the applicable Governing Documents describing the entitlement to benefits under those programs. One such benefit program is The Boeing Company Non-Union Long-Term Disability Plan (PN 625) at issue in this case. The Summary Plan Description, a Governing Document, is a description of the plan which the Plan Administrator is required to provide under ERISA. 1 Orzechowski disputes whether Boeing actually delegated its discretionary authority to Aetna. This argument is raised for the first time on appeal, and we will not consider it. Smith v. Marsh, 194 F.3d 1045, 1052 (9th Cir. 1999). ORZECHOWSKI V. BOEING CO. NON-UNION 5 LONG-TERM DISABILITY PLAN 29 U.S.C. § 1022. Boeing’s Summary Plan Description explains that insured employees are eligible for long-term benefits when they become disabled. For the first 24 months, “disabled” is defined as the employee’s inability to perform “the material duties of [the employee’s] own occupation” due to an injury or illness. (Emphasis added). After 24 months, disability is redefined so that an employee is disabled if she is “unable to work at any reasonable occupation for which [she] may be fitted by training, education, or experience.” (Emphasis added). There are exclusions or limitations on the payment of long-term benefits. Relevant here, the long-term benefits plan covers conditions for a maximum of 24 months if the “primary cause” of the disability is “mental illness.” Aetna issued two documents, a policy and a certificate, which fund the disability benefits and are Governing Documents incorporated into the Master Plan.2 Through the Aetna Life Insurance Company Group Life and Accident and Health Insurance Policy No. 000707 (Policy) issued to Boeing, Aetna agreed to fund and administer long-term disability benefits to employees insured under the Boeing 2 Aetna argues the Policy is not a Governing Document. A Governing document is defined as the applicable certificate of insurance booklets issued by an insurance company, summary plan descriptions or other documents distributed by the Company and intended by the Plan Administrator to be Governing Documents, including summaries of material modification, applicable trust agreements or other funding vehicles . . . . The Policy in question is clearly a “funding vehicle” and meets the definition. 6 ORZECHOWSKI V. BOEING CO. NON-UNION LONG-TERM DISABILITY PLAN plan. The Policy includes a grant of discretionary authority to Aetna to “review all denied claims,” “determine whether and to what extent employees and beneficiaries are entitled to benefits,” and “construe any disputed or doubtful terms of the policy.” The Policy further specifies that “Aetna shall be deemed to have properly exercised such authority unless Aetna abuses its discretion by acting arbitrarily and capriciously.”