Radtke v. Miscellaneous Drivers & Helpers Union Local # 638 Health, Welfare, Eye & Dental Fund, Civil File No. 10–4175 (MJD/JJG).

• Decision Date: 02 April 2012
• Docket Number: Civil File No. 10–4175 (MJD/JJG).
• Parties: Christine Alisen RADTKE, Plaintiff, v. MISCELLANEOUS DRIVERS & HELPERS UNION LOCAL # 638 HEALTH, WELFARE, EYE & DENTAL FUND, Defendant.
• Court: U.S. District Court — District of Minnesota

867 F.Supp.2d 1023

53 Employee Benefits Cas. 1155

Christine Alisen RADTKE, Plaintiff,

v.MISCELLANEOUS DRIVERS & HELPERS UNION LOCAL # 638 HEALTH, WELFARE, EYE & DENTAL FUND, Defendant.

Civil File No. 10–4175 (MJD/JJG).

United States District Court,

D. Minnesota.

April 2, 2012.

Richard D. Snyder, Christopher A. Stafford, and Thomas S. Fraser, Fredrikson & Byron, PA, for Plaintiff.

David L. Hashmall, Peter M. Rosene, Andrew E. Staab, and Alyssa M. Toft, Felhaber Larson Fenlon & Vogt, PA, for Defendant.

MEMORANDUM OF LAW & ORDER

MICHAEL J. DAVIS, Chief Judge.

I. INTRODUCTION

This matter is before the Court on cross motions for summary judgment: Defendant's Motion for Summary Judgment [Docket No. 68] and Plaintiff's Motion for Entry of Judgment [Docket No. 74]. The Court heard oral argument on December 2, 2011.

II. SUMMARY OF THE COURT'S OPINION

The Court enters judgment for Plaintiff Christine Alisen Radtke. The Fund breached the terms of the Plan when it terminated Plaintiff's enrollment based on its erroneous and unreasonable interpretation of Minnesota law. The State of Minnesota law recognizes the Radtkes' marriage as a marriage between a man and a woman because Minnesota law recognizes Plaintiff's sex as female. Ms. Radtke is Mr. Radtke's legal spouse under Minnesota law and an eligible dependent under the Plan.

The Plan was unambiguously written to allow all persons who are legal spouses under Minnesota law to be eligible family dependents. The Fund's role was to ascertain Minnesota law. It was not the Fund's role to impose its own definitions of gender and marriage upon its participants. In this case, the Fund ignored all evidence of the State of Minnesota's view of Plaintiff's sex and marital status. The Fund's decision was not only wrong, under a de novo review, it was a flagrant violation of its duty under any standard of review. In sum, the Fund erred when it terminated Plaintiff's participation as an eligible family dependent. The Fund's termination of Ms. Radtke is reversed and she is reinstated as a participant as of April 19, 2010.

III. BACKGROUNDA. Factual Background

1. The Plan Documents

Defendant Miscellaneous Drivers and Helpers Union Local # 638 Health, Welfare, Eye and Dental Fund (“the Fund”) is a welfare trust fund that provides health care benefits for eligible members and their dependents. The operation of the Fund is governed by the Restated Agreement and Declaration of Trust (“Trust Agreement”). (Snyder Decl., Ex. 1.)

The Plan Document is the Summary Plan Description, Class 12, Amended and Restated Effective May 1, 2005 (the “Plan”). (Snyder Decl., Ex. 2.) Although the document states that it is a summary plan description, it provides that it is the only document governing eligibility and benefits for medical coverage. ( Id., “Important Notice” section.)

Wilson–McShane Corporation is the claims administrator for the Fund. (Snyder Decl., Ex. 5, Winkel Dep. 14.) It adjudicates claims, meaning that it decides whether a claim for medical services is covered and what amount is reimbursable. ( Id. 14–15.) The claims administrator does not make eligibility determinations. ( Id. 19.)

The Fund Office consists of four paid administrative employees of the Fund. (Winkel Dep. 19–20.) The Fund Office handles all eligibility determinations. ( Id. 19; Snyder Decl., Ex. 6, Coleman Dep. 6.) The Plan provides that, “[i]n carrying out its plan responsibilities, the Fund Office shall have discretionary authority to construe the terms of the Plan.” (Plan, Introduction Section ¶ 3.)

2. Plaintiff's Background

a) Plaintiff's Transition

Plaintiff Christine Alisen Radtke was born in Prairie du Chien, Wisconsin, in 1965. At birth, upon inspection of her anatomy, she was declared to be male and was named Richard William Barker. (Snyder Decl., Ex. 9.) While in her early twenties, she was diagnosed with gender dysphoria, in which a patient's psychological identification of her gender does not match the anatomical identification. (Snyder Decl., Ex. 15, Appeal Letter at 1.)

In 1986, the Hennepin County District Court granted Richard Barker's request to change names to Christine Alisen Jensen. (Snyder Decl., Ex. 11.) In the mid–1980s, Plaintiff participated in the Transgender Program at the Program in Human Sexuality through the Department of Family Practice and Community Health at the University of Minnesota Medical School. (Snyder Decl., Ex. 12.) In 1988, Plaintiff received gel breast implants. (Snyder Decl., Ex. 13.)

In 2003, Plaintiff underwent sex-reassignment surgery in Colorado. (Snyder Decl., Ex. 15, Appeal Letter at 12.)

In 2005, Plaintiff filed a “Petition for Modification of Birth Record and Issuance of Replacement Birth Certificate” with the Goodhue County, Minnesota, District Court. (Snyder Aff., Ex. 16.) The verified Petition identified Plaintiff's legal name change and her male-to-female sex-reassignment surgery as the basis for the requested modification and reissuance of her birth certificate. The Petition requested that the court direct the Wisconsin State Registrar to register a replacement birth record changing the name on the birth certificate and designating her sex as female.

Wisconsin Law provides:

The state registrar may change information on a birth certificate registered in this state which was correct at the time the birth certificate was filed under a court or administrative order issued ... in another state ... if: (a) The order provides for a[ ] ... name change with sex change ...

Wis. Stat. § 69.15(1).

The Goodhue County Court heard Plaintiff's Petition on July 1, 2005. (Snyder Decl., Ex. 17, Order Granting Modification of Birth Certificate.) On that date, the court issued an order directing the Wisconsin State Registrar to register a replacement birth certificate for Plaintiff designating her name as Christine Alisen Jensen and designating her sex as female. ( Id.) On July 14, 2005, the Wisconsin State Registrar issued a birth certificate to Plaintiff stating her name as Christine Alisen Jensen and identifying her sex as female. (Snyder Decl., Ex. 18.)

b) Plaintiff's Marriage

On July 12, 2005, Calvin Radtke and Plaintiff applied for a marriage license. A marriage license was granted by Goodhue County, Minnesota, that same day. (Snyder Decl., Ex 19.) On August 10, 2005, Calvin Radtke and Plaintiff were married in a civil ceremony by an authorized official and before two witnesses at the Goodhue County Courthouse in Red Wing, Minnesota. Goodhue County recorded the marriage and issued a marriage certificate on August 10, 2005, marked as a “COMPLETE AND CORRECT COPY OF THE LEGAL MARRIAGE RECORD ON FILE AND OF RECORD.” (Snyder Decl., Ex. 20.) As a result of the marriage, Plaintiff's legal name was changed from Christine Alisen Jensen to Christine Alisen Radtke.

3. Enrollment in the Plan

Calvin Radtke is an employee of United Parcel Service and a participant in the Plan. (Lehnen Aff. ¶ 2.) Mr. Radtke informed the Fund Office that he was planning to marry. On June 22, 2005, the Fund Office sent a letter to Mr. Radtke regarding the process to enroll a spouse in the Plan. (Snyder Decl., Ex. 7.) The letter told him to fill out an enrollment card and to provide a copy of a certified marriage certificate. ( Id.)

On August 11, 2005, after the Radtke's marriage ceremony, Mr. Radtke completed an enrollment card for Ms. Radtke and provided the marriage certificate to the Fund Office. (Snyder Decl., Ex. 22.) The Fund Office accepted the marriage certificate as evidence that Ms. Radtke was Mr. Radtke's legal spouse and enrolled her in the Plan as an eligible family dependent, effective August, 10, 2005. (Lehnen Aff. ¶ 3.)

a) The Plan's Definition of “Spouse”

The Plan defines “Eligible Family Dependents.” (Plan at 6.) The May 2005 version of the Plan states that an eligible spouse is a “[l]egal spouse pursuant to Minnesota Statute 517.” ( Id. at 6.) Effective January 1, 2006, the Trustees amended the definition of eligible spouse to state: “Your legal spouse. The Plan may require that you provide a copy of your marriage certificate before any benefits are paid for a spouse.” (Snyder Decl., Ex. 3 at 1.)

The Fund Office has always interpreted the eligibility language for spouses to mean only that an individual must possess a government-issued marriage certificate verifying that he or she is married. (Snyder Decl., Ex. 6, Coleman Dep. 8–9.) When an employee seeks to enroll a spouse as a participant in the Plan, the Fund Office only requires that the employee fill out an enrollment card and provide a copy of the marriage certificate. (Snyder Decl., Ex. 7; Snyder Decl., Ex. 25, Interrogatories 2–3.) The Fund Office has never based a determination of a person's eligibility to enroll as a “legal spouse” on anything other than the existence of a marriage certificate. (Snyder Decl., Ex. 8, Admission No. 1.)

b) The Fund's Knowledge of Plaintiff's Transgender Status

In 2008, one of Ms. Radtke's gel breast implants ruptured and needed to be replaced. (Snyder Decl., Ex. 13.) On the “pre-authorization” request, Ms. Radtke's physician identified her as a transgender individual. ( Id.) The gel implant replacement request was denied under a Plan exclusion for “charges for sex transformation surgery ... and any related expenses.” ( Id.)

All correspondence relating to the pre-authorization request was sent to the claims administrator, Wilson–McShane. ( Id. at 1.) At that time, an individual in the Fund Office who handles eligibility issues heard a comment about Ms. Radtke's “transgendered status.” (Snyder Decl., Ex. 6, Coleman Dep. 15.) Neither the claims administrator nor the Fund Office took steps to question Ms. Radtke's eligibility to participate in the Fund as a “legal spouse.” ( Id. 17–18.) The Fund continued to pay Ms. Radtke's other medical claims. ( Id.)

In March or April 2010, a nurse spoke to Toni Coleman, a benefits assistant for the Fund. (Coleman Dep. 5, 12–13.) During their conversation, the nurse...