Brogan v. Holland

• Decision Date: 24 January 1997
• Docket Number: No. 96-1022,96-1022
• Citation: 105 F.3d 158
• Parties: Zeffie R. BROGAN, Plaintiff-Appellant, v. Michael H. HOLLAND; Paul R. Dean; Marty D. Hudson; Elliot A. Segal, as Trustees of the United Mine Workers of America Pension Plan and Trust, Defendants-Appellees.
• Court: U.S. Court of Appeals — Fourth Circuit

Page 158

105 F.3d 158

Zeffie R. BROGAN, Plaintiff-Appellant, v. Michael H. HOLLAND; Paul R. Dean; Marty D. Hudson; Elliot A. Segal, as Trustees of the United Mine Workers of America Pension Plan and Trust Defendants-Appellees.

No. 96-1022.

United States Court of Appeals Fourth Circuit.

Argued Oct. 28, 1996.

Decided Jan. 24, 1997.

ARGUED: Robert B. Wilson, Charleston, West Virginia, for Appellant. Matilda Ann Brodnax, Senior Associate Counsel, Office of the General Counsel, UMWA Health and Retirement Funds, Washington, D.C., for Appellees. ON BRIEF: Roger D. Forman, Forman & Crane, L.C., Charleston, West Virginia, for Appellant. Glenda S. Finch, Associate General Counsel, Office of the General Counsel, UMWA Health And Retirement Funds, Washington, D.C., for Appellees.

Before MURNAGHAN, WILLIAMS, and MICHAEL, Circuit Judges.

Affirmed by published opinion. Judge WILLIAMS wrote the opinion, in which Judge MURNAGHAN and Judge MICHAEL joined.

OPINION

WILLIAMS, Circuit Judge:

In early 1988, Zeffie Brogan applied to the United Mine Workers of America 1974 Pension Plan (the Plan) for a disability pension, claiming that he was "totally disabled as a result of a mine accident." The Trustees of the Plan denied Brogan's application. Pursuant to § 502(a)(1)(B) of the Employee Retirement Income Security Act (ERISA), 29 U.S.C. § 1132(a)(1)(B) (1988), Brogan sought relief in federal district court. He contended he suffered a disabling stroke while lifting heavy oxygen tanks in the mine during the early morning hours of December 18, 1986. The district court granted the Trustees' motion for summary judgment, finding that the Trustees did not abuse their discretion in denying Brogan's application for benefits.

On appeal, Brogan claims the Trustees abused their discretion by denying him benefits. He also claims that the Trustees violated the ERISA notice requirements of 29 C.F.R. § 2560.503.1(f) (1996) by denying him the opportunity for a full and fair review of his claims on appeal. We hold that the decision of the Trustees to deny benefits to Brogan under the Plan was not an abuse of discretion considering, among other things, the conflicting medical reports presented. We also hold that the Trustees substantially complied with the applicable notice requirements. Accordingly, we affirm.

I.

Brogan, who last worked on the nightshift of December 17-18, 1986, was employed by Westmoreland Coal Company primarily as a beltman, although he sometimes performed the duties of an electrician and welder. His duties often involved strenuous physical labor, including shoveling coal and lifting and carrying heavy objects. During the three weeks preceding December 18, 1986, Brogan worked extensive overtime. On Friday, December 12, 1986, Brogan began experiencing dizziness and had difficulty maintaining his balance. His condition worsened the following week. On the night of December 17-18, 1986, Brogan was asked to work overtime on a welding job. As part of that task he was required to carry heavy oxygen tanks, lift cables, and "jack up" the scoops he was repairing. Regarding the night of December 17, Brogan later said, "I knew something was wrong with me but I thought that I was just tired." (J.A. at 552.) Not until December 18, however, did Brogan "actually start falling down." (J.A. at 543-44.)

On December 18, 1986, Brogan completed the welding job at 3:30 a.m., drove 4-5 miles home, and went to bed around 5:00 a.m. He awoke at 10:00 a.m., ate, took his insulin, ¹ and slept until noon. When he awoke, Brogan discovered his left side was partially paralyzed. He called in sick for work and stayed in bed the remainder of the day and night. The following morning, December 19, 1986, Brogan was admitted to the hospital where he was diagnosed as having suffered a stroke.

On October 26, 1987, an Administrative Law Judge awarded Brogan Social Security disability insurance benefits commencing December 17, 1986. ² Brogan then applied for disability pension benefits under the Plan on February 17, 1988. The Trustees denied his application on March 7, 1988, finding that he did not establish that he had been "involved in a mine accident." (J.A. at 366.) In July of 1988, Brogan attended a prehearing conference in which a counselor explained why his application had been denied. Brogan subsequently withdrew his request for a hearing to appeal the Trustees' denial of benefits. In December of 1988, Brogan sought state workers' compensation benefits for his injury. His claim was denied because the ALJ found Brogan failed to establish that his stroke "occurred in the course of his employment." (J.A. at 873.) Six years later, in June of 1994, Brogan requested reconsideration of his application for disability benefits under the Plan and submitted additional medical documentation in support of his claim. The Trustees reviewed the additional evidence, including Brogan's entire state workers' compensation file which they obtained with his consent, and again denied his request for benefits. Brogan then appealed to the district court. The district court granted the Trustees' motion for summary judgment, holding the Trustees did not abuse their discretion in denying Brogan benefits. This appeal followed.

II.

In reviewing a grant of summary judgment, we examine the district court's decision de novo, employing the same standards applied by the district court. See Sheppard & Enoch Pratt Hosp., Inc. v. Travelers Ins. Co., 32 F.3d 120, 123 (4th Cir.1994). In Firestone Tire & Rubber Co. v. Bruch, 489 U.S. 101, 109 S.Ct. 948, 103 L.Ed.2d 80 (1989), the Supreme Court significantly curtailed a court's ability to review a discretionary decision of the administrators of an employee benefits plan. The Court held that if "the benefit plan gives the administrator or fiduciary discretionary authority to determine eligibility for benefits or to construe the terms of the plan," id. at 115, 109 S.Ct. at 956, a reviewing court may reverse the denial of benefits only upon a finding of abuse of discretion by the trustees, see id. at 111, 109 S.Ct. at 954; see also Lockhart v. United Mine Workers of America 1974 Pension Trust, 5 F.3d 74, 77 (4th Cir.1993). ³ Because the Trustees of the Plan exercise such discretion, Lockhart, 5 F.3d at 77, their "decisions are reviewed for abuse of discretion and will not be disturbed if they are reasonable." Bernstein v. CapitalCare, Inc., 70 F.3d 783, 787 (4th Cir.1995). Under this standard, the Trustees have not abused their discretion if their decision "is the result of a deliberate, principled reasoning process and if it is supported by substantial evidence." Id. at 788 (internal quotations omitted).

In Lockhart, we discussed the criteria for determining whether the trustees of an employee benefit plan abused their discretion in denying benefits:

"[W]e must give due consideration, for example to whether administrators' interpretation is consistent with the goals of the plan; whether it might render some language in the plan meaningless or internally inconsistent; whether the challenged interpretation is at odds with the procedural and substantive requirements of ERISA itself; whether the provisions at issue have been applied consistently; and of course whether the fiduciaries' interpretation is contrary to the clear language of the plan."

5 F.3d at 77 (quoting de Nobel v. Vitro Corp., 885 F.2d 1180, 1188 (4th Cir.1989)). Brogan's challenge to the Trustees' decision focuses exclusively on the fifth factor, i.e., whether the decision was contrary to the clear language of the Plan. Therefore, we will confine our review to determining whether the Trustees' denial of Brogan's benefits was contrary to the clear language of the Plan and its accompanying rules and regulations.

A.

Article II.C of the Plan provides for disability pension benefits to those persons who become "totally disabled as a result of a mine accident." (J.A. at 1612.) Article VIII.B(1) of the Plan grants the Trustees the authority to promulgate rules and regulations to implement the Plan. (J.A. at 1627.) The Plan also binds all persons claiming benefits under the Plan to these interpretive guidelines, known as "Q & As." We afford the Trustees' interpretation of these rules the same deference that we give the Trustees' interpretation of the language of the Plan itself. See Lockhart, 5 F.3d at 78 n. 6. Because there is no dispute that Brogan is totally disabled, we focus only on whether his disability was causally related to a mine accident.

Q & A 252 provides that a miner is totally disabled as a result of a mine accident if the following conditions are met:

(1) Unexpectedness: The disability must have been unlooked for and unforeseen; (2) Definiteness: The disability must be traceable to a definite time, place, and occasion which occurred within the course of the mine worker's employment. A progressive disease does not meet this test and therefore cannot be a disability that resulted from a mine accident; (3) Force or Impact: The disability must have been caused by the exertion or impact of some external physical force or object against the body or by the exertion or impact of the body against some external physical object; i.e., not simply as the result of the mine worker's own physical condition.

The Trustees found Brogan's disability lacked both "definiteness" and "force or impact" as required under Q & A 252 and therefore, did not occur "as a result of a mine accident."

There is substantial evidence to support the Trustees' conclusion that Brogan failed to demonstrate that his stroke ⁴ was "traceable to a definite time, place, and occasion which occurred within the course of [his] employment." Q & A 252(2). Most compelling are the various medical reports submitted and obtained through Brogan's state workers' compensation file, which present widely conflicting views as to when Brogan's stroke most likely occurred. In Brogan's final hospital discharge summary...