Opinion ID: 168760
Heading Depth: 3
Heading Rank: 1

Heading: Provisions of Plan

Text: The Plan defines “Total Disability” in pertinent part as follow s: “Totally Disabled” or “Total Disability” means, [after the] twenty-four (24) month [elimination] period . . . the inability of such 1 References to specific provisions of the Plan are to the January 1, 2002, version of the Plan, and amendments thereto, contained in the administrative record and provided to us as part of Appellant’s Supplemental Appendix. The district court, and both parties in their appellate briefs, have cited this version of the Plan for its relevant terms. The 2002 version of the Plan specifically provides that “[a]ny individual who participated in the Prior Plan on December 31, 2000, and who was Totally Disabled on such date, shall continue to participate under this Plan” in accordance with its provisions. Aplt. Supp. App., Vol. II, at 405. The Supplemental Appendix volumes are paginated as follows: “BM /TW C.####”, where “####” represents the page number within the appendix. W e have abbreviated the numbering by deleting the reference to “BM /TW C.” -2- Participant, based upon conclusive medical evidence, to engage in any gainful occupation for which he or she is reasonably fitted by education, training or experience, as determined by the Plan Administrator. Aplt. Supp. App., Vol. II, at 403-04. A totally disabled participant is entitled to payment of monthly disability benefits, but such disability benefits may terminate if the Participant ceases to be totally disabled. They may also terminate if the Participant fails to provide evidence that she remains under a physician’s care, or if she fails to provide current medical information regarding the condition of her health. Specifically, paragraph 3.10.2 of the Plan provides: The Plan Administrator shall from time to time and in any event at least every two (2) years require any Participant who shall be receiving M onthly Disability Payments to provide to the Plan Administrator current medical information from his physician, or physicians the Plan Administrator selects, regarding the condition of his health, including evidence of such Participant’s continued Total Disability. Unless a Participant within a reasonable period of time complies with a request of the Plan Administrator to be provided with such information, the Plan Administrator may terminate the Participant’s M onthly Disability Payments. Id. at 417. Paragraph 3.10.4 further provides: W hile receiving M onthly Disability Payments, a Participant shall remain under the regular and appropriate care and treatment of a qualified Physician and, upon request of the Plan Administrator, shall provide evidence thereof satisfactory to the Plan Administrator. If a Participant fails either to remain under such care or to provide such evidence, the Plan A dministrator may terminate such Participant’s M onthly Disability Payments. Id. at 418. -3-