What Is the Legal Definition of ''Eligible'' ?
We must determine the meaning of "eligible" as used in the statutes. Eligible is usually defined as "fit and proper to be selected or to receive a benefit." BLACK'S LAW DICTIONARY 538 (7th ed. 1999).
In construing the term with reference to eligibility for insurance or governmental benefits, courts have taken various positions.
Some courts have defined eligible in terms similar to "status," without regard to actual receipt of benefits.
For example, in Telle v. Northfield Iron Co., 278 Minn. 129, 153 N.W.2d 270 (Minn. 1967), the employer sought review of an order of the State Industrial Commission granting the employee compensation for total and permanent disability without giving the employer credit for federal payments to which the employee was entitled but did not exercise his right to receive.
The Minnesota Supreme Court held that eligibility of the employee for federal benefits, to which the employer and insurer were entitled to be credited, was determined by whether the employee had a right to these benefits, not whether the right was exercised by the employee. Telle v. Northfield Iron Co., 153 N.W.2d at 272.
In the context of whether an individual was eligible for unemployment compensation benefits, the Pennsylvania Commonwealth Court defined as "eligible for benefits" persons whose work and earnings entitle them to receive unemployment compensation.
The court further defined "qualified" as being persons who, being eligible, will receive compensation because their separation from their employers were under circumstances that the applicable law did not declare to be disqualifying. Pataki v. Commonwealth, Unemployment Compensation Bd. of Review, 85 Pa. Commw. 560, 483 A.2d 581, 582 (Pa. Commw. Ct. 1984).
According to the reasoning of these cases, eligibility is determined solely by whether the individual meets the applicable criteria for receipt of benefits, not by whether the benefits are actually received.
On the other hand, in Kuntz v. Reese, 785 F.2d 1410 (9th Cir. 1986), the Ninth Circuit Court of Appeals was called on to review the trial court's dismissal of an action by former employees against a pension plan administrator for breach of fiduciary duty under ERISA. Kuntz v. Reese, 785 F.2d at 1411.
In an opinion on rehearing, the Court of Appeals decided that, because the claimants were former employees whose pension benefits had already been distributed, they had no standing.
The court said:
Former employees who have neither a reasonable expectation of returning to covered employment nor a colorable claim to vested benefits simply do not fit within the "may become eligible" language of [29 U.S.C.] 1002(7). 785 F.2d at 1411.
Under this definition of eligibility, an individual having already received all the benefits to which he is entitled becomes ineligible as a beneficiary.
Texas courts are required to construe terms in accordance with their statutory definitions. Transport Ins. Co. v. Faircloth, 898 S.W.2d 269, 274 (Tex. 1995).
The statutory definitions of eligible spouse and children quoted above define eligibility in terms of marital status, age, or dependency. TEX. LAB. CODE ANN. 408.182 (f)(1), (3).
We think these statutory definitions are in accord with the reasoning employed by the Minnesota and Pennsylvania decisions, i.e., whether a person is eligible to receive benefits is determined solely by whether the individual meets the applicable requirements, not by whether the benefits are actually received.
Adopting the reasoning of the Pennsylvania court in Pataki, an eligible spouse and child may not be qualified or entitled to receive any further benefits, but their status as eligible to receive benefits does not change.