United States District Court, W.D. Wisconsin
OPINION AND ORDER
BARBARA B. CRABB DISTRICT JUDGE
civil action, pro se plaintiff Joseph Reinwand, a prisoner at
the Columbia Correctional Institution in Portage, Wisconsin,
is bringing claims under the Employee Retirement Income
Security Act, 29 U.S.C. § 1132, against the pension plan
of his previous employer. Now before the court is
defendant's motion for summary judgment. Dkt. #30. For
the reasons below, I conclude that defendant did not act
arbitrarily and capriciously in denying plaintiff benefits.
Accordingly, I am granting defendant's motion for summary
the defendant's proposed findings of fact,
plaintiff's responses and the administrative record, I
find the following facts to be undisputed.
Background and Procedural History
Joseph Reinwand was formerly employed as an electrical
worker. For more than a decade, he received monthly
disability benefits from defendant National Electrical
Benefit Fund defendant, a multi-employer pension plan, using
employer contributions to provide benefits for workers in the
electrical industry. Plaintiff qualified for and received a
pension because he was entitled to federal disability
benefits from the Social Security Administration, and a
Social Security award was satisfactory proof of total
disability under defendant's plan. In 2012, defendant
terminated plaintiff's pension benefits after learning
that plaintiff's Social Security benefits had been
terminated when he was incarcerated. Plaintiff later applied
to have defendant reinstate his pension benefits, but
defendant's administrator denied his claim without an
December 2014, plaintiff sued defendant for reinstatement of
his benefits. Reinwand v. National Electrical Benefit
Fund, 14-cv-845-bbc (W.D. Wis.). On June 24, 2016, I
denied plaintiff's request for reinstatement of benefits,
but found that because defendant had denied plaintiff's
claim without explanation, his claim had not received a
“full and fair review” as required by 29 U.S.C.
§ 1133. I remanded plaintiff's claim to
Defendant Denies Plaintiff's Claim after Remand
30, 2016, defendant notified plaintiff that it intended to
review and consider his request for reinstatement of benefits
in accordance with the court's order. Dkt. #32-5 at 2.
Defendant provided plaintiff a blank medical report form to
be completed by a treating physician and directed plaintiff
to submit evidence of a Social Security Administration award
or sufficient medical records to demonstrate that he was
totally disabled. Defendant re-sent the June 30, 2016 letter
to plaintiff on August 16, 2016. Id. at 3.
In a letter to plaintiff dated October 6, 2016, defendant
stated that it had not yet received a response to its
previous letters. Defendant explained that under the terms of
the plan, defendant would pay disability benefits only if
plaintiff was “unable to engage in any substantial
gainful activity by reason of any medically determinable
physical or mental impairment which can be expected to result
in death or has lasted or can be expected to last for a
continuous period of not less than twelve months (12)
months.” Id. at 6. Defendant noted that it had
two medical reports that plaintiff had submitted with his
previous application for benefits, but that neither report
was sufficient to show that plaintiff was totally disabled.
Id. Defendant again requested that plaintiff submit
a Social Security Administration award or “medical
records addressing the nature of your physical or mental
impairment since April 2012 and showing such things as how or
whether your impairment prevents you from engaging in
substantial gainful activity, the date on which you were
first examined by that physician, frequency of visits, and
the date of your last examination.” Id. at 7.
around October 6, 2016, defendant received from plaintiff a
single page medical report dated September 29, 2016 that had
been completed by Dr. David Grodsky at the Columbia
Correctional Institution. Id. at 8. Under
“diagnoses, ” the report lists “(1) PTSD;
(2) Adjustment disorder and mood features; (3) Alcohol use
disorder.” The report states also states:
PTSD diagnosed 1993. Poor sleep, nightmares, depression.
Adult trauma seen monthly. Remains unable to work.
Id. Plaintiff did not submit any medical records
with the report.
forwarded the report, as well as plaintiff's previous two
medical reports, to Dr. Shawn Clausen for her opinion of
about the extent of plaintiff's disability since 2012.
Id. at 9. Dr. Clausen responded to this request on a
form provided by defendant, concluding that plaintiff was
“able to work at the electrical trade.”
Id. at 12. On November 8, 2016, the plan
administrator Lawrence Bradley sent a letter to plaintiff
explaining that his claim was being denied ...