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GOULD v. GREAT-WEST LIFE & ANNUITY INS. CO.
February 24, 1997
MARILYN GOULD, as Executrix of the Estate of Jack Gould, and MARILYN GOULD, Individually, Plaintiffs,
GREAT-WEST LIFE & ANNUITY INSURANCE CO., Defendant
The opinion of the court was delivered by: WALLS
A. Great-West Insurance Policy
For over thirty years, Jack Gould worked for U.S. Liability, Co. ("U.S. Liability") as a lawyer / claims examiner. As a U.S. Liability employee, he participated in the company's employee benefits plan which included group life, disability and other insurance benefits issued and administered by Great-West. U.S. Liability's employee benefits plan was established pursuant to the Employee Retirement Income Security Act ("ERISA"). The terms and conditions of Great-West's insurance policies are set forth in a summary plan description ("SPD"). The SPD provides that insurance coverage extends to full-time employees who are U.S. residents and work at least twenty-eight hours a week. Ryan Aff., Ex.B, Eligibility/Termination at 4. In the event of death, the plan provides that a deceased employee's life insurance benefits are to be disbursed to his or her designated beneficiary. Ryan Aff., Ex. B., Life Benefit at 6.
This action involves claims by Gould's widow and beneficiary to recover life insurance benefits under the plan. The following provisions governing plan eligibility and coverage are central to this dispute. Under the heading "Plan Eligibility, Termination and Reinstatement," the SPD lists the following circumstances that result in termination of an employee's coverage:
Even if the payroll deduction practices of your Employer continue in error after the date determined below, your coverage under this Plan terminates on the earliest of:
. the date Loss of Residence occurs;
. the date your coverage terminates;
. the date you are no longer in an eligible class;
. the date that you or your Employer fails to make a required premium payment;
. the date that your Employer's Plan terminates;
. the date that your Service terminates.
If you are not at Work because of Illness, leave-of-absence, or temporary lay-off, your coverage will continue as long as premiums continue to be paid until the earliest of:
- the date determined by your Employer. This date must be determined on the same basis for all Employees.
- the date you start Work with another Employer.
-- for leave-of-absence or lay-off, 31 days from the date your Service terminates; or
. for all benefits except Long Term Disability, 90 days from the date your ...
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