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Richard Wright v. Carpenters Pension and Annuity Fund of Philadelphia & Vicinity

March 4, 2013

RICHARD WRIGHT
v.
CARPENTERS PENSION AND ANNUITY FUND OF PHILADELPHIA & VICINITY



The opinion of the court was delivered by: Norma L. Shapiro, J.

MEMORANDUM

Before the court are cross-motions for summary judgment arising out of Richard Wright's ("Wright") participation in the Carpenters Pension and Annuity Fund of Philadelphia and Vicinity ("Pension Fund" or "Fund"), a trust fund established under 29 U.S.C. §186(c)(5) and a "multiemployer plan" and "employee benefit plan" within the meaning of 29 U.S.C. §1002(37). There is jurisdiction under 29 U.S.C. § 1132(e) and 28 U.S.C. § 1331.

Wright seeks benefits amounting to approximately $9,909.54 dating back to April 1, 2010, the first day of the month next following the date on which he made his first written application for benefits.*fn1 In determining the validity of Wright's argument, the court decides three issues: (1) what version of the Plan was in effect at the time of Wright's applications for benefits; (2) whether Wright was improperly denied benefits in his initial and/or second application; and (2) whether the Fund's failure to grant Wright retroactive benefits was an abuse of discretion. Wright filed his complaint on April 18, 2011. Defendant timely answered. Both parties agree the matter is to be decided on cross-motions for summary judgment. The court will deny the plaintiff's motion for summary judgment and grant the defendant's motion.

I. Background

On March 27, 2007, Wright, a member of the Carpenters Local Union, was moving drywall sheets weighing approximately 130 pounds when he sustained a work-related disabling injury to his lumbar spine. Wright missed some work because of his condition, but eventually returned to the job for more than one year. In September 2008, Wright's injury forced him to cease working completely. Compl. ¶ 11-12.

Wright then applied for and received weekly benefits from the Carpenters' Health and Welfare Fund of Philadelphia and Vicinity from the date he first became disabled. Benefits included health and welfare weekly disability payments and health and welfare workers compensation payments.*fn2

In September 2008, Wright applied for Social Security Benefits. In a decision dated March 9, 2010, the Social Security Administration determined that, as of September 30, 2008, Wright met the disability criteria under Sections 216(i) and 223(d) of the Social Security Act.

On March 23, 2010, Wright submitted an application to the Fund for disabled participant benefits under the terms of the Carpenters Pension and Annuity Plan of Philadelphia and Vicinity (the "Plan"). *fn3

Under § 3.02 of the Plan, "[e]ach Active Participant who is also a Vested Participant and who becomes a Disabled Participant shall receive a Disability Retirement Pension on the first day of each month beginning on the date he or she becomes a Disabled Participant and continuing for so long as he or she remains a Disabled Participant, with the last payment made on the first day of the month in which he or she ceases to be a Disabled Participant." Plan § 3.02, 2002.

Under § 2.07, a disabled participant is defined as: An Active Participant who ceases to be an Active Participant on account of a disability shall become a Disabled Participant if, and only if, he meets all of the following requirements:

(1) Such Active Participant's disability arose out of disability or bodily injury which was not self-inflicted, and the Board makes a determination based on an examination of such Active Participant carried out by a doctor of medicine named by the Board and such other evidence as the Board may deem necessary, appropriate or desirable that such Active Participant is and presumably will continue to be for the remainder of his lifetime wholly prevented from engaging in any occupation or performing any work for wage or profit on account of such disability; . . . .

Plan § 2.07, 2002. Section 2.07 further provides that:

An Active Participant who becomes a Disabled Participant shall become a Disabled Participant on the latest of the following four dates:

(1) The first day of the month following the sixth monthly anniversary of the onset of his disability;

(2) The first day of the month next following the date on which he makes written application to the Pension and Annuity Fund for disability benefits;

(3) The first day of the month next following the date on which he has been examined and determined to be disabled by the Board of Administration; and

(4) If such Active Participant was entitled to receive weekly income benefits pursuant to the Plan of Benefits of the Health and Welfare Fund, the first day of the month next following the date on which he received his last such weekly income benefit.

Id.

In a letter dated March 26, 2010, Wright's initial application for benefits was denied for failure to meet the eligibility requirements under the terms of the Plan. According to the letter, "Section 2.07#3 of the Pension Plan of Benefits (enclosed) states that a participant must have 10 or more consecutive years of Credited Service on the date of the onset of his disability. At the time you became disabled in March 2007 you had 9 years of credited service preceding your disability claim. The Plan states you must have 10 consecutive credited years before the onset of your disability." Fund Letter, March 26, 2010.

On April 1, 2010, Wright appealed the denial; he asserted that he did, in fact, have the requisite years of service to be eligible for benefits under the Plan. By letter dated May 10, 2010, the Fund acknowledged Wright was eligible for benefits; the Fundnotified Wright that, in accordance with the appeals process, he had an appointment to be examined by a Fund designated physician. Def.'s Mtn. S.J. 3. Wright was examined in May 2010; on June 1, 2010, the Fund's examining physician, Larry S. Kramer, D.O. ("Dr. Kramer"), drafted a report stating that, "[i]t is my opinion that Mr. Wright's physical/mental impairment is not severe enough so that it would prevent him from engaging in any occupation or performing any work for wage or profit on account of his disability for the remainder of his life-time."

In a letter dated June 11, 2010, Wright's appeal was denied for the medical reasons provided in Dr. Kramer's report. The Fund found that, "the [medical report from the Fund physician] showed you are not totally and permanently disabled for the remainder of your lifetime . . . . Plan regulations stipulated that in order for a person to be entitled to a Disability Pension, he must be totally disabled, unable to be employed in any occupation."

Wright then submitted a second appeal, acknowledged by letter dated August 17, 2010. Def.'s Mtn. S.J. 4. The appeal was "tabled" at Wright's request. Id. On November 4, 2010, Wright provided the Fund with his "Notice of Decision --Fully Favorable" from the Social Security Administration and reports from his treating physicians. Administrative Record ("Admin. Rec.") D0046. In accordance with the Fund's appeals procedure, Wright was examined by Anthony J. Mela, Sr., D.O. ("Dr. Mela"), on November 23, 2010.

In December 2010, Dr. Mela provided the Fund with his independent medical evaluation ("the Mela evaluation"). In his evaluation, he states that, "within a reasonable degree of medical certainty, it is my opinion the patient's physical impairment is severe enough that the patient will be prevented from engaging in any occupation or performing ...


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