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Reinwand v. National Electrical Benefit Fund

United States District Court, W.D. Wisconsin

June 24, 2016

JOSEPH REINWAND, Plaintiff,
v.
NATIONAL ELECTRICAL BENEFIT FUND and LAWRENCE J. BRADLEY, Defendants.

          OPINION AND ORDER

          BARBARA B. CRABB District Judge.

         In this lawsuit against defendants National Electrical Benefit Fund and Lawrence J. Bradley, pro se plaintiff Joseph Reinwand contends that defendants violated his rights under the Employee Retirement Income Security Act by denying him disability benefits and failing to give his claim for benefits a full and fair review. Plaintiff also contends that defendants violated 29 U.S.C. § 1132(c)(1) by failing to send him certain documents related to the denial of his claim. Both plaintiff and defendants have filed motions for summary judgment on plaintiff’s claims.

         I am granting plaintiff’s motion for summary judgment with respect to his claim that defendants violated 29 U.S.C. § 1132(a)(1)(B). As defendants concede, their failure to provide him an explanation for their denial of his claim for reinstatement rendered their decision arbitrary and capricious. However, defendants’ failure in this regard does not entitle plaintiff to reinstatement of his benefits; instead, plaintiff’s claim must be remanded to the plan administrator for further proceedings.

         I am granting defendants’ motion for summary judgment with respect to plaintiff’s claim under 29 U.S.C. § 1132(c)(1). First, the undisputed facts establish that defendants complied with plaintiff’s document request and sent him the one and only document their reviewing physician considered in denying his claim. Additionally, even if defendants had failed to provide plaintiff the specific documents he requested, the Court of Appeals for the Seventh Circuit has held that their failure in this regard does not give rise to civil penalties under 29 U.S.C. § 1132(c)(1).

         From the parties’ summary judgment materials and the record, I find that the following facts are not subject to genuine dispute.

         UNDISPUTED FACTS

         Plaintiff is a participant in the National Electrical Benefit Fund employee benefit plan, which is a multi-employer employee benefit plan governed by the Employee Retirement Income Security Act of 1974. The plan offers participants various benefits, including a “Normal Retirement Pension Benefit, ” an “Early Retirement Pension Benefit” and a “Disability Pension Benefit.” The plan is sponsored by the National Electrical Contractors Association and International Brotherhood of Electrical Workers; the plan administrator is defendant Lawrence J. Bradley.

         In January 1996, plaintiff applied for and began receiving social security disability benefits. Under the defendant plan, if a participant qualifies for social security disability benefits, he automatically qualifies for a disability pension benefit. Plaintiff submitted a disability pension application to the plan in July 1998 stating that he was disabled because he had “post-traumatic stress disorder.” Plaintiff’s application for a disability pension was approved based solely on the fact that he had been approved for social security disability benefits; plaintiff was not required to submit any medical records or other evidence related to his alleged disability. Plaintiff began receiving monthly benefit checks in the amount of $460, beginning in April 1999.

         In early 2012, plaintiff’s monthly benefit check was returned to defendants as undeliverable. Defendants sent letters to the forwarding address on file with the post office, asking plaintiff to provide an updated mailing address and confirm that he was still receiving social security disability benefits. Plaintiff’s daughter, Jolynn Reinwand, received and responded to defendants’ letters in her capacity as plaintiff’s agent and attorney-in-fact. In responding to defendants’ letters, Jolynn informed defendants that plaintiff no longer qualified for or received social security disability benefits.

         Because plaintiff was no longer receiving social security disability benefits, defendants terminated his disability benefits under the plan. In a letter dated May 9, 2012 defendants explained that plaintiff’s disability benefit was based on his entitlement to social security disability benefits and that his ineligibility for social security disability benefits rendered him ineligible for a disability pension benefit under the plan. Defendants’ letter assumed that plaintiff’s social security disability benefits had been discontinued because he had returned to work. However, Jolynn Reinwand responded to defendants’ letter, explaining that plaintiff’s social security disability benefits were not discontinued because he had gone back to work, but because he was incarcerated in February 2011 and was not eligible to receive social security disability benefits while in prison.

         Defendants construed the letter submitted by Jolynn as a new application for a disability pension. Under the plan a participant can receive a disability pension benefit despite being ineligible for social security disability benefits if the participant can present sufficient evidence to enable the plan administrator to determine independently that the participant is disabled and unable to work. Defendants sent plaintiff a “Medical Report” form, which is designed to elicit information about a participant’s medical history so that the plan administrator can make an independent determination of the plaintiff’s disability. Plaintiff’s former physician completed the medical report form and stated that two years earlier, in September 2010, she had treated plaintiff for insomnia and post-traumatic stress disorder. The form did not include any information related to the severity of plaintiff’s condition or whether it rendered him unable to work. Additionally, the medical report form was not accompanied by any medical records documenting plaintiff’s condition or treatment.

         Defendants forwarded the medical report to the plan’s reviewing physician, Dr. Frank Blackburn for his opinion. The letter accompanying the medical report asked Dr. Blackburn to determine whether plaintiff suffered from a “total disability” as defined by the plan. Defendants explained that under the plan, a “total disability” is “the inability to engage in substantial gainful activity by reason of any medically determinable physical or mental impairment, which can be expected to . . . last for a continuous period of not less than twelve months.” Blackburn responded to defendant’s letter by stating that the information in the medical report submitted by plaintiff was insufficient to permit him to make a determination as to plaintiff’s disability.

         Defendants wrote to plaintiff’s attorney-in-fact on April 16, 2014 and again on May 22, 2013 requesting any additional documents that could be reviewed to determine whether plaintiff met the plan’s definition of disabled. Defendants did not receive a response to either of these requests. Eventually, on November 21, 2013, plaintiff wrote defendants and asked why his disability benefits were suspended. Defendants responded by explaining that his benefits were terminated because he no longer qualified for social security disability benefits and the medical report form submitted on his behalf did not contain enough information to enable the plan administrator to render an independent decision with respect to his disability. Defendants sent plaintiff another medical report form and instructed him to submit more information documenting his disability, his treatment and how it affected his ability to work.

         Another physician that treated plaintiff completed the blank medical report form defendants sent. This physician explained that plaintiff had been given a diagnosis of post-traumatic stress disorder in 1993 and that his post-traumatic stress symptoms recurred every year on the anniversaries of the deaths of his best friend and his wife. Plaintiff’s best friend had been electrocuted to death and his wife had died from “a self-inflicted gunshot wound.” (As it turns out, although plaintiff’s wife’s death had been ruled a suicide at the time, in the course of the investigation of plaintiff’s 2008 murder of his daughter’s ex- boyfriend, facts came to light suggesting that plaintiff had been responsible for her death. Plaintiff was tried and convicted of murdering ...


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