Opinion ID: 77773
Heading Depth: 2
Heading Rank: 1

Heading: The Benefit Plan

Text: At issue in this case is the Long Term Disability Income Plan of the Coca-Cola Company (the Plan), an employee welfare benefit plan within the meaning of ERISA. See 29 U.S.C. § 1002(1). The Plan document designates Coca-Cola as the Plan Administrator. The Plan document also contains a delegation by Coca-Cola of some of its powers as Plan Administrator to The Coca-Cola Company Long Term Disability Income Plan Committee (the Committee). The Plan document delegates to the Committee primary responsibility for the administration of the Plan, and all powers necessary to enable it to properly perform its duties, including the discretionary authority to determine the eligibility of Participants to receive benefits and the amount of benefits to which any Participant may be entitled under the Plan. R1-24, Exh. 1 §§ F 7.2(b), (b)(3). The Plan also provides that the Committee may delegate to the Administrative Services Provider its discretionary authority to decide claims. Id. § 7.2(b)(3). Broadspire is the Administrative Services Provider. Under the Plan, a claim for benefits involves an initial application, and, if the claimant is unsatisfied with the result of the initial application, two levels of appeals. Pursuant to § 7.2(b)(3) of the Plan, the Committee delegated to Broadspire responsibility for making initial determinations of claims for benefits under the Plan, as well as responsibility for resolving first-level appeals. The Committee is responsible for deciding second-level appeals, although in 1995 the Committee delegated to two Coca-Cola employees (the Delegates) its function of reviewing final claims. Under the Plan, a participant who suffers a Disability, as that term is defined in the Plan, will receive benefits. R1-24, Exh. 1 § 4.1. The term Disability has two definitions under the Plan, one which applies during the first 24 months following the date the disability is incurred, and one which applies after the first 24 months. During the first 24 months, a Disability is defined as a physical or mental illness or injury [that] continuously disables [the participant] from performing his normal duties for his Employer. Id. § 1.11. This is known as the own occupation standard. After the first 24 months, the Plan defines a Disability as a physical or mental illness or injury [that] continuously disables [the participant] from engaging in any occupation for wage or profit, for which he is reasonably qualified by training, education or experience. Id. This definition is known as the any occupation standard.