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Moats v. United Mine Workers of America Health and Retirement Funds

submitted: August 7, 1992.

ARTHUR J. MOATS
v.
THE UNITED MINE WORKERS OF AMERICA HEALTH AND RETIREMENT FUNDS, APPELLANT



ON APPEAL FROM THE UNITED STATES DISTRICT COURT FOR THE WESTERN DISTRICT OF PENNSYLVANIA. (D.C. Civil No. 91-00659).

Before: Greenberg, Alito, and Aldisert, Circuit Judges.

Author: Alito

Opinion OF THE COURT

ALITO, Circuit Judge :

This is an appeal by the Trustees of the United Mine Workers Health and Retirement Funds (the "Trustees") from a district court order granting summary judgment to Arthur J. Moats, a beneficiary who claimed that he was entitled to a disability pension because he was injured in a "mine accident." In granting summary judgment for Moats, the district court held that the Trustees' decision denying Moats's claim was arbitrary and capricious. We hold that the Trustees' decision was not arbitrary or capricious, and we therefore reverse and remand for entry of an order granting summary judgment to the Trustees.

I.

Moats was employed as a roof bolter for Emerald Mine Corporation in Waynesburg, Pennsylvania. One day in May 1985, Moats completed his shift of work and walked to his automobile, which was parked in a lot owned by his employer. While driving through the lot toward the exit, his vehicle collided with a coal truck owned by a coal hauling company working for his employer. Moats was injured and eventually collected worker's compensation and Social Security disability insurance benefits.

Moats applied for a disability pension from the United Mine Workers 1974 Pension Plan (the "UMW Plan"), which provides disability benefits for beneficiaries disabled in a "mine accident." Moats's application was denied on the ground that his automobile accident was not a "mine accident" within the meaning of the Plan. Moats filed a request for review, and a hearing was held before a hearing officer, but the hearing officer also concluded that Moats had not been injured in a "mine accident." The hearing officer cited two questions and answers (Q & As 252 and 288) contained in the Funds' policy interpretation guidelines.

Moats then began this action in the United States District Court for the Western District of Pennsylvania, pursuant to ERISA, 29 U.S.C. § 1132, seeking benefits due under the Plan. On cross-motions for summary judgment, the district court entered summary judgment for Moats, holding that the Trustees' denial of benefits was arbitrary and capricious. Noting that Moats "collided on coal company property with a truck that was engaged in hauling coal for [his] employer," the district court reasoned that there was "a significant connection between the accident in which [Moats] was injured and his employment . . ., and that it would be unreasonable not to consider this accident as an accident in the course of [Moats's] employment." App. at 331.

The district court also relied on its own prior decision in Thomas v. United Mine Workers 1974 Benefit Plan and Trust, Civ. Action No. 89-02371 (Oct. 31, 1990), which we affirmed by judgment order, No. 90-3803 (3d Cir. May 21, 1991). In that case a miner was injured when he slipped on the ice and fell as he walked to his car in his employer's parking lot. The Trustees concluded that Thomas had not been injured in a "mine accident," but the district court held that this decision was arbitrary and capricious. The court relied heavily on a letter from the Funds' general and associate counsel to its director regarding still another disability claim.

This third claim involved a miner, Donald Harless, who was injured when he slipped on the ice and fell while walking from the bathhouse, where he had changed into his work clothes, to the lamphouse, where he was required to pick up his lamp before beginning his shift. This memorandum concluded that Harless had been injured in a "mine accident" because his accident occurred after his arrival at work and while he was preparing for the start of his work day at the mine. The memorandum added that this construction of the term "mine accident" was consistent with a rule applied in worker's compensation cases under which injuries suffered while going to and from work are compensable if they occur close to the job site, on company property, and within a reasonable time of the beginning or end of the work day. The court concluded that Thomas's case fell within this rule. Moreover, because the court could find "no basis for distinguishing between Mr. Thomas and Mr. Harless," the court held that the denial of benefits to Thomas was arbitrary and capricious. App. at 330. Similarly, in the present case, because the court could not distinguish Harless's and Thomas's accidents from Moats's, the court granted summary judgment for Moats. The Trustees then took this appeal.

II.

A. When a benefits plan gives an administrator discretion in determining eligibility, a district court may overturn a decision of the administrator only if it is arbitrary or capricious. Firestone Tire and Rubber Co. v. Bruch, 489 U.S. 101, 111, 115, 103 L. Ed. 2d 80, 109 S. Ct. 948 (1989); Stoetzner v. United States Steel Corp., 897 F.2d 115, 119 (3d Cir. 1990). Here, the district court held -- and both parties agree -- that the plan gives the Trustees such discretion and that their decision denying Moats's claim was thus subject to review in the district court under the arbitrary and capricious standard. The Fourth Circuit has reached the same Conclusion regarding the UMW Plan (Boyd v. Trustees of the United Mine Workers Health and Retirement Funds, 873 F.2d 57, 59 (4th Cir. 1989)), and we also agree. Consequently, the question before us is whether the district court was right in holding that the Trustees' decision was arbitrary and capricious.*fn1

The Supreme Court stated, albeit in another context, that a decision is arbitrary and capricious if it is "not rational and based on consideration of the relevant factors." FCC v. National Citizens Comm. for Broadcasting, 436 U.S. 775, 803, 56 L. Ed. 2d 697, 98 S. Ct. 2096 (1978). The Court added that judicial review under this standard must be " searching and careful'" but that the court may not "substitute its judgment for that of the [decisionmaker]." Id., quoting Citizens to Preserve Overton Park v. Volpe, 401 U.S. 402, 416, 28 L. Ed. 2d 136, 91 S. Ct. 814 (1971). See also Motor Vehicle Mfrs. Ass'n v. State Farm Mutual Automobile Ins. Co., 463 U.S. 29, 43, 77 L. Ed. 2d 443, 103 S. Ct. 2856 (1983). In a case involving the interpretation of a provision of a pension plan, we wrote that under the arbitrary and capricious standard, the trustees' interpretation "should be upheld even if the court disagrees with it, so long as the interpretation is rationally related to a valid plan ...


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