966 F.2d 190 (6th Cir. 1992), 91-3415, Meade v. Pension Appeals and Review Committee

Docket Nº:91-3415
Citation:966 F.2d 190
Party Name:Danny MEADE, Plaintiff-Appellant, v. PENSION APPEALS AND REVIEW COMMITTEE; Ohio Laborers' Fringe Benefit Programs; Laborer's District Council and Contractors Pension Fund of Ohio, Defendants-Appellees.
Case Date:June 04, 1992
Court:United States Courts of Appeals, Court of Appeals for the Sixth Circuit
 
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Page 190

966 F.2d 190 (6th Cir. 1992)

Danny MEADE, Plaintiff-Appellant,

v.

PENSION APPEALS AND REVIEW COMMITTEE; Ohio Laborers' Fringe

Benefit Programs; Laborer's District Council and

Contractors Pension Fund of Ohio,

Defendants-Appellees.

No. 91-3415

United States Court of Appeals, Sixth Circuit

June 4, 1992

Argued April 6, 1992.

Page 191

William H. Baughman, Jr. (argued and briefed), Weston, Hurd, Fallon, Paisley & Howley, Cleveland, Ohio, John K. Everett Columbus, Ohio, for plaintiff-appellant.

Randall S. Rabe, Baker & Hostetler, Columbus, Ohio, Richard H. Bamberger, John J. McGowan, Jr. (argued and briefed), Baker & Hostetler, Cleveland, Ohio, for defendants-appellees.

Before: KEITH and MILBURN, Circuit Judges; and ENSLEN, District Judge. [*]

ENSLEN, District Judge.

This is an action for denial of disability benefits under an employee benefit plan regulated by the Employment Retirement Income Security Act (ERISA), 29 U.S.C. § 1001, et seq. The district court granted summary judgment in favor of defendants 760 F.Supp. 671 and plaintiff appeals. For the reasons which follow, we reverse the decision of the district court and remand for proceedings consistent with this Opinion.

I.

Plaintiff-appellant, Danny Meade (Meade), filed the complaint in the Franklin County, Ohio Court of Common Pleas on January 14, 1988. Named as defendants are the Laborers' District Council and Contractors Pension Fund of Ohio (Fund) and the Pension Appeals and Review Committee (Committee), which is a subcommittee of the Board of Trustees (Trustees) of the Fund. Meade was employed as a general laborer through August 1979, at which time he sustained a back injury for which he claims to be entitled to the "total and permanent" disability benefits provided under the terms of the Fund.

On January 16, 1988, defendants-appellees filed a notice of removal pursuant to 28 U.S.C. § 1441(a) and 28 U.S.C. § 1445, seeking to remove the case to the United States District Court for the Southern District of Ohio. On cross-motions for summary judgment, the district court granted summary judgment in favor of defendants and plaintiff appeals.

There are no material disputes of fact in this case. During the course of Meade's employment as a general laborer, contributions on his behalf were made to the Fund by his employers. Meade has not worked since suffering the back injury in August 1979. In May 1981, Meade applied for total and permanent disability benefits under the terms of the pension plan. The Fund, by its terms, provides participating members and their eligible dependents with pension and other benefits. One of the benefits available under the Fund is a disability benefit. However, the Fund's plan document specifically provides that to be eligible for a disability benefit, a participant must satisfy four separate conditions. The four conditions, as set forth in the Fund's Plan document, are as follows:

(a) The beneficiary meets the Pension Fund's general definition of "Permanent and Total Disability;" and

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(b) the beneficiary has accumulated at least ten (10) years of Pension credit; and

(c) he or she has earned at least 250 hours of service in the calendar year in which the disability occurred or in the calendar year immediately preceding the year in which the disability occurred; and

(d) the disability shall have occurred prior to age 62.

Plan, Article VII § 1. In support of his application for total and permanent disability benefits, Meade submitted a notice from the Social Security Administration, indicating that he had been declared a qualifying recipient for Social Security Benefits. Upon request, Meade submitted an additional medical report of his then attending physician, Dr. F.W. Elder.

Contrary to Meade's assertion that he was "permanently" disabled, Dr. Elder's examination report indicated that Meade was only "temporarily" totally disabled. The report also indicated that the disability did not commence until approximately July 10, 1981--two years after Meade was deemed to have left the trade. 1 Upon receipt of Dr. Elder's report, the administrator of the Fund decided to obtain a second medical opinion. Meade agreed to submit to another examination by a different physician, Dr. Wolfe. Dr. Wolfe concluded that Meade in fact had very little disability and that he could return to work without any restriction.

On the basis of the reports of Dr. Elder and Dr. Wolfe, Meade's application for total and permanent disability benefits was denied. Meade appealed the decision to the Committee, and the decision to deny benefits was upheld. Meade was notified of the denial in January 1982.

Almost three years after Meade's 1981 application for benefits was denied on appeal, Meade filed a second application for the same disability benefits in December 1985. In support of this second application, Meade submitted a medical report of Dr. Paul J. Matkra, his then attending physician. Dr. Matkra's initial report stated that Meade had not become totally and permanently disabled until 1984. However, in subsequent submissions, Dr. Matkra stated that Meade was disabled in 1979 rather than in 1984. Because of unreliability, the additional evidence was considered inconclusive and Meade's second application was also denied. Meade again appealed the second denial to the Committee. Upon request by the Committee, Meade submitted to yet another physical examination by Dr. Kackley, a physician selected by the Committee. Based upon his personal examination of Meade, review of Meade's medical records, and consideration of Meade's narrative description of his medical history, Dr. Kackley concluded that Meade was totally and permanently disabled in 1979. Despite Dr. Kackley's...

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