Case 4:11-cv-00410-Y Document 17 Filed 11/04/11 Page 52 of 103 PageID 185 SUMMARY PLAN DESCRIPTION OF THE HOME DEPOT TEXAS EMPLOYEE ACCIDENT PLAN (As Amended and Restated Effective January 1, 2004) ************************************************ Este librete contiene un sumario en inglés de sus derechos y beneficios bajo el Home Depot Texas Employee Accident Plan (el "Plan"). Si encuentra dificultad en comprender cualquier parte de este librete, por favor póngase en contacto con la oficina de personnel, 2455 Paces Ferry Rd., N.W., Atlanta, GA 30339-4024. La oficina esti' abierta de las 8:30 hasta las 5:00 horas, de-hmes a viernes. * * * * * * * * * * * * * * * * * * * * * * * * * * *.* * * * * * * * * * * * * * * * * * * * * APPENDIX 000052 Case 4:11-cv-00410-Y Document 17 Filed 11/04/11 Page 53 of 103 PageID 186 INTRODUCTION TO THE SUMMARY PLAN DESCRIPTION OF THE HOME DEPOT TEXAS EMPLOYEE ACCIDENT PLAN This Summary Plan Description ("SPD") briefly explains certain key provisions of the Home Depot Texas Employee Accident Plan (the "Plan"). In particular, the SPD describes the Benefits available to you under the Plan and the procedures you should follow if you are injured or become sick at work. The Plan only covers employees in Texas. With one exception, the Plan only covers the physical symptoms of certain workrelated injuries or diseases. The Plan does not cover mental, nervous or emotional symptoms, conditions or diseases. The only exception to this rule is for counseling if you suffer psychological trauma because you are the victim of an armed robbery or aggravated assault while at work. Benefits available under the Plan include payments for medical care, disability income, dismemberment and death coverage, and a safety training program. The Plan provides the only benefits if you are injured or become infected with a disease at work. Home Depot does not carry insurance under the Texas Workers' Compensation Act and Home Depot's group medical plan does not provide coverage for injuries and diseases covered by this Plan. You are encouraged to read the SPD or have it read to you by a trusted advisor. This SPD is only meant to provide you with basic information about the Plan. You should consult the Plan document for a complete explanation of the Plan. In the event of any discrepancy between the Plan and the SPD, the Plan will control. Goals and Objectives. The Plan's goals and objectives include: (a) Attention to safety by every employee, thereby preventing injuries or reducing the severity of any injuries which do occur; (b) Personalized attention to legitimate incidents involving on-the-job injuries, including prompt and caring attention by fellow employees; (c) Providing medical and wage replacement benefits for eligible employees; (d) Encouragement of prompi return to work by employees when they are released to return; and (e) Identification of fraudulent and exaggerated claims, and denial of benefits for those claims. APPENDIX 000053 Case 4:11-cv-00410-Y Document 17 Filed 11/04/11 Page 54 of 103 PageID 187 No Effect On Group Health Insurance Benefits. Participation in the Plan will not affect your group medical insurance benefits, if any. Participation in the Plan will affect only the way claims for certain injuries and diseases (called "Bodily Injuries" and "Diseases") will be evaluated and paid. Certain Claims To Be Denied. The Plan is designed to compensate you for legitimate Bodily Injuries and Diseases, so not every claim will necessarily be approved for payment_ An example of a claim for benefits that would be denied is a claim when the incident is determined not to be work-related. Effect of Participation in the Plan on Employees. Employees should generally see very few effects from participation in the Plan. You will report on-the-job incidents just like you would for a workers compensation claim However, the Plan requires that you receive treatment for work-related injuries or diseases from Designated Healthcare Providers. Failure to do this could result in denial of your claims for medical benefits. The Plan allows for exceptions in emergency situations. Your understanding and support of the Plan are essential to its success, so please read this SPD carefully_ In the event of any discrepancy between the Plan and the SPD, the Plan will control. If you would like to see a complete copy of the Plan, please see your manager_ We encourage and expect every Employee to give his or her full cooperation so that we can work together more safely and more productively. If you have any questions about the Plan, please do not hesitate to contact your manager. Thank you, Home Depot USA, Inc. ii APPENDIX 000054 Document 17 Filed 11/04/11 Page 55 of 103 PageID 188 Case 4 a, 111 APPENDIX 000055 Case 4:11-cv-00410-Y Document 17 Filed 11/04/11 Page 56 of 103 PageID 189 TABLE OF CONTENTS Page INTRODUCTION iii FOREWORD PLAN INFORMATION 1 GENERAL INFORMATION 2 1. IS THIS PLAN INTENDED TO PROVIDE WORKERS' COMPENSATION INSURANCE? 2 ARE THERE ANY TERMS I NEED TO KNOW WHEN READING THIS SUMMARY PLAN DESCRIPTION (SPD)? WHEN WILL I BE ELIGIBLE TO PARTICIPATE IN THE PLAN? 3. 4. WHAT REPORTS ARE REQUIRED WHEN A BODILY INJURY OR DISEASE HAS OCCURRED? WHEN DO I REPORT A BODILY INJURY OR DISEASE? 5. 6. IF I AM INJURED ON-THE-JOB, WHAT ARE MY RESPONSIBILITIES REGARDING MEDICAL TREATMENT? WHAT HEALTH CARE PROVIDERS DO I USE IF I_AM INJURED ON-THE-JOB? 7. WHAT DOCUMENTS WILL I BE REQUIRED TO SIGN BEFORE I RECEIVE NON8. EMERGENCY BENEFITS? WHEN WILL MY BENEFITS BEGIN? 9. 10. WHAT TYPES OF MEDICAL EXPENSES ARE COVERED UNDER THE PLAN? 11. WHAT TYPES OF EXPENSES ARE NOT COVERED UNDER THE PLAN? 12. WHEN WILL MY BENEFITS FOR MEDICAL EXPENSES END? 13. WHAT ARE MY BENEFITS IF I LOSE TIME FROM WORK BECAUSE OF A BODILY INJURY OR DISEASE? 14. CAN I RECEIVE WAGE CONTINUANCE AND OTHER EMPLOYEE BENEFITS AT ME SAME TIME? 15. WHAT ARE MY BENEFITS IN ME CASE OF AN ACCIDENTAL DEATH OR DISMEMBERMENT FROM A BODILY INJURY? 16. WHAT IS THE EMPLOYEE SAFETY TRAINING PROGRAM? 17_ WHO IS RESPONSIBLE FOR INTERPRETING THE TERMS OF THE PLAN AND MAKING DETERMINATIONS REGARDING BENEFITS? 18. WHAT ARE THE PROCEDURES FOR DRUG ANI) ALCOHOL TESTING? 19. ARE THERE ANY OTHER EVENTS OR REASONS THAT WOULD EXCLUDE OTHERWISE ELIGIBLE EXPENSES FROM COVERAGE UNDER THE PLAN? 20. WHAT HAPPENS IF I AM COVERED UNDER ANOTHER SOURCE FOR MY BODILY INJURY OR DISEASE? 21. WHAT IS THE MAXIMUM AMOUNT OF BENEFITS ALLOWED UNDER THE PLAN? 22. WHEN WILL MY COVERAGE CEASE UNDER THE PLAN 2 2 7 7 7 8 8 9 10 10 11 12 13 13 14 14 15 15 16 18 18 18 iv APPENDIX 000056 Case 4:11-cv-00410-Y Document 17 Filed 11/04/11 23. 24. 25. 26. 27. 28. 29. 30. 31. 32. 33. 34. Page 57 of 103 PageID 190 CAN I RETURN TO WORK BEFORE I HAVE COMPLETELY RECOVERED FROM MY BODILY INJURY OR DISEASE? 19 WHAT HAPPENS WHEN MY DOCTOR RELEASES ME TO RETURN TO WORK? 19 How DO I MAKE A CLAIM FOR BENEFITS? 20 WHEN WILL MY CLAIM FOR BENEFITS BE DECIDED? 20 IF MY INITIAL CLAIM IS DENIED, WHAT INFORMATION WILL I RECEIVE? 24 WHAT CAN I DO IF MY CLAIM IS WHOLLY OR PARTIALLY DENIED? 25 IF I APPEAL A DENIED CLAIM, WHEN WILL I RECEIVE A DECISION ON MY APPEAL? 25 IF MY APPEAL IS DENIED,WHAT INFORMATION WILL I RECEIVE? 27 WHAT ARE THE SUBROGATION AND REIMBURSEMENT PROVISIONS OF THE PLAN? 28 _DOES THIS PLAN ALTER MY STATUS AS AN AT- WILL EMPLOYEE? 28 CAN THE PLAN BE AMENDED OR TERMINATED? 29 WHAT ARE MY RIGHTS UNDER ERISA? 29 CONCLUSION APPENDIX A 31 A-1 APPENDIX 000057 Case 4:11-cv-00410-Y Document 17 Filed 11/04/11 Page 58 of 103 PageID 191 PLAN INFORMATION Plan Sponsor: Home Depot USA, Inc. 2455 Paces Ferry Rd., N.W. Atlanta, GA 30339-4024 Phone: (770) 433-8211 Plan Administrator: Home Depot USA, Inc. 2455 Paces Ferry Rd., N.W. Atlanta, GA 30339-4024 Phone: (770) 433-8211 Adopting Employers: Upon request, the Plan Administrator can • provide you with a list of affiliated • employers in Texas that have adopted the Plan. Agent for Service of Legal Process: Home Depot USA, Inc. 2455 Paces Feny Rd., N.W. Atlanta, GA 30339-4024 Phone: (770) 433-8211 Plan Name: Home Depot Texas Employee Accident Plan Plan Type: Employee welfare benefits plan, as defined in Section 3(1) of ERISA Plan Number: 509 IRS Identification Number of Plan Sponsor: 58-1853319 Method of Financing: Self-funded from Home Depot's general assets. No employee contributions are required. Third Party Administrator: Sedgwick Claims Management Services, Inc. P.O. Box 131580 Dallas, Texas 75313-1560 Phone: (214) 849-5203 Fax: (214) 849-5201 APPENDIX 000058 Case 4:11-cv-00410-Y Document 17 Filed 11/04/11 Page 59 of 103 PageID 192 GENERAL INFORMATION? 1. Is this Plan intended to provide workers' compensation insurance? No. The Plan does not provide, nor is it intended to provide, workers' compensation insurance coverage under the Texas Workers' Compensation Act. Notwithstanding any representations that may have been made to the contrary, written, oral or implied, no representation, commitment or guarantee is made by any Employer, nor any of its officers, directors, employees, or agents, that_any Benefits provided under the Plan will be at least equal to benefits that may have been - provided pursuant to an insured arrangement under the Texas Workers' Compensation Act. Furthermore, the mere occurrence of a Bodily Injury or Disease will not automatically result in a Determination to pay Benefits under the Plan; all claims will be evaluated on an individual, case-by-case basis, taking into account the exclusions from coverage as well as the other applicable terms and provisions of the Plan. 2. Are there any terms I need to know when reading this Summary Plan Description (SPD)? Yes. The terms "you" and "your" as used in this SPD refer to a Participant. Also, masculine pronouns include the feminine gender when appropriate, and words used in the singular or plural will include the other tense when appropriate. References to "Q/A" means a question and answer in this SPD. The following terms have the meanings indicated below when used in this SPD: (a) Accident means a sudden, unforeseen, unexpected, unplanned, specific event that occurs at an identifiable time and place by chance or from unknown causes independent of other causes while you are in Active S ervice. (b) Active Service means you are currently performing a job-related activity for Home Depot, i.e., you are performing on a scheduled work day the duties of your employment with Home Depot, either at your customary place of employment or at a location required by Home Depot for furthering its business interest. You are not in Active Service if you are confined in any institution providing care or treatment of physical or mental infirmities. You will be considered to be in Active Service if you are on an authorized work break before the end of your job shift and you remain on Home Depot's premises during the break or make an authorized business trip. APPENDIX 000059 Case 4:11-cv-00410-Y Document 17 Filed 11/04/11 Page 60 of 103 PageID 193 (c) Active Service includes making a business trip authorized by Home Depot; provided, however, Active Service does not include: (i) time spent commuting to or from work, or (ii) time during or after personal deviations made during a business trip. The Plan provides detailed information about commuting and personal deviations_ (d) Average Annual Earnings means, for purposes of accidental death or dismemberment benefits (as described in the schedule set out in Appendix A to this SPD), your Average Weekly Earnings multiplied by fifty-two (52). (e) Average Weekly Earnings means your salary or wages from Home Depot (including overtime, but excluding bonuses, commissions, employee or fringe benefits, or extraordinary remuneration) that you earned over the six (6) week period preceding the first day of lost time due to a Bodily Injury or Disease, divided by six (6). However, if you have not been in Active ServiCe for at least six weeks when the Accident occurs, the Plan Administrator will determine your Average Weekly Earnings using the average wages of other Employees with similar job classifications and experience and who have been in Active Service for at least six weeks. (f) Benefits means the Compensation payments and any non-monetary benefits that are provided to you under the Plan. Benefits also include Home Depot's safety training program pursuant to which you are instructed as to on-the-job safety procedures designed to reduce the potential for Accidents. (g) Bodily Injury means an identifiable physical injury to you that: (1) is caused by an Accident, and (2) solely and independently of any other cause, excelit illness or infection directly resulting from such injury, or medical or surgical treatment rendered necessary by such injury, results in your incurring a Medical Expense or your disability, dismemberment or death within thirty (30) days from the date of the Accident. The term "Bodily Injury" does not include disease unless it results directly from an Accident. (h) Committee means the Incident Review Committee appointed by the Plan Sponsor to oversee the administration of the Plan and to perform the duties specified in this SPD. 3 APPENDIX 000060 Case 4:11-cv-00410-Y Document 17 Filed 11/04/11 Page 61 of 103 PageID 194 Compensation means the money allowance payable to you or on your (i) behalf for Medical Expenses, Wage Continuance, dismemberment, death, and any other monetary Benefits provided under the Plan. Designated Healthcare Provider means the physicians and other health (j) care service providers designated by the Plan Sponsor from time to time to provide services to you under the Plan. Your Designated Healthcare Provider cannot be your spouse, your parent, grandparent, greatgrandparent, sibling, or your or your spouse's child. In addition, your Designated Healthcare Provider cannot be someone who lives with you. The Committee or its delegate reserves the right to change its list of , Designated Healthcare Providers at any time. (k) Determination means the decision of the Committee or its delegate concerning whether or not to award Benefits to you for a Bodily Injury or Disease. Disability means your partial or total inability (whether temporary or permanent) because of a Bodily Injury or Disease to (1) perform the material and substantial duties of your regular job, and (2) earn the same wages you were receiving at the time of the Bodily Injury or Disease. Your Disability must begin within thirty (30) days of the date of the Accident which caused the Bodily Injury. In order to be eligible for Wage Continuance under the Plan, your Disability must result in an excused absence from work with Home Depot. (1) (m ) Disease means an unhealthy condition of the body arising as a result of Active Service that: (1) causes damage or harm to the physical structure of the body and is generally accepted by the National Center of Diseases to be a disease, (2) was caused by exposure to environmental or physical hazards present in Home Depot's work environment, and (3) is not caused by an Accident. The term "Disease" does not include an ordinary disease of lifb to which the general public is exposed outside of Active Service. In order to be eligible for coverage under the Plan, your last day of exposure to the work condition causing the Disease must occur while you are in Active Service. The occurrence date of a Disease is the earlier of (1) the date reported pursuant to Q/A-4 of this SPD, or (2) the first date that the symptoms have developed into a medically diagnosed disease. The term "Disease" also includes a cumulative trauma injury, which is a physical condition that results from the performance of repetitive, physically traumatic activities while you are in Active Service. 4 APPENDIX 000061 Case 4:11-cv-00410-Y Document 17 Filed 11/04/11 (n) Page 62 of 103 PageID 195 Emergency Medical Care means medically necessary health care treatments, services or supplies that are provided for a Bodily Injury or Disease which, if not immediately diagnosed and treated, could reasonably be expected to result in loss of life or limb, serious impairment to bodily function or permanent disfunction of a body part. (o) Employee means a person who is employed as an employee in Texas by Home Depot and whose compensation is reported on an IRS form W-2 (or its successor) by Home Depot. You are not an Employee if you are: (1) an independent contractor or subcontractor, (2) employed by an independent contractor or subcontractor, (3) a third-party agent or other person with a status other than that of a common law employee of an Employer, or (4) covered as a worker under Texas' or another state's workers' compensation law while in Active Service. (p) • Employer means Home Depot and any of its affiliates that adopt the Plan with Home Depot's consent. (q) ERISA means the Employee Retirement Income Security Act of 1974, as amended, and the regulations and other authority issued thereunder by the appropriate governmental authority. (r) Incident Report means a report prepared after an Accident or other incident has occurred describing the time, place and general description of the incident that resulted in your Bodily Injury or Disease. (s) Maximum Medical Improvement means the earlier of the point at which: (1) a physician determines that you will not likely improve substantially as a result of additional medical treatment, surgery, or physical therapy, or (2) you refuse to undergo any surgery or other medical procedure that is recommended by a physician to help you reach the point in your recovery described in clause (1) above. (t) Medical Expense means a charge or expense that results from a Bodily Injury or Disease for which the Committee -has made a Determination to award Compensation. (u) Medical Records means all medical information relevant to your Bodily Injury or Disease, including your diagnosis, prognosis and treatment in narrative form and all reports and evidence of lab test results, x-rays, therapy, physical examinations, drugs, autopsy and other tests and procedures. (v) Participant means an Employee who has satisfied the Plan's eligibility requirements and whose participation in the Plan has not been terminated 5 APPENDIX 000062 Case 4:11-cv-00410-Y Document 17 Filed 11/04/11 Page 63 of 103 PageID 196 as provided under applicable provisions of the Plan. h certain contexts, the term "Participant" may also refer to a former Employee who is receiving Benefits under the Plan for a Bodily Injury or Disease that occuned while he was in Active Service. (w) Plan means the Home Depot Texas Employee Accident Plan, as it may be amended from time to time. (x) Plan Administrator means the Plan Sponsor. (y) Plan Sponsor means Home Depot USA, Inc. or its successor in interest. (z) Plan Year means the calendar year. (aa) Third Party Administrator means an entity that is engaged by the Plan Sponsor as a third-party, contract claims processor for Benefit claims arising under the Plan. (bb) Wage Continuance means the Compensation attributable to lost or reduced earnings capacity that is payable under the Plan to you when you incur a Disability resulting in lost time from Active Service. 6 APPENDIX 000063 Case 4:11-cv-00410-Y Document 17 Filed 11/04/11 Page 64 of 103 PageID 197 ELIGIBILITY 3. When will I be eligible to participate in the Plan? If you are an Employee in Active Service in Texas, you will automatically join the Plan as a Participant as of the later of: (a) your first day of Active Service for Home Depot, or (b) the effective date of the Plan. If you go on a leave of absence, are laid off, or terminate employment with the Employer, you will automatically join the Plan again if you are re-hired as an Employee in Active Service in Texas. INCIDENT REPORTING AND INVESTIGATION 4. What reports are required when a Bodily Injury or Disease has occurred? You must assist Home Depot in completing an Incident Report which details all relevant information concerning the Bodily Injury or Disease incurred. With respect to an incident causing a Bodily Injury, you must provide an account of the incident, including how it occurred, who was involved, the Bodily Injury sustained and which parts of the body were hurt. With respect to a Disease, you must provide an account of all details deemed relevant by Home Depot. In either case, Home Depot may request that you provide your account of the incident in writing. Upon receiving notice of a Bodily Injury or Disease, Home Depot will investigate and take action as it deems appropriate under the circumstances. 5. When do I report a Bodily Injury or Disease? (a) Bodily Injury. You must immediately report an Accident or other incident that results or could result in Bodily Injury, no matter how slight, to your supervisor. If you do not report your Bodily Injury within the same job shift in which it occurs, and in any event within one (1) day, your Bodily Injury will not be considered timely reported, which may result in a loss of Benefits. Under certain circumstances, the Committee may give you up to three (3) days to report your Bodily Injury. If medical necessity or extenuating circumstances prevent you from reporting the Accident in a timely manner, in any event you must report the Bodily Injury within three (3) days from the time that it occurs. The Committee may extend the three (3) day period to a period of up to seven (7) days at its discretion. (b) Disease. Unless there is a valid and compelling reason for the delay, you must report a Disease to your supervisor during the period in which you 7 APPENDIX 000064 Case 4:11-cv-00410-Y Document 17 Filed 11/04/11 Page 65 of 103 PageID 198 are an Employee and seek prompt medical attention as soon as reasonably possible after you first notice symptoms of the Disease. If you first notice symptoms of a Disease after termination of employment, you must report such symptoms to Home Depot within seven (7) days of first noticing the symptoms, but in no event rater than three (3) months after you terminate employment. Any reported, suspected Disease will be subject to the standard claims investigation, review and verification procedures of the Plan. The Plan does not cover any claims for Benefits that are attributable to a Disease that you do not report to Home Depot within the time frames above. 6. If I am injured on-the-job, what are my responsibilities regarding medical treatment? You must seek immediate medical care from a Designated Healthcare Provider, subject to the exceptions set forth in Q/A-7 of this SPD. Except under extenuating circumstances, you must seek medical care within sixty (60) days from the date of the Bodily Injury. You must report back to Home Depot when released by the Designated Healthcare Provider. You must keep all appointments with the Designated Healthcare Provider and follow his instructions regarding treatment, recovery, and return to work. BENEFITS MEDICAL 7. What health care providers do I use if I am injured on the job? Generally, the Plan Sponsor or Third Party Administrator has designated the health care facilities and Designated Healthcare Providers that you must use in order for Benefits to be awarded under the Plan. The Committee, in its discretion, may nevertheless award Benefits for usual and customary charges from health care facilities, physicians or 'other health care service providers that are not Designated Healthcare Providers, in the event that: (a) the Bodily Injury or Disease occurs outside of Home Depot's geographic area, (b) Emergency Medical Care is required, or (c) specialized medical treatment is required and pre-approved for payment by the Committee or its delegate. After Emergency Medical Care is rendered, you will be transferred to a Designated Healthcare Provider as soon as such transfer is practical based on your condition. 8 APPENDIX 000065 Case 4:11-cv-00410-Y Document 17 Filed 11/04/11 Page 66 of 103 PageID 199 The Employer (and its agents and delegates, including the Committee) will not have any responsibility for the actual health care services and supplies provided by your attending physician, healthcare facility and other health care providers. Health care providers are not agents of Home Depot or the Plan, and Home Depot and the Plan will not be liable or responsible for the acts or omissions of any health care provider. The actual medical treatment of a Bodily Injury or Disease remains the prerogative and responsibility of the attending physician and other health care providers based on their independent medical judgment for the provision of quality health care. The Plan is not intended to affect the patientprovider relationship. The Committee or its delegate will have the discretion to assign Designated Healthcare Providers to your case in order to: (a) coordinate and expedite your medical treatment, in consultation with the treating physician, (b) facilitate such managed care, case management, cost control, quality, and efficiency measures and procedures as the Committee deems appropriate or reasonable based upon the particular facts and circumstances, and (c) review the propriety of any treatments, services and supplies, and related charges that are expected to be paid by the Plan. In order to be eligible for Benefits or continued Benefits under the Plan, you will be required to abide by, and submit to, whatever managed care or case management procedures are deemed appropriate by the Committee or its delegate for your case. 8. What documents will I be required to sign before I receive non-emergency Benefits? If you incur a Bodily Injury or Disease, you must sign and return to the Plan Administrator (or its delegate) a release of your Medical Records pertaining to the Bodily Injury or Disease on a form provided by" the Plan Administrator (or its delegate) before any Determination will be made with respect to your claim for Benefits. The Plan Administrator may withhold or deny the payment of any Benefits until you have signed and returned the requested Medical Records release. 9 APPENDIX 000066 Case 4:11-cv-00410-Y Document 17 Filed 11/04/11 9. Page 67 of 103 PageID 200 When will my Benefits begin? The Committee will award Benefits only after making a Determination that Benefits are warranted under the Plan and ensuring that any required medical records releases have been secured in accordance with Q/A-8 of this SPD. The Committee retains all rights to discontinue or reduce Benefits provided on behalf of a Participant if the Committee determines that there is a reason for such action under the Plan. 10. What types of Medical Expenses are covered under the Plan? Medical Expenses generally include the following types of expenses: (a) In-patient charges for semi-private room and board; (b) Charges for use of an operating or emergency room; (c) Fees for physicians, surgeons (including oral surgeons), nurses and other Designated Healthcare Providers; (d) Charges for a licensed nurse who is not a member of the Employee's family; (e) Charges for prosthetic appliances, including artificial limbs; (f) Charges for Emergency Medical Care and emergency service transportation to a local hospital; (g) Charges for medical or surgical treatment, services, supplies, blood, oxygen, anesthesia; and prescription drugs; Dental services for the treatment of injury to sound natural teeth; Services of a home health care agency; Charges for physical rehabilitation treatment for the purpose of restoring the function of motion, speech or vision lost as the result of a Bodily Injury or Disease; (k) Out-patient services and supplies; and (I) Counseling for severe psychological trauma resulting from your having been the victim of an armed robbery or aggravated assault while in Active Service. 10 APPENDIX 000067 Case 4:11-cv-00410-Y Document 17 Filed 11/04/11 Page 68 of 103 PageID 201 The above list is not intended to limit the exact types of expenses which may qualify as Medical Expenses under the Plan; likewise, in accordance with applicable terms and conditions of the Plan, not all of the listed expenses will necessarily be Medical Expenses in each and every case. 11. What types of expenses are not covered under the Plan? Certain expenses are not covered under the Plan. Benefits will not be paid for any charge or expense: (a) that is incurred after you have reached Maximum Medical Improvement, except to complete any continuing treatment as approved in writing by the Committee; (b) that is incurred while you are confined in a hospital owned or operated by the United States government or an agency thereof for treatment of a military service-related disability; (c) that, absent the coverage provided by the Plan, you would not be legally required to pay or for which no charge would be made; (d) that is covered under any workers' compensation, unemployment compensation, or disability benefits law or any similar law of the United States or any State or political subdivision thereof; (e) for the care or treatment of mental, nervous or emotional disorders, except counseling approved by the COmmittee, in its discretion, for severe psychological trauma resulting from the fact that you were the victim of an anned robbery or aggravated assault while in Active Service; (f) for the care or treatment of alcoholism, drug abuse or other substance abuse; (g) for treatment or service that may be rendered safely and reasonably by a person not medically skilled, that is designed to assist you with daily living activities, or by a person who lives with you, unless any such charge or expense is approved in writing by the Committee; (h) for services_or supplies of common household use, for personal comfort or convenience, or for environmental control, including, but not limited to, exercise equipment, air conditioners, humidifiers, air purifiers, water purifiers, allergenic mattresses, blood pressure kits and custodial care, regardless of whether any such item is prescribed by any physician, unless such charge or expense is approved in writing by the Committee; 11 APPENDIX 000068 Case 4:11-cv-00410-Y Document 17 Filed 11/04/11 Page 69 of 103 PageID 202 (i) that is reimbursable by any local, state, federal or other governmental agency; (1) that results from medical care, services or supplies provided to you by someone other than a Designated Healthcare Provider, except for Emergency Medical Care or as otherwise specifically approved in writing by the Committee; (k) for room and board in excess of a semi-private room rate, unless the attending physician deems such an arrangement to be medically necessary; for biofeedback and other forms of self-care or self-help training or any related diagnostic training; (m) or hypnosis or acupuncture; (n) for chiropractic or spinal manipulation services, except to the extent approved in writing by the Committee; (o) for travel or lodging, except if recommended by a physician and approved in writing by the Committee; (p) in excess of the maximum Benefit limitations of the Plan; or (q) not resulting from a Bodily Injury or Disease. The above list is not intended to limit the types of charges or expenses that may be excluded from coverage by the Committee depending on the particular facts and circumstances involved with each case and the applicable tenns and conditions of the Plan. 12. When will my Benefits for Medical Expenses end? Generally, you will be eligible to continue to receive Medical Expenses under the Plan until: (a) your attainment of Maximum Medical Improvement, (b) such time as you are authorized by your treating physician to return to full Active Service, regardless of whether or not you actually return, or (c) after coverage of Medical Expenses for a maximum period of 104 weeks, unless such coverage is extended by the Committee, at its discretion, for up to an additional 12 weeks. Coverage of Medical Expenses may end sooner, however, as provided in Q/A-17, Q/A-21, Q/A-22 or elsewhere in this SPD. 12 APPENDIX 000069 Case 4:11-cv-00410-Y Document 17 Filed 11/04/11 Page 70 of 103 PageID 203 WAGE CONTINUANCE 13. What are my Benefits if I lose time from work because of a Bodily Injury or Disease? If you incur a Disability resulting in lost time from Active Service and you are not able to return to Active Service after three (3) days from the date of the Bodily Injury or Disease (except for death), you will be eligible to receive Wage Continuance. You may use accrued vacation or sick days during this three (3) day waiting period. If you are unable to return to Active Service after fourteen (14) days because of your Disability, your Wage Continuance payment will retroactively cover the three (3) day waiting period. Wage Continuance is payable in an amount equal to ninety percent (90%) of your Average Weekly Earnings. The Committee may require you to provide periodic reports about your health status and when you expect to return to work during any period when you are receiving Wage Continuance payments. The Committee may also require you to submit proof of continued Disability on a periodic basis as often as it considers necessary and reasonable, and may discontinue Benefits until you provide such proof. Generally, you will be eligible to continue to receive Wage Continuance under the Plan until: (a) your attainment of Maximum Medical Improvement, (b) such time that you are authorized by your treating physician to return to Active Service, regardless of whether or not you actually return, (c) when you begin employment with another employer (unless pre-approved in writing by the Committee), (d) after payment of Wage Continuance for the maximum period of 52 weeks (or 104 weeks if extended by the Committee), or (e) your employment with the Employer terminates. You must continue to be unable to return to Active Service (in a full, light or modified duty capacity) due to such Bodily Injury or Disease. Wage Continuance payments will not ordinarily continue for more than, a 52-week period. If you have received Wage Continuance for a .continuous 52-week period, any further Wage Continuance will be subject to review by the Committee, which will evaluate and determine if further Wage Continuance will be paid for an additional period not to exceed another 52 weeks. Wage continuance may end sooner, however, as provided in Q/A-17, Q/A-21, Q1A-22 or elsewhere 1in this SPD. To the extent applicable, the Wage Continuance provisions of the Plan will be construed in accordance with the requirements of the Family and Medical Leave Act of 1993. 14. Can I receive Wage Continuance and other employee benefits at the same time? 13 APPENDIX 000070 Case 4:11-cv-00410-Y Document 17 Filed 11/04/11 Page 71 of 103 PageID 204 The Plan will not provide duplicate payments to or on behalf of any Participant. In that regard, to the extent not prohibited by applicable law, the Committee will reduce your Wage Continuance otherwise payable by the Committee dollar-fordollar by the amount of any: (a) absent-time pay paid from Home Depot's regular payroll, (b) salary continuation paid from Home Depot's regular payroll, (c) salary or wages paid to you while you have a Disability for services rendered in a light-duty or other modified or restricted capacity, (d) benefits payable under the Social Security Act, workers' compensation law, unemployment compensation law, occupational disease law, or another law, and (e) benefits payable under any short-term or long-term disability insurance policy or other employee benefit program maintained by Home Depot that covers you. Any amount to which you are entitled under the terms of any insurance policy maintained by Home Depot will be primary to any Benefits payable under the Plan, and the amount due you under any such insurance policy will reduce or offset the amount due under the Plan. You are required to take whatever benefits are available to you from other sources besides the Plan, including enrolling under the Social Security Act to receive benefits for a disability that is covered under that Act. ACCIDENTAL DEATH AND DISMEMBERMENT 15. What are my Benefits in the case of an accidental death or dismemberment from a Bodily Injury? The Plan provides a Benefit in the event of: (1) your death resulting•from a Bodily Injury or Disease, or (2) dismemberment resulting from a Bodily Injury. Dismemberment means your loss of an eye, foot, hand or finger. The Plan requires that your death or dismemberment occur within twelve (12) months of the occurrence of the Bodily Injury or Disease. The Committee or its delegate will determine the Benefits payable to you or on your behalf due to your death or dismemberment according to the Schedule of Benefits listed in Appendix A to this SPD. In the event of your death, the Plan will pay any death Benefits to your surviving lawful spouse, as established by a marriage certificate, a court of competent jurisdiction, or such other means satisfactory to the Committee. If you have no spouse at the time of your death, the Plan will pay any death Benefits to your estate, after the Committee receives directions from an appropriate representative of the estate. Payment of any death Benefits under the Plan will completely discharge and satisfy any obligation or liability under the Plan to the extent of such payment. SAFETY TRAINING 16. What is the Employee safety training program? 14 APPENDIX 000071 Case 4:11-cv-00410-Y Document 17 Filed 11/04/11 Page 72 of 103 PageID 205 One of the specific Benefits provided under the Plan is the Employee safety training program maintained by Home Depot, which is designed to reduce the potential for Accidents. You are required to work in a safe manner pursuant to instructions and to otherwise abide by Home Depot's occupational safety rules and procedures as then in effect. The Employee safety training program is an integral part of the Plan. BENEFITS — ALL 17. Who is responsible for interpreting the terms of the Plan and making Determinations regarding Benefits? The Committee (or its delegate) is responsible for interpreting the terms of the Plan and making Benefit Determinations. In making Determinations, the Committee will consider all relevant information, concerning: (a) the incident, (b) the nature and severity of the Bodily Injury or Disease sustained, (c) the time expected to be lost from work, (d) the treatment, diagnosis and prognosis, as prescribed by the attending physician, and (e) the applicable terms and conditions of the Plan. There will be no inter-relationship between this Plan and Home Depot's group medical plan, if any, for Participants and their eligible dependents. For example, work-related claims that are accepted under this Plan, in whole or in part, cannot be submitted for reimbursement under Home Depot's group medical plan or viceversa. 18. What are the procedures for drug and alcohol testing? You must submit to drug and/or alcohol testing following an Accident or Bodily Injury, as directed by Home Depot or its agent. Such testing will be conducted by a person designated by Home Depot who has been trained to administer such tests or by a physician (or other health care service provider). The testing may be conducted at the time of medical treatment for a Bodily Injury or Disease, as well as at any other times the Committee or its delegate deems appropriate while you are receiving Benefits under the Plan. You will not receive any further Benefits on account of a Bodily Injury if it is determined that you: (a) were under the influence of drugs (other than prescription drugs used as prescribed) or alcohol at the time of the Bodily Injury, (b) refused to take a drug or alcohol test, (c) tested positive for drug or alcohol use, or (d) tampered with a drug or alcohol test. For more detail on drug and alcohol testing, see exclusion (i) in Q/A-19. 15 APPENDIX 000072 Case 4:11-cv-00410-Y Document 17 Filed 11/04/11 19. Page 73 of 103 PageID 206 Are there any other events or reasons that would exclude otherwise eligible expenses from coverage under the Plan? You will not be entitled to receive, or to continue to receive, Benefits under the Plan for any Bodily Injury, Disease, death or dismemberment caused by or resulting from an Accident if: (a) You fail to timely report the Accident or other incident causing the Bodily Injury or to report the Disease within the period of time prescribed in Q/A5 of this SPD; (b) You fail to fully cooperate in the investigation of the Accident or other incident or Disease; (c) You fail or refuse to appear upon reasonable notice for an examination by a physician or other medical provider; (d) The Bodily Injury or Disease was caused in whole or in part by your violation of Home Depot's employee practices and procedures as then in effect, including, without limitation, disregard of safety instructions for performing a particular task; (e) The Bodily Injury or death was intentionally self-inflicted or aggravated while you were sane or insane, or was caused by your willful action, such as fighting or horseplay, in violation of Home Depot's practices or procedures for on-the-job conduct; (f) You fail to submit, as and when requested by Home Depot or its agent, to a blood test, urinalysis, or other test designed to detect the presence of alcohol or drugs in your system; (g) The Bodily Injury was directly or indirectly caused by or resulted from an assault or another act of a third person or Employee who intended to injure you because of personal reasons and whose actions were not directed at you solely in the course and scope of your employment with Home Depot; (h) The Bodily Injury or Disease occurred at a time when: (1) You were impaired by or under the influence of alcohol; (2) You had an alcohol concentration, as defined in the Texas Alcoholic Beverage Code, as amended; (3) You were impaired by or under the influence of any drug, substance or analogue listed as a controlled substance or a 16 APPENDIX 000073 Case 4:11-cv-00410-Y Document 17 Filed 11/04/11 Page 74 of 103 PageID 207 controlled substance analogue in the Texas Controlled Substances Act, as amended (Health and Safety Code); a dangerous drug or an abusable glue or aerosol paint, as defined in the Texas Health and Safety Code; or any similar substance regulated under the laws of the State of Texas. For the purposes of this exclusion, detectable levels of any Controlled Substance use establishes a presumption that you were impaired or under the influence; (4) You were impaired by or under the influence of any drug which: (i) is not legally obtainable, (ii) is legally obtainable but has not been legally obtained, or (iii) has been legally obtained but is not being used for prescribed purposes or in a prescribed manner. Detectable levels of any Illegal Drug use establishes a presumption that you were impaired or under the influence. You fail or refuse to follow the advice or course of treatment prescribed by a Designated Healthcare Provider, including, but not limited to, failing to notify your supervisor or return to Active Service (full or modified duties) after being cleared to return by a physician, except for a continuing absence that is approved in writing by the Committee, in its discretion, based on your extenuating circumstances; You are determined to have engaged in fraudulent or other deliberate conduct intended to mislead the medical provider or Home Depot as to the nature or severity of the claimed Bodily Injury or Disease; You seek reimbursement for charges from a health care provider which is not a Designated Healthcare Provider, except as provided in Q/A-7 of this SPD; You (or another person claiming your Benefits under the Plan) fail or refuse to sign a Medical Records release in accordance with Q/A-8 of this SPD; Your expenses relate to mental and nervous conditions arising incident to the Bodily Injury or Disease, including for illustration and not limitation, (1) pain and suffering, (2) mental anguish or mental trauma, (3) loss of consortium or companionship, and (4) any other loss, injury or damage of an emotional, mental, psychological or psychiatric nature, except counseling authorized by the Committee for severe psychological trauma resulting from the fact that you were the victim of an armed robbery or aggravated assault while in Active Service; 17 APPENDIX 000074 Case 4:11-cv-00410-Y Document 17 Filed 11/04/11 Page 75 of 103 PageID 208 (n) Your expenses relate to a Ptomaine or bacterial infection, other than a bacterial infection occurring as a consequence of a cut or wound resulting from an Accident; (o) Your expenses result from radioactive contamination, whether directly or indirectly; or Your expenses relate to the use of, or contact Vwith, any asbestos, asbestos fibers or asbestos products, or the hazardous properties of any nuclear material or nuclear by-product material. Any pre-existing condition of yours contributes to the Bodily Injury or Disease or to its aggavation or severity.. What happens if I am covered under another source for my Bodily Injury or Disease? 20. To prevent duplicate payments which exceed 100% of the allowable Benefits, the Plan has certain "coordination of benefits" rules regarding the priority for payments from the Plan and from other sources. If you (or your estate or beneficiaries) are entitled to payment from one or more other plans or insurance policies as a result of a Bodily Injury or Disease, the other sources may contribute to payment of your eligible expenses. Please consult the Plan document for specific information regarding these coordination of benefits provisions. 21. What is the maximum amount of Benefits allowed under the Plan? • The total amount of Benefits,provided to you under the Plan for Bodily Injuries will not exceed an aggregate lifetime limit of two million dollars ($2,000,000), without regard to the number of Bodily Injuries you may incur. The maximum amount of Benefits provided to you under the Plan for Diseases will not exceed an aggregate lifetime limit of one million dollars ($1,000,000), without regard to the number of Diseases you incur. Nothing contained in the Plan requires, or should be construed to require, the Committee to award the maximum amount or any amount of Benefits hereunder. 22. When will my coverage end under the Plan? You will cease to be a Participant on the effective date that the Plan is terminated. Subject to the next paragraph, you will also cease to be a Participant at the effective time on which your status as an Employee is discontinued for whatever reason. 18 APPENDIX 000075 Case 4:11-cv-00410-Y Document 17 Filed 11/04/11 Page 76 of 103 PageID 209 Your right to receive Benefits for Medical Expenses awarded under the Plan for a Bodily Injury or Disease that occurred while you were in Active Service (prior to your termination of employment with an Employer) will not be curtailed solely as the result of such termination, provided that you are otherwise eligible to receive Benefits for a claim incurred while you were in Active Service and reported within the time period prescribed in Q/A-5 of this SPD. You may thus lose your right to receive any other Benefits following termination of employment. If your employment with an Employer terminates, you will again become a Participant on the first day that you recommence employment in Active Service for Home Depot. The purpose of the PIan is to provide coverage for occupational Bodily Injury or Disease only, i. e., only Bodily Injuries or Diseases that occur while you are in Active Service are covered under the Plan. Consequently, coverage will not extend to non-work days, holidays, vacation, or to any other time period when you are not in Active Service. 23. Can I return to work before I have completely recovered from my Bodily Injury or Disease? A modified or light duty position, if appropriate, may be created in Home Depot's discretion to accommodate you if you have not yet reached Maximum Medical Improvement. There will be no permanent or indefinite light or modified duty positions. If you have not returned to full duty after a period of ninety (90) days in a light or modified duty position, the Committee will evaluate the situation to make a determination regarding whether future employment in the light or modified duty assignment should be extended for up to an additional sixty (60) days or discontinued. 24. What happens when my doctor releases me to return to'work? After a physician who is a Designated Healthcare Provider issues a medical release permitting you to return to full, light or modified duties, you must immediately contact your supervisor. If you can't promptly reach that supervisor, then you must contact another supervisor. As directed by the supervisor, you must return to work and perform duties, modified or otherwise, as are assigned by Home Depot. If you fail or refuse to timely contact a supervisor or return to work when released, you will be subject to: (a) immediate cessation of your Wage Continuance and other Benefits under the Plan, as determined by the Committee, and/or (b) termination of employment. 19 APPENDIX 000076 Case 4:11-cv-00410-Y Document 17 Filed 11/04/11 Page 77 of 103 PageID 210 FILING BENEFIT CLAIMS AND CLAIM APPEALS 25. How do I make a claim for Benefits? In the event that you, your beneficiary, or other person or entity (collectively referred to as the "Claimant") has a claim for any Benefit provided under the Plan, the Claimant must file a claim with the Committee or its delegate, such as the Third Party Administrator, on a form provided for that purpose. If the Claimant fails to file a claim for Benefits, the Committee may take whatever steps are necessary to dispose of the Claimant's potential Benefits under the Plan, and will be held harmless by Claimant and all other persons and entities in this respect. The Committee will authorize payment for Medical Expenses to you or on your behalf in accordance with the terms of the Plan. All requests for payment or reimbursement of Medical Expenses must be filed with the Committee or its delegate within sixty (60) days from the date you incur the expenses or, if later, the date you receive an invoice from a health care provider for such expenses. Prior to authorizing any Benefits, the Committee (or its delegate) may require the Claimant to provide proof of loss and other requested information, and to complete any releases, subrogation forms or other forms or documents which it deems to be appropriate for the proper administration of the Plan, including filing of all claims and requests for payment from any other source. 26. When will my claim for Benefits be decided? The time period for deciding your claim for Benefits depends upon what type of Benefits you are claiming. The Benefits offered under the Plan include health benefits (e.g., mcdical benefits), disability benefits (e.g., wage Continuance benefits) and death and dismemberment insurance benefits. There are four different types of health benefit claims: Urgent Care Claims, Pre-Service Claims, Post-Service Claims and Concurrent Care Claims. The amount of time that the Third Party Administrator has to decide your claim depends on the type of claim. You may appoint an authorized representative to act on your behalf with respect to a claim or appeal for Benefits. To do so, the Plan must receive the required forms appointing the representative to act on your behalf. The Plan will also recognize a court order giving a person authority to submit claims on your behalf. However, in the case of an urgent claim, the Plan will, in the absence of such a form or court order, recognize a health care professional with knowledge of your medical condition as your authorized representative. Once an authorized representative is appointed, the Plan will direct all communications to that representative and copies will be sent to you. References to you in questions 26- 20 APPENDIX 000077 Case 4:11-cv-00410-Y Document 17 Filed 11/04/11 Page 78 of 103 PageID 211 30 are intended to include references to an authorized representative appointed by you. Urgent Care Claim An "Urgent Care Claim" means any claim involving a condition that is considered urgent because it could seriously jeopardize your life, health, or ability to regain maximum function, or, in the opinion of a physician with knowledge of your medical condition, subject you to severe pain that cannot be adequately managed without the treatment or care being requested. The determination of whether a claim is an Urgent Care Claim will be made by an individual acting on behalf of the Plan applying the judgment of a prudent lay person who possesses an average knowledge of heath and medicine or by a physician with knowledge of your medical condition who determines the claim involves urgent care. In the case of an Urgent Care Claim, the Third Party Administrator will notify you of the Plan's benefit determination (whether adverse or not) as soon as possible, taking into account the medical urgency, but not later than 72 hours after the receipt of the claim by the Plan, unless you fail to provide sufficient information to determine whether, or to what extent, Benefits are covered or payable under the Plan, in which case, the Third Party Administrator will notify you as soon as possible, but not later than 24 hours after the receipt of the claim by the Plan, of the specific additional information necessary to complete the claim. You will have a reasonable amount of time, taking into account the circumstances, but not less than 48 hours, to provide the specified information. The Third Party Administrator will then notify you of the Plan's benefit determination as soon as possible but in no case later than 48 hours after the earlier of: (1) the Plan's receipt of the specified additional information, or (2) the end of the period given to you to provide the specified additional information. Notification of any denied claim will include the information described in Q/A27, "If my initial claim is denied, what information will I receive?" Pre-Service Claim If you are seeking authorization for a Medical Expense that requires approval from the Plan before obtaining medical care in order for such medical care to be covered by the Plan, your claim is considered a " Pre-Service Claim," and you must follow the Plan's procedures for filing a Pre-Service Claim. If you fail to follow the Plan's procedures for filing a Pre-Service Claim, you will be notified of the failure and the proper procedures to be followed in filing a claim for Benefits. This notification will be provided to you as soon as possible, but not later than 5 days (24 hours in the case of a failure to file a claim involving urgent care) following the failure. The notification may be written or oral, unless you request written notification. 21 APPENDIX 000078 Case 4:11-cv-00410-Y Document 17 Filed 11/04/11 Page 79 of 103 PageID 212 For this notification to apply, the Pre-Service Claim must be communicated by you to the Third Party Administrator and must include your name and the medical condition or symptom and the treatment, service or product for which approval is being requested. The Third Party Administrator will notify you of the Plan's determination (whether adverse or not) within a reasonable period of time appropriate to the medical circumstances, but not later than 15 days after receipt of the claim by the Third Party Administrator. This period may be extended one time for up to 15 days, provided that the Third Party Administrator both determines that such an extension is necessary due to matters beyond the control of the Plan and notifies you prior to the expiration of the initial 15-day period of the circumstances requiring the extension of time and of the date by which the Third Party Administrator expects to make a decision. If such an extension is necessary due to a your failure to submit the information necessary to decide the claim, the notice of extension will specifically describe the required information, and you will be given at least 45 days from receipt of the notice within which to provide the specified information. Notification of any denied claim will include the information described in Q/A-27, "If my initial claim is denied, what information will I receive?" Post-Service Claim A "Post-Service Claim" means any claim that is not a Pre-Service Claim that involves payment for the cost of health care that has already been provided under the Plan. The Third Party Administrator will notify you of the Plan's adverse benefit determination within a reasonable period of time, but not later than 30 days after receipt of the Post-Service Claim. This period may be extended one time by the Plan for up to 15 days, provided that the Claims Administrator both determines that such an extension is necessary due to matters beyond the control of the Plan and notifies you, prior to the expiration of the initial 30-day period, of the circumstances requiring the extension of time and the date by which the Plan expects to render a decision. If such an extension is necessary due to a failure by you to submit the information necessary to , decide the claim, the notice of extension will specifically describe the required information, and you will be afforded at least 45 days from the receipt of the notice with which to provide the specified information. Notification of any denied claim will include the information described in the Q/A-27, "If my initial claim is denied, what information will I receive?" 22 APPENDIX 000079 Case 4:11-cv-00410-Y Document 17 Filed 11/04/11 Page 80 of 103 PageID 213 Concurrent Care Decision If the Plan has approved an ongoing course of treatment to be provided over a period of time or number of treatments, any reduction or termination by the Plan of such course of treatment (other than by Plan amendment or termination) before the end of such period of treatment or number of visits, will be considered a denial of Benefits by the Plan and the Third Party Administrator will provide you with notification of such denial that includes the information described in Q/A-27, "If my initial claim is denied, what information will I receive?" below, at a time sufficiently in advance of the reduction or termination to allow you to appeal and obtain a determination on review of the denial of Benefits by the Plan before the benefit is reduced or terminated. If you request to extend the course of treatment beyond the period of time or specified number of treatments for an Urgent Care Claim, a deeision on such claim will be made as soon as possible, taking into account the medical urgency, and the Third Party Administrator will notify you of the benefit determination (whether adverse or not) within 24 hours after receipt of the claim by the Plan, provided that any such claim is made to the Plan at least 24 hours prior to the expiration of the prescribed period of time or number of treatments. Notification of any denied claim will include the information described in Q/A-27, "If my initial claim is denied, what information will I receive?" Disability Claim A "Disability Claim" means any claim involving a disability determination under the Plan (e.g., Wage Continuance benefits). The Third Party Administrator will notify you of the Plan's adverse benefit determination within a reasonable period of time, but not later than 45 days after receipt of the Disability Claim. This period may be extended by the Plan for up to 30 days (with the possibility of an additional 30 day extension), provided that the Third Party Administrator both determines that such an extension is necessary due to matters beyond the control of the Plan and notifies you,.prior to the expiration of the initial 45-day period, and, if necessary, again at the end of the first 30-day period of extension, of the circumstances requiring the extension of time and the date by which the Plan expects to render a decision. Such a notice of extension will specifically explain the standards on which entitlement to a benefit is based and, the unresolved•issues that prevent decision_ on the claim, and the additional information needed to resolve those issues, and you will have at least 45 days from the receipt of the notice with which to provide the specified information. Notification of any denied claim will include the information described in the Q/A-27, "If my initial claim is denied, what information will I receive?" 23 APPENDIX 000080 Case 4:11-cv-00410-Y Document 17 Filed 11/04/11 Page 81 of 103 PageID 214 Death or Dismemberment Claim The Third Party Administrator will notify you of the Plan's adverse benefit determination within a reasonable period of time, but not later than 90 days after receipt of the Death or Dismemberment Claim. This period may be extended by the Plan for up to 90 days, provided that the Third Party Administrator both determines that such an extension is necessary due to matters beyond the control of the Plan and notifies you, prior to the expiration of the initial 90-day period of the circumstances requiring the extension of time and the date by which the Plan expects to render a decision. Notification of any denied claim will include the information described in the Q/A-27, "If my initial claim is denied, what information will I receive?" 27. If my initial claim is denied, what information will I receive? If a claim for Benefits under the Plan is denied in whole or in part, you will receive written or electronic notification from the Third Party Administrator that will include: • the specific reasons for the denial with reference to the specific Plan provisions on which the denial was based; • a description of any additional information needed to perfect the claim and an explanation of why such information is necessary; • a description of the Plan's claim review procedures and applicable time limits; and • a statement of your right to bring a civil action under ERISA Section 502(a) following an adverse benefit determination on review. If an internal rule, guideline, protocol, or other similar criterion was relied upon in making the deriial, either a copy of or statement that such a rule, guideline, protocol, or other similar criterion was relied upon in making the determination will be provided to you free of charge upon request. If the denial is based on a medical necessity or experimental treatment or similar exclusion or limit, an explanation of the scientific or clinical judgment for the denial, applying the terms of the Plan to the participant's medical circumstances or a statement that such an explanation is available will be provided to you free of charge upon request. In the case of an Urgent Care Claim, the above information may be provided orally within the timeframes described in the Procedures for Urgent Care Claims 24 APPENDIX 000081 Case 4:11-cv-00410-Y Document 17 Filed 11/04/11 Page 82 of 103 PageID 215 above, provided that a written or electronic notification as described above is furnished to you not later than 3 days after the oral notification. 28. What can I do if my claim is wholly or partially denied? If you would like your claim to be reconsidered, after receiving notice of the denial of a claim, submit a written request for reconsideration of the denied claim to the Third Party Administrator within 180 days (or in the case of a death or dismemberment claim, within 60 days). You should include documents, records, or other information in support of the appeal when filing for reconsideration. Upon request, you will be allowed reasonable access to, and copies of, all documents, records, and other information relevant to the claim free of charge. The appeal will take into account all documents, records and other information that you submit or that are submitted on your behalf regarding the claim, without regard to whether the information was considered in the initial benefit determination. To the extent required by law, the appeal will not give deference to the initial decision to deny the claim and will be conducted by an appropriate named fiduciary of the Plan who is neither the individual who made the initial denial, nor the subordinate of such individual. In reconsidering any denial for medical or disability benefits that is based in whole or in part on a medical judgment (including determinations with regard to whether a particular treatment, drug or other item is experimental, investigational, or not medically necessary or appropriate) the appropriate named fiduciary will consult with a health care professional, whose identification must be provided upon request, and who has appropriate training and experience in the field of medicine involved in the medical judgment, and who is not the individual that was consulted in connection with the initial denial of the claim nor a subordinate of any such individual. If the Plan obtains other medical or vocational experts in connection with your claim, they will be identified upon request, regardless of whether the Plan relies on their advice in making any benefit determinations. A failure to timely request a review of a denied claim will be treated as full and complete agreement with the denial. If your appeal involves an Urgent Care Claim, the appeal does not need to be submitted in writing. You or your physician should call the Plan's Committee at 770-384-1234 for urgent care appeals as soon as possible. All necessary information, including the determination will be transmitted by telephone, facsimile or other available method when you request an expedited review. 29. If I appeal a denied claim, when will I receive a decision on my appeal? The time period for deciding your appeal depends upon what type of Benefits you are claiming. The Benefits offered under the Plan include health benefits, disability benefits and death or dismemberment benefits. There are four different 25 APPENDIX 000082 Case 4:11-cv-00410-Y Document 17 Filed 11/04/11 Page 83 of 103 PageID 216 types of health benefits: Urgent Care Claims, Pre-Service Claims, Post-Service Claims and Concurrent Care Claims. The amount of time that the Committee has to decide your appeal depends on the type of claim. Urgent Care Claim The Committee will notify you as soon as possible taking into account the medical urgency, but not later than 72 hours after receipt of your request for reconsideration of the denied claim. The Committee will provide you with notification of its review of your request for reconsideration of the denied claim and such notification will include the information described in Q/A-30 "If my appeal is denied, what information will I receive?" Pre-Service Claim The Committee will notify you of the Plan's response to your appeal within a reasonable period of time appropriate to the medical circumstances but not later than 30 days after receipt of your request for reconsideration of the denied claim. The Committee will provide you with notification of its review of your request for reconsideration of the denied claim and such notification will intlude the information described in Q/A-30 "If my appeal is denied, what information will I receive?" Post Service Claim The Committee will notify you of the Plan's response to your appeal within a reasonable period of time but not later than 60 days after receipt of your request for reconsideration of the denied claim. The Committee will provide you with notification of its review of your request for reconsideration of the denied claim and such notification will include the information described Q/A-30 "If my appeal is denied, what information will I receive?" Disability Claim Tfie Committee will notify you of the Plan's response to your appeal within a reasonable period of time, but not later than 45 days after receipt of your request for reconsideration of the denied claim. This period may be extended for up to 90 days if the Committee determines that special circumstances require an extension of time, in which case you will be notified in writing of the extension before the end of the initial 45-day period, of the reasons for the extension and the date their reconsideration is expected to conclude. The Committee will provide you with notification of its review of your request for reconsideration of the denied claim and such notification will include the information described in Q/A-30, "If my appeal is denied, What information will I receive?" 26 APPENDIX 000083 Case 4:11-cv-00410-Y Document 17 Filed 11/04/11 Page 84 of 103 PageID 217 Death or Dismemberment Claim The Committee will notify you of the Plan's response to your appeal within a reasonable period of time, but not later than 60 days after receipt of your request for reconsideration of the denied claim. This period may be extended for up to 60 days if the Committee determines that special circumstances require an extension of time, in which case you will be notified in writing of the extension before the end of the initial 45-day period, of the reasons for the extension and the date their reconsideration is expected to conclude. The Committee will provide you with notification of its review of your request for reconsideration of the denied claim and such notification will include the information described in Q/A-30, "If my appeal is denied, what information will I receive?" 30. If my appeal is denied, what information will I receive? If your appeal seeking reconsideration of the denied claim under the Plan is again denied in whole or in part, you will receive written or electronic notification from the Committee that will include: the specific 'reasons for the decision, again with reference to the specific Plan provisions on which that decision is based; • that you are entitled to receive, upon request and free of charge, reasonable access to and copies of pertinent documents, records, and other information relevant to your claim for Benefits; and • your right to bring a civil action under ERISA Section 502(a) following an adverse benefit determination on review. If an internal rule, guideline, protocol, or other similar criterion was relied upon in making the denial for health or disability benefits, either the specific rule, guideline, protocol, or other similar criterion or a statement that such a rule, guideline, protocol, or other similar criterion was relied upon in making the determination and that a copy of such information will be provided to you free of charge upon request. If the denial is based on a medical necessity or experimental treatment or similar exclusion or limit, an explanation of the scientific or clinical judgment for the denial, applying the terms of the Plan to your medical circumstances, or a statement that such an explanation will be provided to you free of charge upon request. The Plan's claims review procedures do not generally include any voluntary levels of appeal (such as voluntary arbitration). 27 APPENDIX 000084 Case 4:11-cv-00410-Y Document 17 Filed 11/04/11 Page 85 of 103 PageID 218 Finally, you will be provided a statement that you and the Plan may have other voluntary alternative dispute resolution options, such as mediation. One way to find out what may be available is to contact your local U.S. Department of Labor Office and your State insurance regulatory agency. To be eligible for benefits you must be covered under the Plan, properly submit a claim and follow the Plan's claims and appeals procedures. If a claim is denied initially, you must exhaust the Plan's appeals procedures before filing a suit. Suits may be brought no later than one year following the date on which the appeals process under the Plan is exhausted. MISCELLANEOUS 31. What are the subrogation and reimbursement provisions of the Plan? If you incur a Bodily Injury or Disease because of a third party, the Plan is not obligated to pay any benefits relating to the injury or illness. However, the Plan may advance payment of benefits relating to the injury or illness and may require you to sign a subrogation and assignment agreement. As a condition of payment of benefits, however, the Plan assumes all rights of recovery against the responsible third party, or against any liability or other insurance covering such third party, or your auto insurance carrier in the event a claim is made under the uninsured or under-insured coverage provision of your auto insurance policy. This means the Plan may proceed directly against the responsible third party to recover benefit payment. To aid the Plan in enforcement of its right of recovery and subrogation, you must take any action, give information, and/or execute documents required by the Plan, at its discretion. If you fail to comply with these requests, the Plan may withhold benefits, services, payments, or credits due. The Plan's right of recovery is not subject to reduction for attorney's fees or other expenses, and it applies to the proceeds of any recovery regardless of whether the recovery is attributable to medical expenses and without regard to whether you have been 'made whole. You must notify the Plan Administrator within five (5) business days of any proceeding relating to a third party claim and within two (2) business days of any recovery or settlement_ 32. Does this Plan alter my status as an at-will employee? No. Nothing contained in the Plan will be construed as a contract of employment between an Employer and any Employee or a limitation of the right of an 28 APPENDIX 000085 Case 4:11-cv-00410-Y Document 17 Filed 11/04/11 Page 86 of 103 PageID 219 Employer to discharge any Employee, with or without cause, at any time. All Employees will be subject to discharge to the same extent as if the Plan had never been adopted. 33. Can the Plan be amended or terminated? The Plan Sponsor may amend or terminate the Plan at any time, in its discretion, without prior notice. 34. What are my rights under ERISA? As a participant in the Home Depot Texas Employee Accident Plan, you are entitled to certain rights and protections under the Employee Retirement Income Security Act of 1974, as amended (ERISA).. ERISA provides that all plan participants shall be entitled to: Receive Information About Your Plan and Benefits Examine, without charge, at the plan administrator's office and at other specified locations, such as worksites and union halls, all documents governing the plan, including insurance contracts and collective bargaining agreements, and a copy of the latest annual report (Form 5500 Series) filed by the _plan with the U.S. Department of Labor and available at the Public Disclosure Room of the Employee Benefits Security Administration. Obtain, upon written request to the plan administrator, copies of documents governing the operation of the plan, including insurance contracts and collective bargaining agreements, and copies of the latest annual report (Form 5500 Series) and updated summary plan description. The administrator may make a reasonable charge for the copies. Receive a summary of the plan's annual financial report. The plan administrator is required by law to furnish each participant with a copy of this summary annual report. Prudent Actions by Plan Fiduciaries In addition to creating rights for plan participants ERISA imposes duties upon the people who are responsible for the operation of the employee benefit plan. The people who operate your plan, called "fiduciaries" of the plan, have a duty to do so prudently and in the interest of you and other plan participants and beneficiaries. No one, including your employer, your union, or any other person, may fire you or otherwise discriminate against you in any way to prevent you from obtaining a (pension, welfare) benefit or exercising your rights under ERISA. 29 APPENDIX 000086 Case 4:11-cv-00410-Y Document 17 Filed 11/04/11 Page 87 of 103 PageID 220 Enforce Your Rights If your claim for a welfare benefit is denied or ignored, in whole or in part, you have a right to know why this was done, to obtain copies of documents relating to the decision without charge, and to appeal any denial, all within certain time schedules. Under ERISA, there are steps you can take to enforce the above rights. For instance, if you request a copy of plan documents or the latest annual report from the plan and do not receive them within 30 days, you may file suit in a Federal court. In such a case, the court may require the plan administrator to provide the materials and pay you up to $110 a day until you receive the materials, unless the materials were not sent because of reasons beyond the control of the administrator. If you have a claim for benefits which is denied or ignored, in whole or in part, you may file suit in a state or Federal court. In addition, if you disagee with the plan's decision or lack thereof concerning the qualified status of a domestic relations order or a medical child support order, you may file suit in Federal court. If it should happen that plan fiduciaries misuse the plan's money, or if you are discriminated against for asserting your rights, you may seek assistance from the U.S. Department of Labor, or you may file suit in a Federal court. The court will decide who should pay court costs and legal fees. If you are successful the court may order the person you have sued to pay these costs and fees. If you lose, the court may order you to pay these costs and fees, for example, if it finds your claim is frivolous. Assistance with Your Questions If you have any questions about your plan, you should contact the•plan administrator. If you have any questions about this statement or about your rights under ERISA, or if you need assistance in obtaining documents from the plan administrator, you should contact the nearest office of the Employee Benefits Security Administration, U.S. Department of Labor, listed in your telephone _directory or the Division of Technical Assistance and Inquiries, Employee Benefits Security Administration, U.S. Department of Labor, 200 Constitution Avenue N.W., Washington, D.C. 20210. You may also obtain certain publications about your rights and responsibilities under ERISA by calling the publications hotline of the Employee Benefits Security Administration. 30 APPENDIX 000087 Case 4:11-cv-00410-Y Document 17 Filed 11/04/11 Page 88 of 103 PageID 221 CONCLUSION Home Depot is pleased to sponsor the Plan for your benefit. We value your efforts on behalf of our organization. We sincerely hope that your participation in the Plan will enable you to look with continued confidence to your future with us. Home Depot intends to continue the Plan indefinitely, but necessarily reserves the right to amend or teuninate the Plan, for any reason, in whole or in part, at any time without notice. In the case of any conflict between the terms and provisions of the Plan and the terms and provisions of this SPD, the Plan will control and govern. Home Depot USA, Inc. 31 APPENDIX 000088 Case 4:11-cv-00410-Y Document 17 Filed 11/04/11 Page 89 of 103 PageID 222 APPENDIX A SCHEDULE OF BENEFITS FOR ACCIDENTAL DEATH OR DISMEMBERMENT OF PARTICIPANTS When the Committee has made a Determination to approve Compensation for an accidental death or dismemberment resulting from a Bodily Injury (and not a Disease), the Committee is authorized to pay an amount not to exceed the amount set forth in the schedule below. All decisions concerning (a) the actual amount of Compensation payable for a given accidental death or dismemberment, (b) the Average Weekly Earnings and Average Annual Earnings for a particular Participant, and (c) the schedule of Compensation payments attributable to an accidental death or dismemberment, will be made by the Committee in the exercise of its discretion. Unless otherwise determined by the Committee, Compensation payments awarded for an accidental death or dismemberment will be paid either in a lump sum within one (1) year from the date of the Accident,or in installment payments, without interest, over the number of years deemed appropriate by the Committee, in its discretion, not to exceed ten (10) years. Accidental death or dismemberment Benefits and all other Benefits awarded with respect to a Bodily Injury will be subject to all applicable terms and provisions of the Plan, and will not exceed the limits of the Plan including, without limitation, those described in Q/A-21 of this SPD. ' --- i--DENIM LIp to 30 times Average Annual Earnings, not to exceed $2,000,000. PERMANENT PARALYSIS: Paraplegia from spinal cord Injury Quadriplegia finm spinal cord Injury DISMEMBERMENT: Loss of both hands or both feet Loss of entire sight of both Eyes Loss of the entire sight of one Eye, one hand, or one foot (loss of a thumb and its opposing forefinger will be considered loss of the hand) Loss of one finger Up to 20 times Average Annual Earnings not to exceed $2,000,000. Up to 30 times Average Annual Earnings not to exceed $2,000,000. Up to 30 times Average Annual Earnings, not to exceed $2,000,000. Up to 30 times Average Annual Earnings, not to exceed $2,000,000. Up to 15 times Average Annual Earnings, not to exceed $1,000,000. Up to one times Average Annual Earnings, not to exceed $25,000. A-1 APPENDIX 000089 Case 4:11-cv-00410-Y Document 17 Filed 11/04/11 Page 90 of 103 PageID 223 The Plan does not provide accidental death or dismemberment Benefits for more than one loss from a single Accident (if such occurs, the Plan will pay only the larger Benefit). The Benefits payable under V-- accidental death and dismemberment schedule set out in this Appendix A include, an_, are not in addition to, any Benefits that were paid or accrued on behalf of the Participant for Medical Expenses, Wage Continuance and other Benefits prior to the date that he receives payment, or commences installment payments, of an accidental death or dismemberment award under the Plan; moreover, the Committee (or its delegate) will offset any such prior Benefits payments from any accidental death or dismemberment award. After an accidental death or dismemberment award has been paid, or commenced to be paid, to or on behalf of a Participant, the Participant or his beneficiary Will not be entitled to any further Medical Expenses, Wage Continuance or other Benefits under the Plan for the same or a related Bodily Injury that caused the Participant's accidental death or dismemberment. APPENDIX 000090