Opinion
CIVIL ACTION NO. 3:03CV-289-S
April 26, 2004
MEMORANDUM OPINION
This matter is before the court for consideration of various motions in this action brought pursuant to the Employee Retirement Income Security Act of 1974, 29 U.S.C. § 1001, et seq. ("ERISA").
The plaintiff, David Clark, a carpenter, was a participant in the Kentucky State District Council of Carpenters AFL-CIO Pension Trust Fund ("the Plan") since October 1, 1979. Clark applied for permanent total disability benefits from the Plan by filing a form titled Medical Examiner's Report for Pension Disability. The form was signed by Clark's physicians, Dr. Pat Jarius and Dr. C. Mitchell, on July 9, 2000. It described Clark's disability as "autonomic dysfunction" and indicated that it began in 1998. Dr. Jarius filled out a medical assessment form on Clark's behalf, signing it on March 11, 2000. Five questions on the second page of the assessment were not answered by the physician. The plan requested in these questions "medical findings to support" the particular restrictions indicated and descriptive information concerning the effects of restricted physical functions and environmental restrictions. No reports, medical records, other supporting documentation, or narrative explanation of medical findings as requested on the form were provided with the application.
The appearance of a duplicate of the form with an alteration of the date to July 9, 2001 remains unexplained. The form dated July 9, 2000 is attached as an exhibit to the amended complaint.
On September 24, 2002, the Plan informed Clark that his claim for benefits was denied on the ground that he had suffered a two year break in service during the ten year period immediately prior to sustaining the disability, purportedly a disqualification for benefits under the plan. On March 13, 2003, the Plan informed Clark that it had reconsidered his application for benefits and had determined that the break in service provision, which had apparently been revised, did not bar his claim for benefits. It then said that it would pend final action on Clark's application until medical findings supporting the doctors' diagnosis could be obtained and reviewed. As stated earlier, the initial forms requesting specific medical findings to support the doctor's assessment were incomplete. Clark never responded to the request for authorization to obtain the necessary information. At present, the claim remains pending with the Plan.
Clark filed suit on May 13, 2003 against the union, the Kentucky State District Council of Carpenters AFL-CIO, alleging wrongful denial of benefits under ERISA. On August 27, 2003, he was permitted to amend his complaint to add the Kentucky State District Council of Carpenters AFL-CIO Pension Trust Fund. He alleges that "the Council of Carpenters and/or the Pension Trust Fund owes Clark disability benefits under the Plan." Amended Complaint, ¶ 25.
Clark has moved for default judgment against the union. However, the union has not been properly served pursuant Fed.R.Civ.P. 4(h)(1). The motion for default must therefore be denied.
The union has moved to dismiss for failure to state a claim against it. As established by affidavit, the union is a labor organization which is a plan sponsor of the Kentucky State District Council of Carpenters Pension Trust Fund. It is not the Plan, nor does it administer the plan. It is not a proper party to a suit for wrongful denial of benefits under 29 U.S.C. § 1132(a)(1)(B), and must therefore be dismissed.
The Plan has moved to dismiss the amended complaint, as it states that Clark's claim for benefits remains pending and therefore he has not yet exhausted his administrative remedies. While the Plan seeks dismissal under Fed.R.Civ.P. 12(b), both Clark and the Plan have submitted matters outside the pleadings for the court's consideration. The Plan has submitted a number of letters and a copy of the summary plan description. Clark submitted a portion of the plan description, additional letters, the Medical Assessment form and a Member "Salting" Agreement, none of which were made exhibits to the complaint. The motion will be treated as one for summary judgment in light of the submission of these materials.
A party moving for summary judgment has the burden of showing that there are no genuine issues of fact and that the movant is entitled to summary judgment as a matter of law. Adickes v. S.H. Kress Co., 398 U.S. 144, 151-60, 90 S.Ct. 1598, 16 L.Ed.2d 142 (1970); Felix v. Young, 536 F.2d 1126, 1134 (6th Cir. 1976). Not every factual dispute between the parties will prevent summary judgment. The disputed facts must be material. They must be facts which, under the substantive law governing the issue, might affect the outcome of the suit. Anderson v. Liberty Lobby, Inc., 106 S.Ct. 2505, 2510 (1986). The dispute must also be genuine. The facts must be such that if they were proven at trial, a reasonable jury could return a verdict for the non-moving party. Id. at 2510. The disputed issue does not have to be resolved conclusively in favor of the non-moving party, but that party is required to present some significant probative evidence which makes it necessary to resolve the parties' differing versions of the dispute at trial. First National Bank of Arizona v. Cities Service Co., 391 U.S. 253, 288-89 (1968). The evidence must be construed in a light most favorable to the party opposing the motion. Bohn Aluminum Brass Corp. v. Storm King Corp., 303 F.2d 425 (6th Cir. 1962).
Clark's single argument in opposition to the Plan's motion is that the Plan determined that he was totally and permanently disabled, as evidenced by its letter of January 29, 2003. The letter responded to a request from counsel for additional information concerning the denial of benefits. The September 24, 2002 letter was the denial of benefits that the January letter attempted to explain. The September letter said that Clark did not qualify for benefits because he had suffered a two-year break in service preceding his disability. The letter did not address any of the other requirements for qualification for benefits. The letter of January 29, 2003 states that "with regard to the calculation of the two-year break in service, the Trustees determined that, based on the medical evidence available to them, Mr. Clark's date of disability was 1998 . . ." Clark contends that this statement contains a finding of disability. It says nothing of the sort. First, it is couched in the context of "regard to the calculation of the two-year break in service . . ." which clearly indicates that they are looking at the claim of onset of disability as a point of reference for determining whether a disqualifying break in service had occurred. Second, it is not a finding of "disability" that is required for entitlement to benefits under the Plan. Rather, it is a finding of "permanent total disability" which must be attested to and supported by medical finding. There has been no such determination with respect to Clark's claim to date. Indeed, such a determination would be unnecessary in an instance in which a claimant was found to have an employment or contribution-related disqualification such as a two-year break or less than ten years active service.
The court concludes that no genuine issue of material fact exists and that the Plan is entitled to judgment as a matter of law. Clark has failed to exhaust his administrative remedies inasmuch as his claim for disability benefits remains pending. The claim for wrongful denial of benefits as against the Plan will be dismissed.
A separate order will be entered this date in accordance with this opinion.