Dawson v. Pension Plan for the Office Emps. of the Int'l Bhd. of Elec. Workers

107 F.Supp.3d 15

Vickie L. Dawson, Plaintiff,

v.Pension Plan for the Office Employees of the International Brotherhood of Electrical Workers and International Brotherhood of Electrical Workers, Defendants.

Civil Action No. 14–1765 (RCL)

United States District Court, District of Columbia.

Signed May 26, 2015

Filed May 27, 2015

Juliet C. Purll, Arlington, VA, Elliott Denbo Andalman, Silver Spring, MD, for Plaintiff

Jennifer Bush Hawkins, Washington, DC, for Defendants

MEMORANDUM OPINION

Royce C. Lamberth, United States District Judge.

The instant lawsuit arises from a dispute over disability benefits. Plaintiff Vickie Dawson commenced this action to recover disability benefits from defendants Pension Plan for the Office Employees of the International Brotherhood of Electrical Workers (the Plan) and International Brotherhood of Electrical Workers (IBEW), pursuant to the Employee Retirement Income Security Act, 29 U.S.C. § 1132, and 28 U.S.C. § 1331.

Pending before the Court are cross-motions for summary judgment.

I. FACTUAL AND PROCEDURAL BACKGROUND

IBEW sponsored "the Plan," an employee pension benefit plan governed by its written Rules and Regulations. In order to be entitled to a disability benefit under the Plan, the Rules and Regulations require that a participant be totally disabled, which is defined as "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 (12) months." Ex. 5 of the Administrative R.: Rules and Regulations (R & R) at 9. The Plan also explains how claims are administered:

8.1 AdministrationThe Plan will be administered by the IST [International Secretary–Treasurer of the IBEW]. The IEC [International Executive Council of the IBEW] will pass upon all disputed questions concerning the applications or interpretation of the provisions of the Plan. The IEC will decide all such questions in accordance with the terms of the Plan, and all such decisions of the IEC will be final and binding upon the IBEW and the Participating Employer and upon the Employees. Benefits under this Plan will be paid only if the IEC decides in its discretion that the applicant is entitled to them.

Id. at 23. The International Secretary–Treasurer of the IBEW is Salvatore J. Chilia. Aff. of Salvatore Chilia, Defs.' Mot. S.J. Ex. 1 ¶ 3. The Plan further explains the benefit procedure:

8.3 Benefit Procedure

All claims for benefits under the Plan will be directed to the attention of the IST for determination. All appeals of adverse benefit determinations made by the IST will be directed to the IEC for determination. Benefits under this Plan will be paid only if the IST or IEC decides in his or its discretion in accordance with the claims procedures that the applicant is entitled to them.

R & R 23.

Ms. Dawson submitted her claim for benefits on or around April 23, 2012. Administrative Record (AR), ECF 14–1, at 5. Ms. Dawson included in her application records of her medical history over the last several years. Id. at 7–217. In order to determine whether Ms. Dawson was totally disabled as defined by the Plan, Mr. Chilia directed that her application and medical records be forwarded to IMED, Inc., an organization that provides independent medical reviews. Ms. Dawson's records were reviewed by Dr. Dhruv Pateder, a physician who specializes in orthopedic and neurological spine surgery. Dr. Pateder stated with a reasonable degree of medical certainty that Ms. Dawson was not totally disabled. AR 218–23.

In a letter dated June 12, 2012, Mr. Chilia denied Ms. Dawson's application for retirement disability benefits based on Dr. Pateder's medical opinion. AR 224–25. On June 27, 2012 Ms. Dawson appealed the Plan's denial and asked that the Plan "[p]lease advise of any specific information you require to perfect Ms. Dawson's claim, also as set out in the summary plan description, and of any procedural or scheduling issue of which we should be aware." AR 226.

The Plan then requested IMED, Inc. provide a second independent medical review of Ms. Dawson's medical records as well as a physical exam. Dr. Robert Gordon, an orthopedic surgeon, performed an independent medical review of Ms. Dawson's records, examined Ms. Dawson, and issued his medical opinion on August 30, 2012. AR 230–32. He concluded that Ms. Dawson had the physical capacity to perform sedentary-type work, but recommended that her mental capacity be reviewed by someone in the mental health field or someone who specializes in addiction medicine. AR 232. Given this recommendation, the Plan scheduled an examination for Ms. Dawson with Dr. Bruce Smoller, a physician who specializes in neuropsychiatric medical and occupational psychiatry for October 18, 2012.

By letter dated October 12, 2012, Ms. Dawson submitted to the Plan evidence that she had been approved for disability benefits by the Railroad Retirement Board (RRB) and the National Electrical Benefit Fund (NEBF), along with other medical evidence. AR 240–66.

Ms. Dawson was examined by Dr. Smoller on October 18, 2014, as scheduled. AR 233–39. Dr. Smoller determined that Ms. Dawson did not meet the criteria for total disability as defined by the Plan. Id.

By letter dated November 7, 2012, Ms. Dawson submitted further medical evidence in support of her claim. Id. AR 268–80.

The IEC, in a letter dated December 14, 2012, informed Ms. Dawson of its determination that she was not eligible for disability retirement benefits. AR 1. The letter notified Ms. Dawson of her right to appeal. Id.

Ms. Dawson timely filed suit in this Court.

II. LEGAL STANDARDS

A. Summary Judgment

Summary judgment is appropriate when "the movant shows that there is no genuine dispute as to any material fact and the movant is entitled to judgment as a matter of law." Fed.R.Civ.P. 56(a) ; see also Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 247, 106 S.Ct. 2505, 91 L.Ed.2d 202 (1986). The movant may successfully support its motion by "informing the district court of the basis for its motion, and identifying the portions of ‘the pleadings, depositions, answers to interrogatories, and admissions on file, together with the affidavits, if any,’ which it believes demonstrate the absence of a genuine issue of material fact." Celotex Corp. v. Catrett, 477 U.S. 317, 323, 106 S.Ct. 2548, 91 L.Ed.2d 265 (1986) (quoting Fed.R.Civ.P. 56(c) ).

A dispute is genuine "if the evidence is such that a reasonable jury could return a verdict for the nonmoving party." Anderson, 477 U.S. at 248, 106 S.Ct. 2505. The "evidence of the non-movant is to be believed, and all justifiable inferences are to be drawn in his favor." Id. at 255, 106 S.Ct. 2505. "Credibility determinations, the weighing of the evidence, and the drawing of legitimate inferences from the facts are jury functions, not those of a judge," on a motion for summary judgment. Id. However, if the non-movant's "evidence is merely colorable, or is not significantly probative, summary judgment may be granted." Id. at 249–50, 106 S.Ct. 2505. The non-movant must present more than a "mere ... scintilla of evidence" to avoid summary judgment. Id. at 252, 106 S.Ct. 2505. Indeed, "[c]onclusory allegations unsupported by factual data will not create a triable issue of fact." Pub. Health Research Grp. v. FDA, 185 F.3d 898, 908 (D.C.Cir.1999).

B. Standard of Review

A denial of benefits is subject to de novo review unless the benefit plan gives its fiduciaries discretionary authority to determine eligibility for benefits or to construe the terms of the plan. Firestone Tire & Rubber Co. v. Bruch, 489 U.S. 101, 109, 109 S.Ct. 948, 103 L.Ed.2d 80 (1989). Where the plan grants discretion to the fiduciaries, any fiduciary determination must be upheld unless it was arbitrary and capricious. Id.

III. ANALYSIS

A. Standard of Review

As a preliminary matter, it is clear that the Court's review here is for abuse of discretion because the Plan gives the IEC discretionary authority to interpret the Plan's provisions and to review claims. Ms. Dawson insists that the Plan fails to expressly grant the IST or IEC discretion in its claims decisions because "[t]he actors are mixed in their use of terminology, it is difficult to imagine that the participants of the Plan would be clear." Pl.'s Mem. in Support of Mot. S.J. ("Pl.'s Mot. S.J.") at 8. However, the Court disagrees: The language is clear. The Rules and Regulations plainly state that "[b]enefits under this Plan will be paid only if the IEC decides in its discretion that the applicant is entitled to them." R & R 23, and reiterates that "[b]enefits under this Plan will be paid only if the IST or IEC decides in his or its discretion in accordance with the claims procedures that the applicant is entitled to them." Id. at 24.

B. Reasonableness of Decision

The Plan's decision that Ms. Dawson was not eligible for a disability benefit was not arbitrary and capricious. In order to receive a benefit, Ms. Dawson must be "disabled" under the Plan's definition of the word, or "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 (12) months." R & R 9.

Upon receipt of Ms. Dawson's medical evidence, Mr. Chilia appropriately sought the advice of independent healthcare professional Dr. Pateder. Upon review of Ms. Dawson's records, Dr. Pateder found that she was not totally disabled. AR 218–23. Based upon Dr. Pateder's medical opinion, Mr. Chilia denied Ms. Dawson's application for a disability benefit. AR 224.

Following Ms. Dawson's appeal, the Plan permitted her to submit additional medical evidence to the IEC in consideration of her appeal. AR 240–80. The Plan also arranged for two additional independent medical reviews of her medical records and a...