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Reinwand v. National Electrical Benefit Fund

United States District Court, W.D. Wisconsin

July 5, 2018




         In this 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 judgment.

         From the defendant's proposed findings of fact, plaintiff's responses and the administrative record, I find the following facts to be undisputed.


         A. Background and Procedural History

         Plaintiff 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 explanation.

         In 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's administrator.

         B. Defendant Denies Plaintiff's Claim after Remand

         On June 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.

         On or 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.

         Defendant 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 ...

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