Richards v. United Mine Workers of America Health and Retirement Fund

• Decision Date: 30 January 1990
• Docket Number: No. 87-2154,87-2154
• Citation: 895 F.2d 133
• Parties: Homer RICHARDS; Anna Mae Richards, Plaintiffs-Appellees, v. UNITED MINE WORKERS OF AMERICA HEALTH AND RETIREMENT FUND; Joseph P. Connors, Sr.; Donald E. Pierce, Jr.; William Miller; William B. Jordan; Paul R. Dean, Trustees of the United Mine Workers of America 1974 Pension Trust, Defendants-Appellants.
• Court: U.S. Court of Appeals — Fourth Circuit

Page 133

895 F.2d 133

Homer RICHARDS; Anna Mae Richards, Plaintiffs-Appellees, v. UNITED MINE WORKERS OF AMERICA HEALTH AND RETIREMENT FUND Joseph P. Connors, Sr.; Donald E. Pierce, Jr.; William Miller; William B. Jordan; Paul R. Dean, Trustees of the United Mine Workers of America 1974 Pension Trust Defendants-Appellants.

No. 87-2154.

United States Court of Appeals Fourth Circuit.

Argued Sept. 11, 1989.

Decided Jan. 30, 1990.

Rehearing and Rehearing In Banc Denied Feb, 27, 1990.

Andree M. St. Martin, Associate Gen. Counsel (David W. Allen, Gen. Counsel, Charles G. Starrs, Sr. Associate Counsel, Margaret M. Topps, Associate Gen. Counsel, Edward J. Gilmartin, Associate Counsel, Washington, D.C., UMWA Health & Retirement Funds, Office of Gen. Counsel, on brief), for defendants-appellants.

Edmund A. Sargus, Jr. (Burech & Sargus, St. Clairsville, W.Va., Chris Riley, Riley & Kidner, Wheeling, W.Va., on brief), for plaintiffs-appellees.

Before MURNAGHAN, SPROUSE and CHAPMAN, Circuit Judges.

MURNAGHAN, Circuit Judge:

Here the Fourth Circuit tries for a third time to decide an appeal which has twice split the same panel (Judges Hall, Wilkinson and Merhige, sitting by designation). The panel of the Fourth Circuit that first heard the case initially reversed the district

                court, finding substantial evidence to support the Trustees' decision denying benefits to a miner claiming disability.  Richards v. United Mine Workers Health & Retirement Funds, 851 F.2d 122 (4th Cir.1988) ("Richards I" ).    On rehearing, however, the panel split three ways
                

FACTS

Homer Richards suffered chest pains while lifting 100-pound timbers at a mine site on January 30, 1981. He remained on the job, but did no heavy lifting the rest of the day. The mine operator made no accident report, and there was no independent verification of Richards' injury from eyewitnesses who were with him at the mine that day. The chest pains apparently subsided that evening, and the next day Richards attended a wrestling match. There he again suffered severe chest pains. He was taken to a hospital, where Dr. C.V. Katsaros diagnosed "acute myocardial infarction"--a heart attack. Richards remained hospitalized for about two weeks. A few months later, he was diagnosed as suffering from a progressive heart disease--"severe coronary artery stenoses"--and was urged to undergo bypass surgery.

Disagreement centers on the date when Richards actually suffered the heart attack. The Trustees of the United Mine Workers of America Health and Retirement Funds appeal the district court order granting summary judgment in favor of Homer and Anna Mae Richards and awarding them disability pension benefits. The Trustees had denied the Richardses' claim for benefits, finding that Homer Richards' disability did not result from a "mine accident." The Trustees claim that the attack occurred on January 31, 1981, while Richards was at the wrestling match. Richards contends that he suffered the heart attack on January 30, while lifting the heavy timbers at work.

The following evidence supports Richards' version of the timing:

Richards' own testimony.

A February 17, 1984, letter from Dr. Katsaros, Richards' treating physician, stating that:

[T]his gentlemen [sic] was enjoying good health until January 30, 1981, at which time he sustained an Acute Myocardial Infraction [sic] while lifting railroad ties in excess of hundred pounds.

It does not appear that Katsaros based the date of the heart attack on any evidence other than Richards' own version of the incident.

An administrative law judge's award of social security disability benefits to Richards. The ALJ set the date of disability at January 30, 1981.

A state workers compensation award that also set the date of disability at January 30, 1981.

A report from a Dr. Shaver, who examined Richards in June of 1981, stating that "[t]his patient sustained a myocardial infarction in January of 1981 which began with localized left precordial pain while in the mine and subsided that evening." As with Dr. Katsaros' report, it is unclear whether Dr. Shaver relied solely on Richards' own version of the timing of the attack or had independent verification.

On the other hand, the record also contains evidence that the heart attack occurred on January 31, 1981, while Richards was away from the workplace:

The lack of any accident report from the mine operator noting Richards' attack or his complaints of chest pains on January 30, 1981.

A February 9, 1981, claim for accident benefits that Richards filed with his employer. On that form Richards listed "1-31-81" as the beginning date of his sickness. The statement also included an "Attending Physician's Statement," presumably completed by Dr. Katsaros, which responded "No" when asked "Is condition due to sickness or accident arising out of patient's occupation?" Also, the person completing the form apparently listed "1-31-81" as the "Date symptoms first appeared or accident happened," but later changed it to "1-30-81." Of course, potential for error was not insubstantial, given the natural tendency to concentrate on hospitalization In addition to questions about the date of the heart attack, there are disputes about causation, both of the heart attack and of Richards' disability. The dispute primarily focuses on the conflicting opinions of Dr. Katsaros and Dr. Charles White. Dr. Katsaros opined that while Richards' strenuous work did not cause his progressive heart disease, it "indeed was the precipitating factor in the Acute Myocardial Infraction [sic] [the heart attack]. It is quite possible that the Acute Myocardial Infraction [sic] would not [have] occurred in the absence of such strenuous work."

as the date of onset rather than initial symptoms.

Dr. White, who, in contrast to the treating physician, Dr. Katsaros, did not examine Richards but merely reviewed his medical records, focused on whether Richards' work activities on January 30, 1981, aggravated his preexisting arteriosclerosis to produce a heart attack. He observed that to induce a heart attack, the "physical exertion must be of a highly unusual character or of unusual severity and more intense or involving greater effort than that regularly performed by the affected person." After examining the records, White concluded:

The problem is, of course, due to his severe arteriosclerotic coronary artery disease, which can in no way be attributed to his occupation. Mr. Richards was performing his ordinary duties at the time he first suffered chest pain. There is nothing to indicate unusual strain or work effort at the time. In my opinion, the infarction would have occurred whether he had been working or sitting at home. There is thus no relationship between his work and the coronary occlusion, the underlying coronary artery disease, or his heart condition subsequent to the myocardial infarction.

(Emphasis added.)

DISCUSSION

A. Standard of Review

Since the appeal was last heard, the Supreme Court has decided Firestone Tire & Rubber Co. v. Bruch, --- U.S. ----, 109 S.Ct. 948, 103 L.Ed.2d 80 (1989), which altered the standard for reviewing Trustees' disability decisions. Prior to Bruch, we reviewed such decisions under the "arbitrary and capricious" standard. After Bruch, a denial of pension benefits should be "reviewed under a de novo standard unless the benefit plan gives the administrator or fiduciary discretionary authority to determine eligibility for benefits or to construe the terms of the plan." Bruch, 109 S.Ct. at 956. However, "[w]here the administrator or fiduciary has discretionary authority, an abuse of discretion standard should apply." Boyd v. Trustees of United Mine Workers Health & Retirement Funds, 873 F.2d 57, 59 (4th Cir.1989) (emphasis added) (citing Bruch, 109 S.Ct. at 955).

Here, "abuse of discretion" is patently the proper standard of review. The UMW Pension Plan explicitly grants the Trustees broad discretionary authority. Boyd, 873 F.2d at 59 (interpreting UMW Pension Plan). Article VIII of the Plan provides that the Trustees "shall have full and final determination as to all issues concerning eligibility for benefits." Article VIII also authorizes the Trustees "to promulgate rules and regulations to implement [the] Plan," and emphasizes that "those rules and regulations shall be binding upon all persons dealing with and Participants claiming benefits under [the] Plan."

It is unclear whether the "abuse of discretion" standard adopted in Bruch is synonymous with the "arbitrary and capricious" standard previously used by the Fourth Circuit and most other courts to review denials of disability benefits under pension plans. Some post-Bruch cases suggest that the two standards are synonymous. See, e.g., Guy v. Southeastern Iron Workers' Welfare Fund, 877 F.2d 37, 39 (11th Cir.1989). No Fourth Circuit case directly addresses the point, although the Court has emphasized that if a decision would be "arbitrary and capricious" under pre-Bruch standards, it would be an "abuse of discretion" under Bruch. Boyd, 873 F.2d at 60.

Although the "abuse of discretion" standard is perhaps broader and less deferential

                than the "arbitrary and capricious" standard, "arbitrary and capricious" definitely is encompassed by "abuse of discretion."    Since we conclude that the Trustees acted in an arbitrary and capricious manner in denying benefits to the Richardses, it follows that they also abused their discretion under the Pension Plan
                

B. Merits

Richards qualifies for disability pension benefits if he has been "totally disabled as a result of a mine accident...." Pension Plan Art. II.C. Richards unquestionably is "disabled." Richards receives social security disability insurance benefits, and as this Court has emphasized, "a Social Security disability award conclusively establishes the medical disability of the pension applicant." Boyd, 873 F.2d at 59 (quoting Robertson v. Connors, 848 F.2d 472, 475 (4th Cir.1988)). We...